Pan-retinal photocoagulation and other forms of laser treatment and drug therapies for non-proliferative diabetic retinopathy: systematic review and economic evaluation

BACKGROUND: Diabetic retinopathy is an important cause of visual loss. Laser photocoagulation preserves vision in diabetic retinopathy but is currently used at the stage of proliferative diabetic retinopathy (PDR).

OBJECTIVES: The primary aim was to assess the clinical effectiveness and cost-effectiveness of pan-retinal photocoagulation (PRP) given at the non-proliferative stage of diabetic retinopathy (NPDR) compared with waiting until the high-risk PDR (HR-PDR) stage was reached. There have been recent advances in laser photocoagulation techniques, and in the use of laser treatments combined with anti-vascular endothelial growth factor (VEGF) drugs or injected steroids. Our secondary questions were: (1) If PRP were to be used in NPDR, which form of laser treatment should be used? and (2) Is adjuvant therapy with intravitreal drugs clinically effective and cost-effective in PRP?

ELIGIBILITY CRITERIA: Randomised controlled trials (RCTs) for efficacy but other designs also used.

REVIEW METHODS: Systematic review and economic modelling.

RESULTS: The Early Treatment Diabetic Retinopathy Study (ETDRS), published in 1991, was the only trial designed to determine the best time to initiate PRP. It randomised one eye of 3711 patients with mild-to-severe NPDR or early PDR to early photocoagulation, and the other to deferral of PRP until HR-PDR developed. The risk of severe visual loss after 5 years for eyes assigned to PRP for NPDR or early PDR compared with deferral of PRP was reduced by 23% (relative risk 0.77, 99% confidence interval 0.56 to 1.06). However, the ETDRS did not provide results separately for NPDR and early PDR. In economic modelling, the base case found that early PRP could be more effective and less costly than deferred PRP. Sensitivity analyses gave similar results, with early PRP continuing to dominate or having low incremental cost-effectiveness ratio. However, there are substantial uncertainties. For our secondary aims we found 12 trials of lasers in DR, with 982 patients in total, ranging from 40 to 150. Most were in PDR but five included some patients with severe NPDR. Three compared multi-spot pattern lasers against argon laser. RCTs comparing laser applied in a lighter manner (less-intensive burns) with conventional methods (more intense burns) reported little difference in efficacy but fewer adverse effects. One RCT suggested that selective laser treatment targeting only ischaemic areas was effective. Observational studies showed that the most important adverse effect of PRP was macular oedema (MO), which can cause visual impairment, usually temporary. Ten trials of laser and anti-VEGF or steroid drug combinations were consistent in reporting a reduction in risk of PRP-induced MO.

LIMITATION: The current evidence is insufficient to recommend PRP for severe NPDR.

CONCLUSIONS: There is, as yet, no convincing evidence that modern laser systems are more effective than the argon laser used in ETDRS, but they appear to have fewer adverse effects. We recommend a trial of PRP for severe NPDR and early PDR compared with deferring PRP till the HR-PDR stage. The trial would use modern laser technologies, and investigate the value adjuvant prophylactic anti-VEGF or steroid drugs.

STUDY REGISTRATION: This study is registered as PROSPERO CRD42013005408.

FUNDING: The National Institute for Health Research Health Technology Assessment programme.

New microsatellite loci for the longnose velvet dogfish Centroselachus crepidater (Squaliformes: Somniosidae) and other deep sea sharks

The continuing over-exploitation of traditional coastal stocks has resulted in the shift of commercial fishing towards deep-sea ecosystems in many parts of the world. The effects on target and non-target species have been dramatic; particularly for the deep-sea sharks. With the aim of providing tools that will allow the assessment of population genetic structure of Centroselachus crepidater, novel microsatellite loci have been developed for this deep-sea elasmobranch. Seven of these markers showed between 3 and 7 alleles per locus in two North Atlantic populations, with observed and expected heterozygosities between 0.18-0.95 and 0.25-0.82, respectively. Additionally, ten loci cross-amplify in other Elasmobranch species.

Influence of corneal structure, corneal responsiveness, and other ocular parameters on tonometric measurement of intraocular pressure.

