Small Decrements Research Articles

Echocardiographic phenotypes of diabetic myocardial disorder: evolution over 15 months follow-up in the ARISE-HF trial

BackgroundDiabetic myocardial disorder (DbMD, evidenced by abnormal echocardiography or cardiac biomarkers) is a form of stage B heart failure (SBHF) at high risk for progression to overt HF. SBHF is defined by abnormal LV morphology and function and/or abnormal cardiac biomarker concentrations.ObjectiveTo compare the evolution of four DbMD groups based on biomarkers alone, systolic and diastolic dysfunction alone, or their combination.MethodsThe Aldose Reductase Inhibition for Stabilization of Exercise Capacity in Heart Failure (ARISE-HF) trial was a Phase 3 randomised trial of an aldose reductase inhibitor in patients with well-controlled type 2 diabetes mellitus (T2DM). The 1858 potential participants (age 67 ± 7 years; 50% women) were screened for SBHF based on abnormal echocardiography or biomarkers (N-terminal pro-B-type natriuretic peptide ≥ 40 ng/L or high sensitivity cardiac troponin T ≥ 10 ng/L [women] and ≥ 16 ng/L [men]). Exercise capacity (peak VO2) was reduced in 669 with DbMD (age 68 ± 7, 50% women), and peak VO2 was reassessed at 15 months.ResultsThe 1463 (79%) participants with DbMD were allocated to four clusters; 907 (49%) showed isolated elevation of cardiac biomarkers, 301 (16%) with systolic dysfunction/hypertrophy, 162 (9%) with diastolic dysfunction and 93 (5%) comprised an overlap cluster (combined diastolic, systolic or LV geometric abnormalities). Reduced VO2 (< 75% predicted) was present in 669 (46%); 72% of those with both systolic and diastolic dysfunction, 56% of those with systolic dysfunction and LVH, 53% of those with diastolic dysfunction and 38% with biomarkers alone (p < 0.0001). In 669 patients followed over 15 months, there was a similar small decrement in VO2 in all groups. ConclusionsAmong individuals with T2DM and SBHF, reduced functional capacity is most prevalent in those with multiple physiological disturbances. However, there was no difference between phenogroups in the evolution of exercise intolerance.Trial Registration: ARISE-HF, NCT04083339.

Effect of zinc oxide dopant on the structural, optical, and magnetic properties of α-Fe2O3 nanocrystalline structure

Abstract Recent research demonstrates that unique progressive properties of nanomaterials have contributed to significant advancements in several fields. Therefore, in the current study zinc oxide (5%, 10%, and 20%) - doped Fe2O3 nanoparticles were synthesized by an advanced co-precipitation method. Further, the prepared samples were calcined for two hours at a temperature of 600°C and the samples were characterized using various techniques to check their suitability in various applications. For that purpose, initially the formation of nanoparticles was confirmed using X-Ray diffraction analysis (XRD) data that concluded the formation of hexagonal crystalline structure. The crystallite size was also calculated using Debye Scherrer formula and size of particle increased from 23nm to 30nm with increase in dopant concentration. The IR spectroscopy were used to analysed the various calcined samples and the results show that the sharp peaks at position 540 cm−1 and 625 cm−1 were due to O-Fe-O vibration alpha and gamma Fe2O3 molecules respectively. The UV -Vis spectroscopy were used to determine the optical band gap of calcined samples through Tauc Plots and the results of study reflected that small decrement of band occurred with increase of dopant concentration. The magnetic properties of the calcined sample were analysed by Vibrating sample magnetometer (VSM) and it was observed that the saturation magnetisation intensity decreases as doping concentration of zinc oxide increases.

Iron restriction in sickle cell disease: When less is more.

Primum non nocere! Can iron deficiency, an abnormality that causes anemia, benefit people with sickle cell disease (SCD) who already have an anemia? The published literature we review appears to answer this question in the affirmative: basic science considerations, animal model experiments, and noncontrolled clinical observations all suggest a therapeutic potential of iron restriction in SCD. This is because SCD's clinical manifestations are ultimately attributable to the polymerization of hemoglobin S (HbS), a process strongly influenced by intracellular HbS concentration. Even small decrements in HbS concentration greatly reduce polymerization, and iron deficiency lowers erythrocyte hemoglobin concentration. Thus, iron deficiency could improve SCD by changing its clinical features to those of a more benign anemia (i.e., a condition with fewer or no vaso-occlusive events). We propose that well-designed clinical studies be implemented to definitively determine whether iron restriction is a safe and effective option in SCD. These investigations are particularly timely now that pharmacologic agents are being developed, which may directly reduce red cell hemoglobin concentrations without the need for phlebotomies to deplete total body iron.

