Assessment of Visual Quality Improvement as a Result of Spectacle Personalization.

Personalized spectacles customized according to an individual's facial anatomy were developed to provide enhanced visual performance and overall comfort when compared to standard spectacles. In this comparative crossover trial, each subject was randomly assigned to wear either personalized spectacles or standard spectacles for two weeks and then tried the second pair for another two weeks. Visual acuity and reading speed were measured, and visual quality and comfort were assessed using specific questionnaires. The correlation of the wearing parameters with the subjects' satisfaction was calculated. According to our results, the subjects wearing personalized glasses reported significantly less experience of swaying and significantly higher overall satisfaction compared to those wearing the control spectacles. At the end of the study, 62% of subjects preferred the personalized spectacles, and visual quality was the primary reason for their spectacle preference followed by wearing comfort. The difference from the ideal cornea-vertex distance was significantly lower when wearing the personalized spectacles compared to the control frames. In addition, the absolute value of the difference from the ideal cornea-vertex distance was significantly correlated with patient satisfaction. These results suggest that personalized spectacles, customized according to an individual's facial anatomy for the ideal wearing parameters, result in both visual and comfort advantages for wearers.

Manufacturing pharmaceutical mini-tablets for pediatric patients using drop-on-demand printing.

The pharmaceutical industry has traditionally manufactured medicines in a limited range of dose strengths, with an emphasis on addressing the needs of the largest patient subgroups. This has disadvantaged smaller patient subsets, such as children, who often cannot find drug products in dosage levels suitable for their requirements. In recent years, development of pharmaceutical mini-tablets has emerged as an attractive solution to this problem. These are small-size dosages that offer attractive features such as flexible and personalized drug dosing, ease of swallowing, and tailored drug release, making them an excellent choice for administering medicines to children. This study presents a novel technique for manufacturing pharmaceutical mini-tablets, using a drop-on-demand (DoD) printing system. In this method, a DoD system is used to generate precise droplets of a melt-based formulation, which are then captured and solidified in an inert solvent bath to produce individual mini-tablets. The study also evaluates the performance of this technique for various formulations, and quantifies two critical quality attributes (CQAs) of the resulting mini-tablets: content uniformity and dissolution behavior. The findings demonstrate that the manufactured mini-tablets can meet regulatory specifications for both CQAs, and that their release profiles can be customized by modifying the excipients used. The study also discusses promising areas of application and limitations of this technique.

Analyzing the impact of COVID-19 on the electricity demand in Austin, TX using an ensemble-model based counterfactual and 400,000 smart meters.

The COVID-19 pandemic caused lifestyle changes and has led to the new electricity demand patterns in the presence of non-pharmaceutical interventions such as work-from-home policy and lockdown. Quantifying the effect on electricity demand is critical for future electricity market planning yet challenging in the context of limited smart metered buildings, which leads to limited understanding of the temporal and spatial variations in building energy use. This study uses a large scale private smart meter electricity demand data from the City of Austin, combined with publicly available environmental data, and develops an ensemble regression model for long term daily electricity demand prediction. Using 15-min resolution data from over 400,000 smart meters from 2018 to 2020 aggregated by building type and zip code, our proposed model precisely formalizes the counterfactual universe in the without COVID-19 scenario. The model is used to understand building electricity demand changes during the pandemic and to identify relationships between such changes and socioeconomic patterns. Results indicate the increase in residential usage , demonstrating the spatial redistribution of energy consumption during the work-from-home period. Our experiments demonstrate the effectiveness of our proposed framework by assessing multiple socioeconomic impacts with the comparison between the counterfactual universe and observations.

The Assessment of Acute Chorioretinal Changes Due to Intensive Physical Exercise in Senior Elite Athletes.

