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Glenn O, Tomlinson A, Pinchbeck G, Burrow R. Short‐ and long‐term outcomes of polyethylene band attenuation of congenital extrahepatic portosystemic shunts in dogs: 60 cases (2010‐2020). J Small Anim Pract 2022; 63:882-889. [PMID: 36089752 PMCID: PMC10087761 DOI: 10.1111/jsap.13552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 07/11/2022] [Accepted: 08/12/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To report the short- and long-term outcomes following attenuation of congenital extrahepatic portosystemic shunts in dogs using a novel polyethylene band. MATERIALS AND METHODS Records were retrospectively reviewed for dogs that underwent congenital extrahepatic portosystemic shunt attenuation by a polyethylene banding technique, at a single institution between 2010 and 2020. Short-term outcome data were collected from peri-operative clinical records with follow-up examinations, scheduled at 6 and 18 weeks post-operatively, and post-operative imaging when performed. Long-term follow-up was collected by validated owner questionnaire, telephone interview or medical records. Long-term outcomes were categorised by "excellent", "good" or "poor". RESULTS Sixty dogs were included. Post-operative complications occurred in 10 of 60 dogs (16.7%), four major and six minor, with a peri-operative mortality of 6.7%. Persistent shunting was identified in nine of 53 dogs (17%) available for follow-up examination and four dogs underwent a revision surgery. Long-term follow-up was available for 44 dogs at a median of 75 months post-operatively (range 7 to 128). Long-term outcomes were "excellent" (26) or "good" (8) in 81.8% of dogs and "poor" (8) in 18.2%. At the time of follow-up, 30 of 44 (68.2%) dogs were not receiving any medical treatment and 27 of 28 (96.4%) questionnaire respondents were satisfied with the response to surgery. CLINICAL SIGNIFICANCE Polyethylene band attenuation of congenital extrahepatic portosystemic shunts provides comparable outcomes to cellophane. The material used in this study is widely available and consistent while being pre-sterilised and pre-folded makes it easy to use.
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Affiliation(s)
- O. Glenn
- Royal (Dick) School of Veterinary StudiesThe University of Edinburgh Easter Bush CampusMidlothianEH25 9RGUK
| | - A. Tomlinson
- Small Animal Teaching HospitalUniversity of Liverpool, LeahurstNestonCH64 7TEUK
| | - G. Pinchbeck
- Institute of Infection, Veterinary and Ecological SciencesUniversity of Liverpool. LeahurstNestonCH64 7TEUK
| | - R. Burrow
- Northwest Veterinary SpecialistsCheshireWA7 3FWUK
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Daykin N, Mansfield L, Meads C, Gray K, Golding A, Tomlinson A, Victor C. The role of social capital in participatory arts for wellbeing: findings from a qualitative systematic review. Arts Health 2021; 13:134-157. [PMID: 32809907 DOI: 10.1080/17533015.2020.1802605] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Social capital is often cited as shaping impacts of participatory arts, although the concept has not been systematically mapped in arts, health and wellbeing contexts. In wider health inequalities research, complex, differential, and sometimes negative impacts of social capital have been recognised. METHODS This paper maps of social capital concepts in qualitative research as part of the UK What Works for Wellbeing evidence review programme on culture, sport and wellbeing. RESULTS Studies often cite positive impacts of bonding and, to a lesser extent, bridging social capital. However, reported challenges suggest the need for a critical approach. Forms of linking social capital, such as reframing and political engagement to address social divisions, are less often cited but may be important in participatory arts and wellbeing. CONCLUSIONS Future research should further specify dimensions of social capital as well as their nuanced effects in arts, and wellbeing contexts.
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Affiliation(s)
- Norma Daykin
- Faculty of Information Technology and Communication Sciences, Tampere University, Tampere, Finland
| | - Louise Mansfield
- Welfare, Health and Wellbeing, Institute for Environment, Health and Societies, Brunel University, London, UK
| | - Catherine Meads
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
| | - Karen Gray
- Welfare, Health and Wellbeing, Institute for Environment, Health and Societies, Brunel University, London, UK
| | | | | | - Christina Victor
- Ageing Studies, Institute for Environmental Health and Societies, Brunel University, London, UK
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Fagehi R, Pearce EI, Oliver K, Abusharha AA, Tomlinson A. Care solution effects on contact lens in vivo wettability. Clin Exp Optom 2021; 100:623-632. [DOI: 10.1111/cxo.12518] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 10/19/2016] [Accepted: 11/11/2016] [Indexed: 11/29/2022] Open
Affiliation(s)
- Raied Fagehi
- Optometry Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia,
| | - E Ian Pearce
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK,
| | - Katherine Oliver
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK,
| | - Ali A Abusharha
- Optometry Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia,
| | - Alan Tomlinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK,
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Mansfield L, Kay T, Meads C, Grigsby-Duffy L, Lane J, John A, Daykin N, Dolan P, Testoni S, Julier G, Payne A, Tomlinson A, Victor C. Sport and dance interventions for healthy young people (15-24 years) to promote subjective well-being: a systematic review. BMJ Open 2018; 8:e020959. [PMID: 30008444 PMCID: PMC6082460 DOI: 10.1136/bmjopen-2017-020959] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/26/2018] [Accepted: 05/11/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To review and assess effectiveness of sport and dance participation on subjective well-being outcomes among healthy young people aged 15-24 years. DESIGN Systematic review. METHODS We searched for studies published in any language between January 2006 and September 2016 on PsychINFO, Ovid MEDLINE, Eric, Web of Science (Arts and Humanities Citation Index, Social Science and Science Citation Index), Scopus, PILOTS, CINAHL, SPORTDiscus and International Index to Performing Arts. Additionally, we searched for unpublished (grey) literature via an online call for evidence, expert contribution, searches of key organisation websites and the British Library EThOS database, and a keyword Google search. Published studies of sport or dance interventions for healthy young people aged 15-24 years where subjective well-being was measured were included. Studies were excluded if participants were paid professionals or elite athletes, or if the intervention was clinical sport/dance therapy. Two researchers extracted data and assessed strength and quality of evidence using criteria in the What Works Centre for Wellbeing methods guide and GRADE, and using standardised reporting forms. Due to clinical heterogeneity between studies, meta-analysis was not appropriate. Grey literature in the form of final evaluation reports on empirical data relating to sport or dance interventions were included. RESULTS Eleven out of 6587 articles were included (7 randomised controlled trials and 1 cohort study, and 3 unpublished grey evaluation reports). Published literature suggests meditative physical activity (yoga and Baduanjin Qigong) and group-based or peer-supported sport and dance has some potential to improve subjective well-being. Grey literature suggests sport and dance improve subjective well-being but identify negative feelings of competency and capability. The amount and quality of published evidence on sport and dance interventions to enhance subjective well-being is low. CONCLUSIONS Meditative activities, group and peer-supported sport and dance may promote subjective well-being enhancement in youth. Evidence is limited. Better designed studies are needed. TRIAL REGISTRATION NUMBER CRD42016048745; Results.
