Assessing impact of organised breast screening across small residential areas-development and internal validation of a prediction model.

Monitoring screening mammography effects in small areas is often limited by small numbers of deaths and delayed effects. We developed a risk score for breast cancer death to circumvent these limitations. Screening, if effective, would increase post-diagnostic survivals through lead-time and related effects, as well as mortality reductions. Linked cancer and BreastScreen data at four hospitals (n = 2,039) were used to investigate whether screened cases had higher recorded survivals in 13 small areas, using breast cancer deaths as the outcome (M1), and a risk of death score derived from TNM stage, grade, histology type, hormone receptor status, and related variables (M2). M1 indicated lower risk of death in screened cases in 12 of the 13 areas, achieving statistical significance (p < .05) in 5. M2 indicated lower risk scores in screened cases in all 13 areas, achieving statistical significance in 12. For cases recently screened at diagnosis (<6 months), statistically significant reductions applied in 8 areas (M1) and all 13 areas (M2). Screening effects are more detectable in small areas using these risk scores than death itself as the outcome variable. An added advantage is the application of risk scores for providing a marker of screening effect soon after diagnosis.

A wearable multi-sensor system for real world gait analysis.

Gait analysis is commonly performed in standardized environments, but there is a growing interest in assessing gait also in ecological conditions. In this regard, an important limitation is the lack of an accurate mobile gold standard for validating any wearable system, such as continuous monitoring devices mounted on the trunk or wrist. This study therefore deals with the development and validation of a new wearable multi-sensor-based system for digital gait assessment in free-living conditions. In particular, results obtained from five healthy subjects during lab-based and real-world experiments were presented and discussed. The in-lab validation, which assessed the accuracy and reliability of the proposed system, shows median percentage errors smaller than 2% in the estimation of spatio-temporal parameters. The system also proved to be easy to use, comfortable to wear and robust during the out-of-lab acquisitions, showing its feasibility for free-living applications.

Extracorporeal membrane oxygenation for cardiorespiratory failure in four patients with pandemic H1N1 2009 influenza virus and secondary bacterial infection.

We report four patients with pandemic H1N1 2009 influenza virus and secondary bacterial infection who were treated with extracorporeal membrane oxygenation (ECMO) for cardiorespiratory failure. Three of the four patients had profound shock, necessitating support with venoarterial ECMO. Two patients died during ECMO support. The two survivors had prolonged hospital stays, which were complicated by renal failure and limb ischaemia.

Accumulation of airborne polychlorinated biphenyls in foliage.

Plant foliage accumulates the vapor of polychlorinated biphenyls (PCB's) from the atmosphere, and there is a variation in the amount that is accumulated from one plant species to another. This differential accumulation factor between species remains constant over more than two orders of magnitude of PCB concentrations in plants. The relationships between foliar and atmospheric PCB concentrations hold promise for cost-effective atmospheric PCB monitoring through foliar analyses.

Inter-leg Distance Measurement as a Tool for Accurate Step Counting in Patients with Multiple Sclerosis.

Step detection is commonly performed using wearable inertial devices. However, methods based on the extraction of signals features may deteriorate their accuracy when applied to very slow walkers with abnormal gait patterns. The aim of this study is to test and validate an innovative step counter method (DiSC) based on the direct measurement of inter-leg distance. Data were recorded using an innovative wearable system which integrates a magneto-inertial unit and multiple distance sensors (DSs) attached to the shank. The method allowed for the detection of both left and right steps using a single device and was validated on thirteen people affected by multiple sclerosis (0 <; EDSS <; 6.5) while performing a six-minute walking test. Two different measurement ranges for the distance sensor were tested (DS200: 0-200 mm; DS400: 0-400 mm). Accuracy was evaluated by comparing the estimates of the DiSC method against video recordings used as gold standard. Preliminary results showed a good accuracy in detecting steps with half the errors in detecting the step of the instrumented side compared to the non-instrumented (mean absolute percentage error 2.4% vs 4.8% for DS200; mean absolute percentage error 2% vs 5.4% for DS400). When averaging errors across patients, over and under estimation errors were compensated, and very high accuracy was achieved (E%<; 1.2% for DS200; E%<; 0.7% for DS400). DS400 is the suggested configuration for patients walking with a large base of support.

