Variation of clinical outcomes used in glaucoma randomised controlled trials:a systematic review

Purpose: In randomised clinical trials (RCTs) the selection of appropriate outcomes is crucial to the assessment of whether one intervention is better than another. The purpose of this review is to identify different clinical outcomes reported in glaucoma trials.

Methods We conducted a systematic review of glaucoma RCTs. A sample or selection of glaucoma trials were included bounded by a time frame (between 2006 and March 2012). Only studies in English language were considered. All clinical measured and reported outcomes were included. The possible variations of clinical outcomes were defined prior to data analysis. Information on reported clinical outcomes was tabulated and analysed using descriptive statistics. Other data recorded included type of intervention and glaucoma, duration of the study, defined primary outcomes, and outcomes used for sample size calculation, if nominated.

Results The search strategy identified 4323 potentially relevant abstracts. There were 315 publications retrieved, of which 233 RCTs were included. A total of 967 clinical measures were reported. There were large variations in the definitions used to describe different outcomes and their measures. Intraocular pressure was the most commonly reported outcome (used in 201 RCTs, 86%) with a total of 422 measures (44%). Safety outcomes were commonly reported in 145 RCTs (62%) whereas visual field outcomes were used in 38 RCTs (16%).

Conclusions There is a large variation in the reporting of clinical outcomes in glaucoma RCTs. This lack of standardisation may impair the ability to evaluate the evidence of glaucoma interventions.

Histopathologists’ approach to keratoacanthoma: a multisite survey of regional variation in Great Britain and Ireland

Introduction: This survey examines regional variation in the diagnosis of keratoacanthoma (KA).

Methods: Twenty-three departments from Great Britain and Ireland were invited. The number of cases coded as KA or cutaneous SCC in the previous 12 months was retrieved. An SCC: KA ratio was calculated. Participants also provided free text responses.

Results: Seventeen departments replied. A total of 11 718 cases were included with a breakdown of 998 KA and 10 720 SCC. The mean SCC:KA ratio was 10.7:1, range (2.5:1 to 139:1). Free text responses are presented.

Discussions: An extreme variation in approach is highlighted by this survey. We believe a multidisciplinary team approach to the diagnosis of KA is essential. There seems to be a need for a carefully considered clinicopathological study, backed up by molecular studies, to better understand the natural biology of this diagnosis.

Influence of fill factor variation in high shear granulation on the post granulation processes: Compression and tablet properties

This paper describes an investigation of the effect of fill factor; on the compaction behaviour of the granules during tableting and hence mechanical properties of tablets formed. The fill factor; which is the ratio of volume of wet powder material to vessel volume of the granulator, was used as an indicator of batch size. It has been established previously that in high shear granulation the batch size influences the size distribution and granule mechanical properties [1]. The work reported in this paper is an extension to the work presented in [1], hence granules from the same batches were used in production of tablets. The same tabletting conditions were employed during tabletting to allow a comparison of their properties. The compaction properties of the granules are inferred from the data generated during the tabletting process. The tablet strength and dissolution properties of the tablets were also measured. The results obtained show that the granule batch size affects the strength and dissolution of the tablets formed. The tablets produced from large batches were found to be weaker and had a faster dissolution rate. The fill factor was also found to affect the tablet to tablet variation of a non-functional active pharmaceutical ingredient included in the feed powder. Tablets produced from larger batches show greater variation compared to those from smaller batches.

FLT1 Genetic Variation Predisposes to Neovascular AMD in Ethnically Diverse Populations and Alters Systemic FLT1 Expression

Purpose: Current understanding of the genetic risk factors for age-related macular degeneration (AMD) is not sufficiently predictive of the clinical course. The VEGF pathway is a key therapeutic target for treatment of neovascular AMD; however, risk attributable to genetic variation within pathway genes is unclear. We sought to identify single nucleotide polymorphisms (SNPs) associated with AMD within the VEGF pathway.
Methods: Using a tagSNP, direct sequencing and meta-analysis approach within four ethnically diverse cohorts, we identified genetic risk present in FLT1, though not within other VEGF pathway genes KDR, VEGFA, or VASH1. We used ChIP and ELISA in functional analysis.
Results: The FLT1 SNPs rs9943922, rs9508034, rs2281827, rs7324510, and rs9513115 were significantly associated with increased risk of neovascular AMD. Each association was more significant after meta-analysis than in any one of the four cohorts. All associations were novel, within noncoding regions of FLT1 that do not tag for coding variants in linkage disequilibrium. Analysis of soluble FLT1 demonstrated higher expression in unaffected individuals homozygous for the FLT1 risk alleles rs9943922 (P = 0.0086) and rs7324510 (P = 0.0057). In silico analysis suggests that these variants change predicted splice sites and RNA secondary structure, and have been identified in other neovascular pathologies. These data were supported further by murine chromatin immunoprecipitation demonstrating that FLT1 is a target of Nr2e3, a nuclear receptor gene implicated in regulating an AMD pathway.
Conclusions: Although exact variant functions are not known, these data demonstrate relevancy across ethnically diverse genetic backgrounds within our study and, therefore, hold potential for global efficacy.

