Development and validation of a correction equation for Corvis tonometry.

Primary objectiveThis study uses numerical analysis and validation against clinical data to develop a method to correct intraocular pressure (IOP) measurements obtained using the Corvis Tonometer for the effects of central corneal thickness (CCT), and age.Materials and methodsFinite element analysis was conducted to simulate the effect of tonometric air pressure on the intact eye globe. The analyses considered eyes with wide variations in IOP (10-30 mm Hg), CCT (445-645 microns), R (7.2-8.4 mm), shape factor, P (0.6-1) and age (30-90 years). In each case, corneal deformation was predicted and used to estimate the IOP measurement by Corvis (CVS-IOP). Analysis of the results led to an algorithm relating estimates of true IOP as a function of CVS-IOP, CCT and age. All other parameters had negligible effect on CVS-IOP and have therefore been omitted from the algorithm. Predictions of corrected CVS-IOP, as obtained by applying the algorithm to a clinical data-set involving 634 eyes, were assessed for their association with the cornea stiffness parameters; CCT and age.ResultsAnalysis of CVS-IOP measurements within the 634-large clinical data-set showed strong correlation with CCT (3.06 mm Hg/100 microns, r(2) = 0.204) and weaker correlation with age (0.24 mm Hg/decade, r(2) = 0.009). Applying the algorithm to IOP measurements resulted in IOP estimations that became less correlated with both CCT (0.04 mm Hg/100 microns, r(2) = 0.005) and age (0.09 mm Hg/decade, r(2) = 0.002).ConclusionsThe IOP correction process developed in this study was successful in reducing reliance of IOP measurements on both corneal thickness and age in a healthy European population

Ex vivo testing of intact eye globes under inflation conditions to determine regional variation of mechanical stiffness

BACKGROUND: The eye globe exhibits significant regional variation of mechanical behaviour. The aim of this present study is to develop a new experimental technique for testing intact eye globes in a form that is representative of in vivo conditions, and therefore suitable for determining the material properties of the complete outer ocular tunic. METHODS: A test rig has been developed to provide closed-loop control of either applied intra-ocular pressure or resulting apical displacement; measurement of displacements across the external surface of the eye globe using high-resolution digital cameras and digital image correlation software; prevention of rigid-body motion and protection of the ocular surface from environmental drying. The method has been demonstrated on one human and one porcine eye globe, which were cyclically loaded. Finite element models based on specimen specific tomography, free from rotational symmetry, were used along with experimental pressure-displacement data in an inverse analysis process to derive the mechanical properties of tissue in different regions of the eye’s outer tunic. RESULTS: The test method enabled monitoring of mechanical response to intraocular pressure variation across the surface of the eye globe. For the two eyes tested, the method showed a gradual change in the sclera’s stiffness from a maximum at the limbus to a minimum at the posterior pole, while in the cornea the stiffness was highest at the centre and lowest in the peripheral zone. Further, for both the sclera and cornea, the load–displacement behaviour did not vary significantly between loading cycles. CONCLUSIONS: The first methodology capable of mechanically testing intact eye globes, with applied loads and boundary conditions that closely represent in vivo conditions is introduced. The method enables determination of the regional variation in mechanical behaviour across the ocular surface

Cryptanalytic attacks on Rivest, Shamir, and Adleman (RSA) cryptosystem: issues and challenges

RSA cryptosystem is an information security algorithm used for encrypting and decrypting of digital data in order to protect the content of the data and to ensure its privacy. Prior research studies have shown that RSA algorithm is very successful in protecting enterprises commercial services and systems as well as web servers and browsers to secure web traffic. In an email application, it's utilized to ensure the privacy and authenticity of email message. Some studies have also shown the efficiency of RSA algorithm in securing remote login sessions, and electronic credit-card payment systems. Generally RSA algorithm gain a security support because of it’s frequently use in most applications where security of digital data is mostly a concern. Its strength lies with its ability of withstanding many forms of attacks. While many studies focus on proving that RSA algorithm is breakable under certain cryptanalytic attacks, yet there are some confrontations on the circumstances of applying those attacks. This paper presents the issues and challenges on some key aspects of cryptanalytic attacks on RSA algorithm. The paper also explores the perceived vulnerabilities of implementing RSA algorithm which can render a cryptanalyst easier means of attack

