Development and Validation of Performance-Based Assessment of Daily Living Tasks in Age-Related Macular Degeneration.

Purpose: To establish the reliability and validity of five performance-based activities of daily living task tests (ADLTT), to correlate structure to function, to evaluate the impact of visual impairment (VI) on age-related macular degeneration (AMD), and to develop new outcome measures. Methods: A multidisciplinary team developed five ADLTTs: (1) reading test (RT); (2) facial expression (FE) recognition; (3) item search (IS) task; (4) money counting (MC) task; and (5) making a drink (MD), tested with binocular and monocular vision. ADLTTs were tested for known-group (i.e., difference between AMD group and controls) and convergent (i.e., correlation to other measures of visual function), validity metrics, and test-retest reliability in 36 patients with VI (visual acuity (logMAR VA > 0.4) in at least one eye caused by AMD versus 36 healthy controls without VI. Results: Compared to controls, AMD patients had a slower reading speed (-77.41 words/min; P < 0.001); took longer to complete MC using monocular worse eye and binocular vision (15.13 seconds and 4.06 seconds longer compared to controls, respectively; P < 0.001); and MD using monocular worse eye vision (9.37 sec; P = 0.033), demonstrating known-group validity. Only RT and MC demonstrated convergent validity, showing correlations with VA, contrast sensitivity, and microperimetry testing. Moderate to good test-retest reliability was observed for MC and MD (interclass correlation coefficient = 0.55 and 0.77; P < 0.001) using monocular worse eye vision. Conclusions: Real-world ADL functioning associated with VI-related AMD can be assessed with our validated ADLTTs, particularly MC and MD. Translational Relevance: This study validates visual function outcome measures that are developed for use in future clinical practice and clinical trials.

The influence of cortical activity on perception depends on behavioral state and sensory context.

The mechanistic link between neural circuit activity and behavior remains unclear. While manipulating cortical activity can bias certain behaviors and elicit artificial percepts, some tasks can still be solved when cortex is silenced or removed. Here, mice were trained to perform a visual detection task during which we selectively targeted groups of visually responsive and co-tuned neurons in L2/3 of primary visual cortex (V1) for two-photon photostimulation. The influence of photostimulation was conditional on two key factors: the behavioral state of the animal and the contrast of the visual stimulus. The detection of low-contrast stimuli was enhanced by photostimulation, while the detection of high-contrast stimuli was suppressed, but crucially, only when mice were highly engaged in the task. When mice were less engaged, our manipulations of cortical activity had no effect on behavior. The behavioral changes were linked to specific changes in neuronal activity. The responses of non-photostimulated neurons in the local network were also conditional on two factors: their functional similarity to the photostimulated neurons and the contrast of the visual stimulus. Functionally similar neurons were increasingly suppressed by photostimulation with increasing visual stimulus contrast, correlating with the change in behavior. Our results show that the influence of cortical activity on perception is not fixed, but dynamically and contextually modulated by behavioral state, ongoing activity and the routing of information through specific circuits.

A 10-year review on older patients undergoing colorectal cancer surgery: surgeon-led geriatric service and good quality surgery are drivers of good outcomes.

