Dental health, as a vital component of general health, has a significant impact on the quality of life of the elderly. This study aimed to explore the preferences of the elderly toward geriatric dental services. This study used a qualitative descriptive design and was conducted among a convenience sample of elderly individuals visiting public and private dental settings in Isfahan City in 2024. Data were collected through semi-structured face-to-face interviews. Sampling continued until data saturation was achieved, and 21 participants were included in the study. Data were analyzed using thematic analysis. Pecuniary and non-pecuniary themes were the two identified general themes of elderly preferences regarding dental services. The non-pecuniary theme included three main sub-themes: characteristics of the dental services providers, characteristics of the dental center, and characteristics of the elderly patients. The pecuniary theme was also categorized into two main sub-themes: payment method and cost coverage. This study identified that high costs and inadequate insurance coverage are key pecuniary challenges, while professional skills and the physical accessibility of dental centers are critical non-pecuniary factors. Addressing both dimensions is essential for designing specialized and accessible dental service packages for the elderly.
Kenya introduced the Managed Equipment Services (MES) model in 2015 as a seven-year national contract to address significant gaps in access to hemodialysis, which had previously been available in fewer than ten public hospitals. The MES aimed to expand hemodialysis capacity by centralizing procurement, standardizing equipment, and ensuring maintenance across all 47 counties. This study provides the first national evaluation of hemodialysis performance under the MES model. We conducted a multi-year retrospective analysis of 54 public hospitals equipped through the MES, six years after implementation, using data from the MES contract, the MES final survey, NHIF reimbursement schedules, and the 2019 Population Census. Hemodialysis system performance was assessed across four domains, including capacity, utilization, reporting accuracy, and cost efficiency, using descriptive statistics, time series trends, and discrepancy analysis. A total of 54 hemodialysis centers equipped with 305 machines were established across all 47 counties, resulting in national densities of 1.14 centers and 6.41 machines per million people. Machine density varied more than 30-fold across counties. Between June 2015 and April 2021, 392,497 hemodialysis sessions were conducted, with monthly utilization increasing by 376%, from 2,100 sessions in June 2015 to 10,173 in April 2021. Time-series regression showed a significant upward trend (+75.5 sessions per month, R2 = 0.721), with significant effects of year (F = 258.42, p < 0.001) and calendar month (F = 5.00, p < 0.001), and two periods of acceleration in June 2016 and January 2020. Facility throughput ranged from 217 to 79,202 sessions, and 63% of hospitals operated at less than 50% of their machine capacity. Machine-logged session counts exceeded register-based counts by more than 30% in 79% of hospitals, with a mean absolute percentage error of 180.41%. County-level utilization ranged from 89 to 4,363 sessions per million people, a 49-fold difference. The MES program reached breakeven in month 70, with a projected return on investment of 19.76% by month 84. The MES significantly increased Kenya's public hemodialysis capacity and supported rapid nationwide growth in service use. However, disparities in geography, facilities, and documentation persisted, with many hospitals operating below capacity and inconsistent reporting. Although the program broke even financially and had a positive return on investment, facility performance varied widely. These results show that expanding infrastructure alone was not enough to achieve equity or efficient hemodialysis service delivery, highlighting the need to improve staffing, data quality, and system coordination to make the most of future renal care investments.
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Electrically evoked compound action potentials (ECAPs) represent summation of action potentials generated by neurons of the auditory nerve in response to electrical stimulation. The slope of the ECAP amplitude growth function (AGF) reflects responsiveness or survival of neurons proximal to the stimulating electrode. Goals of the present study were to characterize the magnitude of the AGF slope by electrode site and over time in a cohort of pediatric CI users and measure the degree of correlation of slopes with auditory assessment results. 23 CI users participated in the study, ranging in age from 3 to 12 years. All implanted with 31.5 mm electrode array, full insertion. ECAP AGF slopes measured with all active electrodes intra-operatively, device switch-on, 3-, 6-, 9-, and 12-months post switch-on. Auditory assessments administered at 3-, 6-, 9-, and 12-months post-implantation. Analysis performed by electrode as well as intracochlear electrode site (basal, middle, and apical). AGF slopes significantly increased according to a basal-to-apical gradient. Slopes were more than twice as large at the apical-most electrode compared to the basal-most (43.1 vs. 20.3 µV/nC). AGF slopes stimulated from basal electrodes significantly increased over time, while those stimulated from apical electrodes significantly decreased over time. No statistically significant correlations were observed between AGF slopes and the test results of any auditory assessment at any timepoint. Observations demonstrate AGF slopes vary substantially, both across the array and over time. No significant associations were observed between AGF slopes and auditory perception skills in this cohort. Due to our relatively small sample size and the heterogeneity of the data, no definitive conclusions regarding these associations can be made here.