Kinetic Analysis, Potentiation, and Fatigue During Vertical and Horizontal Plyometric Training: An In-Depth Investigation Into Session Volume.

To investigate vertical and horizontal jump kinetic performance following a low-volume plyometric stimulus with progressively increased session jump volume. Sixteen academy rugby players (20.0 [2.0]y; 103.0 [17.6]kg; 184.3 [5.5]cm) volunteered for this study. Vertical and horizontal jump sessions were conducted 1 week apart and consisted of a 40-jump low-volume plyometric stimulus using 4 exercises, after which volume was progressively increased to 200 jumps, using countermovement jump (CMJ) for vertical sessions and horizontal broad jump (HBJ) for horizontal sessions. Jump performance was assessed via force-plate analysis at baseline (PRE-0), following the low-volume plyometric stimulus (P-40), and every subsequent 10 jumps until the end of the session (P-50, P-60, P-70, . . . P-200). The low-volume stimulus was effective in potentiating HBJ (2% to 5%) but not CMJ (0% to -7%) performance (P < .001). The HBJ performance enhancements were maintained throughout the entire high-volume session, while CMJ realized small but significant decrements (-5% to -7%) in jump height P-50 to P-80 before recovering to presession values. Moreover, increases in eccentric impulse (5% to 24%; P < .001) in both sessions were associated with decreased or maintained concentric impulse, indicating a breakdown in performance-augmenting mechanisms and less effective power transfer concentrically after moderate volumes. Practitioners should consider kinetic differences between HBJ and CMJ with increasing volume to better inform and understand session dosing strategies.

Effects of male paratroopers' initial body composition on changes in physical performance and recovery during a 20-day winter military field training.

Changes in physiological markers and physical performance in relation to paratroopers' initial body composition were investigated during a 20-day winter military field training (MFT) and the subsequent 10-day recovery period. Body composition, serum hormone concentrations and enzymatic biomarkers, and physical performance of 58 soldiers were measured before, during, and after MFT. Comparisons were done according to soldiers' body fat percentage before MFT between low-fat (<12% body fat) and high-fat (>12% body fat) groups. Correlations between body fat percentage preceding MFT and changes in muscle mass, physical performance, and serum hormone concentrations and enzymatic biomarkers were investigated. It was hypothesized that soldiers with a higher fat percentage would have smaller decrements in muscle mass, physical performance, and serum testosterone concentration. The change in muscle and fat mass was different between groups (p <0.001) as the low-fat group lost 0.8kg of muscle mass and 2.0kg of fat mass, while there was no change in muscle mass and a loss of 3.7kg of fat mass in the high-fat group during MFT. Fat percentage before MFT correlated with the changes in muscle mass (R2=0.26, p <0.001), serum testosterone concentration (R2=0.22, p <0.001), and evacuation test time (R2=0.10, p <0.05) during MFT. The change in muscle mass was correlated with the changes in evacuation test time (R2=0.11, p <0.05) and countermovement jump test results (R2=0.13, p <0.01) during MFT. Soldiers with a higher initial fat percentage lost less muscle mass, and had smaller decrements in some aspects of physical performance, as well as in serum testosterone concentration during MFT.

Poster Session: Towards Understanding Retinal Processing of Single-Cone Scale Stimulation.

