Ranibizumab versus Bevacizumab to Treat Neovascular Age-related Macular Degeneration: One-Year Findings from the IVAN Randomized Trial.

Purpose
To compare the efficacy and safety of ranibizumab and bevacizumab intravitreal injections to treat neovascular age-related macular degeneration (nAMD).

Design
Multicenter, noninferiority factorial trial with equal allocation to groups. The noninferiority limit was 3.5 letters. This trial is registered (ISRCTN92166560).

Participants
People >50 years of age with untreated nAMD in the study eye who read =25 letters on the Early Treatment Diabetic Retinopathy Study chart.

Methods
We randomized participants to 4 groups: ranibizumab or bevacizumab, given either every month (continuous) or as needed (discontinuous), with monthly review.

Main Outcome Measures
The primary outcome is at 2 years; this paper reports a prespecified interim analysis at 1 year. The primary efficacy and safety outcome measures are distance visual acuity and arteriothrombotic events or heart failure. Other outcome measures are health-related quality of life, contrast sensitivity, near visual acuity, reading index, lesion morphology, serum vascular endothelial growth factor (VEGF) levels, and costs.

Results
Between March 27, 2008 and October 15, 2010, we randomized and treated 610 participants. One year after randomization, the comparison between bevacizumab and ranibizumab was inconclusive (bevacizumab minus ranibizumab -1.99 letters, 95% confidence interval [CI], -4.04 to 0.06). Discontinuous treatment was equivalent to continuous treatment (discontinuous minus continuous -0.35 letters; 95% CI, -2.40 to 1.70). Foveal total thickness did not differ by drug, but was 9% less with continuous treatment (geometric mean ratio [GMR], 0.91; 95% CI, 0.86 to 0.97; P = 0.005). Fewer participants receiving bevacizumab had an arteriothrombotic event or heart failure (odds ratio [OR], 0.23; 95% CI, 0.05 to 1.07; P = 0.03). There was no difference between drugs in the proportion experiencing a serious systemic adverse event (OR, 1.35; 95% CI, 0.80 to 2.27; P = 0.25). Serum VEGF was lower with bevacizumab (GMR, 0.47; 95% CI, 0.41 to 0.54; P<0.0001) and higher with discontinuous treatment (GMR, 1.23; 95% CI, 1.07 to 1.42; P = 0.004). Continuous and discontinuous treatment costs were £9656 and £6398 per patient per year for ranibizumab and £1654 and £1509 for bevacizumab; bevacizumab was less costly for both treatment regimens (P<0.0001).

Conclusions
The comparison of visual acuity at 1 year between bevacizumab and ranibizumab was inconclusive. Visual acuities with continuous and discontinuous treatment were equivalent. Other outcomes are consistent with the drugs and treatment regimens having similar efficacy and safety.

Financial Disclosure(s)
Proprietary or commercial disclosures may be found after the references.

A modified SILCS contraceptive diaphragm for long-term controlled release of the HIV microbicide dapivirine

Background: There is considerable interest in developing new multipurpose prevention technologies to address women's reproductive health needs. This study describes an innovative barrier contraceptive device--based on the SILCS diaphragm--that also provides long-term controlled release of the lead candidate anti-HIV microbicide dapivirine.

Study design: Diaphragm devices comprising various dapivirine-loaded polymer spring cores overmolded with a nonmedicated silicone elastomer sheath were fabricated by injection molding processes. In vitro release testing, thermal analysis and mechanical characterization were performed on the devices.

Results: A diaphragm device containing a polyoxymethylene spring core loaded with 10% w/w dapivirine provided continuous and controlled release of dapivirine over a 6-month period, with a mean in vitro daily release rate of 174 mcg/day. The mechanical properties of the new diaphragm were closely matched to the SILCS diaphragm.

Conclusions: The study demonstrates proof of concept for a dapivirine-releasing diaphragm with daily release quantities potentially capable of preventing HIV transmission. In discontinuous clinical use, release of dapivirine may be readily extended over 1 or more years. © 2013 Elsevier Inc. All rights reserved.

