Indications and outcomes of strabismus repair in visually mature patients

OBJECTIVE: To identify and examine the indications, outcomes and potential risks of strabismus surgery in visually mature patients. DESIGN: Case series. SETTING: University-based referral practice in Edmonton. PATIENTS: A total of 222 patients (115 females and 107 males) aged 9 to 69 (mean 29) years who underwent strabismus surgery for various types of strabismus (as grouped by original diagnosis). All patients were followed for at least 6 weeks postoperatively. OUTCOME MEASURES: Previous surgery and deviation in prism dioptres (delta) (distance and near), sensory status (measured by the Titmus stereotest at near) and the presence of symptoms (diplopia, abnormal head posture or asthenopia), recorded preoperatively, 6 weeks postoperatively and at the last postoperative visit. RESULTS: The patients were followed for an average of 14 months postoperatively. At the last postoperative visit 187 patients (84%) were aligned to within 15 delta of orthotropia. Overall, 116 patients (52%) demonstrated some degree of stereopsis postoperatively, compared with 78 (35%) preoperatively. A total of 116 patients (52%) had symptoms preoperatively, including diplopia, abnormal head posture or asthenopia; 88 (76%) of the 116 had complete resolution of their symptoms. Six patients (4%) without diplopia preoperatively were found to have this symptom postoperatively. CONCLUSIONS: The findings suggest that most visually mature patients under-going strabismus surgery can expect functional benefits, including improvement of alignment, preservation and occasionally restoration of sensory fusion, and elimination of diplopia, abnormal head posture and asthenopia.     

Epstein-Barr virus uses HLA class II as a cofactor for infection of B lymphocytes

Infection of B lymphocytes by Epstein-Barr virus (EBV) requires attachment of virus via binding of viral glycoprotein gp350 to CD21 on the cell surface. Penetration of the cell membrane additionally involves a complex of three glycoproteins, gH, gL, and gp42. Glycoprotein gp42 binds to HLA-DR. Interference with this interaction with a soluble form of gp42, with a monoclonal antibody (MAb) to gp42, or with a MAb to HLA-DR inhibited virus infection. It was not possible to superinfect cells that failed to express HLA-DR unless expression was restored by transfection or creation of hybrid cell lines with complementing deficiencies in expression of HLA class II. HLA class II molecules thus serve as cofactors for infection of human B cells.     

Remote sensing of structural complexity indices for habitat and species distribution modeling

Spatial distribution models are increasingly used in ecological studies, but are limited by the poor accuracy of remote sensing (RS) for mapping microhabitat (< 0.1 ha) features. Mapping accuracy can be improved by combining advanced RS image-processing techniques with microhabitat data expressed as a structural complexity index (SCI). To test this idea, we used principal components analysis (PCA) and an additive SCI method developed for forest ecology (calculated by re-scaling and summing representative structural variables) to summarize 13 microhabitat-scale (0.04 ha) vegetation structure attributes describing the rare mountain bongo antelope's (Tragelaphus eurycerus isaaci) habitat in Kenya's Aberdare mountains. Microhabitat data were collected in 127 plots: 37 related to bongo habitat use, 90 from 1 km-spaced grid points representing overall habitat availability and bongo non-presence. We then assessed each SCI's effectiveness for discerning microhabitat variability and bongo habitat selection, using Wilcoxon Rank Sum tests for differences in mean SCI scores among plots divided into 4 vegetation classes, and the Area Under the Curve (AUC) of receiver operating characteristics from logistic regressions. We also examined the accuracy of predicted SCI scores resulting from regression models based on variables derived from a) ASTER imagery processed with spectral mixture and texture analysis, b) an SRTM DEM and c) rainfall data, using the 90 grid plots for model training and the bongo plots as an independent test dataset. Of the five SCIs derived, two performed best: the PCA-derived Canopy Structure Index (CSI) and an additive index summarizing 8 structural variables (AI₈). CSI and AI₈ showed significant differences between 5 of 6 vegetation class pairs, strong abilities to distinguish bongo-selected from available habitat (AUCs = 0.71 (CSI); 0.70 (AI₈)), and predicted scores 60-110% more accurate than reported by other studies using RS to quantify individual microhabitat structural attributes (CSI model R² = 0.51, RMSE = 0.19 (training) and 0.21 (test); AI₈ model R² = 0.46, RMSE = 0.17 (training) and 0.19 (test)). Repeating the Wilcoxon tests and logistic regressions with RS-predicted SCI values showed that AI₈ most effectively preserved the patterns found with the observed SCIs. These results demonstrate that SCIs effectively characterize microhabitat structure and selection, and boost microhabitat mapping accuracy when combined with enhanced RS image-processing techniques. This approach can improve distribution models and broaden their applicability, makes RS more relevant to applied ecology, and shows that processing field data to be more compatible with RS can improve RS-based habitat mapping accuracy.     

Are supplementary services provided during methadone maintenance really cost-effective?

OBJECTIVE: Previous research has suggested that support services supplementing methadone maintenance programs vary in their cost-effectiveness. This study examined the cost-effectiveness of varying levels of supplementary support services to determine whether the relative cost-effectiveness of alternative levels of support is sustained over time. METHOD: A group of 100 methadone-maintained opiate users were randomly assigned to three treatment groups receiving different levels of support services during a 24-week clinical trial. One group received methadone treatment with a minimum of counseling, the second received methadone plus more intensive counseling, and the third received methadone plus enhanced counseling, medical, and psychosocial services. The results at the end of the trial period have been published elsewhere. This article reports the results of an analysis at a 6-month follow-up. RESULTS: The follow-up analysis reaffirmed the preliminary findings that the methadone plus counseling level provided the most cost-effective implementation of the treatment program. At 12 months, the annual cost per abstinent client was $16,485, $9,804, and $11,818 for the low, intermediate, and high levels of support, respectively. Abstinence rates were highest, but modestly so, for the group receiving the high-intensity, high-cost methadone with enhanced services intervention. CONCLUSIONS: This study suggests that large amounts of support to methadone-maintained clients are not cost-effective, but it also demonstrates that moderate amounts of support are better than minimal amounts. As funding for these programs is reduced, these findings suggest a floor below which supplementary support should not fall.     

Determination of optimal conditions for selected adsorbent combinations to recover used frying oils

The treatment of frying oils with adsorbents could practically extend the frying life of oils. Combined synthetic adsorbent treatment of used frying oils was studied the first time. The combinations of four commonly used filter aids: Britesorb (Br), Hubersorb 600 (HB), Frypowder (Fr), and Magnesol (Ma) were evaluated for frying oil recovery. AOCS official methods were used to evaluate their adsorptiveness, including free fatty acids (FFA), conjugated diene value, total polar components, oxidative stability index (OSI), and absorbance at 420 nm. The selected combinations HB+Ma+Fr and HB+Ma+Br exhibited consistent high recovery abilities on various used oil samples. A 3, 3, and 2% HB, Ma, and Fr, respectively, for the first combination (F), and 2, 3, and 2% HB, Ma, and Br, respectively, for the second combination (B) were the most effective. The optimal treatment duration was 6–9 min and 3–6 min for combinations F and B, respectively, which reduced FFA by 82.6–87.6%, absorbance by 26.8–32.6%, and Foodoil Sensor readings by 5.6–8.6%. Addition of antioxidant, such as 50 ppm butylated hydroxytoluene and 50 ppm propyl gallate, increased the OSI value by 48.9–80.8%. Such adsorbent combinations may be used in practical operation to extend frying life of frying oils and improve the healthy aspects of used frying oils.