Referrals for proliferative diabetic retinopathy from two UK diabetic retinopathy screening services: a 10-year analysis of visual outcomes, requirement for vitrectomy, and mortality

\ua9 The Author(s) 2024. Background/objectives: To determine long-term outcomes of patients referred with proliferative diabetic retinopathy (PDR) from diabetic eye screening programmes (DESP) to tertiary care centres in the United Kingdom (UK). Methods: Retrospective multicentre study of patients referred from two DESPs in the UK over a 36-month period (2007–9) and followed-up for 10 years. Critical outcomes included severe vision loss (SVL) and the need for vitrectomy. Other outcomes assessed included moderate vision loss (MVL), and patient survival time. Univariate and multiple variable Cox proportional hazards regressions were used to analyse survival outcomes. Results: 212 eyes of 150 patients were referred with a diagnosis of PDR. 109 eyes of 72 patients were confirmed to have active PDR and included in the study. 61% of patients had low-risk PDR, while 39% exhibited high-risk features in at least one eye. Eight (7.3%) eyes developed SVL and 16 (14.7%) MVL during follow up. Vitrectomy was required in 24% (95% CI: 15 to 31%) of all PDR eyes and was most commonly performed for vitreous haemorrhage (65%). The 10-year survival in all PDR patients was 76% (95% CI: 63 to 85%) with the mean time to death for all deceased patients being 5.4 \ub1 3.6 years. On multivariable analysis, only age was found to have a significant association with the survival of patients with PDR. Conclusions: During the 10 year follow up SVL was uncommon, but MVL occurred in almost one-fifth of the eyes. Approximately 1 in 4 eyes required vitrectomy, highlighting its significance in patient management

Evidence for Horizontal Blocking and Reflection of a Small-Scale Gravity Wave in the Mesosphere

The variations of the horizontal phase velocity of an internal gravity wave, generated by wave “blocking” or “reflection” due to an inhomogeneous wind field, have been predicted theoretically and numerically investigated but had yet to be captured experimentally. In this paper, through a collaborative observation campaign using a sodium (Na) Temperature/Wind lidar and a collocated Advanced Mesospheric Temperature Mapper (AMTM) at Utah State University (USU), we report the first potential evidence of such a unique gravity wave process. The study shows that a small-scale wave, captured by the AMTM, with initial observed horizontal phase velocity of 37 ± 5 m/s toward the northwest direction, experienced a large and increasing headwind as it was propagating in the AMTM field of view. This resulted in significant deceleration along its initial traveling direction, and it became quasi-stationary before it was “reflected” to the opposite direction at later time. The USU Na lidar measured the horizontal wind and temperature during the event, when the wave was found traveling within a temperature inversion layer and experiencing an increasing headwind relative to the wave. The wind agrees well with the expected value for wave blocking suggested by the wave tracing theory, implying the existence of a large horizontal wind gradient that night near the OH layer altitudes. The study indicates the critical role of horizontal winds and their horizontal gradients in determining propagation in vertical and horizontal directions

Towards a framework for critical citizenship education

Increasingly countries around the world are promoting forms of "critical" citizenship in the planned curricula of schools. However, the intended meaning behind this term varies markedly and can range from a set of creative and technical skills under the label "critical thinking" to a desire to encourage engagement, action and political emancipation, often labelled "critical pedagogy". This paper distinguishes these manifestations of the "critical" and, based on an analysis of the prevailing models of critical pedagogy and citizenship education, develops a conceptual framework for analysing and comparing the nature of critical citizenship

Src Dependent Pancreatic Acinar Injury Can Be Initiated Independent of an Increase in Cytosolic Calcium

