Methods for a population-based Comprehensive Eye care Workload Assessment (CEWA) study in Southern India.

Eye care programs, in developing countries, are often planned using the prevalence of blindness and visual impairment, often estimated from Rapid Assessment of Avoidable Blindness (RAAB) surveys. A limitation of this planning approach is that it ignores the annual overall eye care requirements for a given population. Moreover, targets set are arbitrary, often influenced by capacity rather than need. To address this lacunae, we implemented a novel study design to estimate the annual need for comprehensive eye care in a 1.2 million populations. We conducted a population-based longitudinal study in Theni district, Tamil Nadu, India. All permanent residents of all ages were included. We conducted the study in three phases, (i) household-level enumeration and enrollment, (ii) basic eye examination (BEE) at household one-year post-enrollment, and (iii) assessment of eye care utilization and full eye examination (FEE) at central locations. All people aged 40 years and above were invited to the FEE. Those aged <40 years were invited to the FEE if indicated. In the main study, we enrolled 24,327 subjects (58% aged below 40 years and 42% aged 40 years and above). Of those less than 40 years, 72% completed the BEE, of whom 20% were referred for FEE at central location. Of the people aged ≥40 years, 70% underwent FEE. Our study design provides insights for appropriate long-term public health intervention planning, resource allocation, effective service delivery, and designing of eye care services for resource-limited settings.

Regurgitation on pressure over the lacrimal sac versus lacrimal irrigation in determining lacrimal obstruction prior to intraocular surgeries.

Purpose: : To determine the diagnostic accuracy of manual regurgitation on pressure over the lacrimal sac (ROPLAS) versus lacrimal irrigation for screening nasolacrimal duct obstruction (NLDO) in adults prior to intraocular surgeries. Methods: This cross-sectional study took place in a tertiary eye care hospital in South Tamil Nadu, India. From January to December 2017 and included consecutive patients who presented for routine cataract surgery. Prospective data collection occurred in 8369 eyes of patients who underwent cataract surgery. All patients underwent ROPLAS testing by an ophthalmologist followed by lacrimal irrigation by trained ophthalmic assistants, rechecked or confirmed in equivocal cases by ophthalmologists who were masked to the ROPLAS status. The primary outcome, the sensitivity, specificity, positive, and negative predictive values to detect lacrimal occlusion by ROPLAS compared with lacrimal irrigation with 95% confidence intervals was estimated. Results: : A total of 8369 eyes underwent cataract surgery during the time periods of the study. ROPLAS and lacrimal irrigation were performed in all eyes. The sensitivity of ROPLAS to diagnose NLDO correctly was 54.5% (95% CI, 44.8%-63.9%) and its specificity was 100% (95% CI, 100%-100%). The positive and negative predictive values were 75.3% (95% CI, 65.6%-83.0%) and 99.4% (95% CI, 99.2%-99.5%), respectively. Conclusion: : We found that ROPLAS when used alone had very low sensitivity and low positive predictive value in detecting NLDO prior to cataract surgery as compared with lacrimal irrigation. Hence, we recommend performing ROPLAS and lacrimal irrigation in every patient as part of the routine preoperative workup prior to cataract surgery.

Screening first-degree relatives of glaucoma patients reveals barriers to participation.

PURPOSE: To report the results of a glaucoma screening campaign targeting first-degree relatives of glaucoma patients in South India. METHODS: 1598 glaucoma patients were contacted via letter or letter and phone call and asked to bring their siblings and children to a glaucoma screening. Participants underwent standardised eye examinations and completed questionnaires that assessed barriers to participation and awareness of glaucoma risk. Two-proportion z-tests were used to compare categorical data. Costs associated with the screening were recorded. RESULTS: 206 probands (12.9%) attended the screening along with 50 siblings and children. Probands were nearly twice as likely to attend if they had been contacted via both letter and phone call rather than letter only. Over half of probands reported that their relatives could not participate because they did not live in the region, and one-fifth reported that their relatives had other commitments. Fifty-eight per cent of the siblings and children who attended did not know that they were at increased risk for glaucoma due to their family history, and 32.0% did not know that the relative who had invited them to the screening had glaucoma. Thirteen siblings and children (26.0% of those who attended) were found to have findings concerning for glaucoma. The average cost per first-degree relative who was screened was INR2422 (£26). CONCLUSION: Participation in this glaucoma screening campaign was poor. The major barrier to participation was distance from the screening site and associated indirect costs. Better strategies for bringing first-degree relatives in for examinations are needed.

A copper(II) complex with a Cu-S8 bond. Attenuated total reflectance, electron paramagnetic resonance, resonance Raman and atoms-in-molecule calculations.

