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Kudzu is an invasive perennial climbing vine characterized by fast growth rates and tolerance to control measures. Repeated applications with high rates of 2,4-D plus picloram provide effective kudzu control, but picloram use is not permitted in certain states due to groundwater pollution concerns. Studies were conducted in Alabama and Florida to compare kudzu control with aminocyclopyrachlor, a new herbicide, to control provided by aminopyralid, clopyralid, metsulfuron methyl, and picloram plus 2,4-D, which are common treatments for kudzu management. Two annual applications of the same herbicide treatment were evaluated for effects on kudzu cover, kudzu volume index, and cover of other vegetation. Aminocyclopyrachlor at 140 to 280 g ae ha−1 (2 to 4 oz ae ac−1) was as effective as the standard 4.48 kg ae ha−1 (4 lb ae ac−1) 2,4-D amine plus 1.2 kg ae ha−1 picloram for kudzu control. There were no differences in kudzu control among the three rates of aminocyclopyrachlor tested. Colonization by graminoids, forbs, and Rubus spp. at 2 yr was greatest for herbicides providing the best kudzu control: aminocyclopyrachlor, and 2,4-D plus picloram. Herbicide treatments were more effective in controlling kudzu at the Alabama location, but repeated annual applications for 2 yr did not completely eliminate kudzu with any treatment at either site.

Trauma patients are exposed to potentially high levels of low-dose radiation during radiologic studies.To assess the cumulative effective dose (CED) of radiation exposure (RE) in 177 successive patients admitted to a trauma service from January 1 through February 28, 2006.Patients received a total of 1505 radiographs and 400 computed tomography (CT) scans in the study period. The CED was 14.56 mSv (0.97 mSv radiographs, 13.59 mSv CT scans) per patient total length of stay (LOS). CED averaged 8.66 mSv in the first hour and 11.76 mSv in the first 24 h after arrival. The most commonly performed CT scan was brain (n = 147), followed by abdomen and pelvis (n = 80), and cervical spine (n = 69). CT scans of the brain and cervical spine were the most commonly performed combined imaging tests (35%). Twelve percent of patients received no radiographs, and 15% received no CT scans. Six or more CT scans were done in 6% of patients. RE increased with longer LOS (6 days vs. 3-5 days vs. 1 day, p0.05). "Pan-scans" (a combination of CTs of the brain, cervical spine, chest, abdomen, and pelvis) were done in 13% (n = 23) of patients. There was a higher total RE from CT scans (25.09 mSv ± 19.48 mSv vs. 4.93 mSv ± 14.20 mSv) in patients with injury severity score (ISS)9 vs. ≤ 9 ( p0.0001). First hour and first 24-h RE rates from radiographs were lower in patients younger than 15 years vs. 15-45 years and older-than-45-year age cohorts (p0.05).In this study, CED was 14.56 mSv per patient. CT scans accounted for 21% of radiologic studies and 93% of CED. There was a higher CED rate in patients with ISS9 and longer LOS.

Current theories suggest that disrupting cortical information integration may account for the mechanism of general anesthesia in suppressing consciousness. Human cognitive operations take place in hierarchically structured neural organizations in the brain. The process of low-order neural representation of sensory stimuli becoming integrated in high-order cortices is also known as cognitive binding. Combining neuroimaging, cognitive neuroscience, and anesthetic manipulation, we examined how cognitive networks involved in auditory verbal memory are maintained in wakefulness, disrupted in propofol-induced deep sedation, and re-established in recovery. Inspired by the notion of cognitive binding, an functional magnetic resonance imaging-guided connectivity analysis was utilized to assess the integrity of functional interactions within and between different levels of the task-defined brain regions. Task-related responses persisted in the primary auditory cortex (PAC), but vanished in the inferior frontal gyrus (IFG) and premotor areas in deep sedation. For connectivity analysis, seed regions representing sensory and high-order processing of the memory task were identified in the PAC and IFG. Propofol disrupted connections from the PAC seed to the frontal regions and thalamus, but not the connections from the IFG seed to a set of widely distributed brain regions in the temporal, frontal, and parietal lobes (with exception of the PAC). These later regions have been implicated in mediating verbal comprehension and memory. These results suggest that propofol disrupts cognition by blocking the projection of sensory information to high-order processing networks and thus preventing information integration. Such findings contribute to our understanding of anesthetic mechanisms as related to information and integration in the brain.

Steven Yeh1, Brian T Chan-Kai2, Andreas K Lauer31Emory Eye Center, Emory University School of Medicine, Atlanta, GA, USA; 2Cullen Eye Institute, Baylor College of Medicine, Houston, TX, USA; 3Casey Eye Institute, Oregon Health and Science University, Portland, OR, USABackground: The purpose of this study was to design and implement a vitreoretinal training module that would be useful for ophthalmology residents and fellows to learn the basic maneuvers required in vitreoretinal surgery.Methods: A prospective pilot study evaluating the training module was undertaken in 13 ophthalmology trainees (residents and vitreoretinal fellows) with varying levels of vitreoretinal training experience. A vitreoretinal training module was designed and consisted of a three-port vitrectomy setup (sclerotomy wound construction, infusion placement), intraocular tasks (core vitrectomy, driving the operating microscope, membrane peel, air–fluid exchange), and wound closure. Standard vitrectomy instrumentation, the VitRet eye (Phillips Studio, Bristol, UK) and vitreous-like fluid using dairy creamer and balanced saline were utilized. A five-point Likert scale, ie, the Casey Eye Institute Vitrectomy Indices Tool for Skills Assessment (CEIVITS), was devised to evaluate each component of the module. Vitreoretinal surgical maneuvers were digitally recorded and graded by an attending vitreoretinal surgeon. Linear regression and correlation were performed to evaluate the relationship between prior vitreoretinal experience and CEIVITS performance. The main outcome measures were correlation of vitreoretinal surgical experience and CEIVITS performance on simulated tasks using a basic vitreoretinal training module.Results: Thirteen participants from postgraduate year 2 to postgraduate year 6 levels were evaluated. Nine participants were male and four were female. The median age of participants was 32 (range 30–36) years and surgical experience was 0–410 prior vitreoretinal surgical procedures. A positive correlation (P < 0.05) was observed between vitreoretinal surgical experience and CEIVITS performance on the following tasks: total score (P = 0.021), sclerotomy wound construction (P = 0.047), infusion line placement (P = 0.012), air–fluid exchange (P = 0.004), and wound closure (P = 0.032). Post module surveys showed that the majority of trainees felt that the vitreoretinal training module improved their understanding of vitreoretinal surgery. The nonbiohazardous nature of the setup was advantageous from sanitation and cost perspectives.Conclusion: The implementation of our training module for residency and vitreoretinal fellowship was feasible and the CEIVITS adequately assessed basic vitrectomy maneuvers. Given that ophthalmologic and subspecialty instruction migrates from an apprenticeship to a competency-based model, the face and content validity makes the CEIVITS module a promising one in vitreoretinal surgical instruction.Keywords: ophthalmology residents, vitreoretinal training, surgical

