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This study investigated the distinctive features and management outcomes of combined exfoliation syndrome and angle-closure glaucoma (XFS-PACG) through a prospective, multicenter observational cohort study including 350 patients (118 XFS, 127 PACG, 105 combined XFS-PACG). Combined pathology demonstrated unique characteristics including bimodal diurnal IOP fluctuations, asymmetric angle closure correlating with exfoliation material distribution, and accelerated zonular weakness with progressive anterior lens displacement. Disease progression was significantly more aggressive in combined cases (visual field deterioration − 2.9 ± 0.8 dB/year versus − 1.7 ± 0.6 and − 1.4 ± 0.5 dB/year in XFS and PACG respectively). Therapeutic response evaluation revealed that prostaglandin-alpha2agonist combinations were most effective pharmacologically in combined cases, while traditional laser peripheral iridotomy achieved limited sustained control (38.1%). Early phacoemulsification with minimally invasive glaucoma surgery demonstrated superior surgical outcomes (72.4% complete success) compared to filtering procedures (53.3%). These findings support an individualized treatment approach for combined XFS-PACG, with early intervention and condition-specific protocols to optimize outcomes in this challenging clinical entity.

Small clinics are important in providing health care in local communities. Accurately predicting their closure would help manage health care resource allocation. There have been few studies on the prediction of clinic closure using machine learning techniques. This study aims to test the feasibility of predicting the closure of medical and dental clinics (MCs and DCs, respectively) and investigate important factors associated with their closure using machine running techniques. The units of analysis were MCs and DCs. This study used health insurance administrative data. The participants of this study ran and closed clinics between January 1, 2020, and December 31, 2021. Using all closed clinics, closed and run clinics were selected at a ratio of 1:2 based on the locality of study participants using the propensity matching score of logistic regression. This study used 23 and 19 variables to predict the closure of MCs and DCs, respectively. Key variables were extracted using permutation importance and the sequential feature selection technique. Finally, this study used 5 and 6 variables of MCs and DCs, respectively, for model learning. Furthermore, four machine learning techniques were used: (1) logistic regression, (2) support vector machine, (3) random forest (RF), and (4) Extreme Gradient Boost. This study evaluated the modeling accuracy using the area under curve (AUC) method and presented important factors critically affecting closures. This study used SAS (version 9.4; SAS Institute Inc) and Python (version 3.7.9; Python Software Foundation). The best-fit model for the closure of MCs with cross-validation was the support vector machine (AUC 0.762, 95% CI 0.746-0.777; P<.001) followed by RF (AUC 0.736, 95% CI 0.720-0.752; P<.001). The best-fit model for DCs was Extreme Gradient Boost (AUC 0.700, 95% CI 0.675-0.725; P<.001) followed by RF (AUC 0.687, 95% CI 0.661-0.712; P<.001). The most significant factor associated with the closure of MCs was years of operation, followed by population growth, population, and percentage of medical specialties. In contrast, the main factor affecting the closure of DCs was the number of patients, followed by annual variation in the number of patients, year of operation, and percentage of dental specialists. This study showed that machine running methods are useful tools for predicting the closure of small medical facilities with a moderate level of accuracy. Essential factors affecting medical facility closure also differed between MCs and DCs. Developing good models would prevent unnecessary medical facility closures at the national level.

State and local governments imposed social distancing measures in March and April 2020 to contain the spread of the novel coronavirus disease (COVID-19). These measures included bans on large social gatherings; school closures; closures of entertainment venues, gyms, bars, and restaurant dining areas; and shelter-in-place orders. We evaluated the impact of these measures on the growth rate of confirmed COVID-19 cases across US counties between March 1, 2020, and April 27, 2020. An event study design allowed each policy's impact on COVID-19 case growth to evolve over time. Adoption of government-imposed social distancing measures reduced the daily growth rate of confirmed COVID-19 cases by 5.4 percentage points after one to five days, 6.8 percentage points after six to ten days, 8.2 percentage points after eleven to fifteen days, and 9.1 percentage points after sixteen to twenty days. Holding the amount of voluntary social distancing constant, these results imply that there would have been ten times greater spread of COVID-19 by April 27 without shelter-in-place orders (ten million cases) and more than thirty-five times greater spread without any of the four measures (thirty-five million cases). Our article illustrates the potential danger of exponential spread in the absence of interventions, providing information relevant to strategies for restarting economic activity.

Lowering of intraocular pressure is currently the only therapeutic measure for Glaucoma management. Many longterm, randomized trials have shown the efficacy of lowering IOP, either by a percentage of baseline, or to a specified level. This has lead to the concept of 'Target\" IOP, a range of IOP on therapy, that would stabilize the Glaucoma/prevent further visual field loss, without significantly affecting a patient's quality of life. A clinical staging of Glaucoma by optic nerve head evaluation and perimetric parameters, allows a patient's eye to be categorized as having - mild, moderate or severe Glaucomatous damage. An initial attempt should be made to achieve the following IOP range for both POAG or PACG after an iridotomy. In mild glaucoma the initial target IOP range could be kept as 15-17 mmHg, for moderate glaucoma 12-15 mmHg and in the severe stage of glaucomatous damage 10-12 mmHg. Factoring in baseline IOP, age, vascular perfusion parameters, and change on perimetry or imaging during follow up, this range may be reassessed over 6 months to a year. \"Target\" IOP requires further lowering when the patient continues to progress or develops a systemic disease such as a TIA. Conversely, in the event of a very elderly or sick patient with stable nerve and visual field over time, the target IOP could be raised and medications reduced. An appropriate use of medications/laser/surgery to achieve such a \"Target\" IOP range in POAG or PACG can maintain visual fields and quality of life, preventing Glaucoma blindness.