BACKGROUND: Older age and frailty are associated with worse postoperative outcomes and prolonged length of stay (LOS). In this study, we aimed to analyze the long-term outcomes after the implementation of our geriatric surgical service (GSS). METHODS: This was a single-center retrospective study from July 2010 to December 2021 on patients aged ≥75 years or patients aged ≥65 years with frailty. Our GSS includes multidisciplinary assessment and optimization by specialized nurses, physiotherapists, anesthetists, dietitians, and geriatricians. Cumulative sum (CUSUM) analysis was used to assess the performance of our GSS. Our primary outcome was defined as the presence of 30-day mortality, prolonged LOS ≥ 14 days, and/or >10% decrease in the modified Barthel Index at 6 weeks, which depicts the failure of GSS. A downsloping CUSUM curve implies consecutive cases of success. RESULTS: There were 233 patients with a mean age of 79.0 ± 4.9 years; of these, 73 patients (31.3%) were frail. The overall 30-day mortality (1.7%), Clavien-Dindo ≥ grade IIIA complications (12.0%), and LOS (median, 7.0 days) were low. The CUSUM analysis showed 3 phases with overall sustained improvement in outcomes. Transient inconsistency in the second phase (during midimplementation of GSS) may be due to the early adoption of laparoscopic surgery (44.6% vs 24.1%; adjusted P =.031) and expansion of service to include patients with higher perioperative risks (weighted Charlson Comorbidity Index score ≥4: 64.9% vs 38.0%; adjusted P =.002) in the second period compared with the first period. The outcomes subsequently improved in the third phase after overcoming the learning curve. CONCLUSION: Our GSS showed sustained performance over the past decade. Good quality surgery and surgeon-led geriatric service are paramount for good postoperative outcomes.

Monocular and Binocular Visual Function Assessments and Activities of Daily Living Performance in Age-Related Macular Degeneration.

PURPOSE: To evaluate the relationship between specific monocular and binocular visual function (VF) assessments with binocularly performed activities of daily living task tests (ADLTTs) in patients with age-related macular degeneration (AMD) and healthy controls. DESIGN: Prospective case-control cohort study. SUBJECTS: Thirty-six AMD patients and 36 controls. METHOD: Visual field assessments included monocular and binocular best-corrected visual acuity (BCVA), contrast sensitivity (CS), and monocular microperimetry testing for mean macula sensitivity, mean retina sensitivity (MRS), fixation area, and fixation distance from fovea (FDF). Age-related macular degeneration lesion area and sensitivity were measured on OCT and microperimetry, respectively. Participants performed 4 validated ADLTTs with binocular BCVA: (1) reading; (2) item-search; (3) money-counting; and (4) multi-step drink-making tasks. MAIN OUTCOME MEASURES: Spearman correlations and multivariate regression analysis, adjusted for age, sex, and potential correlation between the 2 eyes, were used to assess the relationship between monocular and binocular VF assessments, and ADLTT performance in both groups. RESULTS: Age-related macular degeneration patients had poorer VF (BCVA, CS, mean macula sensitivity, and MRS) compared with healthy controls. Monocular BCVA in both better- and worse-vision eyes was moderately correlated with the binocular reading speed and money-counting tasks in participants with AMD. In AMD, monocular worse eye CS, MRS, AMD lesion area on OCT, and lesion sensitivity on microperimetry showed moderate correlations to various ADLTTs, such as reading, money-counting, and drink-making. Similar findings were found in our AMD cohort on multivariate regression analysis. Fewer significant correlations were observed for the better-vision eye, whereas no correlations were observed for healthy controls between VF parameters and ADLTTs. In contrast, significant associations were observed between binocular BCVA and CS with binocular ADLTTs (reading and item-search tasks) but not in AMD patients. CONCLUSION: Although monocular BCVA remains the most common measure of VF, CS and microperimetry testing also show significant correlations with ADLTTs performance in AMD patients, and should be considered as complimentary VF-outcome measures in both clinical and research settings. Unlike healthy subjects, AMD patients do not rely on binocular VF for ADLTT function, with the worse-vision eye impacting binocular ADLTT function more than the better-vision eye. Therefore, the worse-vision eye should not be neglected during the management of AMD. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Delicate dining with a date and burger binging with buddies: impression management across social settings and consumers' preferences for masculine or feminine foods.