Clinical evaluation of a new correction algorithm for dynamic Scheimpflug analyzer tonometry before and after laser in situ keratomileusis and small-incision lenticule extraction

Purpose To compare a biomechanically corrected intraocular pressure (bIOP) algorithm provided by the dynamic Scheimpflug analyzer (Corvis ST) with Goldmann applanation tonometry IOP (Goldmann IOP) and standard dynamic Scheimpflug analyzer IOP measurements before and after laser in situ keratomileusis (LASIK) and refractive lenticule extraction small-incision lenticule extraction (SMILE) surgeries. Setting Smile Eye Clinic, Munich, Germany, and University of Liverpool, Liverpool, United Kingdom. Design Retrospective case series. Methods Patients scheduled for LASIK and patients scheduled for small-incision lenticule extraction for myopia or myopic astigmatism were included. The preoperative and postoperative evaluations included Goldmann, Scheimpflug tomography, and dynamic Scheimpflug analyzer IOP measurements. Results The study comprised 14 patients in the LASIK group and 22 patients in the small-incision lenticule extraction group. Preoperative Goldmann IOP and Scheimpflug analyzer IOP values showed significant positive correlation with central corneal thickness (CCT) (P = .05 for LASIK; P = .003 for small-incision lenticule extraction). No significant correlation was found between bIOP and CCT (P > .05). After both surgeries, there were significant decreases in Goldmann IOP (−3.2 mm Hg ± 3.4 [SD] and −3.2 ± 2.1 mm Hg, respectively; both P < .001) and Scheimpflug analyzer IOP (−3.7 ± 2.1 mm Hg and −3.3 ± 2.0 mm Hg, respectively, both P < .001) compared with preoperative readings, whereas bIOP did not differ significantly (0.1 ± 2.1 mm Hg and 0.8 ± 1.8 mm Hg, respectively; P = .80 and P = .273, respectively). Conclusions The bIOP readings before and after LASIK and small-incision lenticule extraction were neither significantly different nor correlated with CCT. In contrast, both Goldmann IOP and Scheimpflug analyzer IOP had significant reductions postoperatively and showed significant correlation with CCT preoperatively

Compressive behaviour of soft contact lenses and its effect on refractive power on the eye and handling off the eye

PurposeTo investigate the stress-strain behaviour of 9 soft contact lens materials, that are commonly used in the market, under uniaxial compression loading.MethodsSeven types of hydrogel and two types of silicone-hydrogel soft contact lens materials were hydrated in phosphate-buffered saline (PBS) solution then subjected to uniaxial compression loads. The load rate was set to 16.0 N/min starting with two consecutive initial 5.0 N loading cycles followed by three relaxation periods of 4.0 min within which there were two more 5.0 N loading cycles and eventually, a full loading cycle that stopped at a load of 49.0 N. The load and contraction data obtained experimentally were analysed to derive the stress-strain behaviour. Finite Element (FE) analysis was then utilised to evaluate the performance of soft contact lenses on the human eye and handling lenses off the eye.ResultsUnlike tensile tests, all tested materials showed nonlinear behaviour when tested under compression. When fitted to first-order Ogden hyperelastic model, parameter μ was found to be varying in the range 0.12 to 0.74 MPa and material parameter α was found to be varying in the range 8.2 to 20.326 among the nine tested materials. Compression modulus of elasticity was 2.2 times higher than the tensile modulus of elasticity on average. FE simulation with nonlinear Ogden constitutive model showed a limited change (8%~12%) in the optical performance when compared to other material models, however, it predicted higher stress when the lens was simulated under bending during off-eye handling.ConclusionsCompression tests revealed slightly nonlinear behaviour when materials were strained under compression stress down to 15% ~ 30% of their nominal heights. Considering the physiological compression loading range of 8 mmHg, secant moduli of elasticity were 1.5% to 6.9% higher than the tension moduli of elasticity depending on the material. Tensile-based moduli of elasticity could be used in FE analysis as a step towards simulating the optical performance of soft contact lenses on-eye. However, nonlinear compression-based material models are recommended for FE analysis of soft contact lenses when lens-handling is investigated off-eye