Several deleterious intra-acinar phenomena are simultaneously triggered on initiating acute pancreatitis. These culminate in acinar injury or inflammatory mediator generation in vitro and parenchymal damage in vivo. Supraphysiologic caerulein is one such initiator which simultaneously activates numerous signaling pathways including non-receptor tyrosine kinases such as of the Src family. It also causes a sustained increase in cytosolic calcium- a player thought to be crucial in regulating deleterious phenomena. We have shown Src to be involved in caerulein induced actin remodeling, and caerulein induced changes in the Golgi and post-Golgi trafficking to be involved in trypsinogen activation, which initiates acinar cell injury. However, it remains unclear whether an increase in cytosolic calcium is necessary to initiate acinar injury or if injury can be initiated at basal cytosolic calcium levels by an alternate pathway. To study the interplay between tyrosine kinase signaling and calcium, we treated mouse pancreatic acinar cells with the tyrosine phosphatase inhibitor pervanadate. We studied the effect of the clinically used Src inhibitor Dasatinib (BMS-354825) on pervanadate or caerulein induced changes in Src activation, trypsinogen activation, cell injury, upstream cytosolic calcium, actin and Golgi morphology. Pervanadate, like supraphysiologic caerulein, induced Src activation, redistribution of the F-actin from its normal location in the sub-apical area to the basolateral areas, and caused antegrade fragmentation of the Golgi. These changes, like those induced by supraphysiologic caerulein, were associated with trypsinogen activation and acinar injury, all of which were prevented by Dasatinib. Interestingly, however, pervanadate did not cause an increase in cytosolic calcium, and the caerulein induced increase in cytosolic calcium was not affected by Dasatinib. These findings suggest that intra-acinar deleterious phenomena may be initiated independent of an increase in cytosolic calcium. Other players resulting in acinar injury along with the Src family of tyrosine kinases remain to be explored. © 2013 Mishra et al

The deep propagating gravity wave experiment (deepwave): an airborne and ground-based exploration of gravity wave propagation and effects from their sources throughout the lower and middle atmosphere

Abstract The Deep Propagating Gravity Wave Experiment (DEEPWAVE) was designed to quantify gravity wave (GW) dynamics and effects from orographic and other sources to regions of dissipation at high altitudes. The core DEEPWAVE field phase took place from May through July 2014 using a comprehensive suite of airborne and ground-based instruments providing measurements from Earth’s surface to ∼100 km. Austral winter was chosen to observe deep GW propagation to high altitudes. DEEPWAVE was based on South Island, New Zealand, to provide access to the New Zealand and Tasmanian “hotspots” of GW activity and additional GW sources over the Southern Ocean and Tasman Sea. To observe GWs up to ∼100 km, DEEPWAVE utilized three new instruments built specifically for the National Science Foundation (NSF)/National Center for Atmospheric Research (NCAR) Gulfstream V (GV): a Rayleigh lidar, a sodium resonance lidar, and an advanced mesosphere temperature mapper. These measurements were supplemented by in situ probes, dropsondes, and a microwave temperature profiler on the GV and by in situ probes and a Doppler lidar aboard the German DLR Falcon. Extensive ground-based instrumentation and radiosondes were deployed on South Island, Tasmania, and Southern Ocean islands. Deep orographic GWs were a primary target but multiple flights also observed deep GWs arising from deep convection, jet streams, and frontal systems. Highlights include the following: 1) strong orographic GW forcing accompanying strong cross-mountain flows, 2) strong high-altitude responses even when orographic forcing was weak, 3) large-scale GWs at high altitudes arising from jet stream sources, and 4) significant flight-level energy fluxes and often very large momentum fluxes at high altitudes.David C. Fritts, Ronald B. Smith, Michael J. Taylor, James D. Doyle, Stephen D. Eckermann, Andreas Dörnbrack, Markus Rapp, Bifffford P. Williams, P.-Dominique Pautet, Katrina Bossert, Neal R. Criddddle, Carolyn A. Reynolds, P. Alex Reinecke, Michael Uddddstrom, Michael J. Revell, Richard Turner, Bernd Kaifler, Johannes S. Wagner, Tyler Mixa, Christopher G. Kruse, Alison D. Nugent, Campbell D. Watson, Sonja Gisinger, Steven M. Smith, Ruth S. Lieberman, Brian Laughman, James J. Moore, William O. Brown, Julie A. Haggerty, Alison Rockwell, Gregory J. Stossmeister, Steven F. Williams, Gonzalo Hernandez, Damian J. Murphy, Andrew R. Klekociuk, Iain M. Reid, and Jun M

Length of Variable Numbers of Tandem Repeats in the Carboxyl Ester Lipase (CEL) Gene May Confer Susceptibility to Alcoholic Liver Cirrhosis but Not Alcoholic Chronic Pancreatitis

