Tolerance to refractive error with a new extended depth of focus intraocular lens.

PURPOSE: To evaluate the tolerance to refractive errors of a new purely refractive extended depth of focus (EDF) intraocular lens (IOL) using preclinical and clinical metrics. METHODS: Preclinical evaluation included computer simulations of visual acuity (sVA) and dysphotopsia profile of different IOL designs (refractive EDF, diffractive EDF, multifocal, standard, and enhanced monofocals) using an appropriate eye model with and without ±0.50 D defocus and/or +0.75 D of astigmatism. Patients bilaterally implanted with a refractive EDF (Model ZEN00V) or an enhanced monofocal (Model ICB00) IOL from a prospective, randomized study were included. At the 6-month postoperative visit, uncorrected and corrected distance vision (UDVA and CDVA), visual symptoms, satisfaction and dependency on glasses were evaluated in a subgroup of patients with absolute residual refractive error of >0.25 D in one or both eyes. RESULTS: In the presence of defocus and astigmatism, sVA was comparable for all except the multifocal IOL design. The refractive EDF was more tolerant to myopic outcomes and maintained a monofocal-like dysphotopsia profile with defocus. Binocular logMAR UDVA was -0.03 ± 0.08 for ZEN00V and -0.02 ± 0.11 for ICB00. 100% ZEN00V and 97% ICB00 patients did not need glasses and were satisfied with their distance vision. Monocular CDVA, contrast sensitivity and visual symptoms were also similar between both groups. CONCLUSIONS: The clinical outcomes of the refractive EDF IOL demonstrated high quality distance vision and dysphotopsia comparable to a monofocal IOL, even in the presence of refractive error, thus matching the design expectations of the EDF IOL.

Quality of vision clinical outcomes for a new fully-refractive extended depth of focus Intraocular Lens.

BACKGROUND/OBJECTIVE: To evaluate the visual performance of a purely refractive extended depth of focus (EDF) intraocular lens (IOL). SUBJECTS/METHODS: A prospective, multi-center, randomized, subject/evaluator-masked study. Subjects were bilaterally implanted with the EDF test (Model ZEN00V, N = 60) or an enhanced monofocal control (Model ICB00, N = 57) IOL. Monocular corrected distance (CDVA), intermediate (DCIVA), near acuities (DCNVA) and patient reported visual symptoms were evaluated at the 6-month visit. Monocular mesopic contrast sensitivity (CS) and depth of focus (DOF) testing were assessed at 3 months. RESULTS: CDVA (Mean ± SD) was -0.06 ± 0.08 for test and -0.05 ± 0.08 logMAR for control groups. DCIVA was 0.13 ± 0.08 for test and 0.18 ± 0.14 logMAR for control groups (p = 0.0127). DCNVA was 0.37 ± 0.10 for test and 0.43 ± 0.16 logMAR for control groups (p = 0.0137). Test lens was statistically superior for intermediate and near. Overall, 91.7% (halos), 95.0% (starbursts) and 95.0% (glare) of test lens patients reported that they did not experience, were not bothered, or were slightly bothered by specific visual symptoms, compared to 98.2%, 100% and 96.5% in the control group. The DOF range over which monocular visual acuity was 0.20 logMAR or better was -1.6 D for the test lens. Mesopic CS was comparable between both groups, falling within 0.11 log units for all measured cycles per degree with and without glare. CONCLUSION: The EDF IOL demonstrated extended range of vision and statistically superior intermediate and near performance compared to the monofocal IOL. Distance visual acuity, contrast sensitivity and dysphotopsia profile were similar to the monofocal IOL.

Challenging the food waste hierarchy.

