Crossing lines: a multidisciplinary framework for assessing connectivity of hammerhead sharks across jurisdictional boundaries.

Conservation and management of migratory species can be complex and challenging. International agreements such as the Convention on Migratory Species (CMS) provide policy frameworks, but assessments and management can be hampered by lack of data and tractable mechanisms to integrate disparate datasets. An assessment of scalloped (Sphyrna lewini) and great (Sphyrna mokarran) hammerhead population structure and connectivity across northern Australia, Indonesia and Papua New Guinea (PNG) was conducted to inform management responses to CMS and Convention on International Trade in Endangered Species listings of these species. An Integrated Assessment Framework (IAF) was devised to systematically incorporate data across jurisdictions and create a regional synopsis, and amalgamated a suite of data from the Australasian region. Scalloped hammerhead populations are segregated by sex and size, with Australian populations dominated by juveniles and small adult males, while Indonesian and PNG populations included large adult females. The IAF process introduced genetic and tagging data to produce conceptual models of stock structure and movement. Several hypotheses were produced to explain stock structure and movement patterns, but more data are needed to identify the most likely hypothesis. This study demonstrates a process for assessing migratory species connectivity and highlights priority areas for hammerhead management and research.

A novel field method to distinguish between cryptic carcharhinid sharks, Australian blacktip shark Carcharhinus tilstoni and common blacktip shark C. limbatus, despite the presence of hybrids.

Multivariate and machine-learning methods were used to develop field identification techniques for two species of cryptic blacktip shark. From 112 specimens, precaudal vertebrae (PCV) counts and molecular analysis identified 95 Australian blacktip sharks Carcharhinus tilstoni and 17 common blacktip sharks Carcharhinus limbatus. Molecular analysis also revealed 27 of the 112 were C. tilstoni × C. limbatus hybrids, of which 23 had C. tilstoni PCV counts and four had C. limbatus PCV counts. In the absence of further information about hybrid phenotypes, hybrids were assigned as either C. limbatus or C. tilstoni based on PCV counts. Discriminant analysis achieved 80% successful identification, but machine-learning models were better, achieving 100% successful identification, using six key measurements (fork length, caudal-fin peduncle height, interdorsal space, second dorsal-fin height, pelvic-fin length and pelvic-fin midpoint to first dorsal-fin insertion). Furthermore, pelvic-fin markings could be used for identification: C. limbatus has a distinct black mark >3% of the total pelvic-fin area, while C. tilstoni has markings with diffuse edges, or has smaller or no markings. Machine learning and pelvic-fin marking identification methods were field tested achieving 87 and 90% successful identification, respectively. With further refinement, the techniques developed here will form an important part of a multi-faceted approach to identification of C. tilstoni and C. limbatus and have a clear management and conservation application to these commercially important sharks. The methods developed here are broadly applicable and can be used to resolve species identities in many fisheries where cryptic species exist.

Exposure Effects on the Productivity of Commercial Bombus impatiens (Hymenoptera: Apidae) Quads During Bloom in Watermelon Fields.

In light of population declines of honey bees (Apis mellifera L.), research has refocused attention on alternative pollinators and their potential to fulfill pollination services within economically important agricultural crops. Bumble bees are one such alternative, and within the past 20 yr, these pollinators have been reared and sold as commercial pollinators. Investigation into their use has been limited and more research is needed to improve pollinator effectiveness in field settings. Quad pollination units of the commercially reared native bumble bee species, the common eastern bumble bee (Bombus impatiens Cresson), were monitored and evaluated for productivity during peak watermelon [Citrullus lanatus (Thunberg) Matsumura & Nakai] bloom in southern Delaware. Differing colony exposures including various shade structure designs and natural shade were compared to assess the quality of the shade in regards to bumble bee activity during watermelon bloom. Quads receiving different nest treatments were evaluated on the basis of foraging activity and colony weight gain. Results indicated that colonies within quads provided with artificial or natural shade had significantly more foraging activity, weighed more, and produced more cells than colonies in quads placed in the field with no shade. Colonies within quads provided with artificial and natural shade peaked later in terms of foraging and weight gain, suggesting that growers could extend harvest to take advantage of later markets and possible movement into fields that were planted later.

