Care pathways for glaucoma detection and monitoring in the UK

Glaucoma presents considerable challenges in providing clinically and cost-effective care pathways. While UK population screening is not seen as justifiable, arrangements for case finding have historically been considered relatively ineffective. Detection challenges include an undetected disease burden, whether from populations failing to access services or difficulties in delivering effective case-finding strategies, and a high false positive rate from referrals via traditional case finding pathways. The enhanced General Ophthalmic Service (GOS) in Scotland and locally commissioned glaucoma referral filtering services (GRFS) elsewhere have undoubtedly reduced false positive referrals, and there is emerging evidence of effectiveness of these pathways. At the same time, it is recognised that implementing GRFS does not intrinsically reduce the burden of undetected glaucoma and late presentation, and obvious challenges remain. In terms of diagnosis and monitoring, considerable growth in capacity remains essential, and non-medical health care professional (HCP) co-management and virtual clinics continue to be important solutions in offering requisite capacity. National guidelines, commissioning recommendations, and the Common Clinical Competency Framework have clarified requirements for such services, including recommendations on training and accreditation of HCPs. At the same time, the nature of consultant-delivered care and expectations on the glaucoma specialist's role has evolved alongside these developments. Despite progress in recent decades, given projected capacity requirements, further care pathways innovations appear mandated. While the timeline for implementing potential artificial intelligence innovations in streamlining care pathways is far from established, the glaucoma burden presents an expectation that such developments will need to be at the vanguard of future developments

Growth and Characterization of 3C-SiC and 2H-AIN/GaN Films and Devices Produced on Step-Free 4H-SiC Mesa Substrates

While previously published experimental results have shown that the step-free (0 0 0 1) 4H-SiC mesa growth surface uniquely enables radical improvement of 3C-SiC and 2H-AlN/GaN heteroepitaxial film quality (greater than 100-fold reduction in extended defect densities), important aspects of the step-free mesa heterofilm growth processes and resulting electronic device benefits remain to be more fully elucidated. This paper reviews and updates recent ongoing studies of 3C-SiC and 2H-AlN/GaN heteroepilayers grown on top of 4H-SiC mesas. For both 3C-SiC and AlN/GaN films nucleated on 4H-SiC mesas rendered completely free of atomic-scale surface steps, TEM studies reveal that relaxation of heterofilm strain arising from in-plane film/substrate lattice constant mismatch occurs in a remarkably benign manner that avoids formation of threading dislocations in the heteroepilayer. In particular, relaxation appears to occur via nucleation and inward lateral glide of near-interfacial dislocation half-loops from the mesa sidewalls. Preliminary studies of homojunction diodes implemented in 3C-SiC and AlN/GaN heterolayers demonstrate improved electrical performance compared with much more defective heterofilms grown on neighbouring stepped 4H-SiC mesas. Recombination-enhanced dislocation motion known to degrade forward-biased 4H-SiC bipolar diodes has been completely absent from our initial studies of 3C-SiC diodes, including diodes implemented on defective 3C-SiC heterolayers grown on stepped 4H-SiC mesas

Silicon Carbide Gas Sensors for Propulsion Emissions and Safety Applications

Silicon carbide (SiC) based gas sensors have the ability to meet the needs of a range of aerospace propulsion applications including emissions monitoring, leak detection, and hydrazine monitoring. These applications often require sensitive gas detection in a range of environments. An effective sensing approach to meet the needs of these applications is a Schottky diode based on a SiC semiconductor. The primary advantage of using SiC as a semiconductor is its inherent stability and capability to operate at a wide range of temperatures. The complete SiC Schottky diode gas sensing structure includes both the SiC semiconductor and gas sensitive thin film metal layers; reliable operation of the SiC-based gas sensing structure requires good control of the interface between these gas sensitive layers and the SiC. This paper reports on the development of SiC gas sensors. The focus is on two efforts to better control the SiC gas sensitive Schottky diode interface. First, the use of palladium oxide (PdOx) as a barrier layer between the metal and SiC is discussed. Second, the use of atomically flat SiC to provide an improved SiC semiconductor surface for gas sensor element deposition is explored. The use of SiC gas sensors in a multi-parameter detection system is briefly discussed. It is concluded that SiC gas sensors have potential in a range of propulsion system applications, but tailoring of the sensor for each application is necessary

Cervelleite, Ag4TeS: solution and description of the crystal structure

Copyright: Springer-Verlag Wien 2015. This is the final, post refereeing version. You are advised to consult the publisher's version if you wish to cite from it, http://link.springer.com/article/10.1007%2Fs00710-015-0384-

Glaucoma detection: the content of optometric eye examinations for a presbyopic patient of African racial descent

