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BACKGROUND Women with HIV face challenges in engaging in HIV care post partum. We aimed to examine changes in engagement in HIV care through clinic attendance before, during, and after pregnancy, compared with matched women with HIV who had never had a recorded pregnancy. METHODS In this cohort study, we describe changes in engagement in HIV care before, during, and after pregnancy among women with HIV from the UK Collaborative HIV Cohort (CHIC) study from 25 HIV clinics in the UK with a livebirth reported to the National Surveillance of HIV in Pregnancy and Childhood between Jan 1, 2000, and Dec 31, 2017. To investigate whether changes were specific to HIV, we compared these changes to those over equivalent periods among non-pregnant women with HIV in the UK CHIC study matched for ethnicity, year of conception, age, CD4 cell count, viral suppression, and antiretroviral therapy use. Analyses were via logistic regression using generalised estimated equations with an interaction between case-control status (pregnant women vs non-pregnant women) and pregnancy or pseudo pregnancy (for non-pregnant women) stage. FINDINGS 1116 matched pairs of pregnant and non-pregnant women were included (median age 34 years [IQR 30-38], 80·1% Black African, 12·5% white). 69 330 person-months of follow-up were recorded, 25 412 in the before stage, 18 897 during, and 25 021 after pregnancy or pseudo pregnancy stages. Among pregnant women, the proportion of time engaged in care increased during pregnancy (8477 [90·5%] of 9371 person-months) and after pregnancy (10 501 [84·6%] of 12 407), compared with before pregnancy (9979 [78·5%] of 12 707). Among non-pregnant women in the control group, engagement in HIV care remained stable across the three equivalent stages (9688 [76·3%] of 12 705 person-months before pseudo pregnancy; 7463 [78·3%] of 9526 during pseudo pregnancy; and 9892 [78·4%] of 12 614 after pseudo pregnancy). The association of engagement in HIV care with pregnancy or pseudo pregnancy stage differed significantly by case-control status (pinteraction

Background Delay to start antiretroviral therapy (ART) and nonadherence compromise the health and wellbeing of people living with HIV (PLWH), raise the cost of care and increase risk of transmission to sexual partners. To date, interventions to improve adherence to ART have had limited success, perhaps because they have failed to systematically elicit and address both perceptual and practical barriers to adherence. The primary aim of this study is to determine the efficacy of the Supporting UPtake and Adherence (SUPA) intervention. Methods This study comprises 2 phases. Phase 1 is an observational cohort study, in which PLWH who are ART naïve and recommended to take ART by their clinician complete a questionnaire assessing their beliefs about ART over 12 months. Phase 2 is a randomised controlled trial (RCT) nested within the observational cohort study to investigate the effectiveness of the SUPA intervention on adherence to ART. PLWH at risk of nonadherence (based on their beliefs about ART) will be recruited and randomised 1:1 to the intervention (SUPA intervention + usual care) and control (usual care) arms. The SUPA intervention involves 4 tailored treatment support sessions delivered by a Research Nurse utilising a collaborative Cognitive Behavioural Therapy (CBT) and Motivational Interviewing (MI) approach. Sessions are tailored to individual needs and preferences based on the individual patient’s perceptions and practical barriers to ART. An animation series and intervention manual have been developed to communicate a rationale for the personal necessity for ART and illustrate concerns and potential solutions. The primary outcome is adherence to ART measured using Medication Event Monitoring System (MEMS). Three hundred seventy-two patients will be sufficient to detect a 15% difference in adherence with 80% power and an alpha of 0.05. Costs will be compared between intervention and control groups. Costs will be combined with the primary outcome in cost-effectiveness analyses. Quality adjusted life-years (QALYs) will also be estimated over the follow-up period and used in the analyses. Discussion The findings will enable patients, healthcare providers and policy makers to make informed decisions about the value of the SUPA intervention. Trial registration The trial was retrospectively registered 21/02/2014, ISRCTN35514212. Electronic supplementary material The online version of this article (10.1186/s12889-019-6893-z) contains supplementary material, which is available to authorized users.

