Severity of Visual Field Loss at First Presentation to Glaucoma Clinics in England and Tanzania

Purpose: To compare severity of visual field (VF) loss at first presentation in glaucoma clinics in England and Tanzania. Methods: Large archives of VF records from automated perimetry were used to retrospectively examine vision loss at first presentation in glaucoma clinics in Tanzania (N = 1,502) and England (N = 9,264). Mean deviation (MD) of the worse eye at the first hospital visit was used as an estimate of detectable VF loss severity. Results: In Tanzania, 44.7% {CI95%: 42.2, 47.2} of patients presented with severe VF loss (< −20 dB), versus 4.6% {4.1, 5.0} in England. If we consider late presentation to also include cases of advanced loss (-12.01 dB to -20 dB), then the proportion of patients presenting late was 58.1% {55.6, 60.6} and 14.0% {13.3, 14.7}, respectively. The proportion of late presentations was greater in Tanzania at all ages, but the difference was particularly pronounced among working-age adults, with 50.3% {46.9, 53.7} of 18–65-year-olds presenting with advanced or severe VF loss, versus 10.2% {9.3, 11.3} in England. In both countries, men were more likely to present late than women. Conclusions: Late presentation of glaucoma is a problem in England, and an even greater challenge in Tanzania. Possible solutions are discussed, including increased community eye-care, and a more proactive approach to case finding through the use of disruptive new technologies, such as low-cost, portable diagnostic aids

Regenerated sciatic nerve axons stimulated through a chronically implanted macro-sieve electrode

Sieve electrodes provide a chronic interface for stimulating peripheral nerve axons. Yet, successful utilization requires robust axonal regeneration through the implanted electrode. The present study determined the effect of large transit zones in enhancing axonal regeneration and revealed an intimate neural interface with an implanted sieve electrode. Fabrication of the polyimide sieve electrodes employed sacrificial photolithography. The manufactured macro-sieve electrode (MSE) contained nine large transit zones with areas of ~0.285 mm2 surrounded by eight Pt-Ir metallized electrode sites. Prior to implantation, saline or glial derived neurotropic factor (GDNF) was injected into nerve guidance silicone-conduits with or without a MSE. The MSE assembly or a nerve guidance conduit was implanted between transected ends of the sciatic nerve in adult male Lewis rats. At 3 months’ post-operation, fiber counts were similar through both implant types. Likewise, stimulation of nerves regenerated through a MSE or an open silicone conduit evoked comparable muscle forces. These results showed that nerve regeneration was comparable through MSE transit zones and an open conduit. GDNF had a minimal positive effect on the quality and morphology of fibers regenerating through the MSE; thus, the MSE may reduce reliance on GDNF to augment axonal regeneration. Selective stimulation of several individual muscles was achieved through monopolar stimulation of individual electrodes sites suggesting that the MSE might be an optimal platform for functional neuromuscular stimulation

Stoichiometry and thickness dependence of superconducting properties of niobium nitride thin films

The current technology used in linear particle accelerators is based on superconducting radio frequency (SRF) cavities fabricated from bulk niobium (Nb), which have smaller surface resistance and therefore dissipate less energy than traditional nonsuperconducting copper cavities. Using bulk Nb for the cavities has several advantages, which are discussed elsewhere; however, such SRF cavities have a material-dependent accelerating gradient limit. In order to overcome this fundamental limit, a multilayered coating has been proposed using layers of insulating and superconducting material applied to the interior surface of the cavity. The key to this multilayered model is to use superconducting thin films to exploit the potential field enhancement when these films are thinner than their London penetration depth. Such field enhancement has been demonstrated in MgB2 thin films; here, the authors consider films of another type-II superconductor, niobium nitride (NbN). The authors present their work correlating stoichiometry and superconducting properties in NbN thin films and discuss the thickness dependence of their superconducting properties, which is important for their potential use in the proposed multilayer structure. While there are some previous studies on the relationship between stoichiometry and critical temperature T-C, the authors are the first to report on the correlation between stoichiometry and the lower critical field H-C1. (C) 2016 Author(s). All article content, except where otherwise noted, is licensed under a Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/)

Evaluation of a Chlamydia trachomatis-specific, commercial, real-time PCR for use with ocular swabs.

