Cause of death in adults with intellectual disability in the United States.

BACKGROUND: Prior studies report that adults with intellectual disability (ID) have cause of death patterns distinct from adults in the general population but do not provide comparative analysis by specific causes of death. METHODS: Data are from the National Vital Statistics System 2005-2017 US Multiple Cause-of-Death Mortality files. We utilised adjusted odds ratios to identify causes of death that were more common for adults whose death certificate indicated ID (N = 22 512) than for adults whose death certificate did not indicate ID (N = 32 738 229), controlling for severity level of ID. We then examine the associations between biological sex and race-ethnicity and causes of death solely among adults with ID. RESULTS: The leading cause of death for adults with and without ID indicated on their death certificate was heart disease. Adults with ID, regardless of the severity of the disability, had substantially higher risk of death from pneumonitis, influenza/pneumonia and choking. Adults with mild/moderate ID also had higher risk of death from diabetes mellitus. Differences in cause of death trends were associated with biological sex and race-ethnicity. CONCLUSIONS: Efforts to reduce premature mortality for adults with ID should attend to risk factors for causes of death typical in the general population such as heart disease and cancer, but also should be cognisant of increased risk of death from choking among all adults with ID, and diabetes among adults with mild/moderate ID. Further research is needed to better understand the factors determining comparatively lower rates of death from neoplasms and demographic differences in causes of death among adults with ID.

Heterogeneity in age at death for adults with developmental disability.

BACKGROUND: Although increased attention has been devoted to mortality trends for adults with developmental disability, research has not accounted for possible differences in age at death between disability types. We examine whether heterogeneity is present in age at death between adults with different types of developmental disability. METHODS: Data were from the 2012-2016 U.S. Multiple Cause-of-Death Mortality files. Mean age at death and age at death distributions were analysed for adults, aged 18-126, with and without developmental disability collectively and then stratified by biological sex. RESULTS: There were 33 154 decedents with and 13 026 759 without developmental disability. Compared with adults without developmental disability, age at death was lower for all decedents with developmental disability but varied markedly by disability type and biological sex. Among adults with developmental disability, those with intellectual disability had the highest age at death, and those with cerebral palsy or other rare developmental disabilities, especially if co-morbid for a second developmental disability, had the lowest age at death. CONCLUSION: Research on age at death for adults with developmental disability must account for heterogeneity among disability types in order to ensure reliable estimates. Failure to do so conceals important differences between disability types, which can misguide public health and preventive care efforts to reduce premature mortality and/or provide aging-related supports.

Biological vulnerability of two exploited sharks of the genus Deania (Centrophoridae).

Life-history parameters of Deania calcea and Deania quadrispinosa suggested that their productivity was very low. Maturity (L(T50) ) occurs at c. 80% of maximum observed total lengths (L(T) ) for both species and sexes. A large proportion of mature females were neither pre-ovulatory nor pregnant, and the reproductive cycle included a distinct resting phase after pregnancy. For D. calcea, mean ovarian fecundity was 12 and maximum observed litter size was 10 (average of six); D. quadrispinosa averaged 17 pups per litter. Birth L(T) was 28-33 cm for D. calcea and 23-25 cm for D. quadrispinosa. The male and female reproductive cycles were aseasonal, and consequently, the length of the reproductive cycle could not be determined. Preliminary ageing data from dorsal-spine growth bands suggested that female D. calcea lived to 31-36 years and males to 24-32 years. The L(T) -at-age data using external bands on the spines showed maturity occurring at 15·5 years (males) and 21·5 years (females), whereas banding on the internal dentine indicated maturity at 10·5 and 17·5 years for males and females. Thus, a female lifetime of 31-36 years allowed for a maximum of 7 litters if a 2 year cycle is assumed or only five litters with a 3 year cycle, resulting in a lifetime fecundity of only 42 pups (2 year cycle) or even lower (3 year cycle).

Movement patterns of the draughtboard shark Cephaloscyllium laticeps (Scyliorhinidae) determined by passive tracking and conventional tagging.

