Predicting gout flares in people starting allopurinol using the start-low go-slow dose escalation strategy

OBJECTIVE

To determine predictors of gout flare when commencing allopurinol using the "start-low go-slow" dose escalation strategy.

METHODS

A post hoc analysis of a 12 month double-blind placebo-controlled non-inferiority trial with participants randomised 1:1 to colchicine 0.5mg daily or placebo for the first six months was undertaken. Multivariate logistic regression models were used to identify independent predictors of gout flares in the first and last six months of the trial.

RESULTS

Multivariable analysis revealed a significant association between risk of a gout flare in the first six months and flare in the month prior to starting allopurinol (odds ratio (OR) (95% confidence interval (CI)) 2.65 (1.36-5.17)) and allopurinol 100mg starting dose (OR (95% CI) 3.21 (1.41-7.27)). The predictors of any gout flares in the last six months of the trial, after stopping colchicine or placebo, were having received colchicine (OR (95% CI) 2.95 (1.48-5.86)), at least one flare in the month prior to stopping study drug (OR (95% CI) 5.39 (2.21-13.15)), and serum urate ≥0.36mmol/L at month 6 (OR (95% CI) 2.85 (1.14-7.12)).

CONCLUSIONS

Anti-inflammatory prophylaxis when starting allopurinol using the "start-low go-slow" dose escalation strategy may be best targeted at those who have had a gout flare in the month prior to starting allopurinol and are commencing allopurinol 100mg daily. For those with ongoing gout flares during the first six months of starting allopurinol who have not yet achieved serum urate target, a longer period of prophylaxis may be required.

Imaging in international sporting event: experience from the Birmingham Commonwealth Games 2022

AIM

To explain the design and delivery of diagnostic imaging and image-guided intervention services for an international games. The authors share their experiences from the Birmingham Commonwealth Games 2022.

MATERIALS AND METHODS

A retrospective analysis was undertaken of anonymised data from the Zillion, Easyvision (RIS and PACS), and Encounter platforms for image viewing, interpretation and reporting during the Games. The data collected included age and gender, type of sport, nature of the injury, and imaging findings with diagnoses.

RESULTS

The number of individuals who had radiological investigations at the Birmingham Commonwealth Games was 518 and the vast majority of them were athletes (90 %). The average age of athletes who had imaging was 28 years and that of non-athletes who accessed imaging services was 46.4 years with male predominance. Magnetic resonance imaging was the most frequently used imaging technique and the lower limb was the most frequently imaged body part. Athletes playing netball and beach volleyball had the highest percentage of injuries.

CONCLUSION

The authors share their experience from the Birmingham Commonwealth Games 2022 regarding the nuances and challenges in radiology service provision for an international sports event that would be helpful for musculoskeletal radiologists in the design and delivery of similar international events in the future.

The Prevalence, Magnitude, and Reversibility of Elevated Liver Enzyme Activities in Hyperthyroid Cats Presenting for Iodine-131 Treatment

Objectives

The primary objective of this study was to report the prevalence and magnitude of elevated liver enzyme activity in feline hyperthyroidism using a large cohort of cats presenting for iodine-131 treatment. The secondary objective was to determine if elevated liver enzyme activity was a reversible process following successful iodine-131 treatment.

Methods

Cases that presented for a single iodine-131 treatment were retrospectively reviewed. Short-term and long-term follow-up clinicopathologic data was then reviewed for the secondary objective.

Results

Two hundred seventeen hyperthyroid cats met the inclusion criteria for the primary objective. In total, 123/217 (56.7%) of the cats had at least one liver enzyme elevation on their chemistry panel, with alanine transaminase activity being the most common. All cats who were successfully treated with iodine-131 had liver enzyme activity within the reference range at short-term follow-up and long-term follow-up points.

Conclusion and Relevance

Our study demonstrates that elevated liver values are common in cats presenting for iodine-131 treatment. Additionally, our study demonstrates that even when liver values are markedly elevated prior to treatment, the liver enzyme activity will return to normal after successful resolution of hyperthyroidism using iodine-131 treatment. Investigation into hepatobiliary disease and liver function tests for cats with a diagnosis of hyperthyroidism may be unnecessary as the liver values will likely return to normal with successful iodine-131 treatment.

"There Is No (Where a) Face Like Home": Recognition and Appraisal Responses to Masked Facial Dialects of Emotion in Four Different National Cultures

The theory of universal emotions suggests that certain emotions such as fear, anger, disgust, sadness, surprise and happiness can be encountered cross-culturally. These emotions are expressed using specific facial movements that enable human communication. More recently, theoretical and empirical models have been used to propose that universal emotions could be expressed via discretely different facial movements in different cultures due to the non-convergent social evolution that takes place in different geographical areas. This has prompted the consideration that own-culture emotional faces have distinct evolutionary important sociobiological value and can be processed automatically, and without conscious awareness. In this paper, we tested this hypothesis using backward masking. We showed, in two different experiments per country of origin, to participants in Britain, Chile, New Zealand and Singapore, backward masked own and other-culture emotional faces. We assessed detection and recognition performance, and self-reports for emotionality and familiarity. We presented thorough cross-cultural experimental evidence that when using Bayesian assessment of non-parametric receiver operating characteristics and hit-versus-miss detection and recognition response analyses, masked faces showing own cultural dialects of emotion were rated higher for emotionality and familiarity compared to other-culture emotional faces and that this effect involved conscious awareness.

Adjusted calcium concentration as a predictor of ionized hypocalcemia in hypoalbuminemic dogs

Background

Ionized calcium (iCa) is the biologically active fraction of total calcium (tCa) with clinical relevance to evaluate calcium homeostasis, but not all primary veterinarians have access to serum iCa. Formulas that adjust tCa to correct for variability in serum protein concentrations were not designed to predict iCa and are considered unreliable surrogates for iCa.