Regular physical exercise is known to lower the incidence of age-related eye diseases. We aimed to assess the acute chorioretinal alterations in older adults following intense physical strain. Seventeen senior elite athletes were recruited who underwent an aerobic exercise on a cycle ergometer and macular scanning by optical coherence tomography. A significant thinning of the entire retina was observed 1 min after exercise, followed by a thickening at 5 min, after which the thickness returned to baseline. This trend was similar in almost every single retinal layer, although a significant change was observed only in the inner retina. Choroidal thickness changes were neither significant nor did they correlate with the thickness changes of intraretinal layers. The mechanism of how these immediate retinal changes chronically impact age-related sight-threatening pathologies that, in turn, result in a substantially reduced quality of life warrants further investigation on nontrained older adults as well.

Techno-economic analysis of dynamic, end-to-end optimal pharmaceutical campaign manufacturing using PharmaPy.

Increased interest in the pharmaceutical industry to transition from batch to continuouos manufacturing motivates the use of digital frameworks that allow systematic comparison of candidate process configurations. This paper evaluates the technical and economic feasibility of different end-to-end optimal process configurations, viz. batch, hybrid and continuous, for small-scale manufacturing of an active pharmaceutical ingredient. Production campaigns were analyzed for those configurations containing continuous equipment, where significant start-up effects are expected given the relatively short campaign times considered. Hybrid operating mode was found to be the most attractive process configuration at intermediate and large annual production targets, which stems from combining continuous reactors and semi-batch vaporization equipment. Continuous operation was found to be more costly, due to long stabilization times of continuous crystallization, and thermodynamic limitations of flash vaporization. Our work reveals the benefits of systematic digital evaluation of process configurations that operate under feasible conditions and compliant product quality attributes.

The assessment of acute chorioretinal changes due to intensive physical exercise in young adults.

PURPOSE: There is abundant evidence on the benefits of physical activity on cardiovascular health. However, there are only few data on the acute effects of physical exercise on the retina and choroid. Our aim was the in vivo examination of chorioretinal alterations following short intense physical activity by spectral domain optical coherence tomography (SD-OCT). METHODS: Twenty-one eyes of 21 healthy, young subjects (mean age 22.5 ± 4.1 years, 15 males and 6 females) were recruited. Macular scanning with a SD-OCT was performed before and following a vita maxima-type physical strain exercise on a rowing ergometer until complete fatigue. Follow-up OCT scans were performed 1, 5, 15, 30 and 60 minutes following the exercise. The OCT images were exported and analyzed using our custom-built OCTRIMA 3D software and the thickness of 7 retinal layers was calculated, along with semi-automated measurement of the choroidal thickness. One-way ANOVA analysis was performed followed by Dunnett post hoc test for the thickness change compared to baseline and the correlation between performance and thickness change has also been calculated. The level of significance was set at 0.001. RESULTS: We observed a significant thinning of the total retina 1 minute post-exercise (-7.3 ± 0.6 µm, p < 0.001) which was followed by a significant thickening by 5 and 15 minutes (+3.6 ± 0.6 µm and +4.0 ± 0.6 µm, respectively, both p <0.001). Post-exercise retinal thickness returned to baseline by 30 minutes. This trend was present throughout the most layers of the retina, with significant changes in the ganglion cell-inner plexiform layer complex, (-1.3 ± 0.1 µm, +0.6 ± 0.1 µm and +0.7 ± 0.1 µm, respectively, p <0.001 for all), in the inner nuclear layer at 1 and 5 minutes (-0.8 ± 0.1 µm and +0.8 ± 0.1 µm, respectively, p <0.001 for both), in the outer nuclear layer-photoreceptor inner segment complex at 5 minute (+2.3 ± 0.4 µm, p <0.001 for all) and in the interdigitation zone-retinal pigment epithelium complex at 1 and 15 minutes (-3.3 ± 0.4 µm and +1.8 ± 0.4 µm, respectively, p <0.001 for both). There was no significant change in choroidal thickness; however, we could detect a tendency towards thinning at 1, 15, and 30 minutes following exercise. The observed changes in thickness change did not correlate with performance. Similar trends were observed in both professional and amateur sportsmen (n = 15 and n = 6, respectively). The absolute changes in choroidal thickness did not show any correlation with the thickness changes of the intraretinal layers. CONCLUSIONS: Our study implies that in young adults, intense physical exercise has an acute effect on the granular layers of the retina, resulting in thinning followed by rebound thickening before normalization. We could not identify any clear correlation with either choroidal changes or performance that might explain our observations, and hence the exact mechanism warrants further clarification. We believe that a combination of vascular and mechanic changes is behind the observed trends.

