Laser peripheral iridoplasty for angle-closure

BACKGROUND: Angle-closure glaucoma is a leading cause of irreversible blindness in the world. Treatment is aimed at opening the anterior chamber angle and lowering the IOP with medical and/or surgical treatment (e.g. trabeculectomy, lens extraction). Laser iridotomy works by eliminating pupillary block and widens the anterior chamber angle in the majority of patients. When laser iridotomy fails to open the anterior chamber angle, laser iridoplasty may be recommended as one of the options in current standard treatment for angle-closure. Laser peripheral iridoplasty works by shrinking and pulling the peripheral iris tissue away from the trabecular meshwork. Laser peripheral iridoplasty can be used for crisis of acute angle-closure and also in non-acute situations.

OBJECTIVES: To assess the effectiveness of laser peripheral iridoplasty in the treatment of narrow angles (i.e. primary angle-closure suspect), primary angle-closure (PAC) or primary angle-closure glaucoma (PACG) in non-acute situations when compared with any other intervention. In this review, angle-closure will refer to patients with narrow angles (PACs), PAC and PACG.

SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 12), MEDLINE (January 1950 to January 2012), EMBASE (January 1980 to January 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to January 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 5 January 2012.

SELECTION CRITERIA: We included only randomised controlled trials (RCTs) in this review. Patients with narrow angles, PAC or PACG were eligible. We excluded studies that included only patients with acute presentations, using laser peripheral iridoplasty to break acute crisis.

DATA COLLECTION AND ANALYSIS: No analysis was carried out as only one trial was included in the review.

MAIN RESULTS: We included one RCT with 158 participants. The trial reported laser peripheral iridoplasty as an adjunct to laser peripheral iridotomy compared to iridotomy alone. The authors report no superiority in using iridoplasty as an adjunct to iridotomy for IOP, number of medications or need for surgery.

AUTHORS' CONCLUSIONS: There is currently no strong evidence for laser peripheral iridoplasty's use in treating angle-closure.

Intraobserver and interobserver agreement in evaluating the anterior chamber angle configuration by ultrasound biomicroscopy

Purpose: To determine the intra- and interobserver agreement in assessing the configuration of the human anterior chamber angle using ultrasound biomicroscopy (UBM). Methods: Two masked clinicians used ubm images to estimate, in 41 eyes, (a) the position of contact between the peripheral iris and the inside of the eye wall, (b) the angular size of the anterior chamber angle (ACA), and (c) the curvature of the peripheral iris. Both observers, masked to the previous results, examined the same images in a second session. Agreement was evaluated using the unweighted ? statistic. Results: Intraobserver agreement in assessing the iris insertion, angular width, and the iris curvature was high (range of ? values, 0.83-0.92). Interobserver agreement in evaluating the level of iris insertion (? = 0.79), the angular width (? = 0.95), and the iris curvature (? = 0.84) was also high. Conclusion: The agreement within the same observer and between observers in evaluating the ACA configuration by UBM was excellent.

Optimization of image quality and dose for Varian aS500 electronic portal imaging devices (EPIDs)

This study was carried out to investigate whether the electronic portal imaging (EPI) acquisition process could be optimized, and as a result tolerance and action levels be set for the PIPSPro QC-3V phantom image quality assessment. The aim of the optimization process was to reduce the dose delivered to the patient while maintaining a clinically acceptable image quality. This is of interest when images are acquired in addition to the planned patient treatment, rather than images being acquired using the treatment field during a patient's treatment. A series of phantoms were used to assess image quality for different acquisition settings relative to the baseline values obtained following acceptance testing. Eight Varian aS500 EPID systems on four matched Varian 600C/D linacs and four matched Varian 2100C/D linacs were compared for consistency of performance and images were acquired at the four main orthogonal gantry angles. Images were acquired using a 6 MV beam operating at 100 MU min(-1) and the low-dose acquisition mode. Doses used in the comparison were measured using a Farmer ionization chamber placed at d(max) in solid water. The results demonstrated that the number of reset frames did not have any influence on the image contrast, but the number of frame averages did. The expected increase in noise with corresponding decrease in contrast was also observed when reducing the number of frame averages. The optimal settings for the low-dose acquisition mode with respect to image quality and dose were found to be one reset frame and three frame averages. All patients at the Northern Ireland Cancer Centre are now imaged using one reset frame and three frame averages in the 6 MV 100 MU min(-1) low-dose acquisition mode. Routine EPID QC contrast tolerance (+/-10) and action (+/-20) levels using the PIPSPro phantom based around expected values of 190 (Varian 600C/D) and 225 (Varian 2100C/D) have been introduced. The dose at dmax from electronic portal imaging has been reduced by approximately 28%, and while the image quality has been reduced, the images produced are still clinically acceptable.

