Web-based system for outcome analysis and modification in laser vision correction

Refractive laser eye surgery is a specialised field in ophthalmology which aims to correct the refractive disorder of an eye. The most established technique is LASIK, which has shown good results for the treatment of simple myopia. Complex refractive disorders, such as compound myopic astigmatism, have shown less predictable refractive outcomes, and in some cases the severe over- or under-correction can even worsen the preoperative situation and damage the eye. In its first stage, this research aimed to develop a software system able to present and analyse refractive outcomes. Over 2 prototype stages, this research has led to an operational system named IBRA (Internet Based Refractive Analysis), offering web-based data collection and refractive and vector analysis. In a second stage, Nomogram calculation formulas were developed and integrated into IBRA. These formulas were created from linear regression and best-fit analyses of spherical and cylindrical outcome data stored in IBRA. The purpose of the nomogram calculations was to provide surgeons with adjustment factors that could be used to improve the refractive outcome of patients with complex refractive disorders. Two extensive clinical audits and a randomized controlled trial were performed at Moorfields Eye Hospital to evaluate the IBRA nomogram adjustments. This research showed that IBRA was able to achieve a positive health change. In addition, results from the audits and trial contributed to the knowledge of nomogram adjustments and provided a framework in which future investigations on nomogram and treatment modifications could be performed. In addition to the above clinical studies, two evaluations were performed with the use of IBRA and data logging techniques to investigate users‟ behaviour relating to the management of data entry processes and the use of analysis functions. This research revealed the best method for entering refractive data, and was able to identify the most important analysis methods. Finally, the use of IBRA and its user-interface were investigated with a user satisfaction survey. The results from this questionnaire based study showed a high acceptance of the web-based platform of IBRA and indicated points for improvement (Documentation)

ADRENERGIC RECEPTORS IN CORONARY ARTERIES *

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72463/1/j.1749-6632.1967.tb41248.x.pd

Ventricular septal defect associated with aneurysm of the membranous septum

The most common variety of ventricular septal defect, a perimembranous defect, is frequently associated with a so-called aneurysm of the membranous septum. Previous studies have suggested that ventricular septal defects associated with an aneurysm of the membranous septum tend to spontaneously decrease in size or close more than defects without such an aneurysm. To better define the natural history of this entity, clinical and catheterization data from 87 patients with ventricular septal defect and aneurysm of the membranous septum were reviewed. The initial evaluation was made at a median age of 0.3 years (range 0.1 to 11), with the final evaluation at a median age of 10 years (range 1.5 to 20) and a median duration of follow-up of 8.6 years (range 1.2 to 18.8).Approximately 75% of the ventricular septal defects had a small or no left to right shunt at last evaluation. Overall, 48 patients (55%) had no significant change in the size of the defect, and 39 (45%) showed improvement during the period of observation. Only four patients (5%) had spontaneous closure of the defect. Of the 49 patients who presented with a large left to right shunt, with or without congestive heart failure, 23 (47%) had persistence of a shunt large enough to warrant surgery. When spontaneous improvement occurred, it did so by 6 years of age in all but one patient. Therefore, a continued tendency for a ventricular septal defect associated with an aneurysm of the membranous septum to spontaneously decrease in size or close after this age may be less likely than previously suggested. The actual morphologic substrate of this entity usually consists of tricuspid valve tissue adherent to the edges of the ventricular septal defect

Monte Carlo simulation of expected outcomes with the AcrySof® toric intraocular lens

<p>Abstract</p> <p>Background</p> <p>To use a Monte Carlo simulation to predict postoperative results with the AcrySof^®Toric lens, evaluating the likelihood of over- or under-correction using various toric lens selection criteria.</p> <p>Methods</p> <p>Keratometric data were obtained from a large patient population with preoperative corneal astigmatism <= 2.50D (2,000 eyes). The probability distributions for toric marking accuracy, surgically induced astigmatism and lens rotation were estimated using available data. Anticipated residual astigmatism was calculated using a Monte Carlo simulation under two different lens selection scenarios.</p> <p>Results</p> <p>This simulation demonstrated that random errors in alignment, surgically induced astigmatism and lens rotation slightly reduced the overall effect of the toric lens. Residual astigmatism was statistically significantly higher under the simulation of surgery relative to an exact calculation (p < 0.05). The simulation also demonstrated that more aggressive lens selection criteria could produce clinically significant reductions in residual astigmatism in a high percentage of patients.</p> <p>Conclusion</p> <p>Monte Carlo simulation suggests that surgical variability and lens orientation/rotation variability may combine to produce small reductions in the correction achieved with the AcrySof^®Toric^®IOL. Adopting more aggressive lens selection criteria may yield significantly lower residual astigmatism values for many patients, with negligible overcorrections. Surgeons are encouraged to evaluate their AcrySof^®Toric^®outcomes to determine if they should modify their individual lens selection criteria, or their default surgically induced astigmatism value, to benefit their patients.</p

