Impulsivity and self-control in elementary school children and adult females: Using identical task and procedural parameters

Results of studies examining the relationship between impulsivity and age are limited because different tasks, procedural parameters, and different reinforcers have been used with different aged participants. Thus, the current study sought to rectify these differences in two experiments with children (42, ages 5-12) and adults (69 college-aged females) using the same task with identical procedural parameters. In the Self-Control Video Software Task (SCVST; Forzano and Schunk, 2008; Forzano et al., 2014) participants repeatedly choose between larger, more delayed and smaller, less delayed access to viewing video cartoons. No differences in impulsivity were found between adults and children. No age or gender differences were found among children. Differences in task and procedural parameters are identified as important in their implications for research on impulsivity.

Machine Learning Algorithm Helps Identify Non-Diagnosed Prodromal Alzheimer's Disease Patients in the General Population

BACKGROUND

Recruiting patients for clinical trials of potential therapies for Alzheimer's disease (AD) remains a major challenge, with demand for trial participants at an all-time high. The AD treatment R and D pipeline includes around 112 agents. In the United States alone, 150 clinical trials are seeking 70,000 participants. Most people with early cognitive impairment consult primary care providers, who may lack time, diagnostic skills and awareness of local clinical trials. Machine learning and predictive analytics offer promise to boost enrollment by predicting which patients have prodromal AD, and which will go on to develop AD.

OBJECTIVES

The authors set out to develop a machine learning predictive model that identifies prodromal AD patients in the general population, to aid early AD detection by primary care physicians and timely referral to expert sites for biomarker confirmation of diagnosis and clinical trial enrollment.

DESIGN

The authors use a classification machine learning algorithm to extract patterns within healthcare claims and prescription data three years prior to AD diagnosis/AD drug initiation.

SETTING

The study focused on subjects included within proprietary IQVIA US data assets (claims and prescription databases). Patient information was extracted from January 2010 to July 2018, for cohorts aged between 50 and 85 years.

PARTICIPANTS

A total of 88,298,289 subjects aged between 50 and 85 years were identified. For the positive cohort, 667,288 subjects were identified who had 24 months of medical history and at least one record with AD or AD treatment. For the negative cohort, 3,670,254 patients were selected who had a similar length of medical history and who were matched to positive cohort subjects based on the prevalence rate. The scoring cohort was selected based on availability of recent medical data of 2-5 years and included 72,670,283 subjects between the ages of 50 and 85 years. Intervention (if any): None.

MEASUREMENTS

A list of clinically-relevant and interpretable predictors was generated and extracted from the data sets for each subject, including pharmacological treatments (NDC/product), office/specialist visits (specialty), tests and procedures (HCPCS and CPT), and diagnosis (ICD). The positive cohort was defined as patients who have AD diagnosis/AD treatment with a 3 years offset as an estimate for prodromal AD diagnosis. Supervised ML techniques were used to develop algorithms to predict the occurrence of prodromal AD cases. The sample dataset was divided randomly into a training dataset and a test dataset. The classification models were trained and executed in the PySpark framework. Training and evaluation of LogisticRegression, DecisionTreeClassifier, RandomForestClassifier, and GBTClassifier were executed using PySpark's mllib module. The area under the precision-recall curve (AUCPR) was used to compare the results of the various models.

RESULTS

The AUCPRs are 0.426, 0.157, 0.436, and 0.440 for LogisticRegression, DecisionTreeClassifier, RandomForestClassifier, and GBTClassifier, respectively, meaning that GBTClassifier (Gradient Boosted Tree) outperforms the other three classifiers. The GBT model identified 222,721 subjects in the prodromal AD stage with 80% precision. Some 76% of identified prodromal AD patients were in the primary care setting.

CONCLUSIONS

Applying the developed predictive model to 72,670,283 U.S. residents, 222,721 prodromal AD patients were identified, the majority of whom were in the primary care setting. This could drive major advances in AD research by enabling more accurate and earlier prodromal AD diagnosis at the primary care physician level , which would facilitate timely referral to expert sites for in-depth assessment and potential enrolment in clinical trials.

A clinical study of Aicardi syndrome in Northern Ireland: the spectrum of ophthalmic findings

PurposeAicardi syndrome is a rare disorder, affecting ~1 in 100 000 live births. Chorioretinal lacunae feature alongside agenesis of the corpus callosum and spasms in flexion to make up a diagnostic triad. Recently ophthalmic findings such as microphthalmia and optic disc anomalies have been recognised in association with Aicardi syndrome. This population study aims to determine the presence of ocular findings and identifies some novel associations in these patients.MethodsA retrospective review of charts for seven patients with Aicardi syndrome was carried out.ResultsThe incidence of Aicardi syndrome in Northern Ireland was found to be 1 in 110 000 live births. Four patients who had microphthalmus also had iris abnormalities; two patients with bilateral microphthalmus had partial aniridia and two patients with unilateral microphthalmus had iris coloboma in the same eye. Optic disc abnormalities were found in 11 eyes of six patients. Two patients were found to have areas of fibrovascular proliferation with a thickened white ridge and avascular zone beyond. Both of these patients developed retinal detachments.ConclusionsOur review of patients with Aicardi syndrome in Northern Ireland has revealed some novel clinical findings, including aniridia in two cases. We also found a higher than previously reported rate of excavated disc anomalies of 50% in our cohort. We found two cases of peripheral retinal dysplasia, which has not been previously reported. This finding was associated with microphthalmus and severe optic disc abnormalities, and we feel this warrants early EUA to enable early treatment and hopefully result in better visual prognosis.

Bevacizumab compared with diode laser in stage 3 posterior retinopathy of prematurity: A 5 year follow up

We conducted a prospective randomized study to compare outcomes of intravitreal Bevacizumab versus diode laser in thirty eyes of fifteen premature babies with zone 1 or posterior zone 2 retinopathy of prematurity (ROP). We recorded complications, regression/reactivation of ROP, visual outcome, refractive error and systemic complications. The Bevacizumab treated eyes showed rapid regression of the ROP with resolution of plus disease and flattening of the ridge at 48 hours post injection. In 3 Bevacizumab treated eyes, reactivation occurred and were treated with laser (3 eyes) or a further Bevacizumab injection (1 eye). Of the diode laser treated eyes, one showed progression and was treated with Bevacizumab. At 5 year follow up, good outcomes were observed in both treatment groups. Hoever, less myopia was found in the Bevacizumab compared with the diode laser treated eyes.

