text:
Saul Canelo Alvarez vs Caleb Plant Preview
Following the announcement that Saul 'Canelo' Alvarez and Caleb Plant will go head-to-head in the ring, the world of boxing is chattering about sport's pack leader, Alvarez, meeting young gun super middleweight Plant.
Indeed, it is well worth taking a look at what the 'Tale of the Tape' says in regards to these two fighters and what will be up for grabs when they do meet each other in the boxing ring.
Recent records
Canelo has been an incredible and dominant force in the sport ever since he made his debut and as he enters what would be his 60th professional fight, the Mexican would appear to be more than ready for the challenge that will be posed by Plant.
The 31-year-old has only lost one fight so far in his career and that was to Floyd Mayweather in a Light Middleweight contest that was considered controversial at the time, as the scores handed out by the judges were disputed by many.
Nonetheless, he has fought 59 times and has managed to achieve 56 wins, with 38 of those via knockout, with just two draws having been recorded alongside his sole defeat.
Indeed, Canelo has been on an impressive streak as of late as well, with the red-headed boxer having been able to end the perfect records and title reigns of British duo Callum Smith and Billy Joe Saunders.
Caleb Plant is not an opponent to take lightly, though, as the Tennessee-born fighter has carved out a brilliant professional record for himself. Having been an alternate for Team USA at the 2012 Summer Olympics, the 29-year-old has managed to achieve a fight record that consists of 21 wins and no defeats. In those 21 fights, he has managed to win 12 via way of knockout.
Plant's latest fight came against Caleb Truax, in which he managed to outbox his opponent and win via the judges' scorecard after the 12 scheduled rounds of boxing had come to an end.
Why are the pair about to fight?
There is a lot on the line for both Canelo and Plant in the upcoming fight between the two on November 6 in Las Vegas, with the titles being the biggest thing at stake.
As mentioned, Canelo managed to defeat both Smith and Saunders recently which saw him capture the WBC and WBO Super Middleweight titles, adding to the WBA title that he had already been holding. However, the fight against Plant will help to solidify his legacy as the best pound-for-pound fighter currently active.
Whilst his undefeated streak will also be on the line, Plant is the current IBF Super Middleweight champion and will not be prepared to let that championship belt go without a fight.
Whether Canelo will be able to beat three undefeated champions in a year and unify the division remains to be seen, but there will be history made in Las Vegas regardless of the outcome!
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Betting1 day ago


text:
Swine flu warning as deaths increase
By Kate Benson and Andrew Clennell
HEALTH experts fear the state's swine flu death toll could soar with six young, healthy people in Sydney fighting for their lives on last-resort cardiac bypass machines because their lungs are too damaged or diseased for regular mechanical ventilation.
The surge in the number of people with swine flu needing life-saving treatment has forced NSW Health to consider closing elective surgery at some big hospitals to allow staff to redirect resources.
What is your experience? How is your company being affected? Text 0424 SMS SMH (+61 424 767 764), email us with information and pictures or direct message us on Twitter @smh_news
Four people have now died in NSW since the pandemic hit on May 9, a woman, 61, being the latest victim. Her death on Saturday at Lismore Base Hospital was followed by two more suspected swine flu deaths, of men aged between 30 and 50, at Royal North Shore Hospital. Their deaths have been referred to the coroner.
Almost 350 people have been admitted to hospital with swine flu since the pandemic began. Fifty have been treated in intensive care, but doctors say the surge in patients needing cardiac bypass treatment is putting a huge strain on intensive care units and on staff and resources across the state.
All six of the victims on cardiac bypass are at Royal Prince Alfred Hospital, where staff have been forced to borrow three machines to treat 10 patients in the past two weeks. The hospital usually treated about five patients a year using the machines, the head of intensive care services, Robert Herkes, said yesterday.
"This is not an ordinary winter. Swine flu is hitting young, otherwise healthy people … they start with a sore throat, develop shortness of breath and within 12 to 24 hours have rapidly developed respiratory failure and are being ventilated."
Dr Herkes said extracorporeal membrane oxygenation, or ECMO, was considered a last-resort treatment, but staff were "throwing everything" at the patients because they were young and relatively healthy.
Patients in respiratory distress are given anticoagulants by machine, and their blood is drained through tubing in their femoral or jugular veins. It is oxygenated outside the body, allowing the lungs to recover.
Three patients with swine flu had been taken off the treatment at Royal Prince Alfred in the past few days. One was "sitting up talking, on a ward", but two were still critical and were being mechanically ventilated, Dr Herkes said.
Brad Frankum, a general physician and immunologist at Campbelltown Hospital, said he had heard anecdotal reports that "more people than ever before" were being treated with ECMO this winter. "This is of great concern because it would suggest that the number of serious cases [of acute respiratory distress] are threatening the capacity of the system," he said.
The deputy director-general of NSW Health, Tim Smyth, said yesterday five big hospitals in Sydney had now been designated to treat swine flu victims with ECMO, up from two a fortnight ago. He said about a third of swine flu patients in intensive care were needing this treatment, but there was still capacity to deal with the pandemic.
He said the department had stockpiled 130 new standard ventilators two years ago as part of the state's disaster plan and would open more intensive care beds on high dependency units if the number of patients continued to surge.
But Peter Collignon, a professor in infectious diseases at the Australian National University, played down the use of the machines, saying "this happens every winter - it just doesn't get publicity".
A spokesman for the State Government said elective surgery could be cancelled at Royal North Shore, Royal Prince Alfred and St Vincent's hospitals, and patients due for surgery would be moved to less affected hospitals.
"There's no move at this stage to move to a different [status] in our pandemic plan," a spokesman for the Health Minister, John Della Bosca, said.
There are many hundreds of flu deaths every year, but a senior health source said swine flu was likely to hit harder as there was no vaccine and no immunity.
- 2029 people have tested positive in NSW.
- 346 have been admitted to hospital (255 in Sydney's west and south-west).
- Four have died, with two more deaths awaiting coroner's confirmation.
- Five major Sydney hospitals now treating victims with cardiac bypass machines.
- One-third of the population expected to get swine flu.

redpajama_set_name: RedPajamaCommonCrawl


I never thought this day would come.
It's *officially* the first day of Spring.
Winter has felt extremely long these past few months, and I'm ready for a change in the air. Now that the sun sets at 7 PM, I can start to feel subtle changes happening around the City. I've noticed how even a couple more hours of daylight can make such a big difference in one's attitude and mood.
This time of year, I find myself gravitating towards anything fruity and refreshing. I've had my fair share of hot, boozy drinks and I'm ready for a change in not just the air, but even in my choice of cocktail.
I'm partnering with Risata Wines to share a tasty cocktail to try this season -- Risata Lemosa.
I modified the recipe with a couple of different ingredients, in case you need to substitute anything. I had trouble finding the blueberry syrup in the recipe, so I opted for blueberry schnapps instead.
You can find this at any liquor and spirits store.
I prefer wine over beer and liquor any day, so I was excited to try these. I love the detailing of the bottles and how easy the grip is to hold. I think that's something most people tend to overlook when it comes to picking out a bottle of wine. It's important to find a bottle that won't slip out of your hands while pouring... or gifting!
I'll also be trying the iL Rosso and Sparkling Rosé bottles in the weekends to come.
1. Add lemonade and blueberry schnapps in a glass and stir. I decided to not add any ice because my Prosecco was already chilled beforehand.
2. Top with Risata Prosecco.
3. Garnish with blueberries or mint, if desired.
The blueberries were a great touch, in my opinion.
Learn more about Risata Wines and other recipes you can make here.
Thank you to Risata Wines for partnering on this post. All thoughts and opinions are my own.


Do not underestimate the amount of time and effort it takes to truly clean every inch of your lease. Call a professional, pocket that bond and get on with your relocation. Weve got the skills and the equipment to deal with your Vacate Cleaning needs no matter your state of affairs, our end of lease cleaning will assist you. Within our Moving out cleaning packages we also provide carpet steam cleaning service with the house cleaning packages with discounted package deals to make our customer's life easier. With dedicated cleansers, rigorous procedures, and unrivaled experience we are more than happy to offer a bond back guarantee on all of our vacate cleans in Melbourne.
Peters Cleaning offers a hassle free Bond Cleaning Service in Melbourne and affordable Bond Cleaning packages. The very thought of cleaning the whole house can leave someone feeling dejected. The best way to deal with it is to let the professionals handle the tough job. Bond Cleaning in Melbourne covers everything in the dusting of the polishing and furniture of the hardwood flooring to cleaning behind the washers and dryers. We also clean the switches and remove the cobwebs. End of lease cleaning can be a major undertaking, and worrying about the cleaning is the last thing you need when moving home. Using a professional firm perform vocational rental cleaning can be a valuable time saver for you.
We hear a customer's exact requirements and deliver a customised cleanup. We bring our own specialised products and equipment to perform the spring cleaning, which means the client does not need to worry about any equipment. 'Sit back and relax' is what we like to tell our customers when it comes to spring cleaning. We keep the highest standards of quality for the ultimate customer satisfaction. With our trained and skilled cleaners, your home is in good hands.
We know the requirements of real estate agents.