Today, computed tomography (CT) and other studies are used more often early in a trauma case than X-rays, exposing patients to more radiation. The long-term effects of radiation exposure (RE) in trauma patients are of great concern. Investigators randomly selected 60 patients (injury severity scores 15-25) each from the years 2000, 2003, and 2006. The cumulative effective dose (CED) was calculated from the RE of all X-rays and CTs performed during the patient's hospital stay. Total CED/patient increased from 15.97 (2000) to 16.67 (2003) to 23.27 mSv (2006); the increase from 2000 to 2006 was significant ( P < 0.05). X-rays increased over the 6-year period from 9.6/patient (pt) to 11.4/pt to 15.4/pt. CT scans increased from 2.2/pt (15.19 mSv) to 3.5/pt (21.85 mSv, P < 0.05). The CED in children increased: 12.88 versus 13.17 versus 15.32 mSv/pt ( P > 0.05). RE was 19.5 versus 22.0 versus 27.1 mSv in 16 to 45-year-olds compared with 15.5 versus 14.3 versus 27.0 mSv in older adults. Sixteen to 45-year-olds had significantly higher RE than children ( P < 0.05). RE in the first hour and first 24 hours increased but not significantly ( P > 0.05). CED increased from 2000 to 2006, due primarily from CT scans. Children had no significant CED increase during the same period and had lower RE than 16 to 45-year-old adults.

Objective—To evaluate chondrocyte death in canine articular cartilage exposed in vitro to bupivacaine with and without methylparaben and to compare viability for cartilage with intact or mechanically debrided surfaces. Sample Population—Both glenohumeral joints from 10 adult canine cadavers. Procedures—10 osteochondral cores were harvested from each of the 20 humeral heads; synovium and 1 core from each joint were examined to verify joint health, and the other 9 cores were exposed to canine chondrocyte culture medium (CCCM), a 0.5% solution of bupivacaine, or 0.5% solution of bupivacaine with methylparaben for 5, 15, or 30 minutes. Results—For the superficial zone of surface-intact chondrocytes, bupivacaine with methylparaben caused a significantly higher percentage of chondrocyte death at 5 minutes (47.7%) than did bupivacaine (23.6%) or CCCM (25.4%). Bupivacaine (53.8%) and bupivacaine with methylparaben (62.5%) caused a significantly higher percentage of chondrocyte death at 30 minutes than did CCCM (20.0%). For the superficial zone of chondrocytes with debrided surfaces, bupivacaine with methylparaben caused a significantly higher percentage of chondrocyte death at 30 minutes (59%) than it did at 5 minutes (37.7%). Bupivacaine with methylparaben caused a significantly higher percentage of chondrocyte death at 30 minutes (59.0%) than did CCCM (28.9%). For middle and deep zones of chondrocytes, treatment solution and surface debridement had minimal effects on percentage of chondrocyte death. Conclusions and Clinical Relevance—Bupivacaine and bupivacaine with methylparaben were cytotoxic to canine articular chondrocytes in vitro. Intra-articular administration of bupivacaine is not recommended for clinical use until additional studies are conducted.

A dynamic site equation derived using the generalized algebraic difference approach was developed for thinned stands of natural longleaf pine (Pinus palustris Mill.) in the East Gulf region of the United States using 40 years of measurements on 285 permanent plots. The base model predicts height growth of trees once they reach 4.5 ft and was fit using a varying parameter for each tree and global parameters that are constant for all 3,267 trees. Parameters were estimated in one step using the dummy variable approach and a first-order autoregressive error term to account for serial correlation. The final base-age invariant equation allows the user to specify the number of years required for trees to reach 4.5 ft in height.

Patients with the seat belt sign (SBS) from motor vehicle crashes (MVCs) are prone to specific regional injury patterns. Investigators at a Level 1 trauma center analyzed the incidence, clinical implications, and spectrum of regional injuries in patients injured in MVC over 2 years. SBS was seen in 11.3 per cent of patients injured in MVCs and 20.5 per cent of patients with known restraint use. Restrained patients were less severely injured with lower injury severity scores (7.62 vs 11.33) and mortality (1.1 vs 5.7%). Patients with SBS had lower mortality rates than patients without SBS (1.4 vs 3.7%). Thoraco-abdominal injuries were present in 47 per cent (34 of 72) of patients with SBS. Compared with patients without SBS, patients had a higher incidence of hollow viscous injuries (HVI) and solid organ trauma (8 and 17% vs 1 and 3%, P < 0.05); splenic trauma was 24-fold higher (9.7 vs 0.4%), liver injuries 3.1-fold higher (6 vs 3%), and rib fractures 2.4-fold higher ( P < 0.05). Children had 2.8-fold higher rates of HVI (18 vs 9%, P < 0.05). SBS is associated with underlying regional injuries in nearly half of patients with a higher prevalence of HVI and solid organ trauma.