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Affiliation(s)
- Louise Mansfield
- Department of Life Sciences, Division of Sport Health and Exercise Sciences, Brunel University London, Uxbridge, UK
| | - Tess Kay
- Life Sciences, Brunel University London, Uxbridge, UK
| | - Catherine Meads
- Health, Social Care and Education, Anglia Ruskin University, Cambridge, UK
| | | | - Jack Lane
- Arts and Humanities, University of Brighton, Brighton, UK
| | - Alistair John
- Life Sciences, Brunel University London, Uxbridge, UK
| | - Norma Daykin
- Health and Wellbeing, University of Winchester, Winchester, UK
| | - Paul Dolan
- Social Policy, The London School of Economics and Political Science, London, UK
| | - Stefano Testoni
- Social Policy, The London School of Economics and Political Science, London, UK
| | - Guy Julier
- Arts and Humanities, University of Brighton, Brighton, UK
| | - Annette Payne
- Life Sciences, Brunel University London, Uxbridge, UK
| | - Alan Tomlinson
- Arts and Humanities, University of Brighton, Brighton, UK
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Daykin N, Mansfield L, Meads C, Julier G, Tomlinson A, Payne A, Grigsby Duffy L, Lane J, D'Innocenzo G, Burnett A, Kay T, Dolan P, Testoni S, Victor C. What works for wellbeing? A systematic review of wellbeing outcomes for music and singing in adults. Perspect Public Health 2017; 138:39-46. [PMID: 29130840 PMCID: PMC5753835 DOI: 10.1177/1757913917740391] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Aims: The role of arts and music in supporting subjective wellbeing (SWB) is increasingly recognised. Robust evidence is needed to support policy and practice. This article reports on the first of four reviews of Culture, Sport and Wellbeing (CSW) commissioned by the Economic and Social Research Council (ESRC)-funded What Works Centre for Wellbeing (https://whatworkswellbeing.org/). Objective: To identify SWB outcomes for music and singing in adults. Methods: Comprehensive literature searches were conducted in PsychInfo, Medline, ERIC, Arts and Humanities, Social Science and Science Citation Indexes, Scopus, PILOTS and CINAHL databases. From 5,397 records identified, 61 relevant records were assessed using GRADE and CERQual schema. Results: A wide range of wellbeing measures was used, with no consistency in how SWB was measured across the studies. A wide range of activities was reported, most commonly music listening and regular group singing. Music has been associated with reduced anxiety in young adults, enhanced mood and purpose in adults and mental wellbeing, quality of life, self-awareness and coping in people with diagnosed health conditions. Music and singing have been shown to be effective in enhancing morale and reducing risk of depression in older people. Few studies address SWB in people with dementia. While there are a few studies of music with marginalised communities, participants in community choirs tend to be female, white and relatively well educated. Research challenges include recruiting participants with baseline wellbeing scores that are low enough to record any significant or noteworthy change following a music or singing intervention. Conclusions: There is reliable evidence for positive effects of music and singing on wellbeing in adults. There remains a need for research with sub-groups who are at greater risk of lower levels of wellbeing, and on the processes by which wellbeing outcomes are, or are not, achieved.
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Affiliation(s)
- Norma Daykin
- Centre for the Arts as Wellbeing, University of Winchester, Winchester SO22 4NR, UK
| | - Louise Mansfield
- Doctor, Welfare, Health and Wellbeing, Institute for Environment, Health and Societies, Brunel University, London, Uxbridge, UK
| | | | - Guy Julier
- Professor, College of Arts and Humanities, University of Brighton, Brighton, UK
| | - Alan Tomlinson
- Professor, College of Arts and Humanities, University of Brighton, Brighton, UK
| | | | - Lily Grigsby Duffy
- Welfare, Health and Wellbeing, Institute for Environment, Health and Societies, Brunel University London, Uxbridge, UK
| | - Jack Lane
- College of Arts and Humanities, University of Brighton, Brighton, UK
| | - Giorgia D'Innocenzo
- Welfare, Health and Wellbeing, Institute for Environment, Health and Societies, Brunel University London, Uxbridge, UK
| | | | - Tess Kay
- Professor, Welfare, Health and Wellbeing, Institute for Environment, Health and Societies, Brunel University London, Uxbridge, UK
| | - Paul Dolan
- London School of Economics and Political Science, London, UK
| | - Stefano Testoni
- London School of Economics and Political Science, London, UK
| | - Christina Victor
- Professor, Ageing Studies, Institute for Environment Health and Societies, Brunel University London, Uxbridge, UK
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Nelson JD, Craig JP, Akpek EK, Azar DT, Belmonte C, Bron AJ, Clayton JA, Dogru M, Dua HS, Foulks GN, Gomes JAP, Hammitt KM, Holopainen J, Jones L, Joo CK, Liu Z, Nichols JJ, Nichols KK, Novack GD, Sangwan V, Stapleton F, Tomlinson A, Tsubota K, Willcox MDP, Wolffsohn JS, Sullivan DA. TFOS DEWS II Introduction. Ocul Surf 2017; 15:269-275. [PMID: 28736334 DOI: 10.1016/j.jtos.2017.05.005] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/03/2017] [Indexed: 11/30/2022]
Affiliation(s)
- J Daniel Nelson
- Department of Ophthalmology, HealthPartners Medical Group and Clinics, St Paul, MN, USA; University of Minnesota, Minneapolis, USA.