Objectives

To determine whether adjusted calcium concentration (aCa) can predict ionized hypocalcemia in hypoalbuminemic dogs without hyperphosphatemia.

Animals

A total of 262 hypoalbuminemic dogs without hyperphosphatemia.

Methods

Retrospective review of paired tCa and iCa. Patients were included if serum albumin concentration was ≤2.5 g/L and serum phosphorus concentration was ≤5 mg/dL. The aCa was calculated using tCa (mg/dL) − serum albumin concentration (g/dL) + 3.5 (g/dL). Sensitivity, specificity, positive (PPVs) and negative (NPVs) predictive values, and accuracy were determined for tCa and aCa at predicting any (<1.13 mmol/L) and moderate (<1.02 mmol/L) ionized hypocalcemia. Patients also were stratified into mild‐to‐moderate (2.0‐2.5 g/dL) and severe hypoalbuminemia (<2.0 g/dL).

Results

A total of 4296 dogs had paired results of which 262 met the inclusion criteria. Of these, 35 (13.4%) dogs had iCa < 1.13 mmol/L and 13 dogs (5.0%) had concentrations <1.02 mmol/L. The sensitivity, specificity, NPVs and PPVs of a decreased tCa and aCa for detecting moderate ionized hypocalcemia were 100% and 92.3%, 57.8% and 94.8%, 100% and 99.6%, and 11.0% and 48.2%, respectively, and accuracy was 60.0% and 94.7%, respectively.

Conclusions

A low aCa was useful to detect ionized hypocalcemia in hypoalbuminemic nonhyperphosphatemic dogs. A normal aCa indicated that moderate ionized hypocalcemia was unlikely.

Synthesis, characterisation and thermo-physical properties of highly stable graphene oxide-based aqueous nanofluids for potential low-temperature direct absorption solar applications

Two types of highly stable 0.1% graphene oxide-based aqueous nanofluids were synthesised and investigated. The first nanofluid (GO) was prepared under the influence of ultrasonic irradiation without surfactant. The second nanofluid was treated with tetra ethyl ammonium hydroxide to reduce the graphene oxide to form reduced graphene oxide (RGO) during ultrasonic irradiation. The GO and RGO powders were characterised by various techniques such as field emission scanning electron microscopy, transmission electron microscopy, X-ray diffraction and Raman. Also UV–visible absorption spectroscopy was carried out and band gap energies were determined. Optical band gap energies for indirect transitions ranged from 3.4 to 4.4 eV and for direct transitions they ranged between 2.2 and 3.7 eV. Thermal conductivity measurements of the GO-based aqueous nanofluid revealed an enhancement of 9.5% at 40 °C compared to pure water, while the RGO-based aqueous nanofluid at 40 °C had a value 9.23% lower than pure water. Furthermore, the photothermal response of the RGO-based aqueous nanofluid had a temperature increase of 13.5 °C, (enhancement of 60.2%) compared to pure water, the GO-based aqueous nanofluid only displayed a temperature rise of 10.9 °C, (enhancement of 46.6%) after 20 min exposure to a solar irradiance of 1000 W m⁻². Both nanofluid types displayed good long-term stability, with the GO-based aqueous nanofluid having a zeta potential of 30.3 mV and the RGO-based aqueous nanofluid having a value of 47.6 mV after 6 months. The good dispersion stability and photothermal performance makes both nanofluid types very promising working fluids for low-temperature direct absorption solar collectors.

Individual conscious and unconscious perception of emotion: Theory, methodology and applications

In this manuscript we review a seminal debate related to subliminality and concerning the relationship of consciousness, unconsciousness, and perception. We present the methodological implementations that contemporary psychology introduced to explore this relationship, such as the application of unbiased self-report metrics and Bayesian analyses for assessing detection and discrimination. We present evidence concerning an unaddressed issue, namely, that different participants and stimulus types require different thresholds for subliminal presentation. We proceed to a step-by-step experimental illustration of a method involving individual thresholds for the presentation of masked emotional faces. We show that individual thresholds provide Bayesian evidence for null responses to the presented faces. Conversely, we show in the same database that when applying established but biased non-individual criteria for subliminality physiological changes occur and relate - correctly, and most importantly incorrectly - to perception concerning the emotional type, and the valence and intensity of a presented masked emotional face.

SULFUR DISPERSION QUANTITATIVE ANALYSIS IN ELASTOMERIC TIRE FORMULATIONS BY USING HIGH RESOLUTION X-RAY COMPUTED TOMOGRAPHY

Good dispersion of compounded ingredients in a rubber formulation is important for mechanical performance. After mixing, certain materials can remain undispersed within the rubber matrix, which could lead to critical flaws, influencing performance according to the Griffith failure criteria. High resolution X-ray computed tomography (XCT) offers a unique opportunity to measure phase domain size and distributions. Fillers such as carbon black or silica can be differentiated from sulfur or zinc oxide, providing an opportunity to determine dispersion characteristics of the various phases. The XCT technique has become an important characterization tool for three-dimensional and higher dimension material science due to the availability of polychromatic micro-focus X-ray sources and efficient high spatial resolution detectors with superior scintillators. High resolution XCT provides very rich data quantifying mixing efficiency of particulates in a matrix, such as insoluble sulfur or silica particles in rubber. Imaging with X-rays provides attenuation, phase, or scattering contrast and will prove to be a critical method for evaluating the field of rubber crosslinking, considering realistic environments in situ. This paper highlights methodology development and validation and provides insight on the dispersion of polymeric (insoluble) sulfur in rubber formulations. Dispersion assessment is compared using three techniques: high resolution XCT, population survival analysis in tensile testing, and optical microscopy.

