Computer-aided National Early Warning Score to predict the risk of sepsis following emergency medical admission to hospital: a model development and external validation study.

BACKGROUND: In hospitals in England, patients' vital signs are monitored and summarized into the National Early Warning Score (NEWS); this score is more accurate than the Quick Sepsis-related Organ Failure Assessment (qSOFA) score at identifying patients with sepsis. We investigated the extent to which the accuracy of the NEWS is enhanced by developing and comparing 3 computer-aided NEWS (cNEWS) models (M0 = NEWS alone, M1 = M0 + age + sex, M2 = M1 + subcomponents of NEWS + diastolic blood pressure) to predict the risk of sepsis. METHODS: We included all emergency medical admissions of patients 16 years of age and older discharged over 24 months from 2 acute care hospital centres (York Hospital [YH] for model development and a combined data set from 2 hospitals [Diana, Princess of Wales Hospital and Scunthorpe General Hospital] in the Northern Lincolnshire and Goole National Health Service Foundation Trust [NH] for external model validation). We used a validated Canadian method for defining sepsis from administrative hospital data. RESULTS: The prevalence of sepsis was lower in YH (4.5%, 1596/35 807) than in NH (8.5%, 2983/35 161). The C statistic increased across models (YH: M0 0.705, M1 0.763, M2 0.777; NH: M0 0.708, M1 0.777, M2 0.791). For NEWS of 5 or higher, sensitivity increased (YH: 47.24% v. 50.56% v. 52.69%; NH: 37.91% v. 43.35% v. 48.07%), the positive likelihood ratio increased (YH: 2.77 v. 2.99 v. 3.06; NH: 3.18 v. 3.32 v. 3.45) and the positive predictive value increased (YH: 11.44% v. 12.24% v. 12.49%; NH: 22.75% v. 23.55% v. 24.21%). INTERPRETATION: From the 3 cNEWS models, model M2 is the most accurate. Given that it places no additional burden of data collection on clinicians and can be automated, it may now be carefully introduced and evaluated in hospitals with sufficient informatics infrastructure.

Temporal estimation in prediction motion tasks is biased by a moving destination.

An ability to predict the time-to-contact (TTC) of moving objects that become momentarily hidden is advantageous in everyday life and could be particularly so in fast-ball sports. Prediction motion (PM) experiments have sought to test this ability using tasks where a disappearing target moves toward a stationary destination. Here, we developed two novel versions of the PM task in which the destination either moved away from (Chase) or toward (Attract) the moving target. The target and destination moved with different speeds such that collision occurred 750, 1,000 or 1,250 ms after target occlusion. To determine if domain-specific experience conveys an advantage in PM tasks, we compared the performance of different sporting groups ranging from internationally competing athletes to non-sporting controls. There was no difference in performance between sporting groups and non-sporting controls but there were significant and independent effects on response error by target speed, destination speed, and occlusion period. We simulated these findings using a revised version of the linear TTC model of response timing for PM tasks (Yakimoff, Bocheva, & Mitrania, 1987; Yakimoff, Mateeff, Ehrenstein, & Hohnsbein, 1993) in which retinal input from the moving destination biases the internal representation of the occluded target. This revision closely reproduced the observed patterns of response error and thus describes a means by which the brain might estimate TTC when the target and destination are in motion.

A Comparison of Spectacles Purchased Online and in UK Optometry Practice.