There is plenty to do when you come and stay – you don't even need to leave the house! Our cottages and apartments are equipped to entertain you, come rain or shine.
Alternatively, there is loads to do in the local area. West Sussex has much to offer if you feel like going out for the day, from Arundel Castle to Brighton's vibrant arts scene.
If you like spending time by the seaside there are beaches, small traditional harbour towns and excellent seafood restaurants.
Or if you're feeling energetic, you can hire sports equipment locally, like surf boards or jet skis. Nature lovers can enjoy some great walking routes on the South Downs.
In addition to its first class seaside position, our cottages and apartments are close to many walks and nature trails in the nearby Sussex countryside. Rustington has most of the shops you'll need and is on the doorstep, but the seaside town of Littlehampton with its traditional harbour is also close by.
Activities including kitesurfing, windsurfing, sailing, swimming and golf are all locally available as are numerous amusements for children.
Further afield, Brighton and Chichester are good destinations for cosmopolitan shopping and dining.
There are balls and rackets for you to play with on the lawn in the garden.
There are toys to keep children busy at all ages, both inside and out. In both Seacot and Shencot there are two adult bikes and two bikes for children in the garage for you to use.
There is all the nursery equipment you might need, such as travel cot, high chair, baby bath, steriliser, stair gate, stroller and cot rails.
There's a cupboard full of board games for a rainy afternoon, or late night monopoly session.
There's the home cinema system in the lounge, with DVD player and Sky, a selection of popular CDs and DVDs, and an Xbox. There's a TV and DVD player in every bedroom.
There's a laptop and printer with broadband.
The kitchen is full of gadgets, like a breadmaker and a juicer.
There's a shelf of paperbacks, all good for reading in a deckchair if the sun's out. In the garden you'll find a barbeque area, a summerhouse (Seacot House only) and a children's play house.
If you think we've forgotten anything, let us know!
Please note that we cannot accommodate dogs or other pets.


text:
Daga härad var ett härad i mellersta Södermanland. Häradet omfattade merparten av nuvarande Gnesta kommun, vilken är en del av Södermanlands län. Den totala arealen mätte 509 km², vilket år 1926 fördelade sig på drygt 114 km² åker och knappt 283 km² skog. Samma år uppgick befolkningen till 9 030 invånare. Tingsställe var under medeltiden Vadsbro vid Norrtunasjöns sydöstra ände, och från 1500-talet i sockenstugan i Gåsinge för att 1909 flytta till Gnesta.

Geografi
Daga härad utgjorde ett skogigt och bergrikt område beläget öster om sjön Båven, i Trosaåns och Nyköpingsåns vattenområde. Området är starkt kuperat och sänker sig från norr, från vattendelaren mot Mälaren med höjder på omkring 90–100 meter över havet, mot söder till sjöarna Båven (21 m ö.h.), Likstammen (25 m ö.h.) och Sillen (10 m ö.h.). Häradsområdets olika vattendrag rinner till de nämnda sjöarna. Sjöarna Klämmingen (11 m ö.h.) och Sillen ligger i en skarpt utpräglad dal, som genomflyts av Trosaåns övre del. Den begränsas delvis av branta bergväggar och har f.ö. ansetts utgöra Dalälvens preglaciala lopp (det vill säga före den senaste istiden). I väster gränsade Daga härad mot Villåttinge härad, i söder mot Rönö härad, i norr mot Åkers härad och i öster mot Öknebo härad. Längst i nordost har området dessutom en kort gräns mot Selebo härad.

Inom häradet fanns från 1955 en köping – Gnesta köping – belägen cirka 33 km sydväst om Södertälje och 45 km nordväst om Nyköping, som numera också är den största tätorten. Övriga större orter är Björnlunda och Stjärnhov.

Socknar
Daga härad omfattade sex socknar:
 Björnlunda
 Dillnäs
 Frustuna
 Gryt
 Gåsinge
 Kattnäs

Historia
Omkring år 1350 infördes den nuvarande häradsindelningen i landskapet Södermanland och ersatte därmed de tidigare hundare som vilade på förhistoriska anor. Namnet skrevs år 1314 Daundæræ och år 1358 Dawahundære, vilket i det närmaste ska tolkas som en benämning på häradets tingsplats. Ordet Dave är ett sörmländskt dialektalt ord med betydelsen myr, våtmark eller sumpmark. Platsen som avses är de åkrar som idag utbreder sig väster om Södertuna slott mellan Frösjön och den numera försvunna Norrtunasjön. I anslutning till en plats kallad Vad låg den medeltida tingsplatsen som namngav hundaret och sedermera häradet. År 1591 flyttades den till kyrkbacken vid Gåsinge kyrka och höll till där till och med år 1908, då den flyttades till det nybyggda tingshuset i Gnesta. Den ursprungliga Eriksgatan har med viss sannolikhet också gått över vadet mellan Frösjön och Klämmingen till Daga hundares tingsplats innan den flyttades till den medeltida dragningen över Laxne, vilket i stort sett följer nuvarande Länsväg 223 mellan Gripsholms slott och Nyköpingshus. Önnersta by strax söder om Björnlunda tog då över som centrum för bygden och här uppfördes en gästgivaregård med ett särskilt kungshus uppfört av Drottning Kristina och årligen hölls här marknader. Det var först med järnvägens ankomst som bygdens centrum försköts mot Gnesta.

Daga härad har flera större egendomar, därtill många numera nedlagda järnbruk. Några av de större herresätena är Elghammars slott, Södertuna slott, Skeppsta bruk, Jakobsbergs säteri samt Närlunda säteri. Södertuna slott härrör från medeltiden och hette ursprungligen Vad. Det enda Tuna var då Norrtuna gård, vilket till namnet torde innebära att häradets marknadsplats en gång var belägen här. Till de mer kända nedlagda gruvorna hör Skottvångs gruva norr om samhället Laxne.

När Västra stambanan byggdes på 1860-talet kom Daga härad att genomkorsas av denna. Den mycket gamla byn Gnesta kom då att få en station och utvecklades därefter som stationssamhälle med ett visst mått av industri. Även i Stjärnhov i Gryts socken samt i Björnlunda tillkom stationer runt vilka mindre samhällen med industrier växte fram. I övrigt är det mestadels jordbruk med binäringar, bland annat skogsavverkning som varit huvudnäringar i häradet. Välbevarande ålderdomliga kulturmiljöer finns bland annat vid Blacksta och Avla norr om Björnlunda.

År 1952 gick de olika landskommunerna i området upp två storkommuner – Daga och Gnesta landskommun – vilka år 1974 gick upp i Nyköpings kommun. År 1992 delades Nyköpings kommun i tre delar där nya Gnesta kommun var en av dessa.

Län, fögderier, domsagor, tingslag och tingsrätter
Häradet hade sedan 1634 hört till Södermanlands län. Församlingarna i häradet har hört Strängnäs stift.

Härradet ingick under medletiden i Nyköpings län för att i nyare tid ingå i Gripsholms län.

Häradets socknar hörde till följande fögderier:
 1720–1885 Södermanlands läns Fjärde fögderi
 1886–1945/1951 Gripsholms fögderi till 1946 för Björnlunda och Gryts socken; till 1951 för Dillnäs, Frustuna, Gåstuna och Kattnäs socknar
 1946/1952–1966 Flens fögderi för Björnlunda, Dillnäs, Gryts och Gåstuna socknar
 1967–1990 Nyköpings fögderi för Björnlunda, Dillnäs, Gryts och Gåstuna socknar

Häradets socknar tillhörde följande domsagor, tingslag och tingsrätter:
1680-1947 daga tingslag i
1680-1718 Gripsholms, Rävsnäs och Eskilstuna läns domsaga (Åkers, Selebo, Daga samt fram till 1714 Öster- och Västerrekarne härader)
 1719–1878 Åkers, Selebo, Daga samt Öster- och Västerrekarne häraders domsaga, från 1861 benämnt Livgedingets domsaga
 1879–1947 Nyköpings domsaga (med Jönåkers, Rönö, Hölebo och Daga härader)
 1948–1970 Nyköpings domsagas tingslag i Nyköpings domsaga
 1971- Nyköpings tingsrätt och dess domsaga

Se även
Daga härads sparbank

Källor
 Elsa Trolle Önnerfors: Domsagohistorik – Nyköpings tingsrätt (del av Riksantikvarieämbetets Tings- och rådhusinventeringen 1996–2007)
 Nordisk familjebok, uppl 3, band 5, 1926
 Nationalencyklopedin
 C.M. Rosenberg; Geografiskt-Statistiskt Handlexikon öfver Sverige, 1882-1883
 Nationella arkivdatabasen för uppgifter om fögderier, domsagor, tingslag och tingsrätter

Vidare läsning
 Karlsson, Sive (1919-); Min Daga-bok (med teckningar av Nicolaj Jensen Toing), Gnesta, 1993, LIBRIS-id 1857065
 Daga-kommittén i Pojo; Hälsning till Daga härad från dess adoptivort Pojo - Finland, Daga-kommittén i Pojo, Ekenäs, 1947, LIBRIS-id 2718075
 Nyström, Staffan (1952-); Ord för höjder och sluttningar i Daga härad - studie över betydelsen hos två grupper terrängbetecknande appellativ och ortnamnselement, Uppsala Ortnamnsarkivet, (serie: Skrifter utgivna genom Ortnamnsarkivet i Uppsala – Serie B – Meddelanden), Almqvist & Wiksell International (distr), 1988, ,
 Dillström, Stig; Ur dagaspråket, Gåsinge-Dillnäs hembygdsförening, Gnesta, 2000,