CyberKnife versus multicatheter interstitial brachytherapy for accelerated partial breast irradiation: a dosimetrical assessment with focus on organs at risk.

Background: The purpose of the study was to dosimetrically compare multicatheter interstitial brachytherapy (MIBT) and stereotactic radiotherapy with CyberKnife (CK) for accelerated partial breast irradiation with special focus on dose to organs at risk (OARs). Materials and methods: Treatment plans of thirty-one patients treated with MIBT were selected and additional CK plans were created on the same CT images. The OARs included ipsilateral non-target and contralateral breast, ipsilateral and contralateral lung, skin, ribs, and heart for left sided cases. The fractionation was identical (4 × 6.25 Gy). Dose-volume parameters were calculated for both techniques and compared. Results: The D90 of the PTV for MIBT and CK were similar (102.4% vs. 103.6%, p = 0.0654), but in COIN the MIBT achieved lower value (0.75 vs. 0.91, p < 0.001). Regarding the V100 parameter of non-target breast CK performed slightly better than MIBT (V100: 1.1% vs. 1.6%), but for V90, V50 and V25 MIBT resulted in less dose. Every examined parameter of ipsilateral lung, skin, ribs and contralateral lung was significantly smaller for MIBT than for CK. Protection of the heart was slightly better with MIBT, but only the difference of D2cm3 was statistically significant (17.3% vs. 20.4%, p = 0.0311). There were no significant differences among the dose-volume parameters of the contralateral breast. Conclusion: The target volume can be properly irradiated by both techniques with high conformity and similar dose to the OARs. MIBT provides more advantageous plans than CK, except for dose conformity and the dosimetry of the heart and contralateral breast. More studies are needed to analyze whether these dosimetrical findings have clinical significance.

Small-Scale Continuous Drug Product Manufacturing using Dropwise Additive Manufacturing and Three Phase Settling for Integration with Upstream Drug Substance Production.

The pharmaceutical industry has traditionally relied on mass manufacturing to make its products. This has created multiple problems in the drug supply network, including long production times, inflexible and sluggish manufacturing and lack of personalized dosing. The industry is gradually adapting to these challenges and is developing novel technologies to address them. Continuous manufacturing and 3D printing are two promising techniques that can revolutionize pharmaceutical manufacturing. However, most research studies into these methods tend to treat them separately. This study seeks to develop a new processing route to continuously integrate a 3D printing platform (Drop-on-Demand, DoD, printing) with crystallization that is generally the final step of the active ingredient manufacturing. Accomplishing this integration would enable harnessing the benefits of each method- personalized dosing of 3D printing and flexibility and speed of continuous manufacturing. A novel unit operation, three-phase settling (TPS), is developed to integrate DoD with the upstream crystallizer. To ensure on-spec production of each printed dosage, two process analytical technology tools are incorporated in the printer to monitor drug loading in manufactured drug products in real time. Experimental demonstration of this system is carried out via two case studies: the first study uses an active ingredient celecoxib to test the standalone operation of TPS; the second study demonstrates the operation of the integrated system (crystallizer - TPS - DoD) to continuously make drug products for the active ingredient- lomustine. A dissolution test is also performed on the manufactured and commercial lomustine drug products to compare their dissolution behavior.

Ratio of torus and equivalent power to refractive cylinder and spherical equivalent in phakic lenses - a Monte-Carlo simulation study.