Background:It remains unclear whether combination antiretroviral therapy (ART) regimens differ in their ability to fully suppress human immunodeficiency virus (HIV) replication. Here, we report the results of two cross-sectional studies that compared levels of cell-associated (CA) HIV markers between individuals receiving suppressive ART containing either a non-nucleoside reverse transcriptase inhibitor (NNRTI) or a protease inhibitor (PI).Methods:CA HIV unspliced RNA and total HIV DNA were quantified in two cohorts (n = 100, n = 124) of individuals treated with triple ART regimens consisting of two nucleoside reverse transcriptase inhibitors (NRTIs) plus either an NNRTI or a PI. To compare CA HIV RNA and DNA levels between the regimens, we built multivariable models adjusting for age, gender, current and nadir CD4+ count, plasma viral load zenith, duration of virological suppression, NRTI backbone composition, low-level plasma HIV RNA detectability, and electronically measured adherence to ART.Results:In both cohorts, levels of CA HIV RNA and DNA strongly correlated (rho = 0.70 and rho = 0.54) and both markers were lower in NNRTI-treated than in PI-treated individuals. In the multivariable analysis, CA RNA in both cohorts remained significantly reduced in NNRTI-treated individuals (padj = 0.02 in both cohorts), with a similar but weaker association between the ART regimen and total HIV DNA (padj = 0.048 and padj = 0.10). No differences in CA HIV RNA or DNA levels were observed between individual NNRTIs or individual PIs, but CA HIV RNA was lower in individuals treated with either nevirapine or efavirenz, compared to PI-treated individuals.Conclusions:All current classes of antiretroviral drugs only prevent infection of new cells but do not inhibit HIV RNA transcription in long-lived reservoir cells. Therefore, these differences in CA HIV RNA and DNA levels by treatment regimen suggest that NNRTIs are more potent in suppressing HIV residual replication than PIs, which may result in a smaller viral reservoir size.Funding:This work was supported by ZonMw (09120011910035) and FP7 Health (305522).

OBJECTIVES The aim of the study was to investigate the efficacy and safety of first-line antiretroviral therapy (ART) with integrase inhibitor (INI) or protease inhibitor (PI)-based regimens in patients with low CD4 cell counts and/or an AIDS-defining disease. METHODS We conducted a retrospective, multicentre analysis to investigate discontinuation proportions and virological response in patients with CD4 cell counts

This article presents 24-h wind speed forecasting for the city of La Serena in Chile and a methodology to explore forecasting effects on the production of wind turbine power. To that end, we used meteorological data from a weather station located in the southern zone of the hyper-arid Atacama Desert. In this area, energy resources are economically and environmentally important, and wind speed forecasting plays a vital role in the management and marketing processes of wind potential via wind farms. To contribute to the development of this energy, we propose carrying out the short-term prediction of 12 and 24 h ahead (identified as Ws( t + 12) and Ws( t + 24), respectively) using an artificial neural network with backpropagation approach. Hourly time series of wind speed, temperature, and relative humidity (from 2003 to 2006) were considered to characterize the artificial neural network in the training phase, while we used data from the year 2007 to check the efficiency of our prediction. For artificial neural network Ws( t + 12) and Ws( t + 24) models, we obtained similar performance of wind speed prediction with root mean square error of around 0.7 m s−1 and with maximum and minimum residuals of +4 and ‒4 m s−1, respectively. Based on the results, we gain a reliable tool to characterize wind speed properties in the range of 1 day within 20% of uncertainty. Moreover, this tool becomes useful to study the effects of our artificial neural network Ws( t + 12) and Ws( t + 24) models on the generation of wind energy from a wind power turbine parametrization.

Introduction Liver transplantation is an important measure of burden from hepatitis C virus (HCV)-associated liver disease. Aims To describe transplant rates and survival in individuals with HCV infection from 2008 to 2017 in England through data linkage. Methods This is a retrospective observational cohort study. Laboratory reports of HCV infection were linked to the Liver Transplant Registry for individuals aged 15 years and over, first diagnosed between 1998 and 2017. We estimated age-sex standardised incidence rates and used Poisson regression to investigate predictors of liver transplantation and test for a change in incidence after introduction of direct-acting antivirals (DAAs) in 2014. Kaplan-Meier survival analysis was used to calculate post-transplant survival rates. Results Of 124,238 individuals diagnosed with HCV infection, 1,480 were registered and 1,217 received a liver transplant. Of individuals registered, 1,395 had post-HCV cirrhosis and 636 had hepatocellular carcinoma (618 also had post-HCV cirrhosis). Median time from HCV diagnosis to transplant was 3.4 years (interquartile range: 1.3–6.8 years). Liver transplant rates were lower 2014–17 compared with 2011–13 (incidence rate ratio: 0.64; 95% confidence interval: 0.55–0.76). Survival rates were 93.4%, 79.9% and 67.9% at 1, 5 and 10 years, respectively. Data linkage showed minimal under-reporting of HCV in the transplant registry. Conclusion In the post-DAA era, liver transplant rates have fallen in individuals with HCV infection, showing early impact of HCV treatment scale-up; but the short time from HCV diagnosis to liver transplant suggests late diagnosis is a problem.

