Assessment of adherence to visual correction and occlusion therapy in the Infant Aphakia Treatment Study

AbstractOcclusion therapy throughout early childhood is believed to be efficacious in treating deprivation amblyopia but has not been rigorously assessed in clinical trials. Further, tools to assess adherence to such therapy over an extended period of time are lacking. Using data from the Infant Aphakia Treatment Study, a randomized clinical trial of treatment for unilateral congenital cataract, we examined the use of quarterly 48-h recall interviews and annual 7-day prospective diaries to assess reported hours of patching in 114 children throughout the first 5 years of life. Consistency of data reported was assessed using correlation coefficients and intraclass correlation coefficients. Both interview and diary data showed excellent consistency with Cronbach’s Alpha’s ranging from 0.69 to 0.88 for hours of patching and 0.60 to 0.73 for hours of sleep. However, caregivers reported somewhat more adherence in prospective diaries than retrospective interviews. Completion rates, on the other hand, were substantially higher for telephone interviews than prospective diaries. For example, four years after surgery response rates to telephone interviews exceeded 75% versus completion rates of only 54% for diaries. In situations where occlusion dose monitors cannot be used for assessing adherence to occlusion therapy, such as in infants or over an extended period of time, quantitative assessments of occlusion therapy can be obtained by parental report, either as a series of prospective diaries or a series of recall interviews

Redescription of\u3ci\u3e Eimeria escomeli\u3c/i\u3e (Rastegaieff, 1930) from \u3ci\u3eMyrmecophaga tridactyla,\u3c/i\u3e and a First Report from Bolivia

Eimeria escomeli (Rastegaieff, 1930) Levine and Becker, 1933, is redescribed from the giant anteater, Myrmecophaga tridactyla (L.), from the departamento de La Paz, Bolivia. This is the first report of parasites from M. tridactyla from Bolivia and only the third time that coccidians have been recorded from this host

Risk Factors for Strabismus Surgery after Pediatric Cataract Surgery in the United States

Purpose: To determine the cumulative incidence of strabismus surgery after pediatric cataract surgery and identify the associated risk factors. Design: US population-based insurance claims retrospective cohort study. Participants: Patients ≤ 18 years old who underwent cataract surgery in 2 large databases: Optum Clinformatics Data Mart (2003e2021) and IBM MarketScan (2007e2016). Methods: Individuals with at least 6 months of prior enrollment were included, and those with a history of strabismus surgery were excluded. The primary outcome was strabismus surgery within 5 years of cataract surgery. The risk factors investigated included age, sex, persistent fetal vasculature (PFV), intraocular lens (IOL) placement, nystagmus and strabismus diagnoses before cataract surgery, and cataract surgery laterality. Main Outcome Measures: KaplaneMeier estimated cumulative incidence of strabismus surgery 5 years after cataract surgery and hazard ratios (HRs) with 95% confidence intervals (CIs) from multivariable Cox pro- portional hazards regression models. Results: Strabismus surgery was performed on 271/5822 children included in this study. The cumulative incidence of strabismus surgery within 5 years after cataract surgery was 9.6% (95% CI, 8.3%e10.9%). Children who underwent strabismus surgery were more likely to be of younger age at the time of cataract surgery, of female sex, have a history of PFV or nystagmus, have a pre-existing strabismus diagnosis, and less likely to have an IOL placed (all P \u3c 0.001). Factors associated with strabismus surgery in the multivariable analysis included age 1 to 4 years (HR, 0.50; 95% CI, 0.36e0.69; P \u3c 0.001) and age \u3e 5 years (HR, 0.13; 95% CI, 0.09e0.18; P \u3c 0.001) compared with age \u3c 1 year at time of cataract surgery, male sex (HR, 0.75; 95% CI, 0.59e0.95; P \u3c 0.001), IOL placement (HR, 0.71; 95% CI, 0.54e0.94; P ¼ 0.016), and strabismus diagnosis before cataract surgery (HR, 4.13; 95% CI, 3.17e5.38; P \u3c 0.001). Among patients with strabismus diagnosis before cataract surgery, younger age at cataract surgery was the only factor associated with increased risk of strabismus surgery. Conclusions: Approximately 10% of patients will undergo strabismus surgery within 5 years after pediatric cataract surgery. Children of younger age, female sex, and with a pre-existing strabismus diagnosis undergoing cataract surgery without IOL placement are at greater risk. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article

During postnatal development endogenous neurosteroids influence GABA-ergic neurotransmission of mouse cortical neurons

