Glaucoma detection: the content of optometric eye examinations for a presbyopic patient of African racial descent

Aims: Standardised patient (SP) methodology is the gold standard for evaluating clinical practice. We investigated the content of optometric eyecare for an early presbyopic SP of African racial descent, an “at-risk” patient group for primary open-angle glaucoma (POAG). Methods: A trained actor presented unannounced as a 44-year-old patient of African racial descent, complaining of recent near vision difficulties, to 100 community optometrists for an audio-recorded eye examination. The eye examinations were subsequently assessed via a checklist based on evidence-based POAG reviews, clinical guidelines and expert panel opinion. Results: Ninety-five per cent of optometrists carried out optic disc assessment and tonometry, which conforms to the UK College of Optometrists’ advice that those patients aged >40 years should receive at least two of the following tests: tonometry, optic disc assessment, visual field testing. Thirty-five per cent of optometrists carried out all of these tests and 6% advised the SP of increased POAG risk in those of African racial descent. Conclusion: SP encounters are an effective measure of optometric clinical practice. As in other healthcare disciplines, there are substantial differences between optometrists in the depth of their clinical investigations, challenging the concept of a “standard sight test”. There is a need for continuing professional development (CPD) in glaucoma screening, in which the increased risk of POAG in those of African racial descent should be emphasised

Melanoma in Buckinghamshire: Data from the Inception of the Skin Cancer Multidisciplinary Team

Background. Melanoma incidence is increasing faster than any other cancer in the UK. The introduction of specialist skin cancer multidisciplinary teams intends to improve the provision of care to patients suffering from melanoma. This study aims to investigate the management and survival of patients diagnosed with melanoma around the time of inception of the regional skin cancer multidisciplinary team both to benchmark the service against published data and to enable future analysis of the impact of the specialisation of skin cancer care. Methods. All patients diagnosed with primary cutaneous melanoma between January 1, 2003 and December 3, 2005 were identified. Data on clinical and histopathological features, surgical procedures, complications, disease recurrence and 5-year survival were collected and analysed. Results. Two hundred and fourteen patients were included, 134 female and 80 males. Median Breslow thickness was 0.74 mm (0.7 mm female and 0.8 mm male). Overall 5-year survival was 88% (90% female and 85% male). Discussion. Melanoma incidence in Buckinghamshire is in keeping with published data. Basic demographics details concur with classic melanoma distribution and more recent trends, with increased percentage of superficial spreading and thin melanomas, leading to improved survival are reflected

Fenofibrate in the management of AbdoMinal aortic anEurysm (FAME): Study protocol for a randomised controlled trial

Background: Abdominal aortic aneurysm (AAA) is a slowly progressive destructive process of the main abdominal artery. Experimental studies indicate that fibrates exert beneficial effects on AAAs by mechanisms involving both serum lipid modification and favourable changes to the AAA wall. Methods/design: Fenofibrate in the management of AbdoMinal aortic anEurysm (FAME) is a multicentre, randomised, double-blind, placebo-controlled clinical trial to assess the effect of orally administered therapy with fenofibrate on key pathological markers of AAA in patients undergoing open AAA repair. A total of 42 participants scheduled for an elective open AAA repair will be randomly assigned to either 145 mg of fenofibrate per day or identical placebo for a minimum period of 2 weeks prior to surgery. Primary outcome measures will be macrophage number and osteopontin (OPN) concentration within the AAA wall as well as serum concentrations of OPN. Secondary outcome measures will include levels of matrix metalloproteinases and proinflammatory cytokines within the AAA wall, periaortic fat and intramural thrombus and circulating concentrations of AAA biomarkers. Discussion: At present, there is no recognised medical therapy to limit AAA progression. The FAME trial aims to assess the ability of fenofibrate to alter tissue markers of AAA pathology. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12612001226897. Registered on 20 November 2012. © 2017 The Author(s)

Longitudinal Changes of Fixation Location and Stability Within 12 Months in Stargardt Disease: ProgStar Report No. 12

Purpose: To investigate the natural history of Stargardt disease (STGD1) using fixation location and fixation stability. // Design: Multicenter, international, prospective cohort study. // Methods: Fixation testing was performed using the Nidek MP-1 microperimeter as part of the prospective, multicenter, natural history study on the Progression of Stargardt disease (ProgStar). A total of 238 patients with ABCA4-related STGD1 were enrolled at baseline (bilateral enrollment in 86.6%) and underwent repeat testing at months 6 and 12. // Results: Outcome measures included the distance of the preferred retinal locus from the fovea (PRL) and the bivariate contour ellipse area (BCEA). After 12 months of follow-up, the change in the eccentricity of the PRL from the anatomic fovea was −0.0014 degrees (95% confidence interval [CI], −0.27 degrees, 0.27 degrees; P = .99). The deterioration in the stability of fixation as expressed by a larger BCEA encompassing 1 standard deviation of all fixation points was 1.21 degrees squared (deg2) (95% CI, −1.23 deg2, 3.65 deg2; P = .33). Eyes with increases and decreases in PRL eccentricity and/or BCEA values were observed. // Conclusions: Our observations point to the complexity of fixation parameters. The association of increasingly eccentric and unstable fixation with longer disease duration that is typically found in cross-sectional studies may be countered within individual patients by poorly understood processes like neuronal adaptation. Nevertheless, fixation parameters may serve as useful secondary outcome parameters in selected cases and for counseling patients to explain changes to their visual functionality

