Interrater and Test-Retest Reliability of the Beery Visual-Motor Integration in Schoolchildren.

PURPOSE: To assess interrater and test-retest reliability of the 6th Edition Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI) and test-retest reliability of the VMI Visual Perception Supplemental Test (VMIp) in school-age children. METHODS: Subjects were 163 Native American third- to eighth-grade students with no significant refractive error (astigmatism <1.00 D, myopia <0.75 D, hyperopia <2.50 D, anisometropia <1.50 D) or ocular abnormalities. The VMI and VMIp were administered twice, on separate days. All VMI tests were scored by two trained scorers, and a subset of 50 tests was also scored by an experienced scorer. Scorers strictly applied objective scoring criteria. Analyses included interrater and test-retest assessments of bias, 95% limits of agreement, and intraclass correlation analysis. RESULTS: Trained scorers had no significant scoring bias compared with the experienced scorer. One of the two trained scorers tended to provide higher scores than the other (mean difference in standardized scores = 1.54). Interrater correlations were strong (0.75 to 0.88). VMI and VMIp test-retest comparisons indicated no significant bias (subjects did not tend to score better on retest). Test-retest correlations were moderate (0.54 to 0.58). The 95% limits of agreement for the VMI were -24.14 to 24.67 (scorer 1) and -26.06 to 26.58 (scorer 2), and the 95% limits of agreement for the VMIp were -27.11 to 27.34. CONCLUSIONS: The 95% limit of agreement for test-retest differences will be useful for determining if the VMI and VMIp have sufficient sensitivity for detecting change with treatment in both clinical and research settings. Further research on test-retest reliability reporting 95% limits of agreement for children across different age ranges is recommended, particularly if the test is to be used to detect changes due to intervention or treatment.

Insights into the phylogeny of Northern Hemisphere Armillaria: Neighbor-net and Bayesian analyses of translation elongation factor 1-α gene sequences.

Armillaria possesses several intriguing characteristics that have inspired wide interest in understanding phylogenetic relationships within and among species of this genus. Nuclear ribosomal DNA sequence-based analyses of Armillaria provide only limited information for phylogenetic studies among widely divergent taxa. More recent studies have shown that translation elongation factor 1-α (tef1) sequences are highly informative for phylogenetic analysis of Armillaria species within diverse global regions. This study used Neighbor-net and coalescence-based Bayesian analyses to examine phylogenetic relationships of newly determined and existing tef1 sequences derived from diverse Armillaria species from across the Northern Hemisphere, with Southern Hemisphere Armillaria species included for reference. Based on the Bayesian analysis of tef1 sequences, Armillaria species from the Northern Hemisphere are generally contained within the following four superclades, which are named according to the specific epithet of the most frequently cited species within the superclade: (i) Socialis/Tabescens (exannulate) superclade including Eurasian A. ectypa, North American A. socialis (A. tabescens), and Eurasian A. socialis (A. tabescens) clades; (ii) Mellea superclade including undescribed annulate North American Armillaria sp. (Mexico) and four separate clades of A. mellea (Europe and Iran, eastern Asia, and two groups from North America); (iii) Gallica superclade including Armillaria Nag E (Japan), multiple clades of A. gallica (Asia and Europe), A. calvescens (eastern North America), A. cepistipes (North America), A. altimontana (western USA), A. nabsnona (North America and Japan), and at least two A. gallica clades (North America); and (iv) Solidipes/Ostoyae superclade including two A. solidipes/ostoyae clades (North America), A. gemina (eastern USA), A. solidipes/ostoyae (Eurasia), A. cepistipes (Europe and Japan), A. sinapina (North America and Japan), and A. borealis (Eurasia) clade 2. Of note is that A. borealis (Eurasia) clade 1 appears basal to the Solidipes/Ostoyae and Gallica superclades. The Neighbor-net analysis showed similar phylogenetic relationships. This study further demonstrates the utility of tef1 for global phylogenetic studies of Armillaria species and provides critical insights into multiple taxonomic issues that warrant further study.

Screening, Brief Intervention, and Referral to Treatment in a rural Ryan White Part C HIV clinic.

