Health professionals' and service users' perspectives of shared care for monitoring wet age-related macular degeneration: a qualitative study alongside the ECHoES trial

Objectives: To explore the views of eye health professionals and service users on shared community and hospital care for wet or neovascular age-related macular degeneration (nAMD).

Method: Using maximum variation sampling, 5 focus groups and 10 interviews were conducted with 23 service users and 24 eye health professionals from across the UK (consisting of 8 optometrists, 6 ophthalmologists, 6 commissioners, 2 public health representatives and 2 clinical eye care advisors to local Clinical Commissioning Groups). Data were transcribed verbatim and analysed thematically using constant comparative techniques derived from grounded theory methodology.

Results: The needs and preferences of those with nAMD appear to be at odds with the current service being provided. There was enthusiasm among health professionals and service users about the possibility of shared care for nAMD as it was felt to have the potential to relieve hospital eye service burden and represent a more patient-centred option, but there were a number of perceived barriers to implementation. Some service users and ophthalmologists voiced concerns about optometrist competency and the potential for delays with referrals to secondary care if stable nAMD became active again. The health professionals were divided as to whether shared care was financially more efficient than the current model of care. Specialist training for optometrists, under the supervision of ophthalmologists, was deemed to be the most effective method of training and was perceived to have the potential to improve the communication and trust that shared care would require.

Conclusions: While shared care is perceived to represent a promising model of nAMD care, voiced concerns suggest that there would need to be greater collaboration between ophthalmology and optometry, in terms of interprofessional trust and communication.

Tumorigenesis and peritoneal colonization from fallopian tube epithelium

Ovarian cancer is the most lethal gynecological malignancy, primarily because its origin and initiation factors are unknown. A secretory murine oviductal epithelial (MOE) model was generated to address the hypothesis that the fallopian tube is an origin for high-grade serous cancer. MOE cells were stably altered to express mutation in p53, silence PTEN, activate AKT, and amplify KRAS alone and in combination, to define if this cell type gives rise to tumors and what genetic alterations are required to drive malignancy. Cell lines were characterized in vitro and allografted into mice. Silencing PTEN formed high-grade carcinoma with wide spread tumor explants including metastasis into the ovary. Addition of p53 mutation to PTEN silencing did not enhance this phenotype, whereas addition of KRAS mutation reduced survival. Interestingly, PTEN silencing and KRAS mutation originating from ovarian surface epithelium generated endometrioid carcinoma, suggesting that different cellular origins with identical genetic manipulations can give rise to distinct cancer histotypes. Defining the roles of specific signaling modifications in tumorigenesis from the fallopian tube/oviduct is essential for early detection and development of targeted therapeutics. Further, syngeneic MOE allografts provide an ideal model for pre-clinical testing in an in vivo environment with an intact immune system.

Induction of the inflammatory regulator A20 by gibberellic acid in airway epithelial cells

BACKGROUND AND PURPOSE: NF-κB-driven inflammation is negatively regulated by the zinc finger protein A20. Gibberellic acid (GA3 ) is a plant-derived diterpenoid with documented anti-inflammatory activity, which is reported to induce A20-like zinc finger proteins in plants. Here, we sought to investigate the anti-inflammatory effect of GA3 in airway epithelial cells and determine if the anti-inflammatory action relates to A20 induction.

EXPERIMENTAL APPROACH: Primary nasal epithelial cells and a human bronchial epithelial cell line (16HBE14o-) were used. Cells were pre-incubated with GA3 , stimulated with Pseudomonas aeruginosa LPS; IL-6 and IL-8 release, A20, NF-κB and IκBα expression were then evaluated. To determine if any observed anti-inflammatory effect occurred via an A20-dependent mechanism, A20 was silenced using siRNA.

KEY RESULTS: Cells pre-incubated with GA3 had significantly increased levels of A20 mRNA (4 h) and protein (24 h), resulting in a significant reduction in IL-6 and IL-8 release. This effect was mediated via reduced IκBα degradation and reduced NF-κB (p65) expression. Furthermore, the anti-inflammatory action of GA3 was abolished in A20-silenced cells.

CONCLUSIONS AND IMPLICATIONS: We showed that A20 induction by GA3 attenuates inflammation in airway epithelial cells, at least in part through its effect on NF-κB and IκBα. GA3 or gibberellin-derived derivatives could potentially be developed into anti-inflammatory drugs for the treatment of chronic inflammatory diseases associated with A20 dysfunction.

Efficient Processing of Spatial Group Keyword Queries

With the proliferation of geo-positioning and geo-tagging techniques, spatio-textual objects that possess both a geographical location and a textual description are gaining in prevalence, and spatial keyword queries that exploit both location and textual description are gaining in prominence. However, the queries studied so far generally focus on finding individual objects that each satisfy a query rather than finding groups of objects where the objects in a group together satisfy a query.