A combination of passive tracking and conventional tagging was used to provide insight into the movement patterns of the draughtboard shark Cephaloscyllium laticeps, the most common catshark in coastal areas of southern Australia. A series of acoustic receivers deployed throughout south-eastern Tasmania as well as a receiver array along an isolated reef, Crayfish Point Reserve (CPR), passively tracked 25 C. laticeps from January to July 2003. Cephaloscyllium laticeps were present from 4 to 98 days. The majority of the C. laticeps stayed within the CPR where most individuals were active throughout the night. They were found actively moving (i.e. when a C. laticeps was consecutively detected by two or more non-overlapping receivers, suggesting the individual was moving) and spending periods of minor movements (i.e. when an individual was consecutively detected by only one receiver, suggesting it was at rest). The length of these minor movements periods, observed both day and night, ranged from 1 h to 5 days. In addition to passive tracking, 1552 conventionally tagged C. laticeps were released in the eastern and south-western coastal areas of Tasmania and within the CPR between January 2000 and April 2007. The CPR showed a higher recapture rate, 38%, than eastern and south-western areas where the recapture rates were 10 and 3%, respectively. Within the CPR, 36% of the sharks were recaptured on multiple occasions. The maximum time at liberty ranged from 1 month to 7 years. The majority of the C. laticeps were recaptured in the vicinity of where they were released (<10 km), although larger longer-term movements of up to 300 km were recorded. The large amount of multiple recaptures within the CPR, in addition to acoustic tagging results, indicated a high degree of site fidelity for C. laticeps. This isolated reef appears to be an important habitat for this species, and therefore, the current protection status of this area is probably beneficial for the conservation of C. laticeps.

Seasonal occurrence and population structure of the broadnose sevengill shark Notorynchus cepedianus in coastal habitats of south-east Tasmania.

Research longline sampling was conducted seasonally from December 2006 to February 2009 to investigate the occurrence and population structure of the broadnose sevengill shark Notorynchus cepedianus in coastal areas of south-east Tasmania. Notorynchus cepedianus showed a consistent temporal trend in seasonal occurrence in Norfolk Bay characterized by high abundances in summer to near absence in winter. This pattern was less pronounced in the Derwent Estuary, where fish were still caught during winter. The absence of smaller total length (L(T) ) classes (<80 cm) from the catches suggests that N. cepedianus are not using these coastal habitats as nursery areas. Of the 457 individuals tagged, 68 (15%) were recaptured. Time at liberty ranged from 6 days to almost 4 years and all but one of the recaptures were caught in its original tagging location, suggesting site fidelity. The large number of N. cepedianus in these coastal systems over summer indicates that these areas are important habitats for this species and that N. cepedianus may have a significant influence on community dynamics through both direct and indirect predator-prey interactions.

Luteinizing hormone-releasing hormone fusion protein vaccines block estrous cycle activity in beef heifers.

Two LHRH fusion proteins, thioredoxin and ovalbumin, each containing seven LHRH inserts were tested for their ability to inhibit estrous cycle activity. The objective was to evaluate immune and biological responses from alternating the two fusion proteins in an immunization schedule. One hundred ten heifers were divided equally into 11 groups. Two control groups consisted of either spayed or intact, untreated heifers. Heifers in the other nine groups were immunized on wk 0, 4, and 9. Treatments were immunizations of the same protein throughout or alternating the proteins in different booster sequences. Blood was collected weekly for 22 wk, and serum was assayed for concentrations of progesterone and titers of anti-LHRH. At slaughter, reproductive tracts were removed from each heifer and weighed. Heifers with >or=1 ng/mL of progesterone were considered to have a functional corpus luteum and thus to have estrous cycle activity. All LHRH-immunized groups of heifers had a smaller (P < 0.05) proportion of heifers showing estrous cycle activity after 6 wk than the intact, untreated control group. There was no difference in number of heifers cycling between the immunized groups and the spayed heifers during wk 9 to 22. Anti-LHRH did not differ among immunized groups during wk 1 to 9. Starting at wk 10 and continuing through the conclusion of the study, there was an overall difference among treatment groups for anti-LHRH (P < 0.05). Uterine weights differed among treatments (P < 0.05), with intact control animals having heavier uteri than all other groups (P < 0.05). Uterine weights were negatively correlated with maximum LHRH antibody binding (r = -0.44). In summary, the LHRH fusion proteins were as effective as surgical spaying in suppression of estrous cycle activity, but alternating the two proteins in an immunization schedule did not enhance the immunological or biological effectiveness of the vaccine.