Objective—To evaluate the effect of treadmill incline on muscle activity and joint range of motion (ROM) in hind limbs of dogs. Animals—8 purpose-bred healthy adult hounds. Procedures—Activities of the hamstring (semimembranosus, semitendinosus, and biceps femoris muscles), gluteal (superficial, middle, and deep gluteal muscles), and quadriceps (femoris, vastus lateralis, vastus intermedius, and vastus medialis muscles) muscle groups and hip and stifle joint ROM were measured with surface electrogoniometric and myographic sensors in hounds walking on a treadmill at 0.54 m/s at inclines of 5%, 0%, and −5% in random order. Mean electromyographic activities and mean ROMs at each inclination were compared for swing and stance phases. Results—Treadmill inclination did not affect duration of the stance and swing phases or the whole stride. When treadmill inclination was increased from −5% to 5%, hip joint ROM increased and the degree of stifle joint extension decreased significantly. In the beginning of the stance phase, activity of the hamstring muscle group was significantly increased when walking at a 5% incline versus a 5% decline. In the end of the stance phase, that activity was significantly increased when walking at a 5% incline versus at a 5% decline or on a flat surface. Activity of the gluteal and quadriceps muscle groups was not affected when treadmill inclination changed. Conclusions and Clinical Relevance—Treadmill inclination affected joint kinematics only slightly. Walking on a treadmill at a 5% incline had more potential to strengthen the hamstring muscle group than walking on a treadmill with a flat or declined surface.

Residence during childhood and at disease onset in urban, semirural and rural communities respectively was investigated in an epidemiological group of MS patients in Southern Hesse (West Germany). Patients originated more frequently from small rural communities and less frequently from provincial towns than expected, whereas residences at onset corresponded to the distribution in the general population. The size of the community of residence did not influence age at onset, the later progression rate or the symptoms at onset.

Patients with pelvic fractures (PF) have high incidences of associated injuries and mortality. To identify patients with PF at the highest risk for mortality on admission to a Level I trauma center, investigators analyzed 566 PF in 12,128 patients (1996 to 2005). PF were categorized on arrival as high risk (HR) or low risk (LR) by initial blood pressure, examination, radiographs, and CT. HR PF included open fractures, open-book injuries, PF 4 or greater abbreviated injury score, and hypotension (89 mmHg or less systolic blood pressure); all other cases were categorized as LR PF. Patients with PF had 6 per cent (35 of 566) mortality compared with 3 per cent (300 of 11,529) without PF. Mortality was 24 per cent (25 of 103) in HR PF, including 11 per cent (one of nine) of open fractures, 25 per cent (12 of 49) of open-book injuries, 23 per cent (14 of 62) of 4 or greater abbreviated injury score, and 33 per cent (20 of 60) of hypotensive patients compared with 3 per cent (13 of 454) of LR PF. Compared with LR PF, patients with HR PF were younger (43.5 vs 53.8 years) with higher injury severity scores (28.7 vs 11.9) and longer hospital stays (10.6 vs 7.4 days). PF mortality remains high despite treatment in a Level I trauma center. Trauma mechanism, initial blood pressure, pelvic radiography, and CT can be used to predict a patient's mortality risk.

Rib fractures (RF) are noted in 4 to 12 per cent of trauma admissions. To define RF risks at a Level 1 trauma center, investigators conducted a 10-year (1995–2004) retrospective analysis of all trauma patients. Blunt chest trauma was seen in 13 per cent (1,475/11,533) of patients and RF in 808 patients (55% blunt chest trauma, 7% blunt trauma). RF were observed in 26 per cent of children (

SummaryControlled mobilization after the surgical repair of multiple disrupted ligaments is considered to be essential for return to normal function. This study compared the outcome after post-surgical mobilization without any protection to mobilization with two transarticular external skeletal fixator hinge prototypes after surgical repair of experimental injuries to multiple stifle ligaments in 15 hounds. The repair was left unprotected (NP: n = 5), protected with a self-centering hinge (SH: n = 5) andwith a conventional hinge (CH: n = 5) for four weeks after surgical repair. Outcome measurements included: orthopaedic examination, goniometric and thigh circumference (TC) measurements, total tibial translation (TT), radiographs, and kinetic gait analysis up to 120 days post-operatively. Asignificant effect of treatment controlling for time for medial collateral stability, TC, TT, osteophyte scores, peakvertical force (PVF) and vertical impulse (VI) was not found. There was a significant difference between time points for subjective lameness scores, TC, PVF, VI, TT and osteophyte scores within treatment. Stifle extension was significantly decreased in CH dogs compared to NP dogs on day 28. Stifle flexion was significantly decreased in CH and SH dogs on day 28 compared toNP dogs. Stifle flexion was normal in all dogs by day 42. Both hinges compromised stifle flexion initially after hinge removal, but range of motion normalized within two weeks. Hinges were not indicated for adjunct treatment after repair of multiple experimentally induced ligamentous stifle injuries.

M Vaughn Emerson, Andreas K LauerCasey Eye Institute, Oregon Health and Science University, Portland, OR, USAAbstract: Age-related macular degeneration (AMD) is the leading cause of vision loss in the industrialized world. In the last few decades, the mainstay of treatment for choroidal neovascularization (CNV) due to AMD has been thermal laser photocoagulation. In the last decade, photodynamic therapy with verteporfin extended treatment for more patients. While both of these treatments have prevented further vision loss in a subset of patients, improvement in visual acuity is rare. Anti-vascular endothelial growth factor A (VEGF) therapy has revolutionized the treatment of AMD-related CNV. Pegaptanib, an anti-VEGF aptamer prevents vision loss in CNV, although the performance is similar to that of photodynamic therapy. Ranibizumab, an antibody fragment and bevacizumab, a full-length humanized monoclonal antibody against VEGF have both shown promising results with improvements in visual acuity with either agent. VEGF trap, a modified soluble VEGF receptor analogue, binds VEGF more tightly than all other anti-VEGF agents and has also shown promising results in early trials. Other treatment strategies to decrease the effect of VEGF have used small interfering ribonucleic acid (RNA) to inhibit VEGF production and VEGF receptor production. Steroids, including anecortave acetate in the treatment and prevention of CNV, have shown promise in controlled trials. Receptor tyrosine kinase inhibitors, such as vatalanib, inhibit downstream effects of VEGF, and have been effective in the treatment of CNV in early studies. Squalamine lactate inhibits plasma membrane ion channels with downstream effects on VEGF, and has shown promising results with systemic administration. Other growth factors, including pigment epithelium-derived growth factor that has been administered via an adenoviral vector has shown promising initial results. In some patients ciliary neurotrophic factor is currently being studied for the inhibition of progression of geographic atrophy. Combination therapy has been investigated, and may prove to be more effective in the management of AMD-associated CNV. Ongoing and future studies will be crucial for optimizing the treatment of patients with AMD.Keywords: age related macular degeneration, macular degeneration, VEGF, VEGF antagonist, anti-VEGF, choroidal neovascularization