The magnocellular (M) visual pathway can be distinguished from its finer-grained parvocellular (P) counterpart by its stronger response gain to contrasts near human detection threshold. This distinction is found when stimulus size is matched to the relatively large receptive field size of M cells, but it is less clear if preserved at smaller spatial scales. We examined foveal detection thresholds in tandem with a masking paradigm known to desensitize the M pathway. We used a custom DLP display in Maxwellian view to present either 3 or 23 arcmin spots for 100 ms against a uniform gray disk (1° VA) surrounded by a 0.5 cpd, 100% contrast, square wave grating flickered at 7 frequencies ranging from 0 to 30 Hz. Detection data were fit with psychometric functions to estimate threshold and thresholds were normalized to the static (0 Hz) condition. Relative sensitivity was fit with a modified impulse response function and compared to a constant model with ANOVA. With masking we found a significant reduction in sensitivity for large (23arcmin) increments (mean=0.39 log units; n=4; p<0.01) and decrements (0.31 log units; n=4; p=0.02)at 8.3Hz. By contrast, no significant masking effect was observed for small spot increments or decrements (p>0.05). These data suggest that the M pathway is not the primary determinant of small spot thresholds under the conditions studied. Further investigation with adaptive optics may be necessary to fully elaborate single-cone processing in the fovea.

Fake Biometric Detection Based on Photoplethysmography Extracted from Short Hand Videos

An array of authentication methods has emerged, underscoring the importance of addressing spoofing challenges arising from forgery and alteration. Previous studies utilizing palm biometrics have attempted to circumvent spoofing through geometric methods or the analysis of vein images. However, these approaches are inadequate when faced with hand-printed photographs or in the absence of near-infrared sensors. In this study, we propose using remote photoplethysmography (rPPG) signals to tackle spoofing concerns in palm images captured in RGB environments. rPPG signals were extracted using video durations of 3, 5, and 7 s, and 30 features within the heart rate band were identified through frequency conversion. A support vector machine (SVM) model was trained with the processed features, yielding accuracies of 97.16%, 98.4%, and 97.28% for video durations of 3, 5, and 7 s, respectively. These features underwent dimensionality reduction through a principal component analysis (PCA), and the results were compared with the initial 30 features. Additionally, we evaluated the confusion matrix with zero false-positives for each video duration, finding that the overall accuracy experienced a decline of 1 to 3%. The 5 s video retained the highest accuracy with the smallest decrement, registering a value of 97.2%.

Pore-scale evaluation on a volumetric solar receiver with different optical property control strategies

Pore-scale flow and heat transfer model is built for a volumetric solar receiver subjected to highly concentrated irradiation, in order to provide insight into the detailed thermal and hydrodynamic performance. Direct three-dimensional simulations on the coupled radiation-convection-conduction are performed based on the Weaire-Phelan structure which is used to represent the open-cell ceramic foam absorber. The energy conversion characteristics with two ceramic materials (SiC and Al2O3) are firstly predicted and compared. And then several cases focused on the control approaches for the optical property (absorption/reflection/emission) of the solar absorber are introduced and investigated, including gradient surface absorptivity, spectral selectivity, and combination design of semi-transparent and opaque configuration. The results show that a moderate volumetric effect can be achieved at very low inlet fluid velocity for both ceramic materials, however presenting low conversion efficiency. Increasing the inlet velocity could enlarge the thermal non-equilibrium between solid and fluid phases and lower the outlet temperature. SiC absorber shows improved performance compared to Al2O3 absorber, and the efficiency changes obviously with the inlet velocity, while a variation of 24% is found. The optical property of the absorber front region significantly affects the overall performance. Decreasing absorptivity design and spectral selective design both show positive impact, especially for the Al2O3 absorber with an increment by 33% in efficiency relative to the basic one. Among the different strategies, spectral selective improvement shows the best effectiveness. Besides, adding porous fused silica as the front absorber layer can effectively move the high-temperature area inward at a cost of small decrement in efficiency, herein, honeycomb structure shows preponderance compared to the foam silica.

Credit risk analysis using boosting methods

Abstract The use of credit for various occasions has become a routine in our lives. In return, banking and financial institutions require to determine whether the loan demands from them contain any risk. Accordingly, these institutions have been increased their activities in determining whether credit rating models from past credit records of the person applying for the loan works properly. Machine learning-based technologies have opened a new era in this field. AI and machine learning based methods for credit scoring are currently implemented by banking or non-banking financial institutions. Employed models are to extract meaningful features from the required data in which wide variety of information available. In this study, credit risk assessment is conducted using boosting methods such as CatBoost, XGBoost and Light GBM. To this aim, Kaggle Home Credit Default Risk dataset is used and the effect of crediting tendency on the results is also considered. The results have shown that gradient boosting methods provide results that are close to each other, and crediting tendency produces better AUC score in CatBoost while it causes a small decrement in AUC score of XGBoost and LightGBM.