| | - Jennifer P Craig
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Esen K Akpek
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dimitri T Azar
- University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Carlos Belmonte
- Instituto de Neurociencias de Alicante, University Miguel Hernandez-CSIC, Spain; Instituto Fernandez-Vega, Oviedo University, Spain
| | - Anthony J Bron
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK
| | - Janine A Clayton
- Office of Research on Women's Health, National Institutes of Health, Bethesda, MD, USA
| | - Murat Dogru
- Keio University School of Medicine, Tokyo, Japan; Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | - Harminder S Dua
- Academic Section of Ophthalmology, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Gary N Foulks
- Department of Ophthalmology, University of Louisville School of Medicine, KY, USA
| | - José A P Gomes
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo/Paulista School of Medicine, São Paulo, Brazil
| | | | - Juha Holopainen
- Helsinki Eye Lab and Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Lyndon Jones
- Centre for Contact Lens Research, School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Choun-Ki Joo
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Zuguo Liu
- Eye Institute and Affiliated Eye Center of Xiamen University and Eye Center of the Second Xiangya Hospital, Central South University, Xiamen, China
| | - Jason J Nichols
- University of Alabama at Birmingham School of Optometry, Birmingham, AL, USA
| | - Kelly K Nichols
- University of Alabama at Birmingham School of Optometry, Birmingham, AL, USA
| | - Gary D Novack
- Pharma Logic Development, San Rafael, CA, USA; Departments of Pharmacology and Ophthalmology, University of California, Davis, School of Medicine, USA
| | - Virender Sangwan
- Cornea Department, Center for Ocular Regeneration, Srujana-Center for Innovation and L V Prasad Eye Institute, Hyderabad, India
| | - Fiona Stapleton
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Alan Tomlinson
- Vision Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Mark D P Willcox
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - James S Wolffsohn
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - David A Sullivan
- Schepens Eye Research Institute, Massachusetts Eye and Ear, and Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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Daykin N, Mansfield L, Payne A, Kay T, Meads C, D'Innocenzo G, Burnett A, Dolan P, Julier G, Longworth L, Tomlinson A, Testoni S, Victor C. What works for wellbeing in culture and sport? Report of a DELPHI process to support coproduction and establish principles and parameters of an evidence review. Perspect Public Health 2016; 137:281-288. [PMID: 27789779 PMCID: PMC5582641 DOI: 10.1177/1757913916674038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims: There is a growing recognition of the ways in which culture and sport can contribute to wellbeing. A strong evidence base is needed to support innovative service development and a 3-year research programme is being undertaken to capture best evidence of wellbeing impacts and outcomes of cultural and sporting activities in order to inform UK policy and practice. This article provides an overview of methods and findings from an initial coproduction process with key stakeholders that sought to explore and agree principles and parameters of the evidence review for culture, sport and wellbeing (CSW). Methods: A two-stage DELPHI process was conducted with a purposeful sample of 57 stakeholders between August and December 2015. Participants were drawn from a range of culture and sport organisations and included commissioners and managers, policy makers, representatives of service delivery organisations (SDOs) and scholars. The DELPHI 1 questionnaire was developed from extensive consultation in July and August 2015. It explored definitions of wellbeing, the role of evidence, quality assessment, and the culture and sport populations, settings and interventions that are most likely to deliver wellbeing outcomes. Following further consultation, the results, presented as a series of ranked statements, were sent back to participants (DELPHI 2), which allowed them to reflect on and, if they wished, express agreement or disagreement with the emerging consensus. Results: A total of 40 stakeholders (70.02%) responded to the DELPHI questionnaires. DELPHI 1 mapped areas of agreement and disagreement, confirmed in DELPHI 2. The exercise drew together the key priorities for the CSW evidence review. Conclusion: The DELPHI process, in combination with face-to-face deliberation, enabled stakeholders to engage in complex discussion and express nuanced priorities while also allowing the group to come to an overall consensus and agree outcomes. The results will inform the CSW evidence review programme until its completion in March 2018.
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Affiliation(s)
- Norma Daykin
- Professor, Centre for the Arts as Wellbeing, The University of Winchester, Sparkford Road, Winchester SO22 4NR, UK
| | | | | | - Tess Kay
- Professor, Brunel University London, Uxbridge, UK
| | | | | | | | - Paul Dolan
- Professor, London School of Economics, London, UK
| | - Guy Julier
- Professor, University of Brighton, Brighton, UK
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Beaver K, Williamson S, Sutton C, Hollingworth W, Gardner A, Allton B, Abdel-Aty M, Blackwood K, Burns S, Curwen D, Ghani R, Keating P, Murray S, Tomlinson A, Walker B, Willett M, Wood N, Martin-Hirsch P. Comparing hospital and telephone follow-up for patients treated for stage-I endometrial cancer (ENDCAT trial): a randomised, multicentre, non-inferiority trial. BJOG 2016; 124:150-160. [PMID: 27062690 DOI: 10.1111/1471-0528.14000] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of nurse-led telephone follow-up (TFU) for patients with stage-I endometrial cancer. DESIGN Multicentre, randomised, non-inferiority trial. SETTING Five centres in the North West of England. SAMPLE A cohort of 259 women treated for stage-I endometrial cancer attending hospital outpatient clinics for routine follow-up. METHODS Participants were randomly allocated to receive traditional hospital based follow-up (HFU) or nurse-led TFU. MAIN OUTCOME MEASURES Primary outcomes were psychological morbidity (State Trait Anxiety Inventory, STAI-S) and patient satisfaction with the information provided. Secondary outcomes included patient satisfaction with service, quality of life, and time to detection of recurrence. RESULTS The STAI-S scores post-randomisation were similar between groups [mean (SD): TFU 33.0 (11.0); HFU 35.5 (13.0)]. The estimated between-group difference in STAI-S was 0.7 (95% confidence interval, 95% CI -1.9 to 3.3); the confidence interval lies above the non-inferiority limit (-3.5), indicating the non-inferiority of TFU. There was no significant difference between groups in reported satisfaction with information (odds ratio, OR 0.9; 95% CI 0.4-2.1; P = 0.83). Women in the HFU group were more likely to report being kept waiting for their appointment (P = 0.001), that they did not need any information (P = 0.003), and were less likely to report that the nurse knew about their particular case and situation (P = 0.005). CONCLUSIONS The TFU provides an effective alternative to HFU for patients with stage-I endometrial cancer, with no reported physical or psychological detriment. Patient satisfaction with information was high, with similar levels between groups. TWEETABLE ABSTRACT ENDCAT trial shows effectiveness of nurse-led telephone follow-up for patients with stage-I endometrial cancer.