PURPOSE: To estimate the relationships between ocular parameters and tonometrically measured intraocular pressure (IOP), to determine the influence of ocular parameters on different instrument measurements of IOP, and to evaluate the association of ocular parameters with a parameter called hysteresis. METHODS: Patients presenting at a glaucoma clinic were recruited for this study. Subjects underwent IOP measurement with the Goldmann applanation tonometer (GAT), the TonoPen, and the Reichert Ocular Response Analyzer (ORA), and also measurements of central corneal thickness (CCT), axial length, corneal curvature, corneal astigmatism, central visual acuity, and refractive error. Chart information was reviewed to determine glaucoma treatment history. The ORA instrument provided a measurement called corneal hysteresis. The association between measured IOP and the other ocular characteristics was estimated using generalized estimating equations. RESULTS: Among 230 patients, IOP measurements from the TonoPen read lowest, and ORA read highest, and GAT measurements were closest to the mean IOP of the 3 instruments. In a multiple regression model adjusting for age, sex, race, and other ocular characteristics, a 10 microm increase in CCT was associated with an increase of 0.79 mm Hg measured IOP in untreated eyes (P<0.0001). Of the 3 tonometers, GAT was the least affected by CCT (0.66 mm Hg/10 mum, P<0.0001). Hysteresis was significantly correlated with CCT with a modest correlation coefficient (r=0.20, P<0.0007). CONCLUSIONS: Among parameters related to measured IOP, features in addition to CCT, such as hysteresis and corneal curvature, may also be important. Tonometric instruments seem to be affected differently by various physiologic characteristics.

Taxonomic databases for Bursaphelenchus and other aphelenchoid nematodes

Nematodes are the most abundant metazoans, comprising more than 80% of all animals alive today. Since 1743, when Needham (Needham, 1743) described the first nematode, approximately 20,000 - 30,000 species have been named, with estimates of species remaining to be described ranging from 100,000 to 1 million (Blaxter, 2004; De Ley, 2000). Unfortunately, the taxonomic community is woefully inadequate for this task. The number of taxonomists currently describing new species of nematodes around the world is less than 100, and significant increases are not expected. If each of these taxonomists were able to describe 10 new species every year, it would take between 100 to 1,000 years to name these yet to be described species.

Novel microporous silicates and mesoporous MCM materials derivatised with inorganic and organometallic complexes

Os materiais microporosos e mesoporosos são potenciais catalisadores heterogéneos. Os zeólitos e outros materiais microporosos do tipo zeolítico tradicionais, têm átomos tetracoordenados no esqueleto. Nos últimos anos, um vasto número de titanossilicatos contendo Ti(IV) hexacoordenado e Si(IV) tetracoordenado, com estruturas tridimensionais, têm sido alvo de grande interesse. Um dos objectivos desta tese foi preparar silicatos microporosos, contendo átomos metálicos com número de coordenação superior a quatro, e possuindo quer novas estruturas quer propriedades físicas e químicas interessantes. Neste contexto, foi preparado um novo ítriossilicato de sódio, AV-1, análogo do raro mineral montregianite, Na4K2Y2Si16O38·10H2O. Este material é o primeiro sólido microporoso que contem quantidades estequiométricas de sódio (e ítrio) no esqueleto. Foi, também, sintetizado um silicato de cério, AV-5, análogo estrutural do mineral montregianite com potencial aplicação em optoelectrónica. Nesta tese é, ainda, descrita a síntese e caracterização estrutural de um silicato de cálcio hidratado, AV-2, análogo do raro mineral rhodesite (K2Ca4Na2Si16O38.12H2O). Na continuação do trabalho desenvolvido em Aveiro na síntese de novos titanossilicatos surgiu o interesse de preparar novos zirconossilicatos microporosos por síntese hidrotérmica. Foram preparados dois novos materiais análogos dos minerais petarasite Na5Zr2Si3O18(Cl,OH)·2H2O (AV-3) e kostylevite, K2Si3O9·H2O (AV-8). Foram, também, obtidos análogos sintéticos dos minerais parakeldyshite e wadeite, por calcinação a alta temperatura de AV-3 e de umbite sintética. A heterogeneização de complexos organometálicos na superfície de materiais mesoporosos do tipo M41S permite associar a grande actividade catalítica e a presença de sítios activos localizados típicos dos complexos organometálicos, com a robustez e fácil separação, características dos materiais mesoporosos siliciosos. Nesta dissertação relata-se a derivatização dos materiais MCM-41 e MCM-48 através da reacção de [SiMe2{(h5-C5H4)2}]Fe e [SiMe2{(h5-C5H4)2}]TiCl2 com os grupos silanol das superfícies mesoporosas. Os materiais MCMs derivatizados com ansa-titanoceno foram testados na epoxidação de cicloocteno a 323 K na presença de hidrogenoperóxido de t-butilo. Estudou-se a heterogeneização dos sais de complexos com ligação metal-metal [Mo2(MeCN)10][BF4]4, [Mo2(m-O2CMe)2(MeCN)6][BF4]2 e [Mo2(m- O2CMe)2(dppa)2(MeCN)2][BF4]2 via imobilização nos canais do MCM-41. A imobilização dos catalisadores homogéneos na superfície do MCM-41 envolve a saída dos ligandos nitrilo lábeis, preferencialmente em posição axial, através da reacção com os grupos Si-OH da sílica. Verificou-se que a ligação Mo-Mo se mantém intacta nos produtos finais. É provável que estes materiais sejam eficientes catalisadores heterogéneos em reacções de polimerização. As técnicas de caracterização utilizadas nesta tese foram a difracção de raios-X de pós, a microscopia electrónica de varrimento, a espectroscopia de ressonância magnética nuclear do estado sólido (núcleos 13C, 23Na e 29Si), as espectroscopias de Raman e infravermelho com transformadas de Fourier, as análises termogravimétricas e as análises de adsorção de água e azoto.