Earcons to reduce mode confusions in partially automated vehicles: Development and application of an evaluation method

Partially automated vehicles have systems that can ensure lateral and longitudinal control through adaptive cruise control and lane centering assist, meaning that there are three possible levels (modes) of automation: manual driving, automated longitudinal control, and automated lateral and longitudinal control. Confusions can occur when drivers fail to perceive or comprehend the automation mode indicated by the interface. Earcons reflecting the hierarchy of these automation modes through the use of pitch, rhythm, and number of note variations could improve mode awareness. The goal of the present study was therefore to develop and test a method for assessing the efficiency of earcons as indicators of automation mode, based on a mode awareness model. This method consisted in checking during a controlled laboratory situation, that the earcons were perceived correctly (Experiment 1), comprehended in isolation (Experiment 2), and comprehended during the performance of a parallel visual task that mimicked the visual demand of driving with partial automation and having to react to changes of visual icons (Experiment 3). This method was applied to earcons indicating the hierarchy of automation modes. The results of these experiments indicated that the earcons were efficiently perceived. They were comprehended in isolation and had a provoked a small decrement to a visual task. The parameters used here to create earcons for the purpose of reducing mode confusions were therefore validated to future simulator studies. The method for assessing them could be applied elsewhere, to ensure that other auditory signals adequately contribute to all dimensions of mode awareness before being integrated to a vehicle.

Cost-Effectiveness of Respiratory Syncytial Virus Preventive Interventions in Children: A Model Comparison Study

ObjectivesModel-based cost-effectiveness analyses on maternal vaccine (MV) and monoclonal antibody (mAb) interventions against respiratory syncytial virus (RSV) use context-specific data and produce varied results. Through model comparison, we aim to characterize RSV cost-effectiveness models and examine drivers for their outputs. MethodsWe compared 3 static and 2 dynamic models using a common input parameter set for a hypothetical birth cohort of 100 000 infants. Year-round and seasonal programs were evaluated for MV and mAb interventions, using available evidence during the study period (eg, phase III MV and phase IIb mAb efficacy). ResultsThree static models estimated comparable medically attended (MA) cases averted versus no intervention (MV, 1019-1073; mAb, 5075-5487), with the year-round MV directly saving ∼€1 million medical and €0.3 million nonmedical costs, while gaining 4 to 5 discounted quality-adjusted life years (QALYs) annually in <1-year-olds, and mAb resulting in €4 million medical and €1.5 million nonmedical cost savings, and 21 to 25 discounted QALYs gained. In contrast, both dynamic models estimated fewer MA cases averted (MV, 402-752; mAb, 3362-4622); one showed an age shift of RSV cases, whereas the other one reported many non-MA symptomatic cases averted, especially by MV (2014). These differences can be explained by model types, assumptions on non-MA burden, and interventions’ effectiveness over time. ConclusionsOur static and dynamic models produced overall similar hospitalization and death estimates, but also important differences, especially in non-MA cases averted. Despite the small QALY decrement per non-MA case, their larger number makes them influential for the costs per QALY gained of RSV interventions.

A randomised controlled trial of 1- versus 2-day per week formats of Nordic hamstring training on explosive athletic tasks in prepubertal soccer players

ABSTRACT This randomised controlled trial examined the effect of volume-equated programmes of Nordic hamstring exercise (NHE) training, executed at frequencies of 1- or 2-days per week, on explosive athletic tasks (30 m sprint, 15 m manoeuvrability and standing long jump [SLJ]) in male youth soccer players (mean age: 10.3 ± 0.5 years). Players were divided into an experimental group (n = 31) which was further subdivided into 1-day (n = 16) and 2-days (n = 15) per week training conditions, and a control group (n = 14). There were significant group-by-time interactions for 30-m sprint (p < 0.001, d = 0.6), SLJ (p = 0.001, d = 1.27) and 15 m manoeuvrability (p < 0.001, d = 0.61). The experimental group demonstrated small to moderate effect sizes in 30-m sprint (d = 0.42, p = 0.077), SLJ (d = 0.97, p < 0.001) and 15 m manoeuvrability (d = 0.61, p < 0.001). The control group showed small significant performance decrements or no change in these variables. There were no significant differences between the 1-day and 2-day training groups. In two of the three tests (30 m sprint, SLJ) the 2-day group demonstrated larger effect sizes. The NHE enhances explosive athletic task performance in prepubertal youth soccer players and there may be only small advantages to spreading training over two days instead of one.

