Immediate Sequential Bilateral Surgery in Refractive Lens Exchange Patients: Clinical Outcomes and Adverse Events.

PURPOSE: To evaluate outcomes and the incidence of adverse events (AEs) in patients who underwent bilateral same-day refractive lens exchange (RLE). DESIGN: Retrospective case series. PARTICIPANTS: Patients of a private intraocular surgery provider in the United Kingdom who underwent RLE in both eyes on the same day with treatment dates between March 2018 and December 2021. METHODS: Clinical outcomes and AEs were collected for a continuous cohort of patients undergoing bilateral same-day RLE (in the absence of visually significant cataracts) or had mild cataracts (corrected visual acuity ≥ 20/40). One-month clinical outcomes were analyzed. MAIN OUTCOME MEASURES: Refractive outcomes and visual acuity, intraoperative and postoperative AEs, and secondary surgical interventions recorded within the first month after surgery. RESULTS: A total of 17 330 patients (34 660 eyes) were included in the analysis. Of these, 28 827 eyes received a multifocal intraocular lens (IOL), and 5833 eyes had a monofocal IOL. The percentage of eyes within ±0.50 diopters (D) of intended refraction was 85.5% and 86.2% for monofocal and multifocal IOL eyes, respectively. There was a total of 55 intraoperative AEs recorded in 55 eyes of 54 patients (per-eye incidence: 0.159%). Posterior capsule tear was the most common intraoperative event occurring in 37 eyes (0.107%). The number of AEs recorded within the first postoperative month was 267, occurring in 263 eyes of 177 patients (per-eye incidence: 0.759%). These included cystoid macular edema (CME) (172 eyes; 0.496%), significant corneal edema (28 eyes; 0.081%), persistent inflammation (27 eyes; 0.078%), significantly raised intraocular pressure (27 eyes; 0.078%), toxic anterior segment syndrome (8 eyes; 0.023%), wound leak (3 eyes; 0.009%), retinal detachment (1 eye; 0.003%), and retinal tear (1 eye; 0.003%). There were 56 secondary surgical interventions recorded within the first month of surgery, occurring in 54 eyes of 47 patients (per-eye incidence: 0.156%). The most common secondary intervention was the rotation of a misaligned toric IOL (24 eyes; 0.069%). CONCLUSIONS: Elective same-day bilateral RLE had a low incidence of serious AEs, and high refractive predictability. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Initial experience with a new refractive rotationally asymmetric multifocal intraocular lens.

PURPOSE: To assess efficacy, safety, predictability, and patient satisfaction after refractive lens exchange with a new refractive rotational asymmetric multifocal intraocular lens. METHODS: One hundred six eyes of 53 patients after bilateral refractive lens exchange with the SBL-3 lens (Lenstec, Inc., Christ Church, Barbados) implantation were evaluated. The mean preoperative refractive sphere was +1.06 ± 2.63 diopters (D) (range: -8.25 to +5.00 D) and the mean refractive cylinder was -0.51 ± 0.46 D (range: -2.00 to 0.00 D). Monocular and binocular uncorrected and corrected distance visual acuity, uncorrected and distance-corrected intermediate visual acuity, uncorrected and distance-corrected near visual acuity, defocus curve, and patient satisfaction were evaluated 3 months postoperatively. RESULTS: At 3 months, 84.9% (90 eyes) were within ±0.50 D of emmetropia. The mean postoperative uncorrected distance visual acuity was -0.03 ± 0.09 logMAR (6/6 Snellen) monocularly and -0.08 ± 0.08 logMAR (6/4.8 Snellen) binocularly. The mean monocular and binocular uncorrected near visual acuity were 0.12 ± 0.12 and 0.08 ± 0.10 logMAR (6/7.5 Snellen), respectively. Defocus curve showed a slight drop off for vergences equivalent to intermediate vision. Although some night vision phenomena were reported, overall satisfaction was high. No intraoperative or postoperative complications occurred in this study. CONCLUSIONS: The new refractive rotationally asymmetric intraocular lens provided good range of vision for near, intermediate, and distance. Long-term follow-ups are necessary to evaluate the performance of this intraocular lens.

The role of the mesopic pupil on patient-reported outcomes in young patients with myopia 1 month after wavefront-guided LASIK.