Externa länkar

Härader i Södermanland
Härader i Södermanlands län

en:Daga Hundred

redpajama_set_name: RedPajamaWikipedia


Describe about the Infection control in secondary care setting for Shingles?
Shingles is a viral disease and a secondary infection of varicella zoster virus (VZV) and causes painful blisters as well as rashes in one side of the body (Richter, K. 2014). This disease can be caused as the reactivation of previous disease with herpes zoster virus or chicken pox virus. There is much kind of risk factors present behind the occurrence of disease. The risk factors are like if anyone has had chicken pox infection or the chicken pox vaccine then there is possibility that he may carry the herpes zoster virus. This virus in turn can cause shingles. The people who have immunodeficiency have the chance of the occurrence of the disease. It has been seen that people with the risk factors for shingles are found to be healthy as their immune system is strong. In this assignment the infection control for the varicella zoster virus within a health sector has been described. The only known host for the VZV infection is human. The mode of transmission of the varicella zoster virus is from person-to-person and by the droplets and air. The infection must occur when in close contact. Although the virus is very much labile so that it cannot be transmitted via inanimate objects like hospital instruments. There is report for nosocomial infection of this virus. For that reason the virus can be transmitted via air route or by droplets. In contrast, there is no report of the transmission of the virus to the term infants as there is a protection of the maternal transplacental antibodies. To avoid this kind of spreading there is a guideline of CDC that tells that after vaccination who produce rashes should avoid the contact with other persons. EPIC3 and UK based NICE guidelines have to be followed by the hospitals to prevent the spreading of the varicella zoster virus.
Shingles cause pain instead of itching that occurs mainly during chicken pox. The common symptoms and signs include a caution period, outburst of blisters and rashes, and finally pain and flu like symptom.
The warning period: In this case, include skin irritation, itchiness, burns and tingling sensations that usually occur in only one portion of the body. These symptoms may be temporary or permanent. Symptoms may last for two to three days or for a longer time (Jones and Jones, 2013).
Rashes and Blisters: After the warning period of shingles, rashes appear all over the body or in that specific portion. Finally, those rashes turned into blisters that turn bloody before they scab and heal. This lasts for two to three weeks. This phase is so much painful that painkillers are wastage (Hosseini et.al. 2015).
Difficulties of shingles occur in any person with the situation, but are more probable in older adults and those with a destabilized immune structure (Pinninti and Kimberlin, 2013). In general, problems arise in about 12 percent of all persons with shingles. Post-herpetic neuralgia (PHN) is the most general problem of shingles. It causes gentle to harsh pain or horrible sensations and is frequently described as burning. PHN affects 10 to 15 percent of patients, that is a great number, and with about half of these cases in individuals older than 60 years (Gupta et.al. 2015).
Eye complications take place in regarding 2 percent of persons. These are severe cases of shingles. These are much more likely to happen when the shingles rash occurs roughly around the eye. These problems are severe and can lead to loss of visualization (Yawn et.al. 2013). Herpes zoster virus (HSV) of the eye can grounds irritation, injures retina, and termed as acute retinal necrosis. The retina is present in the rear of the eye, and senses beam and facilitates vision. Retinal irritation can develop quickly in persons with HIV virus. Retinal irritation generally initiate with fuzzy hallucination and pain in the one eye. In half of the persons, it afterward distresses the other eye. (Takhar et. al. 2015). These viruses can origin irritation of the ear known as Ramsay Hunt syndrome. Signs consist of the flaw of the facial strength on the exaggerated side. Groups with a weakened immune structure, which includes populace contaminated with HIV, are at considerable hazard for harsh varicella zoster virus linked difficulties.
Chicken pox virus (Varicella zoster) is a deadly virus that becomes an endemic in the United States in recent years. Shingles are the secondary infection that can occur after the chicken pox (Baveja, 2014). Shingles is becoming very much threatening to the population. It also hinders the quality of life of the community. Shingles outbreak in the United Kingdom is very much devastating in nature. This secondary immune infection leads to different kinds of diseases and symptoms later on. These are bacterial skin infections, the signs of Hutchinson, Ramsay Hunt Symptom, neuropathic syndromes linked to motor functional impairment, urinary meningitis infection. Children are mostly affected by the Shingles infection. The contemporary fact in this concern that the children affected by Shingles are not cured properly and the prevalence rate counted at 190,000 numbers of people (Baveja, 2014). The threatening virus VZV remain in the central nervous system of the affected individuals. The reactivation of the virus is the potential cause for respective disease outbreak. It is very much unexpected that in spite of having specific vaccines for chicken pox virus the secondary immune infection of the respective disease affection cannot be controlled within the acceptable limit. Because of developing the secondary immune cells (memory 'B' cell), the infection is not inhibited and protested within the human immune (Bloomfield & Scott, 2013).
The healthy individuals should not come into the contact with the affected person or in the person in remaining disease attenuating condition (Havill, Nucci, Sullivan & Dembry, 2014).
The infection prevention and control team should always be aware on the outbreak of new emergence of the shingles. If the case is informed properly, immediate action should be taken by the control and prevention team (Sciortino, 2013). The affected patients should be always nursed in a different and separate place or room in such a way the airborne transfusion of disease is minimized to a certain extent. Appropriate contact isolation can be needed to prevent the further spreading (Malik, 2013). Day to day monitoring is required to check the degree of affection in the affected patients. VZV antibody test should be performed to check the disease affection in the susceptible community. Consultation of a microbiologist is required to take advice and also the development of a protocol for disease prevention and control within the community (McFarlin, 2012).
VZVIG cannot prevent the shingles. It can attenuate only. When the initial exposure (within 7 days in immune-compromised patients) is observed, the administration of VZIG should be needed. VZIG is supplied by the Clinical Virology Departments of all NHS trusts in the UK. But it is mandatory that the consultation with microbiologists or Health Protection agency should be needed before the administration of VZIG. According to the contemporary prevention and control care guidelines set by Department of Health (UK), the administration procedure must be implemented and conveyed. The information about the decision for VZIG administration must be properly conveyed to the occupational health department or public health department (Millar, 2008).
The respective microbiologists or GP should follow the disease control and preventive measure guidelines set by Department of Health in UK.
Appearance of different severe infectious diseases like shingles, HIV etc have painted the requirement of a well-organized infection control program for every aspect and capacity for different health care workers. These are various practices that upon application restrict the increased infection. One branch of this health care practice also helps to restrict the spread of disease from the patient to health care worker, other patients, and attendants as well. Therefore it is important for each and every worker, friends, and family members of the patients to follow the guidelines strictly (Stevens's et. al. 2014). It is also essential for the supervisor to guarantee the accomplishment of this program with all those health care skills.
Different infection control skills are there that can be grouped in two kinds of categories standard protection and transmission-based protection.
According to EPIC3 guidelines, treatment of every patient having shingles in this health care ability with an equal level of proper precautions contains work practices that are needed to offer a much higher level of defense to patients, health worker as well as visitors. This protocol includes: antisepsis and hygiene maintenance, Hand washing practices as well as to utilize private defensive equipment when managing blood, body substances, secretions and excretions and finally the proper treatment of patient care tools and grubby linens etc.
Additional or transmission-based safety measures are taken whereas ensuring typical safety measures are maintained. Additional safety measures comprise: Airborne protection that includes, application of typical defense mechanisms and the patient should be placed in a single room, and that room should have a properly scrutinized airflow pressure (negative), and is frequently referred to as a negative pressure room. Droplet nuclei protection which includes, Standard terms need to be implemented, and the patient should be placed in a single room or with another patient having the same kind of disease. Contact protection that includes, application of standard protocol and the disease epidemiology should be considered. The patient should be placed in an isolated room or with another patient having shingles.
Biggest factors effecting the control and prevention on this disease is less knowledge of dos and don'ts of this disease. People know very less about shingles, and therefore they cannot understand the triggering factors leading to severe pains and itchiness. Unavailability of proper medication can be another reason. Less availability of vaccines as well as medicines leads to spread of this disease (Russell et. al. 2014). Improper sanitation and handling of the patient also prevents them to recover from this disease as it can persist for long time. Inadequate hospital management and patient care is one of the prime factors effecting people's health due to shingles. Staff working in the sterilization department handles this case.
A polluted scientific surrounding is one of the biggest features that may add towards infectivity rates. On the other hand, high values of sanitation will help to lessen the danger of cross-infection. Good plan in buildings, furniture and equipment is also significant to permit well-organized cleanout. According to regulation available by NHS and NICE guideline states – an organization of the Department of Health – healthcare amenities should be patient-friendly and recommend safe surroundings for care (NHS Estates, 2014).
Sufficient hand washing amenities should be accessible and effortlessly available in every shingles, wards of patients, healing quarters, washrooms and kitchens. Basins, wash-basins in medical areas should have nudge lever functioned mixer taps or should possess automatic controls and should be provided by way of liquid soap distributors, paper, hand towels, leg-driven dustbins. Alcohol containing hand gel should also be obtainable at all prime and inferior care settings All healthcare staff should note any lack of these equipments or practices to inform their managers while properly performing their duties to patients and to themselves as well to stop the process of cross-infection (Loveday et. al. 2014).
Hand cleanliness is extensively recognized to be the sole most significant commotion for reducing the spread of disease, yet facts recommend that a lot of healthcare experts do not clean up their hands as frequently as they require to or use the proper method which means that hands are not properly washed. The key areas that are of main concern of management include: Nails of the hospital staff should be clean, short and polish-free, artificial nails also are avoided. Nurses, Ward boys should not wear any jewelry or wrist watches, stoned rings, etc. during treatment procedures and Cuts, wounds and exposed abrasions should be covered properly with waterproof dressing (Swayne et. al. 2012). Staff should wear masks, visor, and eye protection gears while dealing with the patients. Wherever there is a chance of splash of blood, mucous, or other bodily contaminating fluids. Usage of mouth masks is also should be mandatory in the hospitals to limit the spread of multi-drug resistant diseases and severe contagious viral diseases like varicella zoster shingles.
The prevalence of shingles infection in United Kingdom is around 190,000 people every year and excess of them belongs to the old age group. In a particular study with 183 patients driven by a group of physicians in six countries, it was found that a new drug EMA401 is a new formulated drug which helps to reduce the pain related to the shingles and it did not cause any kind of serious side effects. These findings were published in the Lancet (Wong, 2014).
Usage of different antidepressants can also lead to relief some of the anxieties during the outbreak of this disease. Current researchers are also aiming to find some improved vaccination program to deal with the condition. Incorporation of VSV vaccine during childhood can limit this infection to some extent. Approval of zoster vaccine can also prevent the spread of this disease in the whole UK (Choi et. al. 2015).
One combined drug is tramadol. Oxycodone in combination with acetaminophen or morphine can be another choice of drug (koelle and Corey 2013).
In hospitals, appropriate placement of patients is so much of importance as it determines the rate of transmission of the disease. There should be some general principles related to the placement of patients: There should be proper spacing ( nearly 1-2 meters) between beds to reduce the risk associated with shingles as there is a high chance of cross reaction due to direct or indirect contact ( droplet nuclei, air flow, etc.). Cohorting i.e. people with shingles are sharing a single room can be another option to deal with spreading of this disease (Gould 2014). Availability of single beds is one of the main issues in hospitals so the use of cohort can be an easy way to deal with this situation. Shingles being a highly contagious one needs a proper isolation technique. Therefore, a specific area of the hospital should be courted with shingles patients.
Environment management should be handled with proper dedication and expertise as it can be one of the biggest sources of contamination leading to this contagious disease. The Immunosupressed condition of shingles patient requires adequate care and monitoring. Usage of unidirectional ultra clean air in these wards can minimize the risk. HEPA filers should be used in such rooms. Frequent management and validation of these filters, as well as the temperature, should be maintained. Humidity, pressure gradient, etc. should also be maintained.
There should be a separate department in the hospitals to manage the wastes originated from the hospitals as the wastes are reservoirs of microorganisms and can lead to diseases as well. These require proper, adequate, and reliable handling to store, collect and dispose the originated waste. It should be conducted with the help of infection control squad of the hospital and should include health measures as per guidelines.
The clinical/ hazardous substances should be disposed separately with proper monitoring and under expert supervision. Hazards should be transported to a specific chamber where experts can dispose that to simpler substances. Sharp objects should be sterilized using autoclaves, microwave, whereas plastic objects should be incinerated. Radioactive wastes, on the other hand, should be deal with expertise chemical reactions.
From the above assignment it can be concluded that varicella zoster virus is a very infectious virus and causes a painful disease named shingles. From the EPIC3 and UK based NICE guideline it has been known that the hygiene of the hospital should be maintained to prevent the spreading of the virus. This can be achieved by keeping the hospitals visibly clean by using some effective disinfectants. The hand hygiene must be a matter of concern. If any patient with the infection of varicella zoster virus is admitted then the patient should be given the personal protective equipments to reduce the transmission of the virus from person-to-person contact. The health care workers should be well educated about the infection and its protection. Hospitals should use the disposal gloves and aprons to reduce the chance of the infection. From this assignment this is clear that hospital staffs should maintain their hand hygiene when they attend the patients with the infection with varicella zoster. The patients are immunocompromised in that time and any kind of secondary infection can take place. The patients as well as the health care providers should wear the face mask when staying within the hospital to reduce the chance of transmission of the virus. As the virus cannot live on the inanimate objects, for this reason there is no fear for the transmission of the virus from the hospital instruments. However to reduce the chances of secondary infection the hospital should maintain its sanitary condition as well as the hygiene. It is also recommended that the hospital staffs should be vaccinated against the varicella zoster virus. This assignment also concludes that those health workers who have previously vaccinated should be monitored regularly for the occurrence of any skin symptoms of the disease.
Choi, E. J., Lee, C. H., Kim, Y. C., Shin, O. S., 2015. Wogonin inhibits Varicella-Zoster (shingles) virus replication via modulation of type I interferon signaling and adenosine monophosphate-activated protein kinase activity.Journal of Functional Foods, 17, 399-409.
Russell, M. L., Dover, D. C., Simmonds, K. A., Svenson, L. W. 2014. Shingles in Alberta: before and after publicly funded varicella vaccination. Vaccine, 32(47), 6319-6324.
Richter, K. 2014. Feared shingles is now a preventable disease: health and fitness. Plus 50, 9(4), 50-51.
Yawn, B. P., Wollan, P. C., Sauver, J. L. S., Butterfield, L. C. 2013, June. Herpes zoster eye complications: rates and trends. In Mayo Clinic Proceedings(Vol. 88, No. 6, pp. 562-570). Elsevier.
Wilson, D. D. 2014. Herpes zoster (shingles). The Nurse Practitioner, 39(5), 15-16.
Kawai, K., Gebremeskel, B. G., Acosta, C. J. 2014. Systematic review of incidence and complications of herpes zoster: towards a global perspective.BMJ open, 4(6), e004833.
Gupta, R., Gupta, P., Gupta, S. 2015. Complications of Herpes Zoster: A review. IJAR, 1(7), 175-178.
Hosseini, S., Zawawi, F., Young, J. 2015. Atypical Presentation of a Common Disease: Shingles of the Larynx. Journal of Voice.
Juel-Jensen, B. E., MacCallum, F. O. 2013. Herpes Simplex Varicella and Zoster: Clinical Manifestations and Treatment. Butterworth-Heinemann.
Takhar, S. S., Moran, G. J. 2015. Disseminated Viral Infections: Introduction. Pathophysiology, 2, 16.
Stevens, D. L., Bisno, A. L., Chambers, H. F., Dellinger, E. P., Goldstein, E. J., Gorbach, S. L., ... Wade, J. C. 2014. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 59(2), e10-e52.
Loveday, H. P., Wilson, J., Pratt, R. J., Golsorkhi, M., Tingle, A., Bak, A., Wilcox, M. 2014. epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. Journal of Hospital Infection, 86, S1-S70.
Swayne, L. E., Duncan, W. J., Ginter, P. M. 2012. Strategic management of health care organizations. John Wiley & Sons.
Jones, C. and Jones, C. 2013. Bovine Herpes Virus 1 (BHV-1) and Herpes Simplex Virus Type 1 (HSV-1) Promote Survival of Latently Infected Sensory Neurons, in Part by Inhibiting Apoptosis. JCD, p.1.
Kasetsuwan, N. Tangmonkongvoragul, C. 2013. Concomitant herpes simplex virus and cytomegalovirus endotheliitis in immunocompetent patient. Case Reports, 2013(may09 1), pp.bcr2012007942-bcr2012007942.
Ogle, K. 2012. Shingles. Nursing Made Incredibly Easy!, 10(4), pp.28-34.
Pinninti, S. Kimberlin, D. 2013. Neonatal Herpes Simplex Virus Infections. Pediatric Clinics of North America, 60(2), pp.351-365.
wong, s. 2014. [online] Available at: https://dx.doi.org/10.1016/%20S0140-6736(13)62337-5 [Accessed 5 Feb. 2014].
Gould, D. 2014. Varicella zoster virus: chickenpox and shingles. Nursing Standard, 28(33), 52-58.


