Disease activity and cognition in rheumatoid arthritis : an open label pilot study

Acknowledgements This work was supported in part by NIHR Newcastle Biomedical Research Centre. Funding for this study was provided by Abbott Laboratories. Abbott Laboratories were not involved in study design; in the collection, analysis and interpretation of data; or in the writing of the report.Peer reviewedPublisher PD

Fully Point-wise Convolutional Neural Network for Modeling Statistical Regularities in Natural Images

Modeling statistical regularity plays an essential role in ill-posed image processing problems. Recently, deep learning based methods have been presented to implicitly learn statistical representation of pixel distributions in natural images and leverage it as a constraint to facilitate subsequent tasks, such as color constancy and image dehazing. However, the existing CNN architecture is prone to variability and diversity of pixel intensity within and between local regions, which may result in inaccurate statistical representation. To address this problem, this paper presents a novel fully point-wise CNN architecture for modeling statistical regularities in natural images. Specifically, we propose to randomly shuffle the pixels in the origin images and leverage the shuffled image as input to make CNN more concerned with the statistical properties. Moreover, since the pixels in the shuffled image are independent identically distributed, we can replace all the large convolution kernels in CNN with point-wise ($1*1$) convolution kernels while maintaining the representation ability. Experimental results on two applications: color constancy and image dehazing, demonstrate the superiority of our proposed network over the existing architectures, i.e., using 1/10$\sim$1/100 network parameters and computational cost while achieving comparable performance.Comment: 9 pages, 7 figures. To appear in ACM MM 201

The Berkeley Dry Eye Flow Chart: A fast, functional screening instrument for contact lens-induced dryness.

PurposeIn this article, we introduce a novel flow chart-based screening tool for the categorization of contact lens-induced dryness (CLIDE) and its impact on daily visual activities: the Berkeley Dry Eye Flow Chart (DEFC).MethodsOne hundred thirty (130) experienced soft contact lens wearers discontinued lens wear for 24 hrs, passed a baseline screening and eye health examination, completed the Ocular Surface Disease Index (OSDI) then were dispensed fresh pairs of their habitual lenses. After 6 hrs of wear, subjects were administered a battery of symptom questionnaires, and underwent non-invasive tear breakup time (NITBUT) measurement, grading of distortion in reflected topographer mires, grading of lens surface wettability, and a fluorescein examination of the ocular surface. Subjects returned after at least 48 hrs and repeated all assessments after 6 hrs of wear of a second fresh pair of habitual lenses.ResultsThe repeatability of the DEFC between visits was within 1%, and Limits of Agreement and Coefficient of Repeatability were comparable to those of the other CLIDE assessments. Higher DEFC score was significantly related to shorter pre-lens NITBUT, higher OSDI score, and higher Visual Analog Scale (VAS) ratings of average and end-of-day severity and frequency of dryness (all p < 0.001). For CLIDE as diagnosed based on DEFC score, the highest sensitivities and specificities were achieved by the OSDI and VAS ratings; pre-lens NITBUT exhibited good sensitivity but poor specificity. The optimum pre-lens NITBUT diagnostic threshold was found to be ≤ 2.0 sec for debilitating CLIDE, and the OSDI threshold was ≥ 11.4.ConclusionsThe DEFC provides a means of quickly categorizing CLIDE patients based on severity and frequency of symptoms, and on the degree to which symptoms impact daily life. The DEFC has several potential advantages as a CLIDE screening and monitoring tool, has good repeatability, and is significantly related to commonly employed clinical assessments for CLIDE

Conjunctival epithelial flap in continuous contact lens wear.

PurposeComposed of sheets of cells detached from the underlying conjunctiva, conjunctival epithelial flap (CEF) is a recently reported phenomenon associated with contact lens wear with potential consequences for ocular health. Although CEF is generally asymptomatic, it is not known to what extent it might increase the longer-term risk of discomfort, inflammatory response, or infection. In this study, we use survival analysis methods to obtain unbiased estimates of the probability of developing CEF, the mean survival time free of CEF, and the effects of age, gender, ethnicity, and contact lens type.MethodsTwo hundred four subjects were recruited for a continuous wear (CW) study of silicone hydrogel (SiH) and gas permeable (GP) contact lenses. Subjects were examined by optometrists throughout contact lens adaptation and CW periods. Statistical methods included the Kaplan-Meier nonparametric estimator of the survival function and the Cox proportional hazards model for estimating the relative effects of covariates.ResultsOf the 204 subjects, 72 (35%) developed CEF. In 64% of cases, CEFs were observed bilaterally. The majority of cases (90.3%) presented with CEF in the superior conjunctiva. Mean survival time free of CEF was longer for GP lenses (94.3 days) than for SiH lenses (76.5 days), and the probability of developing CEF was significantly greater for SiH lenses (p = 0.002). Although there was some evidence that women and non-Asians remain free of CEF longer, the effects of age, gender, and ethnicity were not statistically significant.ConclusionsThere was a significantly increased risk of CEF in subjects wearing SiH lenses, compared with GP lenses. Subjects wearing SiH lenses remained free of CEF for a shorter time on average. Further study is needed to determine whether the increased incidence of CEF in CW with SiH lenses poses an increased risk of adverse ocular response or infection

Clinical assessment of a customized free-form progressive add lens spectacle.