PURPOSE: To determine the relationship between low-light pupil size and patient-reported outcomes 1 month after wavefront-guided LASIK in young patients with myopia. METHODS: Retrospective case series of 10,944 eyes of 5,563 young patients with myopia who underwent wavefront-guided LASIK (6.0-mm optical zone). Preoperative pupil size was measured under low-light conditions with an infrared pupillometer. Visual and refractive outcomes were evaluated at 1 month postoperatively. A questionnaire was administered to assess patient-reported outcomes including satisfaction with the procedure, night driving, and glare and halo visual symptoms. RESULTS: The average patient age was 29.8 years (range: 18 to 40 years). The mean preoperative manifest spherical equivalent of -3.49 diopters (D) (range: -0.50 to -11.75 D) was reduced to -0.04 ± 0.29 D at 1 month, with 94% of eyes achieving an uncorrected distance visual acuity of 20/20 or better. The mean low-light pupil diameter was 6.6 mm (range: 4 to 9 mm) and 1,514 patients (27.2%) had a diameter of 8 mm or larger. No correlation between pupil diameter and patient-reported outcomes was found (r range: -0.02 to 0.07). Logistic regression analysis identified postoperative uncorrected distance visual acuity and postoperative manifest refraction as significant predictors of night halo complaints after wavefront-guided LASIK (P < .01). CONCLUSIONS: In this large series of young patients with myopia treated with wavefront-guided LASIK, low-light pupil diameter was not predictive of surgery satisfaction, ability to perform activities, or visual symptoms at 1 month postoperatively.

Early clinical outcomes of wavefront-guided myopic LASIK treatments using a new-generation hartmann-shack aberrometer.

PURPOSE: To provide an initial retrospective evaluation of early postoperative outcomes after wavefront-guided myopic LASIK using a new-generation Hartmann-Shack wavefront sensor. METHODS: A noncomparative, retrospective study of 243 eyes of 126 patients that underwent primary wavefront-guided LASIK, using wavefront data obtained with a new Hartmann-Shack aberrometer (iDesign Advanced WaveScan aberrometer; Abbott Medical Optics, Inc., Santa Ana, CA). Visual acuity, refraction, and patient satisfaction were evaluated 1 month after surgery. RESULTS: The manifest spherical equivalent was reduced from -3.28 ± 1.79 diopters (D) (range: -9.88 to -0.38 D) before surgery to -0.03 ± 0.29 D (range: -1.00 to +1.25 D) 1 month after surgery. The manifest spherical equivalent was within 0.50 and 1.00 D of target in 93.0% and 99.6% of eyes, respectively. Manifest astigmatism preoperatively (-0.72 ± 0.67 [range: 0.0 to -5.00 D]) was reduced to -0.14 ± 0.20 (range: 0.0 to -1.00 D) at 1 month and the vector-derived correction ratio (surgically induced refractive change/intended refractive correction) was 1.02 ± 0.30. Uncorrected distance visual acuity of 20/16, 20/20, and 20/25 or better was achieved in 79.0%, 93.4%, and 96.7% of eyes, respectively. No eyes lost two or more lines of corrected distance visual acuity, whereas a gain of one or more lines was observed in 14.0%. Most patients (98.5%) reported that they were satisfied with the outcome of their procedure. CONCLUSIONS: Wavefront-guided LASIK using the new aberrometer in this retrospective evaluation was effective, safe, and predictable in the early postoperative time period for the correction of myopia with high patient satisfaction.

Piggyback intraocular lens implantation to correct pseudophakic refractive error after segmental multifocal intraocular lens implantation.

