The effectiveness of early lens extraction with intraocular lens implantation for the treatment of primary angle-closure glaucoma (EAGLE): Study protocol for a randomized controlled trial

BACKGROUND: Glaucoma is the leading cause of irreversible blindness. Although primary open-angle glaucoma is more common, primary angle-closure glaucoma (PACG) is more likely to result in irreversible blindness. By 2020, 5·3 million people worldwide will be blind because of PACG. The current standard care for PACG is a stepped approach of a combination of laser iridotomy surgery (to open the drainage angle) and medical treatment (to reduce intraocular pressure). If these treatments fail, glaucoma surgery (eg, trabeculectomy) is indicated. It has been proposed that, because the lens of the eye plays a major role in the mechanisms leading to PACG, early clear lens extraction will improve glaucoma control by opening the drainage angle. This procedure might reduce the need for drugs and glaucoma surgery, maintain good visual acuity, and improve quality of life compared with standard care.EAGLE aims to evaluate whether early lens extraction improves patient-reported, clinical outcomes, and cost-effectiveness, compared with standard care.

METHODS/DESIGN: EAGLE is a multicentre pragmatic randomized trial. All people presenting to the recruitment centres in the UK and east Asia with newly diagnosed PACG and who are at least 50 years old are eligible.The primary outcomes are EQ-5D, intraocular pressure, and incremental cost per quality adjusted life year (QALY) gained. Other outcomes are: vision and glaucoma-specific patient-reported outcomes, visual acuity, visual field, angle closure, number of medications, additional surgery (e.g., trabeculectomy), costs to the health services and patients, and adverse events.A single main analysis will be done at the end of the trial, after three years of follow-up. The analysis will be based on all participants as randomized (intention to treat). 400 participants (200 in each group) will be recruited, to have 90% power at 5% significance level to detect a difference in EQ-5D score between the two groups of 0·05, and a mean difference in intraocular pressure of 1·75 mm Hg. The study will have 80% power to detect a difference of 15% in the glaucoma surgery rate.

TRIAL REGISTRATION: ISRCTN44464607.

Cataract extraction and intraocular lens implantation in anterior megalophthalmos

This report describes the implantation of a standard posterior chamber intraocular lens (IOL) in a patient with bilateral cataract and anterior megalophthalmos. After extracapsular cataract extraction, the IOL was sutured to the posterior surface of the iris and anterior capsule. Different types of IOLs were used in each eye, and the surgical technique was adapted to the characteristics of the IOL. No complications were noted. Visual rehabilitation was successful. Extracapsular cataract extraction with a posterior chamber IOL sutured to the posterior surface of the iris and anterior capsule is a useful option in patients with anterior megalophthalmos and cataract.

London 2012 and Environmental Sustainability: A Study Through the Lens of Environmental Sociology

This rapid response paper examines the claim that Olympic Games hosting can encourage and/or accentuate the adoption of environmental sustainability (ES) policies by the host nation, with London 2012 as a case study. Six indicators that can be used in this examination are identified and subsequently tested in relation to changes brought by austerity/'Big Society' policies. The paper closes by suggesting that although the UK, unlike other hosts, had a relatively good ES standing; however, it appears that this has been significantly downgraded in the event and immediate post-event phases of the Games

Amplitude modulated signal transmission through a phase conjugating lens

Free space transmission of an on-off modulated sinusoidal signal through a phase conjugating lens (PCL) is theoretically examined using a combined time/frequency domain approach. The on-off keyed (OOK) signal is generated by a dipole antenna located in the far-field zone of the lens. The PCL consists of a dual layer of antenna elements interconnected via phase conjugating circuitry. We demonstrate that electromagnetic interference between antenna elements creates spatially localised areas of good-quality reception and zones where the signal is significantly denigrated by interference. Next, it is shown that destructive interference and packet desynchronisation effects critically depend on bit rate. It is also shown that a circular concave lens can be used to produce high-quality signal reception in a given direction while suppressing signal reception in all other directions. The effect that the bandwidth of the phase conjugating unit has on the transmitted signal properties for the cases of high and low bit rate OOK modulation are studied and a signal quality characterisation scheme is proposed which uses cross-correlation. The results of the study yields understanding of the performance of phase conjugating arrays under OOK modulation. The work suggests a novel approach for realising a secure communication wireless system.

