Vitrectomy as an Adjunct to Treat-and-Extend Anti-VEGF Injections for Diabetic Macular Edema: The Vitrectomy in Diabetic Macular Oedema (VIDEO) Randomized Clinical Trial.

Importance: There are reported benefits from vitrectomy for diabetic macular edema (DME); however, data precede anti-vascular endothelial growth therapy (VEGF) therapy, supporting a need to assess the current role of vitrectomy. Objective: To determine rates of recruitment and efficacy outcomes of vitrectomy plus internal limiting membrane (ILM) peeling adjunctive to treat-and-extend (T&E) anti-VEGF injections for diabetic macular edema (DME). Design, Setting, and Participants: This was a single-masked, multicenter randomized clinical trial at 21 sites in the United Kingdom from June 2018 to January 2021, evaluating single eyes of treatment-naive patients with symptomatic vision loss from DME for less than 1 year. Inclusion criteria were best-corrected visual acuity (BCVA) Early Treatment Diabetic Retinopathy Study letter score greater than 35 (approximate Snellen equivalent, 20/200 or better) and central subfield thickness (CST) greater than 350 µm after 3 monthly intravitreal injections of ranibizumab or aflibercept. Data analysis was performed in July 2023. Interventions: Patients were randomized 1:1 into vitrectomy plus standard care or standard care alone and further stratified into groups with vs without vitreomacular interface abnormality. Both groups received a T&E anti-VEGF injection regimen with aflibercept, 2 mg, or ranibizumab, 0.5 mg. The vitrectomy group additionally underwent pars plana vitrectomy with epiretinal membrane or ILM peel within 1 month of randomization. Main Outcomes and Measures: Rate of recruitment and distance BCVA. Secondary outcome measures were CST, change in BCVA and CST, number of injections, rate of completed follow-up, and withdrawal rate. Results: Over 32 months, 47 of a planned 100 patients were enrolled; 42 (89%; mean [SD] age, 63 [11] years; 26 [62%] male) completed 12-month follow-up visits. Baseline characteristics appeared comparable between the control (n = 23; mean [SD] age, 66 [10] years) and vitrectomy (n = 24; mean [SD] age, 62 [12] years) groups. No difference in 12-month BCVA was noted between groups, with a 12-month median (IQR) BCVA letter score of 73 (65-77) letters (Snellen equivalent, 20/40) in the control group vs 77 (67-81) letters (Snellen equivalent, 20/32) in the vitrectomy group (difference, 4 letters; 95% CI, -8 to 2; P = .24). There was no difference in BCVA change from baseline (median [IQR], -1 [-3 to 2] letters for the control group vs -2 [-8 to 2] letters for the vitrectomy group; difference, 1 letter; 95% CI, -5 to 7; P = .85). No difference was found in CST changes (median [IQR], -94 [-122 to 9] µm for the control group vs -32 [-48 to 25] µm for the vitrectomy group; difference, 62 µm; 95% CI, -110 to 11; P = .11). Conclusions and Relevance: Enrollment goals could not be attained. However, with 47 participants, evidence did not support a clinical benefit of vitrectomy plus ILM peeling as an adjunct to a T&E regimen of anti-VEGF therapy for DME. Trial Registration: isrctn.org Identifier: ISRCTN59902040.

Translating in-person care to telehealth: analysis of GP consultations on musculoskeletal conditions.

