Termoterapia transpupilar en neovascularización subretiniana oculta secundaria a degeneración macular asociada a la edad. Primeros resultados

To determine the efficacy of transpupillary thermotherapy (TTT) to treat choroidal neovascularization (CNV) in patients with age-related macular degeneration (ARMD). Patients and Methods: Eight patients (ten eyes) with occult CNV were treated by TTT. A 810 nm diode laser was used to perform TTT. The diode laser was delivered through a panfunduscopic contact lens. Results: Three eyes showed a visual acuity improvement and a decrease in exudation on fluorescein angiography. Four eyes remained stable. Nevertheless, lesions worsened after treatment in three cases. One of these cases suffered an overtreatment. Conclusions: TTT may be a useful therapy in some cases of CNV in patients with age-related macular degeneration. Randomized and multicentric studies are necessary to stablish precise indications of this therap

Concerted Transport and Phosphorylation of Diacylglycerol at ER-PM Contacts Sites Regulates Phospholipid Dynamics During Stress

A universal response of plants to environmental stresses is the activation of plasma membrane (PM) phospholipase C (PLC) that hydrolyzes phosphatidylinositol phosphate (PIP) to produce soluble inositol phosphate (IP) and diacylglycerol (DAG). DAG produced in this way can be either phosphorylated by PM diacylglycerol kinases (DGKs) to produce the second messenger phosphatidic acid (PA) or transferred to the endoplasmic reticulum (ER) by the Synaptotagmin 1 (SYT1) protein at ER-PM Contact Sites (CS). In Arabidopsis, the clearance of DAG at the PM (avoiding deleterious accumulation) by the transfer activity of SYT is essential to maintain PM stability after stress. In this study we identify that DGK1 and DGK2 form a module with SYT1 at ER-PM CS through interaction of their C1 and C2 domains respectively. Global transcriptomic and metabolomic analyses confirms that SYT1 and DGK1/DGK2 are functionally related and lipidomic analysis supports the hypothesis that DGK1 and DGK2 function at the ER by phosphorylating DAG transferred by SYT1 from the PM. DGK1 and DGK2 show structural similarity to human DGKε, the DGK isoform that function at ER-PM CS in the phosphoinositide (PI) cycle. Our data indicate that components of the PI cycle are conserved between animals and plants and provide a novel mechanism leading to an increase in the efficiency of the PI cycle by channeling the transport and hydrolysis of DAG at the ER-PM CS

A decision support system for assessing management interventions in a mental health ecosystem: The case of Bizkaia (Basque Country, Spain)

Evidence-informed strategic planning is a top priority in Mental Health (MH) due to the burden associated with this group of disorders and its societal costs. However, MH systems are highly complex, and decision support tools should follow a systems thinking approach that incorporates expert knowledge. The aim of this paper is to introduce a new Decision Support System (DSS) to improve knowledge on the health ecosystem, resource allocation and management in regional MH planning. The Efficient Decision Support-Mental Health (EDeS-MH) is a DSS that integrates an operational model to assess the Relative Technical Efficiency (RTE) of small health areas, a Monte-Carlo simulation engine (that carries out the Monte-Carlo simulation technique), a fuzzy inference engine prototype and basic statistics as well as system stability and entropy indicators. The stability indicator assesses the sensitivity of the model results due to data variations (derived from structural changes). The entropy indicator assesses the inner uncertainty of the results. RTE is multidimensional, that is, it was evaluated by using 15 variable combinations called scenarios. Each scenario, designed by experts in MH planning, has its own meaning based on different types of care. Three management interventions on the MH system in Bizkaia were analysed using key performance indicators of the service availability, placement capacity in day care, health care workforce capacity, and resource utilisation data of hospital and community care. The potential impact of these interventions has been assessed at both local and system levels. The system reacts positively to the proposals by a slight increase in its efficiency and stability (and its corresponding decrease in the entropy). However, depending on the analysed scenario, RTE, stability and entropy statistics can have a positive, neutral or negative behaviour. Using this information, decision makers can design new specific interventions/policies. EDeS-MH has been tested and face-validated in a real management situation in the Bizkaia MH system.The present research study is frameworked in the REFINEMENT Spain project (Project PI15/01986), funded by the Carlos III Health Institute (http://www.isciii.es/)

