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

Medical Research Council (ref G0701604) and administered by the NIHR-EME (ref 09-800-26)

Asymmetric 3D video coding based on regions of perceptual relevance

This dissertation presents a study and experimental research on asymmetric coding of stereoscopic video. A review on 3D technologies, video formats and coding is rst presented and then particular emphasis is given to asymmetric coding of 3D content and performance evaluation methods, based on subjective measures, of methods using asymmetric coding. The research objective was de ned to be an extension of the current concept of asymmetric coding for stereo video. To achieve this objective the rst step consists in de ning regions in the spatial dimension of auxiliary view with di erent perceptual relevance within the stereo pair, which are identi ed by a binary mask. Then these regions are encoded with better quality (lower quantisation) for the most relevant ones and worse quality (higher quantisation) for the those with lower perceptual relevance. The actual estimation of the relevance of a given region is based on a measure of disparity according to the absolute di erence between views. To allow encoding of a stereo sequence using this method, a reference H.264/MVC encoder (JM) has been modi ed to allow additional con guration parameters and inputs. The nal encoder is still standard compliant. In order to show the viability of the method subjective assessment tests were performed over a wide range of objective qualities of the auxiliary view. The results of these tests allow us to prove 3 main goals. First, it is shown that the proposed method can be more e cient than traditional asymmetric coding when encoding stereo video at higher qualities/rates. The method can also be used to extend the threshold at which uniform asymmetric coding methods start to have an impact on the subjective quality perceived by the observers. Finally the issue of eye dominance is addressed. Results from stereo still images displayed over a short period of time showed it has little or no impact on the proposed method.

Contributors to and impact of residual shunting after device closure of atrial septal defects.

BACKGROUND: The prevalence of residual shunt in patients after device closure of atrial septal defect and its impact on long-term outcome has not been previously defined. METHODS: From a prospective, single-institution registry of 408 patients, we selected individuals with agitated saline studies performed 1 year after closure. Baseline echocardiographic, invasive hemodynamic, and comorbidity data were compared to identify contributors to residual shunt. Survival was determined by review of the medical records and the Social Security Death Index. Survival analysis according to shunt included construction of Kaplan-Meier curves and Cox proportional hazards modeling. RESULTS: Among 213 analyzed patients, 27% were men and age at repair was 47 ± 17 years. Thirty patients (14%) had residual shunt at 1 year. Residual shunt was more common with Helex (22%) and CardioSEAL/STARFlex (40%) occluder devices than Amplatzer devices (9%; P = .005). Residual shunts were more common in whites (79% vs 46%, P = .004). At 7.3 ± 3.3 years of follow-up, 13 (6%) of patients had died, including 8 (5%) with Amplatzer, 5 (25%) with CardioSEAL/STARFlex, and 0 with Helex devices. Patients with residual shunting had a higher hazard of death (20% vs 4%, P = .001; hazard ratio 4.95 [1.59-14.90]). In an exploratory multivariable analysis, residual shunting, age, hypertension, coronary artery disease, and diastolic dysfunction were associated with death. CONCLUSIONS: Residual shunt after atrial septal defect device closure is common and adversely impacts long-term survival.

The Effect of Prenatal Auditory Enrichment on Perceptual Narrowing in Bobwhite Quail Neonates

The development of species-typical perceptual preferences has been shown to depend on a variety of socially and ecologically derived sensory stimulation during both the pre- and postnatal periods. The prominent mechanism behind the development of these seemingly innate tendencies in young organisms has been hypothesized to be a domain-general pan-sensory selectivity process referred to as perceptual narrowing, whereby regularly experienced sensory stimuli are honed in upon, while simultaneously losing the ability to effectively discriminate between atypical or unfamiliar sensory stimulation. Previous work with precocial birds has been successful in preventing the development of species-typical perceptual preferences by denying the organism typical levels of social and/or self-produced stimulation. The current series of experiments explored the mechanism of perceptual narrowing to assess the malleability of a species-typical auditory preference in avian embryos. By providing a variety of different unimodal and bimodal presentations of a mixed-species vocalizations at the onset of prenatal auditory function, the following project aimed to 1) keep the perceptual window from narrowing, thereby interfering with the development of a species-typical auditory preference, 2) investigate how long differential prenatal stimulation can keep the perceptual window open postnatally, 3) explore how prenatal auditory enrichment effected preferences for novelty, and 4) assess whether prenatal auditory perceptual narrowing is affected by modality specific or amodal stimulus properties during early development. Results indicated that prenatal auditory enrichment significantly interferes with the emergence of a species-typical auditory preference and increases openness to novelty, at least temporarily. After accruing postnatal experience in an environment rich with species-typical auditory and multisensory cues, the effect of prenatal auditory enrichment rapidly was found to rapidly fade. Prenatal auditory enrichment with extraneous non-synchronous light exposure was shown to both keep the perceptual narrowing window open and impede learning in the postnatal environment, following hatching. Results are discussed in light of the role experience plays in perceptual narrowing during the perinatal period.