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Q: Add/remove method vs set method in ArrayList While using foreach with ArrayList, I know that using add/remove method will not work as it will throw concurrent modification  exception, but then why am I able to change the value using the set method within the same foreach loop ?
Here is the sample code :
    for (Integer integer : arr) {
        if (integer==2) {
            arr.set(1, 6);
        }
        System.out.println(integer);
    }
    System.out.println(arr);

If we will change arr.add() then it will throw an error, but with set it is working fine, what's the reason here ?

A: According to the docs, CME is thrown if the list is structurally modified after the iterator is created. Since set() only replaces an existing element, no structural modification takes place and the exception is not thrown.

A: There is a difference in the implementation. When the length of the list is modified (which add method does) the iterator returned by ArrayList throws ConcurrentModificationException because it checks the length of the array. While the set method does not modify the length of the array thus no ConcurrentModificationException is thrown.

redpajama_set_name: RedPajamaStackExchange


Correspondence: Tara L. Alvarez, New Jersey Institute of Technology, Department of Biomedical Engineering, 323 Dr. Martin Luther King Jr. Boulevard, University Heights, Newark, NJ 07102-1982; tara.l.alvarez@njit.edu.
Tara L. Alvarez, Eun H. Kim; Analysis of Saccades and Peak Velocity to Symmetrical Convergence Stimuli: Binocularly Normal Controls Compared to Convergence Insufficiency Patients. Invest. Ophthalmol. Vis. Sci. 2013;54(6):4122-4135. doi: 10.1167/iovs.13-11797.
Purpose.: To assess the potential peak velocity asymmetry between the left-eye and right-eye movement responses stimulated by symmetrical vergence steps in those with normal binocular vision and those with convergence insufficiency (CI) before and after vergence training. This study also evaluated whether vergence training influenced convergence peak velocity and the prevalence of saccades within the first second of the response.
Methods.: The peak velocities of the left-eye, right-eye, and combined vergence response evoked from symmetrical 2°, 4°, and 6° convergence step stimuli were assessed in 10 controls and 7 CI subjects. Four of the CI subjects participated in vergence training. An asymmetry ratio was calculated as the peak velocity of the slower eye movement response divided by the peak velocity of the faster eye movement response.
Results.: Controls were significantly more symmetrical (left-eye peak velocity was approximately equal to right-eye peak velocity) compared to CI subjects (P < 0.001). After vergence training, the CI subjects' left-eye and right-eye movements became significantly more symmetrical, convergence peak velocity increased, and the prevalence of saccades within the first 1 second decreased (P < 0.01). Peak convergence velocity was significantly correlated to the prevalence of saccades observed within the first second of the response (r = 0.8; P < 0.05).
Conclusions.: Data suggest that vergence training improves the symmetry between the left-eye and right-eye movements, increases convergence peak velocity, and decreases the prevalence of saccades within the first second of the response, which facilitates binocular coordination in CI patients. Saccades may be a compensatory mechanism used by CI subjects when convergence peak velocity is reduced.
During daily activities, the brain acquires visual information by utilizing a combination of version and vergence eye movements. The eyes typically shift in tandem for version responses (i.e., saccadic movements), whereas the eyes rotate in opposition for vergence responses via either inward (convergence) or outward (divergence) movement. Vergence is defined as the difference between the left-eye and right-eye movement responses. Version is the average of the left-eye and right-eye movement responses. Although unusual within natural viewing conditions, pure vergence stimuli can be easily created within the laboratory setting to study the neural control of vergence responses.
One method to evaluate binocular coordination is through an assessment of the left-eye and right-eye convergence peak velocity. On average, the left-eye and right-eye convergence movement responses elicited from symmetrical convergence stimuli (along the midsagittal plane with no conjugate stimulus) have approximately the same peak velocity (are symmetrical) in binocularly normal controls. 21,22 Some individual responses may show that the convergence peak velocity of one eye is up to twice the speed of the other convergence eye movement response. 21 Symmetrical vergence responses are also reported for binocularly normal primates. 23 Conversely, primates with infantile esotropia (pathologic inward misalignment of the visual axes) exhibit asymmetric convergence responses in which one eye has a reduced peak velocity compared to the other. 23 Studies of the differences between the left-eye and right-eye movements report that the degree of asymmetry between the left and right eyes is dependent on the severity of strabismus in humans and primates. 23,24 Surprisingly, even though CI is described as a problem in binocular coordination, a systematic study of the differences between the left-eye and right-eye convergence movement responses in those with CI has not been conducted and was one of the primary aims of this study.
The second aim of this study was to assess saccades within convergence responses elicited from symmetrical convergence stimuli. A pure symmetrical convergence stimulus should elicit a pure symmetrical convergence response. Yet, studies report that saccades are commonly observed within convergence responses to symmetrical convergence stimuli. 25–28 Prior research supports that when a saccade is initiated within convergence, the peak velocity of convergence is enhanced through a nonlinear interaction compared to saccade-free convergence responses. 29–31 These studies suggest an interaction between the convergence and saccade systems.
Thus, this investigation had two aims: (1) assessment of the peak velocity in the left-eye and right-eye movement responses elicited from pure symmetrical convergence stimuli, comparing binocularly normal controls to CI subjects before and after vergence training; and (2) evaluation of a potential relationship between convergence peak velocity and the prevalence of saccades stimulated from symmetrical convergence stimuli within the first second of the vergence responses from CI subjects before and after vergence training. The study tested two hypotheses. The first hypothesis was that since CI is described as a binocular coordination dysfunction, CI subjects may demonstrate greater asymmetries of left- and right-eye convergence movements mediated from symmetrical convergence stimuli, compared to binocularly normal controls, before vergence training. Asymmetry is defined as one eye movement having, on average, reduced peak velocity compared to the other eye movement. Further, the asymmetry in CI before training may be reduced after vergence training and thus be more similar to values in binocular normal controls. CI subjects have reduced peak convergence velocity before vergence training, which increases after training. The second hypothesis tested was that when the peak velocity of convergence movements is reduced, saccades will be recruited (even though the stimuli do not stimulate conjugate movements) presumably as a means to increase convergence peak velocity. When the convergence peak velocity increases after vergence training, the prevalence of saccades will be reduced compared to the baseline sessions, presumably because the need for saccades to facilitate convergence movement will decline with improvement in convergence binocular coordination.
Seventeen subjects participated in this study: 10 control subjects (5 male and 5 female) with normal binocular vision between 20 and 31 years of age and 7 subjects diagnosed with CI (3 male and 4 female) between 19 and 29 years of age. The 4 female CI subjects participated in 18 hours of vergence training.
The controls had normal binocular vision. Normal binocular vision was defined as having a normal near point of convergence (<8 cm), assessed by measuring the distance a high-acuity target was perceived as diplopic along the subject's midline, 32 and a normal stereopsis (≤50 seconds of arc), assessed by the Randot Stereopsis Test (Bernell Corp., South Bend, IN). Most subjects were emmetropes. Control subjects CONS1 (−1.25 diopters [D]) and CONS9 (−2.25 D) were myopes, and CI subjects CIS3 (−1.0 D) and CIS5 (−2.5 D) were myopes. The myopic subjects wore their contact lenses to correct for their refractive error during the experimental sessions. The remaining control and CI subjects did not require refractive correction.
This study was approved by the Institution Review Board (IRB) of the New Jersey Institute of Technology in accordance with the Declaration of Helsinki. All subjects signed written informed consent approved by the IRB committee.
Instrumentation Used During Eye Movement Experiment.
Schematic of symmetric convergence step stimuli used to study the symmetry between the left and right convergence eye movement responses and the prevalence of saccades evoked via symmetric convergence step stimuli.
Subjects mediated step responses for approximately 25 to 30 minutes per laboratory training session in which eye movements were recorded. The step stimuli used within the laboratory vergence training were symmetrical convergence 2°, 4°, and 6° steps, as well as 4° divergence steps shown along the subject's midline using LED targets; see Figure 1. Subjects were instructed to track stimuli starting at an initial vergence angle of 2° or 4° vergence demand for convergence steps, and 8° vergence demand for divergence steps. To allow a subject adequate time to fuse the new target, step stimuli were presented and eye movement responses were acquired for 4 seconds.
The subject also mediated ramp responses for approximately 25 to 30 minutes per laboratory training session. Ramp stimuli used within the laboratory vergence training were 1°/s and 2°/s between the range of 2° to 8° vergence angular demand. For the 1°/s ramp, the visual stimulus was presented for 12 seconds; for the 2°/s ramp, the visual stimulus was presented for 6 seconds. The ramp stimuli were presented using a custom haploscope (developed by New Jersey Institute of Technology, Newark, NJ). Two computer screens were used to generate a symmetrical disparity vergence stimulus along the subject's midline. The stimulus was a green vertical line 2 cm in height and 2 mm in width with a black background. Two partially reflecting mirrors projected the two vertical lines from the computer screens into the subject's line of sight.
Peak velocity was a primary measure within this study. Velocity was computed by taking the derivative of the position response using a two-point central difference algorithm. 44 Each individual left-eye and right-eye convergence movement response was manually inspected for the presence of a saccade; saccades were easily identified because saccade dynamics were an order of magnitude greater than vergence. A phase plot (vergence velocity as a function of vergence amplitude) for the left-eye and the right-eye movement was used to determine whether the saccades obscured the peak velocity of the vergence response to a symmetrical stimulus. Only when saccades obstructed the convergence peak velocity was the response omitted from the peak velocity analysis, which occurred in less than 10% of the responses depending on the subject. The peak velocity of the left-eye, right-eye, and combined vergence response was quantified as the maximum value within the transient portion of the vergence movement.
An asymmetry ratio was computed per subject. First, the right-eye peak velocity assessed from the 2°, 4°, and 6° step responses was plotted as a function of the left-eye peak velocity for each individual response. Convergence responses, including those that had saccades present where the saccades did not obstruct the peak velocity, were analyzed to compute the left- and right-eye peak velocity. A linear regression analysis was performed, and the trend line was plotted and compared to the perfect symmetry line. The perfect symmetry line was the line where the left-eye peak velocity exactly equaled the right-eye peak velocity. If the linear regression was below the perfect symmetry line, then the right-eye response was on average slower than the left-eye response. In this case, the asymmetry ratio was computed as the right-eye peak velocity divided by the left-eye peak velocity. Conversely, if the linear regression was above the perfect symmetry line, then the left-eye response was on average slower than the right-eye response. Hence, the asymmetry ratio was computed as the left-eye peak velocity divided by the right-eye peak velocity. Using this method, the asymmetry ratio will be less than one regardless of whether the left or right eye is slower. Hence, this method determines whether a subject has one eye that is on average slower than the other, or whether a subject may be asymmetrical on occasion but have, on average, approximately the same peak velocity in the left-eye and right-eye movements. The method also allows a group analysis because it accounts for some subjects having slower left-eye movements while other subjects may have slower right-eye movements. If the analysis simply divided the left-eye peak velocity by the right-eye peak velocity, then within a group analysis, it might appear that on average the group was symmetrical when in actuality the asymmetry was dependent upon a preferred eye.
For the CI subjects, the asymmetry ratio was calculated from the 2°, 4°, and 6° symmetrical vergence step responses. For the binocularly normal controls, the asymmetry ratio was calculated using the 4° near (initial vergence angle of 12°) and 4° far (initial vergence angle of 2° responses. Potential statistical differences were evaluated between the 10 binocularly normal controls and the 7 CI subjects using an unpaired t-test to determine whether differences in the asymmetry ratio existed between populations. In addition, the asymmetry ratio, near point of convergence, PFV range, near phoria, and the CISS from the 4 CI subjects who participated in vergence training were compared to study potential differences between the baseline data and the data after vergence training using a paired t-test. Statistical significance was defined as P < 0.05. The prevalence of saccades and combined convergence peak velocity for the 4 CI subjects who participated in vergence training were evaluated using an ANOVA. The two main factors (combined convergence peak velocity and the number of saccades) were analyzed for statistical differences using a within-subject three-way ANOVA in which time of recording (before versus after vergence training), convergence stimulus step size (2°, 4°, and 6°), and subject were the independent variables. Post hoc Bonferroni all pairwise comparisons were calculated to determine whether significant differences were observed in the convergence peak velocity or the prevalence of saccades by comparing (1) the before to after vergence training measurements and (2) the step size (2°, 4°, and 6°) of the symmetrical stimuli. Statistical comparisons were calculated using NCSS2004 software (Number Cruncher Statistical System, Kaysville, UT).
A linear regression analysis was calculated with MATLAB software. Linear regression assessed the correlation between the left-eye convergence peak velocities and the right-eye convergence peak velocities for the binocularly normal controls and the CI subjects before and after vergence training to determine the asymmetry ratio. In addition, a linear regression analysis assessed the correlation between the prevalence of saccades observed within the first 1 second of the convergence response and the convergence peak velocity before and after vergence training.
