Findings from a rapid assessment of avoidable blindness (RAAB) in Southern Malawi

Background

Data on prevalence and causes of avoidable blindness in Malawi are not readily available. The purpose of this study was to determine the prevalence and causes of blindness in persons aged 50 and above in southern Malawi to plan eye care services for the community.

Methodology

A population-based survey was conducted in 7 districts in southern Malawi. Villages were selected by probability proportionate to size within each district. Clusters were further subdivided into segments. A predetermined number of segments were selected randomly in each cluster. The survey team moved from house to house in each segment until they had examined 50 people over the age of 50. Examination consisted of visual acuity measurement with tumbling “E” chart and ocular examination by an ophthalmologist. Participants were categorized by visual acuity. Those who were visually impaired (VA<6/18 in the better eye with available correction) were assigned a main cause of visual loss. Further information was sought from anyone who had received cataract surgery.

Results

A total number of 3,583 persons aged 50 and above were sampled; among these 3,430 (95.7%) were examined. The prevalence of blindness (presenting visual acuity <3/60 in the better eye) among persons aged 50 and above was 3.3% (95% CI 2.5–4.1). Cataract was the most common cause of blindness contributing to 48.2% of all cases, followed by glaucoma (15.8%) and cornea scarring (12.3%). The cataract surgical coverage in blind persons was 44.6%.

Conclusion

The prevalence of blindness and visual impairment in persons aged 50 and above was lower than the WHO estimate for Malawi. The majority of the causes were avoidable, with cataract accounting for approximately half of all cases of blindness. The data suggests that expansion of eye care programs to address avoidable causes of blindness is necessary in this area of southern Malawi.     

Rapid cold-hardening of Drosophila melanogaster in a field setting

Abstract.  Although laboratory studies demonstrate that cooling to ecologically relevant temperatures and/or at ecologically relevant rates induces rapid cold-hardening (RCH) in a variety of insects, little is known of the induction of RCH in nature. In the present study, caged Drosophila melanogaster (1–2 days posteclosion) from a colony established with flies collected locally are placed in a field setting (i.e. in approximately 4-cm deep leaf litter beneath an apple tree in Mount Pleasant, Michigan) during late afternoon (18.00 h EST; 05.00 h GMT). As the cage temperature falls from 22.1 ± 0.8 to 10.1 ± 0.1 °C between 18.00 and 06.00 h, the proportion of flies surviving a transfer to –6 °C for 1 h increases from 10.0 ± 6.2% to 68.1 ± 7.2%. When obtained from field cages, and then cooled from 23 °C at approximately 0.33 °C min⁻¹, more female flies remain behaviourally responsive (clinging to surfaces, exhibiting an active righting response, and/or climbing) at temperatures of 8–12 °C (24.00 h samples) or 7–12 °C (06.00 h samples), than do those sampled from cages kept in an incubator (23 °C). Field cooling reduces chill coma temperature from 8.7 ± 0.2 °C at 06.00 h to 7.1 ± 0.2 °C at 24.00 h, and to 6.6 ± 0.2 °C at 06.00 h. These data demonstrate that, in a recently collected culture of D. melanogaster , natural changes in microenvironmental temperature induce RCH that can benefit the organism at temperatures encountered in nature.     

Prevention of blindness by screening for diabetic retinopathy: a quantitative assessment.

Diabetic retinopathy is an important cause of blindness in the Western World. A review of the randomised trials of laser photocoagulation of the retina as a method of preventing blindness from this disorder showed that this treatment is very effective, reducing the risk of blindness by 61% in a treated eye. As only one eye is needed for sight the reduction in blindness in a population will be greater than 61% because the effect of treatment in one eye is not always identical with the effect in the other eye. For analysis this reduction was taken as 73%, representing the average of the minimum and maximum estimates (61% and 85%). The effectiveness of this treatment suggests that there is the potential for a national screening programme to bring about a major reduction in blindness from this cause. A quantitative assessment of the effect of screening indicated that a programme in which patients with diabetes mellitus are systematically referred to ophthalmic opticians for a retinal examination could detect 88% of all diabetics with serious retinopathy and that 87% of these cases would be treatable. Screening and early treatment of retinopathy would prevent deterioration of visual acuity and could reduce the risk of blindness due to diabetic retinopathy by an estimated 56% (0.73 X 0.88 X 0.87). The findings suggest that an effectively managed community based screening programme encompassing detection, referral, treatment, and follow up would prevent about 260 new cases of blindness in diabetics under the age of 70 each year in England and Wales. This would represent over 10% of all cases of blindness in adults in this age group.     