The Contribution of Structured Activity and Deliberate Play to the Development of Expert Perceptual and Decision-Making Skill

The developmental histories of 32 players in the Australian Football League (AFL), independently classified as either expert or less skilled in their perceptual and decision- making skills, were collected through a structured interview process and their year-on-year involvement in structured and deliberate play activities retrospectively determined. Despite being drawn from the same elite level of competition, the expert decision-makers differed from the less skilled in having accrued, during their developing years, more hours of experience in structured activities of all types, in structured activities in invasion-type sports, in invasion-type deliberate play, and in invasion activities from sports other than Australian football. Accumulated hours invested in invasion-type activities differentiated between the groups, suggesting that it is the amount of invasion-type activity that is experienced and not necessarily intent (skill development or fun) or specificity that facilitates the development of perceptual and decision-making expertise in this team sport.

Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial

Background
Primary angle-closure glaucoma is a leading cause of irreversible blindness worldwide. In early-stage disease, intraocular pressure is raised without visual loss. Because the crystalline lens has a major mechanistic role, lens extraction might be a useful initial treatment.

Methods
From Jan 8, 2009, to Dec 28, 2011, we enrolled patients from 30 hospital eye services in five countries. Randomisation was done by a web-based application. Patients were assigned to undergo clear-lens extraction or receive standard care with laser peripheral iridotomy and topical medical treatment. Eligible patients were aged 50 years or older, did not have cataracts, and had newly diagnosed primary angle closure with intraocular pressure 30 mm Hg or greater or primary angle-closure glaucoma. The co-primary endpoints were patient-reported health status, intraocular pressure, and incremental cost-effectiveness ratio per quality-adjusted life-year gained 36 months after treatment. Analysis was by intention to treat. This study is registered, number ISRCTN44464607.

Findings
Of 419 participants enrolled, 155 had primary angle closure and 263 primary angle-closure glaucoma. 208 were assigned to clear-lens extraction and 211 to standard care, of whom 351 (84%) had complete data on health status and 366 (87%) on intraocular pressure. The mean health status score (0·87 [SD 0·12]), assessed with the European Quality of Life-5 Dimensions questionnaire, was 0·052 higher (95% CI 0·015–0·088, p=0·005) and mean intraocular pressure (16·6 [SD 3·5] mm Hg) 1·18 mm Hg lower (95% CI –1·99 to –0·38, p=0·004) after clear-lens extraction than after standard care. The incremental cost-effectiveness ratio was £14 284 for initial lens extraction versus standard care. Irreversible loss of vision occurred in one participant who underwent clear-lens extraction and three who received standard care. No patients had serious adverse events.

Interpretation
Clear-lens extraction showed greater efficacy and was more cost-effective than laser peripheral iridotomy, and should be considered as an option for first-line treatment.

Face description for perceptual user interfaces

[EN]We investigate mechanisms which can endow the computer with the ability of describing a human face by means of computer vision techniques. This is a necessary requirement in order to develop HCI approaches which make the user feel himself/herself perceived. This paper describes our experiences considering gender, race and the presence of moustache and glasses. This is accomplished comparing, on a set of 6000 facial images, two di erent face representation approaches: Principal Components Analysis (PCA) and Gabor lters. The results achieved using a Support Vector Machine (SVM) based classi er are promising and particularly better for the second representation approach.

Multiple face detection at different resolutions for perceptual user interfaces

[EN]This paper describes in detail a real-time multiple face detection system for video streams. The system adds to the good performance provided by a window shift approach, the combination of different cues available in video streams due to temporal coherence. The results achieved by this combined solution outperform the basic face detector obtaining a 98% success rate for around 27000 images, providing additionally eye detection and a relation between the successive detections in time by means of detection threads.

Exploring Perceptual Matters: A Textile-Based Approach

This research takes a practice-based approach to exploring perceptual matters that often go unnoticed in the context of everyday lived experience. My approach focuses on the experiential possibilities of knowledge emerging through artistic enquiry, and uses a variety of modes (like textiles, sound, physical computing, programming, video and text) to be conducted and communicated. It examines scholarship in line with the ecological theory of perception, and is particularly informed by neurobiological research on sensory integration as well as by cultural theories that examine the role of sensory appreciation in perception. Different processes contributing to our perceptual experience are examined through the development of a touch-sensitive, sound-generating rug and its application in an experimental context. Participants’ interaction with the rug and its sonic output allows an insight into how they make sense of multisensory information via observation of how they physically respond to it. In creating possibilities for observing the two ends of the perceptual process (sensory input and behavioural output), the rug provides a platform for the study of what is intangible to the observer (perceptual activity) through what can actually be observed (physical activity). My analysis focuses on video recordings of the experimental process and data reports obtained from the software used for the sound generating performance of the rug. Its findings suggest that attentional focus, active exploration, and past experience actively affect the ability to integrate multisensory information and are crucial parameters for the formation of a meaningful percept upon which to act. Although relational to the set experimental conditions and the specificities of the experimental group, these findings are in resonance with current cross-disciplinary discourse on perception, and indicate that art research can be incorporated into the wider arena of neurophysiological and behavioural research to expand its span of resources and methods.