OBJECTIVES Transmission of drug-resistant HIV-1 has decreased in the UK since the early 2000s. This analysis reports recent trends and characteristics of transmitted drug resistance (TDR) in the UK from 2010 to 2013. METHODS Resistance tests conducted in antiretroviral treatment (ART)-naive individuals between 2010 and 2013 were analysed for the presence of transmitted drug resistance mutations (TDRMs), defined as any mutations from a modified 2009 World Health Organization surveillance list, or a modified 2013 International Antiviral Society-USA list for integrase tests. Logistic regression was used to examine associations between demographics and the prevalence of TDRMs. RESULTS TDRMs were observed in 1223 (7.5%) of 16 425 individuals; prevalence declined from 8.1% in 2010 to 6.6% in 2013 (P = 0.02). The prevalence of TDRMs was higher among men who have sex with men (MSM) compared with heterosexual men and women (8.7% versus 6.4%, respectively) with a trend for decreasing TDRMs among MSM (P = 0.008) driven by a reduction in nucleoside reverse transcriptase inhibitor (NRTI)-related mutations. The most frequently detected TDRMs were K103N (2.2%), T215 revertants (1.6%), M41L (0.9%) and L90M (0.7%). Predicted phenotypic resistance to first-line ART was highest to the nonnucleoside reverse transcriptase inhibitors (NNRTIs) rilpivirine and efavirenz (6.2% and 3.4%, respectively) but minimal to NRTIs, including tenofovir, and protease inhibitors (PIs). No major integrase TDRMs were detected among 101 individuals tested while ART-naive. CONCLUSIONS We observed a decrease in TDRMs in recent years. However, this was confined to the MSM population and rates remained stable in those with heterosexually acquired HIV infection. Resistance to currently recommended first-line ART, including integrase inhibitors, remained reassuringly low.

Background:Response to treatment in psoriatic arthritis (PsA) can be captured using the OMERACT PsA Magnetic Resonance Imaging Score (PsAMRIS). While reliable and valid, PsAMRIS interpretation requires a trained reader to assess inflammatory lesions such as synovitis and flexor tenosynovitis on a discrete scale ranging from 0 to 3, which might not have sufficient sensitivity to capture early and subtle changes in inflammation in small cohorts.Objectives:To propose a novel computer-assisted imaging quantitative methodology to assess early response to treatment on a continuous scale and compare its results with those of PsAMRIS.Methods:Patients with active PsA in the hand and wrist were treated with apremilast 30 mg twice daily after a 5-day titration period. A total of 29 patients underwent MRI scans at baseline and months 3, 6, and 12. Images were scored for synovitis using the PsAMRIS interpreted by an experienced reader and were read in blinded sequences. Images for 13 patients with involvement of the wrist and metacarpophalangeal (MCP) joints and MRI available at baseline, 3 months, and 6 months were further processed using a novel computer-assisted imaging quantitative methodology. Images were scored concurrently, with the reader blinded to the order of visits. An experienced reader pre-defined regions of interest (ROIs) around the wrist, MCP joints (MCP-2 to MCP-5), and flexor and extensor tendons of the fingers and wrist (as applicable) with adjacent blood vessels and possible artifacts excluded from ROIs. From these ROIs, the normalized volume of inflammation (NormI) was calculated in each joint and tendon. This was done by automatically counting the pixels that were enhanced above the intensity level of a muscle. Each enhanced pixel was given a weight corresponding to the degree of enhancement, allowing differentiation of areas of residual inflammation and high perfusion. This method has been validated, tested, and implemented in the CE/FDA510-cleared software package Dynamika (IAG, Image Analysis Group). PsAMRIS responses were compared with those of the computer-assisted imaging quantitative methodology at baseline, 3 months, and 6 months. A heat map of normalized intensities was produced, highlighting areas of perfusion higher than that of healthy muscle. Changes from baseline were tested for significance using at-test. Patients with non-missing data were included in the final statistical analysis.Results:The generated NormI map highlighted a reduction in wrist inflammation activity after 3 and 6 months of treatment with apremilast. In all cases, a downward trend in inflammatory activity in the wrist and MCP joints was observed at 3 months, indicating a reduction following treatment with apremilast (Figures 1 and 2). Similar improvements were observed in tenosynovitis (Figures 1 and 2).Conclusion:In this pilot assessment, apremilast was associated with improvements in synovitis and tenosynovitis over a period of 6 months using PsAMRIS. Assessment of images using NormI, a methodology allowing quantification of inflammatory activity within a joint or tendon, demonstrated the same trends over 6 months. Further studies are planned to determine the sensitivity of this novel computer-assisted imaging quantitative methodology relative to that of PsAMRIS and whether it could be used to provide early indications of treatment response in small cohorts of patients.Disclosure of Interests:Paul Bird Consultant of: AbbVie, Celgene Corporation, Eli Lilly, Janssen, Novartis, Pfizer – advisor, Speakers bureau: AbbVie, Celgene Corporation, Eli Lilly, Janssen, Novartis, Pfizer, Mikael Boesen Consultant of: AbbVie, AstraZeneca, Eli Lilly, Esaote, Glenmark, Novartis, Pfizer, UCB, Paid instructor for: IAG, Image Analysis Group, AbbVie, Eli Lilly, AstraZeneca, esaote, Glenmark, Novartis, Pfizer, UCB (scientific advisor)., Speakers bureau: Eli Lilly, Esaote, Novartis, Pfizer, UCB, Mark Hinton: None declared, Eser Sanverdi Employee of: Image Analysis Group – employment, Romiesa Hagoug Employee of: Image Analysis Group – employment, Christoper Sabin Employee of: Image Analysis Group – employment, Priscila Nakasato Employee of: Amgen Inc. – employment; Celgene Corporation – employment at the time of study conduct, Benoit Guerette Employee of: Amgen Inc. – employment; Celgene Corporation – employment at the time of study conduct, Olga Kubassova Shareholder of: IAG, Image Analysis Group, Consultant of: Novartis, Takeda, Lilly, Employee of: IAG, Image Analysis Group