Green [Cu(1,10-phenanthroline)2OH2](ClO4)2 (1) reacts with yellow elemental sulfur at room temperature in methanol to yield turquoise blue [Cu(1,10-phenanthro-line)2(S8)](ClO4)2 (2). A comparative study of the EPR spectra of 1 and 2 in solid state and in methanol glass indicates that the S8 unit in 2 is bound to the metal. High level DFT calculations show that the cation in 2 is five coordinate, distorted square pyramidal with S8 occupying the apical position. The crucial Cu(II)-S bond is around 2.9Å. Such long Cu(II)-S bonds occur in oxidized plastocyanin where it is considered to be bonding. Presence of a weak Cu-S8 bond is revealed in the resonance Raman spectra of 2. Satisfactory matching of the calculated and experimental IR spectra vindicates the theoretically derived structure of the cation in 2.

Chemical potential of molecules contrasted to averaged atomic electronegativities: alarming differences and their theoretical rationalization.

We present the first large-scale empirical examination of the relation of molecular chemical potentials, µ(0)(mol) = -½(I(0) + A(0))(mol), to the geometric mean (GM) of atomic electronegativities, <χ(0)(at)>(GM) = <½(I(0) + A(0))(at)>(GM), and demonstrate that µ(0)(mol) ≠ -<χ(0)(at)>(GM). Out of 210 molecular µ(0)(mol)values considered more than 150 are not even in the range min{µ(0)(at)} < µ(0)(mol) < max{µ(0)(at)} spanned by the µ(0)(at) = -χ(0)(at) of the constituent atoms. Thus the chemical potentials of the large majority of our molecules cannot be obtained by any electronegativity equalization scheme, including the "geometric mean equalization principle", ½(I(0) + A(0))(mol) = <½(I(0) + A(0))(at)>(GM). For this equation the root-mean-square of relative errors amounts to SE = 71%. Our results are at strong variance with Sanderson's electronegativity equalization principle and present a challenge to some popular practice in conceptual density functional theory (DFT). The influences of the "external" potential and charge dependent covalent and ionic binding contributions are discussed and provide the theoretical rationalization for the empirical facts. Support is given to the warnings by Hinze, Bader et al., Allen, and Politzer et al. that equating the chemical potential to the negative of electronegativity may lead to misconceptions.

Ligand substituents effect on 10Dq.

Reaction of 5,6-dihydro-5,6-epoxy-1,10-phenanthroline (L) with Ni(ClO(4))(2)·6H(2)O in methanol in 3:1M proportion at room temperature yields [NiL(3)](ClO(4))(2)·2H(2)O. The X-ray crystal structure of the cation NiL(3)(2+) has been determined. Aminolysis of the three epoxide rings in NiL(3)(2+) by 4-substituted anilines in boiling water without any Lewis acid catalyst gives a family of Ni(II) complexes with octahedral NiL(6)(2+) core. In these complexes, crystal field splitting 10Dq varies from 11601 to 15798 cm(-1) in acetonitrile. The variation in 10Dq is found to be satisfactorily linear (r(2)=0.951) with the Hammett σ(R) parameter of the substituent on the anilino fragment. 10Dq increases with the increase in the electron donation ability of the substituent.

Food security in HIV/AIDS response: insights from Homa Bay, Kenya.

This paper examines the viability and effectiveness of a pilot farming initiative in reversing impacts of HIV/AIDS on the most affected households in Homa Bay, Kenya. The paper argues that once patients are stable, they can effectively be engaged in farming with minimal financial and technical support, resulting in enhanced food security of the affected households. More importantly, it helps to reduce HIV/AIDS-related stigma and improve the individual's self-esteem. Some of the key challenges of the pilot initiative were the limited number of agricultural extension workers and absence of facilities to enable them to deliver services to the farmers, the high cost of farm inputs, the unavailability of farm inputs when they were needed, poorly developed agricultural markets, and the absence of irrigation facilities. The paper recommends the sensitive scaling-up of this approach. However, farming initiatives by HIV/AIDS service NGOs should be linked to at least three key aspects: (a) treatment, care and support to HIV/AIDS affected households; (b) micro grant schemes or subsidies to enable farmers to purchase farming tools and farm inputs; and (c) comprehensive on-farm training support. To ensure effectiveness and wider reach, government needs to view agriculture through an HIV lens and promote a multisectoral approach that recognises the relationship between HIV/AIDS and food security. A number of immediate actions are required to strengthen this relationship, such as increased public investment to augment extension services, subsidise farm inputs, and develop infrastructure including agricultural markets.