Inhalational anaesthetics such as isoflurane and sevoflurane are widely used in veterinary medicine, but are potent greenhouse gases that contribute substantially to climate change. Low-flow anaesthetic techniques are recommended to minimise their environmental impact, yet their adoption in veterinary practice remains uncertain. This study evaluated the environmental benefits of implementing a standardised low-flow anaesthesia protocol at a veterinary teaching hospital as part of a sustainability initiative. Anaesthetic records from 120 procedures before and 120 after the intervention were analysed to compare FGF rates and volatile agent use during the maintenance phase. The intervention included staff education, email correspondence, visual aids, and a standardised low-flow protocol. Post-intervention, mean FGF decreased by 52% (from 1.27 to 0.61 L/min), corresponding to a proportional 52% reduction in greenhouse gas emissions (from 4.24 to 2.03 kg CO2e/h). This equated to a decrease in average car mileage emissions from 31.65 to 15.17 km driven per hour of anaesthesia. Survey responses from anaesthesia staff (n = 21) indicated strong support for the protocol. Targeted education and standardised protocols can meaningfully reduce inhalant use and emissions in veterinary anaesthesia. Broader adoption of similar initiatives could yield considerable environmental benefits across the veterinary profession.
This study examined correlates of fatality as of the time of contact with Emergency Medical Services (EMS) in a nationwide sample of opioid overdose EMS activations, with the aim of identifying salient points of intervention to reduce deaths. We analyzed data from the 2023 National Emergency Medical Services Information System (NEMSIS) Public Release Research Data Set for 373,153 opioid overdose EMS activations (4865 identified as fatal as of the time of EMS contact). Bivariate and multivariable logistic regression models tested potential correlates of fatality, including characteristics of the patient, setting, and emergency response. Approximately 70.8% of fatal (versus 50.7% of nonfatal) opioid overdose EMS activations occurred in a private home. Pre-EMS bystander naloxone administration was reported in 2.3% of fatal, and 3.6% of nonfatal, cases. Adjusted odds of fatality were significantly higher for EMS opioid overdose activations in older patients (Adjusted Odds Ratio [AOR] 1.23; 95% Confidence Interval [CI] 1.11-1.37 in ages 65 + relative to ages 35-44) and in rural/wilderness (AOR 1.73; 95% CI 1.55-1.94) or suburban (AOR 1.45; 95% CI 1.28-1.63) areas versus urban areas, but significantly lower when naloxone was administered by a bystander prior to EMS arrival (AOR 0.58; 95% CI 0.48-0.70). The complaint reported to dispatch, US Census Division, and EMS unit level of care were also correlates of fatality. Results support the association between pre-EMS-bystander naloxone administration and lower fatality. Results also suggest the need for interventions informed by risks associated with older age, rural settings, and drug use at home.
In-hospital mortality following hip fracture surgery remains a significant outcome in elderly patients, yet perioperative determinants - particularly those modifiable during hospitalization - are incompletely characterized. Whether the prognostic impact of acute kidney injury (AKI) on in-hospital mortality differs according to fracture type has not been previously examined. This retrospective cohort study included 342 patients aged ≥65 years who underwent surgical treatment for hip fracture at a tertiary referral center between January 2018 and January 2022. The primary outcome was in-hospital mortality. Independent predictors were identified using multivariable logistic regression. Model performance was assessed by ROC analysis, Hosmer-Lemeshow calibration testing, and bootstrap internal validation with 1000 iterations. A simple additive risk score was derived from the final model. Interaction analysis evaluated whether fracture type modified the association between AKI and mortality. In-hospital mortality occurred in 29 of 342 patients (8.5%). Independent predictors were postoperative AKI (OR 5.46, 95% CI 2.20-13.51), lower preoperative serum albumin (OR per 1 g/dL increase 0.38, 95% CI 0.18-0.78), and lower admission oxygen saturation (OR per 1% increase 0.86, 95% CI 0.77-0.95). The model demonstrated acceptable discrimination (AUC = 0.766, 95% CI 0.655-0.877). A three-variable additive risk score stratified mortality from 3.4% (score 0) to 39.1% (score 2-3). Interaction analysis revealed that fracture type significantly modified the prognostic impact of AKI (interaction p = 0.016), with a substantially stronger effect in extracapsular fractures (OR 14.3, 95% CI 4.0-50.0) than intracapsular fractures (OR 1.32, 95% CI 0.30-5.88). Postoperative AKI, hypoalbuminemia, and reduced admission oxygen saturation independently predict in-hospital mortality after hip fracture surgery. The mortality risk conferred by AKI is substantially greater in extracapsular fractures, highlighting the need for fracture-type-specific perioperative vigilance and early renal protection strategies.
