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.

Investigating high-achieving sixth grade students' erroneous answers on the angle concept in Yozgat

The angle concept is a multifaceted concept having static and dynamic definitions. The static definition of the angle refers to “the space between two rays” or “the intersection of two rays at the same end point” (Mitchelmore & White, 1998), whereas the dynamic definition of the angle concept highlights that the size of angle is the amount of rotation in direction (Fyhn, 2006). Since both definitions represent two diverse situations and have unique limitations (Henderson & Taimina, 2005), students may hold misconceptions about the angle concept. In this regard, the aim of this research was to explore high achievers’ knowledge regarding the definition of the angle concept as well as to investigate their erroneous answers on the angle concept.

104 grade 6 students drawn from four well-established elementary schools of Yozgat, Turkey were participated in this research. All participants were selected via a purposive sampling method and their mathematics grades were 4 or 5 out of 5, and. Data were collected through four questions prepared by considering the learning competencies set out in the grade 6 curriculum in Turkey and the findings of previous studies whose purposes were to identify students’ misconceptions of the angle concept. The findings were analyzed by two researchers, and their inter-rater agreement was calculated as 0.91, or almost perfect. Thereafter, coding discrepancies were resolved, and consensus was established.

The angle concept is a multifaceted concept having static and dynamic definitions.The static definition of the angle refers to “the space between two rays” or“the intersection of two rays at the same end point” (Mitchelmore & White, 1998), whereas the dynamicdefinition of the angle concept highlights that the size of angle is the amountof rotation in direction (Fyhn, 2006). Since both definitionsrepresent two diverse situations and have unique limitations (Henderson & Taimina, 2005), students may holdmisconceptions about the angle concept. In this regard, the aim of thisresearch was to explore high achievers’ knowledge regarding the definition ofthe angle concept as well as to investigate their erroneous answers on theangle concept.

Characterisation of Large Disturbance Rotor Angle and Voltage Stability in Interconnected Power Networks with Distributed Wind Generation

Wind generation in highly interconnected power networks creates local and centralised stability issues based on their proximity to conventional synchronous generators and load centres. This paper examines the large disturbance stability issues (i.e. rotor angle and voltage stability) in power networks with geographically distributed wind resources in the context of a number of dispatch scenarios based on profiles of historical wind generation for a real power network. Stability issues have been analysed using novel stability indices developed from dynamic characteristics of wind generation. The results of this study show that localised stability issues worsen when significant penetration of both conventional and wind generation is present due to their non-complementary characteristics. In contrast, network stability improves when either high penetration of wind and synchronous generation is present in the network. Therefore, network regions can be clustered into two distinct stability groups (i.e. superior stability and inferior stability regions). Network stability improves when a voltage control strategy is implemented at wind farms, however both stability clusters remain unchanged irrespective of change in the control strategy. Moreover, this study has shown that the enhanced fault ride-through (FRT) strategy for wind farms can improve both voltage and rotor angle stability locally, but only a marginal improvement is evident in neighbouring regions.

Crack propagation in non-homogenous materials: Evaluation of mixed-mode SIFs, T-stress and kinking angle using a variant EFG method

A new variant of the Element-Free Galerkin (EFG) method, that combines the diffraction method, to characterize the crack tip solution, and the Heaviside enrichment function for representing discontinuity due to a crack, has been used to model crack propagation through non-homogenous materials. In the case of interface crack propagation, the kink angle is predicted by applying the maximum tangential principal stress (MTPS) criterion in conjunction with consideration of the energy release rate (ERR). The MTPS criterion is applied to the crack tip stress field described by both the stress intensity factor (SIF) and the T-stress, which are extracted using the interaction integral method. The proposed EFG method has been developed and applied for 2D case studies involving a crack in an orthotropic material, crack along an interface and a crack terminating at a bi-material interface, under mechanical or thermal loading; this is done to demonstrate the advantages and efficiency of the proposed methodology. The computed SIFs, T-stress and the predicted interface crack kink angles are compared with existing results in the literature and are found to be in good agreement. An example of crack growth through a particle-reinforced composite materials, which may involve crack meandering around the particle, is reported.

Calibrated Polarisation Tilt Angle Recovery for Wireless Communications

In this paper, we show how the polarisation state of a linearly polarised antenna can be recovered through the use of a three-term error correction model. The approach adopted is shown to be robust in situations where some multipath exists and where the sampling channels are imperfect with regard to both their amplitude and phase tracking. In particular, it has been shown that error of the measured polarisation tilt angle can be improved from 33% to 3% and below by applying the proposed calibration method. It is described how one can use a rotating dipole antenna as both the calibration standard and as the polarisation encoder, thus simplifying the physical arrangement of the transmitter. Experimental results are provided in order to show the utility of the approach, which could have a variety of applications including bandwidth conservative polarisation sub-modulation in advanced wireless communications systems.