The effect of a secondary task on drivers' gap acceptance and situational awareness at junctions

The current studies explored the roles of the visuospatial and phonological working memory subsystems on drivers' gap acceptance and memory for approaching vehicles at junctions. Drivers' behaviour was measured in a high-fidelity driving simulator when at a junction, with, and without a visuospatial or phonological load. When asked to judge when to advance across the junction, gap acceptance thresholds, memory for vehicles and eye movements were not different when there was a secondary task compared to control. However, drivers' secondary task performance was more impaired in the visuospatial than phonological domain. These findings suggest that drivers were able to accept impairment in the secondary task while maintaining appropriate safety margins and situational awareness. These findings can inform the development of in-car technologies, improving the safety of road users at junctions. Practitioner summary: Despite research indicating that concurrent performance on working memory tasks impairs driving, a matched visuospatial or phonological memory load did not change drivers' gap acceptance or situational awareness at junctions. Drivers displayed appropriate compensatory behaviour by prioritising the driving task over the visuospatial secondary task. Abbreviations: ROW: right of way; RIG: random time interval generation.

Evaluating the impact of Heavy Goods Vehicle driver monitoring and coaching to reduce risky behaviour

Determining the impact of driver-monitoring technologies to improve risky driving behaviours allows stakeholders to understand which aspects of onboard sensors and feedback need enhancement to promote road safety and education. This study investigates the influence of camera monitoring on Heavy Goods Vehicle (HGV) drivers' risky behaviours. We also assess whether monitoring affects individual driving events further when coupled with safe driving practices coaching. We evaluate the outcome of those practices on three telematics incidents heavily reliant on driving errors and violations, i.e., the number of vehicle harsh braking, harsh cornering and over speeding incidents. The objective is to understand how frequently individual incidents caused by risky driving behaviour occur (a) without camera monitoring and without any coaching; (b) after camera installation; and (c) after camera installation and coaching. We investigate two commercial HGV companies (Company 1 and Company 2) with 263 and 269 vehicles, respectively, over a 16 months period, from which the first 8 months contain data collected before the installation of cameras (baseline) and the rest of the dataset contains incident counts after the installation of cameras (intervention). Company 1 provides coaching during the intervention phase while Company 2 does not offer coaching. Our analysis considers the baseline and the intervention phases during the same seasons to eliminate any possible bias due to the influence of weather on driving behaviour. Results show an overall significant reduction in the mean frequency of harsh braking incidents from baseline to intervention by 16.82% in Company 1 and 4.62% in Company 2, and a significant reduction in the mean frequency of over speeding incidents from baseline to intervention by 34.29% in Company 1 and 28.13% in Company 2. Furthermore, the effect of coaching has a significant difference in reducing the frequency of harsh braking (p = .011) and harsh cornering (p < .001) compared to just camera monitoring. These results suggest that coaching interventions are more effective in reducing driving errors while monitoring reduces both driving errors and violations.

Lack of effect of tart cherry concentrate dose on serum urate in people with gout

OBJECTIVES

Cherry concentrate has been suggested to reduce serum urate (SU) and gout flares. The aims of this study were to determine the magnitude of the effect of tart cherry concentrate on SU in people with gout, the most effective dose of tart cherry concentrate for lowering SU, and adverse effects.

METHODS

Fifty people with gout and SU > 0.36 mmol/l were recruited. Half were on allopurinol and half were on no urate-lowering therapy. Participants were randomized to receive tart cherry juice concentrate: placebo, 7.5 ml, 15 ml, 22.5 ml or 30 ml twice daily for 28 days. Blood samples were taken at baseline, then at 1, 3 and 5 h post cherry and then on days 1, 3, 7, 14, 21 and 28. The area under the curve for SU was calculated over the 28-day study period.

RESULTS

Cherry concentrate dose had no significant effect on reduction in SU area under the curve, urine urate excretion, change in urinary anthocyanin between day 0 and day 28, or frequency of gout flares over the 28-day study period (P = 0.76). There were 24 reported adverse events, with only one (hyperglycaemia) considered possibly to be related to cherry concentrate. Allopurinol use did not modify the effect of cherry on SU or urine urate excretion.

CONCLUSION

Tart cherry concentrate had no effect on SU or urine urate excretion. If there is an effect of cherry concentrate on gout flares over a longer time period, it is not likely to be mediated by reduction in SU.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTR), https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368887, ANZCTR 12615000741583).

"The Harder One Tries …": Findings and Insights From the Application of Covert Response Pressure Assessment Technology in Three Studies of Visual Perception

In this article, we present a force measuring method for assessing participant responses in studies of visual perception. We present a device disguised as a mouse pad and designed to measure mouse-click-pressure and click-press-to-release-time responses by unaware, as regards to the physiological assessment, participants. The aim of the current technology, in the current studies, was to provide a physiological assessment of confidence and task difficulty. We tested the device in three experiments. The studies comprised of a gender-recognition study using morphed male and female faces, a visual suppression study using backwards masking, and a target-search study that included deciding whether a letter was repeated in a subsequently presented letter string. Across all studies, higher task difficulty was associated with higher click-release-time responses. Higher task difficulty was, intriguingly, also associated with lower click pressure. Higher confidence ratings were consistently associated with higher click pressure and shorter click-release time across all experiments. These findings suggest that the current technology can be used to assess responses relating to task difficulty and participant confidence in studies of visual perception. We suggest that the assessment of release times can also be implemented using standard equipment, and we provide manual and easy-to-use code for the implementation.

