Clinical and cost-effectiveness of internal limiting membrane peeling for patients with idiopathic full thickness macular hole. Protocol for a Randomised Controlled Trial : FILMS (Full-thickness macular hole and Internal Limiting Membrane peeling Study)

Background: A full-thickness macular hole (FTMH) is a common retinal condition associated with impaired vision. Randomised controlled trials (RCTs) have demonstrated that surgery, by means of pars plana vitrectomy and post-operative intraocular tamponade with gas, is effective for stage 2, 3 and 4 FTMH. Internal limiting membrane (ILM) peeling has been introduced as an additional surgical manoeuvre to increase the success of the surgery; i.e. increase rates of hole closure and visual improvement. However, little robust evidence exists supporting the superiority of ILM peeling compared with no-peeling techniques. The purpose of FILMS (Fullthickness macular hole and Internal Limiting Membrane peeling Study) is to determine whether ILM peeling improves the visual function, the anatomical closure of FTMH, and the quality of life of patients affected by this disorder, and the cost-effectiveness of the surgery. Methods/Design: Patients with stage 2–3 idiopathic FTMH of less or equal than 18 months duration (based on symptoms reported by the participant) and with a visual acuity ≤ 20/40 in the study eye will be enrolled in this FILMS from eight sites across the UK and Ireland. Participants will be randomised to receive combined cataract surgery (phacoemulsification and intraocular lens implantation) and pars plana vitrectomy with postoperative intraocular tamponade with gas, with or without ILM peeling. The primary outcome is distance visual acuity at 6 months. Secondary outcomes include distance visual acuity at 3 and 24 months, near visual acuity at 3, 6, and 24 months, contrast sensitivity at 6 months, reading speed at 6 months, anatomical closure of the macular hole at each time point (1, 3, 6, and 24 months), health related quality of life (HRQOL) at six months, costs to the health service and the participant, incremental costs per quality adjusted life year (QALY) and adverse events. Discussion: FILMS will provide high quality evidence on the role of ILM peeling in FTMH surgery. Trial registration: This trial is registered with Current Controlled Trials ISRCTN number 33175422 and Clinical Trials.gov identifier NCT00286507.Chief Scientist Office, Scotland (project ref no CZH/4/235), NHS GrampianPeer reviewedPublisher PD

Global coral bleaching event detection from satellite monitoring of extreme heat stress

Over the past four decades, coral bleaching events have occurred with increasing frequency and severity, directly linked to increasing ocean temperature due to climate change. For the latter half of that period, satellite monitoring by NOAA Coral Reef Watch in near real-time has provided invaluable insight into bleaching risk. Here, we describe a novel application of those products to develop basin-scale tools for tracking the development of extreme heat events that enable monitoring of global coral bleaching events. Case studies of historical extreme events (1982-2018) across the three tropical ocean basins (Indian, Pacific and Atlantic) were analysed using this basin-scale approach to identify key thresholds of heat stress extent for the definition of global bleaching. Global-scale events are apparent when all three tropical basins experience heat stress in at least 10% of reef-containing locations. An 8-month ‘detection window’ was determined as the optimal period of time through which pixels exposed to heat stress should continue to be counted as part of a basin-scale event to account for seasonal variations across ocean basins. Understanding the broader context of basin-scale conditions can inform management of individual reefs, management networks and other reef stakeholders. Operationalising this product for near real-time delivery will provide an effective communication of the status of coral reefs around the world during an era of unprecedented climate threats

Removal of pharmaceuticals in WWTP effluents by ozone and hydrogen peroxide

Ozonation to achieve removal of pharmaceuticals from wastewater effluents, with pH values in the upper and lower regions of the typical range for Swedish wastewater, was investigated. The main aim was to study the effects of varying pH values (6.0 and 8.0), and if small additions of H2O2 prior to ozone treatment could improve the removal and lower the reaction time. The effluents studied differed in their chemical characteristics, particularly in terms of alkalinity (65.3-427 mg center dot l(-1) HCO3-), COD (18.2-41.8 mg center dot l(-1)), DOC (6.9-12.5 mg center dot l(-1)), ammonium content (0.02-3.6 mg center dot l(-1)) and specific UV absorbance (1.78-2.76 l center dot mg(-1)center dot m(-1)). As expected, lower ozone decomposition rates were observed in the effluents at pH 6.0 compared to pH 8.0. When pH 8.0 effluents were ozonated, a higher degree of pharmaceutical removal occurred in the effluent with low specific UV absorbance. For pH 6.0 effluents, the removal of pharmaceuticals was most efficient in the effluent with the lowest organic content. The addition of H2O2 had no significant effect on the quantitative removal of pharmaceuticals but enhanced the ozone decomposition rate. Thus, H2O2 addition increased the reaction rate. In practice, this will mean that the reactor volume needed for the ozonation of wastewater effluents can be reduced