Progression from ocular hypertension to visual field loss in the English hospital eye service

Background There are more than one million National Health Service visits in England and Wales each year for patients with glaucoma or ocular hypertension (OHT). With the ageing population and an increase in optometric testing, the economic burden of glaucoma-related visits is predicted to increase. We examined the conversion rates of OHT to primary open-angle glaucoma (POAG) in England and assessed factors associated with risk of conversion. Methods Electronic medical records of 45 309 patients from five regionally different glaucoma clinics in England were retrospectively examined. Conversion to POAG from OHT was defined by deterioration in visual field (two consecutive tests classified as stage 1 or worse as per the glaucoma staging system 2). Cox proportional hazards models were used to examine factors (age, sex, treatment status and baseline intraocular pressure (IOP)) associated with conversion. Results The cumulative risk of conversion to POAG was 17.5% (95% CI 15.4% to 19.6%) at 5 years. Older age (HR 1.35 per decade, 95% CI 1.22 to 1.50, p<0.001) was associated with a higher risk of conversion. IOP-lowering therapy (HR 0.45, 95% CI 0.35 to 0.57, p<0.001) was associated with a lower risk of conversion. Predicted 5-year conversion rates for treated and untreated groups were 14.0% and 26.9%, respectively. Conclusion Less than one-fifth of OHT patients managed in glaucoma clinics in the UK converted to POAG over a 5-year period, suggesting many patients may require less intensive follow-up. Our study provides real-world evidence for the efficacy of current management (including IOP-lowering treatment) at reducing risk of conversion

Social Health Insurance for the Poor: Targeting and Impact of Indonesia\u27s Askeskin Program

A first step towards meeting Indonesia\u27s ambition for universal health insurance was made in 2005 with the introduction of the health insurance for the poor (askeskin) program, a subsidized social health insurance targeted on the poor and the informal sector. this scheme covered basic healthcare in public health clinics and hospital inpatient care. in this paper we investigate targeting and impact of the askeskin program using household panel data. we find that the program is indeed targeted on the poor and those most vulnerable to catastrophic out-of-pocket health payments. the public health insurance improves access to healthcare in that it increases utilization of outpatient healthcare among the poor, while out-of-pocket spending seems to have increased for askeskin insured in urban areas. keywords: social health insurance, healthcare utilization, out-of-pocket health payments, targeting, impact evaluation, Indonesia jel classification: g22, h55, i1

LEOPARD lightweight encryption operation permutation addition rotation and diffusion

Tactical unmanned vehicles are commonly used to conduct tasks (e.g. monitor and surveillance) in various civilian applications from a remote location. The characteristics of the wireless communication link allows attackers to monitor and manipulate the operation of the unmanned vehicle through passive and active attacks. Cryptography is selected as a countermeasure to mitigate these threats; however, a drawback of using cryptography is the impact on the energy consumed by the unmanned vehicle as energy is often constrained and limits the duration of the mission time. This paper introduces the Lightweight Encryption Operation Permutation Addition Rotation and Diffusion (LEOPARD) cryptographic primitive with a benchmark performance analysis against the standardised Advanced Encryption Standard (AES). Results indicate that LEOPARD is a feasible encryption approach in comparison to the AES encryption algorithm for unmanned vehicles with an average performance increase of 8%

Electron Emission From Foils Induced By Energetic Heavy-ion Impact

Doubly differential cross sections have been measured and calculated for the electron emission produced by collisions of 3.5 MeV u−1 U38+ on thin carbon foils. The electron emission is observed in both forward and backward directions. Calculations are in reasonable agreement with the experimental results in both shape and absolute magnitude. At intermediate foil thicknesses, a double binary peak structure is observed that is due to 0° binary electrons being elastically scattered to angle θ along with those that are produced at θ and suffer no large-angle scattering events in the foil. Absolute electron yields show that several hundred electrons are released per ion impact. The computed time evolution of the forwardly emitted electrons indicates that the electrons tend to follow the ion for thin foils, but precede the ion in thick foils. © 1992 IOP Publishing Ltd

The affect of two cryptographic constructs on QoS and QoE for unmanned control vehicles

Unmanned control vehicles are used for a variety of scenarios where the user can conduct a task from a remote location; scenarios include surveillance, disaster recovery and agricultural farming. The operation of unmanned vehicles is generally conducted over a wireless communication medium. The nature of the wireless broadcast allows attackers to exploit security vulnerabilities through passive and active attacks; consequently, cryptography is often selected as a countermeasure to the aforementioned attacks. This paper analyses simulation undertaken to identify the affect of cryptographic constructs on the Quality of Service (QoS) and Quality of Experience (QoE) of controlling an unmanned vehicle. Results indicate that standardised AEAD cryptographic approaches can increase the additional distance travelled by a unmanned vehicle over multiple hops communications up to 110 meters per second

