IS Score Research Articles

Arbitrary style transformation algorithm based on multi-scale fusion and compressed attention in art and design

In art and design, style conversion algorithms can fuse the content of one image with the style of another image, thereby generating images with new artistic styles. However, traditional style conversion algorithms suffer from high computational complexity and loss of details during row image conversion. Therefore, this study introduces VGG16 multi-scale fusion feature extraction in any style transition algorithm and introduces a compressed attention mechanism to improve its computational complexity. Then it designs an arbitrary style transformation algorithm on the ground of multi-scale fusion and compressed attention. The results showed that the designed algorithm took 0.014 s and 0.021 s to process tasks on the COCO Stuff dataset and WikiArt dataset, respectively, proving its high computational efficiency. The loss values of the designed algorithm are 0.046 and 0.052, respectively, indicating strong fitting performance and good generalization ability. The IS score and FID score of the design algorithm are 2.36 and 91.67, respectively, proving that the generated images have high diversity and quality. The above results demonstrate the effectiveness and practicality of design algorithms in art and design. It has important theoretical and practical value in promoting the development of style conversion technology, enhancing the creativity and expressiveness of art and design.

Pengaruh Pemberian Bakteri dan Trichoderma viride dari Isolat Usus Larva Black Soldier Fly (BSF) terhadap Ketahan Penyakit Cabai Keriting (Capsicum annuum)

Capsicum annuum (curly red chili) is an important commodity for the community. The addition of chemical pesticides is used by farmers to increase plant disease resistance. The use of chemical pesticides is harmful to the environment and can have long-term effects if consumed. Therefore, biopesticide innovation is needed. Black Soldier Fly (BSF) is an insect that has bacteria and fungi in its gut. Bacteria and fungi found in BSF intestinal isolates can function as antimicrobials for plants. Because of this, in this study investigated the effect of the bacteria and fungi Trichoderma viride in increasing disease resistance in C. annuum plants. There were 4 treatments in this study, namely the administration of chemical fungicides, BSF bacterial formula, T. viride. BSF, and a mixture of bacteria and T. viride BSF. The results obtained were analyzed by calculating the Intensity of Attack (IS) score, microscopic observations in the laboratory, and statistical tests. The IS score of the control plants was 75.0%, the fungicide treatment was 37.5%, the bacterial treatment alone was 33.3%, the T. viride treatment was 19.4%, and the mixed treatment of bacteria and T. viride was 4.2%. All plants were attacked by leaf spot disease by Cercospora sp. Control plants were attacked by Sclerotium rolfsii fungus wilt and powdery mildew by Leveillula taurica and jaundice. Jaundice also attacked plants treated with T. viride only and bacteria only. The normality and homogeneity tests show that the data is not normal and not homogeneous but H1 is acceptable based on the Kruskal Wallis test. The conclusion of this study is that bacteria and T. viride from BSF are able to increase disease resistance in curly chili plants, but are not yet effective in preventing disease caused by Cercospora sp.

Preliminary study on developing ocular formulations for natural antioxidants to prevent long‐term complications associated with high myopia

Aims/Purpose: The progression of retinal damage in high myopia (HM) has been associated with a reduction in its antioxidant capacity. α‐Lipoic acid (ALA), among other natural antioxidants, has gained important attention due to its impact on visual health1. The objective of this study is to develop ocular inserts containing ALA and to evaluate the potential ocular irritancy of ALA using the HET‐ CAM (hen's egg test‐chorioallantoic membrane) test.Methods: In the HET‐CAM test, five eggs were used under the following conditions: negative control (NaCl 0.9%), positive control (NaOH 0.1%), low concentration (0.01 M ALA), medium concentration (0.1 M) and high concentration (0.2 M). Bleeding, vascular lysis and coagulation were assessed for 300 s to calculate the Irritation Index (IS)2. For each ocular formulation, 5 mg of ALA was dissolved in phosphate‐buffered saline solution (PBS) with a pH 7.4. Different proportions of selected polymers (HPMC, PVP, HA and PG as an adjuvant) were homogenized and placed into a Petri dish, dried overnight and cut into 1 cm2 inserts.Results: The HET‐CAM measurement demonstrated the absence of haemorrhage, coagulation and lysis in the three tested concentrations of ALA. The IS score falls within the range of 0–0.9, classifying it as non‐irritant. In parallel, four ocular formulations containing 5 mg of ALA were prepared as follows: F1‐ PVP 10%; F2‐ PVP 2.5% and HPMC 1%; F3‐ PVP 2.5% and HA 1%; F4‐ PVP 1%, HA 1% and HPMC 1%. It was shown that F2 and F3 had preferred organoleptic characteristics.Conclusions: ALA was a non‐irritant and probably suitable for ocular administration as an antioxidant. Further research will be conducted to assess the efficacy of the ophthalmic inserts. However, preliminary findings suggest that these inserts hold promise as a potential formulation to delay the long‐term progression of high myopia.