Psychological assessment in XLMR: a proposal for setting international standards

The need for an agreed upon set of standards for assessing individuals with XLMR was made quite evident this past year at the Fragile X and XLMR Workshop in Strasbourg. Several affected individuals from different families may have been incorrectly diagnosed as MR. Many factors can have a negative affect on IQ testing. As a result, evaluating individuals with cognitive deficits can be problematic. To be effective, psychological assessments must produce uniform results that are consistent with the definition of MR. Therefore, to foster international research in XLMR. I propose a two-stage standardized protocol. To determine which tests may be suitable. I review an assortment of instruments for psychological assessment at each stage, noting their strengths and weaknesses. Afterward, I present a set of standardized protocols based on age and language ability.     

Third-party postconflict affiliation of aggressors in chimpanzees

Postconflict management strategies have been defined as any postconflict interaction that mitigates the negative consequences of the preceding agonistic conflict. Although most studies have investigated postconflict interactions between former opponents or between victims and uninvolved bystanders, interactions between aggressors and bystanders have received much less attention. In this study, we examined a database of 1,102 agonistic interactions and their corresponding postconflict periods in two outdoor-housed groups of captive chimpanzees in order to test the occurrence of postconflict third-party affiliation of aggressors. Our results confirmed the occurrence of appeasement, i.e. postconflict affiliation by a bystander toward an aggressor, but failed to detect the occurrence of postconflict affiliation directed from aggressors toward bystanders. Appeasement rates did not differ according to the sex of the involved individuals. In addition, appeasement occurred more often in the absence of reconciliation than after its occurrence suggesting that appeasement may act as an alternative to reconciliation when the latter fails to occur. Both study groups showed behavioral specificity for appeasement, i.e. context-specific use of certain behaviors, supporting the view that chimpanzees exhibit highly visible explicit postconflict affiliation.     

Lessons of a day hospital: Comprehensive assessment of patients with albinism in a European setting

Albinism is a rare genetic disease, comprising syndromic and non‐syndromic forms. We assessed clinical and genetic characteristics in a prospective evaluation of 64 patients (33 children and 31 adults) seen at a specialized day hospital. Causative genetic mutations were found in TYR (23/64, 35.9%), OCA2 (19/64, 29.7%), TYRP1 (1/64, 1.6%), SLC45A2 (12/64, 18.7%), C10orf11 (1/64, 1.6%), HPS1 (3/64, 4.7%), HPS5 (1/64, 1.5%), HPS6 (1/64, 1.6%) and GPR143 (2/64, 3.1%). Causative mutations remained undetermined for one patient (1.6%). Heterogeneity for hair and skin phenotype was noted across and within the different genotypes. Skin and hair hypopigmentation did not correlate with visual impairment. The diagnosis of unrecognized syndromic forms and of cases of ocular albinism in this prospective and comprehensive series of patients with albinism in a European setting is remarkable. Photoprotection was overall good but not optimal.     

Rapid assessment of butterfly diversity in a montane landscape

We present the results of a rapid assessment of butterfly diversity in the 754 ha Beaver Meadows study area in Rocky Mountain National Park, Larimer County, Colorado. We measured butterfly species richness and relative abundance as part of a landscape-scale investigation of diversity patterns involving several groups of organisms. A stratified random sampling design was used to include replication in both rare and common vegetation types. We recorded 49 butterfly species from the twenty-four 0.1 ha plots that were sampled four times during June, July, and August 1996. Butterfly species richness, diversity, and uniqueness were highest in quaking aspen (Populus tremuloides Michaux) groves and wet meadows, which occupy only a small proportion of the studied landscape. This result supports the suggestion that aspen areas represent hotspots of biological diversity in this montane landscape. Patterns of butterfly species richness were positively correlated with total vascular plant species richness (r = 0.69; P < 0.001), and native plant species richness (r = 0.64; P < 0.001). However, exotic plant species richness (r = 0.70; P < 0.001) and the cover of exotic plant species (r = 0.70; P < 0.001) were the best predictors of butterfly species richness.     