PurposeTo determine whether there are significant differences in standard clinical measures of vision, progressive addition lens (PAL)-specific vision tests, or subjective ratings and preferences between customized free-form and standard non-free-form PALs in an experienced wearing population. In addition, we aim to determine whether subjective or objective clinical outcomes depend on demographic, PAL usage, spectacle prescription, or frame fitting characteristics.MethodsIn a randomized, double-masked cross-over trial, 95 experienced wearers wore Zeiss Individual customized free-form PAL spectacles (test) and standard non-free-form PAL spectacles (control) for 1 week each. At dispensing and after 1 week of wear, subjects were tested for distance and near visual acuity under both high and low contrast; in addition, 30° off-axis visual acuity was measured using a novel apparatus, as was the horizontal extent of clear, undistorted vision at reading distance. Subjects also completed a set of questionnaires detailing their satisfaction levels, adaptation times, and preferences for test or control spectacles for different visual tasks.ResultsThe test spectacles were preferred overall and for distance, midrange, transitional and active vision, and rated higher in overall satisfaction (p = 0.006). There were no clinically important differences between test and control spectacles in standard clinical vision assessments. In the PAL-specific assessments, however, the horizontal extent of clear vision at reading distance was significantly greater with the test spectacles (p = 0.004).ConclusionsThere were statistically significant preferences for the optically customized free-form lenses over the non-free-form lenses. Subjects also reported a wider field of undistorted vision when looking through the reading zone of the test spectacles. Although standard clinical vision assessments are not sufficiently refined to detect important objective differences between the spectacle types, customization taking into account back vertex distance, segment height, pantoscopic tilt, and wrap angle can result in a superior subjective wearing experience for many PAL patients

Effects of corneoscleral topography on soft contact lens performance: A pilot study.

To quantify corneoscleral junction (CSJ) topography in soft contact lens (SCL) wearers, and assess the association between the CSJ and SCL performance and subjective comfort, forty-four adapted SCL wearers (16 Asians, 16 Caucasians, 12 Latinos) were recruited for the present study. Corneal topography was taken with a Medmont E300 (Medmont International, Pty Ltd.). CSJ images were taken with a commercial OCT (Bioptigen, Inc.). Our published CSJ image analysis technique was used to describe the geometric properties of the CSJ using the sum of squared orthogonalized residuals (SSRo). Multivariable mixed effects models were employed to examine associations between SSRo and subject demographics, ocular characteristics, SCL fit and performance, and comfort. The SSRo was significantly related to quadrant (p < 0.001), ethnicity (p = 0.014), and horizontal corneal shape factor (p = 0.044). The nasal quadrant had the largest SSRo, indicating the steepest CSJ profile and/or the most irregular CSJ surface, followed by the inferior quadrant. The superior and temporal quadrants had the smallest SSRo, indicating relatively flat and even CSJ topography. Caucasians had the steepest and/or most irregular CSJ compared with Latinos and Asians. Less inferior-superior heterogeneity in the SSRo was associated with greater comfort after 6 h of lens wear. The SSRo was proved to be a useful tool to quantify CSJ geometry in SCL wearers. Significant differences in the SSRo were found among quadrants and ethnic groups. Better subjective comfort after 6 h of SCL wear was associated with a smaller difference in the SSRo between the superior and inferior quadrants

Neural coding in the visual system of Drosophila melanogaster: how do small neural populations support visually guided behaviours?

All organisms wishing to survive and reproduce must be able to respond adaptively to a complex, changing world. Yet the computational power available is constrained by biology and evolution, favouring mechanisms that are parsimonious yet robust. Here we investigate the information carried in small populations of visually responsive neurons in Drosophila melanogaster. These so-called ‘ring neurons’, projecting to the ellipsoid body of the central complex, are reported to be necessary for complex visual tasks such as pattern recognition and visual navigation. Recently the receptive fields of these neurons have been mapped, allowing us to investigate how well they can support such behaviours. For instance, in a simulation of classic pattern discrimination experiments, we show that the pattern of output from the ring neurons matches observed fly behaviour. However, performance of the neurons (as with flies) is not perfect and can be easily improved with the addition of extra neurons, suggesting the neurons’ receptive fields are not optimised for recognising abstract shapes, a conclusion which casts doubt on cognitive explanations of fly behaviour in pattern recognition assays. Using artificial neural networks, we then assess how easy it is to decode more general information about stimulus shape from the ring neuron population codes. We show that these neurons are well suited for encoding information about size, position and orientation, which are more relevant behavioural parameters for a fly than abstract pattern properties. This leads us to suggest that in order to understand the properties of neural systems, one must consider how perceptual circuits put information at the service of behaviour