Assessing Host-Virus Codivergence for Close Relatives of Merkel Cell Polyomavirus Infecting African Great Apes

It has long been hypothesized that polyomaviruses (PyV; family Polyomaviridae) codiverged with their animal hosts. In contrast, recent analyses suggested that codivergence may only marginally influence the evolution of PyV. We reassess this question by focusing on a single lineage of PyV infecting hominine hosts, the Merkel cell polyomavirus (MCPyV) lineage. By characterizing the genetic diversity of these viruses in seven African great ape taxa, we show that they exhibit very strong host specificity. Reconciliation analyses identify more codivergence than noncodivergence events. In addition, we find that a number of host and PyV divergence events are synchronous. Collectively, our results support codivergence as the dominant process at play during the evolution of the MCPyV lineage. More generally, our results add to the growing body of evidence suggesting an ancient and stable association of PyV and their animal hosts

Neural Correlates of Threat Perception: Neural Equivalence of Conspecific and Heterospecific Mobbing Calls Is Learned

Songbird auditory areas (i.e., CMM and NCM) are preferentially activated to playback of conspecific vocalizations relative to heterospecific and arbitrary noise [1]–[2]. Here, we asked if the neural response to auditory stimulation is not simply preferential for conspecific vocalizations but also for the information conveyed by the vocalization. Black-capped chickadees use their chick-a-dee mobbing call to recruit conspecifics and other avian species to mob perched predators [3]. Mobbing calls produced in response to smaller, higher-threat predators contain more “D” notes compared to those produced in response to larger, lower-threat predators and thus convey the degree of threat of predators [4]. We specifically asked whether the neural response varies with the degree of threat conveyed by the mobbing calls of chickadees and whether the neural response is the same for actual predator calls that correspond to the degree of threat of the chickadee mobbing calls. Our results demonstrate that, as degree of threat increases in conspecific chickadee mobbing calls, there is a corresponding increase in immediate early gene (IEG) expression in telencephalic auditory areas. We also demonstrate that as the degree of threat increases for the heterospecific predator, there is a corresponding increase in IEG expression in the auditory areas. Furthermore, there was no significant difference in the amount IEG expression between conspecific mobbing calls or heterospecific predator calls that were the same degree of threat. In a second experiment, using hand-reared chickadees without predator experience, we found more IEG expression in response to mobbing calls than corresponding predator calls, indicating that degree of threat is learned. Our results demonstrate that degree of threat corresponds to neural activity in the auditory areas and that threat can be conveyed by different species signals and that these signals must be learned

A chemically modified antibody mediates complete eradication of tumours by selective disruption of tumour blood vessels

These results reinforce the concept that vascular shutdown can induce a curative avalanche of tumour cell death. Immuno-photodynamic therapy may be particularly indicated for squamous cell carcinoma of the skin, which we show to be strongly positive for markers of angiogenesis

Down from the treetops: Red langur (Presbytis rubicunda) terrestrial behaviour

Using direct observations and camera traps at eight sites across Indonesian Borneo we show how red langurs (Presbytis rubicunda) are more terrestrial than previously believed, regularly coming to the ground. This unusual behavior has been found at six of the eight sites surveyed. We find that red langurs come to the ground more frequently in disturbed forests, specifically ones which have been impacted by logging, fire, and hunting, though more data are needed to confirm this as a direct correlation. We also found a trend towards decreased ground use with increased elevation of the habitat. When on the ground, red langurs are predominantly engaged in feeding (50% direct observations, 61% camera traps) and traveling (29% direct observations, 13% camera traps). Red langurs are found on the ground throughout the day, at similar times to activity periods of the apex predator, the Sunda clouded leopard (Neofelis diardi). We suggest that ground use by red langurs could be an adaptation to disturbed forest to exploit additional food sources and to facilitate travel