About 24% of people living with HIV nationally are identified as needing treatment for alcohol or illicit drug use. Screening, Brief Intervention, and Referral to Treatment (SBIRT) has evolved as a strategy to assess and intervene with substance abuse behaviors in various clinical settings. However, less is known about the processes and outcomes of using the SBIRT intervention in outpatient HIV clinics. This paper presents a descriptive analysis of de-identified existing SBIRT results data from an outpatient HIV clinic located in western Colorado. From 2008 to 2013, a total of 1616 SBIRT evaluations were done, which included duplicate patients because some individual patients were screened more than once in a given year. Over this time period, 37-49% of encounters per year were notable for tobacco use, 8-21% for alcohol use, 6-16% for marijuana use, 3-9% for amphetamine use, and 0-2% for illicit opioid use. Unique, unduplicated patient data from 2013 revealed 40% of patients used tobacco, 16% used alcohol, and 11% used methamphetamine. Analyses highlighted that the majority of our patient population (58% in 2013) used and/or abused tobacco, alcohol, and/or illicit substances. An alarming finding was the increase in methamphetamine use over time with more than 50-fold prevalence of use in our population compared to national rates.

Reading Fluency in School-Aged Children with Bilateral Astigmatism.

PURPOSE: To compare oral reading fluency (ORF) in students with no/low astigmatism and moderate/high astigmatism and to assess the impact of spectacle correction on ORF in moderate and high astigmats. METHODS: Subjects were third- to eighth-grade students from a highly astigmatic population. Refractive error was determined through subjectively refined cycloplegic autorefraction. Data from students with ocular abnormalities, anisometropia, symptomatic binocular vision disorders, or refractive error that did not meet study criteria (no/low [cylinder < 1.00 both eyes, no significant myopia/hyperopia], moderate [cylinder ≥ 1.00 D both eyes, mean ≥ 1.00 D and < 3.00 D], or high astigmatism group [cylinder ≥ 1.00 D both eyes, mean ≥ 3.00 D]) were excluded. Oral reading fluency was tested with a modified version of the Dynamic Indicators of Basic Early Literacy Skills (DIBELS) Next test of ORF. No/low astigmats were tested without spectacles; astigmats were tested with and without spectacles. Mean ORF was compared in no/low astigmats and astigmats (with and without correction). Improvement in ORF with spectacles was compared between moderate and high astigmats. RESULTS: The sample included 130 no/low, 67 moderate, and 76 high astigmats. ORF was lower in uncorrected astigmats than in no/low astigmats (p = 0.011). ORF did not significantly differ in no/low astigmats and corrected astigmats (p = 0.10). ORF significantly improved with spectacle correction in high astigmats (p = 0.001; mean improvement, 6.55 words per minute) but not in moderate astigmats (p = 0.193; mean improvement, 1.87 words per minute). Effects of spectacle wear were observed in students who read smaller text stimuli (older grades). CONCLUSIONS: ORF is significantly reduced in students with bilateral astigmatism (≥1.00D) when uncorrected but not when best-corrected compared with their nonastigmatic peers. Improvement in ORF with spectacle correction is seen in high astigmats but not in moderate astigmats. These data support the recommendation for full-time spectacle wear in astigmatic students, particularly those with high astigmatism.

Rust disease of eucalypts, caused by Puccinia psidii, did not originate via host jump from guava in Brazil.

The rust fungus, Puccinia psidii, is a devastating pathogen of introduced eucalypts (Eucalyptus spp.) in Brazil where it was first observed in 1912. This pathogen is hypothesized to be endemic to South and Central America and to have first infected eucalypts via a host jump from native guava (Psidium guajava). Ten microsatellite markers were used to genotype 148 P. psidii samples from eucalypts and guava plus five additional myrtaceous hosts across a wide geographic range of south-eastern Brazil and Uruguay. Principal coordinates analysis, a Bayesian clustering analysis and a minimum-spanning network revealed two major genetic clusters among the sampled isolates, one associated with guava and another associated with eucalypts and three additional hosts. Multilocus genotypes infecting guava differed by multiple mutational steps at eight loci compared with those infecting eucalypts. Approximate Bayesian computation revealed that evolutionary scenarios involving a coalescence event between guava- and eucalypt-associated pathogen populations within the past 1000 years are highly unlikely. None of the analyses supported the hypothesis that eucalypt-infecting P. psidii in Brazil originated via host jump from guava following the introduction of eucalypts to Brazil approximately 185 years ago. The existence of host-associated biotypes of P. psidii in Brazil indicates that this diversity must be considered when assessing the invasive threat posed by this pathogen to myrtaceous hosts worldwide.