Red-shifts and red herrings in geographical ecology

I draw attention to the need for ecologists to take spatial structure into account more seriously in hypothesis testing. If spatial autocorrelation is ignored, as it usually is, then analyses of ecological patterns in terms of environmental factors can produce very misleading results. This is demonstrated using synthetic but realistic spatial patterns with known spatial properties which are subjected to classical correlation and multiple regression analyses. Correlation between an autocorrelated response variable and each of a set of explanatory variables is strongly biased in favour of those explanatory variables that are highly autocorrelated - the expected magnitude of the correlation coefficient increases with autocorrelation even if the spatial patterns are completely independent. Similarly, multiple regression analysis finds highly autocorrelated explanatory variables "significant" much more frequently than it should. The chances of mistakenly identifying a "significant" slope across an autocorrelated pattern is very high if classical regression is used. Consequently, under these circumstances strongly autocorrelated environmental factors reported in the literature as associated with ecological patterns may not actually be significant. It is likely that these factors wrongly described as important constitute a red-shifted subset of the set of potential explanations, and that more spatially discontinuous factors (those with bluer spectra) are actually relatively more important than their present status suggests. There is much that ecologists can do to improve on this situation. I discuss various approaches to the problem of spatial autocorrelation from the literature and present a randomisation test for the association of two spatial patterns which has advantages over currently available methods.

Immunochemical characterization of a polysaccharide antigen of Bacteroides fragilis with an IgM monoclonal antibody

An IgM mouse monoclonal antibody (McAb) Bf4 was produced to a surface polysaccharide of Bacteroides fragilis NCTC 9343. Immunoblotting showed that McAb Bf4 reacted strongly with a high molecular mass structure which was sensitive to oxidation with periodate but resisted protease treatment. An inhibition enzyme-linked immunosorbent assay (ELISA) indicated that McAb Bf4 did not cross react with the sixteen Bacteroides species and strains tested. Cells of B. fragilis NCTC 9343 recovered from the various interfaces of a Percoll discontinuous density gradient were tested in the inhibition ELISA. Bacteria from the 0-20%, 20-40% and 40-60% interfaces inhibited the ELISA; however, cells from the 60-80% interface did not. Electron microscopy with immunogold labelling showed that McAb Bf4 did not react with the extracellular fibrous network on bacteria recovered from the 0-20% interface, or the extracellular electron dense layer on cells from the 60-80% interface; however, it was associated with a surface structure on cells from the 20-40% interface. Growth in vivo did not enrich for bacteria with this structure.

Computation of stress intensity factors in functionally graded materials using partition-of-unity meshfee method

This paper describes the computation of stress intensity factors (SIFs) for cracks in functionally graded materials (FGMs) using an extended element-free Galerkin (XEFG) method. The SIFs are extracted through the crack closure integral (CCI) with a local smoothing technique, non-equilibrium and incompatibility formulations of the interaction integral and the displacement method. The results for mode I and mixed mode case studies are presented and compared with those available in the literature. They are found to be in good agreement where the average absolute error for the CCI with local smoothing, despite its simplicity, yielded a high level of accuracy.

Permafrost response to last interglacial warming: field evidence from non-glaciated Yukon and Alaska

We present stratigraphic observations from three sites in eastern Beringia - Ch'ijee's Bluff in northern Yukon and nearby exposures on the Old Crow River, the Palisades on the Yukon River in Alaska, and placer mining exposures at Thistle Creek in west-central Yukon - which provide insight into the response of permafrost to regional warming during the last interglaciation. Chronology is based on the presence of Old Crow tephra, an important regional stratigraphic marker that dates to late Marine Isotope Stage 6, supplemented by paleoecology and non-finite C ages on wood-rich organic silts. Old Crow tephra overlies several relict ice wedges at the Palisades and Thistle Creek, indicating that permafrost at these sites did not thaw completely during the last interglaciation. Prominent deposits of last interglacial wood-rich organic silt are present at multiple sites in eastern Beringia, and probably represent accumulations of reworked forest vegetation due to thaw slumping or deposition into thermokarst ponds or depressions. Consistent stratigraphic relations between these deposits, Old Crow tephra, and ice wedge pseudomorphs at our three study sites, and at least six other sites in eastern Beringia, suggest that thaw of shallow permafrost was widespread during the last interglaciation. Limited stratigraphic evidence suggests that thaw was probably on the order of meters, rather than 10s of meters. The ubiquity of shallow permafrost degradation during the last interglaciation suggests that current ground warming may foreshadow widespread near-surface thaw under even modest future warming scenarios. However, the persistence of relict pre-last interglacial ice wedges highlights the potential for the regional antiquity of discontinuous permafrost, and provides compelling field evidence for the long-term resilience of deep permafrost during sustained periods of warmer-than-present climate.