BACKGROUND: The COVID-19 pandemic led to a rapid transition to telehealth particularly in general practice (GP) where continuous care for chronic conditions such as musculoskeletal (MSK) is provided. AIM: To determine the appropriateness of telehealth for MSK by identifying whether in-person tasks can be supported remotely via telehealth. DESIGN & SETTING: This study is a secondary analysis of the HaRI dataset. This dataset comprises of 281 videos of recorded GP consultations. The data set includes 10 general practitioners, across 8 separate clinics and was collected during 2017 in the United Kingdom. METHOD: Content analysis was conducted to identify the clinical tasks, physical examinations and physical artefacts used during the consultations. A scoring method applying two key metrics was developed to assess the translatability of clinical tasks to telehealth. RESULTS: Across the 31 MSK consultations analysed, 12 clinical tasks, five physical examinations and 12 physical artefacts were observed. Of clinical tasks, 17% (2/12) were deemed to be 'easily translatable over telehealth' and 50% (5/12) were deemed 'relatively easy to be translated over telehealth'. Only 17% (2/12) of tasks were rated 'moderately translatable over telehealth', and 17% (2/12) were deemed 'potentially translatable over telehealth'. No clinical tasks in this study were categorised as untranslatable to telehealth. The average telehealth translatability score was 7.1/10. CONCLUSION: Most clinical tasks observed during in-person GP consultations with MSK patients are translatable to telehealth. Further research is necessary to investigate the long-term efficacy and safety of telehealth utilisation for MSK in primary care.

Virtual physical examination in teleconsultation: A scoping review.

BACKGROUND: The conduct of virtual physical examination has provided significant information for the diagnosis during a teleconsultation session, especially during the COVID-19 pandemic, where in-person physical examinations have been greatly compromised. OBJECTIVE: The aim of this scoping review was to provide a comprehensive overview of the available evidence concerning virtual physical examination (VPE) in all healthcare settings during the COVID-19 pandemic. The review focuses on types of VPE, technological and non-technological approaches, patient and clinician experiences, as well as barriers and facilitators of VPE. METHODS: A literature search was conducted across three databases, namely MEDLINE, Embase, and Scopus. Only studies in the English language with primary research data collected from December 2019 to January 2023 were included. A narrative analysis, highlighting patients' and clinicians' experiences, was conducted on the included studies. This scoping review was reported using The PRISMA extension for scoping reviews (PRISMA-ScR) Checklist. RESULTS: A total of 25 articles meeting eligibility criteria were identified. Three major types of VPE included were musculoskeletal, head and neck, and chest exams. Sixteen studies involved specific technological aids, while three studies involved non-technological aids. Patients found VPE helped them to better assess their disease conditions, or aided their clinicians' understanding of their conditions. Clinicians also reported that VPE had provided enough clinically relevant information for decision-making in 2 neurological evaluations. Barriers to conducting VPE included technological challenges, efficacy concerns, confidence level of assistants, as well as patient health conditions, health literacy, safety, and privacy. CONCLUSIONS: Patients found virtual physical examination (VPE) helpful in understanding their own conditions, and clinicians found it useful for better assessing patient's conditions. From the clinicians' point of view, VPE provided sufficient clinically relevant information for decision-making in neurological evaluations. Major barriers identified for VPE included technological issues, patient's health conditions, and their health literacy.

Flow Experiences in Shopping Activities: Testing Materialistic Goal Orientation as an Antecedent.

Given that flow experiences when shopping can encourage positive brand attitudes and purchase behaviours, consumer psychologists are interested in the antecedents to flow within retail environments. Emerging findings suggest that a materialistic goal orientation can undermine an individual's tendency to have optimal experiences of flow. However, this existing work has been conducted largely within the field of Environmental Psychology and thus focused on flow experiences that occur in more ecologically sustainable activities. We hypothesized that materialism may not have the same flow-limiting effects when participants are engaged in shopping activities, which are more in line with the goals of highly materialistic individuals. Across two studies, we tested the relationship between materialism and the experience of flow during shopping activities using cross-sectional (N = 886) and experimental (N = 140) methods. Contrary to our hypothesis, both studies documented a negative effect of materialism on flow experiences when shopping, and this was not moderated by the type of store browsed. Accordingly, it appears that a materialistic goal orientation limits the extent to which people can have enjoyable flow experiences even during activities which are consistent with the life goals of highly materialistic individuals. We discuss the implications of these findings for wellbeing, marketing, and sustainability.

Self-transcendent experiences as promoters of ecological wellbeing? Exploration of the evidence and hypotheses to be tested.