BACKGROUND: Spherical and astigmatic powers for phakic intraocular lenses are frequently calculated using fixed ratios of phakic lens refractive power to refractive spherical equivalent, and of phakic lens astigmatism to refractive cylinder. In this study, a Monte-Carlo simulation based on biometric data was used to investigate how variations in biometrics affect these ratios, in order to improve the calculation of implantable lens parameters. METHODS: A data set of over sixteen thousand biometric measurements including axial length, phakic anterior chamber depth, and corneal equivalent and astigmatic power was used to construct a multidimensional probability density distribution. From this, we determined the axial position of the implanted lens and estimated the refractive spherical equivalent and refractive cylinder. A generic data model resampled the density distributions and interactions between variables, and the implantable lens power was determined using vergence propagation. RESULTS: 50 000 artificial data sets were used to calculate the phakic lens spherical equivalent and astigmatism required for emmetropization, and to determine the corresponding ratios for these two values. The spherical ratio ranged from 1.0640 to 1.3723 and the astigmatic ratio from 1.0501 to 1.4340. Both ratios are unaffected by the corneal spherical / astigmatic powers, or the refractive cylinder, but show strong correlation with the refractive spherical equivalent, mild correlation with the lens axial position, and moderate negative correlation with axial length. As a simplification, these ratios could be modelled using a bi-variable linear regression based on the first two of these factors. CONCLUSION: Fixed spherical and astigmatic ratios should not be used when selecting high refractive power phakic IOLs as their variation can result in refractive errors of up to ±0.3 D for a 8 D lens. Both ratios can be estimated with clinically acceptable precision using a linear regression based on the refractive spherical equivalent and the axial position.

Model-based economic burden of diabetic retinopathy in Hungary / A cukorbetegség szemészeti szövodményeinek modellalapú költségterhe Magyarországon.

Összefoglaló. Bevezetés: A diabeteses retinopathia minden harmadik cukorbeteget érinti a világban, és a dolgozó korú lakosság körében a vakság vezeto oka. Célkituzés: Tanulmányunk célja a diabeteses retinopathia prevalenciaalapú költségterhének meghatározása 2018-ban a 18 évnél idosebb korú lakosság körében Magyarországon. Módszer: Standardizált 'rapid assessment of avoidable blindness' (RAAB) + diabeteses retinopathia modul alapú metodikán alapuló modellel analizáltuk a diabeteses retinopathia költségterhét. A diabeteses retinopathia okozta gazdasági terhet a Nemzeti Egészségbiztosítási Alapkezelo és a páciensek oldaláról felmerülo költségeket analizálva vizsgáltuk. A prevalenciaalapú diabeteses retinopathia költségmodellt a skót diabeteses retinopathia klasszifikációnak és a diabeteses retinopathia súlyossági stádiumának megfeleloen állítottuk össze. Eredmények: A diabeteses retinopathia költségterhe 43,66 milliárd Ft volt 2018-ban. A két fo költségviselo az anti-VEGF-injekciók (28,91 milliárd Ft) és a vitrectomiák (8,09 milliárd Ft) voltak. Ez a két kezelési mód volt felelos a diabeteses retinopathiával kapcsolatban felmerülo összes költség 84,7%-áért. Az egy páciensre jutó átlagos költségteher 54 691 Ft volt hazánkban. Következtetés: A cukorbetegek szemészeti járó- és fekvobeteg-ellátása alulfinanszírozott hazánkban. A proliferatív diabeteses retinopathia és a diabeteses maculaoedema növekvo társadalmi-gazdasági terhe miatt érdemes volna javítani a megelozés, a szurés és a korai kezelés jelenlegi helyzetén. Orv Hetil. 2021; 162(8): 298-305. INTRODUCTION: Diabetic retinopathy affects every third people with diabetes mellitus in the world and is the leading cause of blindness in adults of working age. OBJECTIVE: The aim of this study was to analyse the economic burden associated with diabetic retinopathy in people aged 18 years and older in Hungary. METHOD: Rapid assessment of avoidable blindness (RAAB) with the diabetic retinopathy module (DRM) based diabetic retinopathy cost model study was conducted in Hungary in 2018. Economic burden of diabetic retinopathy was analysed from the perspective of the National Health Insurance Fund system and the patients. Our prevalence-based diabetic retinopathy cost model was performed according to the Scottish diabetic retinopathy grading scale and based on the diabetic retinopathy severity stadium. RESULTS: The total diabetic retinopathy-associated economic burden was 43.66 billion HUF in 2018. The two major cost drivers were anti-VEGF injections (28.91 billion HUF) and vitrectomies (8.09 billion HUF) in Hungary; they covered to 84.7% of the total cost among people with diabetes mellitus. The diabetic retinopathy-related cost per patient was 54 691 HUF in Hungary. CONCLUSION: Outpatient and inpatient eye care of people with diabetes mellitus are underfinanced in Hungary. Due to the increasing socio-economic burden of proliferative diabetic retinopathy and diabetic macular oedema, it would be important to invest in proliferative diabetic retinopathy and macular oedema prevention, screening and early treatment. Orv Hetil. 2021; 162(8): 298-305.

