Accuracy and reliability of GPS devices for measurement of sports-specific movement patterns related to cricket, tennis, and field-based team sports.

The aim of this study was to determine the accuracy and reliability of 5, 10, and 15 Hz global positioning system (GPS) devices. Two male subjects (mean ± SD; age, 25.5 ± 0.7 years; height, 1.75 ± 0.01 m; body mass, 74 ± 5.7 kg) completed 10 repetitions of drills replicating movements typical of tennis, cricket, and field-based (football) sports. All movements were completed wearing two 5 and 10 Hz MinimaxX and 2 GPS-Sports 15 Hz GPS devices in a specially designed harness. Criterion movement data for distance and speed were provided from a 22-camera VICON system sampling at 100 Hz. Accuracy was determined using 1-way analysis of variance with Tukey's post hoc tests. Interunit reliability was determined using intraclass correlation (ICC), and typical error was estimated as coefficient of variation (CV). Overall, for the majority of distance and speed measures, as measured using the 5, 10, and 15 Hz GPS devices, were not significantly different (p > 0.05) to the VICON data. Additionally, no improvements in the accuracy or reliability of GPS devices were observed with an increase in the sampling rate. However, the CV for the 5 and 15 Hz devices for distance and speed measures ranged between 3 and 33%, with increasing variability evident in higher speed zones. The majority of ICC measures possessed a low level of interunit reliability (r = -0.35 to 0.39). Based on these results, practitioners of these devices should be aware that measurements of distance and speed may be consistently underestimated, regardless of the movements performed.

A Comparative Study of Two Photoscreening Devices With Manual Vision Screening Involving Preschool Children.

PURPOSE: To compare referral results from two photoscreening devices that are in wide use relative to a manual screening test protocol in preschool children. METHODS: Children aged 3 to 5 years who attended preschools in two counties within the State of Michigan (N = 1,085) took part in the State's vision screening program, which included the Lea Symbols and Stereo Butterfly tests, during a 3-month period. All who failed this screening or were unable to be tested, and 20% of those who passed, were then invited to undergo testing with the Plusoptix Vision Screener Model S-12C (Plusoptix, Inc) and Welch Allyn SPOT Vision Screener Model VS-100 (Hill-Rom, Inc) photoscreening devices. Screening was conducted by State-trained technicians. With the State's test results considered the gold standard for screening, sensitivity and specificity of the two photo-screening devices were calculated. McNemar's test and logistic regression were used to evaluate the findings. RESULTS: A total of 1,085 children took part in the State's screening program. Their mean ± standard deviation age was 48.8 ± 7.2 months, with a 51:49 female-to-male ratio, and a similar percentage were Black (34.1%) or White (33.3%). The sensitivity of the SPOT and Plusoptix screening was 61.0% and 65.2%, respectively. The specificity of the SPOT and Plusoptix screening was 92.9% and 82.4%, respectively. For 84 children who were unable to be tested by the State's screening, the SPOT and Plusoptix devices completed the screening on the majority (86.9% and 73.8%, respectively). CONCLUSIONS: The photoscreening devices yielded numerous false-negative results and fewer false-positive results. Their ability to screen many children who could not be screened by manual testing indicates a useful application. [J Pediatr Ophthalmol Strabismus. 2022;59(1):46-52.].

Polyomic profiling reveals significant hepatic metabolic alterations in glucagon-receptor (GCGR) knockout mice: implications on anti-glucagon therapies for diabetes.

