The Effectiveness of Teleglaucoma versus In-Patient Examination for Glaucoma Screening: A Systematic Review and Meta-Analysis

BACKGROUND: Glaucoma is the leading cause of irreversible visual impairment in the world affecting 60.5 million people worldwide in 2010, which is expected to increase to approximately 79.6 million by 2020. Therefore, glaucoma screening is important to detect, diagnose, and treat patients at the earlier stages to prevent disease progression and vision loss. Teleglaucoma uses stereoscopic digital imaging to take ocular images, which are transmitted electronically to an ocular specialist. The purpose is to synthesize literature to evaluate teleglaucoma, its diagnostic accuracy, healthcare system benefits, and cost-effectiveness. METHODS: A systematic search was conducted to help locate published and unpublished studies. Studies which evaluate teleglaucoma as a screening device for glaucoma were included. A meta-analysis was conducted to provide estimates of diagnostic accuracy, diagnostic odds ratio, and the relative percentage of glaucoma cases detected. The improvements to healthcare service quality and cost data were assessed. RESULTS: Of 11237 studies reviewed, 45 were included. Our results indicated that, teleglaucoma is more specific and less sensitive than in-person examination. The pooled estimates of sensitivity was 0.832 [95% CI 0.770, 0.881] and specificity was 0.790 [95% CI 0.668, 0.876]. The relative odds of a positive screen test in glaucoma cases are 18.7 times more likely than a negative screen test in a non-glaucoma cases. Additionally, the mean cost for every case of glaucoma detected was $1098.67 US and of teleglaucoma per patient screened was$922.77 US. CONCLUSION: Teleglaucoma can accurately discriminate between screen test results with greater odds for positive cases. It detects more cases of glaucoma than in-person examination. Both patients and the healthcare systems benefit from early detection, reduction in wait and travel times, increased specialist referral rates, and cost savings. Teleglaucoma is an effective screening tool for glaucoma specifically for remote and under-services communities

Immediate versus Delayed Sequential Bilateral Cataract Surgery: A Systematic Review and Meta-Analysis

BACKGROUND: Immediately sequential bilateral cataract surgery (ISBCS), the cataract surgery that is performed in both eyes simultaneously, is gaining popularity worldwide compared to the traditional treatment paradigm: delayed sequential bilateral cataract surgery (DSBCS), the surgery that is performed in each eye on a different day as a completely separate operation. ISBCS provides advantages to patients and patients\u27 families in the form of fewer hospital visits. Additionally, patients enjoy rapid rehabilitation, lack of anisometropia - potentially reducing accidents and falls, and avoid suboptimal visual function in daily life. The hospital may benefit due to lower cost. OBJECTIVE: To perform a systematic review and meta-analysis to evaluate ISBCS and DSBCS. DATA SOURCES: Databases including MEDLINE, EMBASE, BIOSIS, CINAHL, Health Economic Evaluations Database (HEED), ISI Web of Science (Thomson-Reuters) and the Cochrane Library were searched. PARTICIPANTS: Not applicable. METHODS: Literature was systematically reviewed using EPPI-Reviewer 4 gateway. Meta-analysis was conducted using STATA v. 13.0. Standardized mean difference (SMD) and 95% confidence intervals (CI) were calculated and heterogeneity was assessed using I2 statistics. Fixed-effect and random-effect models were computed based on heterogeneity. Meta-analysis was done by instrument used to calculate utility score. RESULTS: In total, 9,133 records were retrieved from multiple databases and an additional 128 records were identified through grey literature search. Eleven articles with 3,657 subjects were included for analysis. Our meta-analysis results indicated significant improvement in post-operative utility score using TTO, EQ5D, HUI3, VF-7, and VF-14 and a non-significant improvement using Catquest questionnaire for both surgeries. For ISBCS versus DSBCS, utility-specific fixed-effect model provided an overall SMD of the utility score using the TTO method as 0.12 (95% CI: -0.15, 0.40), EQ5D as 0.14 (95% CI: -0.14, 0.41), HUI3 as 0.12 (95% CI: -0.15, 0.40), VF-7 as -0.02 (95% CI: -0.15, 0.10), and Catquest Questionnaire as 1.45 (95% CI: -0.88, 2.01). The results for utility score, which were measured using various instruments, indicated non-significant improvement in the utility due to DSBCS compared to ISBCS. However, a significant improvement in post-operative utility score was seen using Catquest questionnaire for ISBCS compared to DSBCS. The included studies using VF-14 instrument were highly heterogeneous (I2 = 97.1%). Results provided SMD of -0.25 (95% CI:-1.06, 0.57) using VF-14 indicating non-significant improvement in the utility due to DSBCS compared to ISBCS surgery. Best corrected visual acuity (BCVA) significantly improved after both surgeries (overall SMD of BCVA due to ISBCS was -1.79 (95% CI: -2.45, -1.14) and due to DSBCS was -1.53 (95% CI: -2.25, -0.81)). A non-significant improvement was seen in BCVA due to ISBCS when compared to DSBCS (SMD = -0.18; 95% CI: -0.37, 0.01). CONCLUSION: Both surgeries, ISBCS and DSBCS significantly improve patients\u27 quality of life and visual acuity. Further, ISBCS may deliver certain additional benefits at the individual and societal levels as well