Experience of propofol sedation in a UK ERCP practice: lessons for service provision.

OBJECTIVE: Endoscopic retrograde cholangiopancreatography (ERCP) in the UK has been historically performed under conscious sedation. However, given the increasing complexity of cases, the role of propofol-assisted ERCP (propERCP) is increasing. We describe our experience of propERCP and highlight the importance of this service. DESIGN: Our prospective ERCP database was interrogated between January 2013 and January 2014. Data collection included procedural information, patient demographics, American Association of Anaesthesiologists (ASA) status, Cotton grade of endoscopic difficulty and endoscopic and anaesthetic complications. Comparison was made with patients undergoing conscious sedation ERCP (sedERCP). RESULTS: 744 ERCPs were performed in 629 patients (53% male). 161 ERCPs were performed under propofol. PropERCP patients were younger compared with the sedERCP group (54 vs 66 years, p<0.0001) but ASA grade 1-2 status was similar (84% vs 78%, p=0.6). An increased number of Cotton grade 3-4 ERCPs were performed in the propERCP group (64% vs 34%, p<0.0001). Indications for propERCP included sphincter of Oddi manometry (27%), previously poorly tolerated sedERCP (26%), cholangioscopy (21%) and patient request (8%). 77% of cases were elective, 12% were urgent day-case transfers and 11% were urgent inpatients. 59% of cases were tertiary referrals. ERCP was completed successfully in 95% of cases. Anaesthetic and endoscopic complications were comparable between the two groups (5% and 7% vs 3% and 5%). Where sedERCP had been unsuccessful due to patient intolerance, the procedure was completed successfully using propofol. CONCLUSIONS: PropERCP is safe and is associated with high endoscopic success. The need for propERCP is likely to increase given patient preference and the high proportion of complex procedures being undertaken. All endoscopy units should look to incorporate propofol-assisted endoscopy into aspects of their services.

Type 1 autoimmune pancreatitis and IgG4-related sclerosing cholangitis is associated with extrapancreatic organ failure, malignancy, and mortality in a prospective UK cohort.

OBJECTIVES: Type I autoimmune pancreatitis (AIP) and IgG4-related sclerosing cholangitis (IgG4-related SC) are now recognized as components of a multisystem IgG4-related disease (IgG4-RD). We aimed to define the clinical course and long-term outcomes in patients with AIP/IgG4-SC recruited from two large UK tertiary referral centers. METHODS: Data were collected from 115 patients identified between 2004 and 2013, and all were followed up prospectively from diagnosis for a median of 33 months (range 1-107), and evaluated for response to therapy, the development of multiorgan involvement, and malignancy. Comparisons were made with national UK statistics. RESULTS: Although there was an initial response to steroids in 97%, relapse occurred in 50% of patients. IgG4-SC was an important predictor of relapse (P<0.01). Malignancy occurred in 11% shortly before or after the diagnosis of IgG4-RD, including three hepatopancreaticobiliary cancers. The risk of any cancer at diagnosis or during follow-up when compared with matched national statistics was increased (odds ratio=2.25, CI=1.12-3.94, P=0.02). Organ dysfunction occurred within the pancreas, liver, kidney, lung, and brain. Mortality occurred in 10% of patients during follow-up. The risk of death was increased compared with matched national statistics (odds ratio=2.07, CI=1.07-3.55, P=0.02). CONCLUSIONS: Our findings suggest that AIP and IgG4-SC are associated with significant morbidity and mortality owing to extrapancreatic organ failure and malignancy. Detailed clinical evaluation for evidence of organ dysfunction and associated malignancy is required both at first presentation and during long-term follow-up.

Prophylactic laser peripheral iridotomy and cataract progression.