Objectives In persons with hepatitis C virus (HCV) infection, HIV coinfection leads to faster progression to advanced liver disease. The aim of our study was to estimate diagnosed HIV prevalence among people with evidence of current HCV infection (polymerase chain reaction positive) and examine predictors of coinfection. Methods Adults (≥ 15 years old) with a current HCV infection reported to the Public Health England (PHE) sentinel surveillance of blood-borne viruses were linked to the PHE national HIV database using a deterministic methodology. Descriptive and multivariate analyses were conducted. Results Between 2008 and 2014, 5.0% (999/20 088) of adults with a current HCV infection were diagnosed with HIV coinfection. The majority acquired HIV through sex between men (441; 64.9%), followed by injecting drug use (153; 22.5%) and heterosexual contact (84; 12.4%). Of persons who were coinfected, 65.5% had been diagnosed with HIV infection > 6 months before their HCV diagnosis, 41.4% of whom had a negative anti-HCV test between their HIV and HCV diagnoses. In a multivariable model among persons with current HCV infection, an HIV diagnosis was more likely among men [adjusted odds ratio (aOR) 3.29; 95% confidence interval (CI) 2.60-4.16] and persons of black ethnicity (aOR 3.19; 95% CI 1.36-7.46), and less likely among older adults (aOR 0.85 per 10-year increase; 95% CI 0.79-0.92) and persons of Asian ethnicity (aOR 0.59; 95% CI 0.41-0.86). Conclusions Our results indicate that the majority of diagnosed HIV and current HCV coinfections are among men who have sex with men. Safer sex campaigns should include awareness of transmission of HCV among MSM living with HIV.

Objectives Current British HIV Association (BHIVA) guidelines recommend that all patients with a CD4 count

Life expectancy (LE) is an important indicator of health used widely by government and healthcare agencies to monitor trends over time and to determine resource allocation, as well as by insurance companies and pension providers. LE of the HIV-positive population has increased dramatically since the introduction of combination antiretroviral therapy (cART); indeed, it is now believed that LE may be similar to that of the general population in some subgroups. There are, however, specific subgroups in which LE remains substantially impaired. The impact of HIV and of cART on mortality may be expressed in several ways. LE itself provides an estimate of the average additional number of years that an individual would be expected to live beyond a particular age. However, the detrimental impact of HIV may also be described in terms of the number of years of life lost or the gains in LE if HIV were to be eliminated as a cause of morbidity in the population. My presentation will start with a description of the different methods that researchers have used to describe the mortality outcomes of those with HIV, and the impact of cART on these. I will then consider how LE in the HIV-positive population has changed over time and will describe the impact of demographic factors (e.g. gender, age, ethnic group) on LE. To investigate the circumstances under which LE may return to normal levels, I will also consider the potential impact of timely diagnosis and linkage into care, continued engagement with care, optimal initiation of cART and maintenance of viral suppression on LE. Finally, I will discuss some of the limitations of the approaches used to estimate LE, with particular emphasis on the confounding effects of lifestyle and behavioural factors when making any comparison with LE in the general population.