BACKGROUND: Glucagon is an important hormone in the regulation of glucose homeostasis, particularly in the maintenance of euglycemia and prevention of hypoglycemia. In type 2 Diabetes Mellitus (T2DM), glucagon levels are elevated in both the fasted and postprandial states, which contributes to inappropriate hyperglycemia through excessive hepatic glucose production. Efforts to discover and evaluate glucagon receptor antagonists for the treatment of T2DM have been ongoing for approximately two decades, with the challenge being to identify an agent with appropriate pharmaceutical properties and efficacy relative to potential side effects. We sought to determine the hepatic & systemic consequence of full glucagon receptor antagonism through the study of the glucagon receptor knock-out mouse (Gcgr-/-) compared to wild-type littermates. RESULTS: Liver transcriptomics was performed using Affymetric expression array profiling, and liver proteomics was performed by iTRAQ global protein analysis. To complement the transcriptomic and proteomic analyses, we also conducted metabolite profiling (~200 analytes) using mass spectrometry in plasma. Overall, there was excellent concordance (R = 0.88) for changes associated with receptor knock-out between the transcript and protein analysis. Pathway analysis tools were used to map the metabolic processes in liver altered by glucagon receptor ablation, the most notable being significant down-regulation of gluconeogenesis, amino acid catabolism, and fatty acid oxidation processes, with significant up-regulation of glycolysis, fatty acid synthesis, and cholesterol biosynthetic processes. These changes at the level of the liver were manifested through an altered plasma metabolite profile in the receptor knock-out mice, e.g. decreased glucose and glucose-derived metabolites, and increased amino acids, cholesterol, and bile acid levels. CONCLUSIONS: In sum, the results of this study suggest that the complete ablation of hepatic glucagon receptor function results in major metabolic alterations in the liver, which, while promoting improved glycemic control, may be associated with adverse lipid changes.

Improved image analysis workflow for 2-D gels enables large-scale 2-D gel-based proteomics studies--COPD biomarker discovery study.

2-D gel electrophoresis has been used for more than three decades to study the protein complement of organisms, tissues, and cells. Three issues are holding back large-scale proteomics studies: low-throughput, high technical variation, and study designs lacking statistical power. We identified image analysis as the central factor connecting these three issues. By developing an improved image analysis workflow we shortened project timelines, decreased technical variation, and thus enabled large-scale proteomics studies that are statistically powered. Rather than detecting protein spots on each gel image and matching spots across gel images, the improved workflow is based on aligning images first, then creating a consensus spot pattern and finally propagating the consensus spot pattern to all gel images for quantitation. This results in a data table without gaps. As an example we show here a study aimed at discovering circulating biomarkers for chronic obstructive pulmonary disease (COPD). Eight candidate biomarkers were identified by comparing plasma from 24 smokers with COPD and 24 smokers without COPD. Among the candidates are proteins such as plasma retinal-binding protein (RETB) and fibrinogen that had previously been linked to the disease and are frequently monitored in COPD patients, as well as other proteins such as apolipoprotein E (ApoE), inter-alpha-trypsininhibitor heavy chain H4 (ITIH4), and glutathione peroxidase.

Outcome of eyes developing retinal detachment during the Early Treatment for Retinopathy of Prematurity Study (ETROP).

OBJECTIVE: To report the structural and visual outcomes of eyes in which retinal detachment developed from retinopathy of prematurity (ROP) in the Early Treatment of Retinopathy of Prematurity (ETROP) Study. Method Infants in the ETROP Study with bilateral high-risk prethreshold ROP had 1 eye randomized to early treatment, with the fellow eye managed conventionally. In infants with asymmetric disease, the eye with high-risk prethreshold ROP was randomized to early treatment or conventional management. When a retinal detachment was detected, observation or vitreoretinal surgery (ie, scleral buckling and/or vitrectomy) was provided at the discretion of the individual investigator. At 9 months corrected age, retinal examinations were performed and visual acuities were assessed by masked testers using grating acuity. RESULTS: The ETROP Study enrolled 401 patients with high-risk prethreshold ROP. Retinal detachments occurred in 89 eyes of 63 patients. Follow-up was available for 78 eyes of 56 patients. The detachments were bilateral in 21 patients (38%) and were classified as stage 4A in 30 eyes, stage 4B in 14 eyes, and stage 5 in 16 eyes. Detachments were not classified in 18 eyes. Twelve eyes of 11 patients were observed and 66 eyes of 52 patients underwent vitreoretinal surgery. Attachment of the macula at 9 months persisted or was achieved in 17 (30%) of 56 eyes after vitrectomy with or without scleral buckle, in 6 (60%) of 10 eyes after scleral buckle only, and in 2 (17%) of 12 eyes followed up without surgery. Favorable visual acuity (> or =1.85 cycles/degree) was found in 13 (17%) of the 78 eyes. All 6 eyes that maintained normal visual acuity (> or =3.70 cycles/degree) had a stage 4A detachment (1 of 6 managed by observation, 3 of 6 by scleral buckle, and 2 of 18 by vitrectomy). Eleven eyes with stage 5 detachment underwent vitreoretinal surgery, resulting in 6 with no light perception, 3 with light perception only, and 2 with detection of only the low vision card. CONCLUSIONS: In the ETROP Study, the outcome of retinal detachment owing to ROP was generally poor. Vitreoretinal surgery for retinal detachment was associated with macular attachment in 16 of 48 eyes. Normal acuity was maintained after surgical repair of stage 4A retinal detachment in 5 (21%) of 24 eyes. Vitreoretinal surgery for stage 5 disease was associated with some structural successes but poor functional outcomes.