MouseMine: a new data warehouse for MGI

MouseMine (www.mousemine.org) is a new data warehouse for accessing mouse data from Mouse Genome Informatics (MGI). Based on the InterMine software framework, MouseMine supports powerful query, reporting, and analysis capabilities, the ability to save and combine results from different queries, easy integration into larger workflows, and a comprehensive Web Services layer. Through MouseMine, users can access a significant portion of MGI data in new and useful ways. Importantly, MouseMine is also a member of a growing community of online data resources based on InterMine, including those established by other model organism databases. Adopting common interfaces and collaborating on data representation standards are critical to fostering cross-species data analysis. This paper presents a general introduction to MouseMine, presents examples of its use, and discusses the potential for further integration into the MGI interface.

Training in the private sector: what works and how do we increase opportunities?

In Australia 61% of elective surgery takes place in private hospitals where current opportunities for surgical education and training (SET) are limited. The situation will shortly be compounded because of the large increase in local medical graduates, many of whom will aspire to be surgeons. How and where to train these extra surgeons to meet the expanding needs of the community must be addressed. Two models of private sector training are reviewed both of which involved combined training in both private and public sectors. Two second-year (SET 2) positions were created from one public hospital SET position by using the private sector for 3.5 days per week for 3 months of a 6-month rotation. The second model was applicable to post-fellowship training with a fairly even split between public and private sector responsibilities. In the first year, four registrars shared the two 6-month rotations for the SET 2 position. Trainees did the required minimum procedures (range 109-139) with primary operating targets of 20-25% (range 21-32%). The post-fellowship position in colorectal surgery was greatly enhanced by the private sector involvement with regard to operating experience as well as meeting part of the remuneration of the trainee. Successful models for training within the private sector in Australia can be found. To expand training in the private sector there will need to be a cultural shift in the perceptions of surgeons, patients, administrators, and trainees. Funding for posts may be available to those private hospitals that can meet the Royal Australasian College of Surgeons' accreditation standards for posts and hospitals.

Merkel cell carcinoma metastasis to the iris in a 23 year old female

Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine malignancy which predominantly affects elderly caucasians. The pathogenesis is poorly understood but ultraviolet light and immunosuppression have both been implicated. MCC most commonly arises on sun exposed areas of the head and neck or extremities and has a propensity for local recurrence and regional lymph node metastasis. It may present as a violaceous or non specific firm nodule or as a small plaque. Histological diagnosis can be difficult and electron microscopy or immunohistochemistry are frequently required in addition to light microscopy. Management is stage dependant and frequently involves wide surgical excision with or without chemotherapy or radiation therapy. Early diagnosis and complete surgical excision is associated with a favourable prognosis. However, aggressive tumours with regional recurrence or distant metastases result in a median survival of 9 months. Reports of primary MCC of the eyelids have been reported in the literature. Intra-ocular metastases to the choroid and ciliary body have also been reported.

Postcataract surgery outcome in a series of infants and children with Down syndrome

AIMS

To report the visual and refractive outcome and complications in children with Down syndrome undergoing cataract extraction.

METHODS

The case notes of 18 infants and children with lens opacities and Down syndrome who underwent cataract extraction between January 1981 and August 2006 were reviewed.

RESULTS

Over the 25-year study period, 7% (33 eyes) of paediatric eyes undergoing cataract extraction had Down syndrome. The average follow-up time was 11.2 (SD 7.5) years with a range of 2.5 months to 25 years. 25 were congenital, and eight were developmental lens opacities. 40% of patients attained a postoperative BCVA between 6/9 and 6/18. There was a large myopic shift of -7.96 (4.7) D for aphakes and -8.06 (7.4) D for pseudophakes with an average increase in axial length of 3.58 (3.14) mm. There was a 30% incidence of posterior capsular opacification (PCO) overall, 38% in eyes without a primary posterior capsulotomy. Five eyes developed aphakic glaucoma, one eventually necessitating an enucleation. Two patients had retinal detachments on follow-up.

CONCLUSION

Cataract extraction in our population of children with Down syndrome is a safe and effective procedure with a very encouraging visual outcome.

Golf--recognising the risk of severe eye injury

Golf related ocular injuries are uncommon but frequently result in severe injury necessitating removal of the eye. As golf increases in popularity, it is vital that awareness is raised among both players and spectators regarding the potential hazards. We determined the nature and frequency of golf related eye injury at our unit from 1990 to 2007. Patient age, nature of injury, management and visual outcome were documented. 10 patients (7 adults, 3 children) sustained golf related eye trauma over this time. 7 cases involved injury inflicted by a golf ball and 3 by a golf club. 7 eyes required enucleation or evisceration. Visual acuity in the remaining 3 eyes ranged from 6/6 to less than 6/60. Golf related ocular injuries while uncommon, frequently have devastating consequences. Public awareness must be raised in order to promote greater safety on the golf course.

Changing pattern of childhood blindness

All children under the age of 16 who fulfilled the criteria of blindness and low vision as defined by WHO were included in the study. These children were recruited from 1990 to 2004 from all the Ophthalmology Departments of Ireland, National Council of Blind and Visually impaired. Data was collected from history, detailed ocular examination and investigations including CT, MRI, ultrasound and chromosomal analysis. The prevalence of blindness in 2004 was 0.05% compared to 0.02% in 1989. The aetiologies were divided in (1) genetic, (2) prenatal, (3) perinatal, (4) childhood categories. The genetic group was 33% of the total, (15.63%) had albinism (11%) had retinal dystrophies. The perinatal group of 27% optic nerve hypoplasia, structural anomalies like microphthalmos, anophthalmos comprised of 15.85% and cataract (5.47%). The perinatal group was 26%, cortical blindness (17.45%), ROP (5.5%) and the childhood group comprised of 12.4% of the total. The overall prevalence of childhood blindness and low vision was shown to have increased compared to 1989. The most significant observation was the decrease in childhood blindness due to ROP, owing to the early diagnosis and treatment and an increase in brain blindness due to cortical disease and disability. This has been shown in other studies and is due to increased survival of preterm neonate.