Generative adversarial networks in computer vision: image synthesis and manipulation

Abstract In this paper, we first use the hidden variable loss to generate an adversarial network to optimize the efficiency of the original GAN operation. Secondly, the optimized GAN algorithm is used to train the encoder and decoder to form a new image-processing GAN by combining with the self-encoder and to standardize the operation process of image synthesis. On this basis, the performance of the self-encoder GAN is compared with the original GAN algorithm, and the quality of images generated by the self-encoder GAN and other ways is tested. The test results show that compared with the original GAN framework, the self-encoder GAN has a 50% improvement in operational efficiency in terms of root-mean-square error and an 80% reduction in synthesized global relative error. The self-coder GAN based on this algorithm is 22.5% higher than the traditional BiGAN framework and 2.5% higher than the OGAN framework in terms of FID quality criteria of the generated images and produces 30% less data capacity than BiGAN. The generated images have an average IS score of 3.435, which is superior to other base algorithms.

Distinct adaptations of endocrine and cognitive functions may contribute to high variability in long-term weight loss outcome after bariatric surgery

Background: Bariatric surgery has been widely recognized as the most efficient long-term treatment method in severe obesity, yet therapy success shows considerable interindividual variability. Postoperative metabolic adaptations, including improved gut hormone secretion (GLP-1, PYY and ghrelin), and restored executive function may play an explanatory role in weight loss, yet causes for poor success in individual patients remain unknown. This study investigates gut-hormonal and cognitive characteristics in extreme weight loss responders to bariatric surgery. Methods: Patients (n = 47) with high or low excessive weight loss (EWL) at least 2 years after Roux-en-Y-gastric bypass or sleeve gastrectomy were allocated into good responders (GR, EWL 82.4 ± 11.6%) and poor responders (PR, EWL 24.0 ± SD 12.8%) to study differences in postprandial secretion of GLP-1, PYY, ghrelin and in working memory (WM). Results: Mean BMI was 47.1 ± 6.2 kg/m² in PR (n = 21) and 28.9 ± 3.1 kg/m² in GR (n = 26, p < 0.001). Fasted GLP-1 and PYY were comparable for GR and PR (p > 0.2) and increased strongly after a standardized test meal (300 kcal liquid meal) with a peak at 15 to 30 min. The increase was stronger in GR compared to PR (GLP-1, PYY: Time x Group p < 0.05). Plasma ghrelin levels already differed between groups at fasted state, showing significantly higher levels for GR (p < 0.05). Postprandially, ghrelin secretion was suppressed in both groups, but suppression was higher in GR (Time x Group p < 0.05). GR showed significantly higher WM scores than PR (p < 0.05). Postprandial ghrelin (iAUC), but not GLP-1 or PYY plasma levels, significantly mediated the relationship between EWL and a WM subscore (IS score, CI = 0.07 - 1.68), but not WM main score (MIS score, CI = -0.07 - 1.54), in mediation analyses. Conclusion: Excess weight loss success after bariatric surgical procedures is associated with distinct profiles of gut-hormones at fasted and postprandial state, and differences in working memory. Better working memory performance in GR might be mediated by higher postprandial reduction in ghrelin plasma levels. Future studies need to integrate longitudinal data, larger samples and more sensitive cognitive tests.

26P Genome-wide copy number variation of circulating cell-free DNA as a biomarker in head and neck cancer patients treated with immunotherapy

26P Genome-wide copy number variation of circulating cell-free DNA as a biomarker in head and neck cancer patients treated with immunotherapy

Impairment of autophagy may represent the molecular mechanism behind the relationship between obesity and inflammation in patients with BPH and LUTS.