AbstractAs neuronal development progresses, GABAergic synaptic transmission undergoes a defined program of reconfiguration. For example, GABAA receptor (GABAAR)-mediated synaptic currents, (miniature inhibitory postsynaptic currents; mIPSCs), which initially exhibit a relatively slow decay phase, become progressively reduced in duration, thereby supporting the temporal resolution required for mature network activity. Here we report that during postnatal development of cortical layer 2/3 pyramidal neurons, GABAAR-mediated phasic inhibition is influenced by a resident neurosteroid tone, which wanes in the second postnatal week, resulting in the brief phasic events characteristic of mature neuronal signalling. Treatment of cortical slices with the immediate precursor of 5α-pregnan-3α-ol-20-one (5α3α), the GABAAR-inactive 5α-dihydroprogesterone, (5α-DHP), greatly prolonged the mIPSCs of P20 pyramidal neurons, demonstrating these more mature neurons retain the capacity to synthesize GABAAR-active neurosteroids, but now lack the endogenous steroid substrate. Previously, such developmental plasticity of phasic inhibition was ascribed to the expression of synaptic GABAARs incorporating the α1 subunit. However, the duration of mIPSCs recorded from L2/3 cortical neurons derived from α1 subunit deleted mice, were similarly under the developmental influence of a neurosteroid tone. In addition to principal cells, synaptic GABAARs of L2/3 interneurons were modulated by native neurosteroids in a development-dependent manner. In summary, local neurosteroids influence synaptic transmission during a crucial period of cortical neurodevelopment, findings which may be of importance for establishing normal network connectivity

Changing times in England: the influence on geography teachers’ professional practice

School geography in England has been characterised as a pendulum swinging between policies that emphasise curriculum and pedagogy alternately. In this paper, I illustrate the influence of these shifts on geography teacher's professional practice, by drawing on three “moments” from my experience as a student, teacher and teacher educator. Barnett's description of teacher professionalism as a continuous project of “being” illuminates how geography teachers can adapt to competing influences. It reflects teacher professionalism as an unfinished project, which is responsive, but not beholden, to shifting trends, and is informed by how teachers frame and enact policies. I argue that recognising these contextual factors is key to supporting geography teachers in “being” geography education professionals. As education becomes increasingly competitive on a global scale, individual governments are looking internationally for “solutions” to improve educational rankings. In this climate, the future of geography education will rest on how teachers react locally to international trends. Geography teacher educators can support this process by continuing to inform the field through meaningful geography education research, in particular in making the contextual factors of their research explicit. This can be supported through continued successful international collaboration in geography education research

Acuity and Contrast Sensitivity in Monkeys After Neonatal Intraocular Lens Implantation With and Without Parttime Occlusion of the Fellow Eye

Purpose. The authors used a monkey model to evaluate intraocular lenses (IOLs) for the treatment of infantile cataract in humans. Specifically, they sought to assess the effectiveness of IOLs, with and without occlusion therapy, in preventing amblyopia. Methods. A diffuser contact lens was placed on one eye each of 11 neonatal monkeys to simulate an infantile cataract. A unilateral lensectomy, combined with the implantation of an IOL, was performed on the same eye 1 to 2 weeks after birth. Clear contact lenses were used to adjust the optical correction of the pseudophakic eyes to a near point, and opaque lenses were used to maintain daily parttime (70%) occlusion of the fellow eyes of half the subjects. Behavioral methods were used to assess grating acuity, optotype acuity (Landolt C), and contrast sensitivity. Results. In five of the animals, complications that developed in the eye with the implant were severe enough to interfere with visual function. The authors present only behavioral outcomes obtained before or in the absence of surgical complications. In monkeys that underwent daily 70% occlusion, grating acuity in the pseudophakic eyes eventually matured to normal adult levels. Grating acuity was significantly poorer in animals with no occlusion therapy. Even in animals with normal grating acuity, assessments of optotype acuity revealed amblyopic deficits; contrast sensitivity was impaired as well at middle and low spatial frequencies. Conclusions. The current study demonstrates that if there are no complications secondary to surgery, normal grating acuity can be obtained in neonatal monkey eyes that undergo IOL implantation, optical correction of the pseudophakic eye to a near point, and 70% occlusion of the fellow eye. However, these good outcomes for grating acuity cannot be attained without occlusion therapy. In addition, optotype acuity and sensitivity to contrast always are impaired

Tumor site immune markers associated with risk for subsequent basal cell carcinomas.