PURPOSE: To compare spectacles bought online with spectacles from optometry practices. METHODS: Thirty-three participants consisting of single vision spectacle wearers with either a low (N = 12, mean age 34 ± 14 years) or high prescription (N = 11, mean age 28 ± 9 years) and 10 presbyopic participants (mean age 59 ± 4 years) wearing progressive addition lenses (PALs) purchased 154 pairs of spectacles online and 154 from UK optometry practices. The spectacles were compared via participant-reported preference, acceptability, and safety; the assessment of lens, frame, and fit quality; and the accuracy of the lens prescriptions to international standard ISO 21987:2009. RESULTS: Participants preferred the practice spectacles (median ranking 4th, IQR 1-6) more than online (6th, IQR 4-8; Mann-Whitney U = 7345, p < 0.001) and practice PALs (median ranking 2nd, IQR 1-4) were particularly preferred (online 6.5th, IQR 4-9, Mann-Whitney U = 455, p < 0.001). Of those deemed unacceptable and unsafe, significantly more were bought online (unacceptable: online 43/154 vs. practice 15/154, Fisher's exact p = 0.0001; unsafe: online 14/154 vs. practice 5/154, Fisher's exact p = 0.03). CONCLUSIONS: Participants preferred spectacles from optometry practice rather than those bought online, despite lens quality and prescription accuracy being similar. A greater number of online spectacles were deemed unsafe or unacceptable because of poor spectacle frame fit, poor cosmetic appearance, and inaccurate optical centration. This seems particularly pertinent to PAL lenses, which are known to increase falls risk. Recommendations are made to improve both forms of spectacle provision.

Intermediate addition multifocals provide safe stair ambulation with adequate 'short-term' reading.

PURPOSE: A recent randomised controlled trial indicated that providing long-term multifocal wearers with a pair of distance single-vision spectacles for use outside the home reduced falls risk in active older people. However, it also found that participants disliked continually switching between using two pairs of glasses and adherence to the intervention was poor. In this study we determined whether intermediate addition multifocals (which could be worn most of the time inside and outside the home and thus avoid continual switching) could provide similar gait safety on stairs to distance single vision spectacles whilst also providing adequate 'short-term' reading and near vision. METHODS: Fourteen healthy long-term multifocal wearers completed stair ascent and descent trials over a 3-step staircase wearing intermediate and full addition bifocals and progression-addition lenses (PALs) and single-vision distance spectacles. Gait safety/caution was assessed using foot clearance measurements (toe on ascent, heel on descent) over the step edges and ascent and descent duration. Binocular near visual acuity, critical print size and reading speed were measured using Bailey-Lovie near charts and MNRead charts at 40 cm. RESULTS: Gait safety/caution measures were worse with full addition bifocals and PALs compared to intermediate bifocals and PALs. The intermediate PALs provided similar gait ascent/descent measures to those with distance single-vision spectacles. The intermediate addition PALs also provided good reading ability: Near word acuity and MNRead critical print size were better with the intermediate addition PALs than with the single-vision lenses (p < 0.0001), with a mean near visual acuity of 0.24 ± 0.13 logMAR (~N5.5) which is satisfactory for most near vision tasks when performed for a short period of time. CONCLUSIONS: The better ability to 'spot read' with the intermediate addition PALs compared to single-vision spectacles suggests that elderly individuals might better comply with the use of intermediate addition PALs outside the home. A lack of difference in gait parameters for the intermediate addition PALs compared to distance single-vision spectacles suggests they could be usefully used to help prevent falls in older well-adapted full addition PAL wearers. A randomised controlled trial to investigate the usefulness of intermediate multifocals in preventing falls seems warranted.

Dizziness, but not falls rate, improves after routine cataract surgery: the role of refractive and spectacle changes.

PURPOSE: To determine whether dizziness and falls rates change due to routine cataract surgery and to determine the influence of spectacle type and refractive factors. METHODS: Self-reported dizziness and falls were determined in 287 patients (mean age of 76.5 ± 6.3 years, 55% females) before and after routine cataract surgery for the first (81, 28%), second (109, 38%) and both eyes (97, 34%). Dizziness was determined using the short-form of the Dizziness Handicap Inventory. Six-month falls rates were determined using self-reported retrospective data. RESULTS: The number of patients with dizziness reduced significantly after cataract surgery (52% vs 38%; χ(2) = 19.14(,) p < 0.001), but the reduction in the number of patients who fell in the 6-months post surgery was not significant (23% vs 20%; χ(2) = 0.87, p = 0.35). Dizziness improved after first eye surgery (49% vs 33%, p = 0.01) and surgery on both eyes (58% vs 35%, p < 0.001), but not after second eye surgery (52% vs 45%, p = 0.68). Multivariate logistic regression analyses found significant links between post-operative falls and change in spectacle type (increased risk if switched into multifocal spectacles). Post-operative dizziness was associated with changes in best eye visual acuity and changes in oblique astigmatic correction. CONCLUSIONS: Dizziness is significantly reduced by first (or both) eye cataract surgery and this is linked with improvements in best eye visual acuity, although changes in oblique astigmatic correction increased dizziness. The lack of improvement in falls rate may be associated with switching into multifocal spectacle wear after surgery.