[Wavefront analysis and adaptive optics]. / Wellenfrontanalyse und adaptive Optiken.

In this paper we attempt to provide an overview of the principles of wavefront measurement. We also discuss the operational principles of different systems currently present on the market including their advantages and disadvantages. Moreover, we speculate on current and possible future implications of this new technology in the laser refractive surgery. Adaptive optics are explained in the context of "customized ablation" and preoperative verification of the desired results. Finally, the first international clinical results of wavefront guided excimer laser surgery are reviewed and critically commented.

Structure and solution equilibria of D-glucose and D-mannose sulfite adducts.

An X-ray crystallographic study has confirmed that the potassium bisulfite adducts of D-glucose and D-mannose have open-chain structures with R and S configurations respectively at C-1. NMR studies have shown that each sugar gives rise to two bisulfite compounds, and solution-state structures and conformations of these isomers have been deduced from analysis of (1)H NMR spectra. (13)C NMR data for the four adducts are given. Furanose forms of the D-glucose and D-mannose have been detected in the equilibrium solutions.

Preparation of 1,2-O-isopropylidene derivatives of alpha-D-galactoseptanose, beta-L-altroseptanose, and 3-O-methyl-alpha-D-guloseptanose.

Displacement of the tosyloxy group in 5-O-benzyl-1,2-O-isopropylidene-4-O-(p-toluenesulfonyl)-alpha-D-glucoseptanose has yielded derivatives of 1,2-O-isopropylidene-alpha-D-galactoseptanose. Acid catalysed acetonation then gave 1,2:3,4-di-O-isopropylidene-alpha-D-galactoseptanose or 1,2;4,5-di-O-isopropylidene-alpha-D-galactoseptanose using lower acid concentrations. Reduction of the ketone derived from 1,2:3,4-O-isopropylidene-alpha-D-septanose gave 1,2;3,4-di-O-isopropylidene-beta-L-altroseptanose. Reaction of 3,4-anhydro-5-O-benzyl-1,2-O-isopropylidene-alpha-D-galactoseptanose with sodium methoxide gave 5-O-benzyl-1,2-O-isopropylidene-4-O-methyl-alpha-D-glucoseptanose and 5-O-benzyl-1,2-O-isopropylidene-3-O-methyl-alpha-D-guloseptanose. Solution-state conformations of these compounds have been deduced from their 1H NMR spectra.

Ischaemic heart disease may predispose to pseudophakic cystoid macular oedema.

PURPOSE: Pseudophakic macular oedema (PMO) is uncommon following uncomplicated phacoemulsification and lens implantation and the cause of infrequent cases is rarely understood. This study was undertaken to determine whether a relationship exists between ischaemic heart disease (IHD) and PMO. METHODS: Retrospective case note review was carried out of 177 (252 eyes) consecutive patients without pre-existing retinal disease who underwent phacoemulsification and intraocular lens implantation during a 12 month period. Patients with a post-operative best corrected visual acuity < 6/9 underwent slit-lamp biomicroscopy and fluorescein angiography to identify PMO. IHD was defined on clinical and electrocardiographic grounds. The incidence of IHD was compared in patients with and without PMO and statistical analysis performed using the Fisher's exact test. RESULTS: PMO occurred in 4 patients (6 eyes), all of whom had IHD, whereas no PMO occurred in the remaining 173 patients (246 eyes) (p = 0.04). CONCLUSIONS: Pseudophakic macular oedema represents an important complication following modern phacoemulsification and intraocular lens implantation and is associated significantly with ischaemic heart disease.