To describe retinal pigment epithelial (RPE) tears in patients with age-related macular degeneration (AMD) status post pegaptanib (Macugen) injection.Six eyes from six patients who developed RPE tears while undergoing treatment with pegaptanib for AMD-related fibrovascular pigment epithelial detachment (PED) and occult choroidal neovascularization (CNV) were identified retrospectively. Diagnosis of pre-pegaptanib fibrovascular PED and post-pegaptanib RPE tears were made by clinical examination, fluorescein angiography (FA), and optical coherence tomography (OCT) imaging of the macula.Four patients developed an RPE tear within 8 weeks after the first pegaptanib injection, while RPE tears were found in two patients following a second injection. Only one of the patients reported acute vision loss, although three of six eyes had a decrease in objective visual acuity in the affected eye to the count fingers level. All six cases displayed the classic clinical and angiographic appearance of RPE tears. In addition, OCT imaging showed an irregular, hyperreflective RPE layer with a focal defect.RPE tears are known to occur in the setting of PED spontaneously or after laser treatment, but have only recently been described in association with intravitreal pegaptanib. OCT imaging of eyes status post pegaptanib therapy may be helpful in identifying this complication. Patients with AMD, especially those with occult CNV and fibrovascular PED, receiving pegaptanib therapy should be monitored for RPE tears, which may warrant deferral of further injections.

Sausage preservation methods (smoking vs. drying), as classified by Hippisley Coxe and Hippisley Coxe (1986), were compared with the prevalence of multiple sclerosis (MS) in 26 countries. Meat, pork, and animal fat consumption, divided by food energy intake, were taken as covariates. In logistic regression smoke preservation, meat consumption and animal fat consumption showed a significant association with MS in univariate analysis. In multiple logistic regression, smoke preservation was associated with MS independently from meat and pork consumption, whereas animal fat contributed with borderline significance. The data suggest an association between sausage preservation by smoking and MS. A possible causal link should be studied further by individual-based epidemiological approaches.

BACKGROUND AND OBJECTIVE To determine which skills are most important to clinicians and how they correlate with Accreditation Council for Graduate Medical Education (ACGME) competencies. PATIENTS AND METHODS A descriptive analysis to test four hypotheses: specific skill sets are likely to be important/mandatory for residents to obtain during training; comprehensive and subspecialist ophthalmologists would likely value skills similarly; year of training would likely affect the ranking of skills; and surveying practicing ophthalmologist could help to modify the educational curriculum. RESULTS Highest-ranked skill sets included interpersonal and communication skills (mean, 1.17 ± 0.08), ocular trauma (mean, 1.28 ± 0.26), and practice-based learning (mean, 1.37). Comprehensive ophthalmologists and subspecialists did not significantly differ in the ranking of skill sets. Year of graduation did not affect the ranking of skill sets. CONCLUSION The ACGME core competencies of interpersonal and communication skills and practice-based learning were ranked as highly important to both comprehensive and subspecialty ophthalmologists. These are included in ACGME core competency requirements. These findings support ACGME core competencies and the need for continued evaluation of ophthalmology residents in all areas of medical training. [Ophthalmic Surg Lasers Imaging 2007;38:107-114.] AUTHORS From the Casey Eye Institute (KSM, AKL); the School of Medicine (TEBH); and the Department of Public Health & Preventive Medicine (DC), Division of Biostatistics, Oregon Health & Science University, Portland, Oregon. Accepted for publication September 16, 2006. Supported in part by an unrestricted grant to the Casey Eye Institute from Research to Prevent Blindness, Inc., New York, New York, and Grant 5P30EY010572 from the National Institutes of Health. The authors thank Genevieve Long, PhD, for her assistance in the development and editing of this manuscript. Address correspondence to Andreas K. Lauer, MD, Casey Eye Institute, 3375 SW Terwilliger Blvd., Portland, OR 97239-4197.

To describe the design, implementation, and evaluation of a tele-education system developed to improve diagnostic competency in retinopathy of prematurity (ROP) by ophthalmology residents.A secure Web-based tele-education system was developed utilizing a repository of over 2,500 unique image sets of ROP. For each image set used in the system, a reference standard ROP diagnosis was established. Performance by ophthalmology residents (postgraduate years 2 to 4) from the United States and Canada in taking the ROP tele-education program was prospectively evaluated. Residents were presented with image-based clinical cases of ROP during a pretest, posttest, and training chapters. Accuracy and reliability of ROP diagnosis (eg, plus disease, zone, stage, category) were determined using sensitivity, specificity, and the kappa statistic calculations of the results from the pretest and posttest.Fifty-five ophthalmology residents were provided access to the ROP tele-education program. Thirty-one ophthalmology residents completed the program. When all training levels were analyzed together, a statistically significant increase was observed in sensitivity for the diagnosis of plus disease, zone, stage, category, and aggressive posterior ROP (P.05). Statistically significant changes in specificity for identification of stage 2 or worse (P=.027) and pre-plus (P=.028) were observed.A tele-education system for ROP education is effective in improving diagnostic accuracy of ROP by ophthalmology residents. This system may have utility in the setting of both healthcare and medical education reform by creating a validated method to certify telemedicine providers and educate the next generation of ophthalmologists.

Retinal vascular diseases are important causes of vision loss. A detailed evaluation of the vascular abnormalities facilitates diagnosis and treatment in these diseases. Optical coherence tomography (OCT) angiography using the highly efficient split-spectrum amplitude decorrelation angiography algorithm offers an alternative to conventional dye-based retinal angiography. OCT angiography has several advantages, including 3D visualization of retinal and choroidal circulations (including the choriocapillaris) and avoidance of dye injection-related complications. Results from six illustrative cases are reported. In diabetic retinopathy, OCT angiography can detect neovascularization and quantify ischemia. In age-related macular degeneration, choroidal neovascularization can be observed without the obscuration of details caused by dye leakage in conventional angiography. Choriocapillaris dysfunction can be detected in the nonneovascular form of the disease, furthering our understanding of pathogenesis. In choroideremia, OCT's ability to show choroidal and retinal vascular dysfunction separately may be valuable in predicting progression and assessing treatment response. OCT angiography shows promise as a noninvasive alternative to dye-based angiography for highly detailed, in vivo, 3D, quantitative evaluation of retinal vascular abnormalities.

