High acceptability of HIV voluntary counselling and testing among female sex workers: impact of individual and social factors.

OBJECTIVES: Voluntary counselling and testing (VCT) for HIV infection is an important tool for prevention of HIV infection and AIDS in high-risk groups. Our goal was to describe the acceptability and consequences of VCT among a stigmatized and vulnerable group, female sex workers (FSWs), in Conakry, Guinea. METHODS: Acceptance of the test and return for test results at baseline and consequences of testing 1 year later were described. The perceived risk of HIV infection and perceived benefits and barriers to testing were examined using quantitative and qualitative methods. RESULTS: All 421 FSW participants agreed to undergo VCT and most participants (92%) returned for their results. The main reason cited for VCT acceptance was the wish to know their HIV status. However, some managers of FSW worksites urged FSWs to be tested, curtailing FSWs' free decision-making. One year later, status disclosure was common (90% of the 198 individuals who knew their results among those who participated in the follow-up part of the study). Positive consequences of testing were far more frequently reported than negative consequences (98% vs. 2%, respectively). Negative life events included banishment from the worksite (one case) and verbal abuse (two cases). CONCLUSION: Acceptability of VCT appears high in the FSW population in Conakry as a consequence of both perceptions of high individual risk and social pressures.

Work-related accidents and daylight saving time in Finland.

BACKGROUND: Recent research has indicated that transitions into and out of daylight saving time (DST) unbalance the physiological circadian rhythm and may lead to sleep disturbance. Sleep deprivation may have negative effects on motivation, attention and alertness and thus it is possible that transitions into and out of DST may increase accident rates. AIMS: To explore the impact of DST transitions on the number of occupational accidents in Finland. METHODS: For the study, we analysed all occupational accidents that happened in Finland 1 week before and 1 week after DST transitions during the years 2002-06. RESULTS: Transitions into and out of DST did not significantly increase the number of occupational accidents. CONCLUSIONS: It seems that sleep deprivation after DST transition is not harmful enough to impact on occupational accident rates.

Load carrying walking test and its relationships to endurance and neuromuscular capabilities in women and men of different ages.

The aim of this study was to examine load carrying walking test (TMload) performance on the treadmill and its associations to endurance and neuromuscular capabilities in women and men of different ages. Sixty participants (aged 28 to 71 years) were divided into young, middle-aged and old groups of both genders. Clinical stress test was performed by stationary cycle ergometer (CEload). Peak oxygen uptake (VO2peak), heart rate and lactate concentration were measured using maximal TMload test. Isometric strength and EMG-activity of upper and lower extremities were measured before and after TMload. VO2peak of TMload correlated significantly with TMload exercise time (ET) in all other groups (r=0.67 to 0.91 and p ≤ 0.05 to p<0.001) except old men. Leg extension force decreased (p ≤ 0.05 to p<0.001) after TMload in all groups, grip force in young groups (p ≤ 0.05), while plantar flexion force and all EMGs remained unchanged. In men VO2peak explained 81% and in women VO2peak and age explained 87% of the total variation of the TMload ET. In conclusion, ET of TMload is associated with high VO2peak, but not with muscle strength or its changes during the loading. The present load carrying walking test may be used for testing workers with heavy loading in their occupation or in rehabilitation purposes. Further research is needed to examine in more detailed the loading model of the present study as well as the effects of different types of training on load carrying performance.

Invasive group A streptococcal infection outbreaks of typeemm118 in a long-term care facility, and of type emm74 in the homeless population, Montréal, Quebec.