Sensitivity and specificity of the empirical lymphocyte genome sensitivity (LGS) assay: implications for improving cancer diagnostics.

Lymphocyte responses from 208 individuals: 20 with melanoma, 34 with colon cancer, and 4 with lung cancer (58), 18 with suspected melanoma, 28 with polyposis, and 10 with COPD (56), and 94 healthy volunteers were examined. The natural logarithm of the Olive tail moment (OTM) was plotted for exposure to UVA through 5 different agar depths (100 cell measurements/depth) and analyzed using a repeated measures regression model. Responses of patients with cancer plateaued after treatment with different UVA intensities, but returned toward control values for healthy volunteers. For precancerous conditions and suspected cancers, intermediate responses occurred. ROC analysis of mean log OTMs, for cancers plus precancerous/suspect conditions vs. controls, cancer vs. precancerous/suspect conditions plus controls, and cancer vs. controls, gave areas under the curve of 0.87, 0.89, and 0.93, respectively (P<0.001). Optimization allowed test sensitivity or specificity to approach 100% with acceptable complementary measures. This modified comet assay could represent a stand-alone test or an adjunct to other investigative procedures for detecting cancer.

Spectacle prescribing II: practitioner experience is linked to the likelihood of suggesting a partial prescription.

PURPOSE: A follow up study to investigate whether UK optometrists partially prescribe significant changes in refractive correction to assist patient adaptation and whether various aspects of practitioner profiles are linked to the nature of these prescribing decisions. METHOD: A case scenario type questionnaire was distributed by post and via the internet to UK optometrists. Five case scenarios were described that included information on patient age, symptoms, habitual refractive correction (if any), subjective refraction and any other relevant clinical information. In each case respondents were asked to indicate and justify what refractive correction they would prescribe. RESULTS: A total of 592 questionnaires were completed. Between 41% and 84% prescribed the subjective refraction result depending on the scenario. The likelihood of partial prescribing increased by 34% for every 10 years following qualification and thus after a typical 40 year career, respondents were now over three times more likely to partially prescribe. There were no other links with the propensity to partially prescribe. CONCLUSION: The subjective refraction result exerted a strong hold on the reported prescribing outcome, particularly for newly qualified optometrists. Partial prescribing was increasingly proposed the greater the number of years the respondent had been qualified. This suggests that with increasing exposure to patients who return dissatisfied with their spectacles, a greater appreciation of partial prescribing is gained. This link seems to be an important finding that provides significant support for the prescribing rules suggested by textbooks, which are not yet supported by research evidence.

The enriched opportunities programme for people with dementia: a cluster-randomised controlled trial in 10 extra care housing schemes.

OBJECTIVES: The Enriched Opportunities Programme (EOP) is a multi-level intervention focussing on improved quality of life for people with dementia. This study compared the experience of people living with dementia and other mental health problems in extra care housing schemes that utilised EOP with schemes that employed an active control intervention. METHOD: Ten extra care housing schemes were cluster randomised to receive either the EOP intervention or an active control intervention for an 18-month period. Residents with dementia or other significant mental health problems (20-30 per scheme) were assessed on a number of outcome measures at baseline, six months, one year and 18 months. The primary outcome measure was quality of life. Self-reported depression was an important secondary outcome. RESULTS: The EOP-participating residents rated their quality of life more positively over time (4.0 (SE 0.6) units; 14% p < 0.001) than the active control (1.3 (SE 0.6) units; 4% p = 0.003). There was also a significant group-time interaction for depressive symptoms (p = 0.003). The EOP-participating residents reported a reduction of 25% at both six and 12 months and a 37% reduction at 18 months (all p's < 0.001). EOP residents were less likely than residents in the active control sites to move to a care home or to be admitted to a hospital inpatient bed. They were more likely to be seen by a range of community health professionals. CONCLUSION: The EOP had a positive impact on the quality of life of people with dementia in well-staffed extra care housing schemes.