Vegetation control after different application timings of Chopper herbicide (active ingredient imazapyr) relative to bedding was examined at four lower Coastal Plain study locations. Two bedding regimes, midseason and late-season, were examined at each location. Midseason bedding occurred between May and July and late-season bedding occurred between September and November. Results indicate that many of the historical application timing limitations placed on imazapyr are not necessary. Chopper herbicide in combination with methylated seed oil can be applied as early as February and as late as November, up to the day before bedding and immediately after bedding. Seasonal timing of application also was found to have a major impact on pine growth. For those treatments that provided good vegetation control, earlier season treatments resulted in the best pine growth. Optimal application timings were (1) June through September at least 3 weeks after midseason bedding, (2) February to the day before midseason bedding, and (3) February through July followed by late-season bedding. An exception is that if deciduous woody species such as hardwood or blackberry are targeted, early season applications (February–April) should not occur until these species have leafed out. The optimal timing windows are wide, allowing forest managers plenty of flexibility in scheduling operations. Use of optimal timing windows has the potential to substantially increase productivity without increasing costs.

The National Synchrotron Light Source II (NSLS-II) is the newest, highly optimized third-generation synchrotron facility in the world. NSLS-II accommodates a wide range of scientific research, from materials and energy science to biological applications, which take advantage of its unprecedented brightness, photon flux, and beam stability in infrared, soft and hard X-rays. New X-ray facilities like NSLS-II provide brighter beams than their predecessors, and new X-ray detectors have been built to take advantage of those higher-intensity beams. As a result, acquisition rates and detector sizes have dramatically increased. Both the raw volume of data to process and the metadata to organize it present new challenges. The technology to acquire, manage, and make full scientific use of this data is just emerging.

SummaryDestabilization is a concept of pursuing gradual staged disassembly of external skeletal fixators (ESFs) intending to increase only axial loading of the fracture while controlling non-axial loading. The purpose of this study was to determine how destabilization alters loading at the fracture site. The destabilization of a Type III to a Type Ia and Ib ESF was analyzed with the Finite Element Method (FEM) for five callus stages (0%, 0.1%, 10%, 50%, 100% modulus of elasticity of intact bone) for axial compression, torsion, and bending. Axial gap strain (A) comprising the linear displacement along the longitudinal bone axis, the remaining degrees of gap strain (R) comprising all other rotational and linear displacements and the R/A ratio were calculated. In the presence of the callus stages 0% and 0.1%, the R/A ratio ranges between 0.1 and 0.3. Destabilization increases A by two to18 fold and R by five to 41 fold. In the presence of the callus stages 10%, 50% and 100%, the R/A ratio ranges between 1 and 3.2. Destabilization increases A by 2% -15%, and R by 15% -176%. A decrease in the ESF stiffness correlates with an increase of R, A and the R/A ratio. We proposed that the clinical benefits of destabilization might be mechanically based on optimization of the R/A ratio and not of axial strain.

Graduate medical education (GME) has shifted its curricula from process-oriented approach to outcomes-oriented models. Program and faculty evaluation are methods by which educational curricula may adjust the teaching and learning environment to meet the needs and fills the gaps in GME. The measurement of educational outcomes is an essential for assessing teaching effectiveness in a shifting health care environment. In addition to trainee, program, and faculty evaluations, annual program review (APR) and evaluation and navigational changes made by the program education committee are essential to maintain effectiveness of an educational curriculum in a contemporary graduate medical training program.

You have worked hard in school over many years to excel in academic and extracurricular activities. You submitted a strong application for successful entry into medical school during which time you doubled up on your academic productivity and soaked in everything that you could possibly learn about medicine. You feel that your academic productivity paid off since you were able to obtain a residency in your favorite field: ophthalmology.

The otorhinolaryngologist is often involved in an interdisciplinary approach to diagnose ototoxic side effects. Under certain conditions, chemical agents-particularly drugs-can have ototoxic effects. This is not only true for systemic administration, but also for local application (e.g., transdermal and transtympanal). Identifying and avoiding ototoxicity is still a challenge in clinical practice. The audiological monitoring of patients receiving potentially cochleotoxic drugs is now standardized. For diagnosis of suspected vestibulotoxic effects, the video head impulse test and vestibular evoked myogenic potentials seem to be suitable procedures for objective assessment. The early detection of such ototoxic effects has important implications for the prevention of hearing and balance disorders. Recent studies show that intratympanic delivery of medications might play an important role in the limitation of ototoxically induced hearing loss. In peripheral vestibulopathies with episodic vertigo, which strongly affect quality of life, ototoxic effects can be used for therapeutic purposes.

Ototoxicity describes reversible or irreversible disorders of inner ear functions due to the influence of chemical, biological, or physical substances. Ototoxicity should be kept in mind during differential diagnosis of hearing loss, tinnitus, dizziness, and vertigo. In clinical practice, drug-induced ototoxic effects play a major role. The otorhinolaryngologist should also be involved in interdisciplinary cooperation, e.g., during treatment with antineoplastic chemotherapeutic agents with potential ototoxic side effects. In clinical practice, multimedication and interactions between different agents can complicate precise correlation in individual cases. Recent studies also show that noncellular components, such as otoconia, are extremely sensitive to chemical attacks.

In the last decade, intravitreal medications targeted to vascular endothelial growth factor (VEGF) such as pegaptanib, ranibizumab and bevacizumab have revolutionized the treatment and significantly improved visual acuity outcomes in patients with retinal vascular diseases such as age-related macular degeneration (AMD), diabetic macula edema (DME) and retinal vein occlusion (RVO). In recent years, aflibercept, an anti-VEGF drug that targets all isoforms of VEGF as well as placenta growth factor, has shown similar effectiveness in recent clinical trials. Aflibercept has firmly joined ranibizumab and bevacizu-mab as an important therapeutic option in the management of neovascular AMD. More recently, aflibercept appears to be contending with ranibizumab and bevacizumab as an important therapeutic option in the management of DME and RVO.

