Editorial stance on duplicate and salami publication

In this edition of the British Orthoptic Journal the notice to contributors has been amended. The sentence ‘Papers are considered for publication on the understanding that they are not being submitted elsewhere at the same time’ has been extended to address the problem of duplicate publication and now appears under ‘Terms of submission’

Orthoptic status before and immediately after heroin detoxification

Aim: To determine whether changes in orthoptic status take place during withdrawal from heroin and/or methadone. Method: A prospective study of patients, using a repeated measures design, attending a 5 day naltrexone compressed opiate detoxification programme. Results: 83 patients were seen before detoxification (mean age 27.1 (SD 4.6) years) and 69 after detoxification. The horizontal angle of deviation became less exo/more eso at distance (p<0.001) but no significant change was found at near (p = 0.069). Stereoacuity, visual acuity, and convergence were found to be reduced in the immediate post-detoxification period. Prism fusion range, refractive error, subjective accommodation, and objective accommodation at 33 cm did not reduce but a small decrease was found in objective accommodation at 20 cm. Conclusions: The eso trend found in these patients may be responsible for the development of acute concomitant esotropia in some patients undergoing heroin detoxification. However, the mechanism for this trend does not appear to be caused by divergence insufficiency or sixth nerve palsy

Ocular sequelae from the illicit use of class A drugs

Aim: To highlight the changes that may take place in the visual system of the class A drug abuser. Methods: A literature review was carried out of ocular/visual sequelae of the more common class A drugs. These include stimulants (cocaine and crack cocaine), narcotics (heroin, morphine, methadone) and hallucinogenics (ecstasy, lysergic acid diethylamide, magic mushrooms, mescaline, phencyclidine). Results: Ocular sequelae affecting visual acuity, the eye and its adnexa, ocular posture and ocular motility can result from recreational use of these drug(s). Conclusions: Awareness of the consequences of illicit drug use should lead to more pertinent questioning during history-taking

Heroin and diplopia

Aims: To describe the eye misalignments that occur during heroin use and heroin detoxification and to give an overview of the management of persisting diplopia (double vision) which results from eye misalignment. Methods: A literature review using Medline and the search terms strabismus, heroin and substance withdrawal syndrome is presented. General management of cases presenting to the ophthalmologist and orthoptist with acute acquired concomitant esotropia is described. Findings: A tendency towards a divergence of the visual axes appears to be present in heroin users, although when present it may not always lead to diplopia. Following detoxification intermittent esotropia or constant esotropia (convergence of the visual axes) can occur; if intermittent the angle tends to be small and diplopia present when viewing distance objects. Occlusion of one eye to eliminate the second image could encourage the development of a constant deviation. The deviation is not caused by a cranial nerve palsy. Constant deviations of this type are classified as 'acute acquired concomitant esotropia'. Relief from the diplopia may be gained by prismatic correction, and the deviation may then resolve spontaneously. Botulinum toxin or surgical intervention may be necessary in cases that do not resolve. Conclusions: Heroin use may lead to intermittent or constant exotropia and withdrawal may result in intermittent or constant esotropia. Awareness of the mechanism causing this may avoid referral to other specialties (e.g. neurology) and awareness of treatment modalities could encourage patients to seek appropriate help for relief of symptoms

The global dimension of water governance: Nine reasons for global arrangements in order to cope with local water problems

Where water problems extend beyond the borders of local communities, the catchment area or river basin is generally seen as the most appropriate unit for analysis, planning and institutional arrangements. In this paper it\ud is argued that addressing water problems at the river basin level is not always sufficient. It is shown that a substantial part of today’s water issues carries a (sub)continental or even global dimension, which urges for a governance approach that comprises coordination and institutional arrangements at a level above that of the river basin. This paper distinguishes and reviews nine developments that support this argument: • Local issues of water scarcity and flooding will be enhanced or weakened by human-induced global climate\ud change.\ud • Local problems of water pollution are often intrinsic to the structure of the global economy.\ud • There is a growing presence of multinationals in the drinking water sector.\ud • Several national governments are developing plans for large-scale inter-basin water transfers.\ud • An increasing number of water-short countries seek to preserve their domestic water resources through the\ud import of water in virtual form.\ud • Global trade in water-intensive commodities offers the opportunity of global water saving if this trade is\ud from countries with high to countries with low water productivity.\ud • The water footprints of individual people are increasingly externalised to other parts of the world, so that\ud many local water problems are strongly related to consumption elsewhere.\ud • Some people around the world have comparatively high water footprints, which raises the question of\ud whether this is fair and sustainable.\ud • Due to its increasing scarcity and uneven distribution across the globe, water is gradually becoming a geopolitical resource, influencing the power of nations.\ud The described developments raise the question of what kind of institutional arrangements could be developed to cope with the global dimension of water issues. A few possible directions are identified in an explorative analysis: an international protocol on full-cost water pricing, a water label for water-intensive products, a disposal tax on goods that will cause water pollution in their waste stage (to be used for pollution prevention and\ud control), international nutrient housekeeping, minimum water rights, maximum allowable water footprints, and tradable water footprint permits

