Early clinical outcomes after small incision lenticule extraction surgery (SMILE)

Purpose Dry eye is known to impact on clinical outcomes after laser vision correction and the use of a newer ‘all femtosecond laser’ surgical approach may be associated with less impact on the ocular surface post-operatively. The purpose of this study was to evaluate the early clinical outcomes and tear instability after the first small incision lenticule extraction (SMILE) cases undertaken by three surgeons at a single site in the UK. Methods Retrospective audit. Seventy-one eyes of 37 patients underwent SMILE surgery using the Zeiss VisuMax laser system (Carl Zeiss Meditec, Germany). Uncorrected and corrected distance visual acuity, spherical equivalent refraction, fluorescein enhanced tear break up time, simulated keratometry and complications were evaluated pre- and post-operatively where applicable. Results The study population consisted of 21 males and 16 females. The mean ± standard deviation age was 33 ± 8 years. The results showed that 100% of eyes achieved 20/40 or better and 88% achieved 20/20 or better uncorrected distance visual acuity. The spherical equivalent refraction after surgery was within ±0.50D in 82% of eyes at three months. There was no significant difference in tear break up time from pre-operative levels at three months. Complications were infrequent. Conclusions This early data from surgeons’ first SMILE procedures suggest SMILE provides good outcomes in terms of refractive predictability and visual acuity with minimal impact on the tear film. Longitudinal research will further improve our understanding of the longer-term impact of SMILE on clinical outcomes, ocular surface metrics and patient reported outcomes

Dry eye following cataract surgery: The effect of light exposure using an in-vitro model

Purpose: Cataract surgery can lead to the temporary development or worsening of dry eye symptoms.Contributing factors may include corneal incisions, agents used before, during or after surgery, light from the operating microscope, disruption of ocular surface tissues and inflammatory processes. The purpose of this study was to observe the effect of light exposure on conjunctival fibroblasts in order to determine whether light has an effect on wound healing closure, assuming that operating microscopes might have an effect on the ocular surface. Method: An in vitro scratch assay was performed on porcine conjunctival fibroblasts. Ten minutes of light exposure from a light microscope with halogen bulb was performed after the scratch assay. Fibroblasts were kept in culture for 48 hours post-exposure and the wound closure rates were visualized by live/dead staining. The fibroblasts which were exposed to light were compared to those without light exposure. Cell viability was also analysed by MTT assay. Results: Slower wound closure rate was found when fibroblasts were exposed to light compared to the non-light exposed controls. Cell viability reduced by 20% with light exposure compared to controls in p3 cells (p = 0.04; however, the trend was not observed with p4 and p5 cells (p > 0.05). Conclusions: These results suggest that light exposure might be one of the possible contributory factors for dry eye after ophthalmic surgery. Further evaluation of light effects should be carried out with different ocular surface cell

Psychotropic medications in older people in residential care facilities and associations with quality of life: a cross-sectional study

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background Psychotropic medications have been associated with many adverse outcomes in older people living in residential care. Home-like models of residential care may be preferable to traditional models of care and we hypothesized that this model may impact on the prevalence of psychotropic medications. The objectives were to: 1) examine associations between psychotropic medications and quality of life in older adults living in residential care facilities with a high prevalence of cognitive impairment and dementia and 2) determine if there was a difference in prevalence of psychotropic medications in facilities which provide a small group home-like model of residential care compared to a ‘standard model’ of care. Methods Participants included 541 residents from 17 residential aged care facilities in the Investigating Services Provided in the Residential Environment for Dementia (INSPIRED) study. Cross-sectional analyses were completed to examine the above objectives. Quality of life was measured with the dementia quality of life questionnaire (DEMQOL) and the EQ-5D-5L completed by the resident or a proxy. Results Overall, 70.8% (n = 380) of the population had been prescribed/dispensed at least one psychotropic medication in the 100 days prior to recruitment. An increased number of psychotropic medications was associated with lower quality of life according to DEMQOL-Proxy-Utility scores (β (SE): − 0.012 (0.006), p = 0.04) and EQ-5D-5L scores (− 0.024 (0.011), p = 0.03) after adjustment for resident-level and facility-level characteristics. Analysis of the individual classes of psychotropic medications showed antipsychotics were associated with lower DEMQOL-Proxy-Utility scores (− 0.030 (0.014), p = 0.03) and benzodiazepines were associated with lower EQ-5D-5L scores (− 0.059 (0.024), p = 0.01). Participants residing in facilities which had a home-like model of residential care were less likely to be prescribed psychotropic medications (OR (95% CI): 0.24 (0.12, 0.46), p < 0.001). Conclusions An increased number of psychotropic medications were associated with lower quality of life scores. These medications have many associated adverse effects and the use of these medications should be re-examined when investigating approaches to improve quality of life for older people in residential care. Home-like models of residential care may help to reduce the need for psychotropic medications, but further research is needed to validate these findings

Geosciences and the Energy Transition

A substantial and rapid decarbonisation of the global economy is required to limit anthropogenic climate change to well below 2°C average global heating by 2050. Yet, emissions from fossil fuel energy generation—which dominate global greenhouse gas emissions—are at an all-time high. Progress and action for an energy transition to net zero carbon is critical, and one in which geoscience sectors and geoscientists will play multiple roles. Here, we outline the landscape of the geosciences and the energy transition in the context of the climate crisis, and intergovernmental policies on climate and social justice. We show how geoscience sectors, skills, knowledge, data, and infrastructure, both directly and indirectly, will play a key role in the energy transition. This may be in the responsible sourcing of raw materials for low carbon energy technologies; in the decarbonisation of heating; and in the near-permanent geological capture and storage of carbon through novel technology development. A new and unprecedented challenge is to reach Geological Net Zero, where zero carbon emissions from geological resource production and consumption are achieved via permanent geological storage. We identify overarching and cross-cutting issues for a sustainable and fair net zero carbon energy transition, and the associated geoscience challenges and opportunities. Finally, we call for geoscience professionals to recognise and take responsibility for their role in ensuring a fair and sustainable energy transition at the pace and scale required