Some additions and other records new to the ornithology of South Carolina

This document contains notes on several species of birds observed by Arthur T. Wayne in South Carolina including the Sooty Shearwater, the Harlequin Duck, the Snow Goose, the Blue Goose, the Egret, the Yellow-crowned Night Heron, the Hudsonian Curlew, the Turnstone, the Pigeon Hawk, the Crested Flycatcher, the Bronzed Grackle, the Carolina Grackle, the Ipswich Sparrow, Leconte’s Sparrow, the Mountain Solitary Vireo, Bachman’s Warbler, the Magnolia Warbler, the Black-throated Green Warbler, and the Connecticut Warbler.

Inappropriate medication use in long-term care facility residents with advanced Alzheimer’s disease and other dementias

Les personnes atteintes de démence sévère, résidant dans un centre d’hébergement et de soins de longue durée (CHSLD) et approchant la fin de leur vie, ne reçoivent pas systématiquement des soins palliatifs, malgré que ce niveau de soins soit le plus approprié. La plupart de ces personnes reçoivent également un grand nombre de médicaments dont les effets indésirables peuvent contribuer à des souffrances évitables. Une approche axée sur les soins palliatifs serait possiblement associée à une réduction de la charge médicamenteuse et, du même coup, à une prescription plus appropriée. Les objectifs de ce projet de recherche étaient de décrire l’usage des médicaments chez les résidents atteints de démence sévère en CHSLD, de comparer leur usage de médicaments à des critères de pertinence et d’évaluer si la mise en œuvre d’une approche axée sur les soins palliatifs était associée aux médicaments prescrits. Cette étude décrit l’usage des médicaments chez 215 sujets atteints de démence sévère et en fin de vie qui ont participé à une étude d’intervention quasi expérimentale menée dans quatre CHSLD du Québec sur la mise en œuvre d’une approche axée sur les soins palliatifs. L’utilisation des médicaments a été comparée à trois listes de critères pertinents publiés, soit ceux de Holmes, Rancourt et Kröger, en utilisant des statistiques descriptives. Les analyses sur l’usage de 412 médicaments différents chez 120 sujets du groupe expérimental et 95 sujets du groupe témoin ont montré que cette approche axée sur les soins palliatifs n’est pas associée à une prescription plus appropriée des médicaments chez ces personnes particulièrement vulnérables.

Environmental ethics: philosophy, ecology and other species

Pressure on the environment has increased in step with economic growth and the mass consumption that fueled rising gross domestic product throughout the twentieth century. Both growth and ecological crises have attained a global reach, challenging our established notions of cause and effect, and our framing of problems and solutions. Accordingly, global environmental politics has witnessed major changes and significant "rescaling" in its "locus, agency and scope" (Andonova and Mitchell2010: 257). Both dimensions of global environmental politics - politics and governance, and the ecological problems that are the subject matter of global environmental politics - are being reinterpreted due to increasing complexity, interconnectedness and interdependence. Accordingly, the range of actors and disciplines that infom1 global environmental politics and contribute to framing global environmental problems is widening, in an acknowledgment of inescapable pluralism.