BackgroundBasal cell carcinoma (BCC) tumors are the most common skin cancer and are highly immunogenic.ObjectiveThe goal of this study was to assess how immune-cell related gene expression in an initial BCC tumor biopsy was related to the appearance of subsequent BCC tumors.Materials and methodsLevels of mRNA for CD3ε (a T-cell receptor marker), CD25 (the alpha chain of the interleukin (IL)-2 receptor expressed on activated T-cells and B-cells), CD68 (a marker for monocytes/macrophages), the cell surface glycoprotein intercellular adhesion molecule-1 (ICAM-1), the cytokine interferon-γ (IFN-γ) and the anti-inflammatory cytokine IL-10 were measured in BCC tumor biopsies from 138 patients using real-time PCR.ResultsThe median follow-up was 26.6 months, and 61% of subjects were free of new BCCs two years post-initial biopsy. Patients with low CD3ε CD25, CD68, and ICAM-1 mRNA levels had significantly shorter times before new tumors were detected (p = 0.03, p = 0.02, p = 0.003, and p = 0.08, respectively). Furthermore, older age diminished the association of mRNA levels with the appearance of subsequent tumors.ConclusionsOur results show that levels of CD3ε, CD25, CD68, and ICAM-1 mRNA in BCC biopsies may predict risk for new BCC tumors

Complications in the first 5 years following cataract surgery in infants with and without intraocular lens implantation in the Infant Aphakia Treatment Study

PURPOSE: To compare rates and severity of complications between infants undergoing cataract surgery with and without intraocular lens (IOL) implantation. DESIGN: Prospective randomized clinical trial. METHODS: A total of 114 infants were enrolled in the Infant Aphakia Treatment Study, a randomized, multi-center (12) clinical trial comparing the treatment of unilateral aphakia in patients under 7 months of age with a primary IOL implant or contact lens. The rate, character, and severity of intraoperative complications, adverse events, and additional intraocular surgeries during the first 5 postoperative years in the 2 groups were examined. RESULTS: There were more patients with intraoperative complications (28% vs 11%, P = .031), adverse events (81% vs 56%, P = .008), and more additional intraocular surgeries (72% vs 16%, P < .0001) in the IOL group than in the contact lens group. However, the number of patients with adverse events in the contact lens group increased (15 to 24) in postoperative years 2-5 compared to the first postoperative year, while it decreased (44 to 14) in years 2-5 compared to the first postoperative year in the IOL group. If only one half of the patients in the contact lens (aphakic) group eventually undergo secondary IOL implantation, the number of additional intraocular surgeries in the 2 groups will be approximately equal. CONCLUSION: The increased rate of complications, adverse events, and additional intraocular surgeries associated with IOL implantation in infants <7 months of age militates toward leaving babies aphakic if it is considered likely that the family will be successful with contact lens correction

The solar photospheric abundance of carbon.Analysis of atomic carbon lines with the CO5BOLD solar model

The use of hydrodynamical simulations, the selection of atomic data, and the computation of deviations from local thermodynamical equilibrium for the analysis of the solar spectra have implied a downward revision of the solar metallicity. We are in the process of using the latest simulations computed with the CO5BOLD code to reassess the solar chemical composition. We determine the solar photospheric carbon abundance by using a radiation-hydrodynamical CO5BOLD model, and compute the departures from local thermodynamical equilibrium by using the Kiel code. We measure equivalent widths of atomic CI lines on high resolution, high signal-to-noise ratio solar atlases. Deviations from local thermodynamic equilibrium are computed in 1D with the Kiel code. Our recommended value for the solar carbon abundance, relies on 98 independent measurements of observed lines and is A(C)=8.50+-0.06, the quoted error is the sum of statistical and systematic error. Combined with our recent results for the solar oxygen and nitrogen abundances this implies a solar metallicity of Z=0.0154 and Z/X=0.0211. Our analysis implies a solar carbon abundance which is about 0.1 dex higher than what was found in previous analysis based on different 3D hydrodynamical computations. The difference is partly driven by our equivalent width measurements (we measure, on average, larger equivalent widths with respect to the other work based on a 3D model), in part it is likely due to the different properties of the hydrodynamical simulations and the spectrum synthesis code. The solar metallicity we obtain from the CO5BOLD analyses is in slightly better agreement with the constraints of helioseismology than the previous 3D abundance results. (Abridged)Comment: Astronomy and Astrophysics, accepte

The economic and innovation contribution of universities: a regional perspective

Universities and other higher education institutions (HEIs) have come to be regarded as key sources of knowledge utilisable in the pursuit of economic growth. Although there have been numerous studies assessing the economic and innovation impact of HEIs, there has been little systematic analysis of differences in the relative contribution of HEIs across regions. This paper provides an exploration of some of these differences in the context of the UK’s regions. Significant differences are found in the wealth generated by universities according to regional location and type of institution. Universities in more competitive regions are generally more productive than those located in less competitive regions. Also, traditional universities are generally more productive than their newer counterparts, with university productivity positively related to knowledge commercialisation capabilities. Weaker regions tend to be more dependent on their universities for income and innovation, but often these universities under-perform in comparison to counterpart institutions in more competitive regions. It is argued that uncompetitive regions lack the additional knowledge infrastructure, besides universities, that are more commonly a feature of more competitive regions