Automated detection and staging of malaria parasites from cytological smears using convolutional neural networks

Microscopic examination of blood smears remains the gold standard for laboratory inspection and diagnosis of malaria. Smear inspection is, however, time-consuming and dependent on trained microscopists with results varying in accuracy. We sought to develop an automated image analysis method to improve accuracy and standardization of smear inspection that retains capacity for expert confirmation and image archiving. Here, we present a machine learning method that achieves red blood cell (RBC) detection, differentiation between infected/uninfected cells, and parasite life stage categorization from unprocessed, heterogeneous smear images. Based on a pretrained Faster Region-Based Convolutional Neural Networks (R-CNN) model for RBC detection, our model performs accurately, with an average precision of 0.99 at an intersection-over-union threshold of 0.5. Application of a residual neural network-50 model to infected cells also performs accurately, with an area under the receiver operating characteristic curve of 0.98. Finally, combining our method with a regression model successfully recapitulates intraerythrocytic developmental cycle with accurate lifecycle stage categorization. Combined with a mobile-friendly web-based interface, called PlasmoCount, our method permits rapid navigation through and review of results for quality assurance. By standardizing assessment of Giemsa smears, our method markedly improves inspection reproducibility and presents a realistic route to both routine lab and future field-based automated malaria diagnosis

Individual variation in 3-methylbutanal: A putative link between human leukocyte antigen and skin microflora

The human derma emits volatile compounds whose interaction with a receiver's olfactory sensory system may affect individual recognition and mating preferences. Studies suggest that both genes and environmental factors determine characteristic odor of an individual. Here, we use solid phase micro-extraction and GC-MS to identify 3-methylbutanal (3-MB) in human axillary odor, show that the abundance of this volatile compound varies significantly between individuals and demonstrate in vitro that its formation may be influenced by interaction between human leukocyte antigen peptide and dermal microflora

Trademarking activities and total factor productivity: some evidence for British commercial banks using a metafrontier approach

In this paper, we compute a non-parametric Metafrontier Malmquist index to evaluate the Total Factor Productivity (TFP) change among UK-based trademarking and non-trademarking commercial banks between 2005 and 2013. The use of the metafrontier approach allows us to: a) identify the drivers of TFP growth for each group of banks, b) compare the TFP growth of each group to the TFP growth experienced by the whole industry, and c) assess the extent to which the former catches up with the latter measured along the metafrontier. Our results suggest that TFP has been increasing among trademarking banks up to the onset of the financial crisis but this process has since reversed. The catch-up indexes suggest that both groups of banks were catching up with the metafrontier up to the financial crisis although the drivers of this process differed between the two groups. After the financial crisis, improvements in technology have been driven by a small number of commercial banks i.e. the non- trademarking banks. These results suggest that a large section of the commercial banking sector has not been able to overcome the effects of the financial crisis

Respiratory Syncytial Virus Binds and Undergoes Transcription in Neutrophils From the Blood and Airways of Infants With Severe Bronchiolitis

Background. Neutrophils are the predominant cell in the lung inflammatory infiltrate of infants with respiratory syncytial virus (RSV) bronchiolitis. Although it has previously been shown that neutrophils from both blood and bronchoalveolar lavage (BAL) are activated, little is understood about their role in response to RSV infection. This study investigated whether RSV proteins and mRNA are present in neutrophils from blood and BAL of infected infants

The death domain kinase RIP1 links the immunoregulatory CD40 receptor to apoptotic signaling in carcinomas

RIP1 is a component of a TRAF2 complex, required for caspase-8 activation and tumor cell killing in response to ligand binding of CD40

Short-term stability in refractive status despite large fluctuations in glucose levels in diabetes mellitus type 1 and 2

Purpose: This work investigates how short-term changes in blood glucose concentration affect the refractive components of the diabetic eye in patients with long-term Type 1 and Type 2 diabetes. Methods: Blood glucose concentration, refractive error components (mean spherical equivalent MSE, J0, J45), central corneal thickness (CCT), anterior chamber depth (ACD), crystalline lens thickness (LT), axial length (AL) and ocular aberrations were monitored at two-hourly intervals over a 12-hour period in: 20 T1DM patients (mean age ± SD) 38±14 years, baseline HbA1c 8.6±1.9%; 21 T2DM patients (mean age ± SD) 56±11 years, HbA1c 7.5±1.8%; and in 20 control subjects (mean age ± SD) 49±23 years, HbA1c 5.5±0.5%. The refractive and biometric results were compared with the corresponding changes in blood glucose concentration. Results: Blood glucose concentration at different times was found to vary significantly within (p0.05). Minor changes of marginal statistical or optical significance were observed in some biometric parameters. Similarly there were some marginally significant differences between the baseline biometric parameters of well-controlled and poorly-controlled diabetic subjects. Conclusion: This work suggests that normal, short-term fluctuations (of up to about 6 mM/l on a timescale of a few hours) in the blood glucose levels of diabetics are not usually associated with acute changes in refractive error or ocular wavefront aberrations. It is therefore possible that factors other than refractive error fluctuations are sometimes responsible for the transient visual problems often reported by diabetic patients