Long chain fatty acid oxidation defects in children: importance of detection and treatment options

BACKGROUND

Mitochondrial beta oxidation plays a major role in energy production. Long chain fatty acid oxidation defects include deficiency of the trifunctional protein (rare) or more commonly defects of the long chain 3-hydroxy acyl-CoA dehydrogenase enzyme (LCHAD). These long chain defects have variable presentations, they may present in the neonate or infant with sudden death, hepatopathy (Reyes disease), hypoketotic hypoglycaemia, rhabdomyolysis, myopathy, cardiomyopathy and with late complications such as peripheral neuropathy, pigmentary retinopathy, retinal degeneration and progressive visual loss. The correct diagnosis at presentation is not only life saving but also allows for the appropriate dietary and other intervention, which may have major effects on outcome.

AIM

Three case reports of patients with long chain fatty acid oxidation defects who have shown significant benefits from treatment are reported.

CONCLUSIONS

These paediatric presentations illustrate the clinical heterogeneity of long chain fatty acid oxidation defects and opportunities for effective management if correctly diagnosed.

The in vitro pharmacology of the peripherally restricted opioid receptor antagonists, alvimopan, ADL 08-0011 and methylnaltrexone

This study characterized the pharmacology of the peripherally restricted opioid receptor antagonists, alvimopan, its metabolite, ADL 08-0011, and methylnaltrexone. The activities of the compounds were investigated with respect to human or guinea pig opioid receptor binding and function in recombinant cell lines and mechanical responsiveness of the guinea pig ileum. Alvimopan and ADL 08-0011 had higher binding affinity than methylnaltrexone at human mu opioid receptors (pK (i) values of 9.6, 9.6, and 8.0, respectively). The compounds had different selectivities for the mu receptor over human delta and guinea pig kappa opioid receptors. ADL 08-0011 had the highest mu receptor selectivity. With respect to their mu opioid receptor functional activity ([(35)S]GTPgammaS incorporation), methylnaltrexone had a positive intrinsic activity, consistent with partial agonism, unlike alvimopan and ADL 08-0011, which had negative intrinsic activities. Alvimopan, ADL 08-0011, and methylnaltrexone antagonized inhibitory responses mediated by the mu opioid agonist, endomorphin-1 (pA (2) values of 9.6, 9.4, and 7.6, respectively) and by U69593, a kappa opioid agonist (pA (2) values of 8.4, 7.2, and 6.7, respectively). In morphine-naive guinea pig ileum, methylnaltrexone reduced, while alvimopan and ADL 08-0011 increased, the amplitude of electrically evoked contractions and spontaneous mechanical activity. In tissue from morphine-dependent animals, alvimopan and ADL 08-0011 increased spontaneous activity to a greater degree than methylnaltrexone. The data suggested that alvimopan-induced contractions resulted predominantly from an interaction with kappa opioid receptors. It is concluded that alvimopan, ADL 08-0011, and methylnaltrexone differ in their in vitro pharmacological properties, particularly with respect to opioid receptor subtype selectivity and intrinsic activity. The clinical significance of the data from this study remains to be determined.

A comparison of the pharmacological properties of guinea-pig and human recombinant 5-HT4 receptors

BACKGROUND AND PURPOSE

5-HT(4) receptor agonists are used therapeutically to treat disorders of reduced gastrointestinal motility. Since such compounds are evaluated in guinea-pigs, we cloned, expressed and pharmacologically characterized the guinea-pig 5-HT(4) and human 5-HT(4(b)) splice variant, which share 95% homology. The functional properties of guinea-pig 5-HT(4(b)) receptors were compared with native receptors in guinea-pig colon.

EXPERIMENTAL APPROACH

Membrane radioligand binding and whole cell cAMP accumulation assays were used to determine the affinities, potencies and intrinsic activities (IA). Contraction of the guinea-pig distal colon longitudinal muscle myenteric plexus preparation (LMMP) was monitored to evaluate functional activity.

KEY RESULTS

pK(i) values for guinea-pig and human recombinant receptors, and guinea-pig striatum 5-HT(4) receptors, were in agreement, as were the potency and IA values for guinea-pig and human 5-HT(4) receptors expressed at a similar density ( approximately 0.2 pmol mg(-1) protein). Tegaserod was a potent (pEC(50)=8.4 and 8.7, respectively), full agonist at both guinea-pig and human 5-HT(4) receptors. In contrast, in the LMMP preparation, tegaserod was a potent, partial agonist (pEC(50)=8.2; IA=66%).

CONCLUSIONS AND IMPLICATIONS

Close agreement between the pharmacological properties of guinea-pig and human 5-HT(4) receptors support the use of guinea-pig model systems for the identification of 5-HT(4) receptor therapeutics. However, the mechanisms underlying the different agonist properties of tegaserod in recombinant and isolated tissue preparations, and the extent to which these impact the clinical efficacy of tegaserod as a prokinetic agent, remain to be determined.

Taxane-resistant lymphoepithelial-like carcinoma: Excellent response to VIP chemotherapy

BACKGROUND

Lymphoepithelial-like carcinoma is a rare tumour type. The optimal treatment for this disease is not known. No effective therapies are described in the literature.

AIMS

This report describes a case of lymphoepithelial-like carcinoma and documents a therapeutic strategy which has proved effective.

RESULTS

The patient was initially treated with a common platinum-based chemotherapy regimen incorporating a taxane (Carbplatin and Docetaxel). Disease stabilization initially occurred but the patient soon progressed. The patient was then treated with VIP chemotherapy and had a complete response.

CONCLUSION

VIP chemotherapy appears to be an effective therapeutic strategy in lymphoepithelial-like carcinoma.