Predicting extreme events in a data-driven model of turbulent shear flow using an atlas of charts

Dynamical systems with extreme events are difficult to capture with data-driven modeling, due to the relative scarcity of data within extreme events compared to the typical dynamics of the system, and the strong dependence of the long-time occurrence of extreme events on short-time conditions.A recently developed technique [Floryan, D. & Graham, M. D. Data-driven discovery of intrinsic dynamics. Nat Mach Intell $\textbf{4}$, 1113-1120 (2022)], here denoted as $\textit{Charts and Atlases for Nonlinear Data-Driven Dynamics on Manifolds}$, or CANDyMan, overcomes these difficulties by decomposing the time series into separate charts based on data similarity, learning dynamical models on each chart via individual time-mapping neural networks, then stitching the charts together to create a single atlas to yield a global dynamical model. We apply CANDyMan to a nine-dimensional model of turbulent shear flow between infinite parallel free-slip walls under a sinusoidal body force [Moehlis, J., Faisst, H. & Eckhardt, B. A low-dimensional model for turbulent shear flows. New J Phys $\textbf{6}$, 56 (2004)], which undergoes extreme events in the form of intermittent quasi-laminarization and long-time full laminarization. We demonstrate that the CANDyMan method allows the trained dynamical models to more accurately forecast the evolution of the model coefficients, reducing the error in the predictions as the model evolves forward in time. The technique exhibits more accurate predictions of extreme events, capturing the frequency of quasi-laminarization events and predicting the time until full laminarization more accurately than a single neural network.Comment: 9 pages, 7 figure

Updating the evidence for the role of corticosteroids in severe sepsis and septic shock: a Bayesian meta-analytic perspective

Introduction: Current low (stress) dose corticosteroid regimens may have therapeutic advantage in severe sepsis and septic shock despite conflicting results from two landmark randomised controlled trials (RCT). We systematically reviewed the efficacy of corticosteroid therapy in severe sepsis and septic shock. Methods: RCTs were identified (1950-September 2008) by multiple data-base electronic search (MEDLINE via OVID, OVID PreMedline, OVID Embase, Cochrane Central Register of Controlled trials, Cochrane database of systematic reviews, Health Technology Assessment Database and Database of Abstracts of Reviews of Effects) and hand search of references, reviews and scientific society proceedings. Three investigators independently assessed trial inclusion and data extraction into standardised forms; differences resolved by consensus. Results:Corticosteroid efficacy, compared with control, for hospital-mortality, proportion of patients experiencing shock-resolution, and infective and non-infective complications was assessed using Bayesian random-effects models; expressed as odds ratio (OR, (95% credible-interval)). Bayesian outcome probabilities were calculated as the probability (P) that OR ≥1. Fourteen RCTs were identified. High-dose (>1000 mg hydrocortisone (equivalent) per day) corticosteroid trials were associated with a null (n = 5; OR 0.91(0.31-1.25)) or higher (n = 4, OR 1.46(0.73-2.16), outlier excluded) mortality probability (P = 42.0% and 89.3%, respectively). Low-dose trials (<1000 mg hydrocortisone per day) were associated with a lower (n = 9, OR 0.80(0.40-1.39); n = 8 OR 0.71(0.37-1.10), outlier excluded) mortality probability (20.4% and 5.8%, respectively). OR for shock-resolution was increased in the low dose trials (n = 7; OR 1.20(1.07-4.55); P = 98.2%). Patient responsiveness to corticotrophin stimulation was non-determinant. A high probability of risk-related treatment efficacy (decrease in log-odds mortality with increased control arm risk) was identified by metaregression in the low dose trials (n = 9, slope coefficient -0.49(-1.14, 0.27); P = 92.2%). Odds of complications were not increased with corticosteroids. Conclusions: Although a null effect for mortality treatment efficacy of low dose corticosteroid therapy in severe sepsis and septic shock was not excluded, there remained a high probability of treatment efficacy, more so with outlier exclusion. Similarly, although a null effect was not excluded, advantageous effects of low dose steroids had a high probability of dependence upon patient underlying risk. Low dose steroid efficacy was not demonstrated in corticotrophin non-responders. Further large-scale trials appear mandated.15 page(s