An earlier study in Kampala, Uganda reported that a proportion of 0.9 children with dental caries remain untreated. A lack of comprehensive data about oral health in Uganda has been identified. However, the limited information available indicates an increasing prevalence of dental caries among adolescents. A recent survey conducted in Kampala revealed that over 75% of adolescents were affected by dental caries. There was limited data about the oral health status among children in Buhweju District of rural Southwestern Uganda. This study sought to establish the prevalence, predictors and treatment needs of dental caries among primary school children in Buhweju district. In a descriptive cross-sectional study design, 433 primary school children aged 5-17 years were enrolled from March to April 2025. Clinical oral examinations were performed in a private room at school under natural light. Every tooth visible in the mouth was examined by use of plain disposable mouth mirror and dental probe. Carious teeth and spaces (if a tooth was removed due to caries) were scored and reported as Decayed, Missing and Filled Teeth (DMFT) due to caries for permanent or Decayed and Filled teeth (dft) for primary dentition. The dental caries treatment needs were captured during clinical examination when there was decay or missing tooth. Overall, 274(63.3%) had dental caries with median DMFT of 0 (IQR=1) and median dft of 0 (IQR=2). Caries was more prevalent among females (64.7%) than males (62.1%). The prevalence of false teeth extraction among the permanent dentition was 72 (16.6%). Some 192 (44.3%) of the study participants needed Prompt treatment (including scaling, and fillings). At bivariate analysis, several variables met the inclusion criterion for multivariate analysis (p<0.25), including age 5-11 years, Bakiga ethnicity, belief that dental caries is not preventable, history of tooth removal, brushing after every meal, never eating cassava, previous dental clinic visits, and lack of oral health information through school career guidance. In the multivariate logistic regression model, two factors remained independently associated with dental caries. Children who had ever visited a dental clinic were twice as likely to have dental caries compared to those who had never visited a clinic (aOR=2.1, 95% CI: 1.2-3.4; p=0.005). Additionally, children who had never consumed cassava had 2.5 times higher odds of dental caries compared to those who consumed cassava monthly (aOR=2.5, 95% CI: 1.1-6.0; p=0.037). The study found a high prevalence of dental caries, mainly in permanent teeth, driven by limited dental health education, dietary factors, and unmet treatment needs. The study recommends strengthening school oral health programs through teacher training and three to six months oral health checkups as this ensures early detection of hygiene issues.
Haplotype networks are widely used in population genetics, phylogeography, and molecular ecology to visualize relationships among DNA sequences and summarize patterns of population connectivity. Existing tools vary in interface, algorithmic approach, input requirements, and output format. Here, I introduce HapNet, an open-source Python command-line package for constructing population-aware, minimum-spanning-tree-based haplotype graphs from aligned FASTA files. HapNet collapses identical sequences into haplotypes, calculates Hamming distances among haplotypes, constructs an MST-based graph, and generates publication-ready visualizations in which node size reflects haplotype frequency and pie-chart sectors indicate population composition. HapNet also produces machine-readable tabular outputs documenting haplotype membership, shared and private haplotypes, individual assignments, summary statistics, and run metadata. This version adds optional metadata input, phased diploid sequence support, individual-level genotype summaries, and label-free figure export. Utility is demonstrated using a published Hydroides dianthus COI dataset and a simulated phased diploid dataset.