We examine the effects of Covid-19 and related restrictions on individuals with dependent children in Germany. We specifically focus on the role of day care center and school closures, which may be regarded as a “disruptive exogenous shock” to family life. We make use of a novel representative survey of parental well-being collected in May and June 2020 in Germany, when schools and day care centers were closed but while other measures had been relaxed and new infections were low. In our descriptive analysis, we compare well-being during this period with a pre-crisis period for different groups. In a difference-in-differences design, we compare the change for individuals with children to the change for individuals without children, accounting for unrelated trends as well as potential survey mode and context effects. We find that the crisis lowered the relative well-being of individuals with children, especially for individuals with young children, for women, and for persons with lower secondary schooling qualifications. Our results suggest that public policy measures taken to contain Covid-19 can have large effects on family well-being, with implications for child development and parental labor market outcomes.

Background To analyze the poor mental status of patients with primary closed-angle glaucoma(PACG), and to explore the correlation between mental status and ocular and systemic indices in patients with PACG. Methods We collected patients' axial length (AL), anterior chamber depth (ACD), nerve fiber layer thickness (RNFL), cup-to-disc ratio (C/D), antinuclear antibody (ANA), toxoplasmosis antibody (anti-Toxoplasma gondii IgM), and anxiety and depression scores (HAMA and HAMD scales). Statistical analysis was utilized to analyze the data for each of the patients in the PACG and cataract patient groups. Results The results showed that there was a statistically significant difference between the glaucoma group and the cataract group in terms of anxiety and depression scores, AL, ACD, RNFL, C/D, ANA, and Anti-Toxo IgM ( P  < 0.05). Anxiety scores of glaucoma patients were positively correlated with AL and C/D ( P  < 0.05), negatively correlated with RNFL ( P  < 0.05), and correlation existed with ANA and Anti-Toxo IgM (Eta 2  > 0.16). Depression scores in glaucoma patients were positively correlated with C/D ( P  < 0.05), negatively correlated with AL and RNFL ( P  < 0.05), and correlated with ANA and Anti-Toxo IgM (Eta 2  > 0.16). In addition,RNFL and C/D can be considered significant predictors of anxiety status. AL and C/D can be considered significant predictors of depression status. Conclusion Patients with primary angle-closure glaucoma have higher anxiety and depression scores than the general population, and clinically we can predict the patient's mental status by their ocular and systemic indicators so that appropriate treatment can be taken in time.

Optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) have the potential application in evaluating pathological structural change of the optic nerve. We aimed to evaluate the value of the OCT and OCTA parameters of the optic disk and macular in differentiating early chronic primary angle-closure glaucoma (CPACG) and early pituitary adenoma (PA) in case of mild visual field defects (the mean defect (MD) > 6 dB). The results showed that regarding OCTA parameters, CPACG patients had lower retinal blood flow density of most layers of the optic disk and macular than PA patients. Regarding OCT parameters, CPACG patients had thinner circumpapillary retinal nerve fiber layer (CP-RNFL) in all quadrants and average CP-RNFL, ganglion cell layer (GCL) and macular ganglion cell complex (GCC) in each quadrant of macular inner and outer rings, and inner plexus layer (IPL) of macular inner ring, superior-outer ring and temporal-outer ring than PA patients. The Z test indicated that OCTA parameters and OCT parameters had similar value in the diagnosis of disease. In conclusion , in the case of similar visual field damage, early CPACG patients have smaller blood flow density and thinner optic disk and macular than early PA. OCTA has similar performance to OCT in diagnosing CPACG and PA.

PurposeTo determine the 10-year incidence of all forms of primary angle closure (PAC) in phakic eyes and its risk factors in an urban Chinese population aged 50 years and older.MethodsSurvivors of 1405 baseline participants were invited to attend the 10-year follow-up visit in the Liwan Eye Study. Participants with established baseline angle closure, including primary angle closure suspects (PACS), PAC and primary angle closure glaucoma (PACG), or those who underwent bilateral cataract surgery during the 10-year period, as well as those who did not tolerate gonioscopic examinations, were excluded from this analysis. Incident PAC was present when those with open angles at baseline developed angle closure in any form in either eye during the 10-year period.ResultsAmong 791 participants who returned during the 10-year follow-up visit, 620 (78.4%) provided data on PAC incidence. The 10-year cumulative incidence of any forms of PAC was 20.5% (127/620, 95% CI 17.4% to 24.9%), including 16.9%, 2.4% and 1.1% with incident PACS, PAC and PACG in either eye, respectively. In multiple logistic regression, significant risk factors for incident angle closure were greater baseline lens thickness (OR=1.82 per mm, p=0.003), shallower anterior chamber depth (OR=3.18 per mm decreased, p=0.010) and narrower angle width (OR=1.63 per decreased angle width, p<0.0001).ConclusionsApproximately one in five people aged 50 years and older developed some form of angle closure over a 10-year period. Small ocular dimensions and hyperopia at baseline were associated with the development of angle closure.