Preclinical Assessments of a Novel Peel and Place Extended-Wear Negative-Pressure Wound Therapy Dressing for up to 35 Days in a Porcine Model.

Objective: While the use of negative pressure wound therapy (NPWT) with reticulated open cell foam (ROCF) is well established, the characteristics of ROCF do not allow for extended-wear use. There is the potential for dressing tissue ingrowth if left in place for greater than the recommended 2-3 days. An easy to use, novel peel and place dressing has been designed for extended wear with the wound management advantages of ROCF while alleviating the challenges of tissue ingrowth. Approach: Paraspinal, full-thickness or deep muscle excisional wounds were created in 11 and 2 swine, respectively, dressings applied with continuous negative pressure at -125 mmHg, and dressings changed weekly. Full-thickness excisional wounds were treated for 13 days and deep muscle wounds for 35 days. Wound dimensions were assessed. Granulation tissue thickness and re-epithelialization were measured via digital morphometry. Tissue quality, fibrinous material prevalence, and dressing removal peel force were analyzed. Results: The peel and place dressing substantially reduces dressing tissue ingrowth, is easy to remove with markedly low dressing peel force and promotes more granulation tissue at day 13 than ROCF with an interface layer. The extended-wear peel and place dressing, when applied to deep muscle wounds with weekly dressing changes, was applied for a total of 35 days. Successful wound closure was evident without any negative impact on wound healing. Innovation: This study assessed the wound management capabilities of an extended-wear peel and place NPWT dressing used until wound closure. Conclusion: The peel and place dressing is a suitable extended-wear NPWT dressing.

The risk of development and progression of diabetic retinopathy in a group of ethnically diverse pregnant women with diabetes attending three regional Diabetic Eye Screening Programs in the UK.

BACKGROUND/OBJECTIVES: Currently, all pregnant women with diabetes are asked to attend screening at least twice during pregnancy, even if no retinopathy is detected in early pregnancy. We hypothesise that for women with no diabetic retinopathy in early pregnancy, the frequency of retinal screening may be safely reduced. SUBJECTS/METHODS: In this retrospective cohort study, data for 4718 pregnant women attending one of three UK Diabetic Eye Screening (DES) Programmes between July 2011 and October 2019 was extracted. The women's UK DES grades at 13 weeks gestation (early pregnancy) and 28 weeks gestation (late pregnancy) were recorded. Descriptive statistics were used to report baseline data. Ordered logistic regression was used to control for covariates, such as age, ethnicity, diabetes duration, and diabetes type. RESULTS: Of the women with grades recorded for both early and late pregnancy, a total of 3085 (65.39%) women had no retinopathy in early pregnancy, and 2306 (74.7%) of these women did not develop any retinopathy by 28 weeks. The number of women without retinopathy in early pregnancy who developed referable retinopathy was 14 (0.45%), none of whom required treatment. Diabetic Retinopathy in early pregnancy remained a significant predictor of DES grade in late pregnancy when covariates of Age, Ethnicity, and Diabetes Type were controlled for (P < 0.001). CONCLUSIONS: In summary, this study has demonstrated that the burden of managing diabetes for pregnant mothers may be safely reduced by limiting the number of diabetic eye screening appointments in women who have no retinal changes in early pregnancy. Screening of women with retinopathy in early pregnancy should continue in line with current UK guidance.

Incidental diagnosis of asymptomatic lipaemia retinalis in a patient with uncontrolled type 2 diabetes mellitus: 'white lines'.