To assess the outcomes of revision ptosis surgeries performed using a surgical technique different from the initial procedure-either Müller muscle conjunctival resection (MMCR) or external levator surgery (ELS) based on the phenylephrine-induced change in margin reflex distance-1 (MRD-1). This retrospective cohort study reviewed medical records of 780 patients who underwent MMCR or ELS for ptosis between January 2019 and December 2023. Revision surgery was required in 108 patients (15%). Among these, 32 eyes of 28 patients underwent a revision surgery using a technique different from the initial approach. Patient demographics, surgical details, and MRD-1 values at key clinical stages (pre-primary surgery, post-primary surgery, pre-revision surgery, and post-revision surgery) were recorded, along with levator function and postoperative complications. Twenty-eight patients (11 female, 17 male) were included. ELS was performed as the initial procedure in 13 eyes, and MMCR in 19 eyes. Surgical method for revision was determined based on the pre-revision phenylephrine response. Patients who initially underwent MMCR were classified as Group 1; those with initial ELS as Group 2. The mean interval between surgeries was 33.3 ± 38.2 months, and the mean follow-up duration was 42.5 ± 22.9 months. No significant difference in levator function or baseline MRD-1 values was observed between groups. A significant improvement in MRD-1 was noted after both primary and revision surgeries in each group. Eyelid symmetry was achieved in all patients. Satisfactory functional and cosmetic outcomes can be obtained in revision ptosis surgery using an alternative technique to the primary approach. Preoperative phenylephrine testing and comprehensive patient evaluation are critical for surgical planning.
Lumbar pseudarthrosis revision is challenging for both patients and surgeons, with no standard approach. This study aimed to evaluate radiographic fusion and index-level re-revision rates after revision using lateral lumbar interbody fusion (LLIF), comparing standalone LLIF (SA-LLIF) and circumferential LLIF with posterior revision (360°-LLIF). Secondary outcomes included perioperative parameters and sagittal alignment. This retrospective, single-center cohort study included patients undergoing LLIF for lumbar pseudarthrosis between 2007 and 2023 with ≥ 1-year follow-up. Patients were stratified into SA-LLIF and 360°-LLIF groups. Fusion was assessed at one year using the Bridwell grading system (grades I-II considered fused). Perioperative parameters, re-revision, and sagittal alignment were evaluated. Thirty-eight patients were included (SA-group: n = 26; 360°-group: n = 12). Groups were comparable except for a higher BMI in the 360°-group (p = 0.035). Overall fusion was 84.2%, with rates of 80.8% in SA-LLIF and 91.7% in 360°-LLIF (p = 0.392). No patient required re-revision for non-union; one 360° patient underwent wound revision. Operative time (233 vs. 84 min, p = 0.005), and estimated blood loss (625 vs. 100 mL, p = 0.001) were higher in the 360°-group. Length of stay and sagittal alignment parameters were similar between groups. Both 360°-LLIF and SA-LLIF may represent viable revision strategies for pseudarthrosis after posterior instrumentation, each with distinct advantages. Fusion rates were numerically higher with 360°-LLIF but not statistically different, and no patient in either group required secondary revision surgery for non-union. SA-LLIF was associated with shorter operative times and reduced EBL. Findings should be interpreted cautiously given the small sample size.
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Pathological narcissism (PN) and narcissistic personality disorder (NPD) are common yet highly stigmatized conditions for which no empirically validated treatment currently exists, despite growing evidence of the central role of psychoeducation. The goal of this study was to evaluate the feasibility and acceptability of our recently published group psychoeducation program for patients with PN, with or without a diagnosis of NPD. Twenty-five adult patients, who met ≥3 NPD criteria or presented with mean grandiosity and vulnerability scores ≥3 on the Pathological Narcissism Inventory-Brief Form and who were participating in our psychoeducation program, were recruited from a psychiatric outpatient center. Feasibility outcomes included attendance, completion, drop-out rates, as well as safety measures (between-session changes in state narcissism and hospitalization rates). Acceptability was assessed using a mixed-methods satisfaction questionnaire and by comparing pre- and post-group levels of trait narcissism using the Pathological Narcissism Inventory-Brief Form. Overall, attendance and completion rates were high (83% mean attendance with only 1 dropout). There were no between-session narcissistic activations and only 1 hospitalization unrelated to the group program; however, participants did report substantial emotional activation and a need for concomitant individual support. They also reported high levels of satisfaction and perceived usefulness. Exploratory pre-post changes suggested a decrease in self-reported grandiosity but not vulnerability, even though no causal conclusions could be drawn due to the uncontrolled design of the study. A major limitation of the study was the high rate of comorbidity with borderline personality disorder (92%), which limits the generalizability to all narcissistic patients. Overall, these findings support the feasibility and acceptability of a brief group psychoeducation program for PN.
