Surveillance for ocular hypertension: An evidence synthesis and economic evaluation

OBJECTIVES: To determine effective and efficient monitoring criteria for ocular hypertension [raised intraocular pressure (IOP)] through (i) identification and validation of glaucoma risk prediction models; and (ii) development of models to determine optimal surveillance pathways.

DESIGN: A discrete event simulation economic modelling evaluation. Data from systematic reviews of risk prediction models and agreement between tonometers, secondary analyses of existing datasets (to validate identified risk models and determine optimal monitoring criteria) and public preferences were used to structure and populate the economic model.

SETTING: Primary and secondary care.

PARTICIPANTS: Adults with ocular hypertension (IOP > 21 mmHg) and the public (surveillance preferences).

INTERVENTIONS: We compared five pathways: two based on National Institute for Health and Clinical Excellence (NICE) guidelines with monitoring interval and treatment depending on initial risk stratification, 'NICE intensive' (4-monthly to annual monitoring) and 'NICE conservative' (6-monthly to biennial monitoring); two pathways, differing in location (hospital and community), with monitoring biennially and treatment initiated for a ≥ 6% 5-year glaucoma risk; and a 'treat all' pathway involving treatment with a prostaglandin analogue if IOP > 21 mmHg and IOP measured annually in the community.

MAIN OUTCOME MEASURES: Glaucoma cases detected; tonometer agreement; public preferences; costs; willingness to pay and quality-adjusted life-years (QALYs).

RESULTS: The best available glaucoma risk prediction model estimated the 5-year risk based on age and ocular predictors (IOP, central corneal thickness, optic nerve damage and index of visual field status). Taking the average of two IOP readings, by tonometry, true change was detected at two years. Sizeable measurement variability was noted between tonometers. There was a general public preference for monitoring; good communication and understanding of the process predicted service value. 'Treat all' was the least costly and 'NICE intensive' the most costly pathway. Biennial monitoring reduced the number of cases of glaucoma conversion compared with a 'treat all' pathway and provided more QALYs, but the incremental cost-effectiveness ratio (ICER) was considerably more than £30,000. The 'NICE intensive' pathway also avoided glaucoma conversion, but NICE-based pathways were either dominated (more costly and less effective) by biennial hospital monitoring or had a ICERs > £30,000. Results were not sensitive to the risk threshold for initiating surveillance but were sensitive to the risk threshold for initiating treatment, NHS costs and treatment adherence.

LIMITATIONS: Optimal monitoring intervals were based on IOP data. There were insufficient data to determine the optimal frequency of measurement of the visual field or optic nerve head for identification of glaucoma. The economic modelling took a 20-year time horizon which may be insufficient to capture long-term benefits. Sensitivity analyses may not fully capture the uncertainty surrounding parameter estimates.

CONCLUSIONS: For confirmed ocular hypertension, findings suggest that there is no clear benefit from intensive monitoring. Consideration of the patient experience is important. A cohort study is recommended to provide data to refine the glaucoma risk prediction model, determine the optimum type and frequency of serial glaucoma tests and estimate costs and patient preferences for monitoring and treatment.

FUNDING: The National Institute for Health Research Health Technology Assessment Programme.

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.

Hardware Acceleration of Background Modeling in the Compressed Domain

In intelligent video surveillance systems, scalability (of the number of simultaneous video streams) is important. Two key factors which hinder scalability are the time spent in decompressing the input video streams, and the limited computational power of the processor. This paper demonstrates how a combination of algorithmic and hardware techniques can overcome these limitations, and significantly increase the number of simultaneous streams. The techniques used are processing in the compressed domain, and exploitation of the multicore and vector processing capability of modern processors. The paper presents a system which performs background modeling, using a Mixture of Gaussians approach. This is an important first step in the segmentation of moving targets. The paper explores the effects of reducing the number of coefficients in the compressed domain, in terms of throughput speed and quality of the background modeling. The speedups achieved by exploiting compressed domain processing, multicore and vector processing are explored individually. Experiments show that a combination of all these techniques can give a speedup of 170 times on a single CPU compared to a purely serial, spatial domain implementation, with a slight gain in quality.

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.

Invaders, Launchpads and Hybrids: The Importance of Transmediality in British Science Fiction Film in the 1950s

With its origins in the trick films of the 1890s and early 1900s, British science fiction film has a long history. While Things to Come (1936) is often identified as significant for being written by H.G.Wells, one of the fathers of science fiction as a genre, the importance of the interactions between media in the development of British science fiction film are often set aside. This chapter examines the importance of broadcast media to film-making in Britain, focusing on the 1950s as a period often valourised in writings about American science fiction, to the detriment of other national expressions of the genre. This period is key to the development of the genre in Britain, however, with the establishment of television as a popular medium incorporating the development of domestic science fiction television alongside the import of American products, together with the spread of the very term ‘science fiction’ through books, pulps and comics as well as radio, television and cinema. It was also the time of a backlash against the perceived threat of American soft cultural power embodied in the attractive shine of science fiction with its promise of a bright technological future. In particular, this chapter examines the significance of the relationship between the BBC television and radio services and the film production company Hammer, which was responsible for multiple adaptations of BBC properties, including a number of science fiction texts. The Hammer adaptation of the television serial The Quatermass Experiment proved to be the first major success for the company, moving it towards its most famous identity as producer of horror texts, though often horror with an underlying scientific element, as with their successful series of Frankenstein films. This chapter thus argues that the interaction between film and broadcast media in relation to science fiction was crucial at this historical juncture, not only in helping promote the identities of filmmakers like Hammer, but also in supporting the identity of the BBC and its properties, and in acting as a nexus for the then current debates on taste and national identity.