Effectiveness of a smartphone application for testing near visual acuity.

PURPOSE: The purpose of this study was to evaluate the discrepancy between the near visual acuity (VA) measurements using the EyeHandBook smartphone application and the conventional method of using the near vision card. METHODS: Using similar environmental/examinational conditions, near VA measurements were obtained and compared using the near vision card and the EyeHandBook app for IPhone 5 from 100 subjects. The obtained data were changed to LogMAR format and the relationship between the two techniques was analyzed by paired sample t-test and scatterplot. RESULTS: With a P-value of<0.0001, our results indicate that the EyeHandBook application running on IPhone 5 overestimates the near VA compared with the conventional near vision card by an average of 0.11 LogMAR unless the measurement done by the near vision card was 20/20. CONCLUSIONS: Owing to vast utilization of portable high-definition screens in VA measurements, eye-care providers have to be mindful of the potential disparity in VA measurement between different platforms, which in our study was likely secondary to the high contrast and brightness levels of the smartphone's high-definition screen when compared with the near vision card.

Symptom report and treatment experience of hypogonadal men with and without type 2 diabetes in a United States health plan.

BACKGROUND: Although hypogonadism (HG) is interrelated with type 2 diabetes mellitus (T2DM), there is little information about men's experiences with HG, T2DM, and testosterone replacement therapy (TRT). We examined symptoms and TRT use among men with HG, with and without T2DM, who received care within a single United States health plan. METHODS: Men aged ≥ 18 years with HG, with and without T2DM, were identified from the 2008 to 2010 Reliant Medical Group electronic medical record database. Surveys responses compared by T2DM status using chi-square or Wilcoxon rank sum tests. RESULTS: A total of 93 men were included (19 with HG and T2DM, 74 with HG only). Men with both HG and T2DM were more frequently treated for their HG by an endocrinologist (52.6%), compared with men with HG only (28.4%, p = 0.058). Erectile dysfunction (ED) was the primary reason for seeking care among all surveyed men, although men with HG and T2DM reported experiencing ED more often (94.7%) than men with HG only (46.0%, p < 0.0001). Additional reasons for seeking care were similar between cohorts and included loss of energy and decreased sex drive. Most men (88.2%) reported using TRT, primarily as injection or gel formulations. Discontinuation of TRT was reported slightly more frequently by men with HG and T2DM (68.4%), compared with men with HG only (55.4%, p > 0.05). CONCLUSIONS: This study provides information about symptoms and TRT utilisation among HG men with and without T2DM. Men with HG only were less likely than those with both HG and T2DM to report that they were currently experiencing key symptoms compared with when they were first diagnosed, regardless of TRT utilisation, and were less likely to report ED as a current symptom.

Intersex in the clam Scrobicularia plana (Da Costa): Widespread occurrence in English Channel estuaries and surrounding areas.

Estuarine clams Scrobicularia plana were sampled from 108 intertidal locations around the English Channel and adjacent areas. Although S. plana is believed to be a strict gonochorist, 58% of the populations sampled included intersexed individuals (described as male clams exhibiting ovotestis). Over the entire region, on average, 8.6% of male clams exhibited intersex, although proportions of affected males ranged from 0% to 53% depending on location. The severity of intersex was assessed using a simple classification scale, with the majority of individuals showing low levels of impact. Sex ratios were significantly skewed at some sites. There were no significant relationships between incidence or severity of intersex; or with size or parasitism of individual clams. Intersex in S. plana is a useful tool to assess endocrine disruptive effects in estuaries, although mechanisms of impact and causative agents remain uncertain.

Experiences and treatment patterns of hypogonadal men in a U.S. health system.

OBJECTIVE: To examine self-reported experiences with hypogonadism (HG) and patterns of testosterone replacement therapy (TRT) in men seeking care in a U.S. healthcare system. METHODS: Men ≥ 18 years old with HG were identified from the 2008-2010 Reliant electronic medical records database. Surveys, including validated instruments for measuring symptoms of HG, were collected and evaluated for demographic and behavioural data. RESULTS: Surveys were mailed to 133 men with HG in 2012. Of the 107 surveys returned, 95 were included in the final analysis. Most respondents were Caucasian (90.5%). Men reported developing symptoms of HG, as well as being diagnosed, at a median age of 50 years. The most common symptoms reported as reasons for seeking treatment were erectile dysfunction (66.3%), fatigue (59.0%) and decreased sex drive (57.9%). These continued to be the most bothersome symptoms at the time of the survey regardless of whether the patient received treatment, although men who were currently taking TRT reported less severe symptoms. Approximately 88% of men reported taking TRT at some point, with 61.9% on therapy at the time of the survey. CONCLUSIONS: This study examined men's experiences with HG, including symptoms, quality of life, and treatments. Some symptoms continued despite treatment, and therapy was discontinued at a high rate, which men generally attributed to cost and perceptions of efficacy. In light of this lack of adherence, patients may benefit from appropriate expectation setting regarding reasonable timelines for symptom improvement, the strengths and challenges of various TRT formulations, the importance of adherence and the benefits and risks of TRT.

Bioaccumulation surveillance in Milford Haven Waterway.

Biomonitoring of contaminants (metals, organotins, polyaromatic hydrocarbons (PAHs), PCBs) was undertaken in Milford Haven Waterway (MHW) and a reference site in the Tywi Estuary (St Ishmael/Ferryside) during 2007-2008. Bioindicator species encompassed various uptake routes-Fucus vesiculosus (dissolved contaminants); Littorina littorea (grazer); Mytilus edulis and Cerastoderma edule (suspension feeders); and Hediste (=Nereis) diversicolor (sediments). Differences in feeding and habitat preference have subtle implications for bioaccumulation trends though, with few exceptions, contaminant burdens in MHW were higher than the Tywi reference site, reflecting inputs. Elevated metal concentrations were observed at some MHW sites, whilst As and Se (molluscs and seaweed) were consistently at the higher end of the UK range. However, for most metals, distributions in MH biota were not exceptional. Several metal-species combinations indicated increases in bioavailability upstream, which may reflect the influence of geogenic/land-based sources-perhaps enhanced by lower salinity. TBT levels in MH mussels were below OSPAR toxicity thresholds and in the Tywi were close to zero. Phenyltins were not accumulated appreciably in M. edulis, whereas some H. diversicolor populations appear subjected to localized (historical) sources. PAHs in H. diversicolor were distributed evenly across most of MHW, although acenaphthene, fluoranthene, pyrene, benzo(a)anthracene and chrysene were highest at one site near the mouth; naphthalenes in H. diversicolor were enriched in the mid-upper Haven (a pattern seen in M. edulis for most PAHs). Whilst PAH (and PCB) concentrations in MH mussels were mostly above reference and OSPAR backgrounds, they are unlikely to exceed ecotoxicological thresholds. Bivalve Condition indices (CI) were highest at the Tywi reference site and at the seaward end of MH, decreasing upstream-giving rise to several significant (negative) relationships between CI and body burdens. Despite the possible influence of salinity gradient as a complicating factor, multivariate analysis indicated that a combination of contaminants could influence the pattern in condition (and the biomarkers metallothionein and TOSC). Integrating bioaccumulation data with biological and biochemical endpoints is seen as a useful way to discriminate environmental quality of moderately contaminated areas such as MHW and to prioritise cause and effect investigations.