Protocol-driven adjustment of ocular hypotensive medication in patients at low risk of conversion to glaucoma

AIM: To investigate the safety and potential savings of decreasing medication use in low-risk patients with ocular hypertension (OH).
METHODS: Patients with OH receiving pressure-lowering medication identified by medical record review at a university hospital underwent examination by a glaucoma specialist with assessment of visual field (VF), vertical cup-to-disc ratio (vCDR), central corneal thickness and intraocular pressure (IOP). Subjects with estimated 5-year risk of glaucoma conversion <15% were asked to discontinue ≥1 medication, IOP was remeasured 1 month later and risk was re-evaluated at 1 year.
RESULTS: Among 212 eyes of 126 patients, 44 (20.8%) had 5-year risk >15% and 14 (6.6%) had unreliable baseline VF. At 1 month, 15 patients (29 eyes, 13.7%) defaulted follow-up or refused to discontinue medication and 11 eyes (5.2%) had risk >15%. The remaining 69 patients (107 eyes, 50.7%) successfully discontinued 141 medications and completed 1-year follow-up. Mean IOP (20.5±2.65 mm Hg vs 20.3±3.40, p=0.397) did not change, though mean VF pattern SD (1.58±0.41 dB vs 1.75±0.56 dB, p=0.001) and glaucoma conversion risk (7.31±3.74% vs 8.76±6.28%, p=0.001) increased at 1 year. Mean defect decreased (-1.42±1.60 vs -1.07±1.52, p=0.022). One eye (0.47%) developed a repeatable VF defect and 13 eyes (6.1%) had 5-year risk >15% at 1 year. The total 1-year cost of medications saved was US$4596.
CONCLUSIONS: Nearly half (43.9%) of low-risk OH eyes in this setting could safely reduce medications over 1 year, realising substantial savings.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Waiting time for cataract surgery and its influence on patient attitudes.

PURPOSE:

To characterize willingness to pay for private operations and preferred waiting time among patients awaiting cataract surgery in Hong Kong.

METHODS:

This was a cross-sectional survey. Subjects randomly selected from cataract surgical waiting lists in Hong Kong (n = 467) underwent a telephone interview based on a structured, validated questionnaire. Data were collected on private insurance coverage, preferred waiting time, amount willing to pay for surgery, and self-reported visual function and health status.

RESULTS:

Among 300 subjects completing the interview, 144 (48.2%) were 76 years of age or older, 177 (59%) were women, and mean time waiting for surgery was 17 +/- 15 months. Among 220 subjects (73.3%) willing to pay anything for surgery, the mean amount was US$552 +/- 443. With adjustment for age, education, and monthly household income, subjects willing to pay anything were less willing to wait 12 months for surgery (OR = 4.34; P = 0.002), more likely to know someone having had cataract surgery (OR = 2.20; P = 0.03), and more likely to use their own savings to pay for the surgery (OR = 2.21; P = 0.04). Subjects considering private cataract surgery, knowing people who have had cataract surgery, using nongovernment sources to pay for surgery, and having lower visual function were willing to pay more.

CONCLUSIONS:

Many patients wait significant periods for cataract surgery in Hong Kong, and are willing to pay substantial amounts for private operations. These results may have implications for other countries with cataract waiting lists.

Heterogeneous error-resilient scheme for spectral analysis in ultra-low power wearable electrocardiogram devices

Wearable devices performing advanced bio-signal analysis algorithms are aimed to foster a revolution in healthcare provision of chronic cardiac diseases. In this context, energy efficiency is of paramount importance, as long-term monitoring must be ensured while relying on a tiny power source. Operating at a scaled supply voltage, just above the threshold voltage, effectively helps in saving substantial energy, but it makes circuits, and especially memories, more prone to errors, threatening the correct execution of algorithms. The use of error detection and correction codes may help to protect the entire memory content, however it incurs in large area and energy overheads which may not be compatible with the tight energy budgets of wearable systems. To cope with this challenge, in this paper we propose to limit the overhead of traditional schemes by selectively detecting and correcting errors only in data highly impacting the end-to-end quality of service of ultra-low power wearable electrocardiogram (ECG) devices. This partition adopts the protection of either significant words or significant bits of each data element, according to the application characteristics (statistical properties of the data in the application buffers), and its impact in determining the output. The proposed heterogeneous error protection scheme in real ECG signals allows substantial energy savings (11% in wearable devices) compared to state-of-the-art approaches, like ECC, in which the whole memory is protected against errors. At the same time, it also results in negligible output quality degradation in the evaluated power spectrum analysis application of ECG signals.

Lattice-based Encryption Over Standard Lattices in Hardware

Lattice-based cryptography has gained credence recently as a replacement for current public-key cryptosystems, due to its quantum-resilience, versatility, and relatively low key sizes. To date, encryption based on the learning with errors (LWE) problem has only been investigated from an ideal lattice standpoint, due to its computation and size efficiencies. However, a thorough investigation of standard lattices in practice has yet to be considered. Standard lattices may be preferred to ideal lattices due to their stronger security assumptions and less restrictive parameter selection process. In this paper, an area-optimised hardware architecture of a standard lattice-based cryptographic scheme is proposed. The design is implemented on a FPGA and it is found that both encryption and decryption fit comfortably on a Spartan-6 FPGA. This is the first hardware architecture for standard lattice-based cryptography reported in the literature to date, and thus is a benchmark for future implementations.
Additionally, a revised discrete Gaussian sampler is proposed which is the fastest of its type to date, and also is the first to investigate the cost savings of implementing with lamda_2-bits of precision. Performance results are promising in comparison to the hardware designs of the equivalent ring-LWE scheme, which in addition to providing a stronger security proof; generate 1272 encryptions per second and 4395 decryptions per second.

Influence of testing on permeability of compacted fine soils

The British standard constant-head triaxial test for measuring the permeability of fine-grained soils takes a relatively long time. A quicker test could provide savings to the construction industry, particularly for checking the quality of landfill clay liners. An accelerated permeability test has been developed, but the method often underestimates the permeability values compared owing to structural changes in the soil sample. This paper reports on an investigation
into the accelerated test to discover if the changes can be limited by using a revised procedure. The accelerated test is assessed and compared with the standard test and a ramp-accelerated permeability test. Four different finegrained materials are compacted at various water contents to produce analogous samples for testing using the three different methods. Fabric analysis is carried out on specimens derived from post-test samples using mercury intrusion porosimetry and scanning electron microscopy to assess the effects of testing on soil structure. The results show that accelerated testing in general underestimates permeability compared with values derived from the standard test, owing to changes in soil structure caused by testing. The ramp-accelerated test is shown to provide an improvement in terms of these structural changes.