Purpose To examine the performance of state-of-the-art wavefront-guided scleral contact lenses (wfgSCLs) on a sample of keratoconic eyes, with emphasis on performance quantified with visual quality metrics; and to provide a detailed discussion of the process used to design, manufacture and evaluate wfgSCLs. Methods Fourteen eyes of 7 subjects with keratoconus were enrolled and a wfgSCL was designed for each eye. High-contrast visual acuity and visual quality metrics were used to assess the on-eye performance of the lenses. Results The wfgSCL provided statistically lower levels of both lower-order RMS (p < 0.001) and higher-order RMS (p < 0.02) than an intermediate spherical equivalent scleral contact lens. The wfgSCL provided lower levels of lower-order RMS than a normal group of well-corrected observers (p < < 0.001). However, the wfgSCL does not provide less higher-order RMS than the normal group (p = 0.41). Of the 14 eyes studied, 10 successfully reached the exit criteria, achieving residual higher-order root mean square wavefront error (HORMS) less than or within 1 SD of the levels experienced by normal, age-matched subjects. In addition, measures of visual image quality (logVSX, logNS and logLIB) for the 10 eyes were well distributed within the range of values seen in normal eyes. However, visual performance as measured by high contrast acuity did not reach normal, age-matched levels, which is in agreement with prior results associated with the acute application of wavefront correction to KC eyes. Conclusions Wavefront-guided scleral contact lenses are capable of optically compensating for the deleterious effects of higher-order aberration concomitant with the disease, and can provide visual image quality equivalent to that seen in normal eyes. Longer duration studies are needed to assess whether the visual system of the highly aberrated eye wearing a wfgSCL is capable of producing visual performance levels typical of the normal population.

The results of this study demonstrated that in men with prostate cancer, receipt of ADT was associated with higher risks of bone fractures, diabetes, dementia, coronary heart disease, acute MI, and sexual dysfunction than in those who did not receive ADT.

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To determine the difference in the bowel care of spinal cord injury patients before and after enterostomy, we interviewed 20 patients--19 men and one woman. Their ages were 27-75, median 55 years. The paralytic lesions were spastic in ten and flaccid in ten. A total of 24 enterostomies were done for the following reasons: fecal contamination of decubitus ulcer in seven, colonic tumor in six, perforation of the colon in four, prolapse of the large intestine in four, inconvenience of bowel care in two, and perirectal abscess in one. There were 17 sigmoid and five transverse colostomies, and two ileostomies. (Two patients accounted for six procedures.) Follow-up time ranged from three months to six years, median nine months. Bowel care time was reduced from 0.7-14 hours, median 6.0 hours per week preoperatively, to 0.3-7 hours, median 1.0 hours per week postoperatively. Reversal of fecal leakage, abdominal pain, gas and anorexia were also reported. All patients were happier with their bowel care after surgery. We conclude that enterostomy in the spinal cord injury patient makes bowel care considerably more convenient, and improves the quality of life as well.

Background Preterm birth (PTB) carries increased risk of short- and long-term health problems as well as higher healthcare costs. Current strategies using clinically accepted maternal risk factors (prior PTB, short cervix) can only identify a minority of singleton PTBs. Objective We modeled the cost-effectiveness of a risk-screening-and-treat strategy versus usual care for commercially insured pregnant US women without clinically accepted PTB risk factors. The risk-screening-and-treat strategy included use of a novel PTB prognostic blood test (PreTRM ® ) in the 19th–20th week of pregnancy, followed by treatment with a combined regimen of multi-component high-intensity-case-management and pharmacologic interventions for the remainder of the pregnancy for women assessed as higher-risk by the test, and usual care in women without higher risk. Methods We built a cost-effectiveness model using a combined decision-tree/Markov approach and a US payer perspective. We modeled 1-week cycles of pregnancy from week 19 to birth (preterm or term) and assessed costs throughout the pregnancy, and further to 12-months post-delivery in mothers and 30-months in infants. PTB rates and costs were based on >40,000 mothers and infants from the HealthCore Integrated Research Database ® with birth events in 2016. Estimates of test performance, treatment effectiveness, and other model inputs were derived from published literature. Results In the base case, the risk-screening-and-treat strategy dominated usual care with an estimated 870 fewer PTBs (20% reduction) and $54 million less in total cost ($863 net savings per pregnant woman). Reductions were projected for neonatal intensive care admissions (10%), overall length-of-stay (7%), and births <32 weeks (33%). Treatment effectiveness had the strongest influence on cost-effectiveness estimates. The risk-screening-and-treat strategy remained dominant in the majority of probabilistic sensitivity analysis simulations and model scenarios. Conclusion Use of a novel prognostic test during pregnancy to identify women at risk of PTB combined with evidence-based treatment is estimated to reduce total costs while preventing PTBs and their consequences.