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Affiliation(s)
- K Beaver
- School of Health Sciences, University of Central Lancashire, Preston, UK
| | - S Williamson
- School of Health Sciences, University of Central Lancashire, Preston, UK
| | - C Sutton
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston, UK
| | - W Hollingworth
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - A Gardner
- Women's Health Research Department, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK
| | - B Allton
- Department of Obstetrics & Gynaecology, University Hospitals of Morecambe Bay NHS Foundation Trust, Royal Lancaster Infirmary, Lancaster, UK
| | - M Abdel-Aty
- Gynaecology Department, East Lancashire Hospitals NHS Trust, Burnley General Hospital, Burnley, UK
| | - K Blackwood
- Women's Healthcare Unit, Wrightington, Wigan & Leigh NHS Foundation Trust, Hanover Diagnostic and Treatment Centre, Wigan, UK
| | - S Burns
- Women's Healthcare Unit, Wrightington, Wigan & Leigh NHS Foundation Trust, Hanover Diagnostic and Treatment Centre, Wigan, UK
| | - D Curwen
- Gynaecological Unit, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - R Ghani
- Department of Obstetrics & Gynaecology, University Hospitals of Morecambe Bay NHS Foundation Trust, Royal Lancaster Infirmary, Lancaster, UK
| | - P Keating
- Women's Health Directorate, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK
| | - S Murray
- Women's Health Directorate, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK
| | - A Tomlinson
- Corporate Cancer Team, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK
| | - B Walker
- Gynaecology Department, East Lancashire Hospitals NHS Trust, Burnley General Hospital, Burnley, UK
| | - M Willett
- Gynaecology Department, East Lancashire Hospitals NHS Trust, Burnley General Hospital, Burnley, UK
| | - N Wood
- Women's Health Directorate, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK
| | - P Martin-Hirsch
- Women's Health Directorate, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK
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Bron AJ, Tomlinson A, Foulks GN, Pepose JS, Baudouin C, Geerling G, Nichols KK, Lemp MA. Rethinking dry eye disease: a perspective on clinical implications. Ocul Surf 2014; 12:S1-31. [PMID: 24725379 DOI: 10.1016/j.jtos.2014.02.002] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 02/07/2014] [Accepted: 02/01/2014] [Indexed: 01/18/2023]
Abstract
Publication of the DEWS report in 2007 established the state of the science of dry eye disease (DED). Since that time, new evidence suggests that a rethinking of traditional concepts of dry eye disease is in order. Specifically, new evidence on the epidemiology of the disease, as well as strategies for diagnosis, have changed the understanding of DED, which is a heterogeneous disease associated with considerable variability in presentation. These advances, along with implications for clinical care, are summarized herein. The most widely used signs of DED are poorly correlated with each other and with symptoms. While symptoms are thought to be characteristic of DED, recent studies have shown that less than 60% of subjects with other objective evidence of DED are symptomatic. Thus the use of symptoms alone in diagnosis will likely result in missing a significant percentage of DED patients, particularly with early/mild disease. This could have considerable impact in patients undergoing cataract or refractive surgery as patients with DED have less than optimal visual results. The most widely used objective signs for diagnosing DED all show greater variability between eyes and in the same eye over time compared with normal subjects. This variability is thought to be a manifestation of tear film instability which results in rapid breakup of the tearfilm between blinks and is an identifier of patients with DED. This feature emphasizes the bilateral nature of the disease in most subjects not suffering from unilateral lid or other unilateral destabilizing surface disorders. Instability of the composition of the tears also occurs in dry eye disease and shows the same variance between eyes. Finally, elevated tear osmolarity has been reported to be a global marker (present in both subtypes of the disease- aqueous-deficient dry eye and evaporative dry eye). Clinically, osmolarity has been shown to be the best single metric for diagnosis of DED and is directly related to increasing severity of disease. Clinical examination and other assessments differentiate which subtype of disease is present. With effective treatment, the tear osmolarity returns to normal, and its variability between eyes and with time disappears. Other promising markers include objective measures of visual deficits, proinflammatory molecular markers and other molecular markers, specific to each disease subtype, and panels of tear proteins. As yet, however, no single protein or panel of markers has been shown to discriminate between the major forms of DED. With the advent of new tests and technology, improved endpoints for clinical trials may be established, which in turn may allow new therapeutic agents to emerge in the foreseeable future. Accurate recognition of disease is now possible and successful management of DED appears to be within our grasp, for a majority of our patients.
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Affiliation(s)
- Anthony J Bron
- Professor emeritus - University of Oxford, Nuffield Laboratory of Ophthalmology, Nuffield Dept of Clinical Neurosciences, UK.
| | - Alan Tomlinson
- Professor of Vision Sciences, Glasgow Caledonian University, Scotland
| | - Gary N Foulks
- Emeritus Professor of Ophthalmology, University of Louisville; Editor-in-Chief, The Ocular Surface, USA
| | - Jay S Pepose
- Professor of Clinical Ophthalmology and Visual Sciences, Washington University School of Medicine, Director, Pepose Vision Institute, St. Louis, Missouri, USA
| | - Christophe Baudouin
- Quinze-Vingts National Ophthalmology Hospital, and Vision Institute, University Paris 6, Paris, France
| | - Gerd Geerling
- Professor and Chair, Department of Ophthalmology, Heinrich-Heine-University Moorenstr. 5 40225 Düsseldorf, Germany
| | - Kelly K Nichols
- FERV Professor (Foundation for Education and Research in Vision), The Ocular Surface Institute, University of Houston, College of Optometry, Houston, Texas, USA
| | - Michael A Lemp
- Clinical Professor of Ophthalmology, Georgetown University, Washington DC and George Washington University, Washington DC, USA
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Hagan S, Tomlinson A, Madden L, Clark AM, Oliver K. Analysis of tear fluid proteins: use of multiplex assays in profiling biomarkers of dry eye disease. EPMA J 2014. [PMCID: PMC4125843 DOI: 10.1186/1878-5085-5-s1-a129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Hagan S, Tomlinson A, Madden L, Clark AM, Oliver K. Analysis of tear fluid proteins: use of multiplex assays in profiling biomarkers of dry eye disease. EPMA J 2014. [PMCID: PMC4125920 DOI: 10.1186/1878-5085-5-s1-a159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Craig JP, Willcox MDP, Argüeso P, Maissa C, Stahl U, Tomlinson A, Wang J, Yokoi N, Stapleton F. The TFOS International Workshop on Contact Lens Discomfort: Report of the Contact Lens Interactions With the Tear Film Subcommittee. ACTA ACUST UNITED AC 2013; 54:TFOS123-56. [DOI: 10.1167/iovs.13-13235] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Jennifer P. Craig
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Mark D. P. Willcox
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Pablo Argüeso
- Schepens Eye Research Institute and Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Cecile Maissa
- Optometric Technology Group Research & Consultancy, London, United Kingdom
| | - Ulrike Stahl
- Centre for Contact Lens Research, School of Optometry and Vision Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Jianhua Wang
- University of Miami, Miller School of Medicine Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Norihiko Yokoi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Fiona Stapleton
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
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Hagan S, Tomlinson A. Tear Fluid Biomarker Profiling: A Review of Multiplex Bead Analysis. Ocul Surf 2013; 11:219-35. [DOI: 10.1016/j.jtos.2013.04.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 04/19/2013] [Accepted: 04/01/2013] [Indexed: 11/30/2022]
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Whitaker A, Martins S, Tomlinson A, Woodhams E, Gilliam M, Quinn M. Contraceptive decisional balance, self-efficiency and stage of change measures among women presenting for induced abortion. Contraception 2013. [DOI: 10.1016/j.contraception.2013.05.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Baudouin C, Aragona P, Messmer EM, Tomlinson A, Calonge M, Boboridis KG, Akova YA, Geerling G, Labetoulle M, Rolando M. Role of hyperosmolarity in the pathogenesis and management of dry eye disease: proceedings of the OCEAN group meeting. Ocul Surf 2013; 11:246-58. [PMID: 24112228 DOI: 10.1016/j.jtos.2013.07.003] [Citation(s) in RCA: 298] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 07/22/2013] [Accepted: 07/30/2013] [Indexed: 12/24/2022]
Abstract
Dry eye disease (DED), a multifactorial disease of the tears and ocular surface, is common and has a significant impact on quality of life. Reduced aqueous tear flow and/or increased evaporation of the aqueous tear phase leads to tear hyperosmolarity, a key step in the vicious circle of DED pathology. Tear hyperosmolarity gives rise to morphological changes such as apoptosis of cells of the conjunctiva and cornea, and triggers inflammatory cascades that contribute to further cell death, including loss of mucin-producing goblet cells. This exacerbates tear film instability and drives the cycle of events that perpetuate the condition. Traditional approaches to counteracting tear hyperosmolarity in DED include use of hypotonic tear substitutes, which have relatively short persistence in the eye. More recent attempts to counteract tear hyperosmolarity in DED have included osmoprotectants, small organic molecules that are used in many cell types throughout the natural world to restore cell volume and stabilize protein function, allowing adaptation to hyperosmolarity. There is now an expanding pool of clinical data on the efficacy of DED therapies that include osmoprotectants such as erythritol, taurine, trehalose and L-carnitine. Osmoprotectants in DED may directly protect cells against hyperosmolarity and thereby promote exit from the vicious circle of DED physiopathology.