Lions Clubs International Foundation Core Four Photoscreening: results from 17 programs and 400,000 preschool children.

INTRODUCTION: Photoscreening programs for preschool vision screening have been promoted by Lions Clubs International Foundation (LCIF) via their 17 Core Four grant project awards since 1999. Results from 15 Core Four grant programs in the United States and one in Taiwan are presented here. METHODS: Photoscreening was modeled after the Tennessee program and instituted statewide in each area. Programs were given latitude with respect to screening instrument and referral criteria, but a partnering academic institution and medical director were expected. Preschool children were screened by volunteers; referred children were examined by community optometrists and ophthalmologists who returned results to each program's coordinating center. Outcome data included number of children screened, referral rate, follow-up rate, and positive predictive value, which was generally determined using AAPOS-defined vision screening criteria. RESULTS: All but one program used the MTI photoscreener (it chose not to participate); photoscreening referral criteria were standard for 13 programs. Through December 2004, more than 400,000 preschool children had been screened. The referral rate for programs using the MTI photoscreener averaged 5.2% (range, 3.7-12.6%). The predictive value of a positive photoscreen was 80%. Overall, 54% of referred children received follow-up examinations. Follow-up rate was the largest variable: 4 programs, screening nearly 250,000 children, had follow-up rates 70% or greater; 10 programs had follow-up data from fewer than 40% of referred children. CONCLUSIONS: Volunteer-led photoscreening programs can be instituted in other locations, including overseas, with high levels of effectiveness. Limitations include the possibility of poor success and variable attention to follow-up.

Use of data mining at the Food and Drug Administration.

OBJECTIVES: This article summarizes past and current data mining activities at the United States Food and Drug Administration (FDA). TARGET AUDIENCE: We address data miners in all sectors, anyone interested in the safety of products regulated by the FDA (predominantly medical products, food, veterinary products and nutrition, and tobacco products), and those interested in FDA activities. SCOPE: Topics include routine and developmental data mining activities, short descriptions of mined FDA data, advantages and challenges of data mining at the FDA, and future directions of data mining at the FDA.

Excimer laser angioplasty in acute myocardial infarction (the CARMEL multicenter trial).

Patients with acute myocardial infarction (AMI) with thrombus-laden lesions constitute a revascularization challenge. Thrombus and atherosclerotic plaque absorb laser energy; thus, we studied the safety and efficacy of excimer laser in AMI. In a multicenter trial, 151 patients with AMI underwent excimer laser angioplasty. Baseline left ventricular ejection fraction was 44 +/- 13%, and 13% of patients were in cardiogenic shock. A saphenous vein graft was the target vessel in 21%. Quantitative coronary angiography and statistical analysis were performed by independent core laboratories. A 95% device success, 97% angiographic success, and 91% overall procedural success rate were recorded. Maximal laser gain was achieved in lesions with extensive thrombus burden (p <0.03 vs small burden). Thrombolysis In Myocardial Infarction (TIMI) trial flow increased significantly by laser: 1.2 +/- 1.1 to 2.8 +/- 0.5 (p <0.001), reaching a final 3.0 +/- 0.2 (p <0.001 vs baseline). Minimal luminal diameter increased by laser from 0.5 +/- 0.5 to 1.6 +/- 0.5 mm (mean +/- SD, p <0.001), followed by 2.7 +/- 0.6 mm after stenting (p <0.001 vs baseline and vs after laser). Laser decreased target stenosis from 83 +/- 17% to 52 +/- 15% (mean +/- SD, p <0.001 vs baseline), followed by 20 +/- 16% after stenting (p <0.001 vs baseline and vs after laser). Six patients (4%) died, each presented with cardiogenic shock. Complications included perforation (0.6%), dissection (5% major, 3% minor), acute closure (0.6%), distal embolization (2%), and bleeding (3%). In a multivariant regression model, absence of cardiogenic shock was a significant factor affecting procedural success. Thus, in the setting of AMI, gaining maximal thrombus dissolution in lesions with extensive thrombus burden, combined with a considerable increase in minimal luminal diameter and restoration of anterograde TIMI flow, support successful debulking by excimer laser. The presence of thrombus does not adversely affect procedural success; however, cardiogenic shock remains a predictor of major adverse events during hospitalization.