Studies of Protein-Protein and Protein-Water Interactions by Small Angle X-Ray Scattering, Terahertz Spectroscopy, ASMOS, And Computer Simulation

The protein folding problem has been one of the most challenging subjects in biological physics due to its complexity. Energy landscape theory based on statistical mechanics provides a thermodynamic interpretation of the protein folding process. We have been working to answer fundamental questions about protein-protein and protein-water interactions, which are very important for describing the energy landscape surface of proteins correctly. At first, we present a new method for computing protein-protein interaction potentials of solvated proteins directly from SAXS data. An ensemble of proteins was modeled by Metropolis Monte Carlo and Molecular Dynamics simulations, and the global X-ray scattering of the whole model ensemble was computed at each snapshot of the simulation. The interaction potential model was optimized and iterated by a Levenberg-Marquardt algorithm. Secondly, we report that terahertz spectroscopy directly probes hydration dynamics around proteins and determines the size of the dynamical hydration shell. We also present the sequence and pH-dependence of the hydration shell and the effect of the hydrophobicity. On the other hand, kinetic terahertz absorption (KITA) spectroscopy is introduced to study the refolding kinetics of ubiquitin and its mutants. KITA results are compared to small angle X-ray scattering, tryptophan fluorescence, and circular dichroism results. We propose that KITA monitors the rearrangement of hydrogen bonding during secondary structure formation. Finally, we present development of the automated single molecule operating system (ASMOS) for a high throughput single molecule detector, which levitates a single protein molecule in a 10 µm diameter droplet by the laser guidance. I also have performed supporting calculations and simulations with my own program codes.

Deep Crustal Structure of the North-West African Margin from Combined Wide-angle and Reflection Seismic Data (MIRROR Seismic Survey)

The structure of the Moroccan and Nova Scotia conjugate rifted margins is of key importance for understanding the Mesozoic break-up and evolution of the northern central Atlantic Ocean basin. Seven combined multichannel reflection (MCS) and wide-angle seismic (OBS) data profiles were acquired along the Atlantic Moroccan margin between the latitudes of 31.5° and 33° N during the MIRROR seismic survey in 2011, in order to image the transition from continental to oceanic crust, to study the variation in crustal structure and to characterize the crust under the West African Coast Magnetic Anomaly (WACMA). The data were modeled using a forward modeling approach. The final models image crustal thinning from 36 km thickness below the continent to approximately 8 km in the oceanic domain. A 100 km wide zone characterized by rough basement topography and high seismic velocities up to 7.4 km/s in the lower crust is observed westward of the West African Coast Magnetic Anomaly. No basin underlain by continental crust has been imaged in this region, as has been identified north of our study area. Comparison to the conjugate Nova Scotian margin shows a similar continental crustal thickness and layer geometry, and the existence of exhumed and serpentinized upper mantle material on the Canadian side only. The oceanic crustal thickness is lower on the Canadian margin.

Probabilistic Evaluation of Three-Dimensional Reconstructions from X-Ray Images Spanning a Limited Angle

An important part of computed tomography is the calculation of a three-dimensional reconstruction of an object from series of X-ray images. Unfortunately, some applications do not provide sufficient X-ray images. Then, the reconstructed objects no longer truly represent the original. Inside of the volumes, the accuracy seems to vary unpredictably. In this paper, we introduce a novel method to evaluate any reconstruction, voxel by voxel. The evaluation is based on a sophisticated probabilistic handling of the measured X-rays, as well as the inclusion of a priori knowledge about the materials that the object receiving the X-ray examination consists of. For each voxel, the proposed method outputs a numerical value that represents the probability of existence of a predefined material at the position of the voxel while doing X-ray. Such a probabilistic quality measure was lacking so far. In our experiment, false reconstructed areas get detected by their low probability. In exact reconstructed areas, a high probability predominates. Receiver Operating Characteristics not only confirm the reliability of our quality measure but also demonstrate that existing methods are less suitable for evaluating a reconstruction.