Spectacle Wear in Toddlers: Frequency of Wear and Impact of Treatment on the Child and Family.

PURPOSE: We assessed the frequency of spectacle wear and impact of spectacle treatment in toddlers. METHODS: Children 12 to <36 months old with significant refractive error were provided spectacles. After 12 (±6) weeks, parents reported the frequency of spectacle wear and completed the Amblyopia Treatment Index (ATI, modified for spectacle treatment). Factor analysis assessed usefulness of ATI for spectacle treatment. Spectacle wear and ATI results were compared across age (1- vs. 2-year-olds) and sex. RESULTS: Participants were 91 children (60% male; mean age, 22.98 [SD 6.24] months, 41 1- and 50 2-year-olds) prescribed spectacles for astigmatism (92%), hyperopia (9%), or myopia (1%). Reported frequency of wear was low (<2 hours/day) in 41%, moderate in 23% (2 to <6 hours/day), and high (≥6 hours/day) in 36% and did not differ across age or sex. ATI factor analysis identified three subscales: adverse effects, treatment compliance, and perceived benefit. One-year-olds had poorer scores on adverse effects (P = 0.026) and treatment compliance scales (P = 0.049). Low frequency of spectacle wear was associated with poorer scores on treatment compliance (P < 0.001) and perceived benefit scales (P = 0.004). CONCLUSIONS: Frequency of spectacle wear was not related to age or sex. Younger children may have more difficulty adjusting to treatment. Parents of children with low spectacle wear reported less perceived benefit of treatment. TRANSLATIONAL RELEVANCE: Data on factors associated with frequency of spectacle wear in toddlers is valuable for parents and clinicians and may lead to methods to improve compliance and reduce the negative impact of treatment.

A preliminary study of astigmatism and early childhood development.

PURPOSE: To determine whether uncorrected astigmatism in toddlers is associated with poorer performance on the Bayley Scales of Infant and Toddler Development, 3rd edition (BSITD-III). METHODS: Subjects were 12- to 35-month-olds who failed an instrument-based vision screening at a well-child check. A cycloplegic eye examination was conducted. Full-term children with no known medical or developmental conditions were invited to participate in a BSITD-III assessment conducted by an examiner masked to the child's eye examination results. Independent samples t tests were used to compare Cognitive, Language (Receptive and Expressive), and Motor (Fine and Gross) scores for children with moderate/high astigmatism (>2.00 D) versus children with no/low refractive error (ie, children who had a false-positive vision screening). RESULTS: The sample included 13 children in each group. The groups did not differ on sex or mean age. Children with moderate/high astigmatism had significantly poorer mean scores on the Cognitive and Language scales and the Receptive Communication Language subscale compared to children with no/low refractive error. Children with moderate/high astigmatism had poorer mean scores on the Motor scale, Fine and Gross Motor subscales, and the Expressive Communication subscale, but these differences were not statistically significant. CONCLUSIONS: The results suggest that uncorrected astigmatism in toddlers may be associated with poorer performance on cognitive and language tasks. Further studies assessing the effects of uncorrected refractive error on developmental task performance and of spectacle correction of refractive error in toddlers on developmental outcomes are needed to support the development of evidence-based spectacle prescribing guidelines.

Armillaria mexicana, a newly described species from Mexico.