A man in his 60s presented for his medical retina clinic appointment, reporting increasing shortness of breath, aches and pains, and increasing insulin requirements during a difficult early lockdown. Wide-field colour fundus imaging (Optos Optomap) and an optical coherence tomography scan (Heidelberg Spectralis) revealed whitened and enlarged hyper-reflective vessels. Retinal colour photography also confirmed a creamy white discolouration of the vessels, which prompted the team to order a lipid profile. The profile showed a raised cholesterol level of 17.5 mmol/L (normal: <4mmol/L) and a marked elevated triglyceride level of 38.41 mmol/L (normal: <1.7 mmol/L).The clinical picture, alongside the biochemical results, suggested a diagnosis of secondary lipaemia retinalis due to poorly controlled diabetes. With aggressive treatment, the patient's biochemistry and vessels returned to baseline.This rare condition should be taken as an indicator of a potential underlying life-threatening medical condition and the role an ophthalmologist has in initiating potential lifesaving intervention.

Effect of socioeconomic deprivation as determined by the English deprivation deciles on the progression of diabetic retinopathy and maculopathy: a multivariate case-control analysis of 88 910 patients attending a South-East London diabetic eye screening service.

PURPOSE: To determine associations between deprivation using the Index of Multiple Deprivation (IMD and individual IMD subdomains) with incident referable diabetic retinopathy/maculopathy (termed rDR). METHODS: Anonymised demographic and screening data collected by the South-East London Diabetic Eye Screening Programme were extracted from September 2013 to December 2019. Multivariable Cox proportional models were used to explore the association between the IMD, IMD subdomains and rDR. RESULTS: From 118 508 people with diabetes who attended during the study period, 88 910 (75%) were eligible. The mean (± SD) age was 59.6 (±14.7) years; 53.94% were male, 52.58% identified as white, 94.28% had type 2 diabetes and the average duration of diabetes was 5.81 (±6.9) years; rDR occurred in 7113 patients (8.00%). Known risk factors of younger age, Black ethnicity, type 2 diabetes, more severe baseline DR and diabetes duration conferred a higher risk of incident rDR. After adjusting for these known risk factors, the multivariable analysis did not show a significant association between IMD (decile 1 vs decile 10) and rDR (HR: 1.08, 95% CI: 0.87 to 1.34, p=0.511). However, high deprivation (decile 1) in three IMD subdomains was associated with rDR, namely living environment (HR: 1.64, 95% CI: 1.12 to 2.41, p=0.011), education skills (HR: 1.64, 95% CI: 1.12 to 2.41, p=0.011) and income (HR: 1.19, 95% CI: 1.02 to 1.38, p=0.024). CONCLUSION: IMD subdomains allow for the detection of associations between aspects of deprivation and rDR, which may be missed when using the aggregate IMD. The generalisation of these findings outside the UK population requires corroboration internationally.

People With Type 1 Diabetes of African Caribbean Ethnicity Are at Increased Risk of Developing Sight-Threatening Diabetic Retinopathy.

OBJECTIVE: There is limited information on the effect of ethnicity on the development of referable sight-threatening diabetic retinopathy (STDR) in people with type 1 diabetes. This study describes the risk factors for STDR in a diverse cohort of people with type 1 diabetes attending a regional diabetes eye screening service. RESEARCH DESIGN AND METHODS: Clinical and digital retinal imaging data from 1,876 people with type 1 diabetes (50% women, 72.1% Caucasian, 17.3% African Caribbean, 2.9% Asian, and 7.6% other) with no retinopathy at baseline, attending surveillance eye screening were reviewed. Referable STDR was defined as the presence of any moderate to severe nonproliferative or preproliferative diabetic retinopathy or proliferative diabetic retinopathy or maculopathy in either eye as per U.K. National Diabetic Eye Screening criteria. Median follow-up was 6 years. RESULTS: The median (interquartile range) age of the cohort was 29 (21, 41) years. Of the cohort of 1,876 people, 359 (19%) developed STDR. People who developed STDR had higher baseline HbA1c, raised systolic blood pressure (SBP), longer diabetes duration, and were more often of African Caribbean origin (24% vs. 15.6%; P < 0.05 for all). In multivariable Cox regression analyses, African Caribbean ethnicity (hazard ratio [HR] 1.39, 95% CI 1.09-1.78, P = 0.009), baseline SBP (HR 1.01, 95% CI 1.00-1.01, P = 0.033), and baseline HbA1c (HR 1.01, 95% CI 1.00-1.01, P = 0.0001) emerged as independent risk factors for STDR. CONCLUSIONS: We observed that people with type 1 diabetes of African Caribbean ethnicity are at significantly greater risk of STDR. Further research is required to understand the mechanisms that explain this novel observation.