Parental preference for sons and daughters in a Western industrial setting: evidence and implications

This paper considers whether sex composition of existing children in Australian families is an important factor in parity progression. Using census data from 1981, 1986, 1991, 1996 and 2001, women are linked with their co-resident children, allowing investigation of family sex composition and its changing impact over time on the propensity to have another child. The study finds that parents are much more likely to have a third and fourth birth if existing children are all of the same sex, indicating a strong preference for children of both sexes. This increased propensity has added around three per cent to the fertility of recent cohorts. The paper concludes with a discussion of the potential impact of sex-selection technologies on fertility. The authors argue that future widespread use of reliable sex-selection technologies might act to increase fertility in the short term, but would lead to a long-term reduction in fertility.     

Proportion of hospital readmissions deemed avoidable: a systematic review

Background

Readmissions to hospital are increasingly being used as an indicator of quality of care. However, this approach is valid only when we know what proportion of readmissions are avoidable. We conducted a systematic review of studies that measured the proportion of readmissions deemed avoidable. We examined how such readmissions were measured and estimated their prevalence.

Methods

We searched the MEDLINE and EMBASE databases to identify all studies published from 1966 to July 2010 that reviewed hospital readmissions and that specified how many were classified as avoidable.

Results

Our search strategy identified 34 studies. Three of the studies used combinations of administrative diagnostic codes to determine whether readmissions were avoidable. Criteria used in the remaining studies were subjective. Most of the studies were conducted at single teaching hospitals, did not consider information from the community or treating physicians, and used only one reviewer to decide whether readmissions were avoidable. The median proportion of readmissions deemed avoidable was 27.1% but varied from 5% to 79%. Three study-level factors (teaching status of hospital, whether all diagnoses or only some were considered, and length of follow-up) were significantly associated with the proportion of admissions deemed to be avoidable and explained some, but not all, of the heterogeneity between the studies.

Interpretation

All but three of the studies used subjective criteria to determine whether readmissions were avoidable. Study methods had notable deficits and varied extensively, as did the proportion of readmissions deemed avoidable. The true proportion of hospital readmissions that are potentially avoidable remains unclear.In most instances, unplanned readmissions to hospital indicate bad health outcomes for patients. Sometimes they are due to a medical error or the provision of suboptimal patient care. Other times, they are unavoidable because they are due to the development of new conditions or the deterioration of refractory, severe chronic conditions.Hospital readmissions are frequently used to gauge patient care. Many organizations use them as a metric for institutional or regional quality of care.¹ The widespread public reporting of hospital readmissions and their use in considerations for funding implicitly suggest a belief that readmissions indicate the quality of care provided by particular physicians and institutions.The validity of hospital readmissions as an indicator of quality of care depends on the extent that readmissions are avoidable. As the proportion of readmissions deemed to be avoidable decreases, the effort and expense required to avoid one readmission will increase. This decrease in avoidable admissions will also dilute the relation between the overall readmission rate and quality of care. Therefore, it is important to know the proportion of hospital readmissions that are avoidable.We conducted a systematic review of studies that measured the proportion of readmissions that were avoidable. We examined how such readmissions were measured and estimated their prevalence.     

Rapid animal welfare assessment: an archaeological approach

The welfare of an individual depends on its capacity to overcome suboptimal conditions in its environment; otherwise, its physical and psychological health becomes compromised. A situation that clearly indicates lack of control of the environment is the expression of abnormal behaviours, such as stereotypies. This study aimed to verify the well-being of police horses using a new rapid form of welfare assessment: an archaeological approach. To this end, we sampled and quantified marks found on the stables, deposited as a result of abnormal behaviour. We cross-referenced these physical marks with veterinary records of diseases, such as colic, known to be associated with stress. A total of 46 horses were sampled and the results showed a significant medium-strength, positive correlation between bite mark frequency on stable doors and the incidence of colic. A weak significant positive correlation was found between length of scratch marks (from pawing) and the incidence of lameness. We conclude that these marks reflect the accumulated expression of abnormal behaviour and can provide rapid insight into the welfare of individual animals.     