Alternative treatments to inhibit VEGF in age-related choroidal neovascularisation: 2-year findings of the IVAN randomised controlled trial

Background: Bevacizumab has been suggested to have similar effectiveness to ranibizumab for treatment of neovascular age-related macular degeneration. The Inhibition of VEGF in Age-related choroidal Neovascularisation (IVAN) trial was designed to compare these drugs and different regimens. Here, we report the findings at the prespecified 2-year timepoint. Methods: In a multicentre, 2×2 factorial, non-inferiority randomised trial, we enrolled adults aged at least 50 years with active, previously untreated neovascular age-related macular degeneration and a best corrected distance visual acuity (BCVA) of at least 25 letters from 23 hospitals in the UK. Participants were randomly assigned (1:1:1:1) to intravitreal injections of ranibizumab (0·5 mg) or bevacizumab (1·25 mg) in continuous (every month) or discontinuous (as needed) regimens, with monthly review. Study participants and clinical assessors were masked to drug allocation. Allocation to continuous or discontinuous treatment was masked up to 3 months, at which point investigators and participants were unmasked. The primary outcome was BCVA at 2 years, with a prespecified non-inferiority limit of 3·5 letters. The primary safety outcome was arterial thrombotic event or hospital admission for heart failure. Analyses were by modified intention to treat. This trial is registered, number ISRCTN92166560. Findings: Between March 27, 2008, and Oct 15, 2010, 628 patients underwent randomisation. 18 were withdrawn; 610 received study drugs (314 ranibizumab; 296 bevacizumab) and were included in analyses. 525 participants reached the visit at 2 years: 134 ranibizumab in continuous regimen, 137 ranibizumab in discontinuous regimen, 127 bevacizumab in continuous regimen, and 127 bevacizumab in discontinuous regimen. For BCVA, bevacizumab was neither non-inferior nor inferior to ranibizumab (mean difference -1·37 letters, 95% CI -3·75 to 1·01; p=0·26). Discontinuous treatment was neither non-inferior nor inferior to continuous treatment (-1·63 letters, -4·01 to 0·75; p=0·18). Frequency of arterial thrombotic events or hospital admission for heart failure did not differ between groups given ranibizumab (20 [6%] of 314 participants) and bevacizumab (12 [4%] of 296; odds ratio [OR] 1·69, 95% CI 0·80-3·57; p=0·16), or those given continuous (12 [4%] of 308) and discontinuous treatment (20 [7%] of 302; 0·56, 0·27-1·19; p=0·13). Mortality was lower with continuous than discontinuous treatment (OR 0·47, 95% CI 0·22-1·03; p=0·05), but did not differ by drug group (0·96, 0·46-2·02; p=0·91). Interpretation: Ranibizumab and bevacizumab have similar efficacy. Reduction in the frequency of retreatment resulted in a small loss of efficacy irrespective of drug. Safety was worse when treatment was administered discontinuously. These findings highlight that the choice of anti-VEGF treatment strategy is less straightforward than previously thought.

Modified crack closure integral technique for extraction of SIFs in meshfee methods

A new approach for extracting stress intensity factors (SIFs) by the element-free Galerkin (EFG) class of methods through a modified crack closure integral (MCCI) scheme is proposed. Its primary feature is that it allows accurate calculation of mode I and mode II SIFs with a relatively simple and straightforward analysis even when a coarser nodal density is employed. The details of the adoption of the MCCI technique in the EFG method are described. Its performance is demonstrated through a number of case studies including mixed-mode and thermal problems in linear elastic fracture mechanics (LEFM). The results are compared with published theoretical solutions and those based on the displacement method, stress method, crack closure integral in conjunction with local smoothing (CCI–LS) technique, as well as the M-integral method. Its advantages are discussed.