Radiographic Contrast Media and the Kidney.

AKI is a potential complication of intravascular iodinated contrast exposure. Contrast-associated AKI, which typically manifests as small and transient decrements in kidney function that develop within several days of contrast administration, is associated with serious adverse outcomes, including progressive kidney dysfunction and death. However, a causal link between the small increases in serum creatinine that characteristically occur with contrast-associated AKI and serious adverse outcomes remains unproven. This is important given mounting evidence that clinically indicated, potentially lifesaving radiographic procedures are underutilized in patients with CKD. This has been hypothesized to be related to provider concern about precipitating contrast-associated AKI. Intravascular gadolinium-based contrast, an alternative to iodinated contrast that is administered with magnetic resonance imaging, has also been linked with potential serious adverse events, notably the development of nephrogenic systemic fibrosis in patients with severe impairment in kidney function. Patients hospitalized in the intensive care unit frequently have clinical indications for diagnostic and therapeutic procedures that involve the intravascular administration of contrast media. Accordingly, critical care providers and others treating critically ill patients should possess a sound understanding of the risk factors for and incidence of such outcomes, the ability to perform evidence-based risk-benefit assessments regarding intravascular contrast administration, and knowledge of empirical data on the prevention of these iatrogenic complications.

Thermal mass impact on energy consumption for buildings in hot climates: A novel finite element modelling study comparing building constructions for arid climates in Saudi Arabia

Contradictory conclusions have been reported on whether thermal mass reduces or increases energy demand in hot and cold climates. A novel approach to measuring the impact of thermal mass on the building’s energy consumption is presented. The method aims to better represent reality and applies two different control conditions simultaneously in a numerical model: the first condition, which has been used in past studies, adjusts the internal boundary condition based on the time duration of heating/cooling activation (simulating an occupancy pattern) and the second, which has not been used in past studies, adjusts the internal boundary condition based on both the time duration and the internal temperature (simulating an occupancy pattern and the thermostatic control system). When investigating the impact of thermal mass on the internal temperature in a scenario where no heat is transferred into the building, the high thermal mass outperforms the low thermal mass, showing a time-shifting effect, long time lag, and small decrement factor. However, when modelled using the method presented in this paper, high thermal mass results in greater energy consumption during summer and winter periods in Saudi Arabia. During transition seasons where temperature swings occur on either side of the indoor set-point temperatures, thermal mass reduces thermal transmission. The impact of thermal mass is also investigated for several climatic conditions in Saudi Arabia. Simulation results show that an internally exposed thermal massive wall section results in greater energy consumption when compared to a similar building with isolated thermal mass (i.e. insulated internally). This is due to the fact that even though the internal temperature inside the building is being cooled/warmed up to the set-point, the thermal mass continues to transfer heat that is absorbed by the building’s fabric from/to the interior, placing a greater demand on the cooling/heating system. Over the course of a year, however, the impact of thermal mass is negligible when compared to other factors, such as the insulative properties of the building’s fabric.

Can Player Tracking Devices Monitor Changes in Internal Response During Multidirectional Running?

ABSTRACTPurpose: We examined the movement, physiological and muscle function responses to running with and without (i.e. linear) multiple directional changes to understand which measures of external demands better reflected changes in the internal response. Methods: Twelve team sport athletes completed a linear and multidirectional running trial during which movement characteristics, oxygen consumption (V˙O2), blood lactate (B[La]) and heart rate (HR) were measured. Isometric peak torque of knee extensors and flexors was also assessed before and after each trial. Results: High speed running distance was higher during the linear trial (p < 0.001), whereas time at high metabolic power (p = 0.046), number of accelerations (p < 0.001), summated HR (p = 0.003) and B[La] (p = 0.002) were higher during the multidirectional trial. Integrated external to internal ratios of high-speed running: summated HR and high-speed running: total V˙O2 were different between multidirectional and linear trials (p ≤ 0.001). Conversely, high metabolic power: summated HR and high metabolic power: total V˙O2 were similar (p ≥ 0.246). Small decrements in knee flexor (p = 0.003) and extensor torque (p = 0.004) were observed after both trials. Conclusion: Time at high metabolic power better reflects the increased internal response during running with more directional changes than high speed running.