Surgical treatment of keratoconus at the turn of the 20th century.

PURPOSE: This paper reviews surgical modalities for treatment of keratoconus at the threshold of the 20th century. METHODS: All ophthalmic literature from 1895 until 1925 in English and German, available at the library of the Institute of Ophthalmology, London, United Kingdom, was studied with respect to this topic. RESULTS: Three thermal procedures were described; galvanocauterization with perforation, without perforation, and a non-contact application of heat to the corneal apex. Radial extension of a thermal burn to correct the minus cylinder represented a further modification. Excision of the conical area was suggested either as a lamellar dissection or as a full thickness trephination. Incision of the cone appeared to be less popular. In staged procedures, a combination of galvanocauterization, splitting of the cornea, conjunctival flap, and a subsequent optical iridectomy were applied. CONCLUSION: The treatment of keratoconus 100 years ago used refractive surgery to improve visual function by modifying corneal shape.

Errors leading to unexpected pseudophakic ametropia.

PURPOSE: Determination of the reasons for clinically significant unplanned ametropia following cataract surgery and the results of management of the ametropia. METHODS: Retrospective review of 11 consecutive cases of tertiary referral for management of pseudophakic ametropia to the authors. Corrective surgery involved either lens implant exchange or LASIK refractive surgery. Final outcome was assessed by uncorrected and best spectacle corrected visual acuity and manifest refractive outcome. RESULTS: Five cases (45%) were due to significant error in axial length determination at pre-surgery biometry. Six cases (55%) were due to surgeon or surgical team error, where the surgeon implanted a lens of power at variance with that specified pre-operatively. Nine patients elected to undergo refractive surgery to correct the ametropia and 2 elected to wear a spectacle lens. Seven underwent lens implant exchange and 2 patients underwent LASIK keratorefractive surgery. Eight of nine patients were within 1 dioptre of intended spherical equivalent after refractive surgery and 1 patients was -1.5 dioptre myopic. CONCLUSIONS: Most cases of serious unintended ametropia after cataract surgery are avoidable. Care should be taken with the biometry and procedural checks to minimise error. When lens implant exchange or LASIK was performed the final refractive results were satisfactory.

Silicone intraocular lens compression and double lens implants in diseased eyes.

PURPOSE: To assess the outcomes of double lens implants in hyperoptic eyes with associated pathology. METHOD: Double lens implants were used in 4 eyes of 4 patients each with a different ophthalmic or neuro-ophthalmic disease. Biometry was performed in the standard contact fashion and lens power formulae used included SRK/T, Holladay and Hoffer Q. RESULTS: Average spherical equivalent refraction improved from +6.875 D to +0.38 D. Absolute average prediction error was greatest for SRK/T (2.65 D) and least for Holladay (1.73 D). Refractive suprises were influenced by the underlying disease process. One patient showed central lens compression. CONCLUSION: Underlying disease can produce biometry errors. Structural ophthalmic or neurological disease is not a contraindication to the use of double lens implants. Double lens implants are useful to correct refractive error in the presence of underlying disease.

Patient-controlled analgesia and urinary retention following lower limb joint replacement: prospective audit and logistic regression analysis.

We studied a number of factors that may be associated with urinary retention, in particular the method of postoperative analgesia delivery, in 47 men and 69 women undergoing lower limb joint replacements. The following factors were studied: age, gender, height, weight, previous history of urinary retention, presence of symptoms suggestive of urinary tract obstruction, type of anaesthetic (general anaesthetic or spinal anaesthetic), type of postoperative analgesia (intramuscular or patient-controlled analgesia with morphine) and the total dose of morphine given. Urinary retention developed in 18.1% of patients. Stepwise logistic regression analysis was used to identify independent explanators of an increased probability of developing urinary retention. Three factors emerged - male gender, increasing age and the use of patient-controlled analgesia.

Phototherapeutic smoothing as an adjunct to photorefractive keratectomy in porcine corneas.