A novel block cipher design paradigm for secured communication

Unmanned aerial vehicles (UAV) are commonly used to conduct tasks (e.g. monitor and surveillance) in various civilian applications from a remote location. Wireless communications (i.e. radio frequency) are often used to remotely pilot the UAV and stream data back to the operator. The characteristics of the wireless communication channel allows attackers to monitor and manipulate the operation of the UAV through passive and active attacks. Cryptography is selected as a countermeasure to mitigate these threats; however, a drawback of using cryptography is the impact on the real-time operation and performance of the UAV. This paper proposes the Permutation Substitution Network (PSN) design paradigm with an instance presented which isthe Alternative Advanced Encryption Standard (AAES) and analysis of its performance against the standardised Substitution Permutation Network (SPN) design paradigm the Advanced Encryption Standard (AES). Results indicate that using the PSN paradigm is a feasible approach in comparison to the SPN design paradigm

Plasma As A High-charge-state Projectile Stripping Medium

The classical trajectory Monte Carlo model has been used to computationally study the charge-state distributions that result from interactions between a high-energy, multielectron projectile and neutral and fully ionized targets. These studies are designed to determine the properties of a plasma for producing highly stripped ions as a possible alternative to gas and foil strippers that are commonly used to enhance the charge states of energetic ion beams. The results of these studies clearly show that a low-atomic-number, highly ionized plasma can yield higher charge states than a neutral target of the same density. The effect is principally attributable to the reduction in the number of available electron-capture channels. In this article, we compare the charge-state distributions that result during passage of a 20-MeV Pb projectile through neutral gas and fully ionized (singly charged) plasma strippers and estimate the effects of multiple scattering on the quality of the beam. © 1992 The American Physical Society

Comparison of alcogas aviation fuel with export aviation gasoline

Mixtures of gasoline and alcohol when used in internal combustion engines designed for gasoline have been found to possess the advantage of alcohol in withstanding high compression without "knock" while retaining advantages of gasoline with regard to starting characteristics. Test of such fuels for maximum power-producing ability and fuel economy at various rates of consumption are thus of practical importance, with especial reference to high-compression engine development. This report discusses the results of tests which compares the performance of alcogas with x gasoline (export grade) as a standard

Auditing service delivery in glaucoma clinics using visual field records: A feasibility study

© 2019 Author(s). Objective This study aimed to demonstrate that large-scale visual field (VF) data can be extracted from electronic medical records (EMRs) and to assess the feasibility of calculating metrics from these data that could be used to audit aspects of service delivery of glaucoma care. Method and analysis Humphrey visual field analyser (HFA) data were extracted from Medisoft EMRs from five regionally different clinics in England in November 2015, resulting in 602 439 records from 73 994 people. Target patients were defined as people in glaucoma clinics with measurable and sustained VF loss in at least one eye (HFA mean deviation (MD) outside normal limits ≥2 VFs). Metrics for VF reliability, stage of VF loss at presentation, speed of MD loss, predicted loss of sight years (bilateral VF impairment) and frequency of VFs were calculated. Results One-third of people (34.8%) in the EMRs had measurable and repeatable VF loss and were subject to analyses (n=25 760 patients). Median (IQR) age and presenting MD in these patients were 71 (61, 78) years and -6 (-10, -4) dB, respectively. In 19 264 patients with >4 years follow-up, median (IQR) MD loss was -0.2 (-0.8, 0.3) dB/year and median (IQR) intervals between VF examinations was 11 (8, 16) months. Metrics predicting loss of sight years and reliability of examinations varied between centres (p<0.001). Conclusion This study illustrates the feasibility of assessing aspects of health service delivery in glaucoma clinics through analysis of VF databases. Proposed metrics could be useful for blindness prevention from glaucoma in secondary care centres

Simulating and modelling the impact of secure communication latency for closed loop control

Closed loop control systems have been implemented to conduct a variety of tasks (e.g. manufacturing and automation). Industrial Control System (ICS) have been used to regulate a closed loop process; however, ICS are exposed to the same security vulnerabilities associated with enterprise networks. Cryptography has been deployed to overcome the associated data communication weaknesses between each ICS node through the use of block ciphers; however, the drawback of applying cryptographic algorithms to ICS is the additional communication latency. This paper investigates the relationship between security constructs and latency for closed loop control system with test conducted in a simulated environment. A case scenario is illustrated to demonstrate the impact of the results obtained to a real world context