PURPOSE: To evaluate refractive and visual outcomes of secondary piggyback intraocular lens implantation in patients diagnosed as having residual ametropia following segmental multifocal lens implantation. METHODS: Data of 80 pseudophakic eyes with ametropia that underwent Sulcoflex aspheric 653L intraocular lens implantation (Rayner Intraocular Lenses Ltd., East Sussex, United Kingdom) to correct residual refractive error were analyzed. All eyes previously had in-the-bag zonal refractive multifocal intraocular lens implantation (Lentis Mplus MF30, models LS-312 and LS-313; Oculentis GmbH, Berlin, Germany) and required residual refractive error correction. Outcome measurements included uncorrected distance visual acuity, corrected distance visual acuity, uncorrected near visual acuity, distance-corrected near visual acuity, manifest refraction, and complications. One-year data are presented in this study. RESULTS: The mean spherical equivalent ranged from -1.75 to +3.25 diopters (D) preoperatively (mean: +0.58 ± 1.15 D) and reduced to -1.25 to +0.50 D (mean: -0.14 ± 0.28 D; P < .01). Postoperatively, 93.8% of eyes were within ±0.50 D and 98.8% were within ±1.00 D of emmetropia. The mean uncorrected distance visual acuity improved significantly from 0.28 ± 0.16 to 0.01 ± 0.10 logMAR and 78.8% of eyes achieved 6/6 (Snellen 20/20) or better postoperatively. The mean uncorrected near visual acuity changed from 0.43 ± 0.28 to 0.19 ± 0.15 logMAR. There was no significant change in corrected distance visual acuity or distance-corrected near visual acuity. No serious intraoperative or postoperative complications requiring secondary intraocular lens removal occurred. CONCLUSIONS: Sulcoflex lenses proved to be a predictable and safe option for correcting residual refractive error in patients diagnosed as having pseudophakia.

The African National Congress's factionalism and targeted killings as risks to human security in KwaZulu-Natal province.

A prevalence of political violence and political assassinations characterised post-1994 South Africa. These politically motivated killings appeared to be dominant in the controversial KwaZulu-Natal (KZN) province. Political killings in South Africa started as a form of inter-party warfare, especially during the transition to democracy, when the two rivals, the African National Congress (ANC) and the Inkatha Freedom Party (IFP), fought each other for some areas of Gauteng and KwaZulu-Natal provinces. However, following the dominance of the ANC in the KZN Province, members of the ruling party fought each other for positions in government and political party structures. Considering this, the article analyses the crisis of factionalism by examining the ANC's intra-party tensions and targeted killings, and how this poses a risk to human security in KZN. Methodologically, the article employs a qualitative literature assessment and content analysis is used to delve into the impact of intra-party tensions and targeted killings on human security in the KZN province. Contribution: In quest for curbing the crisis of factionalism in the ruling ANC, the article recommends that the ANC needs to re-visit its leadership selection as these killings have seemingly happened during leadership selection, which leads to ruthless competition of positions in government and party structures. Members of the ruling party need to identify themselves as one, as opposed to belonging to different factional groups within the party. Failure by the ruling party to address divisions within the organisation shall result in more fatal killings resulting from competition for positions and resources.

Lion lords and sharing hyaenas: Carnivore guild dynamics around elephant carcasses.

Megaherbivore carcasses represent sporadic but energetically rewarding resources for carnivores, offering a unique opportunity to study coexistence dynamics between facultative scavengers. South African fenced protected areas, such as Madikwe Game Reserve (Madikwe hereafter), host viable populations of large carnivores and high densities of elephants, Loxodonta africana. However, high carnivore densities can lead to potentially fatal interspecific encounters and increased competition, particularly around high-quality trophic resources. This study explores the temporal partitioning and co-detection strategies of carnivores at six elephant carcasses in Madikwe, aiming to understand how the increased carrion biomass available at elephant carcasses influences coexistence dynamics. Camera traps were deployed to monitor carcasses during two periods (2019 and 2020), revealing occurrences of six carnivore species. Carnivores, particularly black-backed jackals, Lupulella mesomelas, (hereafter jackal), lions, Panthera leo, and spotted hyaenas, Crocuta crocuta, comprised 56.7% of carcass observations, highlighting their pivotal roles in scavenging dynamics. Pairwise co-detection analysis demonstrated consistent association and shared peak activity periods between jackals and spotted hyaenas, indicating potential resource sharing. However, the minimal co-detection rates between lions and other carnivores highlight their resource domination. There was some evidence of temporal partitioning between carnivores, with most species exhibiting earlier peaks in nocturnal activity to avoid temporal overlap with lions. This study emphasises the importance of elephant carcasses in the diet of multiple species and coexistence techniques utilised to exploit this ephemeral resource. As fenced protected areas become crucial for conserving intact carnivore guilds globally, further research into carnivore behavioural adaptations at carcasses is recommended to shed light on their coexistence strategies.

Effect of residual sphere on uncorrected visual acuity and satisfaction in patients with monofocal and multifocal intraocular lenses.

