Accommodation lags are higher in myopia than in emmetropia:Measurement methods and metrics matter

Purpose: To determine whether accommodative errors in emmetropes and myopes are systematically different, and the effect of using different instruments and metrics. Methods: Seventy-six adults aged 18–27 years comprising 24 emmetropes (spherical equivalent refraction of the dominant eye +0.04 ± 0.03 D) and 52 myopes (−2.73 ± 0.22 D) were included. Accommodation responses were measured with a Grand Seiko WAM-5500 and a Hartmann–Shack Complete Ophthalmic Analysis System aberrometer, using pupil plane (Zernike and Seidel refraction) and retinal image plane (neural sharpness—NS; and visual Strehl ratio for modulation transfer function—VSMTF) metrics at 40, 33 and 25 cm. Accommodation stimuli were presented to the corrected dominant eye, and responses, referenced to the corneal plane, were determined in the fellow eye. Linear mixed-effects models were used to determine influence of the refractive group, the measurement method, accommodation stimulus, age, race, parental myopia, gender and binocular measures of heterophoria, accommodative convergence/accommodation and convergence accommodation/convergence ratios. Results: Lags of accommodation were affected significantly by the measurement method (p < 0.001), the refractive group (p = 0.003), near heterophoria (p = 0.002) and accommodative stimulus (p < 0.05), with significant interactions between some of these variables. Overall, emmetropes had smaller lags of accommodation than myopes with respective means ± standard errors of 0.31 ± 0.08 D and 0.61 ± 0.06 D (p = 0.003). Lags were largest for the Grand Seiko and Zernike defocus, intermediate for NS and VSMTF, and least for Seidel defocus. Conclusions: The mean lag of accommodation in emmetropes is approximately equal to the previously reported depth of focus. Myopes had larger (double) lags than emmetropes. Differences between methods and instruments could be as great as 0.50 D, and this must be considered when comparing studies and outcomes. Accommodative lag increased with the accommodation stimulus, but only for methods using a fixed small pupil diameter.</p

Ciliary muscle dimension changes with accommodation vary in myopia and emmetropia

Purpose: The purpose of this study was to determine whether accommodation-induced changes in ciliary muscle dimensions vary between emmetropes and myopes, and the effect of the image analysis method. Methods: Seventy adults aged 18 to 27 years consisted of 25 people with emmetropia (spherical equivalent refraction [SER] +0.21 ± 0.36 diopters [D]) and 45 people with myopia (-2.84 ± 1.72 D). There were 23 people with low myopia (>-3 D) and 22 people with moderate myopia (-3 to -6 D). Right eye ciliary muscles were imaged (Visante OCT; Carl Zeiss Meditec) at 0 D and 6 D demands. Measures included ciliary muscle length (CML), ciliary muscle curved length (CMLarc), maximum ciliary muscle thickness (CMTmax), CMT1, CMT2, and CMT3 (fixed distances 1-3 mm from the scleral spur), CM25, CM50, and CM75 (proportional distances 25%-75%). Linear mixed model analysis determined effects of refractive groups, race, and demand on dimensions. Significance was set at P < 0.05. Results: Myopic eyes had greater CML and CMLarc nasally than emmetropic eyes. Myopic eyes had thicker muscles than emmetropic eyes at nasal positions, except CM25 and CMT3, and at CM75 temporally. During accommodation and only nasally, CML reduced in emmetropic and myopic eyes, and CMLarc reduced in myopic eyes only. During accommodation, both nasally and temporally, muscles thickened anteriorly (CMT1 and CM25) and thinned posteriorly (CMT3 and CM75) except for temporal CM75. Moderate myopic eyes had greater temporal CMLarc than low myopic eyes, and the moderate myopes had thicker muscles both nasally and temporally using fixed and proportional distances. Conclusions: People with myopia had longer and thicker ciliary muscles than people with emmetropia. During accommodation, the anterior muscle thickened and the curved nasal muscle length shortened, more in myopic than in emmetropic eyes. The fixed distance method is recommended for repeat measures in the same individual. The proportional distance method is recommended for comparisons between refractive groups

Taking stock of 10 years of published research on the ASHA programme: Examining India’s national community health worker programme from a health systems perspective