Long term functional and structural outcomes of laser therapy for retinopathy of prematurity

AIMS

To assess the long term functional and structural outcomes of premature babies who received diode laser photocoagulation for threshold retinopathy of prematurity (ROP).

METHODS

25 patients (43 eyes) treated with laser were recalled for assessment at a mean follow up of 11 years. A further seven patients (14 eyes) with subthreshold ROP, which had regressed spontaneously without laser treatment, were also examined. All children underwent distance acuity, near acuity, contrast sensitivity (CS), and colour vision assessments followed by a dilated fundal examination and cycloplegic autorefraction.

RESULTS

The laser treated eyes had a mean distance visual acuity of 0.37 logMAR, a mean near visual acuity of 0.39 logMAR, a mean contrast sensitivity of 1.49 log CS units, and a mean spherical equivalent of -2.10D. An unfavourable distance visual acuity outcome occurred in five eyes (13.5%). An unfavourable near visual acuity outcome was also noted in the five eyes (13.5%) with poor distance visual outcome. 7% had an unfavourable structural outcome. On comparison with the control group, there was no significant difference in near acuity, CS, refraction, or colour vision between the two groups. However, there was a statistically significant difference in terms of distance visual acuity (p = 0.03).

CONCLUSIONS

Laser treated eyes with favourable structural outcome have a good visual outcome. The results show a long term benefit from diode laser photocoagulation in preserving distance and near vision in eyes with threshold ROP.

Diode laser versus cryotherapy in treatment of ROP

Advantages of laser therapy

RetCam image analysis of optic disc morphology in premature infants and its relation to ischaemic brain injury

AIMS

To assess optic disc characteristics in premature infants with and without ischaemic brain injury and to evaluate the role of optic disc morphology in dating the injury.

METHODS

RetCam fundal images, cranial ultrasounds and magnetic resonance imaging (MRI) of 109 premature infants were analysed. The study cohort was divided into subgroups depending on the presence or absence of periventricular leucomalacia (PVL) and intraventricular haemorrhage (IVH). The control group consisted of infants with normal neuroimaging at term and 2 years of age. Using the image analysis software of the RetCam, optic disc diameter (ODD), optic disc area (ODA), and optic cup area (OCA) were measured at 33-34 weeks gestational age. As serial cranial ultrasonography had been performed, it was possible to date the brain injury in those infants with periventricular white matter (PVWM) damage.

RESULTS

Although there was a trend towards reducing ODD, ODA, and OCA with increasing severity of IVH, only the IVH 4 group differed significantly from the controls for these parameters (p = 0.002, p = 0.02, and p = 0.04, respectively). 44.4% of infants with grade 4 IVH had small discs. Only one patient had a large cup in a normal sized disc; this patient had IVH 4. In patients with PVWM damage, the median time of insult was 27 weeks in those with small discs and 28 weeks in those with normal discs. This difference was not significant (p = 0.23).

CONCLUSIONS

Premature infants with IVH 4 have an increased incidence of optic nerve hypoplasia. We found no association between disc morphology and timing of brain injury.

Ahmed valve drainage implant surgery in the management of paediatric aphakic glaucoma

BACKGROUND

Paediatric aphakic glaucoma presents months or years after cataract surgery in children and is a major long term complication. The results of surgical treatment are poor and many children require multiple and repeat procedures with poor visual outcomes.

METHODS

13 children (19 eyes) had Ahmed valve implantation surgery, nine of the children had previous procedures such as cycloablation or trabeculectomy. Mitomycin was used at surgery in some patients and valve needling with Healon GV and 5-fluorouracil in some blebs after surgery. SF(6) gas was also used at the time of surgery in most children to reform the anterior chamber.

RESULTS

12 of the children (18 eyes) achieved intraocular pressure control of 15 mm Hg or less with a valve alone or with additional medical therapy.

CONCLUSION

Ahmed valve implantation surgery alone or in combination with medical therapy is successful and safe in the management of paediatric aphakic glaucoma.

Nosocomial transmission of Mycobacterium tuberculosis in a children's hospital

An infant was admitted for evaluation of respiratory distress and tracheomalacia. After several weeks of hospitalization, both the infant and her mother were diagnosed with culture-positive pulmonary tuberculosis (TB). Sixteen pediatric patients and 293 health care workers were evaluated for exposure to Mycobacterium tuberculosis. Tuberculin skin test conversions occurred in 6.7% of patients and 1.9% of pediatric health care workers. While nosocomial transmission of TB is relatively rare in children's hospitals, this report highlights the differences between TB control efforts in pediatric vs. adult facilities, including the importance of screening the adult visitors of children admitted with suspected TB.

Guidelines for the medical management of Irish children and adolescents with Down syndrome

Down syndrome (DS) is the most common chromosomal cause of developmental disability in Ireland. Children with DS have a high incidence of associated treatable medical disorders where early intervention carries a better outcome. Currently there are no agreed protocols for the screening and management of children and adults with DS in Ireland. A cross-sectional study of 394 children and adolescents was undertaken in the Eastern Regional Health Authority (ERHA) to assess the medical needs of children and adolescents with DS, in order to develop medical management guidelines. This study provides evidence-based data that children and adolescents with DS have a high incidence of treatable medical disorders, which supports the need for the medical management guidelines presented.

A retrospective review of visual outcome and complications in the treatment of retinoblastoma

The aim of this study was to look at the visual outcome and treatment complications of children diagnosed with Retinoblastoma during the years 1985-2003 inclusive. A retrospective review of all patients records was performed. Patient characteristics, treatment methods and complications were recorded. Twenty eight children presented to Temple street Hospital between 1985-2003. Six of these infants had bilateral tumours. The mean age at presentation was 23.7 months. Sixty-nine percent presented with Leucocoria, of these 33% also had a squint. The mean duration of symptoms was only known in 58% and this figure was approximately 19.8 months. Enucleation was performed in 24 eyes of 24 patients. Three patients required adjuvant chemotherapy post enucleation. Two eyes was treated with external beam radiation and one eye with plaque radiotherapy. One eye (second eye) was treated with systemic chemotherapy and radiation. Five eyes of three patients were treated with systemic chemotherapy followed by adjuvant Argon laser, cryotherapy and diode laser to each eye.The complications of each treatment group was recorded. The visual outcome in the salvaged eyes was favourable. There were no deaths recorded. Though chemotherapy with adjuvant local treatments provide adequate treatment for early tumours, enucleation still plays a major role in the treatment of Retinoblastoma. The total eye salvage rate in this study was 29% with an enucleation rate of 90% in unilateral cases and 33% in bilateral cases. Sixty-six percent of bilateral eyes affected were salvaged. Seventy-one percent of tumours were diagnosed after a parent noticed a gross abnormality of the eye. This highlights the possible need for screening for retinoblastoma in the infant population.