PURPOSE: To assess the effect of residual sphere on vision and satisfaction in pseudophakic patients. SETTING: Private clinics, United Kingdom. DESIGN: Retrospective case series. METHODS: A multivariate model evaluated the effect of 1-month residual sphere on outcomes of pseudophakic patients. Odds ratios (ORs) were calculated to assess the relative risk of not achieving ≥20/20 monocular uncorrected distance visual acuity (UDVA), ≥20/50 uncorrected near visual acuity (UNVA), and not being satisfied with vision. ORs were assessed for residual sphere -1.00 to +1.00 diopter (D) in quarter-diopter steps, using 0.00 D as a reference. RESULTS: The analysis included 38 828 multifocal and 11 571 monofocal intraocular lenses (IOLs). The residual myopic sphere ≤-0.25 D and hyperopic sphere ≥+0.50 D had a clinically meaningful effect on UDVA. Although monofocal IOLs had an improvement in UNVA with every additional 0.25 D of myopia, the change in ORs with increasing myopia was not significant for multifocal IOLs. The mean improvement in UNVA comparing eyes with 0.00 D and -1.00 D sphere was 0.26 logMAR for monofocal and 0.03 logMAR for multifocal IOLs. Low near-addition IOLs had a slightly higher gain in UNVA with increasing myopia, but the gain was not as substantial as with monofocal IOLs. The effect of ametropia on satisfaction was more pronounced for multifocal IOLs. For every 0.25 D of residual myopia, there was >25% increase in dissatisfied patients. CONCLUSIONS: Although myopia improved UNVA in eyes with monofocal IOL, multifocal IOLs did not benefit from residual myopia. Multifocal IOL patients desiring distance vision should be targeted closest to emmetropia, even if it means targeting slight hyperopia.

Seasonal activity patterns of a Kalahari mammal community: Trade-offs between environmental heat load and predation pressure.

Mammals in arid zones have to trade off thermal stress, predation pressure, and time spent foraging in a complex thermal landscape. We quantified the relationship between the environmental heat load and activity of a mammal community in the hot, arid Kalahari Desert. We deployed miniature black globe thermometers within the existing Snapshot Safari camera trap grid on Tswalu Kalahari Reserve, South Africa. Using the camera traps to record species' activity throughout the 24-h cycle, we quantified changes in the activity patterns of mammal species in relation to heat loads in their local environment. We compared the heat load during which species were active between two sites with differing predator guilds, one where lion (Panthera leo) biomass dominated the carnivore guild and the other where lions were absent. In the presence of lion, prey species were generally active under significantly higher heat loads, especially during the hot and dry spring. We suggest that increased foraging under high heat loads highlights the need to meet nutritional requirements while avoiding nocturnal activity when predatory pressures are high. Such a trade-off may become increasingly costly under the hotter and drier conditions predicted to become more prevalent as a result of climate change within the arid and semi-arid regions of southern Africa.

Comparative Analysis of Clinical and Patient-Reported Outcomes of a New Enhanced Monofocal IOL and a Conventional Monofocal IOL.

Purpose: To compare the outcomes of the Tecnis Eyhance ICB00 IOL, designed to enhance intermediate vision, to a conventional Tecnis Monofocal ZCB00 IOL. Methods: This retrospective analysis compared two cohorts of patients undergoing lens replacement surgery with bilateral implantation of the Tecnis ICB00 or the Tecnis ZCB00 IOL (383 patients in each group). Monocular and binocular uncorrected distance (UDVA), intermediate (UIVA; 66cm), and near (UNVA; 40cm) visual acuities, refractive predictability, and patient-reported outcomes were compared. A sub-analysis of patients with the Eyhance IOL was performed to compare patients who achieved bilateral emmetropia to those with mini-monovision. One-month postoperative outcomes were analyzed. Results: Both groups had comparable UDVA outcomes. On average, both monocular and binocular UIVAs were approximately one Snellen line better in patients implanted with Eyhance IOL (monocular UIVA: ICB00 0.23 ± 0.18 logMAR, ZCB00 0.33 ± 0.19 logMAR; binocular UIVA: ICB00 0.18 ± 0.18 logMAR, ZCB00 0.26 ± 0.20 logMAR, p < 0.01). Likewise, the mean UNVA was also one Snellen line better with the ICB00 model (monocular UNVA: ICB00 0.51 ± 0.20 logMAR, ZCB00 0.61 ± 0.18 logMAR; binocular UNVA: ICB00 0.42 ± 0.19 logMAR, ZCB00 0.51 ± 0.22 logMAR, p < 0.01). There was no difference between the two groups in overall satisfaction or visual phenomena. A subgroup of patients who achieved mini-monovision with Eyhance IOL had, on average, one Snellen line better UIVA and UNVA compared to patients with bilateral emmetropia. Conclusion: Patients receiving the enhanced monofocal IOL had better intermediate and near vision compared to those receiving the conventional monofocal IOL, with similar levels of patient-reported photic phenomena in both groups.