Background: As India’s accredited social health activist (ASHA) community health worker (CHW) programme enters its second decade, we take stock of the research undertaken and whether it examines the health systems interfaces required to sustain the programme at scale. Methods: We systematically searched three databases for articles on ASHAs published between 2005 and 2016. Articles that met the inclusion criteria underwent analysis using an inductive CHW–health systems interface framework. Results: A total of 122 academic articles were identified (56 quantitative, 29 mixed methods, 28 qualitative, and 9 commentary or synthesis); 44 articles reported on special interventions and 78 on the routine ASHA program. Findings on special interventions were overwhelmingly positive, with few negative or mixed results. In contrast, 55% of articles on the routine ASHA programme showed mixed findings and 23% negative, with few indicating overall positive findings, reflecting broader system constraints. Over half the articles had a health system perspective, including almost all those on general ASHA work, but only a third of those with a health condition focus. The most extensively researched health systems topics were ASHA performance, training and capacity-building, with very little research done on programme financing and reporting, ASHA grievance redressal or peer communication. Research tended to be descriptive, with fewer influence, explanatory or exploratory articles, and no predictive or emancipatory studies. Indian institutions and authors led and partnered on most of the research, wrote all the critical commentaries, and published more studies with negative results. Conclusion: Published work on ASHAs highlights a range of small-scale innovations, but also showcases the challenges faced by a programme at massive scale, situated in the broader health system. As the programme continues to evolve, critical comparative research that constructively feeds back into programme reforms is needed, particularly related to governance, intersectoral linkages, ASHA solidarity, and community capacity to provide support and oversight

Measurement of single top-quark production in the s-channel in proton–proton collisions at √s = 13 TeV with the ATLAS detector

A measurement of single top-quark production in the s-channel is performed in proton–proton collisions at a centre-of-mass energy of 13 TeV with the ATLAS detector at the CERN Large Hadron Collider. The dataset corresponds to an integrated luminosity of 139 fb−1. The analysis is performed on events with an electron or muon, missing transverse momentum and exactly two b-tagged jets in the final state. A discriminant based on matrix element calculations is used to separate single-top-quark s-channel events from the main background contributions, which are top-quark pair production and W-boson production in association with jets. The observed (expected) signal significance over the background-only hypothesis is 3.3 (3.9) standard deviations, and the measured cross-section is σ=8.2+3.5−2.9 pb, consistent with the Standard Model prediction of σSM=10.32+0.40−0.36 pb

A novel SNP heritability model for heritability analyses and genomic prediction

http://dx.doi.org/10.1017/S000497272300056

Heterogeneous returns to chemical fertilizer at the intensive margins: insights from Nepal

Increased fertilizer use is considered important for agricultural development in low-income countries. Promoting increased use of chemical fertilizer by lowering its price may be ineffective if demand is price inelastic. In theory, the price elasticity of demand depends on the returns to its use, but the evidence is scarce. Furthermore, while returns are often estimated for small changes in chemical fertilizer use, returns to larger changes in its use (intensive margins) are less understood. Through the inter-zonal comparisons in Nepal, we provide indicative evidence that greater returns to chemical fertilizer are associated with greater price elasticities of demand. Moreover, the evidence suggests that returns at the intensive margins, rather than returns to small changes, may largely account for inter-zonal differences in returns to chemical fertilizer within Nepal. The results suggest that better understanding the returns at the intensive margins is critical for effective agricultural inputs policies in developing countries

Central and peripheral choroidal thickness and eye length changes during accommodation

Purpose: Eye length increases during accommodation, both on-axis and in the periphery. The aim of this study was to determine whether the peripheral choroid thins with accommodation and to determine the relationship with eye length changes measured at the same location. Methods: Subjects included 53 young adults in good ocular and general health, with 19 emmetropes and 34 myopes. Measurements from the right eye were made for 0 D and 6 D accommodation stimuli for ±30° horizontal visual field/retinal locations in 10° steps. Valid eye length and choroidal thickness measurements were obtained for 37 and 47 participants, respectively, and both measures were taken for 31 participants. 2.5% phenylephrine was instilled to dilate the pupils. Participants turned their eyes, without head movement, to fixate targets and to make the target ‘as clear as possible’ during measurements. Correction was made for the influence of lens thickness changing at different peripheral angles. Choroidal thickness was measured with a spectral-domain-Optical Coherence Tomographer. For peripheral images, the internal cross target on the capture screen was moved from the centre to 17.25° nasal/temporal positions. Results: In accordance with previous literature, eye length increased with accommodation. The greatest change (mean ± SD) of 41 ± 17 μm occurred at the centre, with a mean change across the locations of 33 μm. There were no significant differences between emmetropes and myopes. Choroidal thickness decreased with accommodation, with changes being about two-thirds of those occurring for eye length. The greatest change of −30 ± 1 μm occurred at the centre, with a mean change of −21 μm. Greater choroidal thinning occurred for myopes than for emmetropes (23 ± 11 vs. 17 ± 8 μm, p = 0.02). Conclusions: With accommodation, eye length increased and the choroid thinned, at both central and peripheral positions. Choroidal thinning accounted for approximately 60% of the eye length increase across the horizontal ±30°.</p