Faster visual reaction times in elite athletes are not linked to better gaze stability.

The issue of whether visually-mediated, simple reaction time (VRT) is faster in elite athletes is contentious. Here, we examined if and how VRT is affected by gaze stability in groups of international cricketers (16 females, 28 males), professional rugby-league players (21 males), and non-sporting controls (20 females, 30 males). VRT was recorded via a button-press response to the sudden appearance of a stimulus (circular target-diameter 0.8°), that was presented centrally, or 7.5° to the left or right of fixation. The incidence and timing of saccades and blinks occurring from 450 ms before stimulus onset to 225 ms after onset were measured to quantify gaze stability. Our results show that (1) cricketers have faster VRT than controls; (2) blinks and, in particular, saccades are associated with slower VRT regardless of the level of sporting ability; (3) elite female cricketers had steadier gaze (fewer saccades and blinks) compared to female controls; (4) when we accounted for the presence of blinks and saccades, our group comparisons of VRT were virtually unchanged. The stability of gaze is not a factor that explains the difference between elite and control groups in VRT. Thus we conclude that better gaze stability cannot explain faster VRT in elite sports players.

Dietitian-led education program to improve phosphate control in a single-center hemodialysis population.

OBJECTIVE: We sought to analyze the effect of a structured, dietitian-led education program on patients' general knowledge of phosphate and phosphate binders, and its impact on serum phosphate concentrations in a single-center hemodialysis population. DESIGN: We compared subjects before and after intervention. SETTING: This study involved two dialysis units operated by a single center. PATIENTS: One hundred and fifteen hemodialysis patients consented to participate in this study (54% male; mean age, 61.1 years; 32% Asian). Patients acted as their own controls. One hundred and eight patients completed the study. INTERVENTION: All patients completed a questionnaire to assess their knowledge of phosphate and phosphate-binder therapy. Small group teaching sessions were then delivered to patients by a single dietitian, with the aid of a hospital interpreter as required. Patients also received information booklets or audio cassettes translated into Urdu. A second identical questionnaire was completed a month later. MAIN OUTCOME MEASURES: Outcome measures involved pre-education and posteducation knowledge scores, monthly measurements of serum phosphate, calcium, and mean Kt/V, and parathyroid hormone concentrations every 3 months during the 5 month run-in period and subsequent 5-month study period. RESULTS: The education program significantly improved patients' general knowledge of phosphate and of phosphate-binders (P < .001), especially in patients with a low pretest score and those of South Asian origin. This result was associated with a significant reduction in serum phosphate in patients with hyperphosphatemia (P = .032). CONCLUSIONS: These findings suggest that a combination of educational initiatives is effective in enhancing patients' knowledge of phosphate and phosphate-binders, and consequently in improving serum phosphate levels in patients with hyperphosphatemia.

Does achieving the 'Best Practice Tariff' criteria for fractured neck of femur patients improve one year outcomes?