Stiffness analysis of polymeric composites using the finite element method

The ability to predict the mechanical behavior of polymer composites is crucial for their design and manufacture. Extensive studies based on both macro- and micromechanical analyses are used to develop new insights into the behavior of composites. In this respect, finite element modeling has proved to be a particularly powerful tool. In this article, we present a Galerkin scheme in conjunction with the penalty method for elasticity analyses of different types of polymer composites. In this scheme, the application of Green's theorem to the model equation results in the appearance of interfacial flux terms along the boundary between the filler and polymer matrix. It is shown that for some types of composites these terms significantly affect the stress transfer between polymer and fillers. Thus, inclusion of these terms in the working equations of the scheme preserves the accuracy of the model predictions. The model is used to predict the most important bulk property of different types of composites. Composites filled with rigid or soft particles, and composites reinforced with short or continuous fibers are investigated. For each case, the results are compared with the available experimental results and data obtained from other models reported in the literature. Effects of assumptions made in the development of the model and the selection of the prescribed boundary conditions are discussed.

Coupling ground and airborne geophysical data with upscaling techniques for regional groundwater modeling of heterogeneous aquifers: Case study of a sedimentary aquifer intruded by volcanic dykes in Northern Ireland

In highly heterogeneous aquifer systems, conceptualization of regional groundwater flow models frequently results in the generalization or negligence of aquifer heterogeneities, both of which may result in erroneous model outputs. The calculation of equivalence related to hydrogeological parameters and applied to upscaling provides a means of accounting for measurement scale information but at regional scale. In this study, the Permo-Triassic Lagan Valley strategic aquifer in Northern Ireland is observed to be heterogeneous, if not discontinuous, due to subvertical trending low-permeability Tertiary dolerite dykes. Interpretation of ground and aerial magnetic surveys produces a deterministic solution to dyke locations. By measuring relative permeabilities of both the dykes and the sedimentary host rock, equivalent directional permeabilities, that determine anisotropy calculated as a function of dyke density, are obtained. This provides parameters for larger scale equivalent blocks, which can be directly imported to numerical groundwater flow models. Different conceptual models with different degrees of upscaling are numerically tested and results compared to regional flow observations. Simulation results show that the upscaled permeabilities from geophysical data allow one to properly account for the observed spatial variations of groundwater flow, without requiring artificial distribution of aquifer properties. It is also found that an intermediate degree of upscaling, between accounting for mapped field-scale dykes and accounting for one regional anisotropy value (maximum upscaling) provides results the closest to the observations at the regional scale.

Germany and the New Global History of Secularism: Questioning the Postcolonial Genealogy

Secularism has emerged as a central category of twenty-first century political thought that in many ways has replaced the theory of secularization. According to postcolonial scholars, neither the theory nor the practice of secularization was politically neutral. They define secularism as the set of discourses, policies, and constitutional arrangements whereby modern states and liberal elites have sought to unify nations and divide colonial populations. This definition is quite different from the original meaning of secularism, as an immanent scientific worldview linked to anticlericalism. Anthropologist Talal Asad has connected nineteenth-century worldview secularism to twenty-first century political secularism through a genealogical account that stresses continuities of liberal hegemony. This essay challenges this account. It argues that liberal elites did not merely subsume worldview secularism in their drive for state secularization. Using the tools of conceptual history, the essay shows that one reason that “secularization” only achieved its contemporary meaning in Germany after 1945 was that radical freethinkers and other anticlerical secularists had previously resisted liberal hegemony. The essay concludes by offering an agenda for research into the discontinuous history of these two types of secularism.