The Listening Network and Cochlear Implant Benefits in Hearing-Impaired Adults

Older adults with mild or no hearing loss make more errors and expend more effort listening to speech. Cochlear implants (CI) restore hearing to deaf patients but with limited fidelity. We hypothesized that patient-reported hearing and health-related quality of life in CI patients may similarly vary according to age. Speech Spatial Qualities (SSQ) of hearing scale and Health Utilities Index Mark III (HUI) questionnaires were administered to 543 unilaterally implanted adults across Europe, South Africa, and South America. Data were acquired before surgery and at 1, 2, and 3 years post-surgery. Data were analyzed using linear mixed models with visit, age group (18–34, 35–44, 45–54, 55–64, and 65+), and side of implant as main factors and adjusted for other covariates. Tinnitus and dizziness prevalence did not vary with age, but older groups had more preoperative hearing. Preoperatively and postoperatively, SSQ scores were significantly higher (¿0.75–0.82) for those aged <45 compared with those 55+. However, gains in SSQ scores were equivalent across age groups, although postoperative SSQ scores were higher in right-ear implanted subjects. All age groups benefited equally in terms of HUI gain (0.18), with no decrease in scores with age. Overall, younger adults appeared to cope better with a degraded hearing before and after CI, leading to better subjective hearing performance.

The MAVERIC Survey: A Red Straggler Binary with an Invisible Companion in the Galactic Globular Cluster M10

We present the discovery and characterization of a radio-bright binary in the Galactic globular cluster M10. First identified in deep radio continuum data from the Karl G. Jansky Very Large Array, M10-VLA1 has a flux density of 27 ± 4 μJy at 7.4 GHz and a flat-to-inverted radio spectrum. Chandra imaging shows an X-ray source with L X ≈ 1031 erg s−1 matching the location of the radio source. This places M10-VLA1 within the scatter of the radio-X-ray luminosity correlation for quiescent stellar-mass black holes, and a black hole X-ray binary is a viable explanation for this system. The radio and X-ray properties of the source disfavor, but do not rule out, identification as an accreting neutron star or white dwarf system. Optical imaging from the Hubble Space Telescope and spectroscopy from the SOAR telescope show that the system has an orbital period of 3.339 days and an unusual "red straggler" component: an evolved star found redward of the M10 red giant branch. These data also show UV/optical variability and double-peaked Hα emission characteristic of an accretion disk. However, SOAR spectroscopic monitoring reveals that the velocity semi-amplitude of the red straggler is low. We conclude that M10-VLA1 is most likely either a quiescent black hole X-ray binary with a rather face-on (i < 4°) orientation or an unusual flaring RS Canum Venaticorum variable-type active binary, and discuss future observations that could distinguish between these possibilities

Process evaluation in the field: global learnings from seven implementation research hypertension projects in low-and middle-income countries

Background Process evaluation is increasingly recognized as an important component of effective implementation research and yet, there has been surprisingly little work to understand what constitutes best practice. Researchers use different methodologies describing causal pathways and understanding barriers and facilitators to implementation of interventions in diverse contexts and settings. We report on challenges and lessons learned from undertaking process evaluation of seven hypertension intervention trials funded through the Global Alliance of Chronic Diseases (GACD). Methods Preliminary data collected from the GACD hypertension teams in 2015 were used to inform a template for data collection. Case study themes included: (1) description of the intervention, (2) objectives of the process evaluation, (3) methods including theoretical basis, (4) main findings of the study and the process evaluation, (5) implications for the project, policy and research practice and (6) lessons for future process evaluations. The information was summarized and reported descriptively and narratively and key lessons were identified. Results The case studies were from low- and middle-income countries and Indigenous communities in Canada. They were implementation research projects with intervention arm. Six theoretical approaches were used but most comprised of mixed-methods approaches. Each of the process evaluations generated findings on whether interventions were implemented with fidelity, the extent of capacity building, contextual factors and the extent to which relationships between researchers and community impacted on intervention implementation. The most important learning was that although process evaluation is time consuming, it enhances understanding of factors affecting implementation of complex interventions. The research highlighted the need to initiate process evaluations early on in the project, to help guide design of the intervention; and the importance of effective communication between researchers responsible for trial implementation, process evaluation and outcome evaluation. Conclusion This research demonstrates the important role of process evaluation in understanding implementation process of complex interventions. This can help to highlight a broad range of system requirements such as new policies and capacity building to support implementation. Process evaluation is crucial in understanding contextual factors that may impact intervention implementation which is important in considering whether or not the intervention can be translated to other contexts