Natural variation of rice strigolactone biosynthesis is associated with the deletion of two MAX1 orthologs

Rice (Oryza sativa) cultivar Azucena--belonging to the Japonica subspecies--exudes high strigolactone (SL) levels and induces high germination of the root parasitic plant Striga hermonthica. Consistent with the fact that SLs also inhibit shoot branching, Azucena is a low-tillering variety. In contrast, Bala, an Indica cultivar, is a low-SL producer, stimulates less Striga germination, and is highly tillered. Using a Bala × Azucena F6 population, a major quantitative trait loci--qSLB1.1--for the exudation of SL, tillering, and induction of Striga germination was detected on chromosome 1. Sequence analysis of the corresponding locus revealed a rearrangement of a 51- to 59-kbp stretch between 28.9 and 29 Mbp in the Bala genome, resulting in the deletion of two cytochrome P450 genes--SLB1 and SLB2--with high homology to the Arabidopsis SL biosynthesis gene, MAX1. Both rice genes rescue the Arabidopsis max1-1 highly branched mutant phenotype and increase the production of the SL, ent-2'-epi-5-deoxystrigol, when overexpressed in Bala. Furthermore, analysis of this region in 367 cultivars of the publicly available Rice Diversity Panel population shows that the rearrangement at this locus is a recurrent natural trait associated with the Indica/Japonica divide in rice.

Relative Biological Effectiveness Variation Along Monoenergetic and Modulated Bragg Peaks of a 62-MeV Therapeutic Proton Beam: A Preclinical Assessment

iological optimization of proton therapy critically depends on detailed evaluation of relative biological effectiveness (RBE) variations along the Bragg curve. The clinically accepted RBE value of 1.1 is an oversimplification, which disregards the steep rise of linear energy transfer (LET) at the distal end of the spread-out Bragg peak. We observed significant cell killing RBE variations dependent on beam modulation, intrinsic radiosensitivity, and LET in agreement with the LEM predicted values, indicating dose-averaged LET as a suitable parameter for biological effectiveness. Data have also been used to validate a RBE parameterized model.

Predation in the marine intertidal amphipod Echinogammarus marinus Leach: implications of inter- and intra-individual variation

Studies of competition, predator–prey dynamics and food webs typically consider conspecifics as equal, however, individuals from the same population that are seemingly identical can show considerable variation with regards to a number of processes. Such phenomena may be demonstrated in terms of diet, and the quantities and types of resources that are consumed are commonly considered. The marine amphipod Echinogammarus marinus, a recently demonstrated predator on intertidal rocky shores, has been shown to consume a wide range of food types but it is unknown how this may vary between individuals. Here, we investigated the variation that occurs both among and within individuals of a population of E. marinus with respect to the mean numbers consumed of a common prey item, the isopod Jaera nordmanni. First, by comparing the length of starvation times, used as a proxy for hunger level, individuals maintained without food for up to 24 h consumed significantly less prey during feeding trials than those starved for 48 h and longer. The degree of inter-individual variation within each starvation period was also found to differ, with greater variation among individuals starved for shorter periods of time than those starved for longer time periods. Secondly, we tested whether individual amphipods tracked over time consumed consistently similar numbers of prey or whether they showed intra-individual variation, and if so, to what degree. We found that the numbers of prey consumed per individual could be predicted in the short-term between consecutive feeding trials, however over the long-term this relationship broke down. These results are discussed with respect to potential physiological and behavioural mechanisms, as well as the implications that such variation may have for stability of prey populations in the field.