We identified predictors of clinical complexity based on data collected in the UK CHIC Study. All subjects under established care (>1 year) from 2000-2010 were included. Each subject’s follow-up (1 year after study entry to last clinic visit, death or 31/12/2010) was stratified into a series of 6-monthly periods and his/her status was assessed at the start of each. Using Poisson regression (with generalised estimating equations to allow for multiple entries per subject), we studied associations between demographic/clinical factors, CD4 count/percent, viral load (VL), calendar year and measures of prior/current antiretroviral (ART) use, and the development of a new AIDS event or death during each period. A complexity score was derived from the coefficients of the final model; subjects were categorised into ten equally sized groups based on the score, and event rates were calculated for each group. The 31,338 eligible subjects had a median (interquartile range) age of 36 (10, 42) years at baseline. Ethnicity was white (55%), black African (27%), black other (5%), other (9%) and unknown (4%). Mode of acquisition was sex between men (52%), heterosexual sex (37%), other (5%) and unknown (5%). Subjects contributed a total of 377,284 periods of follow-up (181,170 person-years [PY]) of which 5796 included a clinical event (rate/1000 PY: 3.20 [95% confidence interval 3.12, 3.28], 4322 AIDS events, 1534 deaths). As an active AIDS-defining event in the past 6 months was the dominant predictor of a new clinical event (relative rate 41.55), subjects with an active event were excluded from further analysis. Risk factors for a clinical event in patients without an active AIDS event (Table 1) were earlier calendar year, non-white ethnicity, older age, lower CD4 count, >80 CD4 cell drop from previous visit, being off ART or on ART with a VL >10,000 copies/ml. Hepatitis co-infection and previous experience of immune suppression were associated with lower clinical risk. A score based on this model discriminated reasonably well between subjects who did/did not develop an endpoint over the next 6 months (approximate C-statistic: 0.72), with event rates increasing from 0.49/100 PY in the lowest score group to 7.16/100 PY in the highest. A score based on clinical markers may provide a means to identify those who will experience clinical progression over the next 6 months, allowing this group to be targeted for closer monitoring and funds for HIV care to be distributed appropriately. (Published: 11 November 2012) Citation: Abstracts of the Eleventh International Congress on Drug Therapy in HIV Infection Sabin C and Delpech V. Journal of the International AIDS Society 2012, 15 (Suppl 4):18133 http://www.jiasociety.org/index.php/jias/article/view/18133 | http://dx.doi.org/10.7448/IAS.15.6.18133

California State University Monterey Bay (CSUMB) is a new comprehensive university founded in 1994 at the Old Fort Ord Army Base. One of its core missions is to serve the diverse people of California and to provide access to traditionally undeserved populations. To reach this goal, CSUMB has taken a different approach to typical college organizational structure. The institution is organized around Centers and Institutes that cluster related but historically separate disciplines. The goal is to facilitate better cross discipline collaboration and communication among disciplines. Cultural diversity is customarily ignored and is almost never considered in developing a delivery strategy. During the process of designing the initial instructional design course we began to wonder if there was a way to better integrate cultural differences within traditional instructional design methodology. To do this would be consistent with the mission of the university of not just providing access but also helping to ensure the success of typically undeserved student populations within computer science disciplines. The authors used an approach by Samovar, Porter and Stefani that divides cultures into 2 basic groups that they call High and Low Context. This paper reports on their findings and recommendations.

Neural tube defects and periconceptional folic acid in England and Wales: retrospective study {#article-title-2} The risks of a first occurrence and a recurrence of neural tube defects have been shown to be reduced by periconceptional folic acid supplementation—that is by taking folic acid from 3 months before conception to 3 months after conception.1 2 The Expert Advisory Group in the United Kingdom recommended in 1992 that women who were trying to conceive should take 0.4 mg folic acid per day.3 We assessed whether there had been any change in the incidence of neural tube defects since this recommendation was made. The number of live births, stillbirths, and pregnancies terminated because the fetus had a neural tube defect (spina bifida, anencephaly, or encephalocele) as well as the total number of live births, stillbirths, and abortions among residents of England and Wales from 1972 to 1996 were obtained from the Office for National Statistics. The true incidence of these abnormalities was defined as the number of affected infants (born alive or dead) plus the number of pregnancies terminated after prenatal diagnosis of a neural tube defect and expressed as a proportion of 100 000 live births, stillbirths, and terminations for neural tube defects. The number of prescriptions dispensed and the number of preparations sold over the counter containing 400 μg to 500 μg folic acid were provided by the Department of Health and Self Medication UK, a department of Intercontinental Medications Statistics-Health, (Pinner, Middlesex), respectively. The total number of prescriptions dispensed was available but data for over the counter sales do not include information from Boots pharmaceutical …