BACKGROUND: Trachoma, the leading infectious cause of blindness worldwide, is caused by conjunctival Chlamydia trachomatis infection. Trachoma is diagnosed clinically by observation of conjunctival inflammation and/or scarring; however, there is evidence that monitoring C. trachomatis infection may be required for elimination programmes. There are many commercial and 'in-house' nucleic acid amplification tests for the detection of C. trachomatis DNA, but the majority have not been validated for use with ocular swabs. This study evaluated a commercial assay, the Fast-Track Vaginal swab kit, using conjunctival samples from trachoma-endemic areas. An objective, biostatistical-based method for binary classification of continuous PCR data was developed, to limit potential user-bias in diagnostic settings. METHODS: The Fast-Track Vaginal swab assay was run on 210 ocular swab samples from Guinea-Bissau and Tanzania. Fit of individual amplification curves to exponential or sigmoid models, derivative and second derivative of the curves and final fluorescence value were examined for utility in thresholding for determining positivity. The results from the Fast-Track Vaginal swab assay were evaluated against a commercial test (Amplicor CT/NG) and a non-commercial test (in-house droplet digital PCR), both of whose performance has previously been evaluated. RESULTS: Significant evidence of exponential amplification (R2 > 0.99) and final fluorescence > 0.15 were combined for thresholding. This objective approach identified a population of positive samples, however there were a subset of samples that amplified towards the end of the cycling protocol (at or later than 35 cycles), which were less clearly defined. The Fast-Track Vaginal swab assay showed good sensitivity against the commercial (95.71) and non-commercial (97.18) tests. Specificity was lower against both (90.00 and 96.55, respectively). CONCLUSIONS: This study defined a simple, automated protocol for binary classification of continuous, real-time qPCR data, for use in an end-point diagnostic test. This method identified a population of positive samples, however, as with manual thresholding, a subset of samples that amplified towards the end of the cycling program were less easily classified. When used with ocular swabs, the Fast-Track Vaginal swab assay had good sensitivity for C. trachomatis detection, but lower specificity than the commercial and non-commercial assays it was evaluated against, possibly leading to false positives

Complete replication of hepatitis C virus in cell culture.

Many aspects of the hepatitis C virus (HCV) life cycle have not been reproduced in cell culture, which has slowed research progress on this important human pathogen. Here, we describe a full-length HCV genome that replicates and produces virus particles that are infectious in cell culture (HCVcc). Replication of HCVcc was robust, producing nearly 10(5) infectious units per milliliter within 48 hours. Virus particles were filterable and neutralized with a monoclonal antibody against the viral glycoprotein E2. Viral entry was dependent on cellular expression of a putative HCV receptor, CD81. HCVcc replication was inhibited by interferon-alpha and by several HCV-specific antiviral compounds, suggesting that this in vitro system will aid in the search for improved antivirals

Diabetic retinopathy in Tanzania: prevalence and risk factors at entry into a regional screening programme.

OBJECTIVE: The number of adults with diabetes in sub-Saharan Africa (SSA) is expected to almost double by 2035. This study investigated the prevalence of diabetic retinopathy (DR) and its risk factors at entry into a community-based screening programme. METHODS: All persons with diabetes screened for retinopathy at entry into a screening programme in Kilimanjaro Region, Tanzania between November 2010 and December 2014 were included. Fundus photographs were taken with a Topcon retinal camera following pupil dilation. Data were collected on BP, random blood sugar, duration of diabetes, BMI and visual acuity on entry. RESULTS: A total of 3187 persons were screened for DR. The prevalence of any DR was 27.9% (95%CI 26.4-29.5%) with background diabetic retinopathy (BDR), pre-proliferative diabetic retinopathy (PPDR) and proliferative diabetic retinopathy (PDR) having a prevalence of 19.1% (95% CI 17.7-20.4%), 6.0% (95%CI 5.2-6.8%) and 2.9% (95%CI 2.3-3.5%), respectively. Maculopathy was present in 16.1% (95%CI 14.8-17.4%) of participants. Multivariable logistic regression analysis for the presence of any DR found independent associations with duration of diabetes (P < 0.0001), systolic BP (P < 0.0001), random blood sugar (P < 0.0001) and attending a government hospital diabetic clinic (P = 0.0339). CONCLUSIONS: This study is the first to present data from a DR screening programme in SSA. The results will provide policymakers with data to aid planning of DR screening and treatment services in the African region. The study highlights the importance of managing comorbidities within DR screening programmes

The Arclight Ophthalmoscope: A Reliable Low-Cost Alternative to the Standard Direct Ophthalmoscope.

Background. The Arclight ophthalmoscope is a low-cost alternative to standard direct ophthalmoscopes. This study compared the Arclight ophthalmoscope with the Heine K180 direct ophthalmoscope to evaluate its reliability in assessing the vertical cup disc ratio (VCDR) and its ease of use (EOU). Methods. Eight medical students used both the Arclight and the Heine ophthalmoscopes to examine the optic disc in 9 subjects. An EOU score was provided after every examination (a higher score indicating that the ophthalmoscope is easier to use). A consultant ophthalmologist provided the reference standard VCDR. Results. 288 examinations were performed. The number of examinations that yielded an estimation of the VCDR was significantly higher for the Arclight ophthalmoscope (125/144, 85%) compared to the Heine ophthalmoscope (88/144, 61%) (p < 0.001). The mean difference from the reference standard VCDR was similar for both instruments, with a mean of -0.078 (95% CI: -0.10 to -0.056) for the Arclight and -0.072 (95% CI: -0.097 to -0.046) for Heine (p = 0.69). The overall EOU score was significantly higher for the Arclight ophthalmoscope (p < 0.001). Conclusion. The Arclight ophthalmoscope performs as well as, and is easier to use than, a standard direct ophthalmoscope, suggesting it is a reliable, low-cost alternative