Aims: Standardised patient (SP) methodology is the gold standard for evaluating clinical practice. We investigated the content of optometric eyecare for an early presbyopic SP of African racial descent, an “at-risk” patient group for primary open-angle glaucoma (POAG). Methods: A trained actor presented unannounced as a 44-year-old patient of African racial descent, complaining of recent near vision difficulties, to 100 community optometrists for an audio-recorded eye examination. The eye examinations were subsequently assessed via a checklist based on evidence-based POAG reviews, clinical guidelines and expert panel opinion. Results: Ninety-five per cent of optometrists carried out optic disc assessment and tonometry, which conforms to the UK College of Optometrists’ advice that those patients aged >40 years should receive at least two of the following tests: tonometry, optic disc assessment, visual field testing. Thirty-five per cent of optometrists carried out all of these tests and 6% advised the SP of increased POAG risk in those of African racial descent. Conclusion: SP encounters are an effective measure of optometric clinical practice. As in other healthcare disciplines, there are substantial differences between optometrists in the depth of their clinical investigations, challenging the concept of a “standard sight test”. There is a need for continuing professional development (CPD) in glaucoma screening, in which the increased risk of POAG in those of African racial descent should be emphasised

4H-SiC JFET Multilayer Integrated Circuit Technologies Tested Up to 1000 K

Testing of semiconductor electronics at temperatures above their designed operating envelope is recognized as vital to qualification and lifetime prediction of circuits. This work describes the high temperature electrical testing of prototype 4H silicon carbide (SiC) junction field effect transistor (JFET) integrated circuits (ICs) technology implemented with multilayer interconnects; these ICs are intended for prolonged operation at temperatures up to 773K (500 C). A 50 mm diameter sapphire wafer was used in place of the standard NASA packaging for this experiment. Testing was carried out between 300K (27 C) and 1150K (877 C) with successful electrical operation of all devices observed up to 1000K (727 C)

Novel High Temperature Capacitive Pressure Sensor Utilizing SiC Integrated Circuit Twin Ring Oscillators

This paper describes initial development and testing of a novel high temperature capacitive pressure sensor system. The pressure sensor system consists of two 4H-SiC 11-stage ring oscillators and a SiCN capacitive pressure sensor. One oscillator has the capacitive pressure sensor fixed at one node in its feedback loop and varies as a function of pressure and temperature while the other provides a pressure-independent reference frequency which can be used to temperature compensate the output of the first oscillator. A two-day repeatability test was performed up to 500C on the oscillators and the oscillator fundamental frequency changed by only 1. The SiCN capacitive pressure sensor was characterized at room temperature from 0 to 300 psi. The sensor had an initial capacitance of 3.76 pF at 0 psi and 1.75 pF at 300 psi corresponding to a 54 change in capacitance. The integrated pressure sensor system was characterized from 0 to 300 psi in steps of 50 psi over a temperature range of 25 to 500C. The pressure sensor system sensitivity was 0.113 kHzpsi at 25C and 0.026 kHzpsi at 500C

Are Patient Self-Reported Outcome Measures Sensitive Enough to Be Used as End Points in Clinical Trials?: Evidence from the United Kingdom Glaucoma Treatment Study

Purpose The United Kingdom Glaucoma Treatment Study (UKGTS) demonstrated the effectiveness of an intraocular pressure-lowering drug in patients with glaucoma using visual field progression as a primary outcome. The present study tested the hypothesis that responses on patient-reported outcome measures (PROMs; secondary outcome measure) differ between patients receiving a topical prostaglandin analog (latanoprost) or placebo eye drops in UKGTS. Design Multicenter, randomized, triple-masked, placebo-controlled trial. Participants Newly diagnosed glaucoma patients in the UKGTS with baseline and exit PROMs (n = 182 and n = 168 patients from the treatment and placebo groups, respectively). Methods In the UKGTS (trial registration number, ISRCTN96423140), patients with open-angle glaucoma were allocated to receive latanoprost (treatment) or placebo; the observation period was 24 months. Patients completed general health PROMs (European Quality of Life in 5 Dimensions [EQ-5D] and 36-item Short Form [SF-36]) and PROMs specific to glaucoma (15-item Glaucoma Quality of Life [GQL-15] and 9-item Glaucoma Activity Limitation [GAL-9]) at baseline and exit from the trial. Percentage changes between measurement on PROMs were calculated for each patient and compared between treatment arms. In addition, differences between stable patients (n = 272) and those with glaucomatous progression (n = 78), as determined by visual field change (primary outcome), were assessed. Main Outcome Measure PROMs on health-related and vision-related quality of life. Results Average percentage change on PROMs was similar for patients in both arms of the trial, with no statistically significant differences between treatment and placebo groups (EQ-5D, P = 0.98; EQ-5D visual analog scale, P = 0.88; SF-36, P = 0.94, GQL-15, P = 0.66; GAL-9, P = 0.87). There were statistically significant differences between stable and progressing patients on glaucoma-specific PROMs (GQL-15, P = 0.02; GAL-9, P = 0.02), but not on general health PROMs (EQ-5D, P = 0.62; EQ-5D visual analog scale, P = 0.23; SF-36, P = 0.65). Conclusions Average change in PROMs on health-related and vision-related quality of life was similar for the treatment and placebo groups in the UKGTS. The PROMs used may not be sensitive enough to function as primary end points in clinical trials when participants have newly diagnosed early-stage glaucoma