The Model Sketch for Enhancing Lie Detection and Eliciting Information.

BACKGROUND: Sketching while narrating is an effective interview technique for eliciting information and cues to deceit. The current research examined the effects of introducing a Model Sketch in investigative interviews andis pre-registered on https://osf.io/kz9mc (accessed on 18 January 2022). METHODS: Participants (N = 163) completed a mock mission and were asked to tell the truth or to lie about it in an interview. In Phase 1 of the interview, participants provided either a free recall (control condition), sketched and narrated with exposure to a Model Sketch (Model Sketch-present condition), or sketched and narrated without exposure to a Model Sketch (Model Sketch-absent condition). In Phase 2, all participants provided a free recall without sketching. RESULTS: Truth tellers reported significantly more information than lie tellers. The Model Sketch elicited more location details than a Free recall in Phase 1 and more veracity differences than the other Modality conditions in Phase 2. CONCLUSION: The Model Sketch seems to enhance the elicitation of information and to have carryover veracity effects in a follow-up free recall.

Automated image curation in diabetic retinopathy screening using deep learning.

Diabetic retinopathy (DR) screening images are heterogeneous and contain undesirable non-retinal, incorrect field and ungradable samples which require curation, a laborious task to perform manually. We developed and validated single and multi-output laterality, retinal presence, retinal field and gradability classification deep learning (DL) models for automated curation. The internal dataset comprised of 7743 images from DR screening (UK) with 1479 external test images (Portugal and Paraguay). Internal vs external multi-output laterality AUROC were right (0.994 vs 0.905), left (0.994 vs 0.911) and unidentifiable (0.996 vs 0.680). Retinal presence AUROC were (1.000 vs 1.000). Retinal field AUROC were macula (0.994 vs 0.955), nasal (0.995 vs 0.962) and other retinal field (0.997 vs 0.944). Gradability AUROC were (0.985 vs 0.918). DL effectively detects laterality, retinal presence, retinal field and gradability of DR screening images with generalisation between centres and populations. DL models could be used for automated image curation within DR screening.

'Please tell me all you remember': a comparison between British and Arab interviewees' free narrative performance and its implications for lie detection.

We examined how much information British and Arab truth tellers and lie tellers volunteer in an initial free narrative. Based on cultural differences in communication styles we predicted that British interviewees would report more details and more complications than Arab interviewees (culture main effect). We further predicted that truth tellers would report more details and complications than lie tellers (veracity main effect), particularly in the British sample (Veracity × Culture interaction effect). A total of 78 British and 76 Israeli-Arab participants took part. The experiment was carried out at a British university and an Israeli university. Participants carried out a mission. Truth tellers were instructed to report the mission truthfully in a subsequent interview whereas lie tellers were asked to lie about certain aspects of the mission. The three hypotheses were supported for details, whereas for complications only the predicted veracity main effect occurred.

Prospective evaluation of an artificial intelligence-enabled algorithm for automated diabetic retinopathy screening of 30 000 patients.