Rapid assessment of avoidable blindness-based healthcare costs of diabetic retinopathy in Hungary and its projection for the year 2045.

BACKGROUND/AIMS: The purpose of this study was to estimate the total healthcare cost associated with diabetic retinopathy (DR) in the population aged 18 years and older in Hungary, and its projection for the year 2045. METHODS: A cost model was developed based on the standardised rapid assessment of avoidable blindness with the diabetic retinopathy module (RAAB+DRM) methodology and recently reported prevalent-based cost of illness model. Projection for 2045 was made based on the estimation for increasing diabetes mellitus (DM) prevalence of the International Diabetes Federation. Costs were analysed from the perspective of the healthcare system and the patients. Our DR cost model was constructed according to the Scottish DR grading scale and based on the DR severity stadium. RESULTS: The total DR-associated healthcare cost was US$145.8 million in 2016 and will increase to US$169.0 million by 2045. The two major cost drivers were intravitreal antivascular endothelial growth factor injections and vitrectomies in this study (US$126.4 million in 2016 and US$146.5 million in 2045); they amounted to 86.7% of the total treatment cost of DR. The DR-related cost per patient was US$180.5 in Hungary. CONCLUSIONS: The cost per patient for treating DR was lower in Hungary than in other countries. Due to the increasing socioeconomic burden of proliferative DR and diabetes-related blindness, it would be important to invest in DR screening, prevention and early treatment. Our new RAAB-based cost of DR model may facilitate comparisons of DR treatment costs across countries.

Design of condition-based maintenance framework for process operations management in pharmaceutical continuous manufacturing.

Continuous manufacturing, an emerging technology in the pharmaceutical industry, has the potential to increase the efficiency, and agility of pharmaceutical manufacturing processes. To realize these potential benefits of continuous operations, effectively managing materials, equipment, analyzers, and data is vital. Developments for continuous pharmaceutical manufacturing have led to novel technologies and methods for processing material, designing and configuring individual equipment and process analyzers, as well as implementing strategies for active process control. However, limited work has been reported on managing abnormal conditions during operations to prevent unplanned deviations and downtime and sustain system capabilities. Moreover, although the sourcing, analysis, and management of real-time data have received growing attention, limited discussion exists on the continued verification of the infrastructure for ensuring reliable operations. Hence, this work introduces condition-based maintenance (CBM) as a general strategy for continually verifying and sustaining advanced pharmaceutical manufacturing systems, with a focus on the continuous manufacture of oral solid drug products (OSD-CM). Frameworks, such as CBM, benefit unified efforts towards continued verification and operational excellence by leveraging process knowledge and the availability of real-time data. A vital implementation consideration for manufacturing operations management applications, such as CBM, is a systems architecture and an enabling infrastructure. This work outlines the systems architecture design for CBM in OSD-CM and highlights sample fault scenarios involving equipment and process analyzers. For illustrative purposes, this work also describes the infrastructure implemented on an OSD-CM testbed, which uses commercially available automation systems and leverages enterprise architecture standards. With the increasing digitalization of manufacturing operations in the pharmaceutical industry, proactively using process data towards modernizing maintenance practices is relevant to a single unit operation as well as to a series of physically integrated unit operations.