Rapid assessment in conservation research: a critique of avifaunal assessment techniques illustrated by Ecuadorian and Madagascan case study data

The urgency of conservation concerns in the tropics, linked with the limitations imposed on research efforts by the tropical environment has resulted in the development of methods for rapid assessment of biological communities. One such method, the MacKinnon list technique, has been increasingly applied in avifaunal surveys worldwide. Using paired tropical bird data sets from Ecuadorian cloud forest and Madagascan littoral forest, we compare the performance of the MacKinnon list with that of the more standard method of point counts in indicating when a site has been adequately surveyed, estimating the magnitude of species richness, quantifying relative species abundance, and providing an α‐index of diversity. In species‐rich Ecuadorian cloud forest, neither method produced data indicating adequate survey effort, despite extensive sampling, whereas in the relatively species‐poor Madagascan littoral forests, data collected by both methods indicated that the area had been sufficiently surveyed with comparable sampling effort. Species richness estimates generated from MacKinnon list data provided a more accurate estimate of the magnitude of the species richness for the Ecuadorian avifauna, whereas estimates for the Madagascan avifauna stabilised with relatively few samples using either method. Data collected by each method reflected different patterns of relative abundance among the five most abundant species, with MacKinnon list data showing a bias towards solitary and territorial species and against monospecific flocking species relative to the point count data. As a consequence of this bias, MacKinnon list data also fail to reflect accurately the structure of communities as quantified by an index of community evenness. Point counts, on the other hand, failed to capture the full species complement of the species‐rich Ecuadorian study area. As techniques for the rapid assessment of unsurveyed areas, both methods are subject to biases that limit their value, if used alone, in collecting data of scientific and management value. We propose a hybrid rapid assessment methodology that capitalises on the strengths of both techniques while compensating for their weaknesses.     

Rapid assessment of sleep-wake behavior in mice

Sleep is a fundamental biological rhythm involving the interaction of numerous brain structures and diverse neurotransmitter systems. The primary measures used to define sleep are the electroencephalogram (EEG) and electromyogram (EMG). However, EEG-based methods are often unsuitable for use in high-throughput screens as they are time-intensive and involve invasive surgery. As such, the dissection of sleep mechanisms and the discovery of novel drugs that modulate sleep would benefit greatly from further development of rapid behavioral assays to assess sleep in animal models. Here is described an automated noninvasive approach to evaluate sleep duration, latency, and fragmentation using video tracking of mice in their home cage. This approach provides a high correlation with EEG/EMG measures under both baseline conditions and following administration of pharmacological agents. Moreover, the dose-dependent effects of sedatives, stimulants, and light can be readily detected. This approach is robust yet relatively inexpensive to implement and can be easily incorporated into ongoing screening programs to provide a powerful first-pass screen for assessing sleep and allied behaviors.     

Pregnancy diagnosis and assessment of fetal numbers in the ewe in a commercial setting

Jugular plasma progesterone concentrations were used to accurately predict open ewes (96 +/- 3%) in early pregnancy, but they less accurately predicted subsequent lambing especially during the late breeding season and most of the seasonal anestrus. Progesterone values clearly indicated that 500 I.U. of P.M.S.G. elevated ovulation rate in synchronized ewes, but did not clearly indicate fetal numbers. During late pregnancy (88-108 days), abdominal palpation, doplar ultrasound and serum progesterone analysis were equally efficacious in predicting lambing (86 +/- 9.8%, 90 +/- 9.0% and 87 +/- 4.1%, respectively), but a high percentage of ewes lambed that were diagnosed as nonpregnant (30 +/- 15.0%, 48 +/- 17.3% and 25 +/- 8.4%, respectively). Accuracy of the serum progesterone test improved the later the test was performed, although considerable individual overlap existed. Progesterone values for ewes bearing 1, 2, or greater than 2 fetuses at 94 to 95 days of gestation differed (5.5 +/- 0.3, 8.0 +/- 0.4 and 12.4 +/- 2.1, respectively (P < 0.05), whereas at 103 to 108 days values for ewes carrying two or more fetuses did not differ.     

Rapid assessment of the distribution of myxomycetes in a southwestern Amazon forest

The distribution of fruit bodies of myxomycetes under different ecological conditions at the Los Amigos Biological Station in southeastern Peru was studied. Six study areas were surveyed using a combined field-laboratory methodology under different climatic conditions. Sixty species were recorded and differences in fruit body abundance and structure of the assemblages were found among collecting periods. A diversity analysis based on fruit bodies showed that values were predominantly higher during the dry period. An analysis of microenvironmental conditions applied to a subset of data collected in the field showed that pH and substratum diameter accounted for most of the variation. In addition, the most abundant myxomycetes based on fruit body occurrence showed a multivariate arrangement that suggests the existence of functional groups.