Comparison of two methods of determining central corneal vault under a scleral lens: Estimation by slit lamp biomicroscope and anterior segment OCT

Purpose: The aim of this study was to ascertain if there is agreement in the measurement of central corneal vault (CCV) under a scleral lens, between estimations made using a slit lamp biomicroscope (SLB) and measurements made using anterior segment optical coherence tomography (AS-OCT). Method: 30 images were taken of CCV under various scleral lenses using a SLB and an AS-OCT. Estimations of CCV from SLB photographs were made using known thicknesses of the scleral lenses used and imagej software. The in-built measurement callipers was used to measure CCV on the AS-OCT. Right eyes were imaged on the AS-OCT first and the SLB second and vice versa for left eyes. Results: Bland-Altman analysis of scleral lens thicknesses as measured with a radiuscope thickness callipers and measured with the AS-OCT showed fair agreement (mean difference 1.88 microns and lower and upper limits of agreement were -47.36 and 51.12 microns respectively) and so it was assumed that the AS-OCT was making reasonably accurate measurements of the CCV. Bland Altman analysis of the agreement between the two methods of measuring CCV showed a mean difference of 84 microns and the lower and upper limits of agreement were -174.72 and 342.72 microns respectively. Conclusions: There is a huge variation in the estimation of CCV as made by SLB when compared to measurements taken by AS-OCT. This variation cannot be explained by; differences in corneal curvature, magnification of the scleral lens, angle at which the illumination is at for the SLB estimation, differences in corneal location between the two measurements or lens settling. It is recommended that CCV should not be estimated using a SLB as these estimations appear to be highly unreliable

A double-blind, placebo-controlled trial of continuous acyclovir therapy in recurrent erythema multiforme

The definitive version can be found at: http://onlinelibrary.wiley.com/ Copyright British Association of Dermatologists and Blackwell [Full text of this article is not available in the UHRA]Twenty patients who suffered from more than four attacks of erythema multiforme (EM) per year were enrolled in a 6-month double-blind, placebo-controlled trial of acyclovir 400 mg twice daily. Fifteen patients had disease precipitated by recurrent herpes simplex. In the acyclovir-treated group the median number of EM attacks during the treatment period was zero, compared with three in the placebo-treated group (P < 0.0005, Wilcoxon rank sum test). Seven of the 11 patients treated with continuous acyclovir did not have any attacks of EM while taking the drug, and one showed almost complete disease suppression. Following treatment with acyclovir, two patients went into complete remission, whereas all individuals in the placebo group continued to have attacks. In the acyclovir-treated group nine of the 11 patients had herpes simplex-precipitated disease. One of the two patients with idiopathic disease showed complete disease suppression while on acyclovir, lending support to the view that idiopathic recurrent EM may be related to subclinical herpetic infection. In this study, we have shown that continuous acyclovir therapy can completely suppress attacks of recurrent EM and, in some cases, may induce disease remission.Peer reviewe

How financial mechanisms can incentivize provision of ecosystem services from land restoration: A systematic review protocol

The current food chain both contributes to, and is affected by, climate change. While GHG emissions and emissions to water and soil are a problem for the whole food chain, the majority of such emissions and the major solutions to them can be found in the farming and land use sector. The farming system needs to reduce its greenhouse-gas emissions and adapt its supply chain to cope with climate change. A broad variety of payment tools have been proposed to motivate farmers and landowners to take certain actions to reduce greenhouse gas emissions and encourage the protection or restoration of natural resources. The protocol described here (OSF preregistration https://doi.org/10.17605/OSF.IO/STGQ6) outlines the methodology for a systematic review to explore how financial mechanisms such as green bonds can provide incentives to agri-food sector to support environmental sustainability and ecosystem service delivery through land-use change. Our primary research question is: how do financial mechanisms incentivize land restoration? Studies will be categorized according to the types of financial mechanisms, their characteristics, methods of land restoration and their impact on mitigating agri-food footprint. The results are expected to increase our understanding about the design of financing tools currently used to accelerate nature restoration. Moreover, they will inform us about the effectiveness of deploying such tools on rural communities, food companies and landowners.</p