Immediate Sequential Bilateral Cataract Surgery in Patients with Bilateral Visually Significant Cataracts.

Purpose: To report our experience of performing immediate sequential bilateral cataract surgery (ISBCS) in patients with visually significant cataracts and reduced preoperative corrected distance visual acuity (CDVA). Methods: Data of patients who underwent ISBCS for visually significant cataracts and had preoperative CDVA ≤20/32 (≤0.2 logMAR) in each eye were retrospectively reviewed. Refractive and visual outcomes were evaluated for the last available postoperative visit. Intraoperative and serious postoperative adverse events occurring within the first three months of surgery were reviewed. Results: A total of 1335 patients (2670 eyes) were included in the analysis, with a mean age of 71.9 ± 9.5 years. On the last visit, 50.2% and 89.1% of eyes achieved uncorrected distance visual acuity (UDVA) ≥20/20 (0.0 logMAR) and ≥20/32 (0.2 logMAR), respectively. Of all eyes, 83.8% were within ±0.50D, and 96.4% were within ±1.00 D of emmetropia. Ten patients had postoperative bilateral ametropia of more than 1.00D in each eye, but eight of them still achieved binocular UDVA ≥20/40. Intraoperative events occurred in 14 eyes of 13 patients (per-eye incidence: 0.524% or 1 in 191 eyes). A total of 86 postoperative adverse events occurred in 80 eyes of 53 patients (per-eye incidence 2.996% or 1 in 33 eyes), of which cystoid macular edema was the most common. Only three eyes had CDVA reduced by more than two Snellen lines compared to preoperative CDVA, two of which were not related to cataract surgery. There was no patient with bilateral CDVA loss. Conclusion: In our cohort of patients with visually significant cataracts, ISBCS resulted in good refractive predictability and a low incidence of serious adverse events.

Prospective evaluation of the safety of ultrasound-guided cervical medial branch blocks using the in-plane technique.

BACKGROUND: While fluoroscopic guidance is currently the imaging standard for cervical medial branch blocks (CMBBs), ultrasound guidance (USG) offers several potential safety advantages such as real-time needle visualization and the ability to detect and avoid critical soft tissue vascular or neural structures. However, no large-scale trials have examined the safety of USG for CMBB. METHODS: Five hundred patients undergoing 2308 individual block levels were recruited using a prospective cohort design, and blocks were performed in an outpatient office setting using an in-plane USG technique. Primary outcomes included immediate block-related complication, as well as delayed occurrences, in the following 2 weeks. Vascular structures adjacent to the target area, as well as the occurrence of vascular breach, were recorded. RESULTS: Three minor immediate complications were noted (two subcutaneous hematomas, one vasovagal reaction) comprising 0.13% of blocks (0.03% to 0.38%; 95% two-sided CI), and no delayed events were recorded (0% to 0.16%; 97.5% one-sided CI). Blood vessels were detected and avoided in 8.2% of blocks, and vascular breach was noted in 0.52% of blocks (0.27% to 0.91%; 95% two-sided CI). CONCLUSION: When performed using an in-plane technique by experienced operators, USG CMBB was found to be safe, with rare minor immediate complications and no further adverse event reported in the following 2 weeks. TRIAL REGISTRATION NUMBER: NCT04852393.

Brain vital sign monitoring of sleep deprivation detects situational cognitive impairment.

Objective, rapid evaluation of cognitive function is critical for identifying situational impairment due to sleep deprivation. The present study used brain vital sign monitoring to evaluate acute changes in cognitive function for healthy adults. Thirty (30) participants were scanned using portable electroencephalography before and after either a night of regular sleep or a night of total sleep deprivation. Brain vital signs were extracted from three established event-related potential components: (1) the N100 (Auditory sensation); (2) the P300 (Basic attention); and (3) the N400 (Cognitive processing) for all time points. As predicted, the P300 amplitude was significantly reduced in the sleep deprivation group. The findings indicate that it is possible to detect situational cognitive impairment due to sleep deprivation using objective, rapid brain vital sign monitoring.