Rural adolescents\u27 help-seeking intentions for emotional problems: the influence of perceived benefits and stoicism

Objective: This study explores the factors that influence adolescents\u27 help-seeking intentions. Specifically, the study investigates the extent to which perceived benefits of help seeking, stoicism, gender and symptoms of psychological distress are associated with intentions to seek professional help for emotional problems.Design and setting: A cross sectional self-report questionnaire was administered to adolescents recruited from seven high schools in rural towns in the Riverina region of New South Wales.Participants: A total of 778 adolescents were recruited. The sample included 373 male and 404 female participants between 13 and 18 years of age.Main outcome measure(s): Participants completed an anonymous self-report questionnaire designed to measure help-seeking intentions in the advent that they were to experience emotional problems, psychological distress symptoms, perceived benefits of help seeking and stoicism.Results: In all, 17% of male participants and 29% of female participants reported they would be likely to seek help from doctors if they were to experience emotional problems. In total, 15% of male participants and 23% of female participants reported they would be likely to seek help from other health care professionals. Multiple regression analysis suggested that adolescents are more likely to seek help from professionals if they perceive help seeking as beneficial (t = 12.91; P \u3c 0.001). Female particpants reported that they were more likely to seek help than male participants (t = 2.69; P = 0.01).Conclusions: Findings suggest that adolescents are reluctant to seek professional help if experiencing emotional problems, because they do not believe professional help seeking is beneficial. Improving adolescents\u27 beliefs about the benefits of professional help seeking might be a key strategy for increasing their use of professional health services to address mental health problem

Analysis and characterization of naphthenic acids by gas chromatography- electron impact mass spectrometry of tert.-butyldimethylsilyl derivatives

The renewed interest in naphthenic acid (NA) as a wood preservative has driven the need for analytical techniques to characterize commercial supplies of NA. The compositional heterogeneity of NA makes analytical characterization extremely difficult. Fluoride ion chemical ionization mass spectrometry (FI-MS) has proven to be an effective technique in NA characterization. However, FI-MS is very complicated and expensive to perform. In this paper, an alternative to the FI-MS technique is presented which offers similar results with a more widely available bench-top electron impact (EI) mass spectrometer. By derivatization of NA components to their tert.-butyldimethylsilyl analogs, the extent of molecular fragmentation is greatly decreased and strong base peaks representing the unfragmented NA constituents are obtained in the El spectra. Molecular mass and tentative structures can be deduced based on sites of unsaturation

Characterization of alpha-pinene-degrading microorganisms and application to a bench-scale biofiltration system for VOC degradation

A study was conducted to isolate and characterize monoterpene-degrading microorganisms and apply them to a biofiltration unit for use in degrading high levels of α-pinene. Soil from a monoterpene-contaminated site was used with enrichment culture techniques to recover a consortium of bacteria able to utilize α-pinene as the sole source of carbon and energy. The Biolog system was utilized to identify the bacteria as Pseudomonas fluorescens and Alcaligenes xylosoxidans. Aerobic growth and biodegradation studies confirmed that rapid growth and biodegradation were being achieved with α-pinene. Complete degradation of α-pinene was achieved in 36 h with a maximum rate of degradation of 3.9 mg/L/h. The microorganisms were placed in a biofiltration column and demonstrated good removal of α-pinene from an air stream at concentrations averaging 295 ppmv. A nitrogen test was performed and confirmed that the removal of α-pinene was due to biological activity. Given the ability of these microorganisms to utilize high levels of α-pinene, they will be used in a coupled treatment system using a physical/chemical adsorption/desorption unit coupled to a biofiltration column. Often, biofiltration studies are performed using much lower levels of analyte in the influent air stream. However, the ability of these microorganisms to utilize higher levels of compounds expands the capabilities for future coupled biofiltration systems. During future studies, high flow rates with low levels of analyte will be concentrated so that a higher analyte concentration and lower flow rate can be utilized with the biofilter

TBX2 controls a proproliferative gene expression program in melanoma

Senescence shapes embryonic development, plays a key role in aging, and is a critical barrier to cancer initiation, yet how senescence is regulated remains incompletely understood. TBX2 is an antisenescence T-box family transcription repressor implicated in embryonic development and cancer. However, the repertoire of TBX2 target genes, its cooperating partners, and how TBX2 promotes proliferation and senescence bypass are poorly understood. Here, using melanoma as a model, we show that TBX2 lies downstream from PI3K signaling and that TBX2 binds and is required for expression of E2F1, a key antisenescence cell cycle regulator. Remarkably, TBX2 binding in vivo is associated with CACGTG E-boxes, present in genes down-regulated by TBX2 depletion, more frequently than the consensus T-element DNA binding motif that is restricted to Tbx2 repressed genes. TBX2 is revealed to interact with a wide range of transcription factors and cofactors, including key components of the BCOR/PRC1.1 complex that are recruited by TBX2 to the E2F1 locus. Our results provide key insights into how PI3K signaling modulates TBX2 function in cancer to drive proliferation