Drugs driving--standardized field sobriety tests: a survey of police surgeons in Strathclyde

OBJECTIVE

To determine the opinion of police surgeons within Strathclyde Police to the proposed introduction of Standardized Field Sobriety Tests (SFSTs) in the assessment of suspect drivers.

METHOD

25 police surgeons who attended a full day training programme in respect of 'Drugs and Driving' received a questionnaire relating to the tests. Following analysis of the responses, an identical questionnaire was posted to all 101 registered police surgeons in Strathclyde, resulting in a 45% response and results compared.

RESULTS

Of the conference attendees, 54% of doctors were satisfied with the tests, while 46% expressed reservations. Each test was considered separately, however the Walk and Turn Test and the One Leg Stand Test caused the highest levels of concern from at least 50% of the doctors. POSTAL RESPONSES: 52% were satisfied with the tests, however 48% expressed concerns. Again, the Walk and Turn Test and the One Leg Stand Test were by far the tests causing most concern.

CONCLUSIONS

a significant percentage of police surgeons in Strathclyde have expressed concerns regarding the SFSTs. Irrespective of length of experience and postgraduate qualification, the tests most contentious are the Walk and Turn Test and the One Leg Stand Test.

LASIK surgery in children

AIMS

To report success in the treatment of high myopia in children with LASIK. To report the visual results, complications and postoperative management of children with high myopia.

METHODS

Six children (seven eyes) with high myopia were included in this series. Preoperative and postoperative refraction, visual acuity, and pachymetry were compared.

RESULTS

Six children with high myopia ranging from -5.00DS to -16DS were treated. There were three males and three females. Five children had improved refraction and visual acuity post-LASIK. Age ranged from 2 to 12 years. Five of the children had unilateral amblyopia preoperatively. One had bilateral high myopia.

CONCLUSION

High myopia in children may be treated safely and effectively with LASIK.

Should parents assess the interpersonal skills of doctors who treat their children? A literature review

Medical consultations in which doctors display good interpersonal skills are associated with a wide range of positive health outcomes. Obtaining the perceptions of patients, or parents in paediatric settings, regarding the interpersonal skills demonstrated by their doctors could provide feedback on doctor behaviours that influence health outcomes. It could also offer an alternative to more traditional methods of assessing interpersonal skills, such as using standardized patients. Patient perceptions of doctor interpersonal skills are most commonly obtained through patient-completed satisfaction questionnaires. A literature review was conducted with the aim of examining the potential role of parent perceptions in the evaluation of paediatric interviews. Studies identified were reviewed for information regarding the rationale for obtaining parent perceptions, the reliability and validity of measures used, the association between parent evaluations and specific doctor interview behaviours and the acceptability and feasibility of obtaining this information. Practical applications of the information obtained from parent evaluations were also sought. There was considerable support for the inclusion of patient evaluations in the assessment of the interpersonal skills of medical students and doctors. Reliable and valid measurement of patient evaluations can be obtained and patients are willing to provide this information. A clear association between specific doctor interview behaviours and parent satisfaction ratings was demonstrated. However, the important issue of feasibility and acceptability to doctors and medical students of obtaining patient perceptions of interpersonal skills, was not addressed. Patient evaluations of the interpersonal skills displayed by their doctors should be a component of clinical skills assessments. Information obtained from parents relating to the care of children could provide feedback to doctors regarding their personal interviewing style. In order to make full use of the information obtained from parents, there is a need for further study to establish the sensitivity of parent evaluations and methods to facilitate the process of obtaining this information.

Visual outcomes and complications of posterior chamber intraocular lens implantation in the first year of life

PURPOSE

To document the visual outcome and postoperative complications in infants who had congenital cataract surgery with posterior chamber intraocular lens (PC IOL) implantation in the first year of life.

SETTING

The Children's Hospital, Dublin, Ireland.

METHODS

Twenty-seven eyes of 20 infants were reviewed. Seven infants (14 eyes) had bilateral congenital cataract and 13 (13 eyes), uniocular cataract. The mean age at surgery was 4 months (range 3 weeks to 11 months). A standard surgical technique involved anterior capsulorhexis, phacoemulsification with or without posterior capsulorhexis with in-the-bag PC IOL implantation, and no anterior vitrectomy. Surgery was performed by 1 surgeon. The mean follow-up was 41 months (range 6 to 88 months).

RESULTS

The main complication was lens reproliferation into the visual axis. Of the 11 eyes that did not have a primary posterior capsulorhexis, 10 had 1 or more capsulotomies. Seven required a neodymium:YAG (Nd:YAG) laser capsulotomy a mean of 6 months postoperatively, and 2 had 2 Nd:YAG capsulotomies. Six eyes also had a surgical capsulotomy when the membrane was deemed too thick for further laser treatment. Fourteen of 25 eyes had a primary posterior capsulorhexis; 8 had no further intervention. Four eyes had persistent hyperplastic primary vitreous (PHPV), 3 required a surgical capsulotomy, 2 had an Nd:YAG laser capsulotomy, 2 had an anterior vitrectomy, and 1 developed open-angle glaucoma. There was a mean refractive shift of 6.0 diopters after a mean follow-up of 41 months, with most of the myopic shift occurring in the first 24 months.