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Affiliation(s)
- Christophe Baudouin
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts and Vision Institute, Paris, France.
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Efron N, Brennan NA, Bright FV, Glasgow BJ, Jones LW, Sullivan DA, Tomlinson A, Zhang J. 2. Contact lens care and ocular surface homeostasis. Cont Lens Anterior Eye 2013; 36 Suppl 1:S9-13. [PMID: 23347575 DOI: 10.1016/s1367-0484(13)60004-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The early focus of contact lens wear and ocular health was on oxygen delivery. However, as we learn more about how the eye works, and investigate how the contact lens interacts with the cornea, the role of the tear film has risen in prominence. A healthy tear film is critical for normal ocular homeostasis, and abnormalities of the tear film are the primary cause of dry eye. In order to improve patient eye health and comfort during lens wear, we need to further elucidate the relationship among contact lenses, contact lens solutions, the tear film, and the corneal epithelium, and find ways to maintain homeostasis of the ocular surface. In this section, we review the latest data and opinions on this complex relationship between contact lenses and lens care solutions.
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Affiliation(s)
- Nathan Efron
- Queensland University of Technology, Institute of Health and Biomedical Innovation, Kelvin Grove, Queensland, Australia
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Tomlinson A, Hair M, McFadyen A. Statistical approaches to assessing single and multiple outcome measures in dry eye therapy and diagnosis. Ocul Surf 2013; 11:267-84. [PMID: 24112230 DOI: 10.1016/j.jtos.2013.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 05/15/2013] [Indexed: 10/26/2022]
Abstract
Dry eye is a multifactorial disease which would require a broad spectrum of test measures in the monitoring of its treatment and diagnosis. However, studies have typically reported improvements in individual measures with treatment. Alternative approaches involve multiple, combined outcomes being assessed by different statistical analyses. In order to assess the effect of various statistical approaches to the use of single and combined test measures in dry eye, this review reanalyzed measures from two previous studies (osmolarity, evaporation, tear turnover rate, and lipid film quality). These analyses assessed the measures as single variables within groups, pre- and post-intervention with a lubricant supplement, by creating combinations of these variables and by validating these combinations with the combined sample of data from all groups of dry eye subjects. The effectiveness of single measures and combinations in diagnosis of dry eye was also considered.
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Affiliation(s)
- Alan Tomlinson
- Vision Sciences, Glasgow Caledonian University, Glasgow, United Kingdom.
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Abstract
Purpose: Dry eye is often characterized by increased tear evaporation due to poor tear film quality, especially of the lipid component of the tear film. Using an environmental chamber to induce environmental stress, this study compared the effect of three lubricant eye drops on various aspects of tear physiology in a crossover design (evaporation was the principal outcome measure). Methods: Three eye drop formulas were tested: 0.5% carmellose sodium (Drop C), 0.5% carmellose sodium with added lipid (Drop C-L) and 1.0% glycerine with added lipid (Drop G-L). Nineteen control and 18 dry eye subjects used each product for 2 weeks, three times per day, in a random order, with a minimum 1-week washout between treatment periods. Tear evaporation, break up time, osmolarity, tear structure (by interferometry) and patient symptoms were assessed with the subjects adapted for 10 min in an environmental chamber controlled at 20% relative humidity and 22 °C. The treatment effects were analyzed using general linear model repeated measures analyses of variance. Results: In dry eye subjects, evaporation, break up time, osmolarity and symptoms improved for all formulas (p < 0.05). Normal subjects showed some improvements: evaporation with C-L, osmolarity with C and symptoms with C-L and G-L. Change in evaporation was greater for both C-L and G-L versus C (p < 0.05), and there was a trend for C-L to reduce evaporation more than G-L (p < 0.11). There were no significant treatment effects on tear film structure. Conclusion: Overall, the eye drop formula containing both carmellose sodium and lipid (C-L) produced a greater treatment effect on tear evaporation than the other formulations containing only one of these ingredients. This study also demonstrates the utility of a controlled environmental chamber in showing the difference in performance between dry eye treatments.
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Affiliation(s)
- Alan Tomlinson
- Vision Sciences, Glasgow Caledonian University, Glasgow, UK.