How does drivers' visual search change as a function of experience? A systematic review and meta-analysis

Novice drivers are statistically over-represented in reported road crashes, with recent evidence suggesting that some of this increased crash involvement may be a result of limitations in their cognitive processing. Such processing has typically been measured by recording drivers' patterns of eye movements, however, the exact ways in which eye movements are reported and interpreted varies substantially between different studies in the literature. Therefore, the objective of this systematic review was to investigate whether novice drivers and experienced drivers do differ in clear and reproducible ways in their visual search. Studies were identified through searches of Web of Science, Medline, TRID Database, and the TRB Research in Progress Database, with no restrictions on publication status. Studies were included if they compared the visual search of a novice driver group (<3 years driving experience) and an experienced driver group (>3 years driving experience) using an eye tracking method and reported at least one of the following four visual search outcomes: fixation durations, horizontal spread of search, vertical spread of search and number of fixations. Two reviewers independently screened searches and assessed the full texts of potentially included studies. Of the 235 studies initially identified 18 were included in the review, with 13 studies reporting sufficient data to be included in the meta-analysis for at least one outcome measure. Given that the included studies deployed a range of method types, additional sub-group analyses were conducted using this factor. Sensitivity analyses were also conducted by temporarily removing extreme experience groups (e.g. driving instructors and learner drivers) in order to test the effect of different levels of experience and training. The meta-analyses, along with support from results discussed narratively, revealed that novice drivers have a narrower horizontal spread of search compared to experienced drivers, however, there were no overall differences in fixation durations, vertical spread of search or number of fixations when the studies were pooled together. These findings have important primary implications for the development of novice training interventions, with novice drivers needing to develop a broader horizontal spread of visual search, but not to necessarily learn to fixate further down the road. Subgroup analyses also provided considerations for future research studies in terms of the experience of the driver groups, and the method type used.

Comparing drivers' visual attention at Junctions in Real and Simulated Environments

Driving simulation is widely used to answer important applied research questions, however, it is vital for specific driving tasks to undergo appropriate behavioural validation testing. Many previous validation studies have used simple driving tasks and measured relatively low-level vehicle control. The purpose of the current study was to investigate whether drivers' visual attention at intersections with different levels of demand, are similar in the simulator and on the road. Unlike simpler driving tasks, crossing intersections requires complex interactions with other vehicles governed by sequences of head and eye movements that may not be accurately captured in a simulated environment. In the current study we directly compare performance at simulated junctions with the same participants' behaviour in a real car. We compared drivers' visual attention in a high-fidelity driving simulator (instrumented car, 360-degree screen) and on-road in both low and medium demand driving situations. The low and medium demand driving situations involved the same motor movements, containing straight on, right turn and left turn manoeuvres. The low demand situations were controlled by the road environment and traffic lights, whereas medium demand situations required the driver to scan the environment and decide when it was safe to pull out into the junction. Natural junctions in Nottingham were used for the on-road phase and the same junctions were recreated in the simulator with traffic levels matched to those that were encountered on the real roads. The frequency and size of drivers' head movements were not significantly different between manoeuvres performed in the simulator and those conducted when driving on real roads. This suggests that drivers' broad search strategies in the simulator are representative of real-world driving. These strategies did change as a function of task demand - compared to low demand situations, behaviour at the medium demand junctions was characterised by longer junction crossing times, more head movements, shorter fixation durations and larger saccadic amplitudes. Although patterns of head movements were equivalent on road and in the simulator, there were differences in more fine-grained measures of eye-movements. Mean fixation durations were longer in the simulator compared to on-road, particularly in low-demand situations. We interpret this as evidence for lower levels of visual engagement with the simulated environment compared to the real world, at least when the task demands are low. These results have important implications for driving research. They suggest that high fidelity driving simulators can be useful tools for investigating drivers' visual attention at junctions, particularly when the driving task is of at least moderate demand.

The 'Saw but Forgot' error: A role for short-term memory failures in understanding junction crashes?

Motorcyclists are involved in an exceptionally high number of crashes for the distance they travel, with one of the most common incidents being where another road user pulls out into the path of an oncoming motorcycle frequently resulting in a fatal collision. These instances have previously been interpreted as failures of visual attention, sometimes termed 'Look but Fail to See' (LBFTS) crashes, and interventions have focused on improving drivers' visual scanning and motorcycles' visibility. Here we show from a series of three experiments in a high-fidelity driving simulator, that when drivers' visual attention towards and memory for approaching vehicles is experimentally tested, drivers fail to report approaching motorcycles on between 13% and 18% of occasions. This happens even when the driver is pulling out into a safety-critical gap in front of the motorcycle, and often happens despite the driver having directly fixated on the oncoming vehicle. These failures in reporting a critical vehicle were not associated with how long the driver looked at the vehicle for, but were associated with drivers' subsequent visual search and the time that elapsed between fixating on the oncoming vehicle and pulling out of the junction. Here, we raise the possibility that interference in short-term memory might prevent drivers holding important visual information during these complex manoeuvres. This explanation suggests that some junction crashes on real roads that have been attributed to LBFTS errors may have been misclassified and might instead be the result of 'Saw but Forgot' (SBF) errors. We provide a framework for understanding the role of short-term memory in such situations, the Perceive Retain Choose (PRC) model, as well as novel predictions and proposals for practical interventions that may prevent this type of crash in the future.

Beauty Is in the Eye of the Beholder: The Appraisal of Facial Attractiveness and Its Relation to Conscious Awareness

Previous research suggests that facial attractiveness relies on features such as symmetry, averageness and above-average sexual dimorphic characteristics. Due to the evolutionary and sociobiological value of these characteristics, it has been suggested that attractiveness can be processed in the absence of conscious awareness. This raises the possibility that attractiveness can also be appraised without conscious awareness. In this study, we addressed this hypothesis. We presented neutral and emotional faces that were rated high, medium and low for attractiveness during a pilot experimental stage. We presented these faces for 33.33 ms with backwards masking to a black and white pattern for 116.67 ms and measured face-detection and emotion-discrimination performance, and attractiveness ratings. We found that high-attractiveness faces were detected and discriminated more accurately and rated higher for attractiveness compared with other appearance types. A Bayesian analysis of signal detection performance indicated that faces were not processed significantly at-chance. Further assessment revealed that correct detection (hits) of a presented face was a necessary condition for reporting higher ratings for high-attractiveness faces. These findings suggest that the appraisal of attractiveness requires conscious awareness.

1-year outcomes of the Xen45 glaucoma implant

OBJECTIVES

To describe the 12-month outcomes of the Xen45 glaucoma stent.