Syphilis outbreak in Walsall, UK: lessons for control and prevention.

An assessment of risk-taking behaviour among men who have sex with men (MSM) attending a sauna venue was undertaken, using a standardized questionnaire, after which outreach screening was introduced targeting MSM. The epidemiology of the continuing outbreak of syphilis was reviewed to determine the factors driving the outbreak and assess the benefit of continuing outreach screening. Findings among the 163 respondents at the sauna included a high rate of casual sex and a tendency not to disclose HIV status. Over 12 months, 51 cases of early syphilis were recorded. Our review showed a decline in incidence in MSM after outreach screening, but an increase in heterosexual spread. Given the frequent anonymous nature of syphilis transmission, traditional contact tracing is ineffective. Outreach screening is required at gay venues and other community settings to target at-risk populations.

An evaluation of digital, split-site and traditional formats in conference poster sessions.

The paper reports an evaluation of digital, split-site and traditional poster presentations at the Association for Medical Education in Europe (AMEE) conference in September 2004. The programme included 300 posters in 19 sessions, viewed, potentially, by 1265 conference participants, in parallel with other events. The instrument was a questionnaire of 16 open- and closed-format questions applied opportunistically and gaining 250 complete responses. Qualitative and quantitative analysis suggested that no one format was preferred. Each had different strengths and weaknesses relating to seeing and hearing the presenter and viewing the poster. Opportunities for discussion were highly valued.

Botulinum toxin in the management of blepharospasm.

Seventy-seven patients with blepharospasm unresponsive to other forms of therapy were treated with botulinum A toxin. The drug was injected into the orbicularis oculi muscle of both upper and lower eyelids and, in some patients, into the brows and upper part of the face as well. A total of 192 treatment sessions were given, with follow-up ranging from four weeks to 18 months. Orbicularis muscle spasms decreased markedly over the first five days following injection, both in patients with essential blepharospasm and in those with hemifacial spasm. Beneficial effect was temporary, however, and repeated injections were required for sustained relief. Fifty-two patients received multiple treatments, ranging from two to eight injections each, with a mean duration of benefit of 11.8 weeks. Results of subsequent injections were similar to the first in rapidity of onset, degree of benefit, and duration of effect. Complications were local, mild, and transient, and no systemic side effects were encountered.

Botulinum toxin for blepharospasm: single-fiber EMG studies.

In four patients who received periocular injections of botulinum toxin for blepharospasm, abnormal neuromuscular transmission was demonstrated by single-fiber EMG in arm muscles. The time course with which the abnormalities developed and cleared, as well as the inverse relationship between the neuromuscular jitter and the firing rate in the abnormal muscles, indicated that the toxin caused the abnormalities in arm muscles. No weakness was detected clinically in muscles distant from the face, but the abnormal neuromuscular transmission indicates that the toxin spread remotely from the site of injection.

Multiple source generation using air-structured optical waveguides for optical field shaping and transformation within and beyond the waveguide.

In this paper we review recent results describing the generation of optical modes within waveguides based on coherent scattering from artificially structured interfaces. The generation of optical waveguide propagation similar to free space propagation enables possible solutions to controlling and shaping optical field generation in free space using coherent scattering of multiple sources. It is shown that the controlled fabrication of such sources can be done simply with air-material structured waveguides such as air-silica structured fibres. Further, the technique of coherent superposition is well known in Fresnel optics, exploiting zone plates to correct the necessary phase adjustments for a desired lens performance. Similarly, in waveguide form this allows fine control of the interference process resulting in the desired mode field and its properties within the waveguide, at the end of the waveguide in the near field regime and well beyond the waveguide into the far field. A factor that can contribute significantly to the coherent scattering within the Fresnel waveguide is resonant-like scattering inside the low index regions since the critical angle of propagation can be very small, increasing Fresnel reflections between interfaces. The results presented here open up a range of hitherto unexplored possibilities in controlling and shaping at first glance disparate phenomena, including free space diffraction.