Food waste is a multi-faceted and complex problem for urban circular economies with far-reaching environmental impacts. Effectively addressing this problem requires a comprehensive understanding of the food waste impacts on food, energy, water, and climate (FEWC) systems. Despite complex dynamics in the FEWC nexus, the most popular guidance for food waste management is the food waste hierarchy framework - which fails to account for ensuing impacts on all nexus elements. Aiming to optimise the framework, we adopt a participatory approach to develop the first comprehensive and replicable system dynamics model of the FEWC footprints of urban food waste throughout the agri-food supply chain. The quantitative model compares different food waste management options, and relevant policies in Bristol, UK (2018-2030). Unlike the guidance of the traditional waste hierarchy framework, our findings show that the preferability of each option can vary for each sector within the supply chain and for each FEWC element. Our results show that increasing food surplus redistribution in the supply sectors and reducing food waste in consumer sectors are the most preferable approaches to reduce the environmental impacts of food. Feeding food leftover to pets at household level also has a promising impact. Other options involve trade-offs between energy and carbon footprints, while having minimal impact on water footprint. We conclude that the traditional food waste hierarchy is too simplified to provide reliable guidance for environmentally sustainable food waste management and policy. Instead, we present an improved food waste hierarchy framework that accounts for the scale of preferability of each option for different sectors and different FEWC nexus elements. This novel framework thus provides more nuanced and more robust understanding of food waste impacts on the FEWC nexus in urban circular economies, thereby enabling the development of policy and management options that are optimised for environmental sustainability.

Developing and testing an environmental economics approach to the valuation and application of urban health externalities.

Background: Poor quality urban environments have substantial impacts on public and planetary health. These costs to society are not readily quantifiable and remain largely external to mainstream measures of progress. Methods for accounting for these externalities exist, but their effective application is in development. Yet there is an increasing urgency and demand given the profound threats to quality of life both now and in the future. Methods: We combine data from a series of systematic reviews of the quantitative evidence linking characteristics of the urban environment with health consequences and the economic valuation of these health impacts from a societal perspective within a spreadsheet-based tool. The tool-named HAUS-allows the user to estimate the health impacts of changes in urban environments. The economic valuation of these impacts in turn facilitates the use of such data in broader economic appraisal of urban development projects and policies. Findings: Using the Impact-Pathway approach, observations of a variety of health impacts associated with 28 characteristics of the urban environment are applied to forecast changes in cases of specific health impacts that result from changes in urban contexts. Unit values for the societal cost of 78 health outcomes are estimated and incorporated in the HAUS model in order to allow the quantification of the potential effect size of a given change in the urban environment. Headline results are presented for a real-world application in which urban development scenarios that have varying quantities of green space are evaluated. The potential uses of the tool are validated via formal semi-structured interviews with 15 senior decision-makers from the public and private sectors. Interpretation: Responses suggest that there is significant demand for this kind of evidence, that it is valued despite the inherent uncertainties, and has a very wide range of potential applications. Analysis of the results suggest expert interpretation and contextual understanding is critical for the value of evidence to be realized. More development and testing is needed to understand how and where it may be possible to apply effectively in real world practice.

Myiasis of the exenterated orbital cavity: Case report and video.

PURPOSE: We present an unusual case of myiasis involving the orbital cavity. OBSERVATIONS: Our patient had undergone orbital exenteration one month prior to presentation. Post-operatively, he presented with multiple, highly mobile larvae in the orbital cavity. The species was identified to be Lucilia sericata, known commonly as the blowfly. The maggots were removed mechanically. CONCLUSION AND IMPORTANCE: The orbital cavity subsequently healed rapidly without sequalae. This raised the question as to whether L. sericata maggots may have had beneficial effects to the healing process.

Designing healthier neighbourhoods: a systematic review of the impact of the neighbourhood design on health and wellbeing.