Background Carboxyl-ester lipase (CEL) contributes to fatty acid ethyl ester metabolism, which is implicated in alcoholic pancreatitis. The CEL gene harbours a variable number of tandem repeats (VNTR) region in exon 11. Variation in this VNTR has been linked to monogenic pancreatic disease, while conflicting results were reported for chronic pancreatitis (CP). Here, we aimed to investigate a potential association of CEL VNTR lengths with alcoholic CP. Methods Overall, 395 alcoholic CP patients, 218 patients with alcoholic liver cirrhosis (ALC) serving as controls with a comparable amount of alcohol consumed, and 327 healthy controls from Germany and the United Kingdom (UK) were analysed by determination of fragment lengths by capillary electrophoresis. Allele frequencies and genotypes of different VNTR categories were compared between the groups. Results Twelve repeats were overrepresented in UK ACP patients (P = 0.04) compared to controls, whereas twelve repeats were enriched in German ALC compared to alcoholic CP patients (P = 0.03). Frequencies of CEL VNTR lengths of 14 and 15 repeats differed between German ALC patients and healthy controls (P = 0.03 and 0.008, respectively). However, in the genotype and pooled analysis of VNTR lengths no statistical significant association was depicted. Additionally, the 16–16 genotype as well as 16 repeats were more frequent in UK ALC than in alcoholic CP patients (P = 0.034 and 0.02, respectively). In all other calculations, including pooled German and UK data, allele frequencies and genotype distributions did not differ significantly between patients and controls or between alcoholic CP and ALC. Conclusions We did not obtain evidence that CEL VNTR lengths are associated with alcoholic CP. However, our results suggest that CEL VNTR lengths might associate with ALC, a finding that needs to be clarified in larger cohorts

Affimer proteins for F-actin: novel affinity reagents that label F-actin in live and fixed cells

Imaging the actin cytoskeleton in cells uses a wide range of approaches. Typically, a fluorescent derivative of the small cyclic peptide phalloidin is used to image F-actin in fixed cells. Lifeact and F-tractin are popular for imaging the cytoskeleton in live cells. Here we characterised novel affinity reagents called Affimers that specifically bind to F-actin in vitro to determine if they are suitable alternatives as eGFP-fusion proteins, to label actin in live cells, or for labeling F-actin in fixed cells. In vitro experiments showed that 3 out of the 4 Affimers (Affimers 6, 14 and 24) tested bind tightly to purified F-actin, and appear to have overlapping binding sites. As eGFP-fusion proteins, the same 3 Affimers label F-actin in live cells. FRAP experiments suggest that eGFP-Affimer 6 behaves most similarly to F-tractin and Lifeact. However, it does not colocalize with mCherry-actin in dynamic ruffles, and may preferentially bind stable actin filaments. All 4 Affimers label F-actin in methanol fixed cells, while only Affimer 14 labels F-actin after paraformaldehyde fixation. eGFP-Affimer 6 has potential for use in selectively imaging the stable actin cytoskeleton in live cells, while all 4 Affimers are strong alternatives to phalloidin for labelling F-actin in fixed cells

Variation in treatment of acute childhood wheeze in emergency departments of the United Kingdom and Ireland: An international survey of clinician practice

© 2015, BMJ Publishing Group. All rights reserved. Objective: National clinical guidelines for childhood wheeze exist, yet despite being one of the most common reasons for childhood emergency department (ED) attendance, signi ficant variation in practice occurs in other settings. We, therefore, evaluated practice variations of ED clinicians in the UK and Ireland. Design: Two-stage survey undertaken in March 2013. Stage one examined department practice and stage two assessed ED consultant practice in acute childhood wheeze. Questions interrogated pharmacological and other management strategies, including inhaled and intravenous therapies. Setting and participants: Member departments of Paediatric Emergency Research in the United Kingdom and Ireland and ED consultants treating children with acute wheeze. Results: 30 EDs and 183 (81%) clinicians responded. 29 (97%) EDs had wheeze guidelines and 12 (40%) had care pathways. Variation existed between clinicians in dose, timing and frequency of inhaled bronchodilators across severities. When escalating to intravenous bronchodilators, 99 (54%) preferred salbutamol first line, 52 (28%) magnesium sulfate (MgSO4) and 27 (15%) aminophylline. 87 (48%) administered intravenous bronchodilators sequentially and 30 (16%) concurrently, with others basing approach on case severity. 146 (80%) continued inhaled therapy after commencing intravenous bronchodilators. Of 170 who used intravenous salbutamol, 146 (86%) gave rapid boluses, 21 (12%) a longer loading dose and 164 (97%) an ongoing infusion, each with a range of doses and durations. Of 173 who used intravenous MgSO4, all used a bolus only. 41 (24%) used non-invasive ventilation. Conclusions: Signi ficant variation in ED consultant management of childhood wheeze exists despite the presence of national guidance. This reflects the lack of evidence in key areas of childhood wheeze and emphasises the need for further robust multicentre research studies