Evidence-based screening criteria for retinopathy of prematurity: natural history data from the CRYO-ROP and LIGHT-ROP studies.

BACKGROUND: The Multicenter Trial of Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) demonstrated the efficacy of treatment for threshold ROP and indicated the need for worldwide ROP screening. Previous guidelines for ROP screening have been largely based on clinical impression; we can now develop evidence-based screening recommendations. OBJECTIVE: To define the appropriate ages and retinal ophthalmoscopic signs that determine when to commence and conclude acute phase ROP screening. DESIGN: Analysis of data from 2 prospective randomized controlled trials: CRYO-ROP (January 1, 1986, to November 30, 1987) and Light Reduction in ROP (LIGHT-ROP) (July 1, 1995, to March 31, 1997). SETTING: Neonatal intensive care units in 23 study centers in the United States for CRYO-ROP and 3 centers for LIGHT-ROP. PATIENTS: Eyes were examined sequentially in 4099 infants with birth weight less than 1251 g (CRYO-ROP study) and in 361 infants with birth weight less than 1251 g and gestational age less than 31 weeks (LIGHT-ROP study). RESULTS: In 99% of infants, retinal conditions indicating a risk of poor outcome were not observed before 31 weeks' postmenstrual age or 4 weeks' chronologic age. Signs indicating that the risk of visual loss from ROP was minimal or had passed were the infant's attainment of 45 weeks' postmenstrual age without the development of prethreshold ROP or worse, progression of retinal vascularization into zone III without previous zone II ROP, and full vascularization. CONCLUSIONS: The initial eye examination should be conducted by 31 weeks' postmenstrual age or 4 weeks' chronologic age, whichever is later. Acute phase ROP screening can be discontinued when any of the 3 signs is present, indicating that the risk of visual loss from ROP is minimal or passed.

The value of adult strabismus correction to the patient.

OBJECTIVES: To look at the value of adult strabismus correction to the patient, to consider what is known, and to define the challenges and opportunities for helping these patients. METHOD: The benefits of adult strabismus correction leading to the establishment of binocularity, expansion of visual field, and improved psychosocial health are presented and supported by published studies. RESULTS: Adults with strabismus can benefit from its correction. CONCLUSION: There is a tremendous need to educate the medical community and the lay public that adults with strabismus can be helped with restoration of their eyes to a position of alignment for normal function.

The efficacy of superior oblique split Z-tendon lengthening for superior oblique overaction.

PURPOSE: To evaluate the efficacy of superior oblique muscle split Z-tendon lengthening in the treatment of superior oblique muscle overaction with respect to normalization of superior oblique ductions and versions, reduction of A-pattern strabismus and correction of vertical deviations. In addition, to determine the incidence of complications of the procedure including overcorrection and the effect of the procedure on horizontal deviation. METHODS: A retrospective review was performed of 19 patients who underwent superior oblique muscle split Z-tendon lengthening for A-pattern strabismus or significant vertical deviation associated with superior oblique overaction between June 1980 and September 1999. Ten males and 9 females were included, ranging in age from 2 to 45 years (mean: 9 years). Patients underwent either a unilateral or bilateral superior oblique tendon lengthening based on the patient's clinical picture. RESULTS: Ten of 11 patients (91%) who underwent unilateral tendon lengthening and 10 of 16 eyes (63%) that underwent bilateral superior oblique tendon had complete normalization of superior oblique action. Seven of 10 patients (70%) who underwent unilateral or bilateral tendon lengthening for a clinically significant A-pattern had the A-pattern completely eliminated or brought to a clinically insignificant level. All 8 patients who underwent a unilateral tendon lengthening for a clinically significant vertical deviation had reduction of the vertical deviation. There was no statistically significant effect of either the unilateral or bilateral procedure on horizontal deviation. CONCLUSIONS: The superior oblique muscle split Z-tendon lengthening procedure is highly effective for normalization of superior oblique muscle function and reduction of A-pattern strabismus and vertical deviations associated with superior oblique muscle overaction.

