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Increasing costs are challenging the capacity for resource management agencies to keep up with mounting needs for robust data about fish populations and their habitats. Furthermore, trust among scientists, government agencies, and the public is fundamental to effective fisheries management, and relations among these three groups are increasingly strained when decisions about fishing limits are made (or are perceived to be made) on the basis of limited information or analysis. In the South Atlantic region of the United States, the South Atlantic Fishery Management Council has begun building a citizen science program to increase the quantity and quality of data used for fisheries management decisions throughout the region and to build trust and foster mutual understanding among those involved in the process. The goal is to build on existing management infrastructure to address key challenges to managing fisheries for long-term sustainability. In the present article, we examine the collaborative process used to establish the program.
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IMPORTANCE: Currently the only treatment for recurrent pterygium is surgery. This is a phase 1 trial investigating ranibizumab as a medical treatment for recurrent pterygium. OBJECTIVE: To assess the safety and efficacy of subtenon Ranibizimab for recurrent pterygia. DESIGN: Subjects with recurrent pterygium received subtenon ranibizumab and were followed for 1 year. Safety parameters were measured. Photographs were taken and quantitatively analyzed to measure the short-term (2 months) and long-term (5-26 months) response to treatment. SETTING: University of New Mexico Eye Clinic. PARTICIPANTS: Eight subjects with recurrent pterygia. INTERVENTIONS: Subtenon delivery of 0.5 to 2 mg of ranibizumab, at day 0, month 1, and month 2. MAIN OUTCOME MEASURES: Safety parameters included visual acuity, intraocular pressure, and assessment of ocular surface. Efficacy was assessed by comparing photographs taken at day 0 with a short-term follow-up photograph taken at month 2 and a long-term follow-up image taken at the final patient visit (range 5-26 months). Quantitative analysis of photographs was performed to measure vascularity in the treated zone. RESULTS: Four subjects had an arrest of pterygium growth with a visual reduction in vascularity and a quantitative reduction in the area of vascularization (average vascularized area in short-term follow-up images was 51% of the baseline photos at day 0, and in the long-term photos was 36% of day 0). The other four subjects had a less marked reduction in their vascularity in the short-term photos (69% of their baseline photos). This resulted in two subjects withdrawing from the study early. Long-term quantitative analysis for the two remaining "nonresponders," who completed the study, showed an average vascularized area that was 71% of that in their baseline photos. The long-term photos in these subjects did not appear to have a clinically relevant difference from the short-term photos. CONCLUSIONS: In half of the subjects, subtenon ranibizumab appeared to arrest growth. Although the response is variable, this may warrant the drug's use when attempting to control growth of recurrent pterygia, and may prevent consecutive surgery for some patients.
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Inibidores da Angiogênese/administração & dosagem , Pterígio/tratamento farmacológico , Ranibizumab/administração & dosagem , Adulto , Inibidores da Angiogênese/efeitos adversos , Feminino , Humanos , Injeções Intraoculares , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Pterígio/patologia , Pterígio/fisiopatologia , Ranibizumab/efeitos adversos , Recidiva , Prevenção Secundária , Acuidade Visual/fisiologiaRESUMO
This study quantifies setup uncertainty in brain tumor patients who received image-guided proton therapy. Patients analyzed include 165 children, adolescents, and young adults (median age at radiotherapy: 9 years (range: 10 months to 24 years); 80 anesthetized and 85 awake) enrolled in a single-institution prospective study from 2020 to 2023. Cone-beam computed tomography (CBCT) was performed daily to calculate and correct manual setup errors, once per course after setup correction to measure residual errors, and weekly after treatments to assess intrafractional motion. Orthogonal radiographs were acquired consecutively with CBCT for paired comparisons of 40 patients. Translational and rotational errors were converted from 6 degrees of freedom to a scalar by a statistical approach that considers the distance from the target to the isocenter. The 95th percentile of setup uncertainty was reduced by daily CBCT from 10 mm (manual positioning) to 1-1.5 mm (after correction) and increased to 2 mm by the end of fractional treatment. A larger variation existed between the roll corrections reported by radiographs vs. CBCT than for pitch and yaw, while there was no statistically significant difference in translational variation. A quantile mixed regression model showed that the 95th percentile of intrafractional motion was 0.40 mm lower for anesthetized patients (p=0.0016). Considering additional uncertainty in radiation-imaging isocentricity, the commonly used total plan robustness of 3 mm against positional uncertainty would be appropriate for our study cohort.