Seven subjects had a diagnosis of CI, and four CI subjects participated in vergence training. Three CI subjects did not participate in vergence training due to time constraints, leading to an inability to complete the 18 hours of training. The Table summarizes the clinical parameters and symptoms quantified via the CISS. All CI subjects had a stereopsis of 40 seconds of arc or better. A paired t-test revealed a significant difference between the baseline (before vergence training) parameters and the parameters after vergence training for the following clinical measurements: the near point of convergence (NPC) break (t = 4.9; P = 0.04), base-out (BO) PFV range (t = 9.5; P = 0.01), near dissociated phoria (t = 11; P = 0.008), and CISS (t = 3.6; P = 0.05). All significant changes were improvements to each parameter studied. Although the recover point of convergence improved, the changes were not statistically significant (t = 2.3; P = 1.5).
Ave ± std, average with one standard deviation; min arc, minutes of arc; exo, exophoria.
An eye movement response from a binocularly normal control, from a CI subject (CIS3) before any vergence training, and from the same CI subject (CIS3) after vergence training is plotted in the left, middle, and right column, respectively, in Figure 2. Figure 2A plots the right-eye (black) and left-eye (gray) movement responses, with convergence, inward rotation, plotted as positive for both eyes to facilitate direct comparison (the right-eye convergence response is inverted). For the CI subject, CIS3 (Fig. 2A, middle plots), the left-eye convergence response is slower compared to the right eye, showing the asymmetry between the convergence responses in the position and velocity traces. After vergence training, the left-eye and right-eye convergence movements are more similar, with the peak velocity almost the same. Figure 2B plots the convergence trace (difference between the eye movements) in black and the conjugate trace (average of the eye movements) in gray. Since the stimulus is a symmetrical convergence step change presented on the subject's midline, there should be no stimulus to the conjugate system. Hence, the conjugate response should be approximately zero. All responses in Figure 2B are saccade-free from the stimulus onset to the first 1 second of the response.
Eye movement responses from a binocularly normal control (left column), a subject with CI (CIS3) before vergence training (middle column), and the same CI subject after vergence training (right column). (A) Position (upper plots) and velocity (lower plots) traces of the right-eye (black line) and left-eye (gray line) responses. Note that convergence movements are both plotted as positive to facilitate comparison; hence conjugate movements are plotted in opposing directions. (B) Convergence or the difference between the left- and right-eye movements (black line) and the conjugate or the average of the left- and right-eye (gray line) position (upper plots) and velocity (lower plots) responses. Note that saccades are not present within the first second of the convergence response. However, the left-eye response is slower compared to the right-eye response before vergence training, and the left-eye and right-eye movements are more similar after vergence training.
All 10 binocularly normal controls' and 7 CI subjects' left-eye and right-eye peak velocity was analyzed. In the interest of comparison, 4 of the binocularly normal controls (Fig. 3A), 4 CI subjects before vergence training (Fig. 3B), and the same CI subjects after training (Fig. 3C) are shown, with the subject number listed in the figure. Figure 3 plots the right-eye peak velocity from 2° (open diamond), 4° with a far initial vergence angle (solid circles), 4° with a near initial vergence angle (x symbol), and 6° (gray triangles) step responses as a function of left-eye peak velocity before vergence training. The perfect symmetry line is plotted in dashed gray, and the linear regression is plotted in solid black. The linear regression analyses of the right-eye peak velocity as a function of the left-eye peak velocity data for the seven CI subjects showed a Pearson correlation coefficient average and standard deviation of r = 0.68 ± 0.17, P < 0.01 (range, r = 0.44–0.89), compared to the 10 binocularly normal controls; for these subjects the linear regression analysis showed an average with one standard deviation of r = 0.63 ± 0.09, P < 0.005 (range, r = 0.49–0.75). For the 4 CI subjects who participated in vergence training, their baseline measurements showed a linear regression of r = 0.68 ± 0.17, P < 0.01 (range, r = 0.44–0.85), compared to the same subjects' measurements after vergence training, which were r = 0.78 ± 0.12, P < 0.001 (range, r = 0.69–0.95). For the binocularly normal controls, the perfect symmetry line was very similar to the linear regression trend of the data. The CI subjects before training exhibited an asymmetry on average whereby one eye was slower than the other. The left-eye convergence movements for CIS1 and CIS4 were on average slower compared to the right-eye convergence movements. Conversely, the right-eye convergence movements for CIS2 and CIS3 were on average slower compared to the left-eye convergence movements. After training, although the same eye was still slower in CIS1 and CIS3, the differences between the eye movement peak velocities were reduced.
Right-eye peak velocity as a function of left-eye peak velocity for four binocularly normal controls (BNC) (A), CI subjects before vergence training (B), and the same CI subjects after vergence training (C). Peak velocities mediated from 2° (open diamonds), 4° beginning at a near vergence angle (solid circles), 4° beginning at a far vergence angle (x symbol), and 6° (gray triangles) symmetrical vergence step stimuli are plotted. The perfect symmetry line is plotted as a dashed gray line and the linear regression fit is plotted as a solid black line.
A group-level analysis was conducted through calculation of the asymmetry ratio as described in the Methods section. Figure 4 plots the average with one standard deviation of the asymmetry ratio for the 10 binocularly normal controls (black), 7 CI subjects' baseline measurements (gray), and 4 CI subjects after training (white). The 10 normal binocular controls had an asymmetry ratio of 0.93 ± 0.06, which was significantly more symmetrical than that of the 7 CI subjects, whose average asymmetry ratio was 0.77 ± 0.09, assessed using an unpaired t-test (degrees of freedom [df] = 15; t = 5.4; P < 0.001). The 4 CI subjects who participated in vergence training had a baseline ratio of 0.76 ± 0.12, which became significantly more symmetrical after training, reaching an average of 0.93 ± 0.11 as assessed using a paired t-test (df = 2; t = 5.6; P < 0.03).
Average asymmetry ratio plus one standard deviation of the group-level analysis of subjects who were binocularly normal controls (black bar), CI subjects measured at baseline (gray bar), and CI subjects after vergence training (white bar). The number of subjects (N) is denoted per bar.
A unique behavior observed from CIS1 is shown in Figure 5. This response is to a symmetrical 4° convergence step with an initial vergence angle of 2°. Figure 5A plots the right-eye (black line) and left-eye (gray) movement position (upper) and velocity (lower) responses. Interestingly, the right eye exhibits two high-velocity convergence movements while the left eye has only one high-velocity convergence movement. Figure 5B plots the convergence (black) and conjugate (gray) position (upper) and velocity (lower) responses. Saccades were not observed within the conjugate response during the first 1 second of the movement. These responses were rare and were observed in 4 of the 7 CI subjects during the baseline measurements. This type of response was also not observed within the binocularly normal controls. The double high velocity in one eye movement convergence response with a single high-velocity component in the other eye movement convergence response was observed during the end of the experimental session, which was conducted prior to the vergence training. However, these responses were not observed after vergence training.
Unique and rare response observed in CIS2 from the baseline session toward the end of the experimental trial. (A) Right-eye (black) and left-eye (gray) position (upper plot) and velocity (lower plot) responses. (B) Vergence (black) and conjugate (gray) position (upper plot) and velocity (lower plot) responses. This type of behavior was not observed in the responses after vergence training.
Figure 6 plots an eye movement response from CIS1 before vergence training (left column) and after vergence training (right column). Figure 6A plots the inward convergence rotation as positive for both the left- and right-eye movements. The right-eye convergence movement is inverted to facilitate direct comparison. The right-eye and left-eye position and velocity traces are shown as black and gray lines, respectively. Hence, saccades are plotted in opposing directions. Figure 6B plots the convergence (black line) and conjugate (gray line) position (upper plot) and velocity (lower plot) traces. A saccade (denoted by the gray dashed line) is clearly observed from its much faster velocity characteristics compared to convergence. A saccade is observed within the left-eye and right-eye responses as well as the conjugate response denoted by the gray dashed vertical lines. Within the first second of the response, the CI subject before vergence training had a slower convergence velocity, with two saccades within the first second compared to the response after vergence training. After vergence training, the peak convergence velocity increased and no saccades were observed within the first second of the response.
Eye movement response from a symmetrical convergence 4° step target from CIS1 before vergence training (left column) and after vergence training (right column). (A) Plot of the right-eye (black line) and left-eye (gray line) position (upper plots) and velocity (lower plots) traces. Note that the inward convergence rotation of each eye movement is plotted as positive to facilitate comparisons between the eye movements. Hence, conjugate movements are plotted in opposing directions. (B) Plot of the vergence (black line) and conjugate (gray line) position (upper plots) and velocity (lower plots) traces. A saccade is denoted by the dashed vertical gray line and can be observed within the left-eye and right-eye movement responses and within the conjugate response.
As discussed in the Methods section, the number of responses per step stimuli (2°, 4°, and 6°) was not exactly the same due to the randomization procedure needed to reduce prediction. Hence, the prevalence of saccades was quantified as an average. This analysis sought to compare the responses recorded during the baseline to the responses recorded after vergence training to determine whether the prevalence of saccades within the first 1 second of the convergence responses was significantly correlated to convergence peak velocity. Hence, only the four CI subjects (CIS1–CIS4) who participated in vergence training were studied within this analysis. Responses that had a saccade obstruct the convergence peak velocity were omitted from this analysis. The group-level analysis is shown in Figure 7. Figure 7 summarizes the mean plus one standard deviation of the average number of saccades present within the first second of the convergence response (Fig. 7A) and the convergence peak velocity (Fig. 7B) for responses from 2°, 4°, and 6° symmetrical convergence step stimuli, before (gray bars) and after (black bars) vergence training. A significant difference was observed when the responses after vergence training were compared to the baseline responses for the following two measurements: combined convergence peak velocity [F(1,3) = 48; P < 0.01] and the average number of saccades observed within the first 1 second of the convergence response [F(1,3) = 280; P < 0.001]. A post hoc Bonferroni (all pairwise) multiple comparison test confirmed that the before measurements were significantly different from the after measurements for both combined convergence peak velocity and the average number of saccades within the first second of the response. The post hoc Bonferroni multiple comparison test also confirmed that peak velocity and the number of saccades within the first second of the response were significantly different between the responses stimulated from 2° and 6° steps. Figure 7C is the linear regression analysis of the average number of saccades as a function of the average convergence peak velocity. A significant correlation assessed using the Pearson correlation coefficient was observed (r = 0.83; P < 0.05). Figure 7 supports that as the convergence peak velocity increases, the prevalence of saccades decreases when the measurements after vergence training are compared to the measurements before vergence training.
Group-level analysis of the number of saccades within the first 1 second of the response (A) and combined convergence peak velocity (B) for 2°, 4°, and 6° convergence step stimuli plotted as the mean (bar) plus one standard deviation (error bar) before (gray bars) and after (black bars) vergence training. (C) Linear regression analysis of the average number of saccades within the first second of the convergence response as a function of convergence peak velocity. Gray diamonds represent the baseline measurements before vergence training, and black squares are the measurements after vergence training.
The first finding of this study was that CI subjects exhibited differences in the peak velocity between the left-eye and right-eye convergence movement responses. Convergence eye movement responses from one eye were consistently slower than the other eye movement convergence responses when presented with symmetrical convergence stimuli. For binocularly normal controls, the left-eye and right-eye movement convergence responses were, on average, similar. A second finding was that the combined convergence peak velocity increased and the number of saccades within the first second of the convergence response decreased after vergence training compared to the baseline measurements. Third, the peak velocity of convergence was significantly correlated to the number of saccades within the first second of the convergence response. The following sections compare the results of the current study to others within the literature.
The asymmetry ratio of peak vergence velocity was 0.77 ± 0.09 with a range of 0.66 to 0.83 prior to vergence training in the 4 CI subjects, supporting that the vergence responses of the two eyes were more asymmetric. Patients with strabismus respond to symmetric binocular disparity convergence step stimuli using asymmetrical vergence and disjunctive saccades. 45 Primates reared to have strabismus also generate asymmetrical responses to symmetrical disparity steps. 23 When these primates were binocularly decorrelated using prism goggles for 3 to 24 weeks, the use of prism goggles was sufficient to cause esotropia. 46 Tychsen 46 reported that disparity vergence was asymmetrical in response to symmetrical vergence stimuli in primates that were binocularly decorrelated for 3 weeks compared to control primates. The primates who were decorrelated had a lack of binocular connections but retained monocular connections within V1. This suggests that the lack of binocular connections within V1 was, in part, the cause of strabismus and the asymmetrical vergence eye movement behavior. 46 However, an animal model does not exist for CI.
The etiology of CI is unknown. Many clinicians define CI as a greater exophoria at near compared to far with a receded near point of convergence. 33 It is suggested that CI patients are symptomatic because of the excessive convergence needed to compensate for high exophoria at near. 15 It is important to note that primary CI does not have significant exophoria at near and that patients may be esophoric or orthophoric, so not all CI will have a large exophoria. 32 Schor 47–51 and Saladin 52,53 hypothesized that CI patients have reduced convergent (base-out prism) adaptation in near compared to far space and that the imbalance in adaptation between the accommodative and convergence systems (via the AC/A ratio) may be a major cause of CI. AC/A is the ratio of the accommodative convergence AC (in prism diopters, Δ) to the stimulus to accommodation A (in diopters, D). In addition, the mechanism(s) by which vision therapy (via vergence training) remediates symptoms is unknown. 15 A randomized clinical trial on children reported that the reduction of symptoms from office-based vergence and accommodative therapy with home reinforcement was sustained at 1 year posttreatment in 89% of patients. 19 Such a long-term reduction in symptoms implies some form of anatomical and/or functional changes.