BACKGROUND: Two invasive group A streptococcus (iGAS) infection outbreaks occurred in Montreal in 2016 and 2017; one in a long-term care facility (typeemm118) and one in the community, primarily involving homeless people (typeemm74). OBJECTIVE: To describe two recent iGAS outbreaks in Montréal and highlight the challenges in dealing with these outbreaks and the need to tailor the public health response to control them. METHODOLOGY: All cases of iGAS were investigated and the isolates were sent to the laboratory foremmtyping. In both outbreaks, cases of superficial group Astreptococcus(GAS) infection were identified, through 1) systematic case detection accompanied by screening for asymptomatic carriers among residents and employees of the long-term care facility and 2) sentinel surveillance among homeless people. Visits were made to community organizations providing homeless services (including shelters) and social networks were analyzed to establish whether there were any links among cases of GAS infection (both invasive and noninvasive) and locations frequented. In both outbreaks, recommendations were made to service providers regarding enhancement of infection prevention and control measures. RESULTS: In the long-term care facility, five cases of typeemm118 iGAS were identified over a 22-month period, one of which resulted in death. All residents were screened and no carriers were identified. Among the employees, 81 (65%) were screened and fourcarriers were identified. Of those, one was a carrier of typeemm118 GAS. All carriers were treated, and subsequent follow-up sampling on three carriers (including the one withemm118) was negative.In the community, 23 cases of typeemm74 iGAS were detected over a 16-month period, four of which resulted in death. Half of the cases (n=12) were described as homeless, and six others were users of services for the homeless. Sentinel surveillance of superficial infections yielded 64 cultures with GAS, chiefly on the skin, including 51 (80%) of typeemm74. An analysis of the social networks revealed the large number and variety of resources for the homeless used by the cases. Visits to the community organizations providing homeless services revealed the heterogeneity and precariousness of some of these services, the difficulties encountered in applying adequate health and hygiene measures, and the high degree of mobility amongst those who use these services. CONCLUSION: The detection and control of iGAS outbreaks in both long-term care establishments and among community organizations providing homeless services are very complex. An outbreak of iGAS can develop in the background over a long time and be easily overlooked despite cases being admitted to the hospital.Emmtyping and systematic research of previous cases of iGAS are essential tools for the detection and characterization of outbreaks. Close cooperation among public health agencies, clinical teams, community organizations and laboratories is essential for proper monitoring and the reduction of GAS transmission in the community and health care settings.

Gonorrhea in Canada, 2010-2015.

BACKGROUND: Gonorrhea is the second most commonly reported sexually transmitted infection (STI) in Canada after chlamydia, and rates for this STI have been increasing since 1997. OBJECTIVE: To summarize trends observed in gonorrhea rates for 2010-2015 in Canada. METHODS: Laboratory-confirmed cases of gonorrhea are reported to the Public Health Agency of Canada (PHAC) by all of the Canadian provinces and territories. The overall national rate was computed, as were rates per sex, age group and province/territory. RESULTS: In 2015, 19,845 cases of gonorrhea were reported in Canada, corresponding to a rate of 55.4 cases per 100,000 population and a 65.4% increase from 2010 (33.5 cases per 100,000 population). Males had consistently higher rates than did females (70.2 per 100,000 versus 40.6 per 100,000 in 2015) and faster rising rates (85.2% versus 39.5% in 2010-2015). Rates among adults 60 years and older increased faster than rates among younger people, although the highest rates were among those 15-29 years of age. The Northwest Territories, Nunavut and Yukon had the highest gonorrhea rates in 2015. CONCLUSION: Males, adolescents and young adults continue to represent the majority of gonorrhea cases. Research is needed to better understand the current trends in gonorrhea infection in order to maintain, evaluate and improve primary and secondary STI prevention activities.

Infectious and congenital syphilis in Canada, 2010-2015.

BACKGROUND: Syphilis is the third most commonly reported notifiable sexually transmitted infection (STI) in Canada, following chlamydia and gonorrhea, respectively. Rates of this STI have been rising rapidly in Canada since 2001. OBJECTIVE: To summarize trends observed in syphilis rates for 2010 to 2015 in Canada. METHODS: Laboratory-confirmed cases of infectious syphilis and early congenital syphilis were reported to the Public Health Agency of Canada by all of the Canadian provinces and territories. National infectious syphilis rates were computed, as were rates per sex, age group and province/territory. Rates of congenital syphilis were also calculated. RESULTS: From 2010 to 2015, the rate of infectious syphilis in Canada increased by 85.6%, from 5.0 to 9.3 cases per 100,000 population. In 2015, a total of 3,321 cases of infectious syphilis were reported, mainly in males (93.7%), among whom the rate was 17.5 cases per 100,000 males versus 1.2 per 100,000 females. The rate also rose faster among males in 2010-2015, a 90.2% increase versus 27.8% among females. Individuals aged 20-39 years had the highest rates. Across the provinces and territories, the highest rates of infectious syphilis were in Nunavut, British Columbia and Manitoba.​: The rate of congenital syphilis decreased from 2010 to 2014 (1.6 to 0.3 cases per 100,000 live births) before increasing to 1.5 cases per 100,000 live births in 2015, which corresponds to six reported cases. CONCLUSION: Rates of syphilis continue to rise in Canada, especially among young men, and this is consistent with trends in the United States of America and European Union. Based on data from Canada and from these regions, the sexual behaviour of men who have sex with men (MSM) is thought to be a major risk factor for syphilis.

