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Monocular deprivation early in development causes amblyopia, a severe visual impairment. Prognosis is poor if therapy is initiated after an early critical period. However, clinical observations have shown that recovery from amblyopia can occur later in life when the non-deprived (fellow) eye is removed. The traditional interpretation of this finding is that vision is improved simply by the elimination of interocular suppression in primary visual cortex, revealing responses to previously subthreshold input. However, an alternative explanation is that silencing activity in the fellow eye establishes conditions in visual cortex that enable the weak connections from the amblyopic eye to gain strength, in which case the recovery would persist even if vision is restored in the fellow eye. Consistent with this idea, we show here in cats and mice that temporary inactivation of the fellow eye is sufficient to promote a full and enduring recovery from amblyopia at ages when conventional treatments fail. Thus, connections serving the amblyopic eye are capable of substantial plasticity beyond the critical period, and this potential is unleashed by reversibly silencing the fellow eye.

Aims We investigated whether the UK has higher child and youth diabetes mortality than in comparable European countries and the USA. Methods We obtained data from the WHO World Mortality Database for the UK, the USA and the EU15+ (the 15 countries of the EU in 2004 plus Australia, Canada and Norway) for 1990 to 2010. Diabetes mortality rates were calculated for 1–14 and 15–24 year olds. Multilevel longitudinal Poisson regression models were constructed including all country-level data from 1990–2010 (378 country years) comparing the UK with the EU15+ and the USA. Graphics show average mortality across the EU15+. Results Mortality trends are shown in Figure 1 for 1–14 year olds (both sexes) and Figure 2 (males) and Figure 3 (females) for 15–24 year olds. In 1990 the UK had higher mortality than the EU15+ amongst 1–14yo (p = 0.004) but not amongst 15–24yo (p > 0.2 both sexes). Diabetes mortality did not significantly change in the EU15+ across the study period in any age group. In contrast, amongst 1–14 year olds the UK had a significantly higher rate of decline than the EU15+ (negative slope coefficient, p = 0.03). UK mortality rose amongst 15–24 year olds compared with the EU15+ (positive slope coefficients, p Discussion Diabetes mortality in the UK for children 1–14 years approximates the EU15+ mean and is better than in the USA. However, for 15–24 year olds, the UK has high and rising diabetes mortality compared with the EU15+ from 2000 onwards. Further work is needed to understand the contributions of healthcare factors to the UK’s poor diabetes mortality record amongst young people.

Aims To reduce neonatal mortality rates in two district hospitals in Southern Ethiopia with a package of staff training and infrastructure improvement. A training course in essential neonatal care and resuscitation was provided alongside equipping and refurbishing a new neonatal unit with locally built and sustainable equipment in two seperate locations. Methods For 11 months during 2012, two paediatric trainees from the UK completed the Voluntary Services Overseas Fellowship in Ethiopia. They were based at two rural hospitals in Southern Ethiopia; Yirgalem General Hospital serving a population of over 3 million with an initial neonatal mortality rate of 22.5%, and Nigist Eleni Mohammed Memorial Hospital (NEMMH) serving a population of over 1.5 million people with an initial neonatal mortality rate of 20.4%. At both hospitals there was no specific provision for neonates prior to intervention. The intervention consisted of a training course in essential neonatal care including neonatal resuscitation for all staff involved in neonatal care following the training of trainers method. This was partnered with the establishment of a separate room for neonates providing respiratory support, phototherapy, feeding support, infection control and treatment of sepsis and adequate thermal control including Kangaroo Mother Care using materials designed and built locally and a layout that maximised the space available but took into account low staffing and monitoring levels. The plan at Yirgalem was implemented over a 6 month period from July 2012 until January 2013 and cost 10,500 US$. After implementing the project at Yirgalem the same model was applied to NEMMH with training, refurbishment and equipment provision completed over a month period at a cost of 6,715 US$. Results The interventions led to a subsequent reduction in neonatal mortality rates over the next 3 months with a reduction to 7.54% at Yirgalem and 6.7% at NEMMH. Conclusion The aim of this paper is to provide insight into developing a low cost, high impact, sustainable solution to the challenges of neonatal care in a resource poor setting.