INTRODUCTION: 'Best Practice Tariff' (BPT) criteria have been developed to improve peri-operative care for hip fracture patients. This paper aims to explore the impact of BPT criteria on 1-year outcomes. PATIENTS AND METHODS: Anonymised data were acquired from the National Hip Fracture Database (NHFD) for patients presenting to Bradford Royal Infirmary with a fractured neck of femur during the period April 2011 to December 2015. Two study groups were defined: those that achieved the BPT uplift criteria, and those that did not. Three primary outcome measures were identified: one year survival, mobility status and residential status. Further analysis was performed to ascertain whether achieving any individual BPT criterion significantly affected 1-year outcomes. RESULTS: 1414 cases were included, 784 (55%) of whom met the BPT criteria. The 1-year survival rate of the BPT-achieved group was 67.7%, compared with 61.4% in the non-BPT group (relative risk reduction 10.3%, p = 0.014). Mobility status declined by at least one grade in 50.8% of the BPT-achieved group, compared with 60.8% of the non-BPT group (risk reduction 16.4%, p = 0.003). BPT achievement had no significant effect on residential status at one year. Multivariate analysis identified that post-operative Abbreviated Mental Test Score (AMTS) and falls assessment were significantly associated with reduced 1-year mortality. Similarly, both pre- and post-operative AMTS assessments resulted in greater potential to return to pre-morbid mobility level. When controlling for potential confounders (age, gender, ASA grade, pre-morbid mobility and residential status) logistic regression modelling showed that achieving the BPT criteria was associated with a 30% increase in the odds of survival at one year (p = 0.046). DISCUSSION: Achieving the BPT requirements has a significant impact on 1-year mortality and return to pre-morbid mobility level. The effect of AMTS and falls assessments on these outcomes may be due to their properties as surrogate markers for more thorough and considered peri-operative assessment. CONCLUSIONS: Few studies describe the effect of BPT criteria on 1-year outcomes; therefore the results presented here help to vindicate the investments made in the scheme. Furthermore, these results may help steer subsequent revisions to BPT requirements by encouraging greater focus on peri-operative assessment and interventions.

Understanding and applying practitioner and patient views on the implementation of a novel automated Computer-Aided Risk Score (CARS) predicting the risk of death following emergency medical admission to hospital: qualitative study.

OBJECTIVES: The Computer-Aided Risk Score (CARS) estimates the risk of death following emergency admission to medical wards using routinely collected vital signs and blood test data. Our aim was to elicit the views of healthcare practitioners (staff) and service users and carers (SU/C) on (1) the potential value, unintended consequences and concerns associated with CARS and practitioner views on (2) the issues to consider before embedding CARS into routine practice. SETTING: This study was conducted in two National Health Service (NHS) hospital trusts in the North of England. Both had in-house information technology (IT) development teams, mature IT infrastructure with electronic National Early Warning Score (NEWS) and were capable of integrating NEWS with blood test results. The study focused on emergency medical and elderly admissions units. There were 60 and 39 acute medical/elderly admissions beds at the two NHS hospital trusts. PARTICIPANTS: We conducted eight focus groups with 45 healthcare practitioners and two with 11 SU/Cs in two NHS acute hospitals. RESULTS: Staff and SU/Cs recognised the potential of CARS but were clear that the score should not replace or undermine clinical judgments. Staff recognised that CARS could enhance clinical decision-making/judgments and aid communication with patients. They wanted to understand the components of CARS and be reassured about its accuracy but were concerned about the impact on intensive care and blood tests. CONCLUSION: Risk scores are widely used in healthcare, but their development and implementation do not usually involve input from practitioners and SU/Cs. We contributed to the development of CARS by eliciting views of staff and SU/Cs who provided important, often complex, insights to support the development and implementation of CARS to ensure successful implementation in routine clinical practice.

Test-retest reproducibility of accommodative facility measures in primary school children.

