Is there overutilisation of cataract surgery in England?

<b>Objectives:</b> Following a 3.7-fold increase in the rate of cataract surgery in the UK between 1989 and 2004, concern has been raised as to whether this has been accompanied by an excessive decline in the threshold such that some operations are inappropriate. The objective was to measure the impact of surgery on a representative sample of patients so as to determine whether or not overutilisation of surgery is occurring. <b>Design:</b> Prospective cohort assessed before and 3 months after surgery. <b>Setting:</b> Ten providers (four NHS hospitals, three NHS treatment centres, three independent sector treatment centres) from across England. <b>Participants:</b> 861 patients undergoing first eye (569) or second eye (292) cataract surgery provided preoperative data of whom 745 (87%) completed postoperative questionnaires. <b>Main outcome measures:</b> Patient-reported visual function (VF-14); general health status and quality of life (EQ5D); postoperative complications; overall view of the operation and its impact. <b>Results:</b> Overall, visual function improved (mean VF-14 score increased from 83.2 (SD 17.3) to 93.7 (SD 13.2)). Self-reported general health status deteriorated (20.3% fair or poor before surgery compared with 25% afterwards) which was reflected in the mean EQ5D score (0.82 vs 0.79; p = 0.003). At least one complication was reported by 66 (8.9%) patients, though this probably overestimated the true incidence. If the appropriateness of surgery is based on an increase in VF-14 score of 5.5 (that corresponds to patients’ reporting being "a little better"), 30% of operations would be deemed inappropriate. If an increase of 12.2 (patients’ reports of being "much better") is adopted, the proportion inappropriate is 49%. Using a different approach to determining a minimally important difference, the proportion inappropriate would be closer to 20%. Although visual function (VF-14) scores were unchanged or deteriorated in 25% of patients, 93.1% rated the results of the operation as "good," "very good" or "excellent," and 93.5% felt their eye problem was "better." This partly reflects inadequacies in the validity of the VF-14. <b>Conclusions:</b> Improvement in the provision of cataract surgery has been accompanied by a reduction in the visual function threshold. However, methodological difficulties in measuring the impact of cataract surgery on visual function and quality of life mean it is impossible to determine whether or not overutilisation of cataract surgery is occurring. N Black1, J Browne1, J van der Meulen1, L Jamieson2, L Copley2 and J Lewsey

Ecological selection pressures for C4 photosynthesis in the grasses

Grasses using the C4 photosynthetic pathway dominate grasslands and savannahs of warm regions, and account for half of the species in this ecologically and economically important plant family. The C4 pathway increases the potential for high rates of photosynthesis, particularly at high irradiance, and raises water-use efficiency compared with the C3 type. It is therefore classically viewed as an adaptation to open, arid conditions. Here, we test this adaptive hypothesis using the comparative method, analysing habitat data for 117 genera of grasses, representing 15 C4 lineages. The evidence from our three complementary analyses is consistent with the hypothesis that evolutionary selection for C4 photosynthesis requires open environments, but we find an equal likelihood of C4 evolutionary origins in mesic, arid and saline habitats. However, once the pathway has arisen, evolutionary transitions into arid habitats occur at higher rates in C4 than C3 clades. Extant C4 genera therefore occupy a wider range of drier habitats than their C3 counterparts because the C4 pathway represents a pre-adaptation to arid conditions. Our analyses warn against evolutionary inferences based solely upon the high occurrence of extant C4 species in dry habitats, and provide a novel interpretation of this classic ecological association

Targeting lentiviral vectors to antigen-specific immunoglobulins

Gene transfer into B cells by lentivectors can provide an alternative approach to managing B lymphocyte malignancies and autoreactive B cell-mediated autoimmune diseases. These pathogenic B cell Populations can be distinguished by their surface expression of monospecific immunoglobulin. Development of a novel vector system to deliver genes to these specific B cells could improve the safety and efficacy of gene therapy. We have developed an efficient rnethod to target lentivectors to monospecific immunoglobulin-expressing cells in vitro and hi vivo. We were able to incorporate a model antigen CD20 and a fusogenic protein derived from the Sindbis virus as two distinct molecules into the lentiviral Surface. This engineered vector could specifically bind to cells expressing Surface immunoglobulin recognizing CD20 (αCD20), resulting in efficient transduction of target cells in a cognate antigen-dependent manner in vitro, and in vivo in a xenografted tumor model. Tumor suppression was observed in vivo, using the engineered lentivector to deliver a suicide gene to a xenografted tumor expressing αCD20. These results show the feasibility of engineering lentivectors to target immunoglobulin-specific cells to deliver a therapeutic effect. Such targeting lentivectors also Could potentially be used to genetically mark antigen-specific B cells in vivo to study their B cell biology