Using the multivariate Hawkes process to study interactions between multiple species from camera trap data.

Interspecific interactions can influence species' activity and movement patterns. In particular, species may avoid or attract each other through reactive responses in space and/or time. However, data and methods to study such reactive interactions have remained scarce and were generally limited to two interacting species. At this time, the deployment of camera traps opens new opportunities but adapted statistical techniques are still required to analyze interaction patterns with such data. We present the multivariate Hawkes process (MHP) and show how it can be used to analyze interactions between several species using camera trap data. Hawkes processes use flexible pairwise interaction functions, allowing us to consider asymmetries and variations over time when depicting reactive temporal interactions. After describing the theoretical foundations of the MHP, we outline how its framework can be used to study interspecific interactions with camera trap data. We design a simulation study to evaluate the performance of the MHP and of another existing method to infer interactions from camera trap-like data. We also use the MHP to infer reactive interactions from real camera trap data for five species from South African savannas (impala Aepyceros melampus, greater kudu Tragelaphus strepsiceros, lion Panthera leo, blue wildebeest Connochaetes taurinus and Burchell's zebra Equus quagga burchelli). The simulation study shows that the MHP can be used as a tool to benchmark other methods of interspecific interaction inference and that this model can reliably infer interactions when enough data are considered. The analysis of real data highlights evidence of predator avoidance by prey and herbivore-herbivore attraction. Lastly, we present the advantages and limits of the MHP and discuss how it can be improved to infer attraction/avoidance patterns more reliably. As camera traps are increasingly used, the multivariate Hawkes process provides a promising framework to decipher the complexity of interactions structuring ecological communities.

Non-penetrating femtosecond laser intrastromal astigmatic keratotomy in patients with mixed astigmatism after previous refractive surgery.

PURPOSE: To report the outcomes of the correction of mixed astigmatism with non-penetrating femtosecond laser intrastromal astigmatic keratotomy in patients with previous refractive surgery. METHODS: One hundred twelve eyes that had low mixed astigmatism after excimer laser surgery, refractive lens exchange, or phakic intraocular lens implantation underwent intrastromal astigmatic keratotomy using paired symmetrical non-penetrating intrastromal arcuate keratotomies created 60 µm from the surface to 80% depth at 7 mm diameter. Outcome measures included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), subjective refraction, and keratometry. A coupling ratio was calculated to assess the change in spherical equivalent. Average follow-up was 7.6 ± 2.9 months. Patients were divided into two groups: no excimer laser corneal ablation and previous excimer laser surgery. Preoperative and postoperative data were compared between groups and analyses were performed on the whole group of eyes. RESULTS: Overall, the mean UDVA improved significantly from 0.18 ± 0.14 to 0.02 ± 0.12 logMAR (6/9 to ≈6/6 Snellen) (P < .01). The mean absolute subjective cylinder decreased significantly from 1.20 ± 0.47 diopters (D) preoperatively to 0.55 ± 0.40 D postoperatively (P < .01). Subjective sphere decreased significantly from +0.61 ± 0.33 to +0.17 ± 0.36 D (P < 0.01). The mean CDVA was -0.03 ± 0.08 logMAR (≈ 6/6 Snellen) preoperatively and -0.05 ± 0.09 logMAR (≈ 6/5 Snellen) postoperatively (P = .06). The coupling ratio was 0.92 ± 0.45. There was no statistically significant difference in the preoperative and postoperative sphere, cylinder, UDVA, CDVA, and coupling ratio between groups. No surgical complications occurred. CONCLUSIONS: Femtosecond laser intrastromal astigmatic keratotomy was effective at reducing refractive error in patients where other surgical options were exhausted. Predictability and efficacy could be improved with nomogram refinement.

Temporal partitioning and the potential for avoidance behaviour within South African carnivore communities.

