A technique called optical coherence tomography (OCT) has been developed for noninvasive cross-sectional imaging in biological systems. OCT uses low-coherence interferometry to produce a two-dimensional image of optical scattering from internal tissue microstructures in a way that is analogous to ultrasonic pulse-echo imaging. OCT has longitudinal and lateral spatial resolutions of a few micrometers and can detect reflected signals as small as approximately 10(-10) of the incident optical power. Tomographic imaging is demonstrated in vitro in the peripapillary area of the retina and in the coronary artery, two clinically relevant examples that are representative of transparent and turbid media, respectively.

/pdf/optical-coherence-tomography-3zqbp7mpwb.pdf

Optical coherence tomography

Aim: To estimate the number of people with open angle (OAG) and angle closure glaucoma (ACG) in 2010 and 2020. Methods: A review of published data with use of prevalence models. Data from population based studies of age specific prevalence of OAG and ACG that satisfied standard definitions were used to construct prevalence models for OAG and ACG by age, sex, and ethnicity, weighting data proportional to sample size of each study. Models were combined with UN world population projections for 2010 and 2020 to derive the estimated number with glaucoma. Results: There will be 60.5 million people with OAG and ACG in 2010, increasing to 79.6 million by 2020, and of these, 74% will have OAG. Women will comprise 55% of OAG, 70% of ACG, and 59% of all glaucoma in 2010. Asians will represent 47% of those with glaucoma and 87% of those with ACG. Bilateral blindness will be present in 4.5 million people with OAG and 3.9 million people with ACG in 2010, rising to 5.9 and 5.3 million people in 2020, respectively. Conclusions: Glaucoma is the second leading cause of blindness worldwide, disproportionately affecting women and Asians.

The number of people with glaucoma worldwide in 2010 and 2020

Optical coherence tomography (OCT) has developed rapidly since its first realisation in medicine and is currently an emerging technology in the diagnosis of skin disease. OCT is an interferometric technique that detects reflected and backscattered light from tissue and is often described as the optical analogue to ultrasound. The inherent safety of the technology allows for in vivo use of OCT in patients. The main strength of OCT is the depth resolution. In dermatology, most OCT research has turned on non-melanoma skin cancer (NMSC) and non-invasive monitoring of morphological changes in a number of skin diseases based on pattern recognition, and studies have found good agreement between OCT images and histopathological architecture. OCT has shown high accuracy in distinguishing lesions from normal skin, which is of great importance in identifying tumour borders or residual neoplastic tissue after therapy. The OCT images provide an advantageous combination of resolution and penetration depth, but specific studies of diagnostic sensitivity and specificity in dermatology are sparse. In order to improve OCT image quality and expand the potential of OCT, technical developments are necessary. It is suggested that the technology will be of particular interest to the routine follow-up of patients undergoing non-invasive therapy of malignant or premalignant keratinocyte tumours. It is speculated that the continued technological development can propel the method to a greater level of dermatological use.

https://link.springer.com/content/pdf/bfm%3A978-3-319-06419-2%2F1.pdf

Optical Coherence Tomography

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(07)61690-0.pdf

Maternal and child undernutrition: global and regional exposures and health consequences

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(13)60937-X.pdf

Maternal and child undernutrition and overweight in low-income and middle-income countries

The articles in this supplemental issue of Public Health Reports provide insight into what it will take for the field of public health to tackle 5 of the most complex and difficult health problems of our time: (1) large numbers of adolescents disconnected from work and school; (2) violence (including gun violence), intimate partner and sexual violence, and suicide; (3) opioid addiction and overdose; (4) a dysfunctional food system associated with obesity; and (5) threats to the environment. These 5 problems are the central focus of the new Bloomberg American Health Initiative, which MacKenzie et al describe in their Commentary. “All 5 areas of focus are serious problems facing the nation, with deep connections to economic and social factors,” they write. “None have quick fixes.” Yet there is reason to believe that public health can lead the way toward meaningful progress. From December 2017 to April 2018, the initiative held 5 national symposia to document the state of understanding and to inform a public health perspective on each challenge. This supplement includes these perspectives, as well as commentaries in the cross-cutting areas of evidence, policy, and equity. Together, these articles provide a road map for efforts to bring public health training to frontline organizations, pursue insights through innovative research, and advance effective programs, policies, and strategies for change. To help adolescents stay connected, and thereby avoid downstream harms including violence, addiction, and mental illness, Mendelson et al envision a comprehensive public health effort in schools and communities. Decker and colleagues illuminate public health approaches that simultaneously address interpersonal violence, suicide, and intimate partner violence. Turning a public health lens on the opioid crisis, Saloner et al emphasize the importance of using evidence and engaging communities to overcome barriers to progress, such as the profound stigma associated with both addiction and its effective treatment with medications. Barnhill and colleagues tackle the complexity of obesity and diet, offering a model of food system change that unites multiple public health strategies to moderate the coming wave of chronic illness associated with unhealthy eating. In their article on the environment, Koehler et al write that public health insights and activities can accelerate improvements in our built environment, promoting both healthy communities and a healthy planet. Three articles highlight several potent public health tools available to address the complex health challenges of the 21st century. To bridge the gap between the “answers policy makers and practitioners need for decision making and the answers that the most rigorous and reliable studies can provide,” Callahan and Stuart explain how innovative methods can be more widely used to evaluate real-world policies and programs. Pollack Porter and colleagues highlight the many ways that policy interventions at the local, state, and federal levels can save lives, often with little or no adverse impact on budget. Cooper et al describe how public health can direct attention, advocacy, and collective impact efforts to the underlying causes of health inequities. Together, these articles do not pull punches about the enormity of the US health crisis. But as MacKenzie and colleagues remind us, “Although it can be dispiriting to contemplate the health challenges facing the United States today, it is the nature of public health to tackle seemingly impossible tasks.” The articles in this supplement illustrate that the field of public health is, once again, up to the challenge.

https://journals.sagepub.com/doi/pdf/10.1177/0033354918799744

Public Health Rising to the Challenge: The Bloomberg American Health Initiative.