All-fibre photonic crystal distributed Bragg reflector (PC-DBR) fibre laser.

We describe an Er3+-doped aluminosilicate core photonic crystal fibre laser incorporating distributed Bragg reflectors written by two-photon 193nm irradiation through an optical phase mask as the feedback elements. The laser is diode pumped at 980nm and evidence of dual linewidth laser operation close to threshold is observed. However, at higher pumping levels gain competition preferentially selects one laser line.

Cataract surgery and intraocular lens implantation in patients with retinoblastoma.

OBJECTIVE: To report the visual outcome and complications after extracapsular cataract extraction with posterior chamber intraocular lens (IOL) implantation in eyes that underwent external beam radiotherapy for the treatment of retinoblastoma. METHODS: Eleven eyes of 8 patients aged 1.5 to 8.0 years at the time of surgery for irradiation-induced cataract were observed for 6 to 39 months (mean [+/-SD], 20+/-10 months). A standard technique of extracapsular cataract extraction, posterior chamber IOL implantation, pars plana posterior capsulotomy, and pars plana anterior vitrectomy was performed in 9 eyes, and secondary IOL placement was performed in 2 eyes. RESULTS: All eyes that underwent primary IOL implantation achieved visual acuities equal to or better than those best ever recorded prior to the development of the cataract. There were no postoperative complications, and all eyes experienced minimal postoperative inflammation. The 2 eyes that underwent secondary IOL implantation achieved their best-corrected aphakic visual acuities but experienced a prolonged course of postoperative inflammation. CONCLUSION: Intraocular lens placement in the posterior chamber of eyes with regressed retinoblastoma and irradiation-induced cataract seems to be a safe and effective method for the correction of aphakia.

Reliability of brightness comparison testing in predicting afferent pupillary defects.

We tested the reliability of brightness comparison testing in predicting relative afferent pupillary defects (RAPDs) in 206 patients. For unselected patients, brightness comparison testing correctly predicted the RAPD in 62% of patients. For subgroups of patients with glaucoma and optic nerve lesions, correct predictions were made in 92% and 83% of patients, respectively. Sensitivity and specificity of brightness comparison testing with a 6-V test light were 85% and 49%, respectively. In subgroups of patients who are strongly suspected of having an RAPD but in whom pupillary testing is not possible, brightness comparison testing can reliably predict presence or absence of an RAPD.

Posttraumatic venous obstructive retinopathy associated with enlarged optic nerve sheath.

A case of posttraumatic unilateral enlargement of the optic nerve sheath associated with a venous obstructive retinopathy and progressive visual loss responded with marked improvement in visual function after nerve sheath decompression. Indirect (closed-head) trauma may be related to the progressive nerve sheath enlargement, venous obstructive retinopathy, and progressive visual loss. It is apparent that a venous stasis retinopathy can result from a posttraumatic optic nerve sheath lesion. Prompt recognition by echographic and/or roentgenographic investigation and subsequent decompression may be curative.

Early retinal vessel development and iris vessel dilatation as factors in retinopathy of prematurity. Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) Cooperative Group.