In recent years, much has been written on the role of different mental states and their potential to influence our way of thinking and, perhaps more importantly, the way we act. With the recent acceleration of environmental and mental health issues, alongside the limited effectiveness of existing interventions, an exploration of new approaches to deliver transformative change is required. We therefore explore the emerging potential of a type of mental state known as self-transcendent experiences (STEs) as a driver of ecological wellbeing. We focus on four types of STEs: those facilitated by experiences of flow, awe, and mindfulness, as well as by psychedelic-induced experiences. Some of these experiences can occur naturally, through sometimes unexpected encounters with nature or during immersion in every-day activities that one intrinsically enjoys, as well as through more intentional practices such as meditation or the administration of psychedelics in controlled, legal settings. We explore the evidence base linking each of the four types of STE to ecological wellbeing before proposing potential hypotheses to be tested to understand why STEs can have such beneficial effects. We end by looking at the factors that might need to be considered if STEs are going to be practically implemented as a means of achieving ecological wellbeing.

A critique of the marketisation of long-term residential and nursing home care.

Long-term care systems across countries within the Organisation for Economic Co-operation and Development have undergone a progressive marketisation and financialisation in recent decades, characterised by the embedding of neoliberal market values such as competition, consumer choice, and the profit motive. In this Personal View, we argue that these make poor guiding principles for the care sector, identifying the dysfunctional dynamics that arise as a result, and reflecting on the clinical implications of each, with a focus on facility-based care. We outline why providers can scarcely respond to competitive forces without compromising care quality. We explain why the promotion of consumer choice cannot effectively motivate improvements to quality of care. And we explore how privatisation opens the door to predatory financial practices. We conclude by considering how far proposals for reform can take us, ultimately arguing for a rejection of neoliberal market ideology, and calling for sector-wide discussions about what principles would be more fitting for a caring economy.

The power, potential, benefits, and challenges of implementing high-throughput sequencing in food safety systems.

The development and application of modern sequencing technologies have led to many new improvements in food safety and public health. With unprecedented resolution and big data, high-throughput sequencing (HTS) has enabled food safety specialists to sequence marker genes, whole genomes, and transcriptomes of microorganisms almost in real-time. These data reveal not only the identity of a pathogen or an organism of interest in the food supply but its virulence potential and functional characteristics. HTS of amplicons, allow better characterization of the microbial communities associated with food and the environment. New and powerful bioinformatics tools, algorithms, and machine learning allow for development of new models to predict and tackle important events such as foodborne disease outbreaks. Despite its potential, the integration of HTS into current food safety systems is far from complete. Government agencies have embraced this new technology, and use it for disease diagnostics, food safety inspections, and outbreak investigations. However, adoption and application of HTS by the food industry have been comparatively slow, sporadic, and fragmented. Incorporation of HTS by food manufacturers in their food safety programs could reinforce the design and verification of effectiveness of control measures by providing greater insight into the characteristics, origin, relatedness, and evolution of microorganisms in our foods and environment. Here, we discuss this new technology, its power, and potential. A brief history of implementation by public health agencies is presented, as are the benefits and challenges for the food industry, and its future in the context of food safety.

The Problematic Role of Materialistic Values in the Pursuit of Sustainable Well-Being.

Strong materialistic values help to maintain consumer capitalism, but they can have negative consequences for individual well-being, for social equity and for environmental sustainability. In this paper, we add to the existing literature on the adverse consequences of materialistic values by highlighting their negative association with engagement in attitudes and actions that support the achievement of sustainable well-being. To do this, we explore the links between materialistic values and attitudes towards sufficiency (consuming "just enough") as well as mindfulness (non-judgmental awareness of the present moment) and flow (total immersion in an activity), which have all been linked to increased well-being and more sustainable behaviours. We present results from three correlational studies that examine the association between materialistic values and sufficiency attitudes (Study 1, n = 310), a multi-faceted measure of mindfulness (Study 2, n = 468) and the tendency to experience flow (Study 3, n = 2000). Results show that materialistic values were negatively associated with sufficiency attitudes, mindfulness, and flow experiences. We conclude with practical considerations and suggest next steps for tackling the problematic aspects of materialism and encouraging the development of sustainable well-being.

Finding flow: exploring the potential for sustainable fulfilment.