Rotman Lens Used as a Demultiplexer/Multiplexer

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A new type of microwave demultiplexer is proposed which combines an arrayed waveguide grating (AWG) and a Rotman lens. The dispersion property of an AWG is employed to produce different phase slope responses for different frequencies, while the Rotman lens routes the frequency components onto different ports. To optimize isolation performance, the design constraints of both the AWG and the Rotman lens are re-examined and new design criteria elaborated. The optimized design is demonstrated of being capable of achieving 15 dB channel isolation over a 25% band range centered at 10 GHz. While a design based on a conventional Rotman lens yields isolation level of around 6 dB over a 9% band range centered at 10GHz.

Fourier Transform using a Rotman Lens

In this paper, the design constraints that are required for a Rotman lens to realize discrete Fourier transform (DFT) amplitude and phase functionality are derived. A Fourier Rotman lens has been designed, fabricated and validated. The amplitude and phase response and the array pattern based on the CST™ results are validated with the theoretical DFT results. To the best of the authors' knowledge, this is the first Fourier Rotman lens to be fabricated and validated. The solution provided replaces multilayer Butler matrix solutions with a simple single layer microstrip technology.

Role of glycation in modification of lens crystallins in diabetic and nondiabetic senile cataracts

To assess the significance of glycation, nonenzymatic browning, and oxidation of lens crystallins in cataract formation in elderly diabetic patients, we measured three distinct products of glycation, browning, and oxidation reactions in cataractous lens crystallins from 29 diabetic patients (mean +/- SD age 72.8 +/- 8.8 yr) and 24 nondiabetic patients (age 73.5 +/- 8.3 yr). Compounds measured included 1) fructoselysine (FL), the first stable product of glycation; 2) pentosidine, a fluorescent, carbohydrate-derived protein cross-link between lysine and arginine residues formed during nonenzymatic browning; and 3) N epsilon-(carboxymethyl)lysine (CML), a product of autoxidation of sugar adducts to protein. In diabetic compared with nondiabetic patients, there were significant increases (P less than 0.001) in HbA1 (10.2 +/- 3.1 vs. 7.1 +/- 0.7%), FL (7.6 +/- 5.4 vs. 1.7 +/- 1.2 mmol/mol lysine), and pentosidine (6.3 +/- 2.8 vs. 3.8 +/- 1.9 mumol/mol lysine). The disproportionate elevation of FL compared with HbA1 suggests a breakdown in the lens barrier to glucose in diabetes, whereas the increase in pentosidine is indicative of accelerated nonenzymatic browning of diabetic lens crystallins. CML levels were similar in the two groups (7.1 +/- 2.4 vs. 6.8 +/- 3.0 mmol/mol lysine), providing no evidence for increased oxidative stress in the diabetic cataract. Thus, although the modification of lens crystallins by autoxidation reactions was not increased in diabetes, the increase in glycation and nonenzymatic browning suggests that these processes may acclerate the development of cataracts in diabetic patients.

Liquid crystal based Rotman lens antenna with switchable monopulse patterns

An electronically reconfigurable Rotman lens is described which generates multiple beams that can be switched from monopulse sum to difference radiation patterns when used in conjunction with a six element Vivaldi antenna array. This is achieved by exploiting the voltage-dependent dielectric anisotropy property of nematic state liquid crystals to provide switched 0 degrees and 180 degrees phase shifts in the array feed lines. The viability of the concept is demonstrated by designing an antenna which exhibits dynamically reconfigurable monopulse radiation patterns over the frequency band 6-10 GHz. Measured and simulated results are shown to be in good agreement. (c) 2013 Wiley Periodicals, Inc.

Sidelobe Modulation Scrambling Transmitter Using Fourier Rotman Lens

A means for scrambling the digital modulation content in the sidelobes of a radio transmission from a steerable antenna array is presented. The method uses a Fourier transform beam-forming network simultaneously excited by an RF information stream and orthogonally injected interference streams. The proposed system is implemented using a Fourier Rotman lens and its operational characteristics are validated for a 10 GHz QPSK transmission.

Electronically Scanned Rotman Lens Antenna with Liquid Crystal Phase Shifters

The performance of a Rotman lens, which forms fixed beams at 0°, ±15° and ±30°, is augmented using liquid crystal phase shifters to simultaneously steer each beam by up to ±7.5°. Measured results are used to demonstrate that the true time delay property of the antenna and voltage controlled phase shifters can be exploited to provide continuously scanned beams with full coverage over an angular range of ±37.5°, and with operation over the band 6-10 GHz.