Carnivora occupy many ecological niches fundamental to ecosystem functioning. Within this diverse order, carnivore species compete to establish dominance, ensure survival and maintain fitness. Subordinate carnivores must, therefore, adapt their behaviour to coexist with dominant species. One such strategy is the partitioning of temporal activity patterns. We aim to determine interspecific avoidance patterns among sympatric carnivores by examining coexistence along a temporal axis. We compared the temporal activity patterns of 13 carnivore species using multi-seasonal camera trapping data from four protected areas across South Africa: Associated Private Nature Reserves, Madikwe Game Reserve, Mountain Zebra National Park and Tswalu Kalahari Reserve. Interspecific coefficients of overlap in diel and core activity periods were calculated over the study period and during the wet and dry seasons. Furthermore, interspecific spatiotemporal behaviour was examined using time-to-event analyses. Our results showed that complete avoidance of diel activity patterns was rare among South African carnivore species. Most species were predominantly nocturnal and, therefore, diel activity overlap was high, whereas core activity overlap was significantly lower (p < .001). Diel activity overlap was significantly lower during the dry than wet seasons (p = .045). Lastly, evidence of spatiotemporal aggregation revolved around scavenging species. We show the importance of seasonality in the temporal avoidance behaviours of South African carnivores while highlighting the need for fine-scaled behavioural analyses. Overall, we show that the daily activity patterns of most subordinate South African carnivore species are not influenced by top-down forces in the form of competitional suppression and risk exerted by dominant species. If avoidance is required, it is more likely to manifest as fine-scaled avoidance of core activity periods. We suggest that the focus on core activity periods might be a more suitable tool for interspecific temporal partitioning research.

Early Clinical Experience with a New Hydrophobic Acrylic Single-Piece Monofocal Intraocular Lens.

Purpose: To evaluate early clinical outcomes and adverse events (AEs) in cataract patients following implantation of a monofocal hydrophobic acrylic IOL with a new optimized non-constant aberration-correcting design (CT LUCIA 621P). Methods: This retrospective study included patients with visually significant cataracts who underwent implantation of the CT LUCIA 621P IOL. Refraction, corrected (CDVA) and uncorrected (UDVA) visual acuity of the last available visit were used in the analysis. Intraoperative and postoperative AEs of the cohort were reviewed. Results: A total of 191 eyes of 133 patients with the mean age of 70.2±11.2 years were included in this study. The mean follow-up time of the last available visit was 1.7±1.3 months. The mean postoperative monocular UDVA was 0.09±0.16 logMAR (≈20/25), and 74.9% (143/191) eyes achieved ≥20/25 UDVA. The percentage of eyes with manifest spherical equivalent (MSE) within ±0.50D and ±1.00D of emmetropia was 84.8% (162/191) and 98.4% (188/191), respectively. Linear regression of attempted vs achieved MSE showed a tight relationship, with the coefficient of determination close to 1 (R2=0.99), indicating a very predictable refractive correction. The reported AEs were those typically expected after cataract surgery. There were no AEs related to intraoperative manipulation with the IOL/injector or to postoperative stability of the IOL in the capsular bag. No eye lost ≥2 lines of CDVA. Conclusion: The implantation of CT LUCIA 621P resulted in good refractive predictability and visual outcomes. No IOL-related adverse events were reported.

Considerations on effort, precision and accuracy for long-term monitoring of African lions (Panthera leo), when using Bayesian spatial explicit capture-recapture models, in fenced protected areas.

Intensive management is frequently required in fenced wildlife areas to reduce deleterious effects of isolation. Decisions on how best to manage such wildlife are ideally informed by regular and reliable estimates of spatiotemporal fluctuations in population size and structure. However, even in small, fenced areas, it is difficult and costly to regularly monitor key species using advanced methods. This is particularly the case for large carnivores, which typically occur at low density and are elusive yet are central to management decision-making due to their top-down effects in ecosystems and attracting tourism. In this study, we aimed to provide robust estimates of population parameters for African lions (Panthera leo) and use the data to inform a resource-efficient long-term monitoring programme. To achieve this, we used unstructured spatial sampling to collect data on lions in Pilanesberg National Park, a small (~550 km2) fenced protected area in South Africa. We used Bayesian spatial capture-recapture models to estimate density, abundance, sex ratio and home range size of lions over the age of 1 year. Finally, to provide guidance on resource requirements for regular monitoring, we rarefied our empirical data set incrementally and analysed the subsets. Lion density was estimated to be 8.8 per 100 km2 (posterior SD = 0.6), which was lower than anticipated by park management. Sex ratio was estimated close to parity (0.9♀:1♂), consistent with emerging evidence in fenced lion populations, yet discordant with unfenced populations, which are usually ~2♀:1♂ in healthy, source populations. Our rarefied data suggest that a minimum of 4000 km search effort needs to be invested in future monitoring to obtain accurate and precise estimates, while assuming similar detection rates. This study demonstrates an important utility of Bayesian spatial explicit capture-recapture methods for obtaining robust estimates of lion densities and other important parameters in fence-protected areas to inform decision-making.