Chlamydia in Canada, 2010-2015.

BACKGROUND: Chlamydia is the most commonly reported notifiable sexually transmitted infection in Canada. Rates have been steadily increasing since 1997. OBJECTIVE: To summarize trends in chlamydia rates for the period 2010-2015 in Canada. METHODS: Laboratory-confirmed cases of chlamydia were reported to the Public Health Agency of Canada by all the Canadian provinces and territories. The overall national rate was computed, as were rates per sex, age group and province/territory. RESULTS: In 2015, a total of 116,499 cases of chlamydia were reported in Canada, corresponding to a rate of 325 cases per 100,000 population. Females accounted for the majority (two-thirds) of chlamydia infections from 2010 to 2015. However, rates among males rose faster during this time period. Youth and young adults aged 15-29 years had the highest rates in 2015. While increased rates were observed over time for most age groups, adults aged 40 years and older had the greatest increase (51%) between 2010 and 2015. Chlamydia rates increased in most provinces during this period, with the highest rates being reported by the Northwest Territories and Nunavut in 2015. CONCLUSION: Between 2010 and 2015, chlamydia rates increased by 16.7% and were highest among females and young adults. Although a number of factors may account for this rising trend, the possibility of a true increase in incidence cannot be ruled out. Ongoing monitoring of chlamydia and research into the reasons for the observed changes will help guide sexually transmitted infection (STI) prevention and control activities.

Impact of availability of direct-acting antivirals for hepatitis C on Canadian hospitalization rates, 2012-2016.

BACKGROUNDS: Hospitalizations associated with hepatitis C virus (HCV) infection and liver disease increased on average by 6.0% per year from 2004 to 2010 in Canada and were projected (in 2010) to increase by another 4% by 2016. The first generation of direct-acting antivirals (DAAs) became available in 2012. In 2014, a second generation of effective and well-tolerated DAA therapy was authorized in Canada. The impact of DAA therapy on the HCV-associated disease burden in Canada has not been documented. OBJECTIVES: To assess the potential impact of DAA therapy on the disease burden by a) comparing the actual hospitalization rates associated with HCV infection and liver disease following the introduction of DAAs in Canada with the 2010 baseline projection and b) documenting the associated uptake of anti-HCV therapy. METHODS: The hospital records of inpatients diagnosed with chronic HCV and chronic liver disease were extracted from the Canadian Discharge Abstract Database (DAD) by fiscal year for 2004-2016. We compared the actual number of hospitalizations to the baseline projection by year and for selected 5-year birth cohorts (1925-1989). The monthly number of new prescriptions for anti-HCV regimens was extracted from the IQVIA CDH CompuScript database (formerly IMS Health), aggregated to annual levels by age group and compared with hospitalization trends. RESULTS: Compared to the baseline projection, there was a slight reduction in hospitalizations in 2014/15 and 2015/16. This slight reduction was followed by a more significant decline in 2016/17 (32% below expected; 95% confidence interval [CI]: 27%-37%). The largest declines were observed for patients born before 1960 (age 55 or older) at 40% below expected in 2016/17. The number of new anti-HCV prescriptions increased from 5,484 in fiscal year 2012/13 to a peak of 17,775 in 2015/2016. The number of new prescriptions corresponds to approximately 1.3 and five times the number of hospitalizations in 2012/13 and 2015/16, respectively. CONCLUSIONS: In Canada there has been a modest decrease in HCV and liver-related hospitalizations following a significant increase in uptake of second-generation DAAs in 2015. However, the burden is still high. Linked health administrative databases created to monitor the disease burden in the new treatment era should provide additional insight with the linkage of treatment history and disease stage to individual outcomes.

The flow properties and presence of crystals in drug-polymer mixtures: Rheological investigation combined with light microscopy.

