The structure and evolution of a forming galaxy cluster at z = 1.62

We present a comprehensive picture of the Cl 0218.3−0510 protocluster at z = 1.623 across 10 comoving Mpc. Using filters that tightly bracket the Balmer and 4000 Å breaks of the protocluster galaxies we obtain precise photometric redshifts resulting in a protocluster galaxy sample that is 89 ± 5 per cent complete and has a contamination of only 12 ± 5 per cent. Both star-forming and quiescent protocluster galaxies are located, which allows us to map the structure of the forming cluster for the first time. The protocluster contains six galaxy groups, the largest of which is the nascent cluster. Only a small minority of the protocluster galaxies are in the nascent cluster (11 per cent) or in the other galaxy groups (22 per cent), as most protocluster galaxies reside between the groups. Unobscured star-forming galaxies predominantly reside between the protocluster’s groups, whereas red galaxies make up a large fraction of the groups’ galactic content, so observing the protocluster through only one of these types of galaxies results in a biased view of the protocluster’s structure. The structure of the protocluster reveals how much mass is available for the future growth of the cluster and we use the Millennium Simulation, scaled to a Planck cosmology, to predict that Cl 0218.3−0510 will evolve into a 2.7+3.9 −1.7 × 1014M cluster by the present day

A z = 2.5 protocluster associated with the radio galaxy MRC 2104-242: star formation and differing mass functions in dense environments

We present results from a narrow-band survey of the field around the high-redshift radio galaxy MRC 2104−242. We have selected Hα emitters in a 7 arcmin2 field and compared the measured number density with that of a field sample at similar redshift. We find that MRC 2104−242 lies in an overdensity of galaxies that is 8.0 ± 0.8 times the average density of a blank field, suggesting it resides in a large-scale structure that may eventually collapse to form a massive cluster. We find that there is more dust obscured star formation in the protocluster galaxies than in similarly selected control field galaxies and there is tentative evidence of a higher fraction of starbursting galaxies in the denser environment. However, on average we do not find a difference between the star formation rate (SFR)–mass relations of the protocluster and field galaxies and so conclude that the SFR of these galaxies at z ∼ 2.5 is governed predominantly by galaxy mass and not the host environment. We also find that the stellar mass distribution of the protocluster galaxies is skewed towards higher masses and there is a significant lack of galaxies at M 1010.5M_) galaxies, the density of the protocluster field increases to ∼55 times the control field density

The formation history of massive cluster galaxies as revealed by CARLA

We use a sample of 37 of the densest clusters and protoclusters across 1.3 ≤ z ≤ 3.2 from the Clusters Around Radio-Loud AGN (CARLA) survey to study the formation of massive cluster galaxies. We use optical i′-band and infrared 3.6 and 4.5 μm images to statistically select sources within these protoclusters and measure their median observed colours; 〈i′ − [3.6]〉. We find the abundance of massive galaxies within the protoclusters increases with decreasing redshift, suggesting these objects may form an evolutionary sequence, with the lower redshift clusters in the sample having similar properties to the descendants of the high-redshift protoclusters. We find that the protocluster galaxies have an approximately unevolving observed-frame i′ − [3.6] colour across the examined redshift range. We compare the evolution of the 〈i′ − [3.6]〉 colour of massive cluster galaxies with simplistic galaxy formation models. Taking the full cluster population into account, we show that the formation of stars within the majority of massive cluster galaxies occurs over at least 2 Gyr, and peaks at z ∼ 2–3. From the median i′ − [3.6] colours, we cannot determine the star formation histories of individual galaxies, but their star formation must have been rapidly terminated to produce the observed red colours. Finally, we show that massive galaxies at z > 2 must have assembled within 0.5 Gyr of them forming a significant fraction of their stars. This means that few massive galaxies in z > 2 protoclusters could have formed via dry mergers

