Change in convergence and accommodation after two weeks of eye exercises in typical young adults

Abstract: Introduction Although eye exercises appear to help heterophoria, convergence insufficiency and intermittent strabismus, true treatment effects can be confounded by placebo, practice and encouragement factors. This study assessed objective changes in vergence and accommodation responses in typical naïve young adults after two weeks of exercises compared to control conditions to assess the extent of treatment effects occur above other factors. Methods 156 asymptomatic young adults were randomly assigned to 6 exercise groups or 2 no-treatment groups. Treatment targeted i) accommodation, ii)vergence, iii) both, iv) convergence>accommodation, v)accommodation>convergence, or vi) a placebo. All were re-tested under identical conditions, except for the second control group who were additionally encouraged during testing. Objective accommodation and vergence were assessed to a range of targets moving in depth containing combinations of blur, disparity and proximity/looming cues. Results Response gain improved more for less naturalistic targets where more improvement was possible. Convergence exercises improved vergence for near across all targets (P=.035). Mean accommodation changed similarly,but non-significantly. No other treatment group differed significantly from the non-encouraged control group, while encouraging effort produced significantly increased vergence (P=.004) and accommodation (P=.005) gains in the other control group. Conclusions True treatment effects were small, only significantly better after vergence exercises to a non-accommodative target, and were rarely related to response they were designed to improve. Exercising accommodation without convergence made no difference to accommodation to cues containing detail. Additional effort improved objective responses the most, so should be controlled carefully in research, and considered when auditing treatment

Patterns of variation in plant diversity vary over different spatial levels in seasonal coastal wetlands

Aim: To quantify the responses of alpha and beta diversity to multivariate gradients, incorporating variation in environmental and management variability in coastal dune slacks. Location: United Kingdom dune slacks. Methods: Plant community composition, plant nutrient status and soil characteristics were measured for 164 quadrats in 41 dune slacks across 12 coastal sand dune systems. Data were collated on climate and atmospheric deposition. Hydrological regimes at daily resolution were modelled and calibrated using daily-to-monthly site measurements, from which we calculated quadrat-level hydrological metrics. Alpha diversity (richness, Shannon diversity and Pielou's evenness) metrics and beta diversity (turnover and nestedness) for species and genera were calculated across three spatial levels from sand dune system (highest) to dune slack to quadrat (lowest). Results: Diversity patterns depended on the spatial and taxonomic level considered. At smaller spatial levels (between dune slacks and between quadrats), alpha and beta diversity varied along gradients driven by soil characteristics, water table depth and atmospheric deposition. At larger spatial levels (between sand dune systems), patterns of beta diversity were a consequence of plant nutrient status. There was little variability in alpha diversity along this same gradient, with only small changes in Pielou's species evenness. Patterns at a coarser taxonomic level (genus) mirrored those at the species level. Main conclusion: We show that patterns of variation in plant diversity are dependent on the spatial level considered, but taxonomic level made little difference in understanding these patterns. Therefore, if we do not consider patterns across different spatial levels, important environmental and management drivers could be missed. The high biodiversity value and degree of threat to these European protected habitats makes such understanding invaluable for their conservation

The Malaria Testing and Treatment Market in Kinshasa, Democratic Republic of the Congo, 2013

Background The Democratic Republic of Congo (DRC) is one of the two most leading contributors to the global burden of disease due to malaria. This paper describes the malaria testing and treatment market in the nation’s capital province of Kinshasa, including availability of malaria testing and treatment and relative anti-malarial market share for the public and private sector. Methods A malaria medicine outlet survey was conducted in Kinshasa province in 2013. Stratified multi-staged sampling was used to select areas for the survey. Within sampled areas, all outlets with the potential to sell or distribute anti-malarials in the public and private sector were screened for eligibility. Among outlets with anti-malarials or malaria rapid diagnostic tests (RDT) in stock, a full audit of all available products was conducted. Information collected included product information (e.g. active ingredients, brand name), amount reportedly distributed to patients in the past week, and retail price. Results In total, 3364 outlets were screened for inclusion across Kinshasa and 1118 outlets were eligible for the study. Among all screened outlets in the private sector only about one in ten (12.1%) were stocking quality-assured Artemisinin-based Combination Therapy (ACT) medicines. Among all screened public sector facilities, 24.5% had both confirmatory testing and quality-assured ACT available, and 20.2% had sulfadoxine-pyrimethamine (SP) available for intermittent preventive therapy during pregnancy (IPTp). The private sector distributed the majority of anti-malarials in Kinshasa (96.7%), typically through drug stores (89.1% of the total anti-malarial market). Non-artemisinin therapies were the most commonly distributed anti-malarial (50.1% of the total market), followed by non quality-assured ACT medicines (38.5%). The median price of an adult quality-assured ACT was $6.59, and more expensive than non quality-assured ACT ($3.71) and SP ($0.44). Confirmatory testing was largely not available in the private sector (1.1%). Conclusions While the vast majority of anti-malarial medicines distributed to patients in Kinshasa province are sold within the private sector, availability of malaria testing and appropriate treatment for malaria is alarmingly low. There is a critical need to improve access to confirmatory testing and quality-assured ACT in the private sector. Widespread availability and distribution of non quality-assured ACT and non-artemisinin therapies must be addressed to ensure effective malaria case management

Data for - Patterns of variation in plant diversity vary over different spatial levels in seasonal coastal wetlands

Data and associated code for data analysis for the paper.  Patterns of variation in plant diversity vary over different spatial levels in seasonal coastal wetlands. Working title was: Local environmental factors control alpha and beta diversity of coastal dune slack plant communities.</p