Materialistic values and lifestyles have been associated with detrimental effects on both personal and planetary health. Therefore, there is a pressing need to identify activities and lifestyles that both promote human wellbeing and protect ecological wellbeing. In this Personal View, we explore the dynamics of a psychological state known as flow, in which people are shown to experience high levels of wellbeing through involvement in challenging activities that require some level of skill, and can often involve less materially intensive activities. By synthesising the results of a series of experience sampling, survey, and experimental studies, we identify optimal activities that are shown to have low environmental costs and high levels of human wellbeing. We also confirm that materialistic values tend to undermine people's ability to experience a flow state. In seeking to understand the reasons for this negative association between materialism and flow experiences, we are drawn towards a key role for what psychologists call self-regulation. We show, in particular, that the tendency to experience a flow state can be limited when self-regulatory strength is low and when people evade rather than confront negative or undesirable thoughts and situations. We reflect on the implications of these findings for the prospect of sustainable and fulfilling lifestyles.

Development of a cardiovascular magnetic resonance-compatible large animal isolated heart model for direct comparison of beating and arrested hearts.

Cardiac motion results in image artefacts and quantification errors in many cardiovascular magnetic resonance (CMR) techniques, including microstructural assessment using diffusion tensor cardiovascular magnetic resonance (DT-CMR). Here, we develop a CMR-compatible isolated perfused porcine heart model that allows comparison of data obtained in beating and arrested states. Ten porcine hearts (8/10 for protocol optimisation) were harvested using a donor heart retrieval protocol and transported to the remote CMR facility. Langendorff perfusion in a 3D-printed chamber and perfusion circuit re-established contraction. Hearts were imaged using cine, parametric mapping and STEAM DT-CMR at cardiac phases with the minimum and maximum wall thickness. High potassium and lithium perfusates were then used to arrest the heart in a slack and contracted state, respectively. Imaging was repeated in both arrested states. After imaging, tissue was removed for subsequent histology in a location matched to the DT-CMR data using fiducial markers. Regular sustained contraction was successfully established in six out of 10 hearts, including the final five hearts. Imaging was performed in four hearts and one underwent the full protocol, including colocalised histology. The image quality was good and there was good agreement between DT-CMR data in equivalent beating and arrested states. Despite the use of autologous blood and dextran within the perfusate, T2 mapping results, DT-CMR measures and an increase in mass were consistent with development of myocardial oedema, resulting in failure to achieve a true diastolic-like state. A contiguous stack of 313 5-µm histological sections at and a 100-µm thick section showing cell morphology on 3D fluorescent confocal microscopy colocalised to DT-CMR data were obtained. A CMR-compatible isolated perfused beating heart setup for large animal hearts allows direct comparisons of beating and arrested heart data with subsequent colocalised histology, without the need for onsite preclinical facilities.

Cardiohelp System use in school age children and adolescents at a center with interfacility mobile extracorporeal membrane oxygenation capability.

Cardiohelp System use for pediatric extracorporeal membrane oxygenation (ECMO) beyond the transport setting is sparsely described in literature. We report the use of Getinge's Cardiohelp System in children and integrated utilization of Mobile ECMO Retrieval Team (MERT) at an all-age specialized cardiorespiratory center. Electronic database of all patients under 16 years of age who received ECMO with use of the Cardiohelp System between January 2018 and March 2020 was retrospectively reviewed and analyzed for demographics, set-up, complications, and outcomes. Out of 41 patients, seven patients (four in middle childhood, three in early teenage) with median age of 10 years (range 8.8-15.6) were supported with use of Cardiohelp System. Median weight and height were 34 kg (range 28-53) and 145 cm (range 134-166) respectively. Initial ECMO deployment was veno-arterial (V-A) in five patients and veno-venous (V-V) in two. There were three interhospital transfers by our MERT, and 12 intrahospital transfers for interventions or imaging. The median ECMO therapy was 7 days (range 4-25), with standard 3/8-inch tubing and ECMO flow rate range at 56-100 mL/kg/min (1.89-5.0 LPM). There were two circuit changes and three reconfigurations of support. Two patients received continuous veno-venous hemofiltration via ECMO circuit. The 90-day and 180-day survival rates were 100% (including two heart transplants at day 7 and day 8). There were no transport-related or circuit-related complications during the 1750 h of Cardiohelp use. Cardiohelp System use is safe in pediatric patients for diverse application of ECMO support including inter- and intrahospital transfers.

