Development of appropriateness explicit criteria for cataract extraction by phacoemulsification

Background: Consensus development techniques were used in the late 1980s to create explicit criteria for the appropriateness of cataract extraction. We developed a new appropriateness of indications tool for cataract following the RAND method. We tested the validity of our panel results. Methods: Criteria were developed using a modified Delphi panel judgment process. A panel of 12 ophthalmologists was assembled. Ratings were analyzed regarding the level of agreement among panelists. We studied the influence of all variables on the final panel score using linear and logistic regression models. The explicit criteria developed were summarized by classification and regression tree analysis. Results: Of the 765 indications evaluated by the main panel in the second round, 32.9% were found appropriate, 30.1% uncertain, and 37% inappropriate. Agreement was found in 53% of the indications and disagreement in 0.9%. Seven variables were considered to create the indications and divided into three groups: simple cataract, with diabetic retinopathy, or with other ocular pathologies. The preoperative visual acuity in the cataractous eye and visual function were the variables that best explained the panel scoring. The panel results were synthesized and presented in three decision trees. Misclassification error in the decision trees, as compared with the panel original criteria, was 5.3%. Conclusion: The parameters tested showed acceptable validity for an evaluation tool. These results support the use of this indication algorithm as a screening tool for assessing the appropriateness of cataract extraction in field studies and for the development of practice guidelines.

Demographics by depth: spatially explicit life-history dynamics of a protogynous reef fish

Distribution and demographics of the hogfish (Lachnolaimus maximus) were investigated by using a combined approach of in situ observations and life history analyses. Presence, density, size, age, and size and age at sex change all varied with depth in the eastern Gulf of Mexico. Hogfish (64–774 mm fork length and 0–19 years old) were observed year-round and were most common over complex, natural hard bottom habitat. As depth increased, the presence and density of hogfish decreased, but mean size and age increased. Size at age was smaller nearshore (<30 m). Length and age at sex change of nearshore hogfish were half those of offshore hogfish and were coincident with the minimum legal size limit. Fishing pressure is presumably greater nearshore and presents a confounding source of increased mortality; however, a strong red tide occurred the year before this study began and likely also affected nearshore demographics. Nevertheless, these data indicate ontogenetic migration and escapement of fast-growing fish to offshore habitat, both of which should reduce the likelihood of fishing-induced evolution. Data regarding the hogfish fishery are limited and regionally dependent, which has confounded previous stock assessments; however, the spatially explicit vital rates reported herein can be applied to future monitoring efforts.

Verifying stability of approximate explicit MPC

Several authors have proposed algorithms for approximate explicit MPC [1],[2],[3]. These algorithms have in common that they develop a stability criterion for approximate explicit MPC that require the approximate cost function to be within a certain distance from the optimal cost function. In this paper, stability is instead ascertained by considering only the cost function of the approximate MPC. If a region of the state space is found where the cost function is not decreasing, this indicates that an improved approximation (to the optimal control) is required in that region. If the approximate cost function is decreasing everywhere, no further refinement of the approximate MPC is necessary, since stability is guaranteed. ©2009 IEEE.