Risk and resilience in couple's adjustment to the COVID-19 pandemic.

The COVID-19 pandemic’s global scope and resulting social distancing measures have caused unprecedented economic, lifestyle, and social impacts to personal and relationship well-being. While lockdowns have prompted individuals to increase reliance on intimate partners for support, stressful external contexts can also interfere with partners’ capacity to request and provide support, resulting in relationship dissatisfaction and even dissolution. Guided by a risk and resilience framework, this study examined the impact of perceived stress, social contextual factors, and dyadic coping on self-reported relationship satisfaction changes during the initial United States COVID-19 lockdown period. Participants were adults in romantic relationships who completed an online survey between April 13 and June 8, 2020. Overall, survey respondents (N = 1106) reported higher perceived stress levels than established population norms, and small but significant decrements in relationship satisfaction. Multivariable models revealed that higher perceived stress levels were associated with lower relationship satisfaction levels. Additionally, dyadic coping was found to moderate the impact of perceived stress on relationship satisfaction (B = .05, 95% CI = .02– .07), suggesting that engaging in dyadic coping buffered individuals from adverse effects of perceived stress on their relationships. Findings emphasize heightened stress experienced by individuals during the pandemic, potential detrimental effects of stress on couple relationships, and suggest dyadic coping may help buffer couples from adverse effects of the pandemic on their relationships. As such, dyadic coping may be an important target for future interventions designed to assist couples during the ongoing pandemic and future pandemics/natural disasters.

285 ‘Smart Phrase’ Ward Rounds: Do They Improve Documentation and Efficiency?

Abstract Aim Accurate ward round documentation plays a crucial role in patient management. In the last two years, UCLH has introduced EPIC software. This gives opportunity to create templates for repetitive processes (‘smart phrases’). The aim of this project was to assess if the introduction of ‘smart phrase’ templates can improve the quality of ward round documentation. Method Following consultation, 5 fundamental domains were agreed to be included in the template, namely: Procedure and postoperative day, current clinical issues, physical examination, objective assessment (including vital signs, fluid balance/drains, blood tests, DVT prophylaxis, antibiotic status), and 24h treatment plan. A baseline audit was performed, then the new template was introduced. Two PDSA cycles were performed, for 3 weeks after introduction, and repeated two months later. Chi-square tests was used to assess statistical significance of change (p&amp;lt;0.05). Results A statistically significant improvement in documentation for all domains - apart from ‘current clinical issues’ and ‘24h planning', which were well documented to start - was observed after the introduction of smart phrases; with an average improvement of 34.8% (range 0–65.6%). The improvement was maintained at 2 months (improvement from baseline 35.1%, range 0–59%). A small decrement in documentation occurred between introduction and the 2-month PDSA assessments in some domains (mean change 0.7%, range -12.3 to 23%), although this was not statistically significant. Conclusions The introduction of smart phrases significantly improved ward round documentation of important parameters. Evolution of additional smart phrase is expected to further improve the accuracy leading to more efficient decisions and safer clinical practice.

Exploring the effects of degraded vision on sensorimotor performance.

Many people experience unilateral degraded vision, usually owing to a developmental or age-related disorder. There are unresolved questions regarding the extent to which such unilateral visual deficits impact on sensorimotor performance; an important issue as sensorimotor limitations can constrain quality of life by restricting 'activities of daily living'. Examination of the relationship between visual deficit and sensorimotor performance is essential for determining the functional implications of ophthalmic conditions. This study attempts to explore the effect of unilaterally degraded vision on sensorimotor performance. In Experiment 1 we simulated visual deficits in 30 participants using unilateral and bilateral Bangerter filters to explore whether motor performance was affected in water pouring, peg placing, and aiming tasks. Experiment 2 (n = 74) tested the hypothesis that kinematic measures are associated with visuomotor deficits by measuring the impact of small visual sensitivity decrements created by monocular viewing on sensorimotor interactions with targets presented on a planar surface in aiming, tracking and steering tasks. In Experiment 1, the filters caused decreased task performance-confirming that unilateral (and bilateral) visual loss has functional implications. In Experiment 2, kinematic measures were affected by monocular viewing in two of three tasks requiring rapid online visual feedback (aiming and steering). Unilateral visual loss has a measurable impact on sensorimotor performance. The benefits of binocular vision may be particularly important for some groups (e.g. older adults) where an inability to complete sensorimotor tasks may necessitate assisted living. There is an urgent need to develop rigorous kinematic approaches to the quantification of the functional impact of unilaterally degraded vision and of the benefits associated with treatments for unilateral ophthalmic conditions to enable informed decisions around treatment.