BACKGROUND/AIMS: Human grading of digital images from diabetic retinopathy (DR) screening programmes represents a significant challenge, due to the increasing prevalence of diabetes. We evaluate the performance of an automated artificial intelligence (AI) algorithm to triage retinal images from the English Diabetic Eye Screening Programme (DESP) into test-positive/technical failure versus test-negative, using human grading following a standard national protocol as the reference standard. METHODS: Retinal images from 30 405 consecutive screening episodes from three English DESPs were manually graded following a standard national protocol and by an automated process with machine learning enabled software, EyeArt v2.1. Screening performance (sensitivity, specificity) and diagnostic accuracy (95% CIs) were determined using human grades as the reference standard. RESULTS: Sensitivity (95% CIs) of EyeArt was 95.7% (94.8% to 96.5%) for referable retinopathy (human graded ungradable, referable maculopathy, moderate-to-severe non-proliferative or proliferative). This comprises sensitivities of 98.3% (97.3% to 98.9%) for mild-to-moderate non-proliferative retinopathy with referable maculopathy, 100% (98.7%,100%) for moderate-to-severe non-proliferative retinopathy and 100% (97.9%,100%) for proliferative disease. EyeArt agreed with the human grade of no retinopathy (specificity) in 68% (67% to 69%), with a specificity of 54.0% (53.4% to 54.5%) when combined with non-referable retinopathy. CONCLUSION: The algorithm demonstrated safe levels of sensitivity for high-risk retinopathy in a real-world screening service, with specificity that could halve the workload for human graders. AI machine learning and deep learning algorithms such as this can provide clinically equivalent, rapid detection of retinopathy, particularly in settings where a trained workforce is unavailable or where large-scale and rapid results are needed.

Amplifying recall after delays via initial interviewing: Inoculating truth-tellers' memory as a function of encoding quality.

Typically, truth-tellers report more detailed statements when interviewed immediately, compared to after delays (displaying forgetting), whereas liars report statements containing similar amounts of detail when interviewed immediately or after a delay (displaying a metacognitive error). Accordingly, the diagnostic utility of the 'richness-of-detail' cue is reduced after delays. We investigated if initial interviewing can facilitate lie-detection using the richness-of-detail cue in sub-optimal memorial conditions, that is, when (i) interviewing occurred after a three-week delay and (ii) truth-teller's attention during encoding was manipulated. Participants (n = 152) witnessed an interaction, that was meaningful to (and intentionally encoded by) liars (n = 50) and half of truth-tellers (n = 51), but meaningless (and incidentally encoded by) the remaining truth-tellers (n = 51). Participants were interviewed after three weeks. Half of the intentional liars and half of the intentional and incidental truth-tellers were also interviewed immediately (initial interview-present condition), whereas the remaining participants received no immediate interview (initial interview-absent condition). Results showed intentional and incidental truth-tellers reported after three weeks more detail in the initial interview-present (versus absent) condition, whereas intentional liars' statements were unaffected by initial interviewing condition. After three weeks, more intentional liars and intentional truth-tellers were correctly distinguished in the initial interview-present (versus absent) condition.

Applying the verifiability approach to deception detection in alibi witness situations.

The application of alibi witness scenarios to deception detection has been overlooked. Experiment 1 was a study of the verifiability approach in which truth-telling pairs completed a mission together, whereas in lying pairs one individual completed this mission alone and the other individual committed a mock theft. All pairs were instructed to convince the interviewer that they completed the mission together by writing individual statements on their own followed by a collective statement together as a pair. In the individual statements, truth-telling pairs provided more checkable details that demonstrated they completed the mission together than lying pairs, whereas lying pairs provided more uncheckable details than truth-telling pairs. The collective statements made truth-telling pairs provide significantly more checkable details that demonstrated they were together in comparison to the individual statements, whereas no effect was obtained for lying pairs. Receiver Operating Characteristic curves revealed high accuracy rates for discriminating between truths and lies using the verifiability approach across all statement types. Experiment 2 was a lie detection study whereby observers' abilities to discriminate between truths and lies using the verifiability approach were examined. This revealed that applying the verifiability approach to collective statements improved observers' ability to accurately detect deceit. We suggest that the verifiability approach could be used as a lie detection technique and that law enforcement policies should consider implementing collective interviewing.

Amplifying deceivers' flawed metacognition: Encouraging disclosures after delays with a model statement.