METHODS

Non-comparative retrospective study of all cases who underwent Xen glaucoma surgery in April 2017 or earlier and completed 12 months of follow-up. The primary outcome measures were intraocular pressure (IOP) reduction and number of glaucoma medications at 12 months postoperatively. The secondary outcome measures were surgical complications and the success rate of surgery at 1 year. Success rate was defined according to the multiple IOP thresholds of 15 mmHg, 18 mmHg, and 21 mmHg with all requiring a drop of 20% and no additional glaucoma surgery. Revision or needling of the Xen conjunctival bleb was not considered to constitute a surgical failure.

RESULTS

Sixty-eight eyes were included in the study. Mean IOP dropped from 22.1 mmHg preoperatively to 14.8 mmHg at 12 months, a 33% drop (p < 0.0001). Mean number of glaucoma medications reduced from 2.9 preoperatively to 1.1 at 12 months (p < 0.0001). In total, 54.4% of cases were back on glaucoma medications by 12 months. Success rate varied from 32.4% when defined as IOP ≤ 15 mmHg and ≥ 6 mmHg and ≥ 20% reduction without medications to 70.6% when defined as IOP ≤ 21 mmHg and ≥ 6 mmHg and ≥ 20% reduction with or without medications. Thirty cases (44.1%) required bleb needling or surgical revision.

CONCLUSIONS

The Xen45 is effective at reducing IOP and glaucoma medication use at 12 months postoperatively. Patients considering this procedure should be warned that by 12 months postoperatively there is a significant chance of requiring postoperative bleb intervention and glaucoma drops.

Drivers' Visual Search Behavior Toward Vulnerable Road Users at Junctions as a Function of Cycling Experience

OBJECTIVES

The current study investigated the behavior and visual attention of two groups of drivers with differing pedal cycling experience (pedal cyclists and nonpedal cyclists) towards vulnerable road users at junctions in a driving simulator.

BACKGROUND

Pedal cyclists and motorcyclists are involved in a disproportionate number of crashes given the distance they travel, with a high proportion of these crashes occurring at junctions. Many studies have found that car drivers who also hold a motorcycle license have increased awareness towards motorcycles.

METHODS

The task involved approaching a T-junction and turning right when it was deemed to be safe. In Study 1, the junction was controlled by a give way sign, and in Study 2, the junction was controlled by a stop sign. Each T-junction contained a target vehicle (car, motorcycle, or pedal cycle), approaching from a near, medium, or far distance from the junction.

RESULTS

Participants did not look at pedal cycles approaching from a far distance for as long as they looked at approaching motorcycles and cars, despite all vehicles travelling at identical speeds. No differences were found between pedal cyclists and nonpedal cyclists on any visual attention measures, indicating that pedal cycling experience was not associated with differences in drivers' attention toward pedal cycles.

CONCLUSIONS

Findings have implications for road safety, demonstrating subtle differences in drivers' everyday visual attention toward differing vehicle types.

APPLICATIONS

This research has the potential to inform the development of in-car technical assistive systems, improving the safety of vulnerable road users at junctions.

Mental workload is reflected in driver behaviour, physiology, eye movements and prefrontal cortex activation

Mental workload is an important factor during driving, as both high and low levels may result in driver error. This research examined the mental workload of drivers caused by changes in road environment and how such changes impact upon behaviour, physiological responses, eye movements and brain activity. The experiment used functional near infrared spectroscopy to record prefrontal cortex activation associated with changes in mental workload during simulated driving. Increases in subjective ratings of mental workload caused by changes in road type were accompanied by increases in skin conductance, acceleration signatures and horizontal spread of search. Such changes were also associated with increases in the concentration of oxygenated haemoglobin in the prefrontal cortex. Mental workload fluctuates during driving. Such changes can be identified using a range of measures which could be used to inform the development of in-vehicle devices and partially autonomous systems.

Comparing car drivers' and motorcyclists' opinions about junction crashes

Motorcyclists are involved in a disproportionate number of crashes given the distance they travel, with a high proportion of these crashes occurring at junctions. Despite car drivers being solely responsible for many road crashes involving a motorcycle, previous research has mostly focussed on understanding motorcyclists' attitudes towards their own safety. We compared car drivers' (n = 102) and motorcyclists' (n = 579) opinions about junction crashes using a web-based questionnaire. Motorcyclists and car drivers were recruited in similar ways so that responses could be directly compared, accessing respondents through driver/rider forums and on social media. Car drivers' and motorcyclists' opinions were compared in relation to who they believe to be blameworthy in situations which varied in specificity, ranging from what road user they believe is most likely to cause a motorcyclist to have a road crash, to what road user is at fault in four specific scenarios involving a car and motorcycle at a junction. Two of these scenarios represented typical 'Right of way' (ROW) crashes with a motorcycle approaching from the left and right, and two scenarios involved a motorcycle overtaking another vehicle at the junction, known as 'Motorcycle Manoeuvrability Accidents' (MMA). Qualitative responses were analysed using LIWC software to detect objective differences in car drivers' and motorcyclists' language. Car drivers' and motorcyclists' opinions about the blameworthiness of accidents changed depending on how specific the situation was that was being presented. When respondents were asked about the cause of motorcycle crashes in a general abstract sense, car drivers' and motorcyclists' responses significantly differed, with motorcyclists more likely to blame car drivers, demonstrating an in-group bias. However, this in-group favouritism was reduced when asked about specific scenarios, especially in MMA situations which involve motorcyclists manoeuvring their motorcycles around cars at a junction. In the four specific scenarios, car drivers were more likely to blame the car driver, and motorcyclists were more likely to blame the motorcyclist. In the typical ROW scenarios, the responses given by both road users, as analysed by the LIWC, show that the law is taken into account, as well as a large emphasis on the lack of observation given around junctions, especially from car drivers. It is concluded that the perception of blameworthiness in crashes is very much dependent on the details of the crash, with a more specific situation eliciting a fairer evaluation by both car drivers and motorcyclists.

