The United Kingdom Glaucoma Treatment Study:a multicenter, randomized, placebo-controlled clinical trial: design and methodology

Elevated intraocular pressure (IOP) is a major risk factor for the deterioration of open-angle glaucoma (OAG); medical IOP reduction is the standard treatment, yet no randomized placebo-controlled study of medical IOP reduction has been undertaken previously. The United Kingdom Glaucoma Treatment Study (UKGTS) tests the hypothesis that treatment with a topical prostaglandin analog, compared with placebo, reduces the frequency of visual field (VF) deterioration events in OAG patients by 50% over a 2-year period.

Conceptual Design and Workspace Analysis of an Exechon-inspired Parallel Kinematic Machine

Inspired by the commercial application of the Exechon machine, this paper proposed a novel parallel kinematic machine (PKM) named Exe-Variant. By exchanging the sequence of kinematic pairs in each limb of the Exechon machine, the Exe-Variant PKM claims an arrangement of 2UPR/1SPR topology and consists of two identical UPR limbs and one SPR limb. The inverse kinematics of the 2UPR/1SPR parallel mechanism was firstly analyzed based on which a conceptual design of the Exe-Variant was carried out. Then an algorithm of reachable workspace searching for the Exe-Variant and the Exchon was proposed. Finally, the workspaces of two example systems of the Exechon and the Exe-Variant with approximate dimensions were numerically simulated and compared. The comparison shows that the Exe-Variant possesses a competitive workspace with the Exechon machine, indicating it can be used as a promising reconfigurable module in a hybrid 5-DOF machine tool system.

The SPHERE Study: Secondary prevention of heart disease in general practice: protocol of a randomised controlled trial of tailored practice and patient care plans with parallel qualitative, economic and policy analyses. [ISRCTN24081411]

Background: The aim of the SPHERE study is to design, implement and evaluate tailored practice and personal care plans to improve the process of care and objective clinical outcomes for patients with established coronary heart disease (CHD) in general practice across two different health systems on the island of Ireland.CHD is a common cause of death and a significant cause of morbidity in Ireland. Secondary prevention has been recommended as a key strategy for reducing levels of CHD mortality and general practice has been highlighted as an ideal setting for secondary prevention initiatives. Current indications suggest that there is considerable room for improvement in the provision of secondary prevention for patients with established heart disease on the island of Ireland. The review literature recommends structured programmes with continued support and follow-up of patients; the provision of training, tailored to practice needs of access to evidence of effectiveness of secondary prevention; structured recall programmes that also take account of individual practice needs; and patient-centred consultations accompanied by attention to disease management guidelines.

Methods: SPHERE is a cluster randomised controlled trial, with practice-level randomisation to intervention and control groups, recruiting 960 patients from 48 practices in three study centres (Belfast, Dublin and Galway). Primary outcomes are blood pressure, total cholesterol, physical and mental health status (SF-12) and hospital re-admissions. The intervention takes place over two years and data is collected at baseline, one-year and two-year follow-up. Data is obtained from medical charts, consultations with practitioners, and patient postal questionnaires. The SPHERE intervention involves the implementation of a structured systematic programme of care for patients with CHD attending general practice. It is a multi-faceted intervention that has been developed to respond to barriers and solutions to optimal secondary prevention identified in preliminary qualitative research with practitioners and patients. General practitioners and practice nurses attend training sessions in facilitating behaviour change and medication prescribing guidelines for secondary prevention of CHD. Patients are invited to attend regular four-monthly consultations over two years, during which targets and goals for secondary prevention are set and reviewed. The analysis will be strengthened by economic, policy and qualitative components.

A Multicenter, Randomised Open Study of Early Corticosteroid Treatment (OSECT) in Preterm Infants With Respiratory Illness: Comparison of Early and Late Treatment and of Dexamethasone and Inhaled Budesonide