ISO Spectroscopy of Young Stellar Objects

Observations of gas-phase and solid-state species toward young stellar objects (YSOs) with the spectrometers on board the Infrared Space Observatory are reviewed. The excitation and abundances of the atoms and molecules are sensitive to the changing physical conditions during star-formation. In the cold outer envelopes around YSOs, interstellar ices contain a significant fraction of the heavy element abundances, in particular oxygen. Different ice phases can be distinguished, and evidence is found for heating and segregation of the ices in more evolved objects. The inner warm envelopes around YSOs are probed through absorption and emission of gas-phase molecules, including CO, CO_2, CH_4 and H_2O. An overview of the wealth of observations on gas-phase H_2O in star-forming regions is presented. Gas/solid ratios are determined, which provide information on the importance of gas-grain chemistry and high temperature gas-phase reactions. The line ratios of molecules such as H_2, CO and H_2O are powerful probes to constrain the physical parameters of the gas. Together with atomic and ionic lines such as [0 I] 63 µm, [S I] 25 µm and (Si II] 35 µm, they can also be used to distinguish between photon- and shock-heated gas. Finally, spectroscopic data on circumstellar disks around young stars are mentioned. The results are discussed in the context of the physical and chemical evolution of YSOs

Resonant laser tunnelling

We propose an experiment involving a gaussian laser tunneling through a twin barrier dielectric structure. Of particular interest are the conditions upon the incident angle for resonance to occur. We provide some numerical calculations for a particular choice of laser wave length and dielectric refractive index which confirm our expectations.Comment: 15 pages, 6 figure

Dark mammoth trunks in the merging galaxy NGC 1316 and a mechanism of cosmic double helices

NGC 1316 is a giant, elliptical galaxy containing a complex network of dark, dust features. The morphology of these features has been examined in some detail using a Hubble Space Telescope, Advanced Camera for Surveys image. It is found that most of the features are constituted of long filaments. There also exist a great number of dark structures protruding inwards from the filaments. Many of these structures are strikingly similar to elephant trunks in H II regions in the Milky Way Galaxy, although much larger. The structures, termed mammoth trunks, generally are filamentary and often have shapes resembling the letters V or Y. In some of the mammoth trunks the stem of the Y can be resolved into two or more filaments, many of which showing signs of being intertwined. A model of the mammoth trunks, related to a recent theory of elephant trunks, is proposed. Based on magnetized filaments, the model is capable of giving an account of the various shapes of the mammoth trunks observed, including the twined structures.Comment: Accepted for publication in Astrophysics & Space Scienc

Come back Marshall, all is forgiven? : Complexity, evolution, mathematics and Marshallian exceptionalism

Marshall was the great synthesiser of neoclassical economics. Yet with his qualified assumption of self-interest, his emphasis on variation in economic evolution and his cautious attitude to the use of mathematics, Marshall differs fundamentally from other leading neoclassical contemporaries. Metaphors inspire more specific analogies and ontological assumptions, and Marshall used the guiding metaphor of Spencerian evolution. But unfortunately, the further development of a Marshallian evolutionary approach was undermined in part by theoretical problems within Spencer's theory. Yet some things can be salvaged from the Marshallian evolutionary vision. They may even be placed in a more viable Darwinian framework.Peer reviewedFinal Accepted Versio

The product of a Petrine circle? A reassessment of the origin and character of 1 Peter

© 2002 SAGE PublicationsRecent studies of 1 Peter, especially by John Elliott, have sought to rescue the letter from its assimilation to the Pauline tradition and to establish the view, now widely held, that 1 Peter is the distinctive product of a Petrine circle. After examining the traditions in 1 Peter, both Pauline and non-Pauline, and the names in the letter (Silvanus, Mark and Peter), this essay argues that there is no substantial evidence, either inside or outside the letter, to support the view of 1 Peter as originating from a specifically Petrine group. It is much more plausibly seen as reflecting the consolidation of early Christian traditions in Roman Christianity. Despite the scholarly majority currently in its favour, the view of 1 Peter as the distinctive product of a Petrine tradition from a Petrine circle should therefore be rejected