Aim of this study was to evaluate the roles of inflammation and autophagy in obese patients with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). We analyzed 150 surgical specimens from patients underwent transurethral resection of the prostate (TURP) for LUTS/BPH (Median age 70.3±8.1 years, median BMI 25.7±4.0 kg/m2 and median PSA 6.0±5.4 ng/mL). All surgical specimens were investigated for the presence inflammatory infiltrates, according to the standardized classification of chronic prostatitis of the National Institute of Health. The inflammatory score (IS Score) was calculated. High IS score was defined as ≥7. Each sample was stained for anti-LC3B (cell signaling) and for anti-P62/SQSTM1 (MBL) according to manufacturer's suggestions and scored as follow: 0 (no dots); 1 (detectable dots in 5-25% of cells); 2 (readily detectable dots in 25-75% of cells); 3 (dots in >75% of cells). High percentage of p62 or LC3B was defined as >25%, whereas low percentage of p62 or LC3B was defined as <25% of cells with dots. Overall 74/150 (49.3%) patients were overweight or obese (BMI >25 kg/m2). Obese patients presented a higher inflammatory score. Obese/overweight patients presented a lower percentage of LC3B (58/74; 78.4%) and higher of p62 (49/74; 66.2%) compared to those of normal weight, which it means a deactivated autophagy (P<0.05). At multivariate analysis LC3B (OR=0.22; CI: 0.069-0.70; P=0.01) percentage and BMI (OR=1.118; CI: 1.001-1.250; P=0.04) were independent risk factors of prostatic inflammation (IS≥7). Here we confirm the association between obesity and prostatic inflammatory infiltrates and present the first evidence of autophagy deregulation in obese patients with LUTS/BPH. Further studies should better investigate this relationship and provide new possible therapeutic targets.

Abstract SY17-01: Analysis of immune contexture to refine prognosis in patients with colon cancer: Implications for immunotherapy

Abstract Current classification of colorectal cancer (CRC) is based on TNM staging which does not account for considerable within stage variability in clinical outcome. Currently, there is no immune-based classification of colon cancer although data suggest that intratumoral T-cell densities can provide prognostic information that is more robust than that has been provided by genomic or transcriptomic profiling. A subset of CRCs show microsatellite instability (MSI) that is a predictive biomarker for immune checkpoint inhibitors whose indication in CRC is limited to metastatic tumors. In a prior study, we compared the density and localization of CD3+ and cytotoxic CD8+ T-cell densities in non-metastatic colon cancers with deficient (dMMR) vs proficient (pMMR) DNA mismatch repair (MMR). CD3+ at the tumor invasive margin (IM) was most strongly associated with patient overall survival, and dichotomization of CD3+ prognostically stratified both dMMR and pMMR tumors. The ability to stratify dMMR tumors was a novel observation and revealed a poorer prognosis dMMR group. By multivariable (MV) analysis, CD3+ density and N (nodal) stage contributed the most to patient survival. In separate studies, expression of FOXP3+ Tregs in CRC has paradoxically been associated with more favorable survival. Interestingly, we found that colon cancers with low FOXP3+ and low CD8+ are a very poor prognostic subset. Immunoscore (IS; HalioDx) is a validated assay that examines CD3+ and CD8+ using digital pathology with conversion of densities into percentile scores using a software algorithm. In patients with stage III colon cancers from a completed adjuvant trial, recurrence rates were inversely related to IS score (0-4), and the dichotomized IS was associated with significantly better survival across all disease subgroups (Forest plot). Stage III colon cancers are categorized into low risk (T1-3N1) and high risk (T4 and/or N2) groups for guiding the duration of adjuvant chemotherapy (3 vs 6 months). IS was shown to prognostically stratify patients within both risk groups and was only a significant variable in low risk tumors by MV analysis. These data suggest the potential of IS to further risk stratify patients and to potentially inform treatment decisions. In patients with metastatic CRC, analysis of IS was shown to predict tumor metastatic burden which had prognostic value. Data also suggest that potential for IS to provide predictive information for chemotherapy (fluoropyrimidine + oxaliplatin) response in CRC, yet further studies are needed. A potential mechanism is immunogenic cell death induced by some anti-cancer drugs, including oxaliplatin. Regarding immune checkpoint inhibitors (ICPs), only 40-50% of patients with metastatic CRC respond to such therapy, and small studies in suggest that TIL densities may be a factor in observed variability in response to ICP inhibitors. To further explore this issue, we are examining tumor immunophenotypes in relationship to response and outcome in CRC patients treated with anti-PD-1 antibodies. We aim to develop a MV model, and to validate it in an independent dataset. Important and relevant issues include the fact that only a fraction of mutations result in neoantigens recognized by T-cells, the potential for poor presentation of neoantigens by MHC1, as well as activating or suppressive cytokines. Citation Format: Frank A. Sinicrope. Analysis of immune contexture to refine prognosis in patients with colon cancer: Implications for immunotherapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr SY17-01.