We define the problem of retrieving a group of spatio-textual objects such that the group's keywords cover the query's keywords and such that the objects are nearest to the query location and have the smallest inter-object distances. Specifically, we study three instantiations of this problem, all of which are NP-hard. We devise exact solutions as well as approximate solutions with provable approximation bounds to the problems. In addition, we solve the problems of retrieving top-k groups of three instantiations, and study a weighted version of the problem that incorporates object weights. We present empirical studies that offer insight into the efficiency of the solutions, as well as the accuracy of the approximate solutions.

The molecular signature of the stroma response in prostate cancer-induced osteoblastic bone metastasis highlights expansion of hematopoietic and prostate epithelial stem cell niches

The reciprocal interaction between cancer cells and the tissue-specific stroma is critical for primary and metastatic tumor growth progression. Prostate cancer cells colonize preferentially bone (osteotropism), where they alter the physiological balance between osteoblast-mediated bone formation and osteoclast-mediated bone resorption, and elicit prevalently an osteoblastic response (osteoinduction). The molecular cues provided by osteoblasts for the survival and growth of bone metastatic prostate cancer cells are largely unknown. We exploited the sufficient divergence between human and mouse RNA sequences together with redefinition of highly species-specific gene arrays by computer-aided and experimental exclusion of cross-hybridizing oligonucleotide probes. This strategy allowed the dissection of the stroma (mouse) from the cancer cell (human) transcriptome in bone metastasis xenograft models of human osteoinductive prostate cancer cells (VCaP and C4-2B). As a result, we generated the osteoblastic bone metastasis-associated stroma transcriptome (OB-BMST). Subtraction of genes shared by inflammation, wound healing and desmoplastic responses, and by the tissue type-independent stroma responses to a variety of non-osteotropic and osteotropic primary cancers generated a curated gene signature ("Core" OB-BMST) putatively representing the bone marrow/bone-specific stroma response to prostate cancer-induced, osteoblastic bone metastasis. The expression pattern of three representative Core OB-BMST genes (PTN, EPHA3 and FSCN1) seems to confirm the bone specificity of this response. A robust induction of genes involved in osteogenesis and angiogenesis dominates both the OB-BMST and Core OB-BMST. This translates in an amplification of hematopoietic and, remarkably, prostate epithelial stem cell niche components that may function as a self-reinforcing bone metastatic niche providing a growth support specific for osteoinductive prostate cancer cells. The induction of this combinatorial stem cell niche is a novel mechanism that may also explain cancer cell osteotropism and local interference with hematopoiesis (myelophthisis). Accordingly, these stem cell niche components may represent innovative therapeutic targets and/or serum biomarkers in osteoblastic bone metastasis.

Site Distribution at the Edge of the Palaeolithic World: A Nutritional Niche Approach

This paper presents data from the English Channel area of Britain and Northern France on the spatial distribution of Lower to early Middle Palaeolithic pre-MIS5 interglacial sites which are used to test the contention that the pattern of the richest sites is a real archaeological distribution and not of taphonomic origin. These sites show a marked concentration in the middle-lower reaches of river valleys with most being upstream of, but close to, estimated interglacial tidal limits. A plant and animal database derived from Middle-Late Pleistocene sites in the region is used to estimate the potentially edible foods and their distribution in the typically undulating landscape of the region. This is then converted into the potential availability of macronutrients (proteins, carbohydrates, fats) and selected micronutrients. The floodplain is shown to be the optimum location in the nutritional landscape (nutriscape). In addition to both absolute and seasonal macronutrient advantages the floodplains could have provided foods rich in key micronutrients, which are linked to better health, the maintenance of fertility and minimization of infant mortality. Such places may have been seen as ‘good (or healthy) places’ explaining the high number of artefacts accumulated by repeated visitation over long periods of time and possible occupation. The distribution of these sites reflects the richest aquatic and wetland successional habitats along valley floors. Such locations would have provided foods rich in a wide range of nutrients, importantly including those in short supply at these latitudes. When combined with other benefits, the high nutrient diversity made these locations the optimal niche in northwest European mixed temperate woodland environments. It is argued here that the use of these nutritionally advantageous locations as nodal or central points facilitated a healthy variant of the Palaeolithic diet which permitted habitation at the edge of these hominins’ range.