Armillaria mexicana (Agaricales, Physalacriaceae) is described as a new species based on morphology, DNA sequence data, and phylogenetic analyses. It clearly differs from previously reported Armillaria species in North, Central, and South America. It is characterized by the absence of fibulae in the basidioma, abundant cheilocystidia, and ellipsoidal, hyaline basidiospores that are apparently smooth under light microscope, but slightly to moderately rugulose under scanning electron microscope. It is differentiated from other Armillaria species by macromorphological characters, including annulus structure, pileus and stipe coloration, and other structures. DNA sequence data (nuc rDNA internal transcribed spacers [ITS1-5.8S-ITS2 = ITS], 28S D-domain, 3' end of 28S intergenic spacer 1, and translation elongation factor 1-α [TEF1]) show that A. mexicana sequences are quite distinct from sequences of analogous Armillaria species in GenBank. In addition, sequences of ITS of the A. mexicana ex-type culture reveal an ITS1 of 1299 bp and an ITS2 of 582 bp, the longest ITS regions reported thus far in fungi. Phylogenetic analysis based on TEF1 sequences place A. mexicana in a well-separated, monophyletic clade basal to the polyphyletic A. mellea complex.

Dihydropyridopyrazinones and dihydropteridinones as corticotropin-releasing factor-1 receptor antagonists: structure-activity relationships and computational modeling.

The CRF antagonist pharmacophore is a heterocyclic ring bearing a critical hydrogen-bond acceptor nitrogen and an orthogonal aromatic ring. CRFR1 antagonists have shown a 40-fold and 200-fold loss in potency against the CRFR1 H199V and M276I mutant receptors, suggesting key interactions with these residues. We have derived a two component computational model that correlates CRFR1 binding affinity within the reported series to antagoinst/H199 complexation energy and M276 hydrophobic contacts.

Visual Motor and Perceptual Task Performance in Astigmatic Students.

Purpose. To determine if spectacle corrected and uncorrected astigmats show reduced performance on visual motor and perceptual tasks. Methods. Third through 8th grade students were assigned to the low refractive error control group (astigmatism < 1.00 D, myopia < 0.75 D, hyperopia < 2.50 D, and anisometropia < 1.50 D) or bilateral astigmatism group (right and left eye ≥ 1.00 D) based on cycloplegic refraction. Students completed the Beery-Buktenica Developmental Test of Visual Motor Integration (VMI) and Visual Perception (VMIp). Astigmats were randomly assigned to testing with/without correction and control group was tested uncorrected. Analyses compared VMI and VMIp scores for corrected and uncorrected astigmats to the control group. Results. The sample included 333 students (control group 170, astigmats tested with correction 75, and astigmats tested uncorrected 88). Mean VMI score in corrected astigmats did not differ from the control group (p = 0.829). Uncorrected astigmats had lower VMI scores than the control group (p = 0.038) and corrected astigmats (p = 0.007). Mean VMIp scores for uncorrected (p = 0.209) and corrected astigmats (p = 0.124) did not differ from the control group. Uncorrected astigmats had lower mean scores than the corrected astigmats (p = 0.003). Conclusions. Uncorrected astigmatism influences visual motor and perceptual task performance. Previously spectacle treated astigmats do not show developmental deficits on visual motor or perceptual tasks when tested with correction.

Convergence Insufficiency, Accommodative Insufficiency, Visual Symptoms, and Astigmatism in Tohono O'odham Students.

Purpose. To determine rate of convergence insufficiency (CI) and accommodative insufficiency (AI) and assess the relation between CI, AI, visual symptoms, and astigmatism in school-age children. Methods. 3rd-8th-grade students completed the Convergence Insufficiency Symptom Survey (CISS) and binocular vision testing with correction if prescribed. Students were categorized by astigmatism magnitude (no/low: <1.00 D, moderate: 1.00 D to <3.00 D, and high: ≥3.00 D), presence/absence of clinical signs of CI and AI, and presence of symptoms. Analyses determine rate of clinical CI and AI and symptomatic CI and AI and assessed the relation between CI, AI, visual symptoms, and astigmatism. Results. In the sample of 484 students (11.67 ± 1.81 years of age), rate of symptomatic CI was 6.2% and symptomatic AI 18.2%. AI was more common in students with CI than without CI. Students with AI only (p = 0.02) and with CI and AI (p = 0.001) had higher symptom scores than students with neither CI nor AI. Moderate and high astigmats were not at increased risk for CI or AI. Conclusions. With-the-rule astigmats are not at increased risk for CI or AI. High comorbidity rates of CI and AI and higher symptoms scores with AI suggest that research is needed to determine symptomatology specific to CI.