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Carcinoma de Células Escamosas/patologia , Neoplasias dos Nervos Cranianos/patologia , Diplopia/diagnóstico , Doenças do Nervo Facial/patologia , Doenças do Nervo Trigêmeo/patologia , Idoso de 80 Anos ou mais , Azatioprina/uso terapêutico , Carcinoma de Células Escamosas/diagnóstico por imagem , Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Diplopia/tratamento farmacológico , Quimioterapia Combinada , Doenças do Nervo Facial/diagnóstico por imagem , Evolução Fatal , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Imageamento por Ressonância Magnética , Masculino , Invasividade Neoplásica , Prednisona/uso terapêutico , Recidiva , Doenças do Nervo Trigêmeo/diagnóstico por imagemRESUMO
Blood glucose measurements provide important diagnostic information regarding stress, disease, and nutritional status. Glucose analytical methodologies include dry chemistry analysis (DCA) of plasma and point-of-care (POC) glucometer analysis of whole blood; however, these 2 methods differ in cost, required sample volume, and processing time. Because POC glucometers use built-in equations based on features of mammalian blood to convert whole blood measurements to plasma equivalent units, obtained glucose data must be compared and validated using gold-standard chemistry analytical methodology in reptiles. For in-water, trawl-captured, immature Kemp's ridley sea turtles (Lepidochelys kempii) from Georgia, USA, we observed significant, positive agreement between the 2 glucose determination methods; however, the glucometer overestimated glucose concentrations by 1.4 mmol/L on average in comparison to DCA and produced a wider range of results. The discordance of these results suggests that POC glucometer glucose data should be interpreted in the context of methodology- and brand-specific reference intervals along with concurrent packed cell volume data.
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Glicemia/análise , Plasma/química , Tartarugas/sangue , Animais , Feminino , Sistemas Automatizados de Assistência Junto ao Leito , Valores de ReferênciaRESUMO
The presence of earthy-musty odors in drinking water is a major concern for water suppliers and consumers worldwide. While geosmin and 2-methylisoborneol are the most studied earthy-musty odor-causing compounds, pyrazine and its alkyl and methoxy compounds possess similar odors and are widely distributed in nature, foods, and beverages. In this study, odor characteristics of pyrazines and their presence in natural and treated waters were determined. Pyrazine, 2,6-dimethyl-pyrazine (DMP), 2,3,5-trimethyl-pyrazine (TrMP), 2-ethyl-5(6)-methyl-pyrazine (EMP), 2,3,5,6-tetramethyl-pyrazine (TeMP), 2-isobutyl-3-methoxy-pyrazine (IBMP) and 2-isopropyl-3-methoxy-pyrazine (IPMP) were measured in source and finished drinking water across China. 2-Methoxy-3,5-dimethyl-pyrazine (MDMP), IBMP, and IPMP were investigated in rivers in Virginia, USA. The results showed that "musty" and "sweet" were the most common descriptors for pyrazine, DMP, MDMP, TrMP, and TeMP. While IBMP and IPMP were never detected in 140 source or drinking water samples from across China, pyrazine, DMP, MDMP, TrMP, and TeMP occurred throughout with concentrations of n.d.-62.2 ng/L-aq in source water and n.d.-39.6 ng/L-aq in finished water. IBMP, IPMP, and MDMP were present in two Virginia rivers; MDMP occurred in 18% of the samples with concentrations of n.d.-4.4 ng/L, many of which were above the aqueous odor threshold of 0.043 ng/L MDMP. The removal efficiencies through conventional water treatment were poor, ranging from negative removals to â¼10%. Advanced oxidation water treatment could only remove EMP and TrMP. The widespread presence of earthy-musty-sweet pyrazines in source and drinking waters on two continents, their poor removal during water treatment, and ng/L odor threshold concentrations confirm their potential to be T&O issues for consumers.
