The Wellcome Trust population initiative

This paper describes what the Wellcome Trust has done and aims to do through its population initiative. The Trust is required to spend its funds to improve the physical welfare of mankind, and in this context there can be no more important issue than the rapid changes that are occurring in the human population. The Trust's first involvement was to help fund the New Delhi population summit covered by the world's scientific academics in 1993 and, following discussions with authorities in the field, initiated its funding programme in 1995. Through this programme, the Trust hopes to bring about improved understanding of the relationship between reproductive health, population growth, and sustainable development and create cadres of high quality research scientists in relevant disciplines. Uniquely, funding is available under this programme to suitably qualified applicants from any country other than the USA.      

Eccentric photorefraction: improving the predictive value and yield in detection of refractive errors

Abstract
Eccentric photorefraction (EPR) is a simple photographic technique for detecting amblyopiogenic conditions. Previous EPR studies to detect refractive errors (RE) have demonstrated high sensitivity but poor predictive value. We have established new criteria for detecting RE involving quantifying retinoscopic reflex crescent widths, thereby achieving 67% predictive value with 100% sensitivity for detecting RE ≥+ 3.5 D in a clinical study of 69 children.
Optical analysis of EPR shows that anticrescent width (light crescent-free portion of the pupil) is independent of pupil diameter. Quantifying anti-crescent widths in the above clinical trial increased the predictive value to 85%.
Schematic eye and human eye EPR studies verify the theoretical prediction that similar ability to detect refractive errors is maintained when the working distance and eccentricity (distance of light source from lens edge) are reduced.
These improvements in EPR reduce its cost and improve its yield; both are essential for its introduction as an acceptable community screening tool.     

Constrictive pericardial disease: prognostic significance of a nonvisualized left ventricular wall

Twenty-six patients with pericardial constriction confirmed by catheterization were studied by dynamic computed tomography (CT). The posterolateral wall of the left ventricular myocardium was not detected in five patients (19.2%). None had evidence of previous myocardial infarction on electrocardiogram or levocardiogram. In 16 patients, a pericardiectomy was performed to remove pericardial constriction. All five patients with nondetectable posterolateral walls of the left ventricle died at or immediately following surgery because of acute myocardial failure. Nonvisualization of the posterolateral wall of the left ventricle in patients with constrictive pericarditis suggests the presence of myocardial fibrosis or atrophy. Surgery is an extremely high risk in these patients.