Truth tellers provide less detail in delayed than in immediate interviews (likely due to forgetting), whereas liars provide similar amounts of detail in immediate and delayed interviews (displaying a metacognitive stability bias effect). We examined whether liar's flawed metacognition after delays could be exploited by encouraging interviewees to provide more detail via a Model Statement. Truthful and deceptive participants were interviewed immediately (n = 78) or after a three-week delay (n = 78). Half the participants in each condition listened to a Model Statement before questioning. In the Immediate condition, truth tellers provided more details than liars. This pattern was unaffected by the Model Statement. In the Delayed condition, truth tellers and liars provided a similar amount of detail in the Model Statement-absent condition, whereas in the Model Statement-present condition, liars provided more details than truth tellers.

A stability bias effect among deceivers.

Research examining how truth tellers' and liars' verbal behavior is attenuated as a function of delay is largely absent from the literature, despite its important applied value. We examined this factor across 2 studies in which we examined the effects of a hypothetical delay (Experiment 1) or actual delay (Experiment 2) on liars' accounts. In Experiment 1-an insurance claim interview setting-claimants either genuinely experienced a (staged) loss of a tablet device (n = 40) or pretended to have experienced the same loss (n = 40). Truth tellers were interviewed either immediately after the loss (n = 20) or 3 weeks after the loss (n = 20), whereas liars had to either pretend the loss occurred either immediately before (n = 20) or 3 weeks before (n = 20) the interview (i.e., hypothetical delay for liars). In Experiment 2-a Human Intelligence gathering setting-sources had to either lie (n = 50) or tell the truth (n = 50) about a secret video they had seen concerning the placing of a spy device. Half of the truth tellers and liars where interviewed immediately after watching the video (n = 50), and half where interviewed 3-weeks later (n = 50; i.e., real delay for liars). Across both experiments, truth tellers interviewed after a delay reported fewer details than truth tellers interviewed immediately after the to-be-remembered event. In both studies, liars failed to simulate this pattern of forgetting and reported similar amounts of detail when interviewed without or after a delay, demonstrating a stability bias in reporting. (PsycINFO Database Record

Using the model statement to elicit information and cues to deceit in interpreter-based interviews.

We examined how the presence of an interpreter during an interview affects eliciting information and cues to deceit, while using a method that encourages interviewees to provide more detail (model statement, MS). A total of 199 Hispanic, Korean and Russian participants were interviewed either in their own native language without an interpreter, or through an interpreter. Interviewees either lied or told the truth about a trip they made during the last twelve months. Half of the participants listened to a MS at the beginning of the interview. The dependent variables were 'detail', 'complications', 'common knowledge details', 'self-handicapping strategies' and 'ratio of complications'. In the MS-absent condition, the interviews resulted in less detail when an interpreter was present than when an interpreter was absent. In the MS-present condition, the interviews resulted in a similar amount of detail in the interpreter present and absent conditions. Truthful statements included more complications and fewer common knowledge details and self-handicapping strategies than deceptive statements, and the ratio of complications was higher for truth tellers than liars. The MS strengthened these results, whereas an interpreter had no effect on these results.

Cilioretinal Artery Territory Infarction Associated With Papilledema in a Patient With Neurofibromatosis Type 2.

Cilioretinal artery territory infarction can occur in isolation or in association with other vascular compromise of the retinal circulation. Our patient, an 18-year-old woman with neurofibromatosis type 2, developed a cilioretinal artery territory infarction in the setting of papilledema. Our case, together with one previous report, suggests that cilioretinal artery territory infarction in the context of papilledema, although rare, is a real entity.

Please be Honest and Provide Evidence: Deterrents of Deception in an Online Insurance Fraud Context.

The present experiment examined whether people could be deterred from lying in an online insurance claim setting. A total of 96 participants were asked to submit a theft insurance claim. Reflecting real life, submitting a claim that went beyond the actual costs of the stolen items was associated with advantages and disadvantages. Two deterrence factors were introduced: asking claimants to provide evidence that they actually owned the stolen items (Evidence Instruction, often used by insurers) and asking participants to read out before starting to submit the claim that they will be truthful (Honesty Statement, not often used by insurers). We also examined at what stage of the interview claimants embedded their lies in their otherwise truthful stories. The honesty statement but not the evidence instruction made claimants more honest, and participants lied more as the interview progressed.