PURPOSE: To study the smoothing effect of phototherapeutic keratectomy (PTK) using masking fluids as an adjunct to standard photorefractive keratectomy ablations. METHODS: Six fresh porcine corneas underwent -6.00, -10.00, and -15.00 D sphere ablations using the VISX Star excimer laser. Multizone treatments to a maximum 6.5 mm radially symmetrical bed were used with a fluence of 160 mJ/cm2. Three of the treatments were supplemented with a thin layer of balanced salt solution and 6 microm of full beam PTK. The corneas were examined by electron microscopy. RESULTS: Smoother treatment zones were apparent in corneas undergoing PTK following PRK. The effect was more marked at higher dioptric ablations. CONCLUSION: PTK may improve surface smoothness after PRK, especially for higher dioptric ablations.

Repair of Descemet's membrane detachment after intraocular surgery.

We repaired three unselected cases of Descemet's membrane detachment. A visually successful outcome was achieved in one case, an anatomically successful outcome in another, and no improvement in the last. We believe that large detachments should be repaired early rather than waiting for possible spontaneous reattachment, and we advocate sulfur hexafluoride fluid-gas exchange as the procedure of choice.

Balanced analgesia with intravenous ketorolac and patient-controlled morphine following lower abdominal surgery.

STUDY OBJECTIVE: To investigate the efficacy, opioid-sparing effects and any reduction in adverse events of a continuous intravenous (i.v.) infusion of ketorolac following lower abdominal surgery. DESIGN: Randomized, double-blind, placebo-controlled, parallel-group study. SETTING: Inpatient elective gynecologic surgical patients. PATIENTS: 60 ASA physical status I or II patients aged 18 to 70 years scheduled for elective abdominal hysterectomy. INTERVENTIONS: Following standardized preparation and anesthesia, continuous i.v. infusions of either ketorolac or placebo were administered for 24 hours postoperatively with a patients' standardized postoperative protocol. Supplementary analgesia was administered by an i.v. patient-controlled analgesia (PCA) system. MEASUREMENTS AND MAIN RESULTS: A significantly lower proportion of the patients in the ketorolac group (6%) rated their pain at 24 hours as moderate or severe compared with patients in the placebo group (34%) (p = 0.04). Mean 24-hour morphine consumption was significantly lower in the ketorolac group (43 mg; SEM 5 mg) compared with the placebo group (55 mg SEM 5 mg) (p = 0.02). There was no significant difference in the incidence of postoperative hypoxemia between the groups with respect to mean times per hour spent with oxygen saturation (SPO2) less than 85%, more than 85% but less than 90%, or more than 90% but less than 94%, mean hourly SPO2, or the incidence and duration of severe hypoxemic episodes. Nausea and vomiting were the only significant adverse events, and they occurred in 30% of patients in both groups. CONCLUSION: Intravenous infusion of ketorolac combined with morphine delivered via a PCA device would appear to be a valuable method of providing balanced analgesia following lower abdominal surgery.

The effect of recurrent pterygium on corneal topography.

Pterygium is known to cause corneal topographic changes that can result in decreased visual acuity. We present a case of recurrent pterygium causing blurred vision and diplopia, and document the corneal topographic changes, showing astigmatism of 15 diopters induced by lateral gaze, prior to surgical excision.

Postoperative blunt trauma to 7.5 mm scleral pocket wounds.

Two patients received blunt trauma to the operated eye after phacoemulsification cataract surgery. Both patients had a three-step 7.5 mm chord width, 3.0 mm long, curving incision, extending from sclera into clear cornea. One patient had rupture of the scleral tunnel and horizontal suture 20 days after surgery. The intraocular lens was dislocated into and along the scleral tunnel. The second patient had direct trauma four days after surgery, resulting in cheese-wiring of the horizontal nylon 10-0 suture and wound leakage but no other sequelae. Blunt trauma after scleral pocket phacoemulsification cataract surgery may result in clinical wound dehiscence if sufficient force is sustained.