UK Vessel Health and Preservation (VHP) Framework: a commentary on the updated VHP 2020.

BACKGROUND: In 2016, a UK vessel health and preservation (VHP) framework was developed to support healthcare staff to select the most appropriate vascular access device for patients requiring intravenous therapy. The VHP framework was based on available evidence and expert consensus. The VHP was based on available evidence and expert consensus. DEVELOPMENT OF THE VHP 2020 FRAMEWORK: A multidisciplinary team reviewed the original UK VHP framework and considered new published evidence, national and international guidelines and expert opinion. A literature search was performed using Cinahl and Medline, incorporating a variety of terms linked to vascular access devices, assessment and selection. Articles published in and after 2014 in English were included. Twelve articles were found to be relevant including three evidence-based guidelines, two randomised control trials and one systematic review. FINDINGS: Three main studies provided the evidence for the update: the MAGIC study that assessed the appropriateness of peripherally inserted central catheters in patients; a study that utilised the 'A-DIVA scale' to predict the likelihood of difficult venous access; and a study that incorporated an 'I-DECIDED tool' for peripheral intravenous catheter assessment and decision-making for device removal. In addition, published guidelines provided evidence that the original advice on appropriate osmolarity of medicines for peripheral administration needed updating. CONCLUSION: The 2020 UK VHP framework reflects latest evidence-based research and guidelines, providing healthcare staff updated guidance to assist in maintaining good practice in vascular access assessment and device selection and patient safety.

The heparin-von Willebrand factor interaction and conventional tests of haemostasis - the challenges in predicting bleeding in cardiopulmonary bypass.

Bleeding is a significant complication of cardiopulmonary bypass (CPB), despite routine anticoagulation monitoring. This is likely to be multifactorial. In this prospective, single-centre cohort study of 30 patients undergoing CPB surgery, our aim was to characterise the changes in von Willebrand factor (VWF) function, platelet interaction and the global coagulation changes during and after CPB surgery and to determine whether bleeding can be predicted. Samples were taken at six time points before, during and after CPB surgery. We observed a significant rise in VWF antigen (VWF:Ag) throughout surgery, which continued postoperatively. The absolute VWF collagen-binding assays (VWF:CB) and VWF ristocetin cofactor (VWF:RCo) rose significantly but the VWF:CB/VWF:Ag and VWF:Ag/VWF:RCo fell significantly (P = 0·0015 and P = 0·0143), suggesting loss of large multimers. We detected a non-significant trend to loss of VWF:RCo after heparinisation and a significant recovery after protamine reversal which could reflect a direct heparin effect. There was a significant increase in the R and K times with a fall in alpha angle and maximum amplitude after heparin administration, using heparinase-thromboelastography (TEG). The parameters both significantly improved following protamine (P = 0·007 and P = 0·0054). The activated clotting time (ACT) and heparin anti-Xa level correlated poorly; neither predicted clinically significant bleeding. None of these parameters had a relationship with intraoperative blood loss or requirement for blood product replacement.

Using critical slowing down indicators to understand economic growth rate variability and secular stagnation.

This paper utilizes Critical Slowing Down (CSD; instability) indicators developed by statistical physics to analyse economic growth rate variability and secular stagnation in historical GDP data. Understanding these phenomena is vital, particularly in advanced economies faced with declining growth rates. Two novel indicators - the autocorrelation (AR1) and the variance - are found particularly useful in providing insight into inter-decadal GDP variability over this period. These indicators are first applied to the Maddison-Project historical dataset, which includes almost a century of data for some 80 countries and almost two centuries of data for 9 countries. They are additionally applied to ~50 years of recent annual data for around 130 countries from the World Bank dataset as well as ~60 years of recent quarterly data for around 20 countries from the OECD dataset. Analysis reveals inter-decadal variability in growth cycles (the recession cycle), highlighting periods of large slow growth cycles and periods of small fast growth cycles. The most commonly occurring pattern is characterised by an increase in CSD from the 1900s to 1940s, a decline in CSD between the 1930s and the 1970s, then a further increase in CSD from the 1960s to 2010. This pattern is significant in ~70% of the advanced economies. CSD indicators may then provide invaluable insights into specific aspects of inter-decadal GDP variability, such as on the nature of the business cycle, secular stagnation and the implicit "restoring forces" of the economy.