Process-variation resilient and voltage-scalable dct architecture for robust low-power computing

In this paper, we present a novel discrete cosine transform (DCT) architecture that allows aggressive voltage scaling for low-power dissipation, even under process parameter variations with minimal overhead as opposed to existing techniques. Under a scaled supply voltage and/or variations in process parameters, any possible delay errors appear only from the long paths that are designed to be less contributive to output quality. The proposed architecture allows a graceful degradation in the peak SNR (PSNR) under aggressive voltage scaling as well as extreme process variations. Results show that even under large process variations (±3σ around mean threshold voltage) and aggressive supply voltage scaling (at 0.88 V, while the nominal voltage is 1.2 V for a 90-nm technology), there is a gradual degradation of image quality with considerable power savings (71% at PSNR of 23.4 dB) for the proposed architecture, when compared to existing implementations in a 90-nm process technology. © 2006 IEEE.

VEDA:Variation-aware energy-efficient discrete Wavelet Transform architecture

In this paper, we present a unified approach to an energy-efficient variation-tolerant design of Discrete Wavelet Transform (DWT) in the context of image processing applications. It is to be noted that it is not necessary to produce exactly correct numerical outputs in most image processing applications. We exploit this important feature and propose a design methodology for DWT which shows energy quality tradeoffs at each level of design hierarchy starting from the algorithm level down to the architecture and circuit levels by taking advantage of the limited perceptual ability of the Human Visual System. A unique feature of this design methodology is that it guarantees robustness under process variability and facilitates aggressive voltage over-scaling. Simulation results show significant energy savings (74% - 83%) with minor degradations in output image quality and avert catastrophic failures under process variations compared to a conventional design. © 2010 IEEE.

Process variation tolerant low power DCT architecture

2-D Discrete Cosine Transform (DCT) is widely used as the core of digital image and video compression. In this paper, we present a novel DCT architecture that allows aggressive voltage scaling by exploiting the fact that not all intermediate computations are equally important in a DCT system to obtain "good" image quality with Peak Signal to Noise Ratio(PSNR) > 30 dB. This observation has led us to propose a DCT architecture where the signal paths that are less contributive to PSNR improvement are designed to be longer than the paths that are more contributive to PSNR improvement. It should also be noted that robustness with respect to parameter variations and low power operation typically impose contradictory requirements in terms of architecture design. However, the proposed architecture lends itself to aggressive voltage scaling for low-power dissipation even under process parameter variations. Under a scaled supply voltage and/or variations in process parameters, any possible delay errors would only appear from the long paths that are less contributive towards PSNR improvement, providing large improvement in power dissipation with small PSNR degradation. Results show that even under large process variation and supply voltage scaling (0.8V), there is a gradual degradation of image quality with considerable power savings (62.8%) for the proposed architecture when compared to existing implementations in 70 nm process technology.

Low-Power Process-Variation Tolerant Arithmetic Units Using Input-Based Elastic Clocking

In this paper we propose a design methodology for low-power high-performance, process-variation tolerant architecture for arithmetic units. The novelty of our approach lies in the fact that possible delay failures due to process variations and/or voltage scaling are predicted in advance and addressed by employing an elastic clocking technique. The prediction mechanism exploits the dependence of delay of arithmetic units upon input data patterns and identifies specific inputs that activate the critical path. Under iso-yield conditions, the proposed design operates at a lower scaled down Vdd without any performance degradation, while it ensures a superlative yield under a design style employing nominal supply and transistor threshold voltage. Simulation results show power savings of upto 29%, energy per computation savings of upto 25.5% and yield enhancement of upto 11.1% compared to the conventional adders and multipliers implemented in the 70nm BPTM technology. We incorporated the proposed modules in the execution unit of a five stage DLX pipeline to measure performance using SPEC2000 benchmarks [9]. Maximum area and throughput penalty obtained were 10% and 3% respectively.

Significance Driven Computation: A Voltage-Scalable, Variation-Aware, Quality-Tuning Motion Estimator

In this paper we present a design methodology for algorithm/architecture co-design of a voltage-scalable, process variation aware motion estimator based on significance driven computation. The fundamental premise of our approach lies in the fact that all computations are not equally significant in shaping the output response of video systems. We use a statistical technique to intelligently identify these significant/not-so-significant computations at the algorithmic level and subsequently change the underlying architecture such that the significant computations are computed in an error free manner under voltage over-scaling. Furthermore, our design includes an adaptive quality compensation (AQC) block which "tunes" the algorithm and architecture depending on the magnitude of voltage over-scaling and severity of process variations. Simulation results show average power savings of similar to 33% for the proposed architecture when compared to conventional implementation in the 90 nm CMOS technology. The maximum output quality loss in terms of Peak Signal to Noise Ratio (PSNR) was similar to 1 dB without incurring any throughput penalty.