PURPOSE: To determine whether prophylactic laser peripheral iridotomy (LPI) for primary angle closure (PAC) is associated with cataract progression. METHODS: In 1999, Mongolian volunteers aged>or=50 years were invited to participate in a longitudinal study. Glaucoma was excluded in all participants and 712 of them were selected to undergo a full ophthalmic examination as part of the study protocol. Lenses were graded and PAC diagnosed using international classification systems. In 2005, all traced participants underwent a similar dilated examination. Diagnosis of cataract progression was based on the inter-observer variation +2 standard deviations. The association between LPI at baseline and cataract progression was assessed using chi2-test and logistic regression. RESULTS: Of 712 participants, 158 were diagnosed with occludable angles and treated with LPI. In 2005, 137 participants (19.2%) had died, 315 (315/575=54.8%) were traced, and dilated examination was performed on 276 (48%) of them. Progression of nuclear opacity (NO), cortical, and posterior subcapsular (PSC) opacities were evident in 40 (14.5%, 95% confidence interval (CI)=10.6-19.2%), 89 (32.2%, 95% CI=26.8-38.1%), and 11 participants (4.0%, 95% CI=2.0-7.0%), respectively. Although NO was more likely to progress in those with LPI in a crude analysis (odds ratio (OR)=2.02, 95% CI=1.00-4.11, P=0.05), no evidence of an independent association was detected in multivariate analysis adjusting for age, sex, and baseline Schaffer grading (adjusted OR=1.24, 0.41-3.75, P=0.7). There was no evidence of an association between LPI and progression of PSC or cortical opacities. CONCLUSIONS: There is no evidence that prophylactic LPI is independently associated with cataract progression in this study.

Incidence of occludable angles in a high-risk Mongolian population.

BACKGROUND: Primary angle closure glaucoma (PACG) accounts for nearly 50% of global glaucoma blindness. There are currently no public health strategies to deal with this problem. Screening and prophylactic treatment of primary angle closure suspects (PACS) with laser peripheral iridotomy (LPI) may form a feasible population-level intervention. However, more information about the natural history of PACS is required before such an approach could be considered. METHODS: Six hundred and forty-four participants aged 50 years with a central anterior chamber depth (cACD) of <2.53 mm underwent a full slit-lamp examination in 1999. Of these, 160 participants diagnosed as having occludable angles by gonioscopy (ISGEO classification) were excluded from all further analysis, leaving 484 for follow-up. Six years later, 95/484 (19.6%) had died. A total of 201 of 389 participants traced (51.7%) were re-examined. The potential risk factors for the development of an occludable angle were assessed using the chi squared test, t test and the Wilcoxon rank sum test. RESULTS: At follow-up, 41 participants (20.4%, 95% CI: 14.8 to 25.7) were diagnosed as having incident PACS. Narrower angles, identified by grading of limbal chamber depth and gonioscopy at baseline, were strongly associated with incident occludable angles (p = 0.01 and p<0.01, respectively). There was weak evidence of an association with change in cACD (p = 0.05), and no evidence of an association with age, gender, and baseline cACD for the development of occludable angles. CONCLUSIONS: Narrower angles as determined by limbal chamber depth grading and gonioscopy at baseline were the main risk factors identified for the development of occludable angles.

Poverty and blindness in Pakistan: results from the Pakistan national blindness and visual impairment survey.