Analysis of the early-time optical spectra of SN 2011fe in M101

The nearby Type Ia supernova SN 2011fe in M101 (cz=241 km s^-1) provides a unique opportunity to study the early evolution of a "normal" Type Ia supernova, its compositional structure, and its elusive progenitor system. We present 18 high signal-to-noise spectra of SN 2011fe during its first month beginning 1.2 days post-explosion and with an average cadence of 1.8 days. This gives a clear picture of how various line-forming species are distributed within the outer layers of the ejecta, including that of unburned material (C+O). We follow the evolution of C II absorption features until they diminish near maximum light, showing overlapping regions of burned and unburned material between ejection velocities of 10,000 and 16,000 km s^-1. This supports the notion that incomplete burning, in addition to progenitor scenarios, is a relevant source of spectroscopic diversity among SNe Ia. The observed evolution of the highly Doppler-shifted O I 7774 absorption features detected within five days post-explosion indicate the presence of O I with expansion velocities from 11,500 to 21,000 km s^-1. The fact that some O I is present above C II suggests that SN 2011fe may have had an appreciable amount of unburned oxygen within the outer layers of the ejecta.

Genomic Resources Notes Accepted 1 June 2015 - 31 July 2015

This article documents the public availability of (i) microbiomes in diet and gut of larvae from the dipteran Dilophus febrilis using massive parallel sequencing, (ii) SNP and SSR discovery and characterization in the transcriptome of the Atlantic mackerel (Scomber scombrus, L) and (iii) assembled transcriptome for an endangered, endemic Iberian cyprinid fish (Squalius pyrenaicus).

Distant activity of 67P/Churyumov-Gerasimenko in 2014: Ground-based results during the Rosetta pre-landing phase

As the ESA Rosetta mission approached, orbited, and sent a lander to comet 67P/Churyumov-Gerasimenko in 2014, a large campaign of ground-based observations also followed the comet. We constrain the total activity level of the comet by photometry and spectroscopy to place Rosetta results in context and to understand the large-scale structure of the comet's coma pre-perihelion. We performed observations using a number of telescopes, but concentrate on results from the 8m VLT and Gemini South telescopes in Chile. We use R-band imaging to measure the dust coma contribution to the comet's brightness and UV-visible spectroscopy to search for gas emissions, primarily using VLT/FORS. In addition we imaged the comet in near-infrared wavelengths (JHK) in late 2014 with Gemini-S/Flamingos 2. We find that the comet was already active in early 2014 at heliocentric distances beyond 4 au. The evolution of the total activity (measured by dust) followed previous predictions. No gas emissions were detected despite sensitive searches. The comet maintains a similar level of activity from orbit to orbit, and is in that sense predictable, meaning that Rosetta results correspond to typical behaviour for this comet. The gas production (for CN at least) is highly asymmetric with respect to perihelion, as our upper limits are below the measured production rates for similar distances post-perihelion in previous orbits.

The design and implementation of a study to investigate the effectiveness of community vs hospital eye service follow-up for patients with neovascular age-related macular degeneration with quiescent disease

Introduction
Standard treatment for neovascular age-related macular degeneration (nAMD) is intravitreal injections of anti-VEGF drugs. Following multiple injections, nAMD lesions often become quiescent but there is a high risk of reactivation, and regular review by hospital ophthalmologists is the norm. The present trial examines the feasibility of community optometrists making lesion reactivation decisions.

Methods
The Effectiveness of Community vs Hospital Eye Service (ECHoES) trial is a virtual trial; lesion reactivation decisions were made about vignettes that comprised clinical data, colour fundus photographs, and optical coherence tomograms displayed on a web-based platform. Participants were either hospital ophthalmologists or community optometrists. All participants were provided with webinar training on the disease, its management, and assessment of the retinal imaging outputs. In a balanced design, 96 participants each assessed 42 vignettes; a total of 288 vignettes were assessed seven times by each professional group.The primary outcome is a participant's judgement of lesion reactivation compared with a reference standard. Secondary outcomes are the frequency of sight threatening errors; judgements about specific lesion components; participant-rated confidence in their decisions about the primary outcome; cost effectiveness of follow-up by optometrists rather than ophthalmologists.

Discussion
This trial addresses an important question for the NHS, namely whether, with appropriate training, community optometrists can make retreatment decisions for patients with nAMD to the same standard as hospital ophthalmologists. The trial employed a novel approach as participation was entirely through a web-based application; the trial required very few resources compared with those that would have been needed for a conventional randomised controlled clinical trial.