Three-dimensional digital mapping of ecosystems: a new era in spatial ecology.

Ecological processes occur over multiple spatial, temporal and thematic scales in three-dimensional (3D) ecosystems. Characterizing and monitoring change in 3D structure at multiple scales is challenging within the practical constraints of conventional ecological tools. Remote sensing from satellites and crewed aircraft has revolutionized broad-scale spatial ecology, but fine-scale patterns and processes operating at sub-metre resolution have remained understudied over continuous extents. We introduce two high-resolution remote sensing tools for rapid and accurate 3D mapping in ecology-terrestrial laser scanning and structure-from-motion photogrammetry. These technologies are likely to become standard sampling tools for mapping and monitoring 3D ecosystem structure across currently under-sampled scales. We present practical guidance in the use of the tools and address barriers to widespread adoption, including testing the accuracy of structure-from-motion models for ecologists. We aim to highlight a new era in spatial ecology that uses high-resolution remote sensing to interrogate 3D digital ecosystems.

Cost-Efficient Printing of Graphene Nanostructures on Smart Contact Lenses.

Smart contact lenses have been put forward for years, but there is still no commercial product in the market; the high cost due to expensive fabrication techniques could be one of the reasons. In this paper, first, a cost-efficient and reliable route to fabricate graphene grating on contact lens was designed and demonstrated based on the direct laser interference patterning graphene film on commercial contact lenses using an Nd:YAG laser. The thickness of the film and the interference angle have been taken into consideration. Optical characterization and simulation have been applied to evaluate the quality of our final achieved grating patterns with a grating size from 0.92 to 3.04 µm. Two-dimensional (2D) patterns could also be obtained through double-time laser interference. Contact angles for samples with different interference angles were presented considering the service environment of smart contact lenses. Of course, the conductivity of the samples was evaluated using a four-probe method. The most conductive sample had the sheet resistance lower than 30 Ω/sq. This research study highlighted the possibility of patterning graphene with the laser ablation method and provided a candidate solution for the fabrication of smart contact lenses under controlled cost.

Veno-arterial mechanical support as bridge to surgery in a patient with severe aortic regurgitation: a case report.

In this case report, we describe the successful application of veno-arterial extracorporeal membrane oxygenation support in a young patient with severe aortic regurgitation caused by a blocked mechanical valve. In this situation, extracorporeal membrane oxygenation mechanical support was used as a bridge to the prompt replacement of the diseased valve. Aortic regurgitation is commonly recognized as a contraindication to extracorporeal membrane oxygenation support because of the risk of ventricular distension, pulmonary oedema and further organ failure. However, in certain cases and with a rapid decision making, extracorporeal membrane oxygenation can be used as a bridge to treatment and recovery.

Ensuring a Post-COVID Economic Agenda Tackles Global Biodiversity Loss.

The COVID-19 pandemic has caused dramatic and unprecedented impacts on both global health and economies. Many governments are now proposing recovery packages to get back to normal, but the 2019 Intergovernmental Science-Policy Platform for Biodiversity and Ecosystem Services Global Assessment indicated that business as usual has created widespread ecosystem degradation. Therefore, a post-COVID world needs to tackle the economic drivers that create ecological disruptions. In this perspective, we discuss a number of tools across a range of actors for both short-term stimulus measures and longer-term revamping of global, national, and local economies that take biodiversity into account. These include measures to shift away from activities that damage biodiversity and toward those supporting ecosystem resilience, including through incentives, regulations, fiscal policy, and employment programs. By treating the crisis as an opportunity to reset the global economy, we have a chance to reverse decades of biodiversity and ecosystem losses.