Consumers often use their food choices as an impression management strategy to signal desirable aspects about themselves to others, especially in public places like restaurants and cafeterias, where the presence of others can promote certain consumption choices and preference patterns. In mating contexts, people prefer gender-typical traits and characteristics in a potential partner. Food options can also be classified according to their gender typicality, with certain alternatives perceived as feminine (e.g., salad, seafood) and with other options perceived as more masculine (e.g., steak, burger). Drawing on impression management theories from the drinking and dining domain and literature on sex differences in human mate preferences, we present a high-powered experiment investigating whether consumers' preferences for masculine or feminine foods depend on the social setting in which the food consumption takes place: dining with an attractive date (mating) or meeting and eating with friends (non-mating). Participants (N = 162, 46.9% females, 53.1% males; age M = 41.8 years, SD = 14.5) were randomly assigned to one of the two experimental conditions (mating vs. non-mating) and were asked to indicate their food preferences for 15 dishes that differed markedly in perceived femininity/masculinity. Consistent with our theorizing, females (males) generally had a stronger preference for foods perceived as more feminine (masculine), thereby supporting the gender-typicality thesis at the aggregate level. Furthermore, females in the mating condition-but not females in the non-mating condition-reported significantly stronger preferences for more feminine food alternatives. However, in direct contrast to our theorizing, males preferred more masculine meals in the non-mating condition (i.e., when dining with friends), whereas this gender-typical tendency did not emerge in the mating condition (i.e., when dining with an attractive date). We discuss the theoretical and practical implications of these findings and present a set of fruitful avenues for future research.

Greater traditionalism predicts COVID-19 precautionary behaviors across 27 societies.

People vary both in their embrace of their society's traditions, and in their perception of hazards as salient and necessitating a response. Over evolutionary time, traditions have offered avenues for addressing hazards, plausibly resulting in linkages between orientations toward tradition and orientations toward danger. Emerging research documents connections between traditionalism and threat responsivity, including pathogen-avoidance motivations. Additionally, because hazard-mitigating behaviors can conflict with competing priorities, associations between traditionalism and pathogen avoidance may hinge on contextually contingent tradeoffs. The COVID-19 pandemic provides a real-world test of the posited relationship between traditionalism and hazard avoidance. Across 27 societies (N = 7844), we find that, in a majority of countries, individuals' endorsement of tradition positively correlates with their adherence to costly COVID-19-avoidance behaviors; accounting for some of the conflicts that arise between public health precautions and other objectives further strengthens this evidence that traditionalism is associated with greater attention to hazards.

Naturally green, irrationally lean: How background scenery affects calorie judgments.

Extant research has found that the addition of vegetables to a meal induces a "health halo," thereby lowering the perceived calorie content of the entire dish. We investigated whether environmental stimuli that convey naturalness could trigger such a halo effect. Specifically, we tested whether meals accompanied by a natural, as opposed to an urban, background scenery were estimated to be lower in their calorie content and whether this effect was moderated by the perceived healthiness of the food alternatives. In a mixed (between-within-subjects) design experiment, 200 participants estimated the calorie content and rated the healthiness of 18 complex meals presented against either a natural or an urban background. Our results showed no main effect of the food rating background. However, there was a negative relationship between inferred food healthiness and the estimated calorie content of the meals. In addition, we found a significant interaction between food rating background and inferred healthiness of the evaluated food alternatives. Specifically, when participants evaluated meals against a natural background, they rated relatively unhealthy food alternatives as lower in calories than when they evaluated such alternatives against an urban background. Overall, our results highlight the moderating role of perceived food healthiness in studying the effects of environmental cues on consumers' calorie judgments.

Effect of atorvastatin on skeletal muscles of patients with knee osteoarthritis: Post-hoc analysis of a randomised controlled trial.