A different study of humans investigated visually evoked cortical potentials (VECP) in controls and patients with binocular and oculomotor dysfunction with mild traumatic brain injury. 54 The patients were divided into two groups—one group received optometric rehabilitation, which trains the vergence system, and the other group did not. Initially, 72% of the patient group who participated in vergence training had abnormalities of the P100 VECP, quantified as increased latencies of 15% or more, a decrease in amplitude of 50% or more, and/or differences of 15% or more between the left and right P100 VECP wave compared to age-matched controls. The abnormalities of the VECP within this group decreased to 38% after training. By comparison, 81% of the other patient group who did not participate in vergence training had VECP abnormalities as described above; and during a repeat measurement, 78% of this patient group still had VECP abnormalities. These data suggest that vergence training improved the electrical activity recorded from the primary visual cortex, V1, for those with binocular and oculomotor dysfunction. 54 Alvarez and colleagues 16 reported changes in functional activity within the frontal, parietal, and cerebellar regions after vergence training compared to baseline measurements, supporting that maximum functional activity and spatial extent were increased after vergence training compared to baseline measurements. The changes were sustained 6 months to 1 year posttraining. 16 The results of the present study support that convergence responses mediated from symmetrical convergence steps from CI subjects exhibit an asymmetry (one convergence eye movement was slower than the other), and that this asymmetry was reduced after vergence training. Future studies may consider examining potential cortical asymmetries before and after vergence training to assess, first, whether hemispheric asymmetry is observed and within which neural substrates; and second, if asymmetry is observed, whether it is decreased after vergence training compared to baseline measurements.
In addition to the potential neural mechanisms, differences within the extraocular muscles may potentially lead to an asymmetry between the left-eye and right-eye peak convergence velocities. Specifically, the arc of contact is defined as the arc between the tangential point and the center of the insertion of the muscle on the sclera. Depending on the axis of the orbit, differences in the arc of contact of the medial and lateral rectus muscles can be found. 55 The medial rectus muscle is closer to the corneal limbus than the lateral rectus; the medial rectus has a longer length and cross section compared to the lateral rectus and therefore weighs more. 55 Perhaps these physiological differences in the medial and lateral recti muscles between the left eye and right eye lead to nonlinearities in the kinematics of the muscles that may, in part, explain the asymmetry between the eye movements in CI subjects. Since the vergence training conducted within this study took place over 6 to 8 weeks, it is possible that the training altered the physiology of the extraocular muscles. Physiological and biochemical studies of the extraocular muscles conclude that the patterns of coexpression of myosin heavy chain (MyHC) result in a range of shortening velocities and contractile forces, which may have a role in the power output of the muscle. 56 However, the relationship between myosin isoform and eye position/movement is currently unknown. McLoon and colleagues stress that the heterogeneity of the extraocular muscles needs further investigation to understand its impact on oculomotor control, specifically its ability to accurately and reliably generate a range of eye movement velocities. 56 Thus, future research should consider studying the potential physiological and biochemical changes associated with the lateral and medial recti muscles before and after vergence training.
One finding of this study was that the prevalence of saccades during the first 1 second of the eye movement response significantly decreased after vergence training. Interestingly, the prevalence of saccades was inversely correlated to the combined convergence peak velocity. Specifically, as the convergence peak velocity increased, the prevalence of saccades decreased. Numerous studies support an interaction between the saccadic and vergence systems, with results showing that saccades enhance the speed of convergence compared to saccade-free convergence responses. 29,31,57–60 Several independent studies also support that CI subjects have reduced peak velocities compared to binocularly normal controls. 16–18 The slowed convergence dynamics lead to a longer period of diplopia, which is a common visual symptom for those with CI. 34,61,62 Prior research on binocularly normal controls reported that the presence of saccades was significantly correlated to vergence peak velocity; the slower the vergence response, the greater the prevalence of saccades. 28 Van Leeuwen and colleagues (1999) observed two types of responders to symmetrical convergence stimuli: vergence and saccadic responders. 18 Vergence responders maintained binocularity during the gaze shift, but the shift was slow (between 800 and 1000 ms). Saccadic responders were monocular during the gaze shift, but the shift was faster. The present results show that the CI subjects before training exhibited many saccades such that they could attain faster gaze shift. However, these subjects also reported visual symptoms. After vergence training, the visual symptoms were reduced. Convergence peak velocity increased even though the overall gaze shift was slower due to the reduction of saccades.
Prior studies support that saccades increase the speed of vergence. 25,29 Perhaps the saccadic system is recruited as a potential compensatory mechanism to facilitate the speed of convergence for a CI subject. The saccade brings the object of interest onto the fovea of the subject's preferred eye. This study supports that after vergence training, convergence peak velocity increases. Furthermore, this study supports that after vergence training, as the convergence peak velocity increases, the prevalence of saccades within the first second of the response decreases in a correlated manner. Hence, once convergence peak velocity increases, the need to generate a saccade is reduced, which may be one of the potential mechanisms leading to the sustained reduction in visual symptoms for CI subjects. Future studies should include measuring motor and sensory eye dominance to determine whether the direction of the saccade correlates to a subject's sensory or motor dominance. This information was not collected in the current study and is a study limitation.
It is important to note that the visual stimuli within this present study were pure, symmetrical convergence step stimuli and hence involved no retinal stimulation to the saccadic system. Yet saccades were observed, especially within the slower convergence responses from the CI subjects before vergence training. Interestingly, as the peak velocity increased after vergence training, the prevalence of saccades within the first second of the response decreased. Peak convergence velocity and the prevalence of saccades were significantly correlated (r = 0.83; P < 0.03). These data support that an interaction may exist between the vergence and saccade subsystems. In a prior investigation studying a range of convergence peak velocities from binocularly normal controls, a significant correlation between convergence peak velocity and the prevalence of saccades was also observed (P < 0.03). 28 Based upon the neurophysiology studies, one potential explanation is that the responses to symmetrical vergence stimuli evoke the near response (NR) cells 70,71 ; and when the vergence velocity is below a designated threshold, a saccade may be initiated by the inhibition of OPNs, the excitation of saccade burst neurons (SBN), or both the excitation and inhibition of SBNs and OPNs, respectively. However, future studies are needed to test this hypothesis and to further understanding of the interaction between saccade and vergence eye movements before and after vergence training, examining evoked potentials from primates.
Although many studies support Hering's Law, recent research has reported evidence in favor of Helmholtz's theory. 64,65,77 Zhou and King showed that premotor neurons in the paramedian pontine reticular formation, which were thought to encode for saccadic velocity commands, encoded monocular saccadic commands for the left and right eye. 73,77 In addition, Van Horn and Cullen reported that SBNs carry monocular vergence-related information during disconjugate saccades, further suggesting evidence of monocular control. 78 Figure 5 shows a unique and fascinating behavior from a CI subject before vergence training. This behavior was not observed in any of the binocularly normal controls. It was observed in four of the seven CI subjects and was present toward the end of the baseline experimental session (before vergence training) when a CI subject may have been less attentive or fatigued. Subject fatigue may potentially occur, resulting in drowsiness or a decrease in attention since the extraocular muscles are fatigue resistance. 79 In addition, the asymmetry and long latencies of the CI response before vergence training shown in Figure 2 support a failure of Hering's Law. CI subjects commonly report diplopia, 20 which may be a result of such long latencies to fuse the visual stimulus. Stark and colleagues reported more violations of Hering's Law for saccadic movements when subject fatigue was experienced. 80 Within these results, the single high-velocity response in one convergence eye movement and the double high-velocity response in the other convergence eye movement suggest a breakdown in binocular coordination between the left-eye and right-eye movement convergence responses. Perhaps the transient portion of convergence is monocularly controlled in some of the CI subjects, with the transient component stimulated twice in one eye and only once in the other eye. Further study is needed to determine whether this behavior becomes more common when the experiment is of a longer duration, since this response was observed toward the end of the experiment. This behavior was not observed after vergence training in any of the CI subjects, supporting the Helmholtz theory that binocular coordination is learned through vergence training.
However, for subjects with normal binocular vision, neither the literature 64,78 nor the data presented in this study can evaluate whether the vergence commands required to drive movements in response to symmetrical disparity vergence stimuli (i.e., when the saccadic burst neurons are not bursting with action potentials) utilize monocular control. Future neurophysiology and behavioral studies are needed to investigate whether these two types of responses (saccade-facilitated convergence and pure symmetrical convergence movements in response to symmetrical disparity stimuli) are monocularly or binocularly controlled.
One limitation to this study is that the binocularly normal control data were collected first; these subjects could mediate 4° convergence steps, beginning at near (12°) and far (2°) initial vergence angles. However, when the CI subjects were recruited, the CIs were unable to generate many responses beginning at the closer 12° vergence angle; hence the CIs were given 2°, 4°, and 6° convergence step movements beginning from 2° or 4° vergence angles. Future experiments could have both binocularly normal controls and CI patients all respond to the same eye movement stimuli.
Future research should include having binocularly normal controls also participate in vergence training to study whether vergence training improves the symmetry and combined peak convergence velocity. It is hypothesized that since controls are on average symmetrical (asymmetry ratio was approximately equal to one), the asymmetry ratio may not substantially change after vergence training for binocularly normal controls. However, the variance within the individual eye movement responses may decrease after vergence training. It is also hypothesized that binocularly normal controls will have some improvements in peak convergence velocity but that the increase in peak velocity will be less than that observed within CI patients.
The multisite randomized clinical trial called the Convergence Insufficiency Treatment Trial (CITT) defined the clinically relevant true mean difference for CISS, NPC, and PFV as 10, 4 cm, and 10Δ with standard deviations of 12, 4.5, and 11.3, respectively. 7 The data from the present study had an estimated correlation of −0.3, 0.9, and −0.4 for CISS, NPC, and PFV, respectively. Assuming 80% power and an alpha of 0.05 yields a sample size of 25, 4, and 25, respectively. While this study had sufficient power to study the near point of convergence, a larger sample size is needed to study the CISS and PFV. Future studies are needed to determine whether the current trends generalize to a larger population; hence the sample size is also a limitation of the current study.
In conclusion, this study reports that in CI subjects, one eye had a consistently slower convergence eye movement response when compared to the other convergence movement mediated via symmetrical convergence step stimuli. Conversely, the left-eye and right-eye movement responses for binocularly normal controls were on average similar. When the CI convergence eye movements after training were compared to initial baseline measurements, the convergence eye movements became more symmetrical; convergence peak velocity was enhanced; the prevalence of saccades within the first 1 second was reduced; near point of convergence receded; positive fusional vergence range increased; dissociated near phoria became less exophoric; and the subject's visual symptoms decreased as assessed using the CISS.
The authors appreciate comments from John Semmlow, Clifton Schor, an editorial board member, and two anonymous reviewers, which strengthened this manuscript.
Supported in part by National Science Foundation (NSF) Major Research Instrumentation (MRI) Chemical, Bioengineering, Environmental, and Transport (CBET) 1228254 (TLA).
Scheiman M Gwiazda J Li T. Non-surgical interventions for convergence insufficiency. Cochrane Database Syst Rev . 2011; 3: CD006768.
Semmlow JL Chen Y-F Pedrono C Alvarez TL. Saccadic behavior during the response to pure disparity vergence stimuli I: general properties. J Eye Mov Res . 2008; 1: 1–11.
Von Noorden GK Campos EC. Binocular Vision and Ocular Motility: Theory and Management of Strabismus. 6th ed. St. Louis: Mosby; 2002.
Cooper JS Burns CR Cotter SA Daum KM Griffin JR Scheiman MM. Care of the Patient with Accommodative and Vergence Dysfunction . St. Louis: American Optometric Association; 2011: 25.
Alvarez TL Semmlow JL Yuan W Munoz P. Comparison of disparity vergence system responses to predictable and non-predictable stimulations. Curr Psychol Cogn . 2002; 21: 243–261.
Griffin JR. Binocular Anomalies Procedures for Vision Therapy. 2nd ed. New York: Professional Press Books/Fairchild Publications; 1988: 547.
Scheiman M Wick B. Binocular Vision Heterophoric, Accommodative and Eye Movement Disorders. 3rd ed. Lippincott Williams & Wilkins; 2008.
Burian HM von Noorden GK. Binocular Vision and Ocular Motility Theory and Management of Strabismus . Saint Louis: C.V. Mosby Company; 1985: 110–111.
Hering E. Die Lehre vom binokularen Sehen ( The Theory of Binocular Vision [ 1868]). New York: Plenum Press; 1977: 17–22.
Mays LE Gamlin PDR. A neural mechanism subserving saccade-vergence interactions. In: JM Findlay Walker R Kentridge RW eds. Eye Movement Research: Mechanisms, Processes and Applications . Amsterdam: Elsevier; 1995: 215–223.
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von Helmholtz H. Helmholtz's Treatise on Physiological Optics . New York: Dover Publications, Inc.; 1962: 281–369.
Semmlow JL Alvarez TL Granger-Donetti B. Error correction in vergence eye movements: evidence supporting Hering's Law. J Eye Mov Res . 2012; 5: 1–9.