AIM: To compare early (15 days) steroid therapy and dexamethasone with inhaled budesonide in very preterm infants at risk of developing chronic lung disease. METHODS: Five hundred seventy infants from 47 neonatal intensive care units were enrolled. Criteria for enrollment included gestational age 30%. Infants were randomly allocated to 1 of 4 treatment groups in a factorial design: early (15 days) dexamethasone, and delayed selective budesonide. Dexamethasone was given in a tapering course beginning with 0.50 mg/kg/day in 2 divided doses for 3 days reducing by half until 12 days of therapy had elapsed. Budesonide was administered by metered dose inhaler and a spacing chamber in a dose of 400 microg/kg twice daily for 12 days. Delayed selective treatment was started if infants needed mechanical ventilation and >30% oxygen for >15 days. The factorial design allowed 2 major comparisons: early versus late treatment and systemic dexamethasone versus inhaled budesonide. The primary outcome was death or oxygen dependency at 36 weeks and analysis was on an intention-to-treat basis. Secondary outcome measures included death or major cerebral abnormality, duration of oxygen treatment, and complications of prematurity. Adverse effects were also monitored daily. RESULTS: There were no significant differences among the groups for the primary outcome. Early steroid treatment was associated with a lower primary outcome rate (odds ratio [OR]: 0.85; 95% confidence interval [CI]: 0.61,1.18) but even after adjustment for confounding variables the difference remained nonsignificant. Dexamethasone-treated infants also had a lower primary outcome rate (OR: 0.86; 95% CI: 0.62,1.20) but again this difference remained not significant after adjustment. For death before discharge, dexamethasone and early treatment had worse outcomes than budesonide and delayed selective treatment (OR: 1.42; 95% CI: 0.93,2.16; OR: 1.51; 95% CI: 0.99,2.30 after adjustment, respectively) with the results not quite reaching significance. Duration of supplementary oxygen was shorter in the early dexamethasone group (median: 31 days vs 40-44 days). Early dexamethasone was also associated with increased weight loss during the first 12 days of treatment (52 g vs 3 g) compared with early budesonide, but over 30 days there was no difference. In the early dexamethasone group, there was a reduced incidence of persistent ductus arteriosus (34% vs 52%-59%) and an increased risk of hyperglycemia (55% vs 29%-34%) compared with the other 3 groups. Dexamethasone was associated with an increased risk of hypertension and gastrointestinal problems compared with budesonide but only the former attained significance. CONCLUSIONS: Infants given early treatment and dexamethasone therapy had improved survival without chronic lung disease at 36 weeks compared with those given delayed selective treatment and inhaled budesonide, respectively, but results for survival to discharge were in the opposite direction; however, none of these findings attained statistical significance. Early dexamethasone treatment reduced the risk of persistent ductus arteriosus. Inhaled budesonide may be safer than dexamethasone, but there is no clear evidence that it is more or less effective

Even order harmonic Series-L/Parallel-Tuned Class-E frequency multiplier

In this brief, we propose a new Class-E frequency multiplier based on the recently introduced Series-L/Parallel-Tuned Class-E amplifier. The proposed circuit produces even-order output harmonics. Unlike previously reported solutions the proposed circuit can operate under 50% duty ratio which minimizes the conduction losses. The circuit also offers the possibility for increased maximum operating frequency, reduced peak switch voltage, higher load resistance and inherent bond wire absorption; all potentially useful in monolithic microwave integrated circuit implementations. In addition, the circuit topology suggested large transistors with high output capacitances can be deployed. Theoretical design equations are given and the predictions made using these are shown to agree with harmonic balance circuit simulation results.

Transmission line matching effects on the performance of shunt-C/series-tuned and series-L/parallel-tuned Class-E amplifiers

The impact that the transmission-line load-network has on the performance of the recently introduced series-L/parallel-tuned Class-E amplifier and the classic shunt-C/series-tuned configuration when compared to optimally derived lumped load networks is discussed. In addition an improved load topology which facilitates harmonic suppression of up to 5 order as required for maximum Class-E efficiency as well as load resistance transformation and a design procedure involving the use of Kuroda's identity and Richard's transformation enable a distributed synthesis process which dispenses with the need for iterative tuning as previously required in order to achieve optimum Class-E operation. © 2005 IEEE.