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This study examined the associations among social rejection, self-compassion, and self-esteem among university students in Pakistan. Drawing on Sociometer Theory as a general conceptual framework, the study explored whether self-compassion was indirectly associated with the link between perceived social rejection and self-esteem. A cross-sectional design was employed with a convenience sample of 301 students recruited from public and private universities in Pakistan. Participants completed the Social Rejection Scale, the Short Form of the Self-Compassion Scale (SCS-SF), and the Rosenberg Self-Esteem Scale (RSES). Data were analyzed using Pearson correlation, hierarchical regression, and bootstrapped mediation analyses. Social rejection was negatively associated with both self-compassion and self-esteem, whereas self-compassion was positively associated with self-esteem. The indirect association between social rejection and self-esteem through self-compassion was statistically significant and consistent with a pattern of partial mediation. However, given the cross-sectional design, the findings should be interpreted as patterns of association rather than evidence of causal relationships. The magnitude of the indirect association was modest, suggesting that additional psychological processes may also be relevant to understanding how individuals respond to experiences of social rejection. Although the study was conducted among Pakistani university students, cultural variables were not directly measured. Consequently, cultural interpretations should be understood as contextual considerations rather than as evidence of culturally specific mechanisms. Overall, the findings suggest that social rejection, self-compassion, and self-esteem are related in ways that are broadly consistent with existing theoretical perspectives and prior empirical research. Future studies employing longitudinal, multi-method, and culturally informed approaches may help clarify the direction and nature of these associations.
Rising out-of-pocket (OOP) health expenditures in the Eastern Caribbean Currency Union (ECCU) underscore persistent gaps in health insurance coverage. This paper develops a Health Insurance Policy Simulation Model (HIPSM) to assess the potential impact of employer health insurance mandates and health insurance tax credits (HITCs) across five small island developing states (SIDS): Antigua and Barbuda, Dominica, Grenada, St. Lucia, and St. Vincent and the Grenadines (SVG). Using social security and insurance data, the model estimates coverage gains, fiscal costs, and labour market effects under varying thresholds and tax credit levels. Results show that employer mandates and HITCs can reduce coverage gaps and OOP expenditure in these countries but are highly sensitive to design characteristics. The findings offer important guidance for SIDS exploring scalable pathways towards universal health coverage through private insurance mechanisms, particularly in the absence of comprehensive public healthcare financing systems.
Obesity is a chronic and multifactorial disease associated with systemic changes and pulmonary impairment. Roux-en-Y gastric bypass (RYGB) is effective in treating severe obesity and has been associated with improvements in pulmonary function; however, evidence comparing the effects of laparoscopic (L) and robotic-assisted (RA) RYGB on respiratory outcomes remains limited. To compare the effects of L- and RA- RYGB on lung function, respiratory muscle strength and physical activity level, at baseline and six months postoperatively. Prospective, non-randomized study conducted at a private bariatric surgery center in Brazil, including patients of both sexes, aged 18-65 years with body mass index (BMI) 40.0-49.9 kg/m² undergoing Roux-en-Y gastric bypass. Patients with a history of smoking or pre-existing pulmonary disease were excluded. Patients were divided into L- and RA- groups and evaluated at baseline and six months after surgery with spirometry (forced vital capacity [FVC], forced expiratory volume in one second [FEV₁], and FEV₁/FVC ratio), manovacuometry (maximal inspiratory pressure [MIP] and maximal expiratory pressure [MEP]), and physical activity level (International Physical Activity Questionnaire-Short Form [IPAQ-SF]), following ATS/ERS standards. Statistical analyses included chi-square, Fisher's exact, Student's t, Mann-Whitney U, and mixed-effects models (p < 0.05). A total of 98 patients were included (49 L-, 49 RA-), with 84 completing the six-month follow-up. Among those who completed follow-up, most participants were women (75.0%), with a mean age of 37.3 years. Significant improvements in pulmonary function were observed over time following surgery. Although a reduction in maximal expiratory pressure was observed in the laparoscopic group in within-group analyses, mixed-effects models showed no significant differences between surgical approaches regarding respiratory muscle strength, pulmonary function, physical activity level, or longitudinal changes over time. Laparoscopic and robotic-assisted Roux-en-Y gastric bypass were associated with improved pulmonary function six months after surgery, with no significant differences between surgical approaches in respiratory outcomes or physical activity level.