OBJECTIVE: To explore the association between blindness and deprivation in a nationally representative sample of adults in Pakistan. DESIGN: Cross sectional population based survey. SETTING: 221 rural and urban clusters selected randomly throughout Pakistan. PARTICIPANTS: Nationally representative sample of 16 507 adults aged 30 or above (95.3% response rate). MAIN OUTCOME MEASURES: Associations between visual impairment and poverty assessed by a cluster level deprivation index and a household level poverty indicator; prevalence and causes of blindness; measures of the rate of uptake and quality of eye care services. RESULTS: 561 blind participants (<3/60 in the better eye) were identified during the survey. Clusters in urban Sindh province were the most affluent, whereas rural areas in Balochistan were the poorest. The prevalence of blindness in adults living in affluent clusters was 2.2%, compared with 3.7% in medium clusters and 3.9% in poor clusters (P<0.001 for affluent v poor). The highest prevalence of blindness was found in rural Balochistan (5.2%). The prevalence of total blindness (bilateral no light perception) was more than three times higher in poor clusters than in affluent clusters (0.24% v 0.07%, P<0.001). The prevalences of blindness caused by cataract, glaucoma, and corneal opacity were lower in affluent clusters and households. Reflecting access to eye care services, cataract surgical coverage was higher in affluent clusters (80.6%) than in medium (76.8%) and poor areas (75.1%). Intraocular lens implantation rates were significantly lower in participants from poorer households. 10.2% of adults living in affluent clusters presented to the examination station wearing spectacles, compared with 6.7% in medium clusters and 4.4% in poor cluster areas. Spectacle coverage in affluent areas was more than double that in poor clusters (23.5% v 11.1%, P<0.001). CONCLUSION: Blindness is associated with poverty in Pakistan; lower access to eye care services was one contributory factor. To reduce blindness, strategies targeting poor people will be needed. These interventions may have an impact on deprivation in Pakistan.

The critical role of myosin IIA in platelet internal contraction.

BACKGROUND: Shape change and centralization of granules surrounded by a microtubular coil (internal contraction) are among the earliest morphologic changes observed following platelet activation. Myosin IIA contributes to initiation of platelet shape change, but its role in internal contraction has not been defined. OBJECTIVE: To define the contribution of myosin IIA to platelet internal contraction. METHODS: Aspirin-treated platelets suspended in calcium-free buffer were activated with a low concentration (25 nm) of the thromboxane A(2) analog U46619 which initiated shape change and internal contraction via a Rho kinase pathway. Shape change and internal contraction were assessed by aggregometry and transmission electron microscopy (TEM), and Rho activation and myosin regulatory light chain (MRLC) phosphorylation were studied concurrently. RESULTS AND CONCLUSIONS: Low-concentration blebbistatin (10 microm) inhibited internal contraction in the majority of platelets with minimal inhibition of shape change without significant suppression of MRLC phosphorylation. Higher blebbistatin concentrations (25-100 microm) produced concentration-dependent inhibition of aggregation, shape change, Rho activation, and MRLC phosphorylation. These data demonstrate: (i) direct platelet myosin IIA participation in internal contraction; and (ii) inhibition of Rho activation and MRLC phosphorylation by >10 microm blebbistatin.

A guide to murine platelet structure, function, assays, and genetic alterations.

Platelets play an important role in hemostasis, thrombosis and several other biological processes. The adaptability of mice to genetic manipulation and their genetic similarity to humans has resulted in a plethora of murine models to study platelet function. Although murine platelets differ from human platelets with regard to size, number and structure, functionally they are very similar. Thus, studies which employed these model systems have greatly improved our current understanding of the contribution of platelets to hemostasis and thrombosis. This review presents general recommendations with respect to collection, isolation and processing of murine platelets. It also describes the assays currently available to study platelet function and critically assesses their utility. The extensive literature on the effects of genetic alterations on murine platelet function is considered in detail. This review is intended to provide a convenient source of reference for platelet investigators.

A guide to murine coagulation factor structure, function, assays, and genetic alterations.

Murine blood coagulation factors and function are quite similar to those of humans. Because of this similarity and the adaptability of mice to genetic manipulation, murine coagulation factors and inhibitors have been extensively studied. These studies have provided significant insights into human hemostasis. They have also provided useful experimental models for evaluation of the pathophysiology and treatment of thrombosis. This review contains recommendations for obtaining, processing and assaying mouse blood hemostatic components, and it summarizes the extensive literature on murine coagulation factor structure and function, assays and genetic alteration. It is intended to be a convenient reference source for investigators of hemostasis and thrombosis.

Angle-closure glaucoma in East Asian and European people. Different diseases?