CONCLUSIONS

Visual axis reopacification was the main complication of IOL implantation in infants, with PHPV leading to more complications and repeat procedures. Anterior vitrectomy appeared to reduce the reoperation rate. Results indicate that primary posterior capsulorhexis is important and Nd:YAG capsulotomy is not satisfactory in infants. In addition, the reduction in glaucoma with IOL implantation, if borne out over the long term, is a significant advantage in cases of congenital cataract.

Classification of the spectrum of Coats' disease as subtypes of idiopathic retinal telangiectasis with exudation

PURPOSE

An increasing variety of eponymous terms have been used to describe atypical cases of Coats' disease. A group of typical cases of Coats' disease and other cases of differing severity were classified as one of four subtypes of idiopathic retinal telangiectasis with exudation and compared with regard to clinical outcome.

METHODS

In a retrospective clinical review patients with typical and atypical Coats' disease were classified as severe, focal, juxtafoveal or associated (with another disease) forms of idiopathic retinal telangiectasis with exudation.

RESULTS

53 eyes in 50 patients were examined of which 62% (n=31) were male. 12 eyes were classified as severe (group 1), 22 focal (group 2), 12 juxtafoveal (group 3) and 7 associated (group 4). The mean age at diagnosis was lowest in group 1 eyes (6.8 years). The best visual acuity at presentation was 6/60 in group 1 whereas high proportions of eyes in the other groups had initial visual acuities of 6/24 or better. In group 1 only one eye was treated, the majority of eyes were blind or had been enucleated whereas 34 (79%) of eyes in the other groups were suitable for treatment and 29 eyes (67%) retained pre-treatment visual acuity or better at last follow-up.

CONCLUSIONS

Idiopathic retinal telangiectasis with exudation is a spectrum of disease, which is synonymous with Coats' disease. In this retrospective study eyes with severe idiopathic retinal telangiectasis with exudation corresponding to typical Coats' disease, have poorer vision at presentation, are less suitable for treatment and have worse outcomes than eyes with other subtypes. The spectrum of disease severity seen in idiopathic retinal telangiectasis with exudation may be due to second somatic mutations in genes with an existing germline mutation (the two hit theory) and a mosaic phenotype.

Temperature-modulated array high-performance liquid chromatography

Using novel monolithic poly(styrene-divinylbenzene) capillary columns with an internal diameter of 0.2 mm, we demonstrate for the first time the feasibility of constructing high-performance liquid chromatography arrays for the detection of mutations by heteroduplex analysis under partially denaturing conditions. In one embodiment, such an array can be used to analyze one sample simultaneously at different temperatures to maximize the detection of mutations in DNA fragments containing multiple discrete melting domains. Alternatively, one may inject different samples onto columns kept at the same effective temperature. Further improvements in throughput can be obtained by means of laser-induced fluorescence detection and the differential labeling of samples with up to four different fluorophores. Major advantages of monolithic capillary high-performance liquid chromatographic arrays over their capillary electrophoretic analogs are the chemical inertness of the poly(styrene-divinylbenzene) stationary phase, the physical robustness of the column bed due to its covalent linkage to the inner surface of the fused silica capillary, and the feasibility to modify the stationary phase thereby allowing the separation of compounds not only on the principle of size exclusion, but also adsorption, distribution, and ion exchange. Analyses times are on the order of a few minutes and turnaround time is extremely short as there is no need for the replenishment of the separation matrix between runs.

Two cases of hereditary optic atrophy associated with an enzymatic defect of the respiratory chain

Hereditary optic atrophy is a significant cause of optic atrophy in children. We report two male siblings who suffered profound irreversible loss of vision over a 2-month period. Neither patient had any prior ophthalmic problems. Both siblings had a metabolic disorder characterized by transient episodes of ataxia and paresis, whereas in one brother a slight increase of lactate in blood and cerebrospinal fluid was detected during an acute episode. Respiratory chain defect in complex I was confirmed in one patient.

Penetrating keratoplasty in infants

PURPOSE

To analyze graft survival and visual outcome after penetrating keratoplasty in infants with congenital corneal opacity.

METHODS

We retrospectively reviewed the records of 11 patients with congenital corneal opacity who underwent penetrating keratoplasty as infants. Six patients had a diagnosis of Peter's anomaly, 1 of congenital hereditary endothelial dystrophy, 1 of posterior polymorphous dystrophy, and 2 of sclerocornea, and in the other patient, the cause of the opacity was unknown.

RESULTS

In total, 26 penetrating keratoplasties were performed on 16 eyes of 11 infants. All patients initially underwent surgery before the age of 13 months. Five patients underwent bilateral penetrating keratoplasty, and 10 of the transplants were repeat operations on eyes that had already had at least one previously failed graft. The age of the infants at the time of first penetrating keratoplasty ranged from 2 to 56 weeks (median, 13 weeks). The graft survival time for all transplants ranged from 3 to 137 months (median, 16 months). Overall first graft survival at 12 months was 61% (95% CI, 33%-81%), with 10 of 16 eyes retaining a clear corneal graft. Peter's anomaly, lensectomy, and repeat penetrating keratoplasty were factors most highly associated with poor graft survival and a low final visual acuity.

CONCLUSION

Early penetrating keratoplasty for congenital corneal opacity may prevent deprivation amblyopia. Although this procedure carries a high risk of failure, particularly in those patients with Peter's anomaly, careful case selection, optical correction, and management of postoperative amblyopia may result in a successful visual outcome.

Long-term visual results following primary trabeculectomy for infantile glaucoma

PURPOSE

To report the long-term visual outcome of eyes that underwent primary trabeculectomy for infantile glaucoma and to evaluate factors that affect visual prognosis.

METHODS

Thirty-five eyes of 22 consecutive patients presenting between 1980 and 1995 were included. Visual acuity, visual fields and refractive status were assessed and patient records reviewed.

RESULTS

Nineteen of 22 patients (86.3%) achieved 6/12 or better, (21 of 35 eyes; 60%). Reasons for decreased vision included amblyopia (5 eyes), field loss (4 eyes), corneal opacification (2 eyes), and uncontrolled IOP (1 eye). Primary glaucoma had a better outcome than secondary glaucoma. Vision was frequently unequal despite controlled pressure, clear media and full fields in both eyes. This was associated with myopic anisometropia and apparent amblyopia. Ten patients responded to patching. Eyes with field defects were unresponsive to patching.