Assessment of Grating Acuity in Infants and Toddlers Using an Electronic Acuity Card: The Dobson Card.

PURPOSE: To determine if testing binocular visual acuity in infants and toddlers using the Acuity Card Procedure (ACP) with electronic grating stimuli yields clinically useful data. METHODS: Participants were infants and toddlers ages 5 to 36.7 months referred by pediatricians due to failed automated vision screening. The ACP was used to test binocular grating acuity. Stimuli were presented on the Dobson Card. The Dobson Card consists of a handheld matte-black plexiglass frame with two flush-mounted tablet computers and is similar in size and form to commercially available printed grating acuity testing stimuli (Teller Acuity Cards II [TACII]; Stereo Optical, Inc., Chicago, IL). On each trial, one tablet displayed a square-wave grating and the other displayed a luminance-matched uniform gray patch. Stimuli were roughly equivalent to the stimuli available in the printed TACII stimuli. After acuity testing, each child received a cycloplegic eye examination. Based on cycloplegic retinoscopy, patients were categorized as having high or low refractive error per American Association for Pediatric Ophthalmology and Strabismus vision screening referral criteria. Mean acuities for high and low refractive error groups were compared using analysis of covariance, controlling for age. RESULTS: Mean visual acuity was significantly poorer in children with high refractive error than in those with low refractive error (P = .015). CONCLUSIONS: Electronic stimuli presented using the ACP can yield clinically useful measurements of grating acuity in infants and toddlers. Further research is needed to determine the optimal conditions and procedures for obtaining accurate and clinically useful automated measurements of visual acuity in infants and toddlers.

Chemotherapy-induced amenorrhea from adjuvant breast cancer treatment: the effect of the addition of taxanes.

PURPOSE: Adjuvant chemotherapy for breast cancer can be associated with a variety of side effects, one of which is the induction of premature menopause in premenopausal patient. Although taxanes have increasingly been used in the adjuvant setting, there has been relatively little published on the frequency of amenorrhea related to their use. PATIENTS AND METHODS: We review records of 159 premenopausal patients receiving adjuvant chemotherapy from our practice. RESULTS: Altogether, 51% of all patients retained menstrual function after chemotherapy. CONCLUSION: It was observed that patients receiving adjuvant anthracycline-based chemotherapy with sequential taxane therapy did not have a higher rate of amenorrhea than those not receiving a taxane.

Accommodation in astigmatic children during visual task performance.

PURPOSE: To determine the accuracy and stability of accommodation in uncorrected children during visual task performance. METHODS: Subjects were second- to seventh-grade children from a highly astigmatic population. Measurements of noncycloplegic right eye spherical equivalent (Mnc) were obtained while uncorrected subjects performed three visual tasks at near (40 cm) and distance (2 m). Tasks included reading sentences with stimulus letter size near acuity threshold and an age-appropriate letter size (high task demands) and viewing a video (low task demand). Repeated measures ANOVA assessed the influence of astigmatism, task demand, and accommodative demand on accuracy (mean Mnc) and variability (mean SD of Mnc) of accommodation. RESULTS: For near and distance analyses, respectively, sample size was 321 and 247, mean age was 10.37 (SD 1.77) and 10.30 (SD 1.74) years, mean cycloplegic M was 0.48 (SD 1.10) and 0.79 diopters (D) (SD 1.00), and mean astigmatism was 0.99 (SD 1.15) and 0.75 D (SD 0.96). Poor accommodative accuracy was associated with high astigmatism, low task demand (video viewing), and high accommodative demand. The negative effect of accommodative demand on accuracy increased with increasing astigmatism, with the poorest accommodative accuracy observed in high astigmats (≥3.00 D) with high accommodative demand/high hyperopia (1.53 D and 2.05 D of underaccommodation for near and distant stimuli, respectively). Accommodative variability was greatest in high astigmats and was uniformly high across task condition. No/low and moderate astigmats showed higher variability for the video task than the reading tasks. CONCLUSIONS: Accuracy of accommodation is reduced in uncorrected children with high astigmatism and high accommodative demand/high hyperopia, but improves with increased visual task demand (reading). High astigmats showed the greatest variability in accommodation.