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Água Potável , Poluentes Químicos da Água/análise , China , Comportamento do Consumidor , Odorantes/análise , Pirazinas/análise , VirginiaRESUMO
PURPOSE: To quantitatively describe the structural corneal changes from infancy to early adulthood using ultrasound biomicroscopy. METHODS: In this prospective study, 168 ultrasound biomicroscopy images were obtained from 24 healthy eyes of 24 patients who consented and enrolled in the Pediatric Anterior Segment Imaging Innovation Study. Their ages ranged from birth to 26 years. An established ultrasound biomicroscopy imaging protocol including seven views of one eye per patient were obtained and measured using ImageJ software (National Institutes of Health). Twelve corneal structural parameters were measured. Means were compared between younger and older groups. RESULTS: Among the 12 measured structures, 5 demonstrated statistically significant differences (P < .05) between patients younger than 1 year and patients older than 1 year. The mean values for corneal cross-sectional width and length, central corneal thickness, and radii of curvature (anterior and posterior) were significantly different in patients younger than 1 year. Curvature and limbus-to-limbus dimensions changed more dramatically than thickness and tissue density. When comparing the youngest to oldest subgroups, anterior curvature flattened (6.14 to 7.55 radius), posterior curvature flattened (5.53 to 6.72 radius), angle-to-angle distance increased (8.93 to 11.40 mm), and endothelial cross-sectional distance increased (10.63 to 13.61 mm). CONCLUSIONS: Pediatric corneal structures change with age. The most significant changes occur in the first months of life, with additional changes later in childhood. This study further demonstrates the importance of age in pediatric corneal imaging analysis. [J Pediatr Ophthalmol Strabismus. 2020;57(4):238-245.].
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Córnea/diagnóstico por imagem , Córnea/crescimento & desenvolvimento , Microscopia Acústica , Adolescente , Adulto , Biometria , Criança , Pré-Escolar , Paquimetria Corneana , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Adulto JovemRESUMO
Health assessments of wildlife species are becoming increasingly important in an ever-changing environment. Kemp's ridley sea turtles (Lepidochelys kempii; hereafter, Kemp's ridleys) are critically endangered and incur several on-going threats to their population recovery; therefore, it is imperative to advance the understanding of baseline blood analyte data as a diagnostic and monitoring tool. For in-water, trawl-captured, immature Kemp's ridleys (minimum N = 31) from Georgia, USA, the objectives of this study were to (1) establish reference intervals (RIs) for packed cell volume (PCV) and 27 plasma biochemistry analytes and (2) determine length-specific relationships in blood analytes. We observed significant positive correlations between minimum straight carapace length and PCV, amylase, calcium:phosphorus ratio, cholesterol, magnesium, triglycerides, total solids, total protein and all protein fractions (e.g. alpha-, beta- and gamma-globulins); aspartate aminotransferase and chloride showed significant negative relationships. These results suggest that certain blood analytes in Kemp's ridleys change as these animals grow, presumptively due to somatic growth and dietary shifts. The information presented herein, in due consideration of capture technique that may have impacted glucose and potassium concentrations, represents the first report of blood analyte RIs for Kemp's ridley sea turtles established by guidelines of the American Society for Veterinary Clinical Pathology and will have direct applications for stranded individuals in rehabilitative care and for future investigations into the health status of wild individuals from this population.
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PURPOSE: To report the long-term outcomes of transscleral fixation of capsular tension rings (CTR) with intraocular lens (IOL) placement in pediatric patients with ectopia lentis. SETTING: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. DESIGN: Retrospective case series. METHODS: Pediatric patients requiring lens extraction with transscleral capsular bag fixation with a CTR and IOL for ectopia lentis between January 2006 and January 2016 were analyzed. RESULTS: Thirty-seven patients (67 eyes) who had transscleral fixation of the capsular bag using a CTR fixated with 9-0 or 10-0 polypropylene (Prolene), 8-0 polytetrafluoroethylene (Gore-Tex), or 9-0 nylon were identified. The mean age at time of surgery was 7.25 years (2 to 18 years) and the mean follow-up was 35.3 months (0.25 to 120 months). The proportion of eyes showing improvement in corrected distance visual acuity (CDVA) postoperatively was 78.5%, which demonstrated significance with a 95% confidence interval. In the immediate postoperative period, 1 eye developed a hyphema and 1 eye required IOL repositioning. Long-term complications included posterior capsule opacification in 35 eyes (52%) and uveitis-glaucoma-hyphema syndrome in 1 eye (1.5%). Three eyes (4.4 %) required IOL repositioning for spontaneous delayed IOL dislocation, 2 sutured with 8-0 polytetrafluoroethylene at postoperative month 8 and postoperative year 3 and 1 sutured with 9-0 polypropylene at postoperative year 7. CONCLUSION: Transscleral fixation of the capsular bag using a CTR improved CDVA and provided IOL stability in pediatric patients with ectopia lentis.