In contrast to the pattern of disease in Europeans, primary angle closure has a higher prevalence and tends to be asymptomatic in East Asians. The higher prevalence is attributed to differences in anterior chamber and angle anatomy. Several studies suggest that central anterior chamber depth is shallower in East Asians than in Europeans, although this is not universally accepted. It is debated whether pupil block is the predominant mechanism of angle closure in Asian people. Meaningful comparison between studies is currently hindered by differences in patient selection, examination technique, and case definition; however, the major scientific deficiency is the paucity of prospective followup data to give an insight into natural history of the disease. This review examines the data on prevalence, risk factors, and mechanism of angle closure. Special consideration is given to limitations of methodology in research to date, with the intention of developing more robust data in future studies.

Can we prevent angle-closure glaucoma?

PURPOSE: Glaucoma is the second cause, after cataract, of world blindness. Approximately half is thought to be primary angle-closure glaucoma (ACG). This review asks whether ACG can be prevented on a population basis. METHODS AND POPULATIONS: Review of published information from the Inuit of Greenland, Canada and Alaska, and descriptions of recent studies in Asian populations in Mongolia, China and South-East Asia. RESULTS: The Greenland Inuit have the shallowest anterior chamber depths (ACDs) so far recorded. The proportion of blindness due to ACG was reduced from 64% to 9% over 37 years by systematic optical measurement of central ACD and the van Herick test in the older Inuit, followed by gonioscopy and prophylactic iridectomy or laser iridotomy when indicated. In Mongolia, ultrasound measurement of central ACD had good sensitivity and specificity as a screening test. A randomized controlled trial of screening and prophylactic laser is being completed. In China and South-East Asia, the mechanism of angle closure appears to be more varied and complex and its detection may require more elaborate imaging. CONCLUSIONS: The mechanism of angle closure and potential for prevention by screening are likely to have to be determined specifically for each population at risk.

A population based survey of the prevalence and types of glaucoma in rural West Bengal: the West Bengal Glaucoma Study.

AIM: To determine (i) the prevalence of glaucoma in people aged > or =50 years, (ii) the proportions of different types of glaucoma, (iii) the distributions of intraocular pressure and vertical cup disc ratio. METHOD: Population based prevalence survey in rural West Bengal. People aged > or =50 years in randomly selected villages in 24 Parganas South district. The main outcome measures were diagnosis of glaucoma, based on criteria described by the International Society for Geographic and Epidemiological Ophthalmology. RESULTS: 1594 people aged > or =50 years were enumerated in nine villages; 1324 (83.1%) were surveyed and 1269 people adequately examined. 42 definite cases of glaucoma were identified, with prevalence increasing from 2.7% (95% CI 1.7 to 3.7) in people aged 50-59 years to 6.5% (95% CI 0.0 to 14.1) in those aged > or =80 years. The age standardised estimate for the prevalence of all glaucoma in people aged > or =50 years was 3.4%. Only three cases of primary angle closure glaucoma (PACG) were identified, giving a crude ratio of primary open angle glaucoma (POAG) to PACG of more than 10:1. Three people with glaucoma were blind in one eye but none was blind in both eyes. CONCLUSION: Compared to other surveys of glaucoma in India, the age standardised prevalence observed was less than in Hyderabad, but similar to Tamil Nadu and Dhaka. The ratio of POAG to PACG was much higher than found previously, suggesting that PACG may be less prevalent in Bengalis than in Indian populations living in south India. The authors conclude that ophthalmic services in West Bengal should focus on detecting POAG. Since there is still no satisfactory method of screening for POAG, there is no alternative to case detection (opportunistic screening) in eye clinics.

A randomised controlled trial of azithromycin following surgery for trachomatous trichiasis in the Gambia.