Several studies have investigated the impact of neighbourhood design on health and wellbeing, yet there are limited reviews investigating the quality of the evidence and the most effective interventions at a population level. This systematic review aims to clarify the impact of the neighbourhood design on health and wellbeing and evaluate the quality of the evidence underpinning such associations. Eight electronic databases were searched for studies conducted between 2000 and 2016. Additional searches were conducted on Google to identify potentially eligible grey literature. A total of 7694 studies were returned from the literature search, and a final selection of 39 studies were deemed eligible for inclusion. Quality appraisal was conducted using the Quality Assessment Tool for Quantitative Studies. Findings from the studies showed important associations between neighbourhood design principles such as walkability, access to green space and amenities on health and wellbeing. Findings from this review also highlight areas with inconsistent findings and gaps in the evidence for future research.

Referrals for physical therapy for osteoarthritis during the COVID-19 pandemic: A retrospective analysis.

BACKGROUND: Osteoarthritis (OA) is a leading cause of musculoskeletal pain and disability among Americans. Physical therapy (PT) is recommended per the 2019 ACR /Arthritis Foundation Guideline for Treatment of OA of the Hand, Hip, and Knee. During COVID-19, access to healthcare has been altered in a variety of clinical settings, with the pandemic creating delays in healthcare, with an unknown impact on access to PT care for OA. OBJECTIVES: We sought to determine whether referrals to PT for OA were reduced in 2020 during the COVID-19 pandemic compared to 2019. METHODS: A retrospective analysis was done of 3586 PT referrals placed by the University of California, Davis for 206 OA ICD-10 codes from January to November 2019 and from January to November 2020. The numbers of PT referrals per month of each year were compared using both descriptive statistics and Poisson Regression analysis. RESULTS: A total of 1972 PT referrals for OA were placed from January to November 2019. Only 1614 referrals for OA were placed from January to November 2020, representing a significant decrease (p = 0.001). Month-by-month analysis of 2020 compared to 2019 revealed statistically significant drops in PT referrals for OA in April (p = 0.001), May (p = 0.001), and August (p = 0.001). CONCLUSIONS: These findings reveal a significant reduction in the number of referrals for PT for OA placed in 2020 during the first year of the COVID-19 pandemic. These reductions were particularly evident in the months following state-mandated actions and closures. Factors associated with this outcome may include decreased access to primary care providers, perceptions of PT availability by health care providers, decreased mobility limiting access to both clinic and PT appointments, and/or willingness to engage in PT by patients during the pandemic.

Overcoming Systemic Barriers Preventing Healthy Urban Development in the UK: Main Findings from Interviewing Senior Decision-Makers During a 3-Year Planetary Health Pilot.

This paper sets out the main findings from two rounds of interviews with senior representatives from the UK's urban development industry: the third and final phase of a 3-year pilot, Moving Health Upstream in Urban Development' (UPSTREAM). The project had two primary aims: firstly, to attempt to value economically the health cost-benefits associated with the quality of urban environments and, secondly, to interview those in control of urban development in the UK in order to reveal the potential barriers to, and opportunities for, the creation of healthy urban environments, including their views on the use of economic valuation of (planetary) health outcomes. Much is known about the 'downstream' impact of urban environments on human and planetary health and about how to design and plan healthy towns and cities ('midstream'), but we understand relatively little about how health can be factored in at key governance tipping points further 'upstream', particularly within dominant private sector areas of control (e.g. land, finance, delivery) at sub-national level. Our findings suggest that both public and private sector appeared well aware of the major health challenges posed by poor-quality urban environments. Yet they also recognized that health is not factored adequately into the urban planning process, and there was considerable support for greater use of non-market economic valuation to help improve decision-making. There was no silver bullet however: 110 barriers and 76 opportunities were identified across a highly complex range of systems, actors and processes, including many possible points of targeted intervention for economic valuation. Eight main themes were identified as key areas for discussion and future focus. This findings paper is the second of two on this phase of the project: the first sets out the rationale, approach and methodological lessons learned.

The Application of 'Elite Interviewing' Methodology in Transdisciplinary Research: a Record of Process and Lessons Learned during a 3-Year Pilot in Urban Planetary Health Research.