Calibration of the GLAST Burst Monitor detectors

The GLAST Burst Monitor (GBM) will augment the capabilities of GLAST for the detection of cosmic gamma-ray bursts by extending the energy range (20 MeV to > 300 GeV) of the Large Area Telescope (LAT) towards lower energies by 2 BGO-detectors (150 keV to 30 MeV) and 12 NaI(Tl) detectors (10 keV to 1 MeV). The physical detector response of the GBM instrument for GRBs is determined with the help of Monte Carlo simulations, which are supported and verified by on-ground calibration measurements, performed extensively with the individual detectors at the MPE in 2005. All flight and spare detectors were irradiated with calibrated radioactive sources in the laboratory (from 14 keV to 4.43 MeV). The energy/channel-relations, the dependences of energy resolution and effective areas on the energy and the angular responses were measured. Due to the low number of emission lines of radioactive sources below 100 keV, calibration measurements in the energy range from 10 keV to 60 keV were performed with the X-ray radiometry working group of the Physikalisch-Technische Bundesanstalt (PTB) at the BESSY synchrotron radiation facility, Berlin.Comment: 2 pages, 1 figure; to appear in the Proc. of the First Int. GLAST Symp. (Stanford, Feb. 5-8, 2007), eds. S.Ritz, P.F.Michelson, and C.Meegan, AIP Conf. Pro

The Fermi GBM Gamma-Ray Burst Spectral Catalog: Four Years Of Data

In this catalog we present the updated set of spectral analyses of GRBs detected by the Fermi Gamma-Ray Burst Monitor (GBM) during its first four years of operation. It contains two types of spectra, time-integrated spectral fits and spectral fits at the brightest time bin, from 943 triggered GRBs. Four different spectral models were fitted to the data, resulting in a compendium of more than 7500 spectra. The analysis was performed similarly, but not identically to Goldstein et al. 2012. All 487 GRBs from the first two years have been re-fitted using the same methodology as that of the 456 GRBs in years three and four. We describe, in detail, our procedure and criteria for the analysis, and present the results in the form of parameter distributions both for the observer-frame and rest-frame quantities. The data files containing the complete results are available from the High-Energy Astrophysics Science Archive Research Center (HEASARC).Comment: Accepted for publication in ApJ

Ground-based calibration and characterization of the Fermi Gamma-Ray Burst Monitor Detectors

One of the scientific objectives of NASA's Fermi Gamma-ray Space Telescope is the study of Gamma-Ray Bursts (GRBs). The Fermi Gamma-Ray Burst Monitor (GBM) was designed to detect and localize bursts for the Fermi mission. By means of an array of 12 NaI(Tl) (8 keV to 1 MeV) and two BGO (0.2 to 40 MeV) scintillation detectors, GBM extends the energy range (20 MeV to > 300 GeV) of Fermi's main instrument, the Large Area Telescope, into the traditional range of current GRB databases. The physical detector response of the GBM instrument to GRBs is determined with the help of Monte Carlo simulations, which are supported and verified by on-ground individual detector calibration measurements. We present the principal instrument properties, which have been determined as a function of energy and angle, including the channel-energy relation, the energy resolution, the effective area and the spatial homogeneity.Comment: 36 pages, 28 figures, accepted for publication in Experimental Astronom

Fermi Large Area Telescope Constraints on the Gamma-ray Opacity of the Universe

The Extragalactic Background Light (EBL) includes photons with wavelengths from ultraviolet to infrared, which are effective at attenuating gamma rays with energy above ~10 GeV during propagation from sources at cosmological distances. This results in a redshift- and energy-dependent attenuation of the gamma-ray flux of extragalactic sources such as blazars and Gamma-Ray Bursts (GRBs). The Large Area Telescope onboard Fermi detects a sample of gamma-ray blazars with redshift up to z~3, and GRBs with redshift up to z~4.3. Using photons above 10 GeV collected by Fermi over more than one year of observations for these sources, we investigate the effect of gamma-ray flux attenuation by the EBL. We place upper limits on the gamma-ray opacity of the Universe at various energies and redshifts, and compare this with predictions from well-known EBL models. We find that an EBL intensity in the optical-ultraviolet wavelengths as great as predicted by the "baseline" model of Stecker et al. (2006) can be ruled out with high confidence.Comment: 42 pages, 12 figures, accepted version (24 Aug.2010) for publication in ApJ; Contact authors: A. Bouvier, A. Chen, S. Raino, S. Razzaque, A. Reimer, L.C. Reye

Constraints on the Synchrotron Shock Model for the Fermi GBM Gamma-Ray Burst 090820A

Discerning the radiative dissipation mechanism for prompt emission in Gamma-Ray Bursts (GRBs) requires detailed spectroscopic modeling that straddles the $\nu F_{\nu}$ peak in the 100 keV - 1 MeV range. Historically, empirical fits such as the popular Band function have been employed with considerable success in interpreting the observations. While extrapolations of the Band parameters can provide some physical insight into the emission mechanisms responsible for GRBs, these inferences do not provide a unique way of discerning between models. By fitting physical models directly this degeneracy can be broken, eliminating the need for empirical functions; our analysis here offers a first step in this direction. One of the oldest, and leading, theoretical ideas for the production of the prompt signal is the synchrotron shock model (SSM). Here we explore the applicability of this model to a bright {\it Fermi} GBM burst with a simple temporal structure, GRB {\it 090820}A. Our investigation implements, for the first time, thermal and non-thermal synchrotron emissivities in the RMFIT forward-folding spectral analysis software often used in GBM burst studies. We find that these synchrotron emissivities, together with a blackbody shape, provide at least as good a match with the data as the Band GRB spectral fitting function. This success is achieved in both time-integrated and time-resolved spectral fits