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Ectopia do Cristalino/cirurgia , Cápsula do Cristalino/cirurgia , Implante de Lente Intraocular/métodos , Esclera/cirurgia , Técnicas de Sutura , Acuidade Visual , Adolescente , Criança , Pré-Escolar , Ectopia do Cristalino/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Desenho de Prótese , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
PURPOSE: To compare the consistency of incision architecture utilizing a traditional diamond keratome and a newly designed diamond keratome. METHODS: We used a traditional diamond keratome and newly designed diamond keratome to create clear corneal incisions in human cadaveric donor eyes. Three surgeons with varying levels of experience made 30 incisions with each keratome; and the wound architecture was measured including incision lengths, epithelial and endothelial widths, and the central epithelial incision's deviation from a straight line entrance. RESULTS: The mean absolute difference in right and left incision lengths (traditional: 0.182 ± 0.158 mm and new 0.088±0.077 mm [P<0.003]), mean absolute difference in epithelial and endothelial incision width (traditional: 0.181±0.144 mm and new 0.080±0.092 mm [P<0.002]), endothelial incision central deviation from a straight line (traditional: 0.128±0.242 mm and new -0.046±0.124 mm [P<0.001]) were all significantly more consistent with the newly designed diamond keratome than with the traditional diamond keratome. CONCLUSION: The newly designed diamond keratome creates a more consistent clear corneal incision than a traditional diamond keratome across a variety of surgical skill levels and does not require advanced levels of training to achieve this consistency.
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IMPORTANCE: We present a method to reintroduce ophthalmic training into the medical school curriculum. OBJECTIVES: To evaluate knowledge and skills acquired when participating in a service project, the Community Vision Project, and to develop a quantitative method for testing skills with the direct ophthalmoscope in patients. DESIGN: Second-year medical students participated in the study. After 1 month, their knowledge was compared with that of peers and graduates (internal medicine residents). Also at 1 month, their direct ophthalmoscope skills were compared with those of upperclassmen who had completed all core clerkships. One year later, after the participants had completed their core clerkships, long-term ophthalmoscope skills retention was tested, and their performance was compared with that of their classmates. SETTING AND PARTICIPANTS: Training occurred in mobile eye clinics. Knowledge and skills assessments were performed in the hospital eye clinic among students and residents at The University of New Mexico School of Medicine. Patients were recruited from the hospital eye clinic. Participants attended a 3-hour training session held by an attending physician in the hospital eye clinic and took part in at least 1 mobile eye clinic. MAIN OUTCOMES AND MEASURES: A knowledge assessment quiz was administered to participants (n = 12), their classmates (n = 18), and internal medicine residents (n = 33). Skills assessment with the direct ophthalmoscope was performed at 1 month and at 1 year in 5 participants and 5 nonparticipants. Tonometer skills were assessed by comparing participants' readings with those of an ophthalmologist's obtained in patients at the mobile eye clinics. RESULTS Participants' median knowledge assessment scores were 48% higher than those of their classmates and 37% higher than those of internal medicine residents (P < .001 for both). Short-term (1 month) direct ophthalmoscopy median scores were 60% (quartile 1 to quartile 3 range, 40%-80%) for participants and 40% (quartile 1 to quartile 3 range, 20%-60%) for nonparticipating upperclassmen (P = .24). Long-term direct ophthalmoscopy median scores were 100% (quartile 1 to quartile 3 range, 75%-100%) for participants and 0% (quartile 1 to quartile 3 range, 0%-25%) for nonparticipating classmates (P = .11). Participants' tonometer readings were similar to those of the ophthalmologist's; their median reading was 2 mm Hg (quartile 1 to quartile 3 range, 0-4 mm Hg) higher than that of the ophthalmologist's (P = .05, sign test). CONCLUSIONS AND RELEVANCE: Service-based learning offered an efficient model for incorporating ophthalmic training into the medical school curriculum. A viable tool for quantitatively testing ophthalmoscope skills is presented.