The impact of protocluster environments at z = 1.6

We investigate the effects of dense environments on galaxy evolution by examining how the properties of galaxies in the z = 1.6 protocluster Cl 0218.3−0510 depend on their location. We determine galaxy properties using spectral energy distribution fitting to 14-band photometry, including data at three wavelengths that tightly bracket the Balmer and 4000 Å breaks of the protocluster galaxies. We find that two-thirds of the protocluster galaxies, which lie between several compact groups, are indistinguishable from field galaxies. The other third, which reside within the groups, differ significantly from the intergroup galaxies in both colour and specific star formation rate. We find that the fraction of red galaxies within the massive protocluster groups is twice that of the intergroup region. These excess red galaxies are due to enhanced fractions of both passive galaxies (1.7 times that of the intergroup region) and dusty star-forming galaxies (3 times that of the intergroup region). We infer that some protocluster galaxies are processed in the groups before the cluster collapses. These processes act to suppress star formation and change the mode of star formation from unobscured to obscured

Effectiveness of Community versus Hospital Eye Service follow-up for patients with neovascular age-related macular degeneration with quiescent disease (ECHoES): a virtual non-inferiority trial

Objectives: To compare the ability of ophthalmologists versus optometrists to correctly classify retinal lesions due to neovascular age-related macular degeneration (nAMD). Design: Randomised balanced incomplete block trial. Optometrists in the community and ophthalmologists in the Hospital Eye Service classified lesions from vignettes comprising clinical information, colour fundus photographs and optical coherence tomographic images. Participants' classifications were validated against experts' classifications (reference standard). Setting: Internet-based application. Participants: Ophthalmologists with experience in the age-related macular degeneration service; fully qualified optometrists not participating in nAMD shared care. Interventions: The trial emulated a conventional trial comparing optometrists' and ophthalmologists' decision-making, but vignettes, not patients, were assessed. Therefore, there were no interventions and the trial was virtual. Participants received training before assessing vignettes. Main outcome measures: Primary outcome- correct classification of the activity status of a lesion based on a vignette, compared with a reference standard. Secondary outcomes-potentially sight-threatening errors, judgements about specific lesion components and participants' confidence in their decisions. Results: In total, 155 participants registered for the trial; 96 (48 in each group) completed all assessments and formed the analysis population. Optometrists and ophthalmologists achieved 1702/2016 (84.4%) and 1722/2016 (85.4%) correct classifications, respectively (OR 0.91, 95% CI 0.66 to 1.25; p=0.543). Optometrists' decision-making was non-inferior to ophthalmologists' with respect to the prespecified limit of 10% absolute difference (0.298 on the odds scale). Optometrists and ophthalmologists made similar numbers of sight-threatening errors (57/994 (5.7%) vs 62/994 (6.2%), OR 0.93, 95% CI 0.55 to 1.57; p=0.789). Ophthalmologists assessed lesion components as present less often than optometrists and were more confident about their classifications than optometrists. Conclusions: Optometrists' ability to make nAMD retreatment decisions from vignettes is not inferior to ophthalmologists' ability. Shared care with optometrists monitoring quiescent nAMD lesions has the potential to reduce workload in hospitals

Solving the puzzle of subhalo spins

Investigating the spin parameter distribution of subhalos in two high-resolution isolated halo simulations, recent work by Onions et al. suggested that typical subhalo spins are consistently lower than the spin distribution found for field halos. To further examine this puzzle, we have analyzed simulations of a cosmological volume with sufficient resolution to resolve a significant subhalo population. We confirm the result of Onions et al. and show that the typical spin of a subhalo decreases with decreasing mass and increasing proximity to the host halo center. We interpret this as the growing influence of tidal stripping in removing the outer layers, and hence the higher angular momentum particles, of the subhalos as they move within the host potential. Investigating the redshift dependence of this effect, we find that the typical subhalo spin is smaller with decreasing redshift. This indicates a temporal evolution, as expected in the tidal stripping scenario