Background/aim: Iris nodules are an uncommon clinical sign in uveitis. The diseases most commonly associated with iris nodules and uveitis include sarcoidosis, Vogt-Koyanagi-Harada syndrome, multiple sclerosis, Fuchs’ heterochromic iridocyclitis, and metastatic infection. While many of these diseases may be appropriately treated with immunosuppressive medication, the management of infectious uveitis is antimicrobial therapy. Inappropriate immunosuppressive therapy may result in a poor outcome for the patient with an infection. Consequently, cases of uveitis with iris nodules were reviewed to identify clinical features that may help differentiate infection from non-infectious inflammation. Methods: The clinical database of 1353 consecutive patients evaluated at a tertiary care referral based North American uveitis clinic were retrospectively reviewed to identify cases of infectious uveitis with iris nodules. A Medline search was performed to identify additional cases. From these cases information regarding clinical presentation, diagnosis, treatment, and outcome were collected. Results: Three cases (three eyes) were identified from the authors’ own records of infectious uveitis with iris nodules. An additional 25 cases of infectious uveitis with iris nodules were identified in 22 published reports. Analysis of the authors’ cases and these reports showed that infectious uveitis with iris nodules was specifically characterised by some or all of the following: (1) creamy, soft appearance to the nodule(s), (2) unilateral disease, (3) persistence or growth of the nodule(s) despite corticosteroid therapy, (4) marked inflammatory response in the anterior chamber and/or vitreous humour, and/or (5) history suggesting a potential source of septic emboli. Conclusion: Certain features of the clinical history and examination are useful in the diagnosis of metastatic infection in patients presenting with uveitis and iris nodules.

Purpose:Telomerase activity appears to play a crucial role in the development of many tumors. More than 80% of all malignant human tumors show an increased telomerase activity. However, conflicting results have been reported about telomerase activity in sarcomas. The aim of the study was to obtain more information about telomerase activity in sarcomas based on a large number of cases.Methods:Telomerase activity was measured in 69 different tumor samples (33 malignant bone tumors and 36 soft tissue sarcomas). Tumor samples were obtained intraoperatively and frozen immediately in liquid nitrogen. Telomerase activity was detected by the telomeric repeat amplification assay (TRAP-assay).Results:Only 7% of the samples showed telomerase activity. No correlation between staging and telomerase activity could be observed.Discussion:The fact that only five out of 69 examined tumor samples showed a telomerase activity provides experimental evidence that in sarcomas the reactivation of telomerase may play a subordinate role. Our results suggest that alternative mechanisms for cell immortalization, yet to be determined, seem to be involved in the development and/or maintenance of soft-tissue sarcomas and malignant bone tumors.

PURPOSE The authors present a case of intraocular cysticercosis caused by Taenia crassiceps and provide further insight into this unusual infection. METHODS The clinical, laboratory, photographic, and histopathologic records of this observational case report are reviewed, as are previously published cases. RESULTS A healthy 14-year-old girl was referred to the retina service for evaluation of a total retinal detachment in her left eye. She described painless visual loss in this eye of 2 months' duration. The patient underwent a diagnostic vitrectomy to recover the organisms for identification. Thirty to forty larval T crassiceps cysticerci were recovered. CONCLUSION The clustered proliferation of 1 to 2 mm cysticerci is a distinguishing feature of intraocular cysticercosis due to T crassiceps. The organism can reside in the subretinal space, and may invade through the retina and proliferate in the vitreous cavity. When in the vitreous cavity, inflammation and proliferative vitreoretinopathy may ensue, leading within a few months to severe vision loss due to retinal detachment. Thus far, cases of intraocular T crassiceps have only been reported in female patients.

PURPOSE The purpose of this study was to report culture-positive endophthalmitis after intravitreal antibiotic injection and initial culture-negative tap. METHODS This is an interventional case report of an 84-year-old woman who underwent vitrectomy and intravitreal antibiotic injection. The main outcome measures include resolution of infection, inflammation, and visual acuity improvement. RESULTS Endophthalmitis after intravitreal pegaptanib injection was treated initially with a vitreous and aqueous tap and intravitreal antibiotic injection at a satellite clinic, because the patient was seen 5 hours from the nearest retina surgical facility. She subsequently underwent vitrectomy and intravitreal antibiotic injection. The initial culture results were negative and only the second culture was positive for Staphylococcus aureus. One year later, visual acuity was 20/30 after cataract extraction with intraocular lens implantation. CONCLUSION When a suspected endophthalmitis case is seen many hours from a retina surgical facility, it may be best to perform tap and injection of intravitreal antibiotics although vitrectomy surgery may still be required but will be delayed.

BACKGROUND Multiple myeloma is typically a disease found in older women and is a rare diagnosis in pregnancy. CASE A 22-year-old woman, gravida 1 para 0, at 32 3/7 weeks of gestation presented with nausea, vomiting, and rib and back pain. She was hypertensive, anemic, thrombocytopenic, and in acute renal insufficiency, with hypercalcemia and laboratory parameters indicative of pancreatitis. She was admitted to the obstetric intensive care unit with working diagnoses of preeclampsia, pancreatitis, nephrolithiasis, and renal insufficiency. She ultimately was delivered because of declining clinical status, and multiple myeloma eventually was diagnosed as the underlying cause of her myriad of problems. CONCLUSION Multiple myeloma is unusual during pregnancy. However, in patients with significant and unexplained hypercalcemia, malignancy should remain high on the differential diagnosis.