Comparison of the 1st Generation and 3rd Generation Wavefront-Guided LASIK for the Treatment of Myopia and Myopic Astigmatism.

Purpose: To compare refractive, visual, and patient-reported outcomes associated with a 1st generation wavefront-guided (WFG) treatment with those associated with a 3rd generation WFG treatment. Patients and Methods: This retrospective study included patients who underwent femtosecond laser-assisted in situ keratomileusis (LASIK) for myopia/myopic astigmatism. Two random stratified samples of patients who underwent either 1stgeneration (WaveScan, Johnson & Johnson Vision, Santa Ana, CA) or 3rd generation (iDesign 2.0, Johnson & Johnson Vision, Santa Ana, CA) treatment matched on preoperative refraction were compared (4290 eyes of 2145 patients in each group). One-month postoperative visual, refractive, and patient-reported outcomes were analyzed. Refractive and monocular visual acuity analyses were performed using one random eye of each patient. Results: The percentage of eyes achieving 20/20 or better uncorrected vision was 91.3% (1958/2145) in the 1st generation group and 95.9% (2056/2145) in the 3rd generation group (p<0.01). Binocularly, the percentage of patients with 20/20 or better UDVA was 97.0% (2080/2145) and 99.2% (2127/2145) in the 1st and 3rd generation groups, respectively (p<0.01). The mean postoperative MSE was -0.01 ± 0.33 D in the 1st generation group and +0.19 ± 0.33 D in the 3rd generation group (p<0.01). Postoperative refractive astigmatism had a mean value of -0.20 ± 0.26 D and -0.18 ± 0.24 D in the 1st and 3rd generation groups, respectively (p<0.01). The mean correction index of refractive astigmatism was 1.09 ± 0.53 in the 1st generation group and 1.02 ± 0.38 in the 3rd generation group, p<0.01. The overall percentage of patients satisfied with vision was 92.8% (1991/2145 patients) in the 1st generation group and 97.3% (2087/2145 patients) in the 3rd generation group (p<0.01). Conclusion: For the majority of postoperative variables, there were significant differences between 1st and 3rd generation treatments. The 3rd generation treatments had better visual acuity outcomes and higher patient satisfaction.

Real world evidence of improved attention and cognition during physical therapy paired with neuromodulation: a brain vital signs study.

Background: Non-invasive neuromodulation using translingual neurostimulation (TLNS) has been shown to advance rehabilitation outcomes, particularly when paired with physical therapy (PT). Together with motor gains, patient-reported observations of incidental improvements in cognitive function have been noted. Both studies in healthy individuals and case reports in clinical populations have linked TLNS to improvements in attention-related cognitive processes. We investigated if the use of combined TLNS/PT would translate to changes in objective neurophysiological cognitive measures in a real-world clinical sample of patients from two separate rehabilitation clinics. Methods: Brain vital signs were derived from event-related potentials (ERPs), specifically auditory sensation (N100), basic attention (P300), and cognitive processing (N400). Additional analyses explored the attention-related N200 response given prior evidence of attention effects from TLNS/PT. The real-world patient sample included a diverse clinical group spanning from mild-to-moderate traumatic brain injury (TBI), stroke, Multiple Sclerosis (MS), Parkinson's Disease (PD), and other neurological conditions. Patient data were also acquired from a standard clinical measure of cognition for comparison. Results: Results showed significant N100 variation between baseline and endpoint following TLNS/PT treatment, with further examination showing condition-specific significant improvements in attention processing (i.e., N100 and N200). Additionally, CogBAT composite scores increased significantly from baseline to endpoint. Discussion: The current study highlighted real-world neuromodulation improvements in neurophysiological correlates of attention. Overall, the real-world findings support the concept of neuromodulation-related improvements extending beyond physical therapy to include potential attention benefits for cognitive rehabilitation.