The uterotrophic bioassay is a recognized tool for assessing estrogenic activities of chemicals, relying on estrogen-induced uterine growth. This study employed the assay in immature female rats using ethinyl estradiol (EE) to explore temporal gene expression dynamics in the uterus and pituitary gland, both estrogen-responsive organs. Gene expression changes were evident as early as 2 h post-EE administration in the uterus, with early responses indicating increased proliferation, macromolecule synthesis, and immune responses-notably through WNT/β-catenin signaling and cholesterol biosynthesis. Estrogen's influence on inflammation was observed, with macrophage polarization shifting from anti-inflammatory M2 to pro-inflammatory M1 types over time. In the pituitary gland, early gene upregulation suggested proliferative and metabolic responses to estrogen. The findings enhance understanding of estrogen's effects on uterine and pituitary function during the uterotrophic assay, offering avenues for assay optimization, improved in vitro models, and refined adverse outcome pathways (AOPs).
Orthognathic surgery is widely performed to correct skeletal Class III deformities and improve both function and aesthetic balance. However, surgical repositioning of the maxillomandibular complex can alter upper airway structure by affecting the spatial relationships among the mandible, tongue, and hyoid bone. This study aims to evaluate three-dimensional changes in the airway after bimaxillary orthognathic surgery in patients with skeletal Class III deformities and to analyze their association with cephalometric parameters and hyoid bone position. Forty-nine patients with skeletal Class III deformities who underwent bimaxillary orthognathic surgery were retrospectively evaluated. Pre- and postoperative computed tomography scans obtained after a minimum of six months of follow-up were analyzed. Three-dimensional airway models were generated to measure nasopharyngeal, oropharyngeal, and total airway volumes, as well as the minimum cross-sectional area (MCA). Linear and angular cephalometric analyses were performed to assess maxillary and mandibular movements. Hyoid bone displacement was assessed relative to the third cervical vertebra (C3) and the mandibular base. Significant reductions were observed in total and oropharyngeal airway volumes postoperatively, whereas nasopharyngeal volume decreased non-significantly. Despite these volumetric changes, the MCA remained stable. Airway volume changes were significantly correlated with mandibular displacement and hyoid-C3 distance. Nasopharyngeal airway volume was positively correlated with the maxillary occlusal plane angle. Bimaxillary orthognathic surgery in patients with skeletal Class III deformities induces measurable three-dimensional airway alterations, predominantly in the oropharyngeal region. It also influences airway morphology, emphasizing the importance of considering airway changes during surgical planning.
Describe visual outcomes, rotational stability, and patient experience with a new, trifocal, toric intraocular lens (IOL), CNWTTx (Alcon, Fort Worth, TX.). Prospective, cohort study in a private practice in Salt Lake City, UT. Patients 45 years and older with visually significant cataracts, bilateral regular corneal astigmatism requiring a T3-T6 IOL power lens, no other significant eye disease undergoing sequential cataract surgery with Clareon PanOptix Toric IOL (CNWTTx) followed for 3 months postoperatively. Primary endpoints: monocular corrected distance visual acuity (CDVA), distance-corrected intermediate visual acuity (DCIVA), and distance-corrected near visual acuity (DCNVA). Secondary endpoints: rotational position of the IOL and a patient satisfaction survey. Twenty-five patients were recruited into the study and 22 received bilateral Clareon PanOptix Toric IOLs. At 3-month postoperative visit, visions were monocular mean CDVA of LogMAR (LM) 0.004, mean DCIVA of LM 0.110, and mean DCNVA of LM 0.056. 89% of patients had 0.5 diopters or less of residual astigmatism. Mean lens rotation was 1.67° at 1 month, and no lenses had rotated more than 5°. The majority of patients "never" used glasses at near (88%), at arm's length (100%) and at a distance (92%). In spite of 25% of patients noting photopic phenomena either "most of the time" or "always," a majority (88%) of patients were either "satisfied" or "very satisfied" with their vision, and 92% would have the same lens implanted again. The CNWTTx lens results in excellent visual acuities at distance, intermediate, and near, leading to high rates of spectacle independence. The lens is rotationally stable, and patients are subjectively satisfied with their visual outcomes.