To evaluate the clinical, anatomic and functional effects of conversion to aflibercept following ranibizumab and/or bevacizumab in patients with neovascular age-related macular degeneration (AMD).A retrospective review of patients with neovascular AMD treated with intravitreal ranibizumab and/or bevacizumab who were switched to aflibercept was performed. The primary outcome was change in injection frequency in the year following the change. Secondary outcomes included change in central macular thickness (CMT) at 6 months and 1 year, presence of intraretinal and subretinal fluid at 6 months and visual acuity at 1 year.A total of 109 eyes with neovascular AMD were switched to aflibercept and met inclusion criteria. Overall, aflibercept injection frequency was unchanged with patients receiving 7.4 antivascular endothelial growth factor (VEGF) injections the year prior to conversion compared with 7.2 aflibercept injections in the year following (p=0.47). However, the change to aflibercept was associated with improvement in CMT from 324 to 295 μm (p=0.0001) at 6 months and 299 μm (p=0.0047) at 1 year. There was no effect on visual acuity at 1 year. In a subgroup analysis, patients who had received ≥10 anti-VEGF injections in the year prior had fewer injections (11.1 to 8.4, p0.0001) and clinic visits (13.9 to 9.6, p0.0001) as well as a significant decrease in CMT (-35 μm, p=0.02).In our population, switching to aflibercept therapy was not associated with a change in injection frequency nor improved visual acuity, but was associated with improved CMT at 6 months and 1 year. In patients who received at least 10 anti-VEGF injections in the year prior, transitioning to aflibercept was associated with a reduced injection frequency and CMT, suggesting potential cost savings in this population.

Site preparation treatments of early single bed (EB), late single bed (LB), double bed (DB), EB + banded pre-plant herbicide (PP), and EB + broadcast pre-plant herbicide (BPP) were applied to four locations in Florida. Three of the four locations included these treatments crossed with a first-year post-plant herbicide application to control herbaceous vegetation(HC). Second-year pine heights evaluated at two slash pine (P. elliottii Engelm.) locations and one loblolly pine (P. taeda L.) location averaged taller (4.6 vs. 3.5 ft) following double-pass (DB, PP, BPP) than single-pass (EB, LB) treatments, taller (4.9 vs. 4.0 ft) for pre-plant herbicide (PP, BPP) than DB, but did not differ between PP and BPP. There were no significant interactions between site preparation and HC with HC, increasing second-year pine height by 0.5 ft. Pine height was greater for pre-plant herbicide treatments than for DB treatments because pre-plant herbicide treatments provided better control of competing vegetation. Vegetation control differed among treatments. DB improved control of woody shrubs over single bedding alone, but increased herbaceous cover in the first growing season. The increase in herbaceous cover following DB accounts for the relatively small gain in second-year pine height (0.2 ft) for DB compared to LB. Pre-plant herbicide treatments following early bedding improved control of both woody shrubs and first-year herbaceous vegetation. Pre-plant herbicide treatments also shifted the composition of herbaceous vegetation towards less competitive species. HC improved control of herbaceous plants, and lowest first-year herbaceous cover was achieved with the combination of HC with pre-plant herbicide treatments. South. J. Appl. For. 25(2):75–83.

Objective To determine the prevalence of Bartonella henselae seropositivity in patients with a clinical diagnosis of neuroretinitis. Design Retrospective, clinic-based, cross-sectional study. Participants Eighteen consecutive patients seeking treatment at the Casey Eye Institute from November 1993 through November 1998 who had neuroretinitis. Methods The billing and photographic records of the Casey Eye Institute were searched for patients with a primary or secondary diagnosis of neuroretinitis or Leber's idiopathic stellate neuroretinitis. Charts were then reviewed to determine the results of B. henselae antibody titers and other pertinent clinical information. Main outcome measures Results of B. henselae serologic testing. Results Fourteen of 18 patients with neuroretinitis had serologic studies. Nine of the 14 tested patients (64.3%) were found to have elevated IgM or IgG for B. henselae , suggesting current or past infection. Patients with positive serologic analysis results tended to have worse vision at presentation. There were no other obvious differences between seropositive and seronegative groups in this study, including duration or quality of recovery. Conclusions At our tertiary care ophthalmology institution, most tested patients with neuroretinitis had evidence of past or present cat-scratch disease based on positive serologic analysis for B. henselae , a much greater prevalence than is expected to be found in the general population or in patients with idiopathic uveitis. Further study is indicated to clarify the prevalence of cat-scratch disease in neuroretinitis and the role and efficacy of antibiotics in treatment.

Objective— To determine the mechanical properties of articulations and diagonals in an 8-pin type 1b external skeletal fixator (ESF). Study Design— Finite element method—computer simulation. Methods— The control type 1b ESF was supplemented with different articulations and diagonals. The parameters of frame angle, articulation diameter, and pin- or connector-based fastening were altered. The configurations were loaded for axial compression, torsion, and craniocaudal and mediolateral bending as single loads and as a combination. Three-dimensional linear and rotational gap strain and Von Mises stress maxima were determined. Results— For 90°, 60°, and 30° frame angles and 0.48-cm-diameter articulations and diagonals, the best configurations, based on lower gap strain combined with decreased or minimally increased stress maxima for the combined load, were single or double diagonals or four horizontal articulations. Combining double diagonals with double wide horizontal articulations further lowered gap strain. For a 90° frame angle and 0.32-cm-diameter articulations and diagonals, the superior configurations, showing the lowest gap strain combined with decreased or minimally increased stress maxima for the combined load, were double diagonals, four horizontal, or wide double horizontal articulations. The 0.48-cm articulations and diagonals provided lower or similar gap strain than 0.32-cm articulations and diagonals. The connector-to-connector version of these superior configurations provided slightly lower or similar gap strain and stress maxima than the pin-to-pin version. Only pin-to-pin–fastened double diagonals provided better stress maxima than the corresponding connector-to-connector version. Conclusions— Supplementing a type 1b ESF with double diagonals and wide double articulations results in the greatest increase in stability at the fracture gap for complex fractures or in the initial phase of bone healing.