CONCLUSIONS

Field defects, corneal scarring, marked anisometropia and severe astigmatism result in poor vision. Anisometropic amblyopia is frequently present and responds well to patching. Visual outcome is dependent on early and sustained control of intraocular pressure and aggressive treatment of amblyopia.

Ocular findings among patients with late-diagnosed or poorly controlled homocystinuria compared with a screened, well-controlled population

INTRODUCTION

Untreated homocystinuria (HCU) leads to systemic and ocular complications preventable by early treatment.

METHODS

This study describes the ocular features in HCU patients who had late diagnosis or were noncompliant with treatment compared with a control group of early-diagnosed and well-controlled subjects.

RESULTS

Fourteen late-diagnosed HCU patients with a median age at diagnosis of 4 years (range, 1.25-28 years) were studied. Five patients were born outside of Ireland or before screening began. All 14 patients had lens subluxation or dislocation at diagnosis. Only 28.6% of eyes had 20/40 vision or better. Three patients were tested for HCU following the diagnosis in a sibling. Four patients attended ophthalmology departments for a median of 12.8 years (range, 4-23 years) prior to diagnosis of HCU; all had steadily progressive myopic astigmatism and lens subluxation. Six patients who became poorly controlled in their teens or early twenties showed significant progression of their myopia, and 3 had phacodonesis or lens subluxation develop. All eyes in this group had 20/40 vision or better. Fifteen patients who were detected in the newborn period and remained well controlled had no evidence of lens subluxation. All of the control group patients had 20/20 vision bilaterally. The difference in visual acuity between late-diagnosed patients and the control group was highly significant (P =.0002). The differences in refractive errors between the groups were also highly significant (P =.0001).

CONCLUSIONS

Lens subluxation is a principal feature of untreated HCU, yet we found a median lag period of 5.5 years in 4 cases before diagnosis. Young persons with marked and progressive myopia or idiopathic lens subluxation should be screened for HCU.

Classification, assessment, and management of childhood ptosis

Ptosis in childhood may both impair normal visual development and be cosmetically disfiguring. Ptosis may sometimes be a component part of a more extensive disorder involving the extraocular muscles, facial structures, or nervous system. Each patient must receive a thorough ocular examination, as well as careful assessment of the ptosis itself. Optimum outcome following surgical repair depends on the correct choice of operation for the specific type of ptosis and degree of levator muscle function.

Myopic and hyperopic laser in situ keratomileusis retreatments: indications, techniques, limitations, and results

PURPOSE

To assess the efficacy of myopic and hyperopic laser in situ keratomileusis (LASIK) retreatment procedures.

SETTING

Mater Private Hospital, Dublin, Ireland.

METHODS

Retreatment was defined as either lifting the previously created flap or when this was not possible, cutting a new flap. Fifty-six patients were retreated, 17 with hyperopia (Group 1) and 39 with myopia (Group 2). The mean preoperative spherical equivalent in Group 1 was +3.79 diopters (D) +/- 1.53 (SD) (range +1.75 to +8.12 D) and in Group 2, -5.46 +/- 2.87 D (range -0.38 to -15.25 D).

RESULTS

The indications for retreatment were undercorrection, decentration, epithelial ingrowth, and central island. Postoperatively, the mean spherical equivalents in Groups 1 and 2 were +1.11 +/- 2.02 D (range -1.75 to +5.50 D) and -1.02 +/- 2.20 D (range +4.75 to -9.00 D), respectively. In Group 1, the uncorrected visual acuity (UCVA) was 6/12 or better in 5.8% preoperatively and in 35% postoperatively. In Group 2, the UCVA was 6/12 or better in 5.1% preoperatively and in 59.0% postoperatively. Although 29% of the hyperopic eyes and 8% of the myopic eyes lost 1 Snellen line of best corrected visual acuity (BCVA), there was an improvement (of 1 or more lines) in BCVA in 12% and 49%, respectively. In cases that were decentered preoperatively, the postoperative optical zone ablation centration was better in 85.7% of Group 1 eyes and 61.5% of Group 2 eyes. Corneal complications following retreatment included peripheral scarring, epithelial ingrowth, Bowman's folds, and keratectasia.

CONCLUSIONS

Both myopic and hyperopic retreatments resulted in a stable refractive outcome. Myopic retreatments were superior to hyperopic retreatments in both efficacy and safety.

Medical student interviewing skills and mother-reported satisfaction and recall

BACKGROUND

Providing feedback to medical students about their interviewing skills is an important component of teaching programmes. There is very little information about mothers' views of medical student consultations in paediatrics, and in particular about what mothers consider to be the key elements of a successful consultation. Patient-centred interviewing is a model which emphasizes the active seeking of patient views. In association with appropriate clinical skills, it is reported to promote improved health outcomes.

OBJECTIVES

To examine whether greater medical student clinical competence and more frequent use of patient-centred techniques is associated with higher maternal satisfaction, higher maternal rating of the medical student's interpersonal skills, and greater maternal recall of relevant diagnosis and treatment recommendations.

METHOD

Two standardized 'medical student' videotaped interviews were created based on actual senior medical student consultations. Interview A demonstrated both higher student clinical competence and higher patient-centredness compared with interview B. Both videotaped interviews were viewed and then rated, using a questionnaire, by 11 mothers attending a teaching general practice.

RESULTS

Significantly higher mean scores, indicating greater maternal satisfaction, were associated with interview A (P < 0.01 for all measures). Accurate recall for diagnosis and management was also significantly greater after interview A (mean diagnosis recall, interview A 35%, interview B 14%, P < 0.01; mean management recall, interview A 95%, interview B 57%, P < 0.01).

CONCLUSIONS

Maternal satisfaction and recall were higher following a more clinically competent and patient-centred medical student interview. Maternal ratings of student interviews could be used as an additional method of assessment as well as providing feedback to medical students on their interview skills development.