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Abstract
Meta-analyses were carried out of studies of tear production (by fluorophotometry, tear turnover rate[TTR]) and evaporation (from capture of fluid loss from the eye). TTR was reduced in dry eye relative to normal at 9.26 +/- 5.08%/min (0.54 +/- 0.28 μl/min) vs 16.19 +/- 5.1%/min (1.03 +/- 0.39 μl/min); with values of 7.71 +/- 1.02 %/min (0.4 +/- 0.10 μl/min) in aqueous deficiency dry eye (ADDE) and 11.95 +/- 4.25%/min (0.71 +/- 0.25 l/min) in evaporative dry eye (EDE). Evaporation was increased in dry eye at 21.05 +/- 13.96 x 10(-7)g/cm(2)/s (0.21 +/- 0.13 μl/min) vs 13.57 +/- 6.52 x 10(-7)g/cm(2)/s (0.14 +/- 0.07 μl/min) in normals; with values of 17.91 +/- 10.49 x 10(-7)g/cm(2)/s (0.17 +/- 0.1 μl/min) in ADDE and 25.34 +/- 13.08 x 10(-7)g/cm(2)/s (0.26 +/- 0.16 μl/min) in EDE. Evaporation rate from tear film thinning was also considered, and possible reasons and consequences for the much higher rates thereby reported are discussed. A new statistical approach determined diagnostic efficacy of cut-offs for dry eye derived from the meta-analyses; sensitivities and specifications ranging from 69.5 to 98.6% and 58.7 to 96.8% (TTR) and 45.5 to 61.2% and 79.8 to 90.6% (evaporation). Indices of tear dynamics were reconsidered, and ratios of evaporation and TTR suggest that an increase of between 2 and 3 times may be associated with dry eye.
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Affiliation(s)
- Alan Tomlinson
- Vision Sciences, Glasgow Caledonian University, Glasgow, UK.
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Fagehi R, Tomlinson A, Manahilov V, Haddad M. 67 New measures of contact lens wetting. Cont Lens Anterior Eye 2011. [DOI: 10.1016/s1367-0484(11)60146-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Tomlinson A, Khanal S. Tear physiology in dry eye associated with chronic graft vs host disease. Cont Lens Anterior Eye 2011. [DOI: 10.1016/s1367-0484(11)60072-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Tomlinson A, Bron AJ, Korb DR, Amano S, Paugh JR, Pearce EI, Yee R, Yokoi N, Arita R, Dogru M. The international workshop on meibomian gland dysfunction: report of the diagnosis subcommittee. Invest Ophthalmol Vis Sci 2011; 52:2006-49. [PMID: 21450918 DOI: 10.1167/iovs.10-6997f] [Citation(s) in RCA: 562] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Alan Tomlinson
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom
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Abstract
The purpose of this study was to compare tear physiology characteristics of chronic GVHD (cGVHD)-associated dry eye to dry eye caused by Sjogren's syndrome (SS), a extreme form of aqueous-deficient dry eye, and meibomian gland dysfunction (MGD), the major cause of evaporative dry eye. Tear turnover rate, evaporation and osmolarity along with meibomian gland dropout and lipid layer interferometric patterns were assessed in the right eyes of 12 patients with dry eye associated with cGVHD, 12 age-matched patients with SS and 12 age-sex matched subjects with MGD. In cGVHD, the decrease in tear turnover rate was similar (P=0.33), but the number of non-functioning meibomian glands was significantly higher (P<0.01) than in SS. Tear evaporation rate in cGVHD dry eye was found to be similar to that in MGD (P=0.36) and significantly higher than in SS (P<0.01). The lipid layer was most unstable in cGVHD compared with other groups. There was no variation in tear volume across all groups. Although statistical significance was not detected, the mean tear osmolarity (333.51±14.67mOsm/L) was highest in cGVHD. Major aspects of tear physiology were severely impaired in cGVHD-associated dry eye.
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Affiliation(s)
- S Khanal
- School of Natural Sciences, University of Western Sydney, Sydney, Australia.
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Sullivan BD, Whitmer D, Nichols KK, Tomlinson A, Foulks GN, Geerling G, Pepose JS, Kosheleff V, Porreco A, Lemp MA. An Objective Approach to Dry Eye Disease Severity. ACTA ACUST UNITED AC 2010; 51:6125-30. [DOI: 10.1167/iovs.10-5390] [Citation(s) in RCA: 374] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | | | - Kelly K. Nichols
- the College of Optometry, The Ohio State University, Columbus, Ohio
| | - Alan Tomlinson
- the Department of Vision Sciences, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom
| | - Gary N. Foulks
- the Kentucky Lions Eye Center, University of Louisville, Louisville, Kentucky
| | - Gerd Geerling
- the Department of Ophthalmology, University of Würzburg, Würzburg, Germany; and
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Morgan E, Tomlinson A, Hunter S, Nichols T, Roberts E, Fox M, Taylor M. Angiostrongylus vasorum and Eucoleus aerophilus in foxes (Vulpes vulpes) in Great Britain. Vet Parasitol 2008; 154:48-57. [DOI: 10.1016/j.vetpar.2008.02.030] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Revised: 02/19/2008] [Accepted: 02/25/2008] [Indexed: 01/01/2023]
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Affiliation(s)
| | | | - Angus McFadyen
- Mathematics, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Charles Diaper
- Southern General Hospital, South Glasgow University Hospital Trust, Glasgow, United Kingdom; and
| | - Kannu Ramaesh
- Gartnavel Hospital, North Glasgow University Hospital Trust, Glasgow, United Kingdom
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Khanal S, Tomlinson A, Esakowitz L, Bhatt P, Jones D, Nabili S, Mukerji S. Changes in corneal sensitivity and tear physiology after phacoemulsification. Ophthalmic Physiol Opt 2008; 28:127-34. [DOI: 10.1111/j.1475-1313.2008.00539.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Using monoclonal and polyclonal antibodies as differentiation markers, we have found that the eight photoreceptors of the Drosophila ommatidium differentiate in a fixed sequence. The foundation photoreceptor, R8, expresses neural antigens first. The paired photoreceptors R2/5 are next to express, followed by the pair R3/4, followed by the pair R1/6; R7 is the final photoreceptor to differentiate. From previous studies it is known that Drosophila photoreceptors use local, positional cues to select their identities. Together with the morphological picture of ommatidial development, the sequential order of photoreceptor differentiation demonstrated here suggests that these cues may be encoded in the particular combination of cells an undetermined cell finds itself in contact with.
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Affiliation(s)
- A Tomlinson
- Department of Biology, Princeton University, Princeton, New Jersey 08544, USA
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Tomlinson A. Cellular communication in the developing Drosophila eye. Ciba Found Symp 2007; 144:281-7; discussion 287-9, 290-5. [PMID: 2673682 DOI: 10.1002/9780470513798.ch16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Undetermined cells are directed to their fate in the Drosophila eye by positional cues which are probably presented by adjacent differentiating cells. The sevenless protein is thought to function as a signal-receiving protein on the plasma membrane of the cell destined to form the seventh photoreceptor, R7. Localization of the protein indicates the interactions between undetermined and differentiating cells and suggests the existence of other receptor proteins similar to sevenless.