The Burden of Macular Diseases in Central and Eastern Europe-Implications for Healthcare Systems.

BACKGROUND: Despite the significant impact of retinal diseases such as wet age-related macular degeneration (wAMD) and diabetic macular edema (DME), there is a limited understanding of how these conditions are managed in Central and Eastern Europe (CEE). OBJECTIVES: To provide a comprehensive overview of the clinical and economic burden of wAMD and DME in CEE and the status quo associated with their management. METHODS: A narrative literature review was undertaken to identify existing data on wAMD and DME, including epidemiology, economic burden, clinical guidelines, and available and reimbursed treatments. Data were collected from relevant sources such as PubMed, ophthalmology associations, national statistical offices, and government agency websites; practical viewpoints were provided by local ophthalmologists and healthcare economics experts in CEE. RESULTS: Epidemiological data on wAMD and DME are limited in CEE, and intercountry comparison is difficult because of differences in data collection methodologies. There are effective treatment options for wAMD and DME, and international guidelines advocate the use of intravitreal anti-vascular endothelial growth factor injections as first-line therapy. Local expert organizations broadly support these recommendations; nevertheless, no clinical practice guidelines exist on the treatment of wAMD and DME in CEE. Access to and reimbursement of anti-vascular endothelial growth factor agents vary significantly in the region and, as a result, many patients remain untreated or inadequately treated. CONCLUSIONS: There is an urgent need for the creation of a wAMD/DME treatment program in CEE to ensure that patients have timely access to the most appropriate treatments.

On the impact of improved dosimetric accuracy on head and neck high dose rate brachytherapy.

PURPOSE: To study the effect of finite patient dimensions and tissue heterogeneities in head and neck high dose rate brachytherapy. METHODS AND MATERIALS: The current practice of TG-43 dosimetry was compared to patient specific dosimetry obtained using Monte Carlo simulation for a sample of 22 patient plans. The dose distributions were compared in terms of percentage dose differences as well as differences in dose volume histogram and radiobiological indices for the target and organs at risk (mandible, parotids, skin, and spinal cord). RESULTS: Noticeable percentage differences exist between TG-43 and patient specific dosimetry, mainly at low dose points. Expressed as fractions of the planning aim dose, percentage differences are within 2% with a general TG-43 overestimation except for the spine. These differences are consistent resulting in statistically significant differences of dose volume histogram and radiobiology indices. Absolute differences of these indices are however small to warrant clinical importance in terms of tumor control or complication probabilities. CONCLUSIONS: The introduction of dosimetry methods characterized by improved accuracy is a valuable advancement. It does not appear however to influence dose prescription or call for amendment of clinical recommendations for the mobile tongue, base of tongue, and floor of mouth patient cohort of this study.

Microstructural parameter estimation in vivo using diffusion MRI and structured prior information.

PURPOSE: Diffusion MRI has recently been used with detailed models to probe tissue microstructure. Much of this work has been performed ex vivo with powerful scanner hardware, to gain sensitivity to parameters such as axon radius. By contrast, performing microstructure imaging on clinical scanners is extremely challenging. METHODS: We use an optimized dual spin-echo diffusion protocol, and a Bayesian fitting approach, to obtain reproducible contrast (histogram overlap of up to 92%) in estimated maps of axon radius index in healthy adults at a modest, widely-available gradient strength (35 mT m(-1)). A key innovation is the use of influential priors. RESULTS: We demonstrate that our priors can improve precision in axon radius estimates--a 7-fold reduction in voxelwise coefficient of variation in vivo--without significant bias. Our results may reflect true axon radius differences between white matter regions, but this interpretation should be treated with caution due to the complexity of the tissue relative to our model. CONCLUSIONS: Some sensitivity to relatively large axons (3-15 µm) may be available at clinical field and gradient strengths. Future applications at higher gradient strength will benefit from the favorable eddy current properties of the dual spin-echo sequence, and greater precision available with suitable priors. Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance.