Presentation of Primary Open Angle Glaucoma (POAG) at Lions Sight First Eye Hospital in Blantyre, Malawi

Objective Primary open angle glaucoma (POAG) is the most common type of glaucoma in Africa. We carried out a study to determine the clinical presentation pattern of patients with primary open angle glaucoma (POAG) at a tertiary hospital in Malawi. Design A cross-sectional study Setting Lions Sight First Eye Hospital—a major referral and teaching state eye hospital in Blantyre, Malawi Subjects Study participants were newly diagnosed POAG patients at specialist eye clinic during study period. Results A total of 60 POAG patients were recruited into the study. The mean age was 58.7 years (SD= 16.6, range 18 - 86). There were more male (44, 73.3%) than female (16, 27.7%) patients. The majority of patients (73%) presented one year after onset of visual symptoms. Twenty-six patients (43%) had unilateral blindness (visual acuity < 3/60; WHO classification), while nine patients (15%) presented with bilateral blindness. A vertical cup-to-disc ratio (CDR) of 0.8 or worse was seen in 92 eyes (79%). The mean intraocular pressure (IOP) reading was 35.5 mmHg (SD 13.30). Of the thirty-three eyes that successfully underwent visual field analysis, very advanced defects were recorded in 12 eyes (36%). Conclusion This study demonstrates delayed presentation and male predominance among POAG patients at a tertiary eye hospital in Malawi. Glaucoma intervention programmes should aim at identifying patients with treatable glaucoma with particular attention to women.

Accelerating wide-angle converging waves in the near field

We show that a wide-angle converging wave may be transformed into a shape-preserving accelerating beam having a beam-width near the diffraction limit. For that purpose, we followed a strategy that is particularly conceived for the acceleration of nonparaxial laser beams, in contrast to the well-known method by Siviloglou et al (2007 Phys. Rev. Lett. 99 213901). The concept of optical near-field shaping is applied to the design of non-flat ultra-narrow diffractive optical elements. The engineered curvilinear caustic can be set up by the beam emerging from a dynamic assembly of elementary gratings, the latter enabling to modify the effective refractive index of the metamaterial as it is arranged in controlled orientations. This light shaping process, besides being of theoretical interest, is expected to open up a wide range of broadband application possibilities.

Flow around a hemisphere-cylinder at high angle of attack and low Reynolds number. Part II: POD and DMD applied to reduced domains

Three-dimensional direct numerical simulations (DNS) have been performed on a finite-size hemispherecylinder model at angle of attack AoA = 20◦ and Reynolds numbers Re = 350 and 1000. Under these conditions, massive separation exists on the nose and lee-side of the cylinder, and at both Reynolds numbers the flow is found to be unsteady. Proper orthogonal decomposition (POD) and dynamic mode decomposition (DMD) are employed in order to study the primary instability that triggers unsteadiness at Re = 350. The dominant coherent flow structures identified at the lower Reynolds number are also found to exist at Re = 1000; the question is then posed whether the flow oscillations and structures found at the two Reynolds numbers are related. POD and DMD computations are performed using different subdomains of the DNS computational domain. Besides reducing the computational cost of the analyses, this also permits to isolate spatially localized oscillatory structures from other, more energetic structures present in the flow. It is found that POD and DMD are in general sensitive to domain truncation and noneducated choices of the subdomain may lead to inconsistent results. Analyses at Re = 350 show that the primary instability is related to the counter rotating vortex pair conforming the three-dimensional afterbody wake, and characterized by the frequency St ≈ 0.11, in line with results in the literature. At Re = 1000, vortex-shedding is present in the wake with an associated broadband spectrum centered around the same frequency. The horn/leeward vortices at the cylinder lee-side, upstream of the cylinder base, also present finite amplitude oscillations at the higher Reynolds number. The spatial structure of these oscillations, described by the POD modes, is easily differentiated from that of the wake oscillations. Additionally, the frequency spectra associated with the lee-side vortices presents well defined peaks, corresponding to St ≈ 0.11 and its few harmonics, as opposed to the broadband spectrum found at the wake.

Flow around a hemisphere-cylinder at high angle of attack and low Reynolds number. Part I: Experimental and numerical investigation

Three-dimensional Direct Numerical Simulations combined with Particle Image Velocimetry experiments have been performed on a hemisphere-cylinder at Reynolds number 1000 and angle of attack 20◦. At these flow conditions, a pair of vortices, so-called “horn” vortices, are found to be associated with flow separation. In order to understand the highly complex phenomena associated with this fully threedimensional massively separated flow, different structural analysis techniques have been employed: Proper Orthogonal and Dynamic Mode Decompositions, POD and DMD, respectively, as well as criticalpoint theory. A single dominant frequency associated with the von Karman vortex shedding has been identified in both the experimental and the numerical results. POD and DMD modes associated with this frequency were recovered in the analysis. Flow separation was also found to be intrinsically linked to the observed modes. On the other hand, critical-point theory has been applied in order to highlight possible links of the topology patterns over the surface of the body with the computed modes. Critical points and separation lines on the body surface show in detail the presence of different flow patterns in the base flow: a three-dimensional separation bubble and two pairs of unsteady vortices systems, the horn vortices, mentioned before, and the so-called “leeward” vortices. The horn vortices emerge perpendicularly from the body surface at the separation region. On the other hand, the leeward vortices are originated downstream of the separation bubble, as a result of the boundary layer separation. The frequencies associated with these vortical structures have been quantified.