Microcredit for people affected by HIV and AIDS: insights from Kenya.

Consequences of HIV and AIDS are exponential in Kenya, touching not only the health of those infected, but also depleting socioeconomic resources of entire families. Access to financial services is one of the important ways to protect and build economic resources. Unfortunately, the norm of financial viability discourages microfinance institutions from targeting people severely impacted by HIV and AIDS. Thus, HIV and AIDS service NGOs have been increasingly getting involved in microcredit activity in recent years for economic empowerment of their clients. Despite limited human resources and funding in the area of microcredit activity, these NGOs have demonstrated that nearly 50% of their microcredit beneficiaries invested money in income-generating activities, resulting in enhancement to their livelihood security. In the short term these NGOs need to improve their current practices. However, this does not mean launching microfinance initiatives within their AIDS-focused programmes, as financial services are best provided by specialised institutions. Longer-term cooperation between microfinance institutions and other AIDS service organisations and donors is necessary to master appropriate and rapid responses in areas experiencing severe impacts of HIV and AIDS.

Use of HNO(3) as the source of NO to prepare a nitric oxide complex of ruthenium.

Reaction of cis-Ru(bisox)(2)Cl(2), where bisox is 4,4,4',4'-tetramethyl-2,2'-bisoxazoline, with HNO(3) in 1 : 4 molar proportion in boiling water under N(2) atmosphere and subsequent addition of an excess of NaClO(4).H(2)O yields [Ru(bisox)(HL)(NO)](ClO(4))(NO(3)) (1). HL is a hydrolysed form of bisox where one of the oxazoline rings opens up. X-Ray crystallography shows that 1 contains an octahedral RuN(5)O core. HL binds the metal through an imino N, an amide N and an alcoholic O atom. Reaction of cis-Ru(bisox)(2)Cl(2) with an excess of NaNO(2) in water gives cis-Ru(bisox)(2)(NO(2))(2) (2). On acidification by HClO(4) in methanol, is smoothly converted to cis-[Ru(bisox)(2)(NO(2))(NO)](ClO(4))(2) (3) due to equilibrium (1). [Formula: see text] (1) The X-ray crystal structures of 2 and 3 have also been determined. NO binds Ru in 1 and 3 linearly. The Ru-NO bond length in 1 is 1.764(13) A and that in 3 is approximately 1.78 A. All the three complexes have been characterised by FTIR, NMR and ESIMS. The NO stretching frequencies in 1 and 3 are 1897 and 1936 cm(-1) respectively. While 3 reverts back to 2 readily in presence of OH(-) [equilibrium (1)], 1 does not react with OH(-). It is concluded that while in the reaction of cis-Ru(bisox)(2)Cl(2) with HNO(3), bisox is hydrolysed following abstraction of NO from HNO(3), generation of the nitrosyl complex 3 via reaction (1) is not accompanied with such hydrolysis.

Metallo-organic domino reactions: C-H versus C-C bond breaking.

HL and MeL are prepared by condensing benzil dihydrazone with 2-formylpyridine and 2-acetylpyridine, respectively, in 1:2 molar proportions. While in a reaction with [Ru(C(6)H(6))Cl(2)]2, HL yields the cation [Ru(C(6)H(6)){5,6-diphenyl-3-(pyridin-2-yl)-1,2,4-triazine}Cl]+, MeL gives the cation [Ru(C(6)H(6))(MeL)Cl]+. Both the cations are isolated as their hexafluorophosphate salts and characterised by X-ray crystallography. In the case of HL, double domino electrocyclic/elimination reactions are found to occur. The electrocyclic reaction occurs in a C=N-N=C-C=N fragment of HL and the elimination reaction involves breaking of a C-H bond of HL. Density functional calculations on model complexes indicate that the identified electrocyclic reaction is thermochemically as well as kinetically feasible for both HL and MeL in the gas phase. For a double domino reaction, similar to that operative in HL, to occur for MeL, breaking of a C-C bond would be required in the elimination step. Our model calculations show the energy barrier for this elimination step to be much higher (329.1 kJ mol(-1)) for MeL than that for HL (96.3 kJ mol(-1)). Thus, the domino reaction takes place for HL and not for MeL. This accounts for the observed stability of [Ru(C(6)H(6))(MeL)Cl]+ under the reaction conditions employed.

Modulation of the lowest metal-to-ligand charge-transfer state in [Ru(bpy)2(N-N)]2+ systems by changing the N-N from hydrazone to azine: photophysical consequences.