Public management, Peace-building and Creating Change: Shifting the Lens of Analysis from the Macro to the Micro

Considerable time, research money and expertise has been spent exploring the complex reality of ethno nationalist conflict and the role that public management plays in supporting the transition from violent conflict to stability, order and prosperity (Esman 1999; Guelke and Milton-Edwards 2000; Brinkerhoff 2005; Brinkerhoff, Wetterberg et al. 2012; Rao 2014). However, there seems to be a gap in relation to the practical challenges of managing change within, through and beyond such conflict. This paper aims to begin the process of putting a framework around the real experience of public management in conflict and transition by shifting the lens of analysis from macros concerns about sequencing interventions (Rao 2014) and legitimate requirements of security, stability and service delivery (Brinkerhoff, Wetterberg et al. 2012) to a micro analysis of the attitudes, behaviours, challenges and compromises held and faced by those public servants on the front line of conflict management and conflict transformation processes. Using senior managers as the unit of analysis and Northern Ireland as an embryonic case study, this paper discusses the links between ethno nationalist societal conflict, public sector reform and manager behaviour. In doing so, it highlights some initial data from an early pilot study into the experiences of individuals in significant public service roles at various stages of the NI conflict / peace process and draws some tentative conclusions about the viability of a wider study.

Out of the Shadows: A one day investigation of the politics of architecture explored through the lens of post-conflict, Belfast

This booklet covers the itinerary and some of the findings of a day-long visit to Belfast on the 7th November 2014 by Peter Oborn; Vice President International of the Royal Institute of British Architects. His visit was in response to a motion submitted to the RIBA council (19.05.2014) calling for the suspension of the Israeli Association of United Architects from the International Union of Architects. Despite members of council speaking against the motion it was carried; 23 members voting for, 16 against, and 10 abstentions. Subsequently the RIBA came under considerable pressure to consider its position in such critical contexts. This visit to Belfast was part of a wider fact-finding mission and evidence taking. At its heart was the question: 'Is it appropriate for the institute (RIBA) to engage with communities facing civil conflict and/or natural disaster and, if so, how it can do so most effectively.' The visit was facilitated by Ruth Morrow, Professor of Architecture, School of Planning, Architecture & Civil Engineering, Queen's University Belfast, and Martin Hare, Royal Society of Ulster Architects (RSUA) president.

Fourier Rotman Lens Enabled Directional Modulation Transmitter

A 10 GHz Fourier Rotman lens enabled dynamic directional modulation (DM) transmitter is experimentally evaluated. Bit error rate (BER) performance is obtained via real-time data transmission. It is shown that Fourier Rotman DM functionality enhances system security performance in terms of narrower decodable low BER region and higher BER values associated with BER sidelobes especially under high signal to noise ratio (SNR) scenarios. This enhancement is achieved by controlled corruption of constellation diagrams in IQ space by orthogonal injection of interference. Furthermore, the paper gives the first report of a functional dual-beam DM transmitter, which has the capability of simultaneously projecting two independent data streams into two different spatial directions while simultaneously scrambling the information signals along all other directions.

Electromagnetic Focusing and Imaging in Stratified Media Using Gradient Phase Profiled Conjugating Lens

High-resolution imaging of a dipole source in stratified medium based on negative refraction is presented in this paper. Compensation of the material parameter contrast at the stratified media interface is achieved using a gradient phase profiled conjugating lens (GPCL). It is shown both analytically and numerically that the phase gradient applied across the GPCL positioned at the interface of vertically stratified media enables a high-quality image of a dipole source in a mirror symmetric position with respect to the lens plane. The analytical closed form expression of the phase gradient function is derived using Huygens-Kirchhoff principle. The result is applicable to media with arbitrary stratification and material parameters, including lossy materials. The mechanism for formation of the dipole image in the stratified medium and aberration due to the dielectric contrast at the interface, particularly electromagnetic loss, is discussed in detail. The efficacy of gradient phase and amplitude aberration compensations mechanisms available through the GPCL is articulated. The results of the study are of importance in a wide range of imaging problems in stratified media for medical, civil, and military applications.