This paper sets out the rationale and process for the interviewing methodology utilized during a 3-year research pilot, 'Moving Health Upstream in Urban Development' (UPSTREAM). The project had two primary aims: firstly, to attempt to value economically the health cost benefits associated with the quality of urban environments and secondly, to engage with those in control of urban development in the UK in order to determine what are the barriers to and opportunities for creating healthy urban environments, including those identified through the utilisation of economic valuation. Engagement at senior level with those who have most control over key facets of planning and development implementation-such as land disposal, investment, development delivery and planning permission-was central to the approach, which encompassed the adoption of 'elite interviewing', a method developed in the USA in the 1950s and used in the political sciences but relatively unutilized in the health and environmental sciences [1]. Two rounds of semi-structured interviews were undertaken with 15 senior decision-makers from the UK's main urban development delivery agencies, both public and private. The 'elite interviewing' approach successfully enabled the UPSTREAM project to capture and analyse the information received from the interviewees, all of whom held influential or leadership posts in organisations that are important actors in the process of planning, developing and constructing the built environment in the UK. Having academic and practitioner research leads on an equal footing created some minor tensions, but it also appeared to strengthen the rigor of the approach through a broad knowledge of context 'in-house'. This form of co-production at times challenged academic traditions in qualitative analysis, but it also appeared to build trust with interviewees and provided greater clarity of the real-world context under investigation. Findings from this study are written up in a separate paper.

Tackling Root Causes Upstream of Unhealthy Urban Development (TRUUD): Protocol of a five-year prevention research consortium.

Poor quality urban environments substantially increase non-communicable disease. Responsibility for associated decision-making is dispersed across multiple agents and systems: fast growing urban authorities are the primary gatekeepers of new development and change in the UK, yet the driving forces are remote private sector interests supported by a political economy focused on short-termism and consumption-based growth. Economic valuation of externalities is widely thought to be fundamental, yet evidence on how to value and integrate it into urban development decision-making is limited, and it forms only a part of the decision-making landscape. Researchers must find new ways of integrating socio-environmental costs at numerous key leverage points across multiple complex systems. This mixed-methods study comprises of six highly integrated work packages. It aims to develop and test a multi-action intervention in two urban areas: one on large-scale mixed-use development, the other on major transport. The core intervention is the co-production with key stakeholders through interviews, workshops, and participatory action research, of three areas of evidence: economic valuations of changed health outcomes; community-led media on health inequalities; and routes to potential impact mapped through co-production with key decision-makers, advisors and the lay public. This will be achieved by: mapping system of actors and processes involved in each case study; developing, testing and refining the combined intervention; evaluating the extent to which policy and practice changes amongst our target users, and the likelihood of impact on non-communicable diseases (NCDs) downstream. The integration of such diverse disciplines and sectors presents multiple practical/operational issues. The programme is testing new approaches to research, notably with regards practitioner-researcher integration and transdisciplinary research co-leadership. Other critical risks relate to urban development timescales, uncertainties in upstream-downstream causality, and the demonstration of impact.

Pandemics, vulnerability, and prevention: time to fundamentally reassess how we value and communicate risk?: CITIES, HEALTH and COVID-19: Initial reflections and future challenges.

For over a decade, pandemics have been on the UK National Risk Register as both the likeliest and most severe of threats. Non-infectious 'lifestyle' diseases were already crippling our healthcare services and our economy. COVID-19 has exposed two critical vulnerabilities: firstly, the UK's failure to adequately assess and communicate the severity of non-communicable disease; secondly, the health inequalities across our society, due not least to the poor quality of our urban environments. This suggests a potentially disastrous lack of preventative action and risk management more generally, notably with regards to the existential risks from the climate and ecological crises.

Building a Methodological Foundation for Impactful Urban Planetary Health Science.