Impact of adverse events on quality of life and hospital costs in secondary cardiovascular disease prevention

Abstract Background and purpose People with atherosclerotic vascular disease remain at high risk of cardiovascular (CVD) events despite effective risk factor management 1. There is little research on impacts of adverse events on quality of life (QoL) and hospital cost to inform evaluations of novel interventions in this population. We estimate QoL and annual hospital costs associated with a range of adverse events of interests using the individual participant data from the Randomized Evaluation of the Effects of Anacetrapib through Lipid Modification (REVEAL) trial. Methods Data from the 30,449 participants with atherosclerotic vascular disease receiving effective statin therapy in REVEAL, were used to estimate regression models for participants' hospital costs and QoL using participants' characteristics at entry (socio-demographic, clinical, prior diseases and treatments) and time-updated adverse events. We estimate costs and QoL in the year of an event, and in subsequent years, using stepwise covariate selection (p-value &amp;lt;0.01). Standard errors were adjusted for clustering of participant annual costs. Hospital episodes were costed (2019 UK£) using the UK Healthcare Resource Groups reference costs 2. One- and two-part generalized linear regression models (GLMs) for annual hospital costs (part 1: logistic model for estimating probability of incurring cost, part 2: GLM with Gaussian, Poisson or Gamma distributions with identity or log links for estimating costs, conditional on incurring any) were compared. EQ-5D-5L questionnaires, completed by study participants at entry and final follow-up visits in the study, were mapped into QoL utility scores 3. QoL utility at final follow-up was used to estimate QoL decrements of adverse events using GLM linear model and adjusting for QoL at entry in addition to other participants characteristics. Results The two-part model with gamma distribution and identity link, indicated by specification tests and model fit statistics, was selected for modelling annual hospital costs (Figure 1). Non-haemorrhagic stroke, non-coronary revascularization, coronary revascularization and incident cancer were associated with highest hospital costs. The QoL model (Figure 2) indicated large QoL decrements associated with non-fatal non-haemorrhagic stroke, heart failure hospitalization, incident cancer and non-coronary revascularization, and comparatively small QoL decrement associated with experiencing non-fatal myocardial infarction. Conclusion These cost and QoL models in a well-managed contemporary high CVD risk patient population would assist in assessments of long-term net effects and cost-effectiveness of novel interventions to reduce cardiovascular risk. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): Merck Sharp &amp; Dohme and UK Medical Research Council Figure 1Figure 2

A Clinical Conundrum: Intensifying Glycemic Control in the Presence of Advanced Diabetic Retinopathy.

Diabetic retinopathy (DR) is a potentially devastating complication of diabetes because of the risk of developing blindness. While therapies to prevent blindness are improving, in much of the world visual impairment continues to occur and impact on the lives of people with diabetes and the societies they live in (1,2). Glycemic control has been shown to provide protection from progression of DR (3–5), but there appear to be limits to that protection. Lowering A1C with a goal of achieving A1C <7% was no better than using a goal slightly above that (6.8% vs. 7.3%) when baseline A1C was ∼7.5% at the outset; this small decrement and small continued difference did not further protect the retina (6). Furthermore, if duration of diabetes is sufficiently long, even relatively tight control is eventually associated with development of DR (3–5), suggesting that there are other factors that mediate DR besides glycemia (7,8). Another factor that might limit the effect of improving glycemia to prevent progression is the presence of advanced DR at the time of initiating a glycemic control trial (9). The Veterans Affairs Diabetes Trial (VADT) did not show evidence of protection against DR progression, explained by the severity level of DR at the start of the trial (9), which was greater than in other comparable large trials (3–5). This month's issue of Diabetes Care contains another publication from the VADT with the major outcome focused on eye procedures that were performed subsequent to entry into …