Skin Conductance Responses to Masked Emotional Faces Are Modulated by Hit Rate but Not Signal Detection Theory Adjustments for Subjective Differences in the Detection Threshold

The biological preparedness model suggests that survival-related visual cues elicit physiological changes without awareness to enable us to respond to our environment. Previous studies have reported some evidence for this effect. In the current article, we argue that this evidence is subject to methodological confounds. These include the use of a universal masked presentation threshold, the employment of hit rates (HRs) to measure meta-awareness, and the assertion of overall guess-level target detection using nonsignificance. In the current report, we address these issues and test whether masked emotional faces can elicit changes in physiology. We present participants with subjectively adjusted masked angry, fearful, happy, and neutral faces using HRs and signal detection theory. We assess detection performance using a strict Bayesian criterion for meta-awareness. Our findings reveal that HR adjustments in the detection threshold allow higher skin conductance responses to happy, fearful, and angry faces, but that this effect could not be reported by the same participants when the adjustments were made using signal detection measures. Combined these findings suggest that very brief biologically relevant stimuli can elicit physiological changes but cast doubt to the extent that this effect can occur in response to truly unconscious emotional faces.

Changes in clinical disease activity are weakly linked to changes in MRI inflammation on treat-to-target escalation of therapy in rheumatoid arthritis

Background

Rheumatoid arthritis (RA) treat-to-target (T2T) regimens often use the disease activity score (28 joints) incorporating C-reactive protein (DAS28_CRP) as an outcome measure. We compared changes in the DAS28_CRP with changes in magnetic resonance imaging (MRI) inflammation on treatment escalation.

Methods

Eighty seropositive RA patients with active disease were enrolled. Group A (N = 57) escalated to another conventional disease-modifying therapy (cDMARD) combination, and Group B (N = 23) to anti-TNF therapy/cDMARDs. Contrast-enhanced 3T-MRI wrist scans were obtained before and 4 months after regimen change. Scan pairs were scored for inflammation (MRI(i)) and damage. Disease activity was assessed using the DAS28_CRP.

Results

Eighty patients were enrolled and 66 MRI scan pairs were available for analysis. Intra-reader reliability was high: intraclass correlation coefficient (average) 0.89 (0.56–0.97). ΔDAS28_CRP did not differ between groups: Group A, −0.94 (−3.30, 1.61); Group B, −1.53 (−3.59, 0.56) (p = 0.45). ΔMRI(i) also did not differ: Group A, 0 (−25, 10); Group B, −1 (−15, 28) (p = 0.12). Combining groups, ΔMRI(i) correlated weakly with ΔDAS28_CRP (Spearman’s 0.36, p = 0.003). Using multiple linear regression analysis adjusting for confounders, ΔDAS28_CRP was associated with ΔMRI(i) (p = 0.056). Of the individual MRI measures, only Δtenosynovitis correlated with ΔDAS28_CRP (Spearman’s 0.33, p = 0.007). ΔMRI(i) was negatively associated with the MRI erosion score at entry (p = 0.0052).

Conclusions

We report the first study investigating the link between changes in clinical and imaging inflammation in a real-world RA cohort escalating to conventional and biologic DMARDs. The association was significant but relatively weak, suggesting that MRI targets cannot yet be advocated as outcomes for T2T escalation.

Trial registration

ANZCTR 12614000895684. Registered 22 August 2014.

Rates of Joint Replacement Surgery in New Zealand, 1999-2015: A Comparison of Rheumatoid Arthritis and Osteoarthritis

OBJECTIVE

To determine rates of joint replacement for people with rheumatoid arthritis (RA) and osteoarthritis (OA) and to examine the characteristics of those receiving elbow replacements.

METHODS

Data were extracted from the New Zealand Joint Registry from 1999 to 2015 and annual rates calculated.

RESULTS

Rates of joint replacement increased over time for OA but not RA. Elbow replacement was the only procedure performed more commonly in RA.

CONCLUSION

There has been a substantial increase in joint replacement for OA in New Zealand. For RA, where access to biologics has been limited to those with erosions, joint replacement rates have not declined, with the exception of elbow replacements.

More for less: Analysis of the performance of avian acute oral guideline OECD 223 from empirical data

Since the publication of the Organisation for Economic Co-operation and Development (OECD) avian acute oral guideline, OECD 223, empirical data have become available to compare the performance of OECD 223 with statistical simulations used to validate this guideline and with empirical data for US Environmental Protection Agency Office of Chemical Safety and Pollution Prevention (USEPA OCSPP) guideline OCSPP 850.2100. Empirical studies comprised 244 for Northern bobwhite, of which 73 were dose-response tests and 171 were limit tests. Of the dose-response tests, 26 were conducted to OECD 223 (using 3-4 stages) and 33 to OCSPP 850.2100 (using the single 50-bird design). Data were collected from 5 avian testing laboratories from studies performed between 2006 and 2013. The success with which the LD50 and slope could be determined was 100% and 96% for OECD 223 (mean 26 birds per test) and 100% and 51% for OCSPP 850.2100 (mean 50 birds per test). This was consistent with the statistical simulations. Control mortality across all species and designs amounted to 0.26% (n = 2655) with only single mortalities occurring in any 1 study and <1% for any 1 species. The simulations used to validate the OECD 223 design showed that control mortality up to 1% will have no observable impact on the performance. The distribution of time to death for Northern bobwhite, zebra finch, and canary were obtained from 90, 29, and 17 studies, and mortalities appeared within 3 d for 71%, 95%, and 91% of birds tested, respectively. Integr Environ Assess Manag 2017;13:906-914. © 2017 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Development of Preliminary Remission Criteria for Gout Using Delphi and 1000Minds Consensus Exercises

OBJECTIVE

To establish consensus for potential remission criteria to use in clinical trials of gout.