PURPOSE: To report severe ocular and orbital toxicity after administration of intracarotid etoposide phosphate and carboplatin. METHOD: Case report. RESULTS: A 52-year-old man with glioblastoma multiforme underwent left intracarotid administration of etoposide phosphate and carboplatin inferior to the ophthalmic artery. Within 7 hours, a nonpupillary block angle-closure glaucoma developed secondary to uveal effusion in the ipsilateral eye, which was relieved by cycloplegia. Four days later, severe orbital inflammation resulted in a visual acuity of counting fingers, proptosis, optic neuropathy, and total external ophthalmoplegia in the eye. The patient’s condition improved after a lateral cantholysis and administration of high-dose intravenous corticosteroids. Two weeks later, an anterior uveitis occurred in the left eye, which responded to topical corticosteroids. During a 2-month period, the patient recovered to a visual acuity of 20/70, near normal motility, and normal intraocular pressure, and the ocular and orbital inflammation resolved. Preexisting ipsilateral chemotherapy-induced maculopathy became more pronounced. CONCLUSION: Ocular and orbital toxicity after intracarotid etoposide phosphate and carboplatin therapy is infrequently reported.

Herbicide treatments were used at four flatwood locations in north Florida and south Georgia to compare early pine response to control of herbaceous and shrub vegetation following bedding. Treatments consisted of three levels of shrub control (none, first year, repeated) with and without first year herbaceous vegetation control. All studies were located on spodosols planted with either loblolly (Pinus taeda L.) or slash (Pinus elliottii Englem.) pine. Responses due to shrub control were about twice that of herbaceous control with height responses of 2.2, 5.0, and 6.9 ft due to first year herbaceous control, shrub control, and the combination of both herbaceous and shrub control, respectively. Pine response did not differ due to duration of shrub control because the difference in shrub cover between first year and repeated shrub control treatments was minor in these young stands. Pines averaged 18.3 ft in height and 3.2 in. in dbh 5 yr after planting when both herbaceous and shrub vegetation was controlled with these operational-like site preparation treatments that combine bedding with first year herbicide applications. Shrub occupancy was highest on treatments that did not include shrub control and continued to increase through the first 5 yr. Operational site-preparation treatments that combine bedding with herbicide applications should be considered in situations where shrub vegetation is present because of the long-term impact that shrubs have on pine yield. South. J. Appl. For. 15(4):201-208.

The authors report a case of typical acute posterior multifocal placoid pigment epitheliopathy in which an ocular coherence tomographic scan was performed through an acute lesion and then repeated through the same lesion 12 months later. The initial ocular coherence tomographic scan showed marked anterior displacement of both neuroretina and outer reflective band. A subsequent ocular coherence tomographic scan revealed resolution of the prior displacement, increased reflectance of the outer reflective band and mild disruption of the outer retinal layers. These findings are consistent with a primary choroiditis.

This report describes the features, treatment and outcome of globe perforation by a Taser dart electrode in a 21-year-old man. The Taser electrode caused mechanical iris, lens and retinal injury and consequent retinal detachment as result of proliferative vitreoretinopathy. The effect of electrical stimulation on ocular tissues is unknown. After the scleral and corneal wounds, traumatic cataract and retinal tear were repaired, the patient regained a visual acuity of 6/18. Nine months later a retinal detachment with proliferative vitreoretinopathy was discovered. The Taser may cause globe perforation and posterior segment injury. Understanding the barbed configuration of the dart electrode is important when extricating this device. Visual recovery is possible despite electric discharge of the Taser and suggests that the mechanism of ocular injury is largely mechanical.

PURPOSE The purpose of this study was to compare images of the retina and choroid obtained with Spectralis 1050-nm spectral-domain optical coherence tomography (SD-OCT) with and without enhanced depth imaging (EDI) to the commercially available 870-nm SD-OCT with and without EDI. METHODS Full-length 30° line scans were obtained with both 870- and 1050-nm Spectralis OCT instruments, with and without EDI. Two trained retina physicians masked to wavelength and EDI status assessed the ability to visualize the vitreoretinal interface and full-thickness choroid, and subfoveal choroidal thickness (SFCT) was measured. RESULTS Included in the study were 21 eyes. The vitreoretinal interface was visualized best with 870-nm OCT without EDI and was diminished with 1050-nm OCT. Graders preferred 1050 nm with EDI over 870 nm with EDI in qualitative comparisons of the choroid; 1050 nm without EDI was slightly preferred over 870 nm with EDI but was not statistically significant. SFCT measurements correlated well among the imaging modalities except for 870 nm without EDI. CONCLUSIONS SD-OCT with EDI at 870 nm provides good visualization of both the vitreoretinal interface and choroid, whereas 1050-nm SD-OCT with or without EDI provides more choroidal detail at the expense of visualization of the vitreoretinal interface. TRANSLATIONAL RELEVANCE Use of longer wavelength 1050-nm SD-OCT provides greater choroidal detail compared with 870-nm SD-OCT, but has reduced detail of the vitreoretinal interface. The significance of this trade-off for clinical management of retinal disease needs further evaluation.

To compare the outcomes of combination systemic and intravitreal antiviral therapy vs systemic antiviral therapy alone for treating acute retinal necrosis syndrome (ARN). We hypothesize that combination therapy might result in superior visual acuity (VA) and retinal detachment (RD) outcomes vs traditional systemic antiviral therapy alone.A retrospective, interventional, comparative single-center study of patients with ARN. We reviewed demographic data, herpesvirus diagnoses, polymerase chain reaction (PCR) results, VA, RD, and the use of systemic and intravitreal antiviral therapy. Outcome measures included VA improvement by 2 or more lines, severe visual loss, VA ≤20/200, and RD.We studied 29 eyes of 24 patients, treated from 1987 through 2009. Mean age was 42.6 years and mean follow-up was 44.0 months. Twelve patients (14 eyes) were treated with combined systemic and intravitreal antiviral therapy and 12 patients (15 eyes) with systemic therapy alone. Kaplan-Meier survival analysis revealed that patients receiving combination intravitreal and systemic antiviral therapy were more likely to have VA improved by 2 lines or greater (P=.006). Patients receiving combination therapy also showed a decreased incidence of progression to severe visual loss (0.13/patient-years [PY]) compared to patients receiving systemic therapy alone (0.54/PY, P=.02) and had decreased incidence of RD (0.29/PY vs 0.74/PY, P=.03).Combination oral and intravitreal antiviral therapy may improve visual and functional outcomes in patients with ARN. Clinicians should consider prompt administration of combination systemic and intravitreal antiviral therapy as first-line treatment for patients with clinical features of ARN.