Metais em águas e sedimentos da plataforma dos Açores

A presente tese tem por objetivo principal contribuir para o conhecimento da geoquímica sedimentar da zona oceânica da crista da Terceira e montanhas submarinas a sul (região entre 29-39ºN e 27-32ºW), integrando também a caraterização dos metais e nutrientes na coluna de água e propondo concentrações para servirem de referência nesta região do Atlântico Central. Para o efeito foram realizadas amostragens na coluna de água em sete locais e de sedimento em cinco locais, durante a campanha oceanográfica designada por EMEPC/AÇORES/G3/2007 a bordo do navio SV Kommandor Jack, no âmbito do projeto da Estrutura de Missão para a Extensão da Plataforma Continental (EMEPC). Os perfis de CTD da coluna de água na região estudada revelam a presença de massas de água distintas: a Western North Atlantic Central Water (WNACW), a Eastern North Atlantic Central Water tropical (ENACWt), a Eastern North Atlantic Central Water polar (ENACWp), a Mediterranean Overflow Water (MOW), a Deep Mediterranean Water (DMW) e a North Eastern Atlantic Deep Water (NEADW). Observou-se nos perfis de temperatura e salinidade, referentes aos primeiros 200 m da coluna de água, um gradiente meridional negativo entre as estações localizadas na crista da Terceira e as estações localizadas mais a sul. Observou-se nas águas superficiais valores de oxigénio dissolvido de 93% e de pH de 8,1, assim como que as concentrações dos nutrientes NOx, PO4 e SiO2 variam de acordo com a atividade biológica, tendo-se registado concentrações medianas mais baixas, respetivamente de 6,5, 0,23 e 1,3 mol L-1, que aumentam com a profundidade devido à ausência de produção primária (respetivamente 31, 1,4 e 22 mol L-1). As concentrações de NH4 e de SO4 não variam significativamente nas massas de água, sendo os valores medianos mínimos e máximos de 0,69 a 0,79 mol L-1 para o NH4 e de 30 a 32 mol L-1 para o SO4. São propostas concentrações de referência para as massas de água, para os elementos cobre, cádmio, chumbo e arsénio. Os perfis de sedimento analisados permitem distinguir os sedimentos na crista da Terceira (core A) dos restantes (cores B a E). A grande variabilidade textural encontrada no core A, que contrasta com os outros cores analisados, deve-se a importantes contribuições terrígenas, originadas pela erosão sub-aérea e pela atividade vulcânica das ilhas próximas. iv resumo (continuação) A análise mineralógica, efetuada à fração areia e à fração fina (< 63 μm), confirma que os sedimentos do core A derivam de rochas vulcânicas formadas maioritariamente por piroxenas, olivinas, anfíbolas, biotite, alterites e ainda calcite, plagióclase e magnetite, tendo-se identificado ao microscópio a glauconite e o vidro vulcânico. De acordo com a composição química destes minerais o core A apresenta valores mais elevados de Al, Fe, K, P, Mg, Si, Na, Zn, V, Cr e Mn relativamente aos cores B a E. Os cores B a E apresentam grandes quantidades de calcite (>80%) formada maioritariamente por foraminíferos e nanoplâncton calcário (cocolitóforos). A fração areia confirma a composição maioritariamente carbonatada com grande abundância de material biogénico formado por oozes de foraminíferos (planctónicos e bentónicos) com raras espículas de espongiários e restos de conchas. Os cores B a E apresentam valores muito mais elevados que o core A para os elementos Ca e Sr. Os resultados para o Al, Fe, K, P, Si, Na, As, Cu, Ni, Zn, V, Cr, Li, Pb, Cd e Co presentes nos locais B, C, D e E sugerem que estes cores são comparáveis aos sedimentos de fundo carbonatados. Propõe-se concentrações de referência para a região do Atlântico compreendida entre 29-39ºN e 27-32ºW considerando a primeira camada colhida em cada core. Para o core A as concentrações são normalizadas a 5% de Al e CaCO3, enquanto que para os cores B a E são normalizadas a 2% de Al e CaCO3. Assim as concentrações de referência para o core A são: As – 18 mg kg-1, Cr – 91 mg kg-1, Cu – 127 mg kg-1, Ni – 84 mg kg-1, Pb – 41 mg kg-1, Hg – 41 ng g-1 e Zn – 482 mg kg-1. Para os cores B a E as concentrações de referência são: As – 3 mg kg-1, Cr – 10 mg kg-1, Cu – 36 mg kg-1 Ni – 12 mg kg -1, Hg – 3 ng g-1 e Zn – 20 mg kg-1. Para os restantes metais as concentrações de referência para o core A são: Al – 9%, Si – 25%, Fe – 6%, Ca – 13%, K – 2%, Mg – 2%, Na – 3%, P – 0,4%, Sr – 900 mg kg-1, Li – 10 mg kg-1, Mn – 1200 mg kg-1, Ba – 700 mg kg-1 e V – 140 mg kg-1. Para os cores B a E as concentrações de referência são: Al – 0,9%, Si – 2%, Fe – 0,2%, Ca – 95%, K – 0,3%, Mg – 0,4%, Na – 0,3%, P – 0,04%, Sr – 2600 mg kg-1, Li – 5 mg kg-1, Mn – 240 mg kg-1, Ba – 345 mg kg-1, Co – 2 mg kg-1 e V – 6 mg kg-1. Os resultados da presente tese constituem um contributo para a caraterização geoquímica da região e podem servir de referência à monitorização futura do mar dos Açores e montes submarinos a sul.