Incidence of Acute Angle-closure Glaucoma After Pharmacologic Mydriasis: Author Reply

1 Osterholm MT, Kelley NS, Sommer A, Belongia EA. Effi cacy and eff ectiveness of infl uenza vaccines: a systematic review and meta-analysis. Lancet Infect Dis 2012; 12: 36–44. 2 Ohmit SE, Petrie JG, Cross RT, et al. Infl uenza hemagglutination-inhibition antibody titer as a correlate of vaccine-induced protection. J Infect Dis 2011; 204: 1–7. 3 Wilkinson TM, Li CKF, Chui CSC, et al. Preexisting infl uenza-specifi c CD4+ T cells correlate with disease protection against infl uenza challenge in humans. Nat Med 2012; 18: 274–80. 4 Subbramanian RA, Basha S, Shata MT, et al. Pandemic and seasonal H1N1 infl uenza hemagglutinin-specifi c T cell responses elicited by seasonal infl uenza vaccination. Vaccine 2010; 28: 8258–67. 5 Marcelin G, Sandbulte MR, Webby RJ. Contribution of antibody production against neuraminidase to the protection aff orded by infl uenza vaccines. Rev Med Virol 2012; 22: 267–79. 6 Russell CJ. Stalking infl uenza diversity with a universal antibody. N Engl J Med 2011; 365: 1541–42. 7 El Bakkouri K, Descamps F, De Filette M, et al. Universal vaccine based on ectodomain of matrix protein 2 of infl uenza A: Fc receptors and alveolar macrophages mediate protection. J Immunol 2011; 186: 1022–31. 8 Loeb M, Russell ML, Moss L, et al. Eff ect of infl uenza vaccination of children on infection rates in Hutterite communities: a randomized trial. JAMA 2010; 303: 943–50. 9 Arinaminpathy N, Ratmann O, Koelle K, et al. Impact of cross-protective vaccines on epidemiological and evolutionary dynamics of infl uenza. Proc Natl Acad Sci USA 2012; 109: 3173–77. 10 Simpson CR, Ritchie LD, Robertson C, Sheikh A, McMenamin J. Vaccine eff ectiveness in pandemic infl uenza—primary care reporting (VIPER): an observational study to assess the eff ectiveness of the pandemic infl uenza A (H1N1)v vaccine. Health Technol Assess 2010; 14: 313–46. 11 Castilla J, Moran J, Martinez-Artola V, et al. Eff ectiveness of the monovalent infl uenza A(H1N1)2009 vaccine in Navarre, Spain, 2009–2010: cohort and case-control study. Vaccine 2011; 29: 5919–24. 12 Griffi n MR, Monto AS, Belongia EA, et al. Eff ectiveness of non-adjuvanted pandemic infl uenza A vaccines for preventing pandemic infl uenza acute respiratory illness visits in 4 U.S. communities. PLoS One 2011; 6: e23085. 13 Yih WK, Kulldorff M, Fireman BH, et al. Active surveillance for adverse events: the experience of the Vaccine Safety Datalink project. Pediatrics 2011; 127 (suppl 1): S54–64. was made for calendar time (4 week intervals) in the analysis. Had this study had been reported earlier and included in our meta-analysis, the median vaccine eff ectiveness would have been 72% with the same range (60–93%). We also note that all the pandemic vaccine studies included in our analysis were done in populations in which adjuvanted vaccine was widely used. Yin and colleagues do not mention a subsequent report of pandemic vaccine eff ectiveness in the USA, where no licensed infl uenza vaccines contain adjuvant. The overall estimate of pandemic vaccine eff ectiveness was 56% (23–75%). We support the eff orts of Yin and colleagues to promote vaccine trials in developing countries, and we also support increased public access to infl uenza vaccination in those countries outside of the trial setting. We agree with Alessandra Soriano and Raff aele Manna that continuous monitoring is needed to identify potential adverse eff ects after immunisation in adults and children. The infl uenza vaccine has an excellent safety record overall. However, the health eff ects of repeated exposure to vaccines containing adjuvant are not well understood. We caution against overinterpretation of anecdotal case reports: a temporal relation between vaccination and an adverse event does not prove a causal relation. Case reports and adverse event registries are useful for generation of hypotheses, but controlled studies are necessary to confi rm and quantify the risk. In the USA, the Vaccine Adverse Event Reporting System provides a platform for physicians and the public to report suspected vaccine-related adverse events (hypothesis generation). The Vaccine Safety Datalink provides access to a population of more than 9 million individuals for epidemiological studies to assess and quantify risk (hypothesis testing).

https://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(12)70170-6.pdf

Alfred Sommer

Papers

Public Health Rising to the Challenge: The Bloomberg American Health Initiative.

Incidence of Acute Angle-closure Glaucoma After Pharmacologic Mydriasis: Author Reply

Antiretroviral therapy requires life-long adherence

Keratoconus in contact lens wear.

Xerophthalmia, the Deadly Disease