Integrating petrography, mineralogy and hydrochemistry to constrain the influence and distribution of groundwater contributions to baseflow in poorly productive aquifers: Insights from Gortinlieve catchment, Co. Donegal, NW Ireland

Identifying groundwater contributions to baseflowforms an essential part of surfacewater body characterisation. The Gortinlieve catchment (5 km2) comprises a headwater stream network of the Carrigans River, itself a tributary of the River Foyle, NW Ireland. The bedrock comprises poorly productive metasediments that are characterised by fracture porosity. We present the findings of a multi-disciplinary study that integrates new hydrochemical and mineralogical investigations with existing hydraulic, geophysical and structural data to identify the scales of groundwater flow and the nature of groundwater/bedrock interaction (chemical denudation). At the catchment scale, the development of deep weathering profiles is controlled by NE-SW regional scale fracture zones associated with mountain building during the Grampian orogeny. In-situ chemical denudation of mineral phases is controlled by micro- to meso-scale fractures related to Alpine compression during Palaeocene to Oligocene times. The alteration of primary muscovite, chlorite (clinochlore) and albite along the surfaces of these small-scale fractures has resulted in the precipitation of illite, montmorillonite and illite/montmorillonite clay admixtures. The interconnected but discontinuous nature of these small-scale structures highlights the role of larger scale faults and fissures in the supply and transportation of weathering solutions to/from the sites of mineral weathering. The dissolution of primarily mineral phases releases the major ions Mg, Ca and HCO3 that are shown to subsequently formthe chemical makeup of groundwaters. Borehole groundwater and stream baseflow hydrochemical data are used to constrain the depths of groundwater flow pathways influencing the chemistry of surface waters throughout the stream profile. The results show that it is predominantly the lower part of the catchment, which receives inputs from catchment/regional scale groundwater flow, that is found to contribute to the maintenance of annual baseflow levels. This study identifies the importance
of deep groundwater in maintaining annual baseflow levels in poorly productive bedrock systems.

Differential evolution combined with clonal selection for dynamic economic dispatch

Dynamic economic load dispatch (DELD) is one of the most important steps in power system operation. Various optimisation algorithms for solving the problem have been developed; however, due to the non-convex characteristics and large dimensionality of the problem, it is necessary to explore new methods to further improve the dispatch results and minimise the costs. This article proposes a hybrid differential evolution (DE) algorithm, namely clonal selection-based differential evolution (CSDE), to solve the problem. CSDE is an artificial intelligence technique that can be applied to complex optimisation problems which are for example nonlinear, large scale, non-convex and discontinuous. This hybrid algorithm combines the clonal selection algorithm (CSA) as the local search technique to update the best individual in the population, which enhances the diversity of the solutions and prevents premature convergence in DE. Furthermore, we investigate four mutation operations which are used in CSA as the hyper-mutation operations. Finally, an efficient solution repair method is designed for DELD to satisfy the complicated equality and inequality constraints of the power system to guarantee the feasibility of the solutions. Two benchmark power systems are used to evaluate the performance of the proposed method. The experimental results show that the proposed CSDE/best/1 approach significantly outperforms nine other variants of CSDE and DE, as well as most other published methods, in terms of the quality of the solution and the convergence characteristics.

Micromechanical Modelling of Non-Homogenous Materials by Meshless Methods

A detailed study of bi-material composites, using meshless methods (MMs), is presented in this paper. Firstly, representative volume elements (RVEs) for different bi-material combinations are analysed by the element-free Galerkin (EFG) method in order to confirm the effective properties of heterogeneous material through homogenization. The results are shown to be in good agreement with experimental results and those obtained using the finite element method (FEM) which required a higher node density. Secondly, a functionally graded material (FGM), with a crack, is analysed using the EFG method. This investigation was motivated by the possibility of replacing the distinct fibrematrix interface with a FGM interface. Finally, an illustrative example showing crack propagation, in a two-dimension micro-scale model of a SiC/Al composite is presented. 

The Cyrenaican Prehistory Project 2011: Late-Holocene environments and human activity from a cave fill in Cyrenaica, Libya

Little is known about late Holocene environmental change in Cyrenaica. The late Holocene sequence in the Haua Fteah, the key regional site, is highly discontinuous and characterised by stable-burning deposits. The geoarchaeology of the late-Holocene cave fill of a small cave, CP1565, located close to the Haua Fteah, is described. The well-stratified sequence, dating from the fourth century AD to the present day, provides a glimpse of life at the bottom of the settlement hierarchy and of changing environments over the last 1600 years, with degraded vegetation and aridity in the ‘Little Ice Age’.