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Affiliation(s)
- A Tomlinson
- MRC Laboratory of Molecular Biology, Cambridge, UK
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Abstract
PURPOSE To determine the effect of an oil-in-water emulsion eye drop compared with a conventional dry eye supplement (hypromellose) on tear physiology in dry eye. METHODS A randomized parallel, longitudinal, and investigator-masked study of the efficacy of 1.25% castor oil emulsion and 0.32% hypromellose solution was carried out. A total of 53 patients with mild to moderate dry eye (27 in emulsion group and 26 in hypromellose group) were recruited for the study. Patients were enrolled if they reported at least 2 symptoms on a McMonnies Dry Eye Questionnaire together with 1 of the following screening tests: noninvasive tear breakup time (5-10 seconds) and Schirmer test without anesthesia (2-5 mm in 5 minutes). Patients were instructed to use the test solutions 3 times a day for 30 days. Tear production, evaporation, lipid layer structure, and osmolality were measured before and 30 days after use of the drops. RESULTS A statistically significant decrease was seen after 1 month in tear evaporation rates with both emulsion (7.25 +/- 5.43 g/m2/h) and hypromellose (2.02 +/- 4.75 g/m2/h). However, the decrease with emulsion was significantly greater than with hypromellose (P < 0.001). Lipid layer structure improved from day 1 to day 30 of the study with the emulsion but not with the hypermellose. No significant changes were seen in tear production and osmolality with either of the drops. CONCLUSIONS The oil-water emulsion was more effective in reducing tear evaporation than hypromellose after repeated application over a 1-month period. This finding signifies the potential of the emulsion in the management of evaporative dry eye.
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Affiliation(s)
- Santosh Khanal
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
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Affiliation(s)
- Alan Tomlinson
- Department of Vision Sciences, Glasgow Caledonian University, Scotland
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Abstract
PURPOSE To determine new referents, or cutoff levels for tear film hyperosmolarity in the diagnosis of keratoconjunctivitis sicca (KCS) and to assess their effectiveness in independent patient groups. METHOD A meta-analysis was performed on published data for tear osmolarity in samples of normal eyes and various subtypes of dry eye, and pooled estimates of the mean and standard deviations for normal and (all) dry eye subjects were determined. Diagnostic referents were derived from the intercept between the distributions of osmolarity in the two samples and from receiver operator characteristic (ROC) curves. This referent was tested for effectiveness of diagnosis in independent groups with normal and dry eyes. RESULTS An osmolarity referent of 315.6 mOsmol/L was derived from the intercept of the distribution curves, and 316 mOsmol/L from the ROC curve. When applied to independent groups of normal and dry eye subjects a value of 316 mOsmol/L was found to yield sensitivity of 59%, specificity of 94%, and an overall predictive accuracy of 89% for the diagnosis of dry eye syndrome. CONCLUSIONS Tear hyperosmolarity, defined by a referent of 316 mOsmol/L, was superior in overall accuracy to any other single test for dry eye diagnosis (Lactoplate, Schirmer test, and Rose Bengal staining), even when the other test measures were applied to a diagnosis within the sample groups from which they were derived. For overall accuracy in the diagnosis of dry eye, the osmolarity test was found to be comparable with the results of combined (in parallel or series) tests.
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Affiliation(s)
- Alan Tomlinson
- Department of Vision Sciences, Glasgow Caledonian Unviersity, Glasgow, Scotland.
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Beattie TK, Tomlinson A, McFadyen AK. Attachment of Acanthamoeba to first- and second-generation silicone hydrogel contact lenses. Ophthalmology 2005; 113:117-25. [PMID: 16360208 DOI: 10.1016/j.ophtha.2005.10.018] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2005] [Revised: 07/27/2005] [Accepted: 10/06/2005] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To investigate the attachment of Acanthamoeba to first- and second-generation silicone hydrogel contact lenses, and to determine if patient wear or the presence of a bacterial biofilm coating affects attachment characteristics. DESIGN Experimental study. PARTICIPANTS AND CONTROLS Attachment to the silicone hydrogel lenses was compared with that to a conventional hydrogel control lens. Sixteen replicates (n = 16) were carried out for unworn, worn, and biofilm-coated lenses of each type. METHODS Unworn, worn, and Pseudomonas aeruginosa biofilm-coated first-generation (lotrafilcon A) and second-generation (galyfilcon A) silicone hydrogel and conventional hydrogel (etafilcon A) lens quarters were incubated for 90 minutes in suspensions of plate-cultured Acanthamoeba castellanii trophozoites. MAIN OUTCOME MEASURES Trophozoites attached to one surface of each lens quarter were counted by direct light microscopy. Logarithmic transformation of data allowed the use of parametric analysis of variance for statistical analysis. RESULTS Attachment of Acanthamoeba was affected significantly by lens material type (P<0.001), with higher numbers of trophozoites attaching to the first-generation lotrafilcon A silicone hydrogel lens, compared with the second-generation galyfilcon A lens and the conventional hydrogel lens. Attachments to the latter 2 lenses did not differ significantly from each other (P = 0.126). Patient wear and the presence of a bacterial biofilm had no significant effect on attachment to the lotrafilcon A lens (P = 0.426) but did significantly increase attachment to the galyfilcon A (P<0.001) and the etafilcon A (P = 0.009) lenses; attachment to the latter 2 lenses was still significantly less than that found with the first-generation silicone hydrogel (P<0.001). CONCLUSIONS Acanthamoeba demonstrated a significantly greater affinity for the first-generation silicone hydrogel lens as compared with the second-generation silicone hydrogel and the conventional hydrogel. If exposed to Acanthamoeba (e.g., when showering or swimming, through noncontinuous wear and ineffective lens care regimes), first-generation silicone hydrogel lenses may promote a greater risk of Acanthamoeba infection due to the enhanced attachment characteristics of this lens material. However, prospective studies in patients are required to determine if these experimental results are clinically significant.
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Affiliation(s)
- Tara K Beattie
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom.