High-resolution, H band Spectroscopy of Be Stars with SDSS-III/APOGEE: I. New Be Stars, Line Identifications, and Line Profiles

APOGEE has amassed the largest ever collection of multi-epoch, high-resolution (R~22,500), H-band spectra for B-type emission line (Be) stars. The 128/238 APOGEE Be stars for which emission had never previously been reported serve to increase the total number of known Be stars by ~6%. We focus on identification of the H-band lines and analysis of the emission peak velocity separations (v_p) and emission peak intensity ratios (V/R) of the usually double-peaked H I and non-hydrogen emission lines. H I Br11 emission is found to preferentially form in the circumstellar disks at an average distance of ~2.2 stellar radii. Increasing v_p toward the weaker Br12--Br20 lines suggests these lines are formed interior to Br11. By contrast, the observed IR Fe II emission lines present evidence of having significantly larger formation radii; distinctive phase lags between IR Fe II and H I Brackett emission lines further supports that these species arise from different radii in Be disks. Several emission lines have been identified for the first time including ~16895, a prominent feature in the spectra for almost a fifth of the sample and, as inferred from relatively large v_p compared to the Br11-Br20, a tracer of the inner regions of Be disks. Unlike the typical metallic lines observed for Be stars in the optical, the H-band metallic lines, such as Fe II 16878, never exhibit any evidence of shell absorption, even when the H I lines are clearly shell-dominated. The first known example of a quasi-triple-peaked Br11 line profile is reported for HD 253659, one of several stars exhibiting intra- and/or extra-species V/R and radial velocity variation within individual spectra. Br11 profiles are presented for all discussed stars, as are full APOGEE spectra for a portion of the sample.Comment: accepted in A

Interventions to promote access to eye care for non-Indigenous, non-dominant ethnic groups in high-income countries: a scoping review protocol.

INTRODUCTION: For many people, settling in a new country is associated with a new identity as an 'ethnic minority', one that can remain through future generations. People who are culturally distinct from the dominant population group may experience a variety of barriers to accessing healthcare, including linguistic and cultural barriers in communication, navigation of an unfamiliar health system and unconscious or overt discrimination. Here, we outline the protocol of a scoping review to identify, describe and summarise interventions aimed at improving access to eye care for non-Indigenous, non-dominant ethnic groups residing in high-income countries. METHODS AND ANALYSIS: We will search MEDLINE, Embase and Global Health from their inception to July 2019. We will include studies of any design that describe an intervention to promote access to eye care for non-Indigenous, non-dominant ethnic groups. Two authors will independently review titles, abstracts and full-text articles for inclusion. Reference lists from all included articles will also be searched. In cases of disagreement between initial reviewers, a third author will help resolve the conflict. For each included article, we will extract data about the target population, details of the intervention delivered and the effectiveness of or feedback from the intervention. Overall findings will be summarised with descriptive statistics and thematic analysis. ETHICS AND DISSEMINATION: This review will summarise existing literature and as such ethics approval is not required. We will publish the review in an open-access, peer-reviewed journal, and draft appropriate summaries for dissemination to the wider community. This wider community could include clinicians, policymakers, health service managers and organisations that work with non-dominant ethnic groups. Our findings will also feed into the ongoing Lancet Global Health Commission on Global Eye Health

Identification of candidate MYB transcription factors that influence CslF6 expression in barley grain

(1,3;1,4)-β-Glucan is a non-cellulosic polysaccharide required for correct barley grain fill and plant development, with industrial relevance in the brewing and the functional food sector. Barley grains contain higher levels of (1,3;1,4)-β-glucan compared to other small grain cereals and this influences their end use, having undesirable effects on brewing and distilling and beneficial effects linked to human health. HvCslF6 is the main gene contributing to (1,3;1,4)-β-glucan biosynthesis in the grain. Here, the transcriptional regulation of HvCslF6 was investigated using an in-silico analysis of transcription factor binding sites (TFBS) in its putative promoter, and functional characterization in a barley protoplast transient expression system. Based on TFBS predictions, TF classes AP2/ERF, MYB, and basic helix-loop-helix (bHLH) were over-represented within a 1,000 bp proximal HvCslF6 promoter region. Dual luciferase assays based on multiple HvCslF6 deletion constructs revealed the promoter fragment driving HvCslF6 expression. Highest HvCslF6 promoter activity was narrowed down to a 51 bp region located −331 bp to −382 bp upstream of the start codon. We combined this with TFBS predictions to identify two MYB TFs: HvMYB61 and HvMYB46/83 as putative activators of HvCslF6 expression. Gene network analyses assigned HvMYB61 to the same co-expression module as HvCslF6 and other primary cellulose synthases (HvCesA1, HvCesA2, and HvCesA6), whereas HvMYB46/83 was assigned to a different module. Based on RNA-seq expression during grain development, HvMYB61 was cloned and tested in the protoplast system. The transient over-expression of HvMYB61 in barley protoplasts suggested a positive regulatory effect on HvCslF6 expression