Evaluation of surgical intervention in familial isolated simple ectopia lentis: younger v. older generations.

BACKGROUND: There continues to be a debate whether surgical management of ectopia lentis in children is an appropriate course to improve visual acuity and prevent further amblyopia over medical and optical management. The long term outcome and postoperative status of three generations of patients in a single family with simple ectopia lentis is presented. SUBJECTS: Nine family members (ages 6-61 years) were evaluated at Children's Hospital of Michigan (CHM) (6 patients) and Kresge Eye Institute (KEI) (3 patients) for primary or secondary visual acuity problems and a family history of simple bilateral ectopia lentis without any systemic manifestations. RESULTS: Three of the four children with ectopia lentis had improved postoperative vision OU and one child was moderately amblyopic following lensectomy with 6 years followup. Of the older generation, one of the three adults had removal of dislocated lenses, with 20/50 amblyopia in one eye and 20/25 vision in the other. The other two adults were treated for end stage glaucoma with poor visual acuity. CONCLUSIONS: For the younger generations of this family, surgical intervention for simple ectopia lentis provided improvement in visual acuity. Without surgery, amblyopia may have occurred in one or both eyes. For the oldest generation of this family, glaucoma and poor vision was the end result. Hopefully, the earlier treatment of the ectopia lentis in these children will result in better vision now and in the long term.

Masked bilateral superior oblique palsy in children.

PURPOSE: Following surgery on an eye for unilateral superior oblique palsy, it is a well-recognized postoperative occurrence for the unoperated eye to develop superior oblique palsy, commonly referred to as masked bilateral superior oblique palsy. The purpose of this study was to describe this postoperative finding in children following unilateral inferior oblique weakening surgery. METHODS: A retrospective review of records of children who underwent unilateral inferior oblique weakening surgery at Children's Hospital of Michigan, Detroit, Michigan, from 1987 to 2005, including information on the development of masked bilateral superior oblique palsy with contralateral inferior oblique overaction requiring a second surgical intervention. RESULTS: Of 50 children (25 boys and 25 girls, mean age: 5.6 years) who underwent unilateral inferior oblique weakening surgery (47 recessions and 3 myectomies), 9 (18%) manifested masked bilateral superior oblique palsy postoperatively, requiring subsequent surgical weakening of the inferior oblique muscle in the unoperated eye. Preoperative primary position hypertropia in children who were eventually diagnosed as having masked bilateral superior oblique palsy (5.56±4.22 prism diopters [PD]) was significantly smaller compared to children with unilateral superior oblique palsy (10.4±6.5 PD, P=.012), and preoperative primary position hypertropia of less than 5 PD was associated with an odds ratio of 8.2 (95% confidence interval: 1.7 to 38.5, P=.008) for requiring reoperation. CONCLUSIONS: Masked bilateral superior oblique palsy is a possible outcome after surgery for the correction of pediatric unilateral superior oblique palsy. Parents should be informed of this possible outcome, especially when primary position hypertropia is less than 5 PD.

The role and efficacy of secondary intraocular lenses in the treatment of monocular infantile cataracts.