Perceptual load affects eyewitness accuracy and susceptibility to leading questions

Load Theory (Lavie, 1995, 2005) states that the level of perceptual load in a task (i.e.,the amount of information involved in processing task-relevant stimuli) determines the efficiency of selective attention. There is evidence that perceptual load affects distractor processing, with increased inattentional blindness under high load. Given that high load can result in individuals failing to report seeing obvious objects, it is conceivable that load may also impair memory for the scene. The current study is the first to assess the effect of perceptual load on eyewitness memory. Across three experiments (two video-based and one in a driving simulator), the effect of perceptual load on eyewitness memory was assessed. The results showed that eyewitnesses were less accurate under high load, in particular for peripheral details. For example, memory for the central character in the video was not affected by load but memory for a witness who passed by the window at the edge of the scene was significantly worse under high load. High load memories were also more open to suggestion, showing increased susceptibility to leading questions. High visual perceptual load also affected recall for auditory information, illustrating a possible cross-modal perceptual load effect on memory accuracy. These results have implications for eyewitness memory researchers and forensic professionals.

Vacuum-assisted closure treatment of leg skin necrosis after angiographic embolization of a giant plexiform neurofibroma

Type 1 neurofibromatosis is a relatively common inherited disease of the nervous system, with a frequency of almost 1 in 3000. It is associated with neurofibromas of various sites. Our case report is about the surgical management of a giant neurofibroma of the right gluteal fold in a 46-year-old male with NF1. The patient presented with increasing edema and accelerated growth of the mass; he underwent percutaneous embolization of lesion vessels that induced necrosis of the neurofibroma. The patient was taken to the operating room, where surgical resection of the bulk of the lesion was undertaken. The postoperative course was complicated by delayed wound closure managed with antibiotics and vacuum-assisted wound closure. Giant neurofibromas similar to this tumor require complex preoperative, intraoperative and postoperative management strategies. Surgical debulk is best managed with preoperative percutaneous embolization that help to avoid surgical bleeding. Postoperative delayed wound closure was managed with the application of negative pressure in a closed environment that triggers granulation and tissue formation.

Evaluation of negative pressure vacuum-assisted system in acute and chronic wounds closure. Our experience

Negative-pressure therapy or vacuum-assisted closure (VAC) has been used in clinical applications since the 1940’s and has increased in popularity over the past decade. This dressing technique consists of an open cell foam dressing put into the wound cavity, a vacuum pump produces a negative pressure and an adhesive drape. A controlled sub atmospheric pressure from 75 to 150 mmHg is applied. The vacuum-assisted closure has been applied by many clinicians to chronic wounds in humans; however it cannot be used as a replacement for surgical debridement. The initial treatment for every contaminated wound should be the necrosectomy. The VAC therapy has a complementary function and the range of its indications includes pressure sores, stasis ulcers, chronic wounds such as diabetic foot ulcers, post traumatic and post operative wounds, infected wounds such as necrotizing fasciitis or sternal wounds, soft-tissue injuries, bone exposed injuries, abdominal open wounds and for securing a skin graft. We describe our experience with the VAC dressing used to manage acute and chronic wounds in a series of 135 patients, with excellent results together with satisfaction of the patients.

Two-year clinical outcome from the Iberian registry patients after left atrial appendage closure