Two within household telephone sampling techniques for collecting citizen survey data for community mental health center's needs assessments were compared on the basis of respondent demographic characteristics; response, completion, and refusal rates; and, administrative costs. Initially, all households were chosen via random digit dialing. Then, one technique allowed the surveyor to interview any adult member of a household who answered the phone. The other technique used was developed by Troldahl and Carter and required the use of a reference table procedure to determine the appropriate respondent. While more expensive, the Troldahl-Carter method produced significantly better representativeness of the population for a rural county. Factors relating to a decision regarding which technique to employ are discussed.

This paper describes the Biomedical Services of Northern Montana Hospital, a separate corporation under the parent corporation of Northern Montana Health Care Inc. Located in Havre, Montana, a rural area of north central Montana, the hospital is a 120-bed, non-profit organization. The two BMETs work as part of the Engineering Department and service almost every piece of equipment in the building (approximately 1100 items), as well as a telephone system for another facility. This paper shows that a non-urban hospital, located far from any service company outlet, can be self-supporting as far as equipment service and maintenance are concerned.

Paw-shake responses (PSRs) were evoked by wrapping masking tape around the hind-paw in nine cats spinalized at the T12 level either at 2 or 12 wk of age or as young adults (10-12 mo). Electromyographic responses of ankle extensors (LG and SOL) and one ankle flexor (TA) were recorded through the 6th mo after cord transection. Activity of the LG was used to determine the cycle characteristics. Cycle characteristics did not differ among cats spinalized at different ages. The average PSR, consisting of 11 cycles with a cycle time of 85 ms, was similar to the PSR of normal adult cats (16). Activity in the TA and LG muscles alternated with the onset of the flexor burst occurring at 52% of the extensor cycle. Burst durations averaged 39 and 57 ms for LG and TA muscles, respectively. Relatively normal PSRs were evoked within 48 h following cordotomy of the young-adult cats; differences being that the responses were elicited less frequently with fewer and slightly longer cycle times than normal. Within 2 wk following cord transection, PSR parameters returned to normal values. In the spinal cats, the SOL was active during PSR, showing either tonic low-level activity or discrete bursts that were coactive with the LG. In normal adult cats, the slow extensor (SOL) is usually inactive (16). In spinal cats, participation of the SOL may depend on a conversion of muscle units from slow to fast contracting (8, 13) or on the absence of inhibition of slow motor units from descending tracts (11). Both mechanisms are discussed.(ABSTRACT TRUNCATED AT 250 WORDS)

Introduction In a recently published paper 1 data were described which showed that the amount of convergence associated with a given change in the dioptric stimulus to accommodation is greatly increased when the eyes are under cycloplegia induced by homatropine over that when they are in the normal state. This phenomenon was first described by Maddox and more recently by Morgan. 2 As measured quantitatively, homatropine causes a marked increase in the accommodative convergence-accommodation (stimulus) ratio [(A — C)/A] over that ratio measured normally. The increase seems to vary as a function of the degree of cycloplegia. The data were obtained by the fixation-disparity technique. With this technique of measuring ocularmotor imbalance, extrafoveal binocular vision and fusion are maintained throughout the test and both eyes are subjected simultaneously to the same dioptric stimulus to accommodation. Most interestingly, the data showed that in the presence of homatropine cycloplegia the change in

To the Editor: —At a meeting of the Herkimer County Medical Society on Tuesday evening it was my pleasure to introduce a resolution that the society donate $5 toward the fund which is being raised for the Memorial Salon of Pershing Hall. This motion was unanimously carried and a check for this amount will be mailed your office. When this worthy proposition was begun byThe JournalI thought that it would go across with a bang, there being about 150,000 physicians in the United States. The memorandum inThe Journalof April 11 shows that the response has been anything but encouraging. This apparent failure to a worthy cause should be considered an affront of the so-called organized profession in this country. May we hope for better success in this worthy undertaking.