BACKGROUND: To determine the test-retest reproducibility of accommodative facility (AF) measures in an unselected sample of UK primary school children. METHODS: Using ±2.00 DS flippers and a viewing distance of 40 cm, AF was measured in 136 children (range 4-12 years, average 8.1 ± 2.1) by five testers on three occasions (average interval between successive tests: eight days, range 1-21 days). On each occasion, AF was measured monocularly and binocularly, for two minutes. Full datasets were obtained in 111 children (81.6 per cent). RESULTS: Intra-individual variation in AF was large (standard deviation [SD] = 3.8 cycles per minute [cpm]) and there was variation due to the identity of the tester (SD = 1.6 cpm). On average, AF was greater: (i) in monocular compared to binocular testing (by 1.4 cpm, p < 0.001); (ii) in the second minute of testing compared to the first (by 1.3 cpm, p < 0.001); (iii) in older compared to younger children (for example, AF for 4/5-year-olds was 3.3 cpm lower than in children ≥ 10 years old, p = 0.009); and (iv) on subsequent testing occasions (for example, visit-2 AF was 2.0 cpm higher than visit-1 AF, p < 0.001). After the first minute of testing at visit-1, only 36.9 per cent of children exceeded published normative values for AF (≥ 11 cpm monocularly and ≥ 8 cpm binocularly), but this rose to 83.8 per cent after the third test. Using less stringent pass criteria (≥ 6 cpm monocularly and ≥ 3 cpm binocularly), the equivalent figures were 82.9 and 96.4 per cent, respectively. Reduced AF did not co-exist with abnormal near point of accommodation or reduced visual acuity. CONCLUSIONS: The results reveal considerable intra-individual variability in raw AF measures in children. When the results are considered as pass/fail, children who initially exhibit normal AF continued to do so on repeat testing. Conversely, the vast majority of children with initially reduced AF exhibit normal performance on repeat testing. Using established pass/fail criteria, the prevalence of persistently reduced AF in this sample is 3.6 per cent.

Development and validation of a novel computer-aided score to predict the risk of in-hospital mortality for acutely ill medical admissions in two acute hospitals using their first electronically recorded blood test results and vital signs: a cross-sectional study.

OBJECTIVES: There are no established mortality risk equations specifically for emergency medical patients who are admitted to a general hospital ward. Such risk equations may be useful in supporting the clinical decision-making process. We aim to develop and externally validate a computer-aided risk of mortality (CARM) score by combining the first electronically recorded vital signs and blood test results for emergency medical admissions. DESIGN: Logistic regression model development and external validation study. SETTING: Two acute hospitals (Northern Lincolnshire and Goole NHS Foundation Trust Hospital (NH)-model development data; York Hospital (YH)-external validation data). PARTICIPANTS: Adult (aged ≥16 years) medical admissions discharged over a 24-month period with electronic National Early Warning Score(s) and blood test results recorded on admission. RESULTS: The risk of in-hospital mortality following emergency medical admission was 5.7% (NH: 1766/30 996) and 6.5% (YH: 1703/26 247). The C-statistic for the CARM score in NH was 0.87 (95% CI 0.86 to 0.88) and was similar in an external hospital setting YH (0.86, 95% CI 0.85 to 0.87) and the calibration slope included 1 (0.97, 95% CI 0.94 to 1.00). CONCLUSIONS: We have developed a novel, externally validated CARM score with good performance characteristics for estimating the risk of in-hospital mortality following an emergency medical admission using the patient's first, electronically recorded, vital signs and blood test results. Since the CARM score places no additional data collection burden on clinicians and is readily automated, it may now be carefully introduced and evaluated in hospitals with sufficient informatics infrastructure.

HIV enteropathy: crypt stem and transit cell hyperproliferation induces villous atrophy in HIV/Microsporidia-infected jejunal mucosa.

OBJECTIVES: The study aim was to analyse the kinetics of stem and transit cells in the crypts of jejunal mucosa infected with HIV and Microsporidia. DESIGN: The size of villi, depth of crypts and proliferative activity of transit and stem cells in jejunal mucosa were measured using morphometric techniques. METHODS: The surface area/volume ratio (S/V) of jejunal biopsies was estimated under light microscopy using a Weibel graticule. Crypt length was measured by counting enterocytes along the crypt side from the base to the villus junction, and the mean crypt length was calculated. The S/V and crypt lengths of the jejunal mucosa of 21 HIV and Microsporidia-infected test cases were compared with 14 control cases. The labelling index in relation to the crypt cell position of 10 of the test cases was analysed compared with 13 control cases. RESULTS: Differences were found in the S/V and crypt length, and there was a negative correlation between S/V and crypt length in test and control cases combined. Cell labelling indices fell into low and high proliferation groups. There were significant differences in labelling indices between low proliferation test cases and controls, between high proliferation test cases and controls, and between high and low proliferation test cases. CONCLUSION: Villous atrophy induced by HIV and Microsporidia is attributed to crypt cell hyperplasia and the encroachment of crypt cells onto villi. These infections induce crypt hypertrophy by stimulating cell mitosis predominantly in transit cells but also in stem cells. Increased stem cell proliferation occurs only in high proliferation cases.