PURPOSE: To determine if and when a secondary intraocular lens (IOL) can be beneficial to the successful treatment of a monocular infantile cataract. METHODS: This retrospective study reviewed medical records of children undergoing treatment of a monocular congenital cataract from 1996 to 2009 at one pediatric ophthalmology practice. Patients had unilateral cataracts removed by age 8 months and a secondary IOL inserted prior to 6 years of age. At the final visit, the children had to perform linear Snellen visual acuity testing. RESULTS: Of 11 identified patients, 8 had treatment onset by age 4 months and 3 between 5 and 7 months of age. These 3 children had final acuities of 20/500 (n=2) and hand motion (n=1). Those undergoing treatment prior to age 5 months had Snellen acuities of 20/30 to 20/400. The best results were obtained by patients who were compliant with contact lenses and patching before insertion of a secondary IOL. CONCLUSIONS: If treatment of a monocular congenital cataract begins by 4 months of age (ie, the critical period for visual development) and patients remain compliant with occlusion therapy and an aphakic contact lens, then they will likely do well after IOL implantation. Furthermore, it appears that insertion of a secondary IOL will maintain vision that was established with a contact lens and patching and perhaps prevent deterioration that might still occur if compliance issues develop. However, secondary IOL placement will not dramatically improve the final visual result from that developed with occlusion and a contact lens.

Secondary or new compensatory head posture after Anderson-Kestenbaum surgery.

PURPOSE: To report clinical findings and surgical management of 4 patients with congenital nystagmus who presented with a new or reversal of their original horizontal compensatory head posture (CHP) after Anderson-Kestenbaum (A-K) surgery. METHOD: Retrospective chart review. RESULTS: All 4 patients demonstrated a 40°-45° horizontal face turn at the time of their initial surgery and 3 underwent 20% and one 30% augmented A-K surgery to correct the CHP. The new CHP or reversal of the original CHP was observed at a mean of 4 years (range 1-9 years) after the initial surgery. The reversed CHPs measured 20°, 40°, 20°, and 20°, respectively. These new or residual CHPs were surgically managed in 3 patients and an acceptable head position was achieved in all patients. CONCLUSIONS: This series of patients points out the occurrence of secondary null points and reversed CHP after surgical correction of initial CHP.

Functional results of the surgical repair of a lacerated canaliculus in children.

PURPOSE: This study examined the functional success of surgical repair of lacerated canaliculi in a pediatric population. METHODS: A retrospective chart review was performed on 46 patients who had surgical repair of a lacerated canaliculus. Functional success was defined as no tearing or discharge present at the end of treatment. RESULTS: Forty-four of the 46 patients had repair with a Crawford tube. Of these, 39 presented for postoperative follow-up. Two patients had some tearing present at the time of tube removal. Eight patients whose tube fell out or was pulled out by the patient had no symptoms at their last visit. Fourteen patients were able to be contacted by phone for follow-up more than a year after treatment and 13 were symptom free. The child with reported discharge was more than 2 years post treatment and had not scheduled any return appointments to seek treatment. CONCLUSION: Surgical repair of a lacerated canaliculus using a Crawford silicone tube in the pediatric population has an excellent chance of having a good functional outcome with no tearing or discharge present.

Progression of type 2 to type 1 retinopathy of prematurity in the Early Treatment for Retinopathy of Prematurity Study.

OBJECTIVE: To examine the frequency and timing of progression from type 2 to type 1 retinopathy of prematurity (ROP) in the Early Treatment for Retinopathy of Prematurity Study. METHODS: Infants with prethreshold ROP that was no worse than low risk in 1 or both eyes, based on the RM-ROP2 model, were examined every 2 to 4 days for at least 2 weeks. Using the Early Treatment for Retinopathy of Prematurity Study-defined classification of eyes as having type 1 or type 2 prethreshold ROP, we analyzed the time to conversion from type 2 to type 1. Data were analyzed for 1 randomly selected eye for each child. RESULTS: Of 294 eyes at first diagnosis of type 2 ROP, 65 (22.1%) progressed to type 1 (mean [SD] interval, 9.0 [6.6] days; median, 7.0 days). Of 217 eyes with type 2 ROP that had an examination in less than 7 days, 25 (11.5%) were diagnosed with type 1 ROP in less than 7 days. Of 200 eyes that continued to have type 2 disease at the first follow-up examination and underwent a subsequent examination, 24 (15.7% of the 153 eyes that had an examination in <7 days) developed type 1 ROP in less than 7 days. The risk of progression from type 2 to type 1 in less than 7 days was greatest between 33 and 36 weeks' postmenstrual age, regardless of zone of retinopathy. CONCLUSIONS: Type 1 ROP can be identified with weekly examinations in most eyes with initial diagnosis of type 2 ROP; a small subset progresses to type 1 in less than 7 days. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00027222.