On the Condition Number Distribution of Complex Wishart Matrices

This paper investigates the distribution of the condition number of complex Wishart matrices. Two closely related measures are considered: the standard condition number (SCN) and the Demmel condition number (DCN), both of which have important applications in the context of multiple-input multipleoutput (MIMO) communication systems, as well as in various branches of mathematics. We first present a novel generic framework for the SCN distribution which accounts for both central and non-central Wishart matrices of arbitrary dimension. This result is a simple unified expression which involves only a single scalar integral, and therefore allows for fast and efficient computation. For the case of dual Wishart matrices, we derive new exact polynomial expressions for both the SCN and DCN distributions. We also formulate a new closed-form expression for the tail SCN distribution which applies for correlated central Wishart matrices of arbitrary dimension and demonstrates an interesting connection to the maximum eigenvalue moments of Wishart matrices of smaller dimension. Based on our analytical results, we gain valuable insights into the statistical behavior of the channel conditioning for various MIMO fading scenarios, such as uncorrelated/semi-correlated Rayleigh fading and Ricean fading. © 2010 IEEE.

Is the number of species on earth increasing or decreasing? Time, chaos and the origin of species

Darwin's On the Origin of Species has led to a theory of evolution with a mass of empirical detail on population genetics below species level, together with heated debate on the details of macroevolutionary patterns above species level. Most of the main principles are clear and generally accepted, notably that life originated once and has evolved over time by descent with modification. Here, I review the fossil and molecular phylogenetic records of the response of life on Earth to Quaternary climatic changes. I suggest that the record can be best understood in terms of the nonlinear dynamics of the relationship between genotype and phenotype, and between climate and environments. 'The origin of species' is essentially unpredictable, but is nevertheless an inevitable consequence of the way that organisms reproduce through time. The process is 'chaotic', but not 'random'. I suggest that biodiversity is best considered as continuously branching systems of lineages, where 'species' are the branch tips. The Earth's biodiversity should thus (1) be in a state of continuous increase and (2) show continuous discrepancies between genetic and morphological data in time and space. © The Palaeontological Association.

Screw conveyor device for laboratory tests on conditioned soil for EPB tunneling operations

Earth pressure balanced (EPB) full face tunneling machines have experienced a remarkable increase in the number of applications throughout the world due to both mechanical developments and a more effective use of additives to condition the ground. Conditioning modifies the mechanical and hydraulic properties of a soil by making it suitable for the pressure control in the bulk chamber and extraction with the screw conveyor. The extraction system plays a fundamental role during the EPB operations particularly for a correct application of the face pressure. Despite the extensive use of the EPB technique, little knowledge exists concerning the understanding of the behavior of conditioned soil, particularly for noncohesive ground (sand and gravel). This paper presents and describes a prototype laboratory device, which simulates the extraction of the ground from a pressurized tank with a screw conveyor. The results of a preliminary test program carried out on a medium sized sand show that the prototype device is efficient in verifying the effects of foam for an optimal use in EPB conditioning. © 2007 ASCE.

Modification of the formation of high-Mach number electrostatic shock-like structures by the ion acoustic instability

The formation of unmagnetized electrostatic shock-like structures with a high Mach number is examined with one- and two-dimensional particle-in-cell (PIC) simulations. The structures are generated through the collision of two identical plasma clouds, which consist of equally hot electrons and ions with a mass ratio of 250. The Mach number of the collision speed with respect to the initial ion acoustic speed of the plasma is set to 4.6. This high Mach number delays the formation of such structures by tens of inverse ion plasma frequencies. A pair of stable shock-like structures is observed after this time in the 1D simulation, which gradually evolve into electrostatic shocks. The ion acoustic instability, which can develop in the 2D simulation but not in the 1D one, competes with the nonlinear process that gives rise to these structures. The oblique ion acoustic waves fragment their electric field. The transition layer, across which the bulk of the ions change their speed, widens and their speed change is reduced. Double layer-shock hybrid structures develop.

Impact of the number of users on error probabilities in multiuser diversity systems

Multiuser diversity gain has been investigated well in terms of a system capacity formulation in the literature. In practice, however, designs on multiuser systems with nonzero error rates require a relationship between the error rates and the number of users within a cell. Considering a best-user scheduling, where the user with the best channel condition is scheduled to transmit per scheduling interval, our focus is on the uplink. We assume that each user communicates with the base station through a single-input multiple-output channel. We derive a closed-form expression for the average BER, and analyze how the average BER goes to zero asymptotically as the number of users increases for a given SNR. Note that the analysis of average BER even in SI SO multiuser diversity systems has not been done with respect to the number of users for a given SNR. Our analysis can be applied to multiuser diversity systems with any number of antennas.

Dynamical symmetry breaking with optimal control: Reducing the number of pieces

We analyze the production of defects during the dynamical crossing of a mean-field phase transition with a real order parameter. When the parameter that brings the system across the critical point changes in time according to a power-law schedule, we recover the predictions dictated by the well-known Kibble-Zurek theory. For a fixed duration of the evolution, we show that the average number of defects can be drastically reduced for a very large but finite system, by optimizing the time dependence of the driving using optimal control techniques. Furthermore, the optimized protocol is robust against small fluctuations.