The presence of solid matter in polymer melts affects the rheological properties of a drug-polymer mixture, and thus the processability of these mixtures in melt-based processes. The particle morphological changes related to dissolution and crystal growth in the mixtures of paracetamol and ibuprofen with polyethylene oxide and methacrylate copolymer (Eudragit® E PO) were observed by polarized microscopy simultaneously while measuring their rheological properties within temperature ranges relevant for melt processes, such as hot melt extrusion and fused deposition modeling 3D printing. The dissolution of solid crystalline matter into the molten polymer and its effects on the rheological parameters showed that the plasticization effect of the drug was highly dependent on the temperature range, and at a temperature high enough, plasticization induced by the small-molecule drugs could enhance the flowability even at very high drug loads. Therefore, even supersaturated mixtures can be plasticized efficiently, enabling their melt processing, such as hot melt extrusion or 3D printing. The combination of rheometry and polarized light microscopy proved to be very useful for studying the link between morphological changes in the drug-polymer and the flow behavior of the drug-polymer mixtures at different temperature ranges and deformation modes.

The effect of poly (lactic-co-glycolic) acid composition on the mechanical properties of electrospun fibrous mats.

The aim of this study was to investigate the influence of polymer molecular structure on the electrospinnability and mechanical properties of electrospun fibrous mats (EFMs). Polymers with similar molecular weight but different composition ratios (lactic acid (LA) and glycolic acid (GA)) were dissolved in binary mixtures of N,N-dimethylformamide (DMF) and tetrahydrofuran (THF). The intrinsic viscosity and rheological properties of polymer solutions were investigated prior to electrospinning. The morphology and mechanical properties of the resulting EFMs were characterized by scanning electron microscope (SEM) and dynamic mechanical analysis (DMA). Sufficiently high inter-molecular interactions were found to be a prerequisite to ensure the formation of fibers in the electrospinning process, regardless the polymer composition. The higher the amount of GA in the polymer composition, the more ordered and entangled molecules were formed after electrospinning from the solution in THF-DMF, which resulted in higher Young's modulus and tensile strength of the EFMs. In conclusion, this study shows that the mechanical properties of EFMs, which depend on the polymer molecule-solvent affinity, can be predicted by the inter-molecular interactions in the starting polymer solutions and over the drying process of electrospinning.

Outbreak of tuberculosis among substance users and homeless people in Greater Montréal, Canada, 2003-2016.

BACKGROUND: In Canada, active tuberculosis (TB) is found mainly among migrants from endemic countries and Indigenous populations. However, cases of active tuberculosis in substance users and homeless persons have been reported in Greater Montréal since 2003. OBJECTIVE: To describe the Montréal TB outbreak in terms of the sociodemographic characteristics, risk factors and clinical characteristics of cases, as well as the intensity of public health interventions, the follow-up and identification of locations of potential transmission. METHODS: All cases of active tuberculosis with the same genotype of interest residing in Quebec and epidemiologically linked cases were included in the analysis. Data were retrospectively extracted from routine public health investigations. Characteristics of cases were summarized using Excel. Spatial analysis of locations frequented during cases' infectiousness periods was performed. RESULTS: Between January 2003 and February 2016 a total of 35 cases were identified. Most (86%) were non-Indigenous people born in Canada. Of these, 28 had several risk factors, including substance use (93%), alcohol abuse (64%), homelessness (46%), comorbidities such as HIV coinfection (36%) and advanced stage of the disease. Seven cases without risk factors were all close contacts of cases. Intensity of case management by public health authorities was high. Locations frequented by cases with risk factors included crack houses, shelters and rehabilitation centers in Montréal's downtown core and a residential setting in a suburban area. CONCLUSION: TB outbreaks can occur in marginalized Canadian-born urban populations, especially those with substance use. Tailored interventions in this population may be needed for screening, and earlier identification of both latent and active TB and better linkage to care.

Electronic patient record systems and the general practitioner: an evaluation study.

We studied how well electronic patient record (EPR) systems meet the needs of general practitioners (GPs) and other health-care professionals for specific information. GPs in eight health centres in the South-Ostrobothnia region of Finland were invited to participate. They used three types of EPR system. They were asked to access EPRs to obtain 20 types of information for patients receiving anticoagulant treatment. In total 2,389 patient cases were studied. All of the information requested was available for 73% of the cases (range 55-93%). There was a significant difference between the type of EPR system and the percentage of patients for whom information was available through the EPR. However, further analysis showed that differences in performance between EPR systems probably reflected differences in the way EPRs were used by different organizations. Great care should be taken in attempts to rank EPR systems based on their performance.