First large-scale DNA barcoding assessment of reptiles in the biodiversity hotspot of Madagascar, based on newly designed COI primers.

BACKGROUND: DNA barcoding of non-avian reptiles based on the cytochrome oxidase subunit I (COI) gene is still in a very early stage, mainly due to technical problems. Using a newly developed set of reptile-specific primers for COI we present the first comprehensive study targeting the entire reptile fauna of the fourth-largest island in the world, the biodiversity hotspot of Madagascar. METHODOLOGY/PRINCIPAL FINDINGS: Representatives of the majority of Madagascan non-avian reptile species (including Squamata and Testudines) were sampled and successfully DNA barcoded. The new primer pair achieved a constantly high success rate (72.7-100%) for most squamates. More than 250 species of reptiles (out of the 393 described ones; representing around 64% of the known diversity of species) were barcoded. The average interspecific genetic distance within families ranged from a low of 13.4% in the Boidae to a high of 29.8% in the Gekkonidae. Using the average genetic divergence between sister species as a threshold, 41-48 new candidate (undescribed) species were identified. Simulations were used to evaluate the performance of DNA barcoding as a function of completeness of taxon sampling and fragment length. Compared with available multi-gene phylogenies, DNA barcoding correctly assigned most samples to species, genus and family with high confidence and the analysis of fewer taxa resulted in an increased number of well supported lineages. Shorter marker-lengths generally decreased the number of well supported nodes, but even mini-barcodes of 100 bp correctly assigned many samples to genus and family. CONCLUSIONS/SIGNIFICANCE: The new protocols might help to promote DNA barcoding of reptiles and the established library of reference DNA barcodes will facilitate the molecular identification of Madagascan reptiles. Our results might be useful to easily recognize undescribed diversity (i.e. novel taxa), to resolve taxonomic problems, and to monitor the international pet trade without specialized expert knowledge.

The role of femtolaser in cataract surgery.

Having been very successful in corneal surgery, femtolasers were recently introduced into the surgery of crystalline lens. The most important indications and advantages include: perfectly centered and sized capsulotomy, liquefaction of softer lenses and fragmentation of harder lenses which allows for chopping the nucleus without the use of phaco energy. Femtolaser can also be used for creating corneal wounds (tunnels) of any size at any location, and in order to manage the preoperative astigmatism using arcuate incisions at the desired depth within the cornea. Because of controlled steps in cataract surgery, wide acceptance and spread is to be expected.

Deinstitutionalization in Europe: two recent examples from Germany and Hungary.

Deinstitutionalization has made possible the development of modern community psychiatric services, however radical decrease in the number of hospital beds may result in a reduction in the overall standard of psychiatric care and disruptions in service delivery. The authors present an example of deinstitutionalisation in Hungary, which led to serious difficulties in the provision of healthcare in the field of psychiatry, contrasted with a case from Germany serving as an example of an alternative solution.

[The way out from crisis--from the closing of the National Psychiatric and Neurologic Institute (OPNI) to Semmelweis University]. / A válságlói kivezetô út--az OPNI megszûnésétôl a Semmelweis Egyetemig.

In our recent article we attempt to sum up the circumstances of the closing-down of the National Psychiatric and Neurologic Institute (OPNI). We intend to summarize the values that may disappear by the liquidation of the institute and try to explore the possibilities how to keep them alive in the future. Most of the divisions can operate further under the umbrella of the Semmelweis University; the modus operandi and the role of the University are also covered in this article.