BACKGROUND/AIM: Trachomatous trichiasis frequently returns following surgery. Several factors may promote recurrence: preoperative disease severity, surgeon ability, surgical procedure, healing responses, and infection. This study investigates whether enhanced control of infection, both of Chlamydia trachomatis and other bacteria, with azithromycin can improve surgical outcome in a trachoma control programme. METHODS: Individuals with trachomatous trichiasis were examined and operated. After surgery patients were randomised to the azithromycin or control group. The azithromycin group and children in their household were given a dose of azithromycin. Antibiotic treatment was repeated at 6 months. All patients were reassessed at 6 months and 12 months. Samples were collected for C trachomatis polymerase chain reaction and general microbiology at each examination. RESULTS: 451 patients were enrolled. 426 (94%) were reassessed at 1 year, of whom 176 (41.3%) had one or more lashes touching the eye and 84 (19.7%) had five or more lashes. There was no difference in trichiasis recurrence between the azithromycin and control group. Recurrent trichiasis was significantly associated with more severe preoperative trichiasis, bacterial infection, and severe conjunctival inflammation at 12 months. Significant variability in outcome was found between surgeons. Visual acuity and symptoms significantly improved following surgery. CONCLUSION: In this setting, with a low prevalence of active trachoma, azithromycin did not improve the outcome of trichiasis surgery conducted by a trachoma control programme. Audit of trichiasis surgery should be routine.

Long term outcome of trichiasis surgery in the Gambia.

BACKGROUND: Trichiasis surgery is believed to reduce the risk of losing vision from trachoma. There are limited data on the long term outcome of surgery and its effect on vision and corneal opacification. Similarly, the determinants of failure are not well understood. METHODS: A cohort of people in the Gambia who had undergone surgery for trachomatous trichiasis 3-4 years earlier was re-assessed. They were examined clinically and the conjunctiva was sampled for Chlamydia trachomatis polymerase chain reaction (PCR) and general bacterial culture. RESULTS: In total, 141/162 people were re-examined. Recurrent trichiasis was found in 89/214 (41.6%) operated eyes and 52 (24.3%) eyes had five or more lashes touching the globe. Corneal opacification improved in 36 of 78 previously affected eyes. There was a general deterioration in visual acuity between surgery and follow up, which was greater if new corneal opacification developed or trichiasis returned. Recurrent trichiasis was associated with severe conjunctival inflammation and bacterial infection. C trachomatis was detected in only one individual. CONCLUSIONS: Recurrent trichiasis following surgery is a common potentially sight threatening problem. Some improvement in the cornea can occur following surgery and the rate of visual loss tended to be less in those without recurrent trichiasis. The role of conjunctival inflammation and bacterial infection needs to be investigated further. Follow up of patients is advised to identify individuals needing additional surgical treatment.

Review article: smoking cessation as primary therapy to modify the course of Crohn's disease.

This article aims to offer an updated review of the effects of smoking on inflammatory bowel disease, and provide a review of the methods of achieving smoking cessation. A systematic review of Embase and Medline databases was conducted. Smoking causes opposing effects on ulcerative colitis and Crohn's disease. The odds ratio of developing ulcerative colitis for smokers compared with lifetime non-smokers is 0.41. Conversely, smokers with Crohn's disease have a more aggressive disease requiring more therapeutic intervention. Smoking cessation is associated with a 65% reduction in the risk of a relapse as compared with continued smokers, a similar magnitude to that obtained with immunosuppressive therapy. Although difficult to achieve smoking cessation can best be encouraged by accessing appropriate counselling services, nicotine replacement therapy and bupropion. Using a combination of these treatments there is an improved chance of success of up to 20% compared with an unassisted quit attempt. Smoking cessation unequivocally improves the course of Crohn's disease and should be a primary therapeutic aim in smokers with Crohn's disease.

Routine monitoring of visual outcome of cataract surgery. Part 1: Development of an instrument.