METHODS

Experts (n = 88) in gout from multiple countries were invited to participate in a web-based questionnaire study. Three rounds of Delphi consensus exercises were conducted using SurveyMonkey, followed by a discrete-choice experiment using 1000Minds software. The exercises focused on identifying domains, definitions for each domain, and the timeframe over which remission should be defined.

RESULTS

There were 49 respondents (56% response) to the initial survey, with subsequent response rates ranging from 57% to 90%. Consensus was reached for the inclusion of serum urate (98% agreement), flares (96%), tophi (92%), pain (83%), and patient global assessment of disease activity (93%) as measurement domains in remission criteria. Consensus was also reached for domain definitions, including serum urate (<0.36 mm), pain (<2 on a 10-point scale), and patient global assessment (<2 on a 10-point scale), all of which should be measured at least twice over a set time interval. Consensus was not achieved in the Delphi exercise for the timeframe for remission, with equal responses for 6 months (51%) and 1 year (49%). In the discrete-choice experiment, there was a preference towards 12 months as a timeframe for remission.

CONCLUSION

These consensus exercises have identified domains and provisional definitions for gout remission criteria. Based on the results of these exercises, preliminary remission criteria are proposed with domains of serum urate, acute flares, tophus, pain, and patient global assessment. These preliminary criteria now require testing in clinical data sets.

Commentary driver training: Effects of commentary exposure, practice and production on hazard perception and eye movements

Commentary driving typically involves being trained in how to produce a verbal running commentary about what you can see, what you are doing, what might happen and what action you will take to avoid potential hazards, while driving. Although video-based commentary training has been associated with subsequent hazard perception improvements, it can have a negative impact on hazard perception when a live commentary is produced at test (Young, Chapman, & Crundall, 2014). In the current study we use balanced training and testing blocks to isolate the effects of commentary exposure, production of a commentary with and without practice, and learning from earlier self-generation of commentary on behavioural and eye movement measures. Importantly, both commentary exposed and unexposed groups gave hazard perception responses during the commentary video, ensuring that the unexposed control group remained engaged in the procedure throughout. Results show that producing a live commentary is detrimental to concurrent hazard perception, even after practice, and does not enhance any later effect of commentary exposure. Although commentary exposure led to an initial increase in the accuracy of hazard perception responses, this effect was limited to the first occasion of testing, and showed no later benefits relative to engaged hazard exposure.

A Cautionary Note: Ceriodaphnia dubia Inter-Laboratory Test Variability

An inter-laboratory comparison of the three-brood survival and reproduction Ceriodaphnia dubia toxicity test was conducted involving three toxicity testing laboratories. This comparison was initiated due to sporadic toxicity with this test related to discharge of a mine effluent, which some regulators believed indicated adverse effects in the receiving environment. One mine effluent and two receiving water samples were evaluated. There were no adverse effects on C. dubia survival in any tests. However, sublethal effects on reproduction (i.e., the IC25; the concentration that causes a 25 % inhibitory effect in the measured sublethal endpoint) ranged from 35 % to >100 % among all test treatments. All laboratories were certified for this test and followed established procedures. Dilute mineral water appears to be the best medium for culturing, dilution, and control water. Variability in the C. dubia laboratory toxicity test should not be mistaken for adverse effects in receiving environments.

Prefrontal Cortex Activation and Young Driver Behaviour: A fNIRS Study

Road traffic accidents consistently show a significant over-representation for young, novice and particularly male drivers. This research examines the prefrontal cortex activation of young drivers and the changes in activation associated with manipulations of mental workload and inhibitory control. It also considers the explanation that a lack of prefrontal cortex maturation is a contributing factor to the higher accident risk in this young driver population. The prefrontal cortex is associated with a number of factors including mental workload and inhibitory control, both of which are also related to road traffic accidents. This experiment used functional near infrared spectroscopy to measure prefrontal cortex activity during five simulated driving tasks: one following task and four overtaking tasks at varying traffic densities which aimed to dissociate workload and inhibitory control. Age, experience and gender were controlled for throughout the experiment. The results showed that younger drivers had reduced prefrontal cortex activity compared to older drivers. When both mental workload and inhibitory control increased prefrontal cortex activity also increased, however when inhibitory control alone increased there were no changes in activity. Along with an increase in activity during overtaking manoeuvres, these results suggest that prefrontal cortex activation is more indicative of workload in the current task. There were no differences in the number of overtakes completed by younger and older drivers but males overtook significantly more than females. We conclude that prefrontal cortex activity is associated with the mental workload required for overtaking. We additionally suggest that the reduced activation in younger drivers may be related to a lack of prefrontal maturation which could contribute to the increased crash risk seen in this population.

Are anxiety and fear separable emotions in driving? A laboratory study of behavioural and physiological responses to different driving environments

Research into anxiety and driving has indicated that those higher in anxiety are potentially more dangerous on the roads. However, simulator findings suggest that conclusions are mixed at best. It is possible that anxiety is becoming confused with fear, which has a focus on more clearly defined sources of threat from the environment, as opposed to the internal, thought-related process associated with anxiety. This research aimed to measure feelings of fear, as well as physiological and attentional reactions to increasing levels of accident risk. Trait anxiety was also measured to see if it interacted with levels of risk or its associated reactions. Participants watched videos of driving scenarios with varying levels of accident risk and had to rate how much fear they would feel if they were the driver of the car, whilst skin conductance, heart rate, and eye movements were recorded. Analysis of the data suggested that perceptions of fear increased with increasing levels of accident risk, and skin conductance reflected this pattern. Eye movements, when considered alongside reaction times, indicated different patterns of performance according to different dangerous situations. These effects were independent of trait anxiety, which was only associated with higher rates of disliking driving and use of maladaptive coping mechanisms on questionnaires. It is concluded that these results could provide useful evidence in support for training-based programmes; it may also be beneficial to study trait anxiety within a more immersive driving environment and on a larger scale.