The Effectiveness, cost-effectiveness and acceptability of Community versus Hospital Eye Service follow-up for patients with neovascular age-related macular degeneration with quiescent disease (ECHoES): a virtual randomised balanced incomplete block trial

Background Patients with neovascular age-related macular degeneration (nAMD) usually attend regular reviews, even when the disease is quiescent. Reviews are burdensome to health services, patients and carers. Objectives To compare the proportion of correct lesion classifications made by community-based optometrists and ophthalmologists from vignettes of patients; to estimate the cost-effectiveness of community follow-up by optometrists compared with follow-up by ophthalmologists in the Hospital Eye Service (HES); to ascertain views of patients, their representatives, optometrists, ophthalmologists and clinical commissioners on the proposed shared care model. Design Community-based optometrists and ophthalmologists in the HES classified lesions from vignettes comprising clinical information, colour fundus photographs and optical coherence tomography images. Participants’ classifications were validated against experts’ classifications (reference standard). Setting Internet-based application. Participants Ophthalmologists had to have≥3 years post-registration experience in ophthalmology, have passed part 1 of the Royal College of Ophthalmologists, Diploma in Ophthalmology or equivalent examination, and have experience in the age-related macular degeneration service. Optometrists had to be fully qualified, be registered with the General Optical Council for≥3 years and not be participating in nAMD shared care. Interventions The trial sought to emulate a conventional trial in comparing optometrists’ and ophthalmologists’ decision-making, but vignettes, not patients, were assessed; therefore, there were no interventions. Participants received training prior to assessing vignettes Main Outcome Measures Primary outcome–correct classification of the activity status of a lesion based on a vignette, compared with a reference standard. Secondary outcomes–frequencies of potentially sight-threatening errors, participants’ judgements about specific lesion components, participant-rated confidence in their decisions and cost-effectiveness of follow-up by community-based optometrists compared with HES ophthalmologists. Results In total, 155 participants registered for the trial; 96 (48 in each professional group) completed training and main assessments and formed the analysis population. Optometrists and ophthalmologists achieved 1702 out of 2016 (84.4%) and 1722 out of 2016 (85.4%) correct classifications, respectively [odds ratio (OR) 0.91, 95% confidence interval (CI) 0.66 to 1.25; p=0.543]. Optometrists’ decisionmaking was non-inferior to ophthalmologists’ with respect to the pre-specified limit of 10% absolute difference (0.298 on the odds scale). Frequencies of sight-threatening errors were similar for optometrists and ophthalmologists [57/994 (5.7%) vs. 62/994 (6.2%), OR 0.93, 95% CI 0.55 to 1.57;p=0.789]. Ophthalmologists assessed lesion components as present less often than optometrists and were more confident about their lesion classifications than optometrists. The mean care-pathway cost for assessment was very similar by group, namely £397.33 for ophthalmologists and £410.78 for optometrists. The optometrist-led monitoring reviews were slightly more costly and less effective than ophthalmologist-led reviews, although the differences were extremely small. There was consensus that optometrist-led monitoring has the potential to reduce clinical workload and be more patient-centred. However, potential barriers are ophthalmologists’ perceptions of optometrists’ competence, the need for clinical training, the ability of the professions to work collaboratively and the financial feasibility of shared care for Clinical Commissioning Groups Conclusions The ability of optometrists to make nAMD retreatment decisions from vignettes is non-inferior to that of ophthalmologists. Various barriers to implementing shared cared for nAMD were identified. Future Work Recommendations The Effectiveness, cost-effectiveness and acceptability of Community versus Hospital Eye Service follow-up for patients with neovascular age-related macular degeneration with quiescent disease (ECHoES) study web application was robust and could be used for future training or research. The benefit of reducing HES workload was not considered in the economic evaluation. A framework of programme budgeting and marginal analysis could explicitly explore the resource implications of shifting resources within a given health service area, as the benefit of reducing HES workload was not considered in the economic evaluation. Future qualitative research could investigate professional differences of opinion that were identified in multidisciplinary focus groups.</p