AIM: To develop a system for routine monitoring of visual outcome after cataract surgery. METHODS: Staff from eight eye centres in Asia and Africa defined the data collection form and report formats to be used for monitoring visual outcome after cataract surgery. Several operational research questions were raised and methods developed to address them. The system was field tested for 6 months and the operational studies undertaken. The system was finalised based upon the experience gained. FINDINGS: Two different systems for data collection were developed: a manual paper tally system and a computer system (cataract surgery record forms (CSRF)). Both systems report on operative complications; the proportion with good outcome (can see 6/18) and poor outcome (cannot see 6/60); and causes of poor outcome. Data are collected at discharge and at specified time intervals at follow up. Both systems were well accepted. CONCLUSION: The major problem in field testing was data entry errors in centres using the computerised system. Routine monitoring of cataract outcome should be used by individual surgeons or centres to follow trends in their own results over time, and not to compare surgeons, in an atmosphere of trust and support. Visual acuity at discharge, which can readily be collected on all patients, can be used providing it is appreciated that the final results will be much better. Rapid feedback of results can enhance the consciousness of the eye surgeons to causes of poor outcome. Accuracy in data entry and an efficient flow of record forms are essential.

Routine monitoring of visual outcome of cataract surgery. Part 2: Results from eight study centres.

AIM: To determine whether monitoring of cataract outcome can be implemented as a routine activity in different hospital settings in Africa and Asia, and to assess the impact of routine monitoring. METHODS: Eight eye centres in Asia and Africa were involved in the study between 1 June and 31 December 2000. Seven centres used a specifically designed cataract surgery record form with computerised data entry and analysis (CCSRF), and one centre used a manual recording form (MCSRF). Data were used to evaluate quality of data entry, follow up after surgery, and to assess trends in the proportion of complications and visual outcome after surgery. FINDINGS: The reporting systems were accepted and used by all centres, and data were recorded for 5198 cataract operations. Overall, 54% of eyes were followed for 8 weeks or more and 41% for 6 months. Follow up rates varied between centres from nil to almost 100%. Visual acuity tended to improve over time. The outcome could be improved at all follow up periods by providing best spectacle correction. At 8 weeks or more follow up, surgical complications or inadequate spectacle correction accounted for 72% of the causes of poor outcome. Three centres showed a significant reduction in complication rates over the course of the 6 month study. Data entry was identified as a problem and the CCSRF software has been modified to include consistency checks to reduce data entry errors. CONCLUSION: A simple system to monitor cataract outcome has been successfully field tested. The results suggest that monitoring can sensitise surgeons to quality control, which can lead to a decrease in complication rates and improved visual outcomes.

The prevalence of glaucoma in Bangladesh: a population based survey in Dhaka division.

BACKGROUND/AIM: Few studies have reported on the epidemiology and clinical characteristics of glaucoma in south Asia. This project aimed to determine the prevalence of glaucoma of Dhaka, Bangladesh. METHOD: A multistage, stratified, clustered sample was drawn from Dhaka Division, Bangladesh, using systematic sampling to identify individual subjects aged 35 years and older. Examination of all subjects included Snellen visual acuity, slit lamp examination (including gonioscopy and applanation tonometry) and a stereoscopic assessment of the vertical cup:disc ratio (CDR). In selected subjects, a threshold visual field examination was performed. Glaucoma was diagnosed on the basis of statistical abnormality of the vertical CDR combined with an abnormal visual field test, or in subjects with advanced glaucoma who could not complete field testing, a grossly abnormal CDR. If it was not possible to examine the optic discs and the subject was blind, glaucoma was diagnosed on the basis of a raised intraocular pressure. RESULTS: Of 3562 eligible subjects, 2347 were examined (66%). Among people aged 40 years and older, the prevalence of definite glaucoma was 2.1% (95% confidence interval: 1.5 to 2.9; 39 people). The prevalence of definite and probable glaucoma was 3.1% (95% CI: 2.4 to 4.0; 58 people) in subjects of the same age. Primary open angle glaucoma was the most common form of glaucoma, accounting for 75% of the total. Among cases of blindness not attributable to refractive error, 5% were caused by glaucoma. Glaucoma prevalence was higher in men than women, but did not show the typical increase with age. CONCLUSION: Glaucoma prevalence is relatively high in Bangladesh, although it accounts for only a small proportion of blindness in the community. It is estimated that there are approximately 586 000 people 40 years and older with definite or probable glaucoma in Bangladesh.