A Computationally Virtual Histological Staining Method to Ovarian Cancer Tissue by Deep Generative Adversarial Networks.

Histological analysis to tissue samples is elemental for diagnosing the risk and severity of ovarian cancer. The commonly used Hematoxylin and Eosin (H&E) staining method involves complex steps and strict requirements, which would seriously impact the research of histological analysis of the ovarian cancer. Virtual histological staining by the Generative Adversarial Network (GAN) provides a feasible way for these problems, yet it is still a challenge of using deep learning technology since the amounts of data available are quite limited for training. Based on the idea of GAN, we propose a weakly supervised learning method to generate autofluorescence images of unstained ovarian tissue sections corresponding to H&E staining sections of ovarian tissue. Using the above method, we constructed the supervision conditions for the virtual staining process, which makes the image quality synthesized in the subsequent virtual staining stage more perfect. Through the doctors' evaluation of our results, the accuracy of ovarian cancer unstained fluorescence image generated by our method reached 93%. At the same time, we evaluated the image quality of the generated images, where the FID reached 175.969, the IS score reached 1.311, and the MS reached 0.717. Based on the image-to-image translation method, we use the data set constructed in the previous step to implement a virtual staining method that is accurate to tissue cells. The accuracy of staining through the doctor's assessment reached 97%. At the same time, the accuracy of visual evaluation based on deep learning reached 95%.

Impairment of autophagy may represent the molecular mechanism behind the relationship between obesity and inflammation in patients with BPH and LUTS.

BACKGROUND Aim of this study was to evaluate the roles of inflammation and autophagy in obese patients with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). METHODS We analyzed 150 surgical specimens from patients underwent transurethral resection of the prostate (TURP) for LUTS/BPH (Median age 70.3±8.1 years, median BMI 25.7±4.0 kg/m2 and median PSA 6.0±5.4 ng/mL). All surgical specimens were investigated for the presence inflammatory infiltrates, according to the standardized classification of chronic prostatitis of the National Institute of Health. The inflammatory score (IS Score) was calculated. High IS score was defined as ≥7. Each sample was stained for anti-LC3B (cell signaling) and for anti-P62/SQSTM1 (MBL) according to manufacturer's suggestions and scored as follow: 0 (no dots); 1 (detectable dots in 5-25% of cells); 2 (readily detectable dots in 25-75% of cells); 3 (dots in >75% of cells). High percentage of p62 or LC3B was defined as >25%, whereas low percentage of p62 or LC3B was defined as 25 kg/m2). Obese patients presented a higher inflammatory score. Obese/overweight patients presented a lower percentage of LC3B (58/74; 78.4%) and higher of p62 (49/74; 66.2%) compared to those of normal weight, which it means a deactivated autophagy (P<0.05). At multivariate analysis LC3B (OR=0.22; CI: 0.069-0.70; P=0.01) percentage and BMI (OR=1.118; CI: 1.001-1.250; P=0.04) were independent risk factors of prostatic inflammation (IS≥7). CONCLUSIONS Here we confirm the association between obesity and prostatic inflammatory infiltrates and present the first evidence of autophagy deregulation in obese patients with LUTS/BPH. Further studies should better investigate this relationship and provide new possible therapeutic targets.

Veterinarians and impostor syndrome: an exploratory study

BackgroundImpostor syndrome (IS) is the tendency to doubt one’s abilities despite positive evidence to the contrary. Individuals with IS are afraid of being discovered as intellectual frauds and attribute their...

Acute kidney Injury in Critically Ill Children; Frequency, Risk Factors and Outcomes.