Factors influencing accuracy of referral and the likelihood of false positive referral by optometrists in Bradford, United Kingdom.

AIMS: Levels of false positive referral to ophthalmology departments can be high. This study aimed to evaluate commonality between false positive referrals in order to find the factors which may influence referral accuracy. METHODS: In 2007/08, a sample of 431 new Ophthalmology referrals from the catchment area of Bradford Royal Infirmary were retrospectively analysed. RESULTS: The proportion of false positive referrals generated by optometrists decreases with experience at a rate of 6.2% per year since registration (p<0.0001). Community services which involved further investigation done by the optometrist before directly referring to the hospital were 2.7 times less likely to refer false positively than other referral formats (p=0.007). Male optometrists were about half as likely to generate a false positive referral than females (OR=0.51, p=0.008) and as multiple/corporate practices in the Bradford area employ less experienced and more female staff, independent practices generate about half the number of false positive referrals (OR=0.52, p=0.005). CONCLUSIONS: Clinician experience has the greatest effect on referral accuracy although there is also a significant effect of gender with women tending to refer more false positives. This may be due to a different approach to patient care and possibly a greater sensitivity to litigation. The improved accuracy of community services (which often refer directly after further investigation) supports further growth of these schemes.

What you see is what you step: the horizontal-vertical illusion increases toe clearance in older adults during stair ascent.

PURPOSE: Falls on stairs are a significant cause of morbidity and mortality in elderly people. A simple safety strategy to avoid tripping on stairs is increasing foot clearance. We determined whether a horizontal-vertical illusion superimposed onto stairs to create an illusory perceived increase in stair-riser height would increase stair ascent foot clearance in older participants. METHODS: Preliminary experiments determined the optimum parameters for the horizontal-vertical illusion. Fourteen older adults (mean age ± 1 SD, 68.5 ± 7.4 years) ascended a three-step staircase with the optimized version of the horizontal-vertical illusion (spatial frequency: 12 cycles per stair riser) positioned either on the bottom or top stair only, or on the bottom and top stair simultaneously. These were compared to a control condition, which had a plain stair riser with edge highlighters positioned flush with each stair-tread edge. Foot clearance and measures of postural stability were compared across conditions. RESULTS: The optimized illusion on the bottom and top stair led to a significant increase in foot clearance over the respective stair edge, compared to the control condition. There were no significant decreases in postural stability. CONCLUSIONS: An optimized horizontal-vertical visual illusion led to significant increases in foot clearance in older adults when ascending a staircase, but the effects did not destabilize their postural stability. Inclusion of the horizontal-vertical illusion on raised surfaces (e.g., curbs) or the bottom and top stairs of staircases could improve stair ascent safety in older adults.

NAD(P)H:Quinone oxidoreductase-1 C609T polymorphism analysis in human superficial bladder cancers: relationship of genotype status to NQO1 phenotype and clinical response to Mitomycin C.

NAD(P)H:Quinone oxidoreductase-1 (NQO1) has been implicated in the bioreductive activation of the clinically active anticancer drug Mitomycin C (MMC) and a polymorphic variant of NQO1 which lacks functional enzyme activity (NQO1*2) has been linked with poor survival in patients treated with MMC. The relationship between NQO1 activity and cellular response to MMC is however controversial and the aim of this study was to determine whether the response of bladder cancer patients to MMC can be forecast on the basis of NQO1*2 genotype status. Genomic DNA was extracted from formalin-fixed, paraffin-embedded tissue from 148 patients with low to intermediate grade (G1/G2) superficial (Ta/T1) bladder cancers and NQO1*2 genotype status determined by PCR-RFLP. NQO1*2 genotype status was retrospectively compared with clinical response to intravesical administered MMC with the primary end-point being time to first recurrence. NQO1 phenotype was determined by immunohistochemistry. Of the 148 patients genotyped, 85 (57.4%) were NQO1*1 (wild-type), 59 (39.8%) were NQO1*1/*2 (heterozygotes) and 4 (2.7%) were NQO1*2/*2. No NQO1 protein expression was detected in NQO1*2/*2 tumours. A broad spectrum of NQO1 protein expression existed in tumours genotyped as NQO1*1 and NQO1*1/*2 although tumours with NQO1*1 typically expressed higher NQO1 protein. A poor correlation existed between NQO1*2 genotype status and clinical response to MMC. The results of this retrospective study suggest that tailoring MMC therapy to individual patients with superficial bladder cancer on the basis of NQO1 genotype status is unlikely to be of clinical benefit.