Sixty yet still active!

The British Orthoptic Society published the first British Orthoptic Journal in 1939, the second appeared in 1944 then, with the exception of 1946, annually. In the first copy of the British Orthoptic Journal the editorial outlines the events leading up to the formation of the British Orthoptic Society, and this and the subsequent history of the Society is described in the 1987 editorial, the year of the Society’s Golden Jubilee. In the president’s letter published in that first edition, Mary Maddox wrote: ‘This journal will afford a method of recording the progress of orthoptics.

Heroin withdrawal as a possible cause of acute concomitant esotropia in adults

Aim: To report the possible effects of heroin withdrawal on binocular vision. Methods: To present a case series of patients in whom esotropia developed on cessation of heroin use. Results: In each case the esotropia was concomitant and prismatic correction restored binocular single vision. Intermittent spontaneous control occurred in one patient, the deviation resolved in one and one patient was lost to follow-up. Conclusions: Heroin withdrawal should be considered as a cause of acute concomitant esotropia. However, accurate history of other medication is needed to ensure that this is not the cause of decompensation

Class A drug abuse: an ophthalmologist's problem?

[First Paragraph] The 2002/3 British Crime Survey reported that 3% of all 16 to 59 year olds (equating to around one million people) had used a class A drug in the last year. Use of a class A drug in the 16-24 year old age group (8%) has remained similar since 1996. Use of cocaine and crack cocaine are on the increase. For the first time since 1996 the use of ecstasy has decreased. Poly drug use is not uncommon. During the year 2000/1, 118,500 patients were in treatment with drug misuse agencies and general practitioners. Ocular sequelae from illicit drug use are varied, affecting visual acuity, visual perception, ocular posture or motility, the globe itself or its adnexa. Large studies are not available to allow us to quantify the problem, and many of the reports are of single cases or small case series. However, an awareness of possible problems which may arise from the use of class A drugs may alert the clinician to this as the aetiology of a condition presenting to them

A relationship between rational and multi-soliton solutions of the BKP hierarchy

We consider a special class of solutions of the BKP hierarchy which we call $\tau$-functions of hypergeometric type. These are series in Schur $Q$-functions over partitions, with coefficients parameterised by a function of one variable $\xi$, where the quantities $\xi(k)$, $k\in\mathbb{Z^+}$, are integrals of motion of the BKP hierarchy. We show that this solution is, at the same time, a infinite soliton solution of a dual BKP hierarchy, where the variables $\xi(k)$ are now related to BKP higher times. In particular, rational solutions of the BKP hierarchy are related to (finite) multi-soliton solution of the dual BKP hierarchy. The momenta of the solitons are given by the parts of partitions in the Schur $Q$-function expansion of the $\tau$-function of hypergeometric type. We also show that the KdV and the NLS soliton $\tau$-functions coinside the BKP $\tau$-functions of hypergeometric type, evaluated at special point of BKP higher time; the variables $\xi$ (which are BKP integrals of motions) being related to KdV and NLS higher times

Bible Theory or Biblical Living: What are Christian Schools Providing for Families With Children With Special Needs?

Private Christian elementary and secondary schools, along with Bible training and Bible exercises, have been a part of the United States and international community since the 1800s. This article examines these questions: (1) What Biblically-based principles are in evidence in Christian schools’ treatment of children with special needs; and (2) how do Christian schools work with the parents of these children. Results from the Christian schools that participated in this study indicate although that they were attending to their children with special needs, these schools may actually be missing many more students who are in need of services