A technique for visual confirmation of intrathoracic placement of tube thoracostomy using a fiberoptic laryngoscope in a cadaver.

PURPOSE: Safe intrathoracic placement of chest tubes is a continual challenge. Current techniques for determining the intrathoracic location of the thoracostomy site include blunt dissection and digital exploration, with subsequent tube placement. Using current techniques, complication rates for this procedure approach 30%. We present a novel technique using available endotracheal intubation technology for determining intrathoracic placement of tube thoracostomy. METHODS: One cadaver was used for placement of tube thoracostomy. Both sides of the thorax were prepared in the standard fashion for tube thoracostomy placement, and tube thoracostomy was performed on each hemithorax at interspaces 3 through 7. The right side of the thorax was used for standard thoracostomy placement, and the left side was used for fiberoptic visualization of thoracostomy placement using a video laryngoscope. Thoracic wall thickness was measured at all thoracostomy sites. Proper placement and any injuries were documented for each site. RESULTS: Chest wall thickness ranged from 2.4 to 3.8 cm on the right and 2.8 to 4.0 cm on the left. With use of fiberoptic thoracostomy, no injuries were generated. During the standard thoracostomy placement in the sixth intercostal space, a pulmonary laceration was caused using blunt dissection. CONCLUSIONS: Use of a fiberoptic laryngoscope offers a novel technique for direct visualization the thoracic space during tube thoracostomy. Further studies are needed to determine the safety of this technique in patients.

Fine structure and sugar transport functions of the tegument in Clinostomum marginatum (Digenea: Clinostomatidae): environmental effects on the adult phenotype.

Digenean flukes can be classified into 3 groups according to their location in the host: the lumen of the alimentary canal or associated organ, body cavity or tissue, and external surfaces. We obtained adults of Clinostomum marginatum that had matured in these 3 habitats and compared the fine structure and glucose transporting capacity of their teguments. Adults from the esophagus of herons, Ardea herodias, had thick, smooth teguments and took up glucose by facilitated diffusion, the type of transport that is Na(+)-independent and insensitive to phlorizin. By contrast, the surfaces of adults cultured from metacercariae in body cavities of laboratory mice were amplified 3-5-fold due to numerous irregular projections of the tegument. Glucose transport by these worms was largely Na(+)-dependent and inhibited by phlorizin, indicating active transport. Ectoparasites from herons' mouths had relatively thick, smooth teguments, but these worms always were encrusted with bacteria and yeast that are known to absorb and metabolize glucose. Most of the attached bacteria, and the apparent glucose uptake associated with their presence, were removed by treating the worms with antibiotics prior to transport assays. As facilitated diffusion and active transport are operational simultaneously in metacercariae, the type of transport function, if any, expressed in the adult is determined by environmental conditions associated with the worm's habitat.

Bacteria associated with tegument of Clinostomum marginatum (Digenea).

Adults of Clinostomum marginatum freshly collected from a heron, Ardea herodias, were examined using transmission electron microscopy. Specimens from the mouth of the bird were encrusted with bacteria that were not removed by washing unless the saline contained antibiotics. There was no evidence that the attached bacteria were damaging to the trematode tegument. Three species of Gram-negative bacteria were isolated from the worm surfaces and identified; Achromobacter sp. was present in pure culture on 4 of 6 original cultures and in mixed culture with Edwardsiella tarda and Enterobacter agglomerans in 2 cultures. These species and 3 unidentified species of bacteria were isolated from the oral epithelium of the heron. Microorganisms were not seen attached to the surfaces of worms recovered from the esophagus. Because E. tarda and E. agglomerans were the only species isolated from the heron esophagus, the intimate bacterial-worm association in the heron mouth may be due specifically to Achromobacter sp.

The parasite fauna of the American alligator (Alligator mississippiensis) in South Carolina.

Twelve American alligators (Alligator mississippiensis) were obtained from three different areas of South Carolina. One species of pentastome (Sebekia oxycephala), two species of nematodes (Dujardinascaris waltoni and Multicaecum tenuicolle), four species of trematodes (Polycotyle ornata, Acanthostomum coronarium, Archaeodiplostomum acetabulatum and Pseudocrocodilicola americaniense) and one species of hemogregarine (Haemogregarina crocodilnorum) were recovered. Polycotyle ornata was observed only in alligators from Par Pond while P. americaniense was found in Par Pond and coastal hosts, A. acetabulatum from Kiawah Island and coastal alligators, and A. coronarium only at Kiawah Island. These patterns suggest disjunct distributions for the trematode species in South Carolina alligators. The other parasites were found in alligators from all three locations. The only parasite observed to initiate damage or lesions in the alligator was the pentastome.