Associations of circulating calcium and 25-hydroxyvitamin D with glucose metabolism in pregnancy: a cross-sectional study in European and South Asian women.

BACKGROUND: Vitamin D deficiency is thought to impair insulin action and glucose metabolism; however, previous studies have not examined ethnic differences or the influence of calcium and parathyroid hormone. We investigated this in a cohort of predominantly white European and south Asian women during pregnancy. METHODS: In this cross-sectional study from an urban population in northern England (53.8°N), 1467 women were recruited when undergoing glucose tolerance testing (75 g oral glucose tolerance test) at 26 weeks' gestation. RESULTS: Gestational diabetes mellitus (GDM) was diagnosed in 137 women (9.3%). Median 25-hydroxyvitamin D concentration for the study population was 9.3 ng/mL (interquartile range 5.2, 16.9) and was higher in European [15.2 ng/mL (10.7, 23.5)] than in south Asian women [5.9 ng/mL (3.9, 9.4), P < .001]. After appropriate adjustment for confounders, 25-hydroxyvitamin D showed a weak inverse association with fasting plasma glucose (FPG; mean difference 1.0% per 1 SD; the ratio of geometric means (RGM) 0.99, 95% confidence interval (CI) 0.98, 1.00), and PTH was weakly associated with FPG (RGM 1.01, 95% CI 1.00, 1.02), but neither was associated with fasting insulin, postchallenge glucose, or GDM. Serum calcium (albumin adjusted) was strongly associated with fasting insulin (RGM 1.06; 95% CI 1.03, 1.08), postchallenge glucose (RGM 1.03, 95% CI 1.01, 1.04), and GDM (odds ratio 1.33, 95% CI 1.06, 1.66) but not with FPG. Associations were similar in European and south Asian women. CONCLUSIONS: These findings do not indicate any important association between vitamin D status and glucose tolerance in pregnancy. Relationships between circulating calcium and glucose metabolism warrant further investigation.

Test-retest reproducibility of accommodation measurements gathered in an unselected sample of UK primary school children.

PURPOSE: To determine the test-retest reproducibility of accommodation measurements gathered in an unselected sample of primary school children. METHODS: Monocular and binocular amplitudes of accommodation (AA) were collected by five different Testers using the push-up method in an unselected sample of school children (n=137, age: 8.1±2.1 years). Testing was conducted on three occasions (average testing interval: 8 days) in 91.2% of the children. RESULTS: The median AA was 19.1D, the variation due to the identity of the Tester was 3.1D (p<0.001) and the within-subject variation (which takes the variation due to Tester identity into account) was 5.2D. Around 75-79% of children exhibited monocular AAs≥12D when tested on the first occasion, but more than 90% exhibited an AA≥12D when subsequently tested. Around 74-80% of those with an AA<12D on the first occasion had values≥12D on subsequent testing even though no treatment had been undertaken. Poorer initial AA measurements were less likely to improve on repeat testing. CONCLUSIONS: Our results reveal substantial intra-individual variation in AA measurements, raising questions about the usefulness of this test in children aged 4-12 years. We suggest that AA assessment may prove most useful in children in this age range as a pass/fail check for substantially reduced AA, for example, where the AA is <12D. Our sample would suggest that the prevalence of persistently reduced AA may be around 3.2% when tested under binocular conditions and 4-6.4% when tested monocularly.