Initial experience with endoscopic retrograde cholangiography and endoscopic retrograde biliary stenting for treatment of extrahepatic bile duct obstruction in dogs

OBJECTIVE

To describe techniques for endoscopic retrograde cholangiography (ERC) and endoscopic retrograde biliary stenting of the common bile duct (CBD) for minimally invasive treatment of extrahepatic bile duct obstruction (EHBDO) in dogs.

DESIGN

Experimental study and clinical report.

ANIMALS

7 healthy research dogs and 2 canine patients.

PROCEDURES

ERC and endoscopic retrograde biliary stenting were performed in healthy purpose-bred research dogs and client-owned dogs with a diagnosis of EHBDO that underwent an attempted biliary stent procedure. Research dogs were euthanized after completion of the procedure and underwent necropsy. With dogs under general anesthesia, the pylorus was cannulated with a side-view duodenoscope, and the duodenum was entered. The major duodenal papilla (MDP) and minor duodenal papilla were then identified, and the MDP was cannulated. Endoscopic retrograde cholangiography and endoscopic retrograde biliary stenting were attempted with the aid of endoscopy and fluoroscopy in all dogs. Procedure time, outcome for duodenal and MDP cannulation, and success of stent placement were recorded.

RESULTS

Endoscopic retrograde cholangiography was successfully performed in 5 of 7 research dogs and in 1 of 2 patients. Biliary stenting was achieved in 4 of 7 research dogs and 1 of 2 patients, with a polyurethane (n = 4) or self-expanding metallic stent (1). One patient had a mass such that visualization of the MDP was impossible and no attempt at biliary cannulation could be made. After placement, stent patency was documented by means of contrast cholangiography and visualization of biliary drainage into the duodenum intra-operatively. No major complications occurred during or after the procedure in any patient. Follow-up information 685 days after stent placement in 1 patient provided evidence of biliary patency on serial repeated ultrasonography and no evidence of complications. CONCLUSIONS and

CLINICAL RELEVANCE

ERC and endoscopic retrograde biliary stenting were successfully performed in a small group of healthy dogs and 1 patient with EHBDO, but were technically challenging procedures. Further investigation of this minimally invasive technique for the treatment of EHBDO in dogs is necessary before this may be considered a viable alternative to current treatment methods.

Driving behaviour in adults with attention deficit/hyperactivity disorder

BACKGROUND

Little is known about the impact of cognitive impairments on driving in adults with ADHD. The present study compared the performance of adults with and without ADHD in a driving simulator on two different routes: an urban route which we hypothesised would exacerbate weak impulse control in ADHD and a motorway route, to challenge deficits in sustained attention.

METHODS

Adults with (n = 22, 16 males) and without (n = 21, 18 males) ADHD completed a simulated driving session while eye movement data were recorded simultaneously. Participants also completed the Manchester Driving Behaviour Questionnaire (DBQ) and the Conners Adult ADHD Rating Scale (CAARS). Measures of driving performance included average speed, proportion distance travelled over speed limit (speeding) and lane deviation. These variables and the eye movement measures (spread of fixations, mean fixation duration) were compared between groups and routes. Also, driving behaviours, including responses to programmed events, were categorised and the frequencies within categories were compared between groups. Finally, speech analysis was performed to compare emotional verbal expressions during driving between groups.

RESULTS

ADHD participants reported significantly more Violations and Lapses on the DBQ than control participants and significantly more accidents. Average speed and speeding were also higher but did not interact with route type. ADHD participants showed poorer vehicle control, greater levels of frustration with other road users (including greater frequencies of negative comments) and a trend for less safe driving when changing lanes/overtaking on the motorway. These effects were predicted by hyperactive/impulsive CAARS scores. They were also more likely to cause a crash/near miss when an event occurred on the urban route.

CONCLUSIONS

The results suggest that difficulty regulating and controlling impulsive behavior, reflected in speeding, frustration with other road users, less safety when changing lanes on the motorway and a greater likelihood of an accident following an unexpected event, underlie impaired driving in ADHD. Hyperactivity/impulsivity symptoms correlated with these indices. Deficits in sustained attention seemed to play a lesser role in this particular study, although further research is needed to determine whether effects on attention emerge over longer periods of time and/or are influenced by the novelty of the simulator environment.

Processing of Spontaneous Emotional Responses in Adolescents and Adults with Autism Spectrum Disorders: Effect of Stimulus Type

Recent research has shown that adults with autism spectrum disorders (ASD) have difficulty interpreting others' emotional responses, in order to work out what actually happened to them. It is unclear what underlies this difficulty; important cues may be missed from fast paced dynamic stimuli, or spontaneous emotional responses may be too complex for those with ASD to successfully recognise. To explore these possibilities, 17 adolescents and adults with ASD and 17 neurotypical controls viewed 21 videos and pictures of peoples' emotional responses to gifts (chocolate, a handmade novelty or Monopoly money), then inferred what gift the person received and the emotion expressed by the person while eye movements were measured. Participants with ASD were significantly more accurate at distinguishing who received a chocolate or homemade gift from static (compared to dynamic) stimuli, but significantly less accurate when inferring who received Monopoly money from static (compared to dynamic) stimuli. Both groups made similar emotion attributions to each gift in both conditions (positive for chocolate, feigned positive for homemade and confused for Monopoly money). Participants with ASD only made marginally significantly fewer fixations to the eyes of the face, and face of the person than typical controls in both conditions. Results suggest adolescents and adults with ASD can distinguish subtle emotion cues for certain emotions (genuine from feigned positive) when given sufficient processing time, however, dynamic cues are informative for recognising emotion blends (e.g. smiling in confusion). This indicates difficulties processing complex emotion responses in ASD. Autism Res2015, 8: 534–544. © 2015 International Society for Autism Research, Wiley Periodicals, Inc.