Non-attendance at diabetic eye screening and risk of sight-threatening diabetic retinopathy: a population-based cohort study.

AIMS/HYPOTHESIS: This study evaluated whether repeated non-attendance for diabetic eye screening is associated with the risk of sight-threatening diabetic retinopathy (STDR). METHODS: This was a cohort study of 6,556 residents with diabetes who were invited for screening between 2008 and 2011 in a population-based eye screening programme in inner London and who attended for their first-ever screen in 2008. The proportion of participants with STDR was evaluated in relation to the number of years in which screening was missed. RESULTS: The proportion of participants who did not attend screening decreased between 2009 and 2011 (annual reduction 1.6% [95% CI 0.9%, 2.3%]). The adjusted relative odds of STDR for 210 participants who did not attend two consecutive years of screening were 3.76 (95% CI 2.14, 6.61; p < 0.001), compared with participants who were screened annually. In 605 participants with mild non-proliferative retinopathy at the first screen, the adjusted relative odds of developing proliferative or moderate to severe non-proliferative retinopathy were 5.72 (95% CI 7.43, 22.83; p = 0.013) for 53 participants who missed two screens. CONCLUSIONS/INTERPRETATION: Patients who do not attend diabetic eye screening are at increased risk of developing STDR. Tracing of non-attenders with evidence of established retinopathy should be an important fail-safe procedure.

Changes in detection of retinopathy in type 2 diabetes in the first 4 years of a population-based diabetic eye screening program: retrospective cohort study.

OBJECTIVE: Annual diabetic eye screening has been implemented in England since 2008. This study aimed to estimate changes in the detection of retinopathy in the first 4 years of the program. RESEARCH DESIGN AND METHODS: Participants included 32,340 patients with type 2 diabetes resident in three London boroughs with one or more screening records between 2008 and 2011. Data for 87,570 digital images from 2008 to 2011 were analyzed. Frequency of sight-threatening diabetic retinopathy (STDR) was estimated by year of screen for first screens and for subsequent screens according to retinopathy status at first screen. RESULTS: Among 16,621 first-ever screens, the frequency of STDR was 7.1% in 2008, declining to 6.4% in 2011 (P = 0.087). The proportion with a duration of diabetes of <1 year at first screen increased from 18.7% in 2008 to 48.6% in 2011. Second or later screens were received by 26,308 participants. In participants with mild nonproliferative retinopathy at first screen, the proportion with STDR at second or later screen declined from 21.6% in 2008 to 8.4% in 2011 (annual change -2.2% [95% CI -3.3 to -1.0], P < 0.001). In participants with no retinopathy at first screen, STDR declined from 9.2% in 2008 to 3.2% in 2011 (annual change -1.8% [-2.0 to -1.7], P < 0.001). Declining trends were similar in sociodemographic subgroups. CONCLUSIONS: After the inception of population-based diabetic eye screening, patients at lower risk of STDR contribute an increasing proportion to the eligible population, and the proportion detected with STDR at second or subsequent screening rounds declines rapidly.

The effect of question expectedness and experience on lying about intentions.

In recent years researchers have started to focus on lying about intentions (Granhag, 2010). In the present experiment participants were interviewed about their forthcoming trip. We tested the hypothesis that liars (N=43) compared to truth tellers (N=43) would give fewer details to unexpected questions about planning, transportation and the core event, but an equal amount or more detail to expected questions about the purpose of the trip. We also tested the hypothesis that participants who had previously experienced the intention (i.e., they had made such a trip before) would give more detail than those who had never experienced the intended action. The unexpected question hypothesis was supported, whereas the previous experience effect only emerged in interactions. The benefit of using different types of questions for lie detection purposes is discussed.