Serologic profile of exotic deer at Point Reyes National Seashore.

Serotests were conducted on axis (Axis axis) and fallow (Dama dama) deer at Point Reyes National Seashore to determine their status with respect to nine diseases enzootic to the native black-tailed deer (Odocoileus hemionus columbianus) or to resident dairy cattle. In the exotic deer, the proportion of animals that were seropositive included: anaplasmosis, 35%; bluetongue, 48%; brucellosis, 0%; bovine viral diarrhea, 2%; infectious bovine rhinotracheitis, 3%; leptospirosis, 7%; parainfluenza-3, 49%; toxoplasmosis, 8%; and Q fever, 51%. The prevalence of antibodies among a small sample of the black-tailed deer included anaplasmosis, 100%; toxoplasmosis, 29%; and Q fever, 57%. The antibody prevalences in a sample of dairy cattle in the area included anaplasmosis, 19%; toxoplasmosis, 8%; and Q fever, 100%.

Injuries associated with the use of ejection seats in Finnish pilots.

During the years 1958-91 17 Finnish pilots were forced to use ejection seats. The aircraft types were as follows: a) BA Hawk in 6 instances; b) a Mig 21-F-13 in 4; c) a Mig-21-Bis in 3; d) a Gnat Folland in 2; e) a Vampire Trainer in 1; and f) a MU-3 in 1 case. There were 3 ejections completed successfully, 12 pilots sustained slight injuries, and 5 pilots suffered major injuries--3 from compression fractures of the thoracic spine, 1 from fracture of the femur, and 1 from rupture of the medial collateral ligament of the knee. All major injuries were associated with Soviet aircraft. One BA-Hawk pilot died due to a direct impact against a tree after a low-altitude ejection. Two pilots launched the seat under negative G-forces. One of these became temporarily blind, and suffered a partial loss of vision for 3 months. Four Hawk pilots were saved during landing phase by a tandem ejection, receiving only minor injuries.

On the significance of heterophoria for stereoscopic vision.

This study was undertaken to explain the possible correlation between heterophoria and stereopsis because, in the literature, there are different opinions. The subjects were 806 recruits. They were trained as rangefinder men, of whom a perfect stereopsis is required. The permitted maximal limits of heterophoria were 1 prism diopter (PrD) vertically, of esophoria 5 PrD, and of exophoria 6 PrD. Soldiers wit abnormal stereopsis, myopia, hyperopia more than 1.75, or astigmatism over 0.50 diopters, were omitted. The heterophoria was tested with Herschel's prism to 5 m distance. The stereoscopic vision was investigated using Pulfrich's device and the so-called three-needle test. No statistically significant correlation could be demonstrated between heterophoria and the degree of stereopsis. Surprisingly, it could be noticed that persons with esopheria finshed Pulfrich's test more quickly than those with exophoria. This difference was statistically highly significant. In the three-needle test, the results had the same trend. This might have some importance to rangefinder men and to pilots if it can be confirmed in the military practice.

Heterophoria--its influence on stereopsis and the importance of cycloplegia in refraction testing of pilot applicants.

Heterophoria, its influence on stereopsis, and the importance of cycloplegia in refraction testing of pilot applicants were studied. Distant heterophoria was found in 94.5-100% while near heterophoria was found in 86.9-98.1% of the cases, depending on the test used. Hyperphoria of over 1 prism diopter was extremely rare. No statistically significant correlation between distant heterophoria and the degree of stereopsis could be demonstrated at a range of up to at least 6 prism diopters. Cycloplegia induced a mean difference of +0.75 diopter in refraction before and during cycloplegia. Eight percent of the applicants failed because of refractive errors (spherical extremes, -0.75 diopter and +4.50 diopters; cylindrical extreme, 1.25 diopters). It is concluded that stereopsis does not seem to be affected much by heterophoria within moderate limits, and that cycloplegia in refraction testing of young pilot applicants must be considered relatively important.