Comparison of the VIMOS-VLT Deep Survey with the Munich semi-analytical model. II. The colour-density relation up to z=1.5

[Abridged] We perform on galaxy mock catalogues the same colour-density analysis made by Cucciati et al. (2006) on a 5 Mpc/h scale using the VVDS-Deep survey, and compare the results from mocks with observed data. We use mocks with the same flux limits (I=24) as the VVDS (CMOCKS), built using the semi- analytic model by De Lucia & Blaizot (2007) applied to the Millennium Simulation. From CMOCKS, we extracted samples of galaxies mimicking the VVDS observational strategy (OMOCKS). We computed the B-band Luminosity Function LF and the colour-density relation (CDR) in the mocks. We find that the LF in mocks roughly agrees with the observed LF, but at z<0.8 the faint-end slope of the model LF is steeper than the VVDS one. Computing the LF for early and late type galaxies, we show that mocks have an excess of faint early-type and of bright late-type galaxies with respect to data. We find that the CDR in OMOCKS is in excellent agreement with the one in CMOCKS. At z~0.7, the CDR in mocks agrees with the VVDS one (red galaxies reside mainly in high densities). Yet, the strength of the CDR in mocks does not vary within 0.2<z<1.5, while the observed relation flattens with increasing z and possibly inverts at z=1.3. We argue that the lack of evolution in the CDR in mocks is not due only to inaccurate prescriptions for satellite galaxies, but that also the treatment of central galaxies has to be revised. The reversal of the CDR can be explained by wet mergers between young galaxies, producing a starburst event. This should be seen on group scales. A residual of this is found in observations at z=1.5 on larger scales, but not in the mocks, suggesting that the treatment of physical processes affecting satellites and central galaxies in models should be revised.Comment: 15 pages, 12 figures, accepted for publication in A&

Barrett’s oESophagus trial 3 (BEST3): study protocol for a randomised controlled trial comparing the Cytosponge-TFF3 test with usual care to facilitate the diagnosis of oesophageal pre-cancer in primary care patients with chronic acid reflux

Abstract Background Early detection of oesophageal cancer improves outcomes; however, the optimal strategy for identifying patients at increased risk from the pre-cancerous lesion Barrett’s oesophagus (BE) is not clear. The Cytosponge, a novel non-endoscopic sponge device, combined with the biomarker Trefoil Factor 3 (TFF3) has been tested in four clinical studies. It was found to be safe, accurate and acceptable to patients. The aim of the BEST3 trial is to evaluate if the offer of a Cytosponge-TFF3 test in primary care for patients on long term acid suppressants leads to an increase in the number of patients diagnosed with BE. Methods The BEST3 trial is a pragmatic multi-site cluster-randomised controlled trial set in primary care in England. Approximately 120 practices will be randomised 1:1 to either the intervention arm, invitation to a Cytosponge-TFF3 test, or the control arm usual care. Inclusion criteria are men and women aged 50 or over with records of at least 6 months of prescriptions for acid-suppressants in the last year. Patients in the intervention arm will receive an invitation to have a Cytosponge-TFF3 test in their general practice. Patients with a positive TFF3 test will receive an invitation for an upper gastro-intestinal endoscopy at their local hospital-based endoscopy clinic to test for BE. The primary objective is to compare histologically confirmed BE diagnosis between the intervention and control arms to determine whether the offer of the Cytosponge-TFF3 test in primary care results in an increase in BE diagnosis within 12 months of study entry. Discussion The BEST3 trial is a well-powered pragmatic trial testing the use of the Cytosponge-TFF3 test in the same population that we envisage it being used in clinical practice. The data generated from this trial will enable NICE and other clinical bodies to decide whether this test is suitable for routine clinical use. Trial registration This trial was prospectively registered with the ISRCTN Registry on 19/01/2017, trial number ISRCTN68382401