Background Acute kidney injury (AKI) is a common problem in critically ill children and is associated with high rate of mortality. The definition and staging of AKI has been recently standardized using the RIFLE classification and the KDIGO classifications. Most cases of AKI represent acute tubular necrosis that is secondary to hypovolemia, sepsis or the use of nephrotoxic agents. Aim of the study To investigate the frequency, risk factors and outcome in critically ill children and to compare the pRIFLE and KDIGO classifications. Patients and methods 100 critically ill children admitted to the pediatric intensive care unit (PICU) were screened for AKI using both pRIFLE and KDIGO classifications. All included children were subjected to full history taking, full clinical examination, assessment of disease severity at admission, daily monitoring of urine output serum creatinine and calculation of estimated GFR and inotrope score. Results Thirty –eight percent of our patients had developed AKI during their course of stay. There was no significant difference between the two scoring systems at admission at day 3and at day 7 post admission. Infant age group, duration of stay > 7 days, the use of vasoactive drugs, nephrotoxic drugs and mechanical ventilation were risk factors for the development of AKI. Mortality was significantly higher in patients with AKI (58% versus 13%, p= .008). Conclusion Lower age, higher IS score and mechanical ventilation were independent risk factors for AKI. AKI was associated with higher mortality and was associated with significantly longer ICU stay.

Autophagy deactivation is associated with severe prostatic inflammation in patients with lower urinary tract symptoms and benign prostatic hyperplasia.

Autophagy is a conserved evolutionary process that allows cells to maintain macromolecular synthesis and energy homeostasis during starvation and stressful conditions. We prospectively evaluated the relationship between autophagy and prostatic inflammation in a series of transurethral prostatic resection samples. Inflammatory infiltrates were defined according to the standardized classification of chronic prostatitis of the National Institute of Health. The inflammatory score (IS score) was calculated. High IS score was defined as ≥7. Each sample was stained for anti-LC3B and for anti-P62/SQSTM1 and scored. High p62 or LC3B percentage was defined as >25%, whereas low was defined as <25% of cells with dots.We analyzed 94 specimens. Overall, 18/94 (19%) showed no sign of prostatic inflammation, whereas 76/94 (81%) presented inflammatory infiltrates. Inflammation was mild in 61/76 (80%), moderate/severe in 15/76 (20%). Patients with high p62 percentage were 62/94 (66%) while 32 (34%) showed low p62 percentage. Patients with high LC3B percentage were 37/94 (39%) while 57(61%) showed low LC3B percentage. Overall 42/94 (44%) patients presented a high p62 percentage and concomitant a low LC3B percentage. IS score was significantly higher in patients with a with high p62 percentage (median IS 7 (6/8) vs 5 (3/7); p= 0.04) and in patients with a low LC3B percentage (median IS 7 (6/8) vs 5 (3/7); p= 0.004) when compared to patients with a low p62 percentage or a high LC3B percentage respectively. On multivariate analysis, p62 (OR: 10.1, 95%CI: 2.6-38.6; p= 0,001) and LC3B expression (OR: 0.319; 95%CI: 0.112-0.907; p= 0.032) were independent predictors of a high IS.Here we present the first evidence of autophagy deregulation in prostatic inflammation. These results raise many questions about the mechanisms mediating the autophagy dysfunction and the links to prostatic inflammation that need to be addressed.

Insight and aggressive behavior in acute schizophrenic patients

Introductionaggressive behavior in wards is associated to poor treatment compliance and low clinical insight. Most studies focused on the clinical and cognitive dimensions of insight, while the relationship between metacognitive dimension and aggressive behaviors was not investigated. Our aim was to understand what relationship occurs between dimensions of insight (metacognitive, cognitive, clinical), and specific aggressive behaviors in acute patients.Methodswe recruited 75 acute schizophrenic patients using: aQ; MO aS; IS; P aNSS; BCIS.Resultsa positive correlation between the IS score and the hostility, angry and physical aggression sub-scores of the aQ was highlighted, while no correlation between the score of IS and MO aS total score was found. No correlation between the score of the P aNSS G12 item and the aQ scores and MO aS was found, and no correlation between BCIS scores, MO aS and aQ scores was found.Conclusionsin our patients, a higher level of metacognitive insight, but not clinical nor cognitive insight, was associated to higher levels of hostility. we suggest that a higher ability to monitor and appraise one's own altered processes of thought and related discomfort, feeling of destabilization and loss of control, could contribute to enhance resentment and suspiciousness. Findings help develop specific therapeutic strategies to enhance metacognitive and self-monitoring abilities, helping patient's understanding of the illness, improving compliance with treatment, and patient's quality of life. Our results support the multidimensional nature of insight in schizophrenia, confirming that clinical, cognitive and metacognitive dimensions are independent though related facets of the phenomenon of insight in schizophrenia.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Risk factors and clinical effects of trauma induced coagulopathy in ICU patients with major trauma