text:
Tsaraxa-Aibes school battling vandalism and gang violence
July 31, 2012 August 4, 2012 No Comments
OTJIWARONGO: The Tsaraxa-Aibes Combined School in Otjiwarongo on Tuesday invited the Namibian Police (NamPol) to address its school learners alleged to be involved in vandalising school properties, gangsterism and alcohol abuse.
Its school principal, Wilfriedtine Naobes told Nampa in an interview on Tuesday that it was necessary for the NamPol officers to talk to the learners before the school could get out of control since the school has a lot of in-disciplined learners.
She said most of those problem learners at her school are from broken home families and some do not live with any of their own parents.
"They are the ones abusing alcohol after school hours and involved in gang activities and cigarette smoking," she stressed.
Naobes even said that teenage pregnancy at her school is already a concern.
Therefore, on Tuesday morning two female police constables, Ntumba Likoko and Martha Kayofa from the Otjiwarongo community police division were at the Tsaraxa-Aibes Combined School to conduct a public awareness campaign.
Constable Kayofa presented to the learners here about how to behave at school and encouraged them to refrain from abusing alcohol and other drugs as well as keeping dangerous objects.
She said that any crime according to the police force in Namibia is a concern and it has to be addressed.
"As a learner you must be disciplined and refrain from any kind of uncalled for behaviours," noted Kayofa.
Using cannabis and other prohibited drugs inside school premises and out of school yards is a serious crime by law, she said.
Kayofa said that the use of alcohol substance to people under-18-years is not allowed at all, and it is a punishable crime by law to a fine of N.dollars 2 000 according to the Liquor Act, Act no. 6 of 1998.
"To you carrying dangerous sharp objects like knives, screw drivers and firearms at this school yard be aware that it is not allowed and if we catch you in possession of it you will be arrested, charged and brought before the court of law," warned Kayofa.
Kayofa also discussed the different types of crimes with learners of Tsaraxa-Aibes Combined School who had gathered at their school assembly point.
She said according to NamPol's Amended Act of 1999, Act no. 3 of 1999 Section 4, the police will arrest any person who commits murder, public violence and rape.
She advised the learners to abstain from offences like malicious damage to properties, culpable homicide, indecent assault, assault with intent to cause grievous body harm, breaking in a building with intent to commit an offence and robbery amongst others.
At the end of her presentation, learners were also given chance to ask questions.
A 16-year-old learner (girl) in Grade 8, Ndinelao Severin asked if abortion was still a crime in Namibia.
"Yes abortion is still a serious crime in Namibia," replied constable Kayofa.
Angeloeu !Gaoseb, 16, (boy) in Grade 9 also wanted to know if fighting someone in self-defense while a learner was a crime.
Kayofa answered: "As long as you are at school and you are a learner you are prohibited from fight other learners. If you feel that your fellow learner has offended you or provoked you report him or her to your school teacher or principal. It is not a waste of time that's what the law says," she said.
Tsaraxa-Aibes Combined School is situated in the middle of the Tsaraxa-Aibes township in Otjiwarongo in the Otjozondjupa Region.
The school gives classes from Grade One to Grade 10, to its 1034 learners.
Corporate Social Responsibility conference on next month
NamPost records operating income of over N$ 30 million