Two Ru(II) complexes, [Ru(bpy)2L](ClO4)2 (1) and [Ru(bpy)2L'](BF4)2 (2), where bpy is 2,2'-bipyridine, L is diacetyl dihydrazone, and L' 1:2 is the condensate of L and acetone, are synthesized. From X-ray crystal structures, both are found to contain distorted octahedral RuN(6)(2+) cores. NMR spectra show that the cations in 1 and 2 possess a C2 axis in solution. They display the expected metal-to-ligand charge transfer (1MLCT) band in the 400-500 nm region. Complex 1 is nonemissive at room temperature in solution as well as at 80 K. In contrast, complex 2 gives rise to an appreciable emission upon excitation at 440 nm. The room-temperature emission is centered at 730 nm (lambda(em)(max)) with a quantum yield (Phi(em)) of 0.002 and a lifetime (tau(em)) of 42 ns in an air-equilibrated methanol-ethanol solution. At 80 K, Phi(em) = 0.007 and tau(em) = 178 ns, with a lambda(em)(max) of 690 nm, which is close to the 0-0 transition, indicating an 3MLCT excited-state energy of 1.80 eV. The radiative rate constant (5 x 10(4) s(-1)) at room temperature and 80 K is almost temperature independent. From spectroelectrochemistry, it is found that bpy is easiest to reduce in 2 and that L is easiest in 1. The implications of this are that in 2 the lowest (3)MLCT state is localized on a bpy ligand and in 1 it is localized on L. Transient absorption results also support these assignments. As a consequence, even though 2 shows a fairly strong and long-lived emission from a Ru(II) --> bpy CT state, the Ru(II) --> L CT state in 1 shows no detectable emission even at 80 K.

Quality of life after community-based rehabilitation for blind persons in a rural population of South India.

This study aimed to determine the impact of community-based rehabilitation on the quality of life of blind persons in a rural south Indian population. We performed a population-based survey followed by clinical examinations to identify blind persons in a rural south Indian population. Pre-and-post rehabilitation quality of life of 159 blind persons aged 15 years or above was ascertained through a questionnaire previously validated for use in this population. Post-rehabilitation quality-of-life scales showed some improvement for 151 (95.0%) subjects. The additional benefit from rehabilitation was greatest for the self-care and mobility subscales, ranging from 24.6% to 30.0% for the self care subscale and 37.6% to 44.3% for the mobility subscale with effect sizes of 21.5 and 2.38 respectively. Overall quality of life scores were not significantly different between those who did and did not receive economic rehabilitation (P = 0.1). Blind persons in this rural population benefited considerably from rehabilitation services even if economic rehabilitation is not provided. Initiatives against blindness need to consider rehabilitation of the blind as a priority.

Utilization of community-based rehabilitation services for incurably blind persons in a rural population of southern India.

PURPOSE: To identify barriers in utilisation of community based rehabilitation (CBR) services for incurably blind persons in rural South India. METHODS: A community-based rehabilitation programme for incurably blind persons was initiated in Theni district of southern Tamil Nadu in south India. After door-to-door enumeration and preliminary ocular screening by trained workers at the village, identified blind persons were categorised as either curable or incurable by an ophthalmologist. Trained workers provided rehabilitation, including mobility training (OM), training to perform activities of daily living (ADL), and economic rehabilitation for the incurably blind in their respective villages. RESULTS: Of the 460,984 persons surveyed, 400 (0.09%) were certified as incurably blind including 156 (39.00%) persons blind from birth. Social rehabilitation was provided for 268 (67.00%) incurably blind persons. Economic rehabilitation was provided to 96 persons, and integrated education to 22 children. Nearly one-fifth (n=68, 17.00%) of incurably blind persons refused the services provided. The major reasons for refusal included old age and other illnesses (41.18%), and multiple handicaps (19.12%). Twenty-seven (6.75%) persons had either migrated or died, and 29 (7.25%) persons were already able to function independently. CONCLUSION: Although CBR programmes provide useful services to the incurably blind, a better understanding of barriers is required to improve service utilisation. Developing a standardised data collection format for every CBR programme can result in the creation of a national database of ophthalmic diseases.

Observation of 3MC emission in a mixed 1,10-phenanthroline complex of ruthenium(II) having a RuIIN6 core at room temperature in solution.

[Ru(1,10-phenanthroline)(2)(4,4,4',4'-tetramethyl-2,2'-bisoxazoline)](PF(6))(2).H(2)O (1) shows a (3)MC emission in CH(3)CN and CH(3)OH at room temperature around 590 nm with radiative lifetimes of 1.22 x 10(-4) and 1.40 x 10(-4) s, respectively. The X-ray crystal structure of 1 has been determined.