Anthropogenic environmental change will heavily impact cities, yet associated health risks will depend significantly on decisions made by urban leaders across a wide range of non-health sectors, including transport, energy, housing, basic urban services, and others. A subset of planetary health researchers focus on understanding the urban health impacts of global environmental change, and how these vary globally and within cities. Such researchers increasingly adopt collaborative transdisciplinary approaches to engage policy-makers, private citizens, and other actors in identifying and evaluating potential policy solutions that will reduce environmental impacts in ways that simultaneously promote health, equity, and/or local economies-in other words, maximising 'co-benefits'. This report presents observations from a participatory workshop focused on challenges and opportunities for urban planetary health research. The workshop, held at the 16th International Conference on Urban Health (ICUH) in Xiamen, China, in November 2019, brought together 49 participants and covered topics related to collaboration, data, and research impact. It featured research projects funded by the Wellcome Trust's Our Planet Our Health (OPOH) programme. This report aims to concisely summarise and disseminate participants' collective contributions to current methodological practice in urban planetary health research.

Clinical Evaluation of a Novel Preloaded Intraocular Lens Delivery System During Routine Cataract Surgery.

PURPOSE: To evaluate the clinical handleability and acceptability of a novel preloaded intraocular lens (IOL) delivery system for implantation of the TECNIS ZCB00 IOL (Johnson & Johnson Surgical Vision, Inc., Santa Ana, CA, USA) during routine small-incision cataract surgery. SUBJECTS AND METHODS: In this prospective, open-label, noncomparative, unilateral or bilateral, multicenter study, adult subjects with unilateral or bilateral cataracts scheduled for IOL implantation were enrolled. Surgeons and surgical technicians completed per-eye day-of-surgery and end-of-surgical-day questionnaires. The primary endpoint of the study was the rate of acceptable overall clinical performance of the preloaded IOL delivery system. Other endpoints included additional responses from the questionnaires, preimplantation incision size, and safety. RESULTS: The study included 91 eyes that underwent cataract surgery and IOL implantation using the preloaded delivery system and were available for the 1-day postoperative visit. Five surgeons and 14 surgical technicians from four investigational sites participated in the study. The rate of acceptable overall clinical performance was 100% (91/91) of eyes, with most responses (78/91; 85.7%) being the highest possible rating of 5 (very satisfied). Favorable responses by most surgeons and surgical technicians regarding additional endpoints further highlighted the handleability and acceptability of the preloaded delivery system. No ocular adverse events or lens findings (ie, no cases of IOL instability, haptic breakage, IOL marking, or crimping) were reported. CONCLUSION: The results of this study demonstrated that this preloaded IOL delivery system was safe and effective during routine small-incision cataract surgery. TRIAL REGISTRATION: German Clinical Trials Register identifier, DRKS00014757.

Moving Health Upstream in Urban Development: Reflections on the Operationalization of a Transdisciplinary Case Study.

This paper describes the development, conceptualization, and implementation of a transdisciplinary research pilot, the aim of which is to understand how human and planetary health could become a priority for those who control the urban development process. Key challenges include a significant dislocation between academia and the real world, alongside systemic failures in valuation and assessment mechanisms. The National Institutes of Health four-phase model of transdisciplinary team-based research is drawn on and adapted to reflect on what has worked well and what has not operationally. Results underscore the need for experienced academics open to new collaborations and ways of working; clarity of leadership without compromising exploration; clarification of the poorly understood "impacts interface" and navigation toward effective real world impact; acknowledgement of the additional time and resource required for transdisciplinary research and "nonacademic" researchers. Having practitioner-researchers as part of the research leadership team requires rigourous reflective practice and effective management, but it can also ensure breadth in transdisciplinary outlook as well as constant course correction toward real-world impact. It is important for the research community to understand better the opportunities and limitations provided by knowledge intermediaries in terms of function, specialism, and experience.

Carboxylic ester hydrolases: Classification and database derived from their primary, secondary, and tertiary structures.