When we mix oil and water, the oil floats to the top. When we mix water and alcohol, they mix together. Why don't oil and water mix?
In short, water and oil don't mix because they are two substances with different types of molecules. The structure of oil's molecules makes it hydrophobic, so it won't mix with water's molecules.
Water is a polar molecule, meaning the amount of electrons in the hydrogen and electronegative oxygen is unequal. The result is the bent-shaped molecule having a positive charge on the hydrogen and a negative charge on the oxygen. This means that water is a polar solvent. So just hydrophilic (hydro meaning 'water' and philic meaning 'loving') substances will combine with water.
Oils are comprised of hydrocarbon chains or chains where carbon atoms are bonded to hydrogen atoms. The configuration of oil molecules makes them non-polar and hydrophobic (meaning they avoid water).
"Like dissolves like" is a saying that explains the way a solvent will react to a solute. Polar solutes will dissolve in polar solvents, and only non-polar solutes will dissolve in non-polar solvents.
This explains why oil and water don't mix. If you were to use emulsifier, you could get oil and water to mix together.
An emulsifier is a substance that has one end that is polar and the other end that is non-polar. Emulsifiers are usually surfactants and long molecules. The non-polar ends will border an oil molecule to make submicroscopic units termed "micelles" containing non-polar cores and polar exteriors. Because of their polar exterior, micelles are will mix with water. The molecules will still have a different density when compared to water, but they will be spread throughout the solution. The density of this new solution will have a different density than water.
Relative density isn't related to the miscibility properties of oil in water, but it does explain why oil will layer on top of water when they're not mixed.


Be sure to visit all these other great WW participants: A Beautiful Mess, 5 Minutes for Mom, and Mama to 4 Blessings.
UPDATE: As of tonight, the above photo HAS become the cover to our Christmas card! Thanks for your comments!
What counts is they are having fun.
OK, that pic is priceless!
So reminds me that I still have to take our photo...yikes! Times running out! This is actually what I'm posting about tomorrow (Wednesday)!
I like it. It's natural and fun.
Happy WW . . . fun and happy photo . . . I'm a new follower!
That picture is better than any posed one for sure!!!!!!
oh my goodness, this picture made me laugh out loud! Love it :) I think it is fabulous that you made it into your Christmas card!!
I love the pic! These are the pics we enjoy seeing years later.
That is priceless! A REAL life family photo! Nobody wants to see these for your OFFICIAL photo, but this is what family life really looks like, isn't it!? Love it!
I think this picture makes a fabulous Christmas card picture. It's funny and loving.
Yup ours usually turns out about like that!


Hypothetical Software is proud to announce the upcoming release of the second major expansion to Sleuth: Shadow of the Villains. In Shadow of the Villains, players will be able to match wits against devious Arch Villains while unraveling wider mysteries of the Sleuth World.
Arch Villains: A dark cabal of Villains has unleashed a flood of crime across the streets of Sleuth. Will the detectives of the world match this new menace?
Shangri La: Visit this secluded, mountain city, where an enigmatic prince has promised to deliver the world from the clutch of the Arch Villains. What are the true motives of this mysterious figure?
Check back later for more details. And Happy Sleuthing.