Spent coffee grounds for biodiesel production and other applications

This work evaluates the possibility of using spent coffee grounds (SCG) for biodiesel production and other applications. An experimental study was conducted with different solvents showing that lipid content up to 6 wt% can be obtained from SCG. Results also show that besides biodiesel production, SCG can be used as fertilizer as it is rich in nitrogen, and as solid fuel with higher heating value (HHV) equivalent to some agriculture and wood residues. The extracted lipids were characterized for their properties of acid value, density at 15 °C, viscosity at 40 °C, iodine number, and HHV, which are negatively influenced by water content and solvents used in lipid extraction. Results suggest that for lipids with high free fatty acids (FFA), the best procedure for conversion to biodiesel would be a two-step process of acid esterification followed by alkaline transesterification, instead of a sole step of direct transesterification with acid catalyst. Biodiesel was characterized for its properties of iodine number, acid value, and ester content. Although these quality parameters were not within the limits of NP EN 14214:2009 standard, SCG lipids can be used for biodiesel, blended with higher-quality vegetable oils before transesterification, or the biodiesel produced from SCG can be blended with higher-quality biodiesel or even with fossil diesel, in order to meet the standard requirements.

Spinoffs and other entrants: Evidence from Portugal

This thesis studies the prevalence and survival of spinoff entrants in Portugal from 1987 to 2008. Information on worker flows is used to identify them at a population level, providing evidence on other operations such as mergers and acquisitions. We show that the number of spinoffs has been increasing at a higher rate than other entrants of comparable size. Studying the determinants of their exit suggests that the most important predictor is whether the spinoff was motivated by the failure of the parent firm. The effect of industry specific knowledge and previous experience of the founders from working together in the parent firm is seemingly negligible, with only weak evidence supporting the latter.

Fingermarks and Other Impressions Left by the Human Body - A Review (August 2007-July 2010)

The purpose of this paper is to review the scientific literature from August 2007 to July 2010. The review is focused on more than 420 published papers. The review will not cover information coming from international meetings available only in abstract form. Fingermarks constitute an important chapter with coverage of the identification process as well as detection techniques on various surfaces. We note that the research has been very dense both at exploring and understanding current detection methods as well as bringing groundbreaking techniques to increase the number of marks detected from various objects. The recent report from the US National Research Council (NRC) is a milestone that has promoted a critical discussion on the state of forensic science and its associated research. We can expect a surge of interest in research in relation to cognitive aspect of mark and print comparison, establishment of relevant forensic error rates and statistical modelling of the selectivity of marks' attributes. Other biometric means of forensic identification such as footmarks or earmarks are also covered in the report. Compared to previous years, we noted a decrease in the number of submission in these areas. No doubt that the NRC report has set the seed for further investigation of these fields as well.

Impact of carotid plaque screening on smoking cessation and other cardiovascular risk factors: a randomized controlled trial.

BACKGROUND: Screening of peripheral atherosclerosis is increasingly used, but few trials have examined its clinical impact. We aimed to assess whether carotid plaque screening helps smokers to improve their health behaviors and cardiovascular risk factors. METHODS: We randomly assigned 536 smokers aged 40 to 70 years to carotid plaque ultrasonographic screening (US group) vs no screening (control group) in addition to individual counseling and nicotine replacement therapy for all participants. Smokers with at least 1 plaque received pictures of their plaques with a 7-minute structured explanation. The outcomes included biochemically validated smoking cessation at 12 months (primary outcome) and changes in cardiovascular risk factor levels and Framingham risk score. RESULTS: At baseline, participants (mean age, 51.1 years; 45.0% women) smoked an average of 20 cigarettes per day with a median duration of 32 years. The US group had a high prevalence of carotid plaques (57.9%). At 12 months, smoking cessation rates were high, but did not differ between the US and control groups (24.9% vs 22.1%; P = .45). In the US group, cessation rates did not differ according to the presence or absence of plaques. Control of cardiovascular risk factors (ie, blood pressure and low-density lipoprotein cholesterol and hemoglobin A(1c) levels in diabetic patients) and mean absolute risk change in Framingham risk score did not differ between the groups. The mean absolute risk change in Framingham risk score was +0.6 in the US group vs +0.3 in the control group (P = .56). CONCLUSION: In smokers, carotid plaque screening performed in addition to thorough smoking cessation counseling is not associated with increased rates of smoking cessation or control of cardiovascular risk factors. Trial Registration  clinicaltrials.gov Identifier: NCT00548665.