We classified the carboxylic ester hydrolases (CEHs) into families and clans by use of multiple sequence alignments, secondary structure analysis, and tertiary structure superpositions. Our work for the first time has fully established their systematic structural classification. Family members have similar primary, secondary, and tertiary structures, and their active sites and reaction mechanisms are conserved. Families may be gathered into clans by their having similar secondary and tertiary structures, even though primary structures of members of different families are not similar. CEHs were gathered from public databases by use of Basic Local Alignment Search Tool (BLAST) and divided into 91 families, with 36 families being grouped into five clans. Members of one clan have standard α/ß-hydrolase folds, while those of other two clans have similar folds but with different sequences of their ß-strands. The other two clans have members with six-bladed ß-propeller and three-α-helix bundle tertiary structures. Those families not in clans have a large variety of structures or have no members with known structures. At the time of writing, the 91 families contained 321,830 primary structures and 1378 tertiary structures. From these data, we constructed an accessible database: CASTLE (CArboxylic eSTer hydroLasEs, http://www.castle.cbe.iastate.edu).

cis-Dichlorido(3,6,9-trithiabicyclo[9.3.1]pentadecane-κ2S3,S6)palladium(II) acetonitrile 0.8-solvate.

In the title complex, [PdCl2(C12H22S3)]·0.8CH3CN, a potentially tridentate thioether ligand coordinates in a cis-bidentate manner to yield a square-planar environment for the Pd(II) cation [mean deviation of the Pd from the Cl2S2 plane = 0.0406 (7) Å]. Each square-planar entity packs in an inverse face-to-face manner, giving pairs with plane-to-plane separations of 3.6225 (12) Šoff-set by 1.1263 (19) Å, with a Pd···Pd separation of 3.8551 (8) Å. A partial acetonitrile solvent molecule is present. The occupancy of this molecule was allowed to refine, and converged to 0.794 (10). The synthesis of the previously unreported 3,6,9-trithiabicyclo[9.3.1]pentadecane ligand is also outlined.

Synthesis, spectroscopic, electrochemical and computational studies of rhenium(I) dicarbonyl complexes based on meridionally-coordinated 2,2':6',2''-terpyridine.

A homologous series of meridionally-coordinated tridentate 2,2':6',2''-terpyridine Re(I) dicarbonyl complexes have been prepared and investigated. The complexes mer,cis-[Re(tpy-κ(3)N)(CO)2(L)](n) (L = Cl(-) (1), OSO2CF3(-) (2), NCCH3 (3), CN(-) (4), NC5H5 (5), PMe3 (6), PEt3 (7), PPh3 (8), P(OMe)3 (9) and P(OEt)3 (10); n = 0 or +1) have been synthesized and characterized by elemental analysis, (1)H NMR and infrared spectroscopy. The electrochemistry of these compounds has been studied and compared to that of other known rhenium compounds using an electrochemical parameterization model. Cyclic voltammetry measurements have shown that the first oxidation of the complexes varies systematically in potential as the ligand L is altered. Many of these one-electron oxidations occur at lower potentials compared to more familiar bidentate diimine Re(I) tricarbonyl complexes. A correlation exists between CO, a strong π-acidic ligand, and deviations of the observed reduction potentials from the calculated values. Many of the complexes absorb light throughout a significant portion of the visible spectrum. Two of these complexes, mer,cis-Re(tpy-κ(3)N)(CO)2Cl (1) and mer,cis-Re(tpy-κ(3)N)(CO)2CN (4), absorb light throughout the entire visible spectrum. Low temperature emission spectra were obtained for the compounds mer,cis-Re(tpy-κ(3)N)(CO)2Cl (1) and mer,cis-[Re(tpy-κ(3)N)(CO)2(P(OEt)3)](+) (10) at 77 K in a 4 : 1 methanol-ethanol glass matrix and give metal-to-ligand charge transfer ((3)MLCT) luminescence. Density functional theory (DFT) calculations of the electronic structure are in good agreement with the experimental data.