Multiphysics simulation of the effect of leaflet thickness inhomogeneity and material anisotropy on the stress-strain distribution on the aortic valve

This study developed a realistic 3D FSI computational model of the aortic valve using the fixed-grid method, which was eventually employed to investigate the effect of the leaflet thickness inhomogeneity and leaflet mechanical nonlinearity and anisotropy on the simulation results. The leaflet anisotropy and thickness inhomogeneity were found to significantly affect the valve stress-strain distribution. However, their effect on valve dynamics and fluid flow through the valve were minor. Comparison of the simulation results against in-vivo and in-vitro data indicated good agreement between the computational models and experimental data. The study highlighted the importance of simulating multi-physics phenomena (such as fluid flow and structural deformation), regional leaflet thickness inhomogeneity and anisotropic nonlinear mechanical properties, to accurately predict the stress-strain distribution on the natural aortic valve

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

AI-Enabled Energy-Aware Carrier Aggregation in 5G New Radio With Dual Connectivity

Aggregating multiple component carriers (CCs) from different frequency bands, also known as Carrier Aggregation (CA), and Dual Connectivity (DC), i.e., concurrently transmitting and receiving from two nodes or cell groups, are employed in 5G and 6G wireless networks to enhance coverage and capacity. In wireless networks with DC and CA, the performance can be boosted by dynamically adjusting the uplink (UL) transmit power level for the user equipments (UEs) and properly activating/deactivating the CCs for the UEs. In this paper, we study the problem of joint dynamic UL power-sharing and CC management. The objective is to simultaneously minimize the delay and power consumption for the UEs. The pertinent problem is a multi-objective optimization problem with both discrete and continuous variables and therefore is hard to solve. We first model it as a multi-agent reinforcement learning (RL) system with compound action to handle the problem. Then, we employ a compound-action actor-critic algorithm to find the optimal policy and propose the Joint Power-Sharing and Carrier Aggregation (JPSCA) algorithm. The performance of the JPSCA algorithm is compared with two baseline algorithms. Our results show that the performance of the JPSCA algorithm in terms of the average rate, delay, and UL transmit power level outperforms the baselines where UL power control and CC management are performed disjointly. For 25 UEs, our proposed JPSCA algorithm decreases the UE power consumption and UE delay by about 28&#x0025; and 16&#x0025;, respectively, concerning the all-CC and equal power-sharing schemes

Comparison of a fixed-grid and arbitrary Lagrangian-Eulerian methods on modelling fluid-structure interaction of the aortic valve.

This study was aimed at assessing the robustness of a fixed-grid fluid-structure interaction method (Multi-Material Arbitrary Lagrangian-Eulerian) to modelling the two-dimensional native aortic valve dynamics and comparing it to the Arbitrary Lagrangian-Eulerian method. For the fixed-grid method, the explicit finite element solver LS-DYNA was utilized, where two independent meshes for the fluid and structure were generated and the penalty method was used to handle the coupling between the fluid and structure domains. For the Arbitrary Lagrangian-Eulerian method, the implicit finite element solver ADINA was used where two separate conforming meshes were used for the valve structure and the fluid domains. The comparison demonstrated that both fluid-structure interaction methods predicted accurately the valve dynamics, fluid flow, and stress distribution, implying that fixed-grid methods can be used in situations where the Arbitrary Lagrangian-Eulerian method fails