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Abstract
OBJECTIVE This study was conducted to compare the performance of liquid-based cytology (LBC) and conventional cytology (CS) in the high prevalence setting of colposcopy clinic. DESIGN A split sample of matched ThinPrep (TP) and conventional smear from 563 patients were evaluated blindly. The performance of both techniques was compared with the gold standard of biopsy results or normal colposcopy examination in 441 cases. SETTING Colposcopy clinic of an inner city hospital for women and children. SAMPLE Five hundred and sixty-three women referred to colposcopy clinic over 14-month period. METHODS Cervical smears were taken from 563 women referred for colposcopy. Using the split-sample technique, the material was spread on a conventional (CS) slide and the remaining material rinsed in a PreservCyt solution. A T2000 processor was used to prepare LBC preparations. All women underwent colposcopy/biopsy according to local protocol. Four hundred and forty-one women met the diagnostic standard criteria of the study, which was either a normal colposcopy or histopathology result. Sensitivity, specificity and positive and negative predictive values were calculated for both methods of cytology preparations. MAIN OUTCOME MEASURES Matched TP and conventional smears, detection of abnormality, matched biopsies, sensitivity, specificity, and positive and negative predictive values. RESULTS Inadequate rates for CS and LBC (TP) were 4.3% and 0.68%, respectively. In 73% of cases, the CS and the LBC preparations showed exact agreement, whereas 77% agreement was seen when comparison was made for amalgamated low grade and high grade abnormalities. Low grade cytological abnormalities accounted for 44% of LBC slides versus 37% in CS slides. High grade cytological abnormalities accounted for 22% of LBC versus 17% seen in CS cases (P < 0.001). LBC showed increased sensitivity in the detection of CIN2 or worse than CS (92% and 83%, respectively) and CS showed greater specificity than LBC (82% and 76%, respectively). CONCLUSIONS In high prevalence setting, LBC performed at least as well as CS. The inadequate rate was significantly lower with LBC. The numbers are too small, however, to make confident comments about increased sensitivity and negative predictive value with LBC. Larger studies are required to verify these findings.
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Affiliation(s)
- T Hussein
- Manchester Cytology Centre, Manchester Royal Infirmary, UK
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Abstract
PURPOSE Disruption of the anterior refracting surface of the eye (i.e., the tear layer) reduces visual performance. Tear layer breakup occurs soon after a blink in contact lens wearers and patients with dry eye. This study determined whether artificial tears stabilize the tear film and improve visual performance in contact lens wearers who also exhibit a dry eye. METHODS Five subjects with mild to moderate dry eye (probably as a result of an evaporative dry eye) during spectacle and contact lens wear were fitted with a Focus Night & Day hydrogel lens for this study. A temporal, two-alternative, forced-choice paradigm was used to measure contrast sensitivity. The stimuli were vertically oriented sine wave gratings (between 0.5 and 14 cpd) presented for 16.67 msec. The stimuli were presented at two different times after blink detection: 2 sec after blink detection (i.e., before tear layer breakup) or 4 sec after tear film breakup. Four conditions were investigated at 4 sec after tear layer breakup: 1) without artificial tears added, 2) with Clerz2 (Alcon, Fort Worth, TX) instilled, 3) with Sensitive Eyes (Bausch & Lomb, Rochester, NY), and 4) with GenTeal (Novartis, Basel, Switzerland) applied. The artificial tears were instilled at 10-min intervals during the data collection. The short-term visual effects of drop instillation were also investigated by continually monitoring contrast sensitivity for a 14-cpd grating after a single-drop administration. RESULTS High spatial frequency contrast sensitivity and visual acuity were found to be reduced after tear film breakup in the absence of supplementation with artificial tears. For the group data (and four of five subjects), the instillation of Sensitive Eyes improved the contrast sensitivity and visual acuity to the level attained before tear breakup, thus prolonging visual performance. Clerz2 and GenTeal did not produce any enhancement in visual performance. A short-term decrease in contrast sensitivity was also observed with a single administration of Clerz2 and GenTeal. CONCLUSIONS This study indicates that there was a benefit of Bausch & Lomb Sensitive Eyes tear supplementation on visual performance in subjects with an evaporative dry eye. This may be the result of 1) aqueous supplementation in these subjects and/or 2) the minimal tear layer disruption found with Sensitive Eyes drop administration. The results suggest that practitioners need to identify those patients who can benefit from the use of appropriate artificial tear supplements.
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Affiliation(s)
- William H Ridder
- Southern California College of Optometry, 2575 Yorba Linda Boulevard, Fullerton, CA 92831, USA.
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Ramnarayan P, Tomlinson A, Britto J, Kulkarni G. Diagnostic decision support in the ED: practical considerations. Emerg Med J 2005; 22:462. [PMID: 15911967 PMCID: PMC1726797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
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Ramnarayan P, Tomlinson A, Britto J, Kulkarni G. Diagnostic decision support in the ED: practical considerations. Emerg Med J 2005; 22:462. [PMID: 15911967 PMCID: PMC1726797 DOI: 10.1136/emj.2005.22780corr1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
The dynamics of the tear film are reviewed with specific reference to the biophysical aspects: distribution, turnover and elimination through evaporation, drainage, and absorption. The review concentrates on quantitative assessments and is confined to aspects of the dynamics that can be fully and directly measured. The techniques of fluorophotometry, fluorescein clearance, lacrimal scintigraphy, evaporimetry and osmometry are described. Reports in the literature for values of tear turnover (flow), evaporation and osmolarity for normal and dry eyes are collated. Indices of tear film dynamics based on these measurements, including tear function index, total tear flow, and osmolarity, are discussed in relation to their potential in the differential diagnosis of dry eye and new referent values for the disease suggested. The limitations of derivation and application of these indices are discussed.
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Affiliation(s)
- Alan Tomlinson
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK.
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Affiliation(s)
- A Tomlinson
- MRC Laboratory of Molecular Biology, Hills Road, Cambridge CB2 2QH, UK
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Couny F, Sabert H, Roberts P, Williams DP, Tomlinson A, Mangan B, Farr L, Knight J, Birks T, Russell PS. Visualizing the photonic band gap in hollow core photonic crystal fibers. Opt Express 2005; 13:558-563. [PMID: 19488385 DOI: 10.1364/opex.13.000558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The light radiated from the guided mode of a hollow core photonic crystal fiber into free space is measured as a function of angle and wavelength. This enables the direct experimental visualization of the photonic band gap and the identification of localized modes of the core region.
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Roberts P, Couny F, Sabert H, Mangan B, Williams D, Farr L, Mason M, Tomlinson A, Birks T, Knight J, St J Russell P. Ultimate low loss of hollow-core photonic crystal fibres. Opt Express 2005; 13:236-244. [PMID: 19488348 DOI: 10.1364/opex.13.000236] [Citation(s) in RCA: 186] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Hollow-core photonic crystal fibres have excited interest as potential ultra-low loss telecommunications fibres because light propagates mainly in air instead of solid glass. We propose that the ultimate limit to the attenuation of such fibres is determined by surface roughness due to frozenin capillary waves. This is confirmed by measurements of the surface roughness in a HC-PCF, the angular distribution of the power scattered out of the core, and the wavelength dependence of the minimum loss of fibres drawn to different scales.
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