Troglitazone improves ovulation and hirsutism in the polycystic ovary syndrome: a multicenter, double blind, placebo-controlled trial

We hypothesized that the administration of troglitazone, an insulin-sensitizing agent of the thiazolidinedione class, would improve the ovulatory dysfunction, hirsutism, hyperandrogenemia, and hyperinsulinemia of polycystic ovary syndrome (PCOS) patients. Four hundred and ten premenopausal women with PCOS in a multicenter, double blind trial were randomly assigned to 44 weeks of treatment with placebo (PBO) or troglitazone [150 mg/day (TGZ-150), 300 mg/day (TGZ-300), or 600 mg/day (TGZ-600)]. We compared changes in ovulatory function (by monitoring the urinary level of pregnanediol-3-glucuronide daily), hirsutism (by a modified Ferriman-Gallwey scoring method), hormonal levels (total and free testosterone, androstenedione, sex hormone-binding globulin, LH, FSH, and the LH/FSH ratio), and measures of glycemic parameters (fasting levels of glucose, insulin, hemoglobin A(1c), and the glucose and insulin areas under the curve during an oral glucose challenge) among study groups. Of the 410 patients recruited, 305 (74.4%) met evaluability criteria and were included in the analyses. The patients' baseline characteristics were similar across all treatment arms. Ovulatory rates were significantly greater for patients receiving TGZ-300 and TGZ-600 than for those receiving PBO (0.42 and 0.58 vs. 0.32; P < 0.05 and 0.0001, respectively). Of PCOS patients treated with TGZ-600, 57% ovulated over 50% of the time compared with 12% of placebo-treated patients. There was a significant decrease in the Ferriman-Gallwey score with TGZ-600 compared with PBO (0.22 +/- 0.53 vs. -2.21 +/- 0.49; P < 0.05, respectively). Free testosterone decreased and sex hormone-binding globulin increased in a dose-related fashion with troglitazone treatment, and all three troglitazone treatment groups were significantly different from placebo. Nearly all glycemic parameters showed dose-related decreases with troglitazone treatment. The total number and severity of adverse events (including elevations in liver enzymes) and the proportion of patients withdrawn from the study due to the development of adverse effects were similar between treatment groups. Troglitazone improves the ovulatory dysfunction, hirsutism, hyperandrogenemia, and insulin resistance of PCOS in a dose-related fashion, with a minimum of adverse effects.

An inter-university community child health clinical placement programme for medical students

BACKGROUND

Inpatient teaching no longer reflects the full spectrum of paediatric practice and community-based programmes with clearly defined aims and evaluation of learning are becoming increasingly important. Competition for community resources poses threats to the delivery of effective community child health learning programmes by individual medical schools.

OBJECTIVES

To develop and evaluate a combined inter-university, child-focused, active learning programme in community child health.

METHODS

A total of 55 postgraduate-entry medical students from the Flinders University of South Australia and 97 undergraduate-entry University of Adelaide students were placed with 25 community child health agencies and instructed to assess services from a client perspective by tracking one child and family through multiple agency contacts. Following each placement, achievement of specific programme aims was evaluated by students and agency staff using a 7-point Likert scale.

RESULTS

Students and agency staff indicated substantial achievement of programme aims. Mean agency ratings were significantly higher than student ratings for three aims: students' experiencing a wider spectrum of health care problems than in teaching hospitals (5.7 +/- 1.5 versus 4.9 +/- 1.6, P < 0.001); the importance of social and environmental factors (5.9 +/- 1.0 versus 5.2 +/- 1.4, P < 0.001), and the importance of coordinating care (6.0 +/- 1.0 versus 5.2 +/- 1.2, P < 0.001). Ratings from undergraduate-entry students differed from those of postgraduate-entry students only with respect to the importance of social and environmental factors (4.8 +/- 1.4 versus 5.7 +/- 1.1, P < 0.001).

CONCLUSIONS

The new collaborative Community Child Health Programme substantially achieved learning aims and demonstrated effective integration of postgraduate- and undergraduate-entry medical students from two universities.

A method for parallel, automated, thermal cycling of submicroliter samples

A large fraction of the cost of DNA sequencing and other DNA-analysis processes results from the reagent costs incurred during cycle sequencing or PCR. In particular, the high cost of the enzymes and dyes used in these processes often results in thermal cycling costs exceeding $0.50 per sample. In the case of high-throughput DNA sequencing, this is a significant and unnecessary expense. Improved detection efficiency of new sequencing instrumentation allows the reaction volumes for cycle sequencing to be scaled down to one-tenth of presently used volumes, resulting in at least a 10-fold decrease in the cost of this process. However, commercially available thermal cyclers and automated reaction setup devices have inherent design limitations which make handling volumes of <1 microL extremely difficult. In this paper, we describe a method for thermal cycling aimed at reliable, automated cycling of submicroliter reaction volumes.

Ocular significance of intraventricular haemorrhage in premature infants

AIM

To document ocular outcome in premature infants with intraventricular haemorrhages (IVH).

METHODS

68 preterm infants with IVH were examined.

RESULTS

Mean gestational age was 28.1 weeks (range 24-35). Mean birth weight was 1045.9 g (630-2240). Mean follow up was 54.6 months (6-150). IVH is graded from 1 to 4 based on the severity of haemorrhages. The incidence of ocular abnormalities was compared between low grade IVH (grade 1 and 2) and high grade IVH (grade 3 and 4). Of the 68 infants with IVH, ROP occurred in 33 infants (48.5%); 13 (43.3%) had low grade IVH; 20 (52.6%) had high grade IVH. Strabismus developed in 30 infants (44.1%); 14 (46.6%) had low grade IVH; 16 (42.1%) had high grade IVH. Infants with high grade IVH were at significant greater risk than infants with low grade IVH for the development of optic atrophy (31.5% v 16.6%), hydrocephalus (57.8% v 10%).

CONCLUSION

This study highlights the serious significance of all grades of IVH with the higher incidence of optic atrophy and hydrocephalus with high grade IVH.