OBJECTIVE: To determine whether the extent of retinal vessel development present on early screening examinations for retinopathy of prematurity has prognostic value? DESIGN: The prospectively collected data from the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity were used to compare the development of acute retinopathy of prematurity and long-term structural and visual outcomes for eyes with differing extents of retinal vessel development. PATIENT: Study patients had eyes with the following vessel development. In zone I eyes, vessels extended from the disc less than twice the distance from the disc to the macula. In zone II eyes, vessels extended beyond zone I but not to the nasal ora serrata. Transitional eyes had vessels partly in zone I and partly in zone II. RESULTS: The chance of developing threshold retinopathy of prematurity was inversely related to the early degree of vessel development: 54% for zone I eyes, 25% for transitional eyes, and 8% for zone II eyes. The presence of prominent iris vessels at 34 to 35 weeks of postmenstrual age was associated with increased risk for all three groups; zone I eyes almost always needed treatment (94%). The chance of having an unfavorable anatomic alteration of the posterior fundus, or poor vision at the ages of 1 year and 3 1/2 years, was also inversely related to the degree of early vessel development. Vessel development was an independently important factor even when birth weight, gestational age, and race were considered. CONCLUSIONS: The degree of early retinal vessel development is a significant predictor of outcome from retinopathy of prematurity. Iris vessel dilatation is an important indication for greater vigilance in following these infants.

Axenfeld-Rieger syndrome. A spectrum of developmental disorders.

The clinical and histopathologic features of Axenfeld's anomaly and Rieger's anomaly and syndrome are reviewed, and recent findings regarding the pathogenesis of this spectrum of developmental disorders are discussed. Based on these observations, it has been suggested that a developmental arrest, in the third trimester of gestation, of tissues derived from the neural crest cells accounts for the ocular and most of the nonocular abnormalities in this group of disorders. Since previous collective terms, such as mesodermal dysgenesis and anterior chamber cleavage syndrome, are not consistent with these new observations, the alternative name, Axenfeld-Rieger syndrome, has been proposed. The differential diagnosis of the syndrome includes two additional spectra of disorders: the iridocorneal endothelial syndrome and the posterior polymorphous dystrophies. The most serious ocular problem in Axenfeld-Rieger syndrome is the associated glaucoma, which occurs in a high percentage of patients and is typically difficult to control. Recent observations regarding the mechanism of the glaucoma, as reviewed in this paper, provide guidance in the management of this aspect of Axenfeld-Rieger syndrome.

The case of the gray optic disc!

A child with interstitial deletion of chromosome 17, right optic nerve hypoplasia, and impaired speech had bilateral congenital optic disc pigmentation, giving the appearance of gray optic discs. This appearance did not change over a period of two-and-a-half years. Previous cases of gray optic discs in neonates have been notable for 1) absence of visible pigmentation within the optic discs, 2) resolution of the gray discoloration over a period of months, and 3) development of albinotic features in several infants. This suggests that congenital optic disc pigmentation is a rare cause of gray optic discs. Congenital optic disc pigmentation is compatible with good vision.

A simple transposition procedure for complicated strabismus.

We combined a recession or resection of recti muscles with a vertical or horizontal transposition to correct a complicated paralytic ocular deviation in eight patients. The transposed muscles were reattached to the globe parallel to the spiral of Tillaux and adjacent to the paralyzed muscle. Postoperatively, seven patients demonstrated fusion in the primary position or required a slight head turn to fuse. There were no surgical complications, and no patient developed symptomatic cyclotropia, diplopia, or anterior segment ischemia.

Dyskinetic strabismus as a sign of cerebral palsy.

We found dyskinetic strabismus in 66 patients with cerebral palsy. The most striking feature of dyskinetic strabismus is the fluctuation from esotropia to exotropia under the same accommodative conditions with a slow tonic deviation similar to a vergence movement. With increasing age, exodeviation becomes more prevalent. Dyskinetic strabismus is seen exclusively in cerebral palsy patients. Many of these patients have an athetoid component to their disorder. The association of dyskinetic strabismus with athetosis and upward gaze palsy suggests that the basal ganglia may be the site of the malfunction. The strabismus responds poorly to surgery and the associated athetosis is important in the diagnosis and treatment of cerebral palsy.