Series-L/parallel-tuned comparison with shunt-C/series-tuned class-E power amplifier

An analysis of the operation of a series-L/parallel-tuned class-E amplifier and its equivalence to the classic shunt-C/series-tuned class-E amplifier are presented. The first reported closed form design equations for the series-L/parallel-tuned topology operating under ideal switching conditions are given. Furthermore, a design procedure is introduced that allows the effect that nonzero switch resistance has on amplifier performance efficiency to be accounted for. The technique developed allows optimal circuit components to be found for a given device series resistance. For a relatively high value of switching device ON series resistance of 4O, drain efficiency of around 66% for the series-L/parallel-tuned topology, and 73% for the shunt-C/series-tuned topology appear to be the theoretical limits. At lower switching device series resistance levels, the efficiency performance of each type are similar, but the series-L/parallel-tuned topology offers some advantages in terms of its potential for MMIC realisation. Theoretical analysis is confirmed by numerical simulation for a 500mW (27dBm), 10% bandwidth, 5 V series-L/parallel-tuned, then, shunt-C/series-tuned class E power amplifier, operating at 2.5 GHz, and excellent agreement between theory and simulation results is achieved. The theoretical work presented in the paper should facilitate the design of high-efficiency switched amplifiers at frequencies commensurate with the needs of modern mobile wireless applications in the microwave frequency range, where intrinsically low-output-capacitance MMIC switching devices such as pHEMTs are to be used.

Co-design of Distributed Systems Using Skeleton and Autonomic Management Abstractions

We discuss how common problems arising with multi/many core distributed architectures can he effectively handled through co-design of parallel/distributed programming abstractions and of autonomic management of non-functional concerns. In particular, we demonstrate how restricted patterns (or skeletons) may be efficiently managed by rule-based autonomic managers. We discuss the basic principles underlying pattern+manager co-design, current implementations inspired by this approach and some result achieved with proof-or-concept, prototype.

Semi-formal Models to Support Program Development: Autonomic Management within Component Based Parallel and Distributed Programming

Functional and non-functional concerns require different programming effort, different techniques and different methodologies when attempting to program efficient parallel/distributed applications. In this work we present a "programmer oriented" methodology based on formal tools that permits reasoning about parallel/distributed program development and refinement. The proposed methodology is semi-formal in that it does not require the exploitation of highly formal tools and techniques, while providing a palatable and effective support to programmers developing parallel/distributed applications, in particular when handling non-functional concerns.

Effects of Constraint Errors on Parallel Manipulators with Decoupled Motion

From perspective of structure synthesis, certain special geometric constraints, such as joint axes intersecting at one point or perpendicular to each other, are necessary in realizing the end-effector motion of kinematically decoupled parallel manipulators (PMs) along individual motion axes. These requirements are difficult to achieve in the actual system due to assembly errors and manufacturing tolerances. Those errors that violate the geometric constraint requirements are termed “constraint errors”. The constraint errors usually are more troublesome than other manipulator errors because the decoupled motion characteristics of the manipulator may no longer exist and the decoupled kinematic models will be rendered useless due to these constraint errors. Therefore, identification and prevention of these constraint errors in initial design and manufacturing stage are of great significance. In this article, three basic types of constraint errors are identified, and an approach to evaluate the effects of constraint errors on decoupling characteristics of PMs is proposed. This approach is illustrated by a 6-DOF PM with decoupled translation and rotation. The results show that the proposed evaluation method is effective to guide design and assembly.

Advanced educational parallel DSP system based on TMS320C25 processors

This paper describes the design, application, and evaluation of a user friendly, flexible, scalable and inexpensive Advanced Educational Parallel (AdEPar) digital signal processing (DSP) system based on TMS320C25 digital processors to implement DSP algorithms. This system will be used in the DSP laboratory by graduate students to work on advanced topics such as developing parallel DSP algorithms. The graduating senior students who have gained some experience in DSP can also use the system. The DSP laboratory has proved to be a useful tool in the hands of the instructor to teach the mathematically oriented topics of DSP that are often difficult for students to grasp. The DSP laboratory with assigned projects has greatly improved the ability of the students to understand such complex topics as the fast Fourier transform algorithm, linear and circular convolution, the theory and design of infinite impulse response (IIR) and finite impulse response (FIR) filters. The user friendly PC software support of the AdEPar system makes it easy to develop DSP programs for students. This paper gives the architecture of the AdEPar DSP system. The communication between processors and the PC-DSP processor communication are explained. The parallel debugger kernels and the restrictions of the system are described. The programming in the AdEPar is explained, and two benchmarks (parallel FFT and DES) are presented to show the system performance.