Objective To investigate the risk factors of trauma induced coagulopathy and its effect on the outcome of ICU patients with severe trauma.Methods Totally 223 severe trauma patients admitted to emergency ICU within 24h after injuring between June,2008 and September,2009 were retrospectively analyzed.Injury severity score (ISS),APACHE Ⅱ score,coagulation function,routine blood test,biochemical test,and blood gas assay were completed for each patient. Hypoperfusion was defined as vasoactive agents usage,or base deficit (BD) ≥ 6 or shock index ≥ 1. Patients were divided into coagulopathy group and non-coagulopathy (control) group according to coagulation function.ISS,APACHE Ⅱ score,the occurrence of hypothermia and hypoperfusion were compared between the two groups.The risk factors of trauma induced coagulopathy were analyzed,and the multivariate logistic regression equation was formulated.Coagulation function and incidence of trauma induced coagulopathy were compared between nonsurvival and survival group.Results Fifty-two of 223 (23.3 ％ ) patients met the criteria of trauma induced coagulopathy.Mortality rate in this group was significantly higher than that in non-coagulopathy group (36.5％ vs 9.4％, P ＜ 0.01 ). Patients in both groups had the comparability in age,sex, injury mechanism and time after trauma.ISS,the incidence of hypothermia,hypoperfusion and severe traumatic brain injury in coagulopathy group were higher than those in non-coagulopathy group ( P ＜ 0.01 ).GCS,hemoglobin,hematocrit,and platelet counts in coagulopathy group were significantly lower than that in noncoagulopathy group (P＜ 0.01).Base deficit ≥6,GCS ≤ 8,and platelet counts were considered as the independent risk factors involved in trauma- induced coagulopathy according to logistic regression in this study.Coagulation function of non-survivors also remarkably attenuated when compared with survival group.Conclusions The incidence rate of trauma induced coagulopathy is high in severe trauma patients admitted to ICU within 24h. Trauma induced coagulopathy correlates well with ISS core,severe traumatic brain injury,shock and hypothermia,and results in high mortality. Key words: Major trauma; Trauma induced coagulopathy; Risk factors; Outcome

AN ACTIGRAPHIC STUDY COMPARING COMMUNITY DWELLING POOR SLEEPERS WITH NON-DEMENTED CARE HOME RESIDENTS

Sleep disturbances are a common problem among institutionalized older people. Studies have shown that this population experiences prolonged sleep latency, increased fragmentation and wake after sleep onset, more disturbed circadian rhythms, and night-day reversal. However, studies have not examined the extent to which this is because of individual factors known to influence sleep (such as age) or because of the institutional environment. This article compares actigraphic data collected for 14 days from 122 non-demented institutional care residents (across ten care facilities) with 52 community dwelling poor sleepers >65 yrs of age. Four dependent variables were analyzed: (i) “interdaily stability” (IS); (ii) “intradaily variability” (IV); (iii) relative amplitude (RA) of the activity rhythm; and (iv) mean 24 h activity level. Data were analyzed using a fixed-effect, single-level model (using MLwiN). This model enables comparisons between community and institutional care groups to be made while conditioning out possible “individual” effects of “age,” “sex,” “level of dependency,” “level of incontinence care,” and “number of regular daily/prescribed medications.” After controlling for the effects of a range of individual level factors, and after controlling for unequal variance across groups (heteroscedascity), there was little difference between community dwelling older adults and institutional care residents in IS score, suggesting that the stability of day-to-day patterns (such as bed get-up, lunch times, etc.) is similar within these two resident groups. However, institutional care residents experienced more fragmented rest/wake patterns (having significantly higher IV scores and significantly lower mean activity values). Our findings strongly suggest that the institutional care environment itself has a negative association with older people's rest/wake patterns; although, longitudinal studies are required to fully understand any causal relationships. (Author correspondence: r.meadows@surrey.ac.uk)