AIMS: The aim of this study was to observe the percentage of thromboembolic and haemorrhagic events over a 2-year follow-up in patients with non-valvular atrial fibrillation (NVAF) undergoing closure of the left atrial appendage (LAA) with an occlusion device. Observed events and CHADS2 (congestive heart failure, hypertension, age, diabetes, stroke history), CHA2DS2-VASc (also adding: vascular disease and sex) and HAS-BLED (hypertension, abnormal liver/renal function, stroke history, bleeding predisposition, labile international normalised ratios, elderly, drugs/alcohol use)-predicted events were compared. METHODS: LAA closure with an occlusion device was performed in 167 NVAF patients contraindicated for oral anticoagulants and recruited from 12 hospitals between 2009 and 2013. At least two transoesophageal echocardiograms were performed in the first 6 months postimplantation. Antithrombotics included clopidogrel and aspirin. Patients were monitored for death, stroke, major and relevant bleeding and hospitalisation for concomitant conditions. Mean age was 74.68±8.58, median follow-up was 24 months, 5.38% had intraoperative complications and implantation was successful in 94.6% of subjects. Mortality during follow-up was 10.8%, mostly (9.5%) non-cardiac related. Bleeding occurred in 10.1% of subjects, 5.7% major and 4.4% minor though relevant, and 4.4% suffered stroke. Major bleeding and stroke/transient ischaemic attack events within 2 years (annual event rates, 290 patients/year) were less frequent than expected from CHADS2 (2.4% vs 9.6%), CHA2DS2-VASc (2.4% vs 8.3%) and HAS-BLED (3.1% vs 6.6%) risk scores (p<0.001, p=0.003, p=0.047, respectively). CONCLUSIONS: LAA closure with an occlusion device in patients contraindicated for oral anticoagulants is a therapeutic option associated with fewer thromboembolic and haemorrhagic events than expected from risk scores, particularly in the second year postimplantation.

Conditional moment closure for chemical reactions in laminar chaotic flows

We implement conditional moment closure (CMC) for simulation of chemical reactions in laminar chaotic flows. The CMC approach predicts the expected concentration of reactive species, conditional upon the concentration of a corresponding nonreactive scalar. Closure is obtained by neglecting the difference between the local concentration of the reactive scalar and its conditional average. We first use a Monte Carlo method to calculate the evolution of the moments of a conserved scalar; we then reconstruct the corresponding probability density function and dissipation rate. Finally, the concentrations of the reactive scalars are determined. The results are compared (and show excellent agreement) with full numerical simulations of the reaction processes in a chaotic laminar flow. This is a preprint of an article published in AlChE Journal copyright (2007) American Institute of Chemical Engineers: http://www3.interscience.wiley.com/

Mechanical behavior of rock joints: influence of joint roughness on its closure and shear behavior

En esta tesis se estudia la fricción en juntas rocosas utilizando el Método de Elementos Discretos (DEM). En particular, se estudia la influencia de la rugosidad de las superficies de la junta, la elasticidad, la fractura, y el nivel de carga de compresión sobre el comportamiento de cierre y de cizalla de las juntas rocosas. Por primera vez la rugosidad de las juntas considerada como auto-afín es utilizada para estudiar la fricción de juntas rocosas, la rugosidad se describe mediante tres parámetros: el exponente de rugosidad, la longitud de correlación auto-afín y la varianza de alturas. Mediante un algoritmo de computadora basado en métodos espectrales, ocho superficies autoafines isotrópicas con diferente rugosidad fueron creadas. Posteriormente, las ocho superficies fueron utilizadas como moldes para generar las juntas utilizando elementos discretos. Antes de realizar las simulaciones de compresión y cizallaura, se calibraron las propiedades elásticas y de fractura (criterio de fractura elíptico basado en esfuerzos) de las juntas numéricas a los datos experimentales (obtenidos previamente) de unas muestras de mortero mediante la utilización de un volumen elemental representativo (REV). Una vez que las propiedades mecánicas de las juntas se obtuvieron mediante la calibración del REV, se realizaron las pruebas de cierre (prueba de compresión) de las ocho juntas DEM. Se utilizaron dos niveles de esfuerzo de compresión para las pruebas de cierre: 14 MPa y 21 MPa. Después, las ocho juntas DEM fueron cizalladas en dos direcciones mutuamente perpendiculares. Para cada dirección de cizalla y cada nivel de esfuerzo de compresión (14 y 21 MPa), las juntas fueron cizalladas usando uno de los tres modelos mecánicos siguientes: 1) un modelo rígido, en el que las juntas no se pueden deformar, excepto en su superficie, 2) un modelo puramente elástico, en el que las juntas se pueden deformar en todo su volumen y 3) un modelo elástico con fractura en el que las juntas se pueden deformar en su volumen y, si el esfuerzo sobre las uniones entre partículas excede cierto nivel de esfuerzo máximo, las uniones se rompen de una manera irreversible. El uso de estos tres modelos mecánicos nos permitirá estudiar de manera sistemática: la influencia de la rugosidad (modelo rígido), la influencia de la elasticidad y rugosidad (modelo puramente elástico) y, finalmente, el efecto combinado de la rugosidad de las juntas, la elasticidad y la fractura (modelo elástico con fractura). El estudio de los resultados obtenidos de las simulaciones DEM es seguido por una análisis energético el cual permite estudiar la evolución de los diferentes tipos de energía en función del desplazamiento de cizalla: energía elástica almacenada en el sistema, energía de fricción entre elementos discretos, el trabajo relacionado con la dilatación de la junta y la energía disipada por el amortiguamiento interno del DEM.