Objective: Populations with knee osteoarthritis (KOA) are at increased risk of cardiovascular disease, due to higher prevalence of risk factors including dyslipidaemia, where statins are commonly prescribed. However, the effect of statins on muscles and symptoms in this population is unknown. Thus, this study examined the effect of atorvastatin on muscle properties in patients with symptomatic KOA. Design: Post-hoc analysis of a 2-year multicentre randomised, double-blind, placebo-controlled trial. Setting: Australian community. Participants: Participants aged 40-70 years (mean age 55.7 years, 55.6% female) with KOA who met the American College of Rheumatology clinical criteria received atorvastatin 40 mg daily (n = 151) or placebo (n = 153). Main outcome measures: Levels of creatinine kinase (CK), aspartate transaminase (AST), and alanine transaminase (ALT) at 1, 6, 12, and 24 months; muscle strength (by dynamometry) at 12 and 24 months; vastus medialis cross-sectional area (CSA) on magnetic resonance imaging at 24 months; and self-reported myalgia. Results: There were no significant between-group differences in CK and AST at all timespoints. The atorvastatin group had higher ALT than placebo group at 1 (median 26 vs. 21, p = 0.004) and 6 (25 vs. 22, p = 0.007) months without significant between-group differences at 12 and 24 months. Muscle strength increased in both groups at 24 months without between-group differences [mean 8.2 (95% CI 3.5, 12.9) vs. 5.9 (1.3, 10.4), p = 0.49]. Change in vastus medialis CSA at 24 months favoured the atorvastatin group [0.11 (-0.10, 0.31) vs. -0.23 (-0.43, -0.03), p = 0.02] but of uncertain clinical significance. There was a trend for more myalgia in the atorvastatin group (8/151 vs. 2/153, p = 0.06) over 2 years, mostly occurring within 6 months (7/151 vs. 1/153, p = 0.04). Conclusions: In those with symptomatic KOA, despite a trend for more myalgia, there was no clear evidence of an adverse effect of atorvastatin on muscles, including those most relevant to knee joint health.

Does aerobic exercise effect pain sensitisation in individuals with musculoskeletal pain? A systematic review.

BACKGROUND: Pain sensitisation plays a major role in musculoskeletal pain. However, effective treatments are limited, and although there is growing evidence that exercise may improve pain sensitisation, the amount and type of exercise remains unclear. This systematic review examines the evidence for an effect of aerobic exercise on pain sensitisation in musculoskeletal conditions. METHODS: Systematic searches of six electronic databases were conducted. Studies were included if they examined the relationship between aerobic physical activity and pain sensitisation in individuals with chronic musculoskeletal pain, but excluding specific patient subgroups such as fibromyalgia. Risk of bias was assessed using Cochrane methods and a qualitative analysis was conducted. RESULTS: Eleven studies (seven repeated measures studies and four clinical trials) of 590 participants were included. Eight studies had low to moderate risk of bias. All 11 studies found that aerobic exercise increased pressure pain thresholds or decreased pain ratings in those with musculoskeletal pain [median (minimum, maximum) improvement in pain sensitisation: 10.6% (2.2%, 24.1%)]. In these studies, the aerobic exercise involved walking or cycling, performed at a submaximal intensity but with incremental increases, for a 4-60 min duration. Improvement in pain sensitisation occurred after one session in the observational studies and after 2-12 weeks in the clinical trials. CONCLUSIONS: These findings provide evidence that aerobic exercise reduces pain sensitisation in individuals with musculoskeletal pain. Further work is needed to determine whether this translates to improved patient outcomes, including reduced disability and greater quality of life.

Populated Places and Conspicuous Consumption: High Population Density Cues Predict Consumers' Luxury-Linked Brand Attitudes.

Population density has been identified as an ecological factor with considerable behavioral implications. The present research aimed to examine whether the mere perception of more (vs. less) populated places can change consumers' luxury-linked brand attitudes. To this end, we experimentally manipulated consumers' perceptions of population density using pictorial exposure to high (vs. low) population density cues. The results revealed a significant interaction between manipulated population density and perceived brand luxury on brand attitudes. Specifically, exposure to high rather than low population density cues resulted in more positive (negative) attitudes toward brands deemed to be more (less) luxurious. These findings support our prediction that high population density cues can shift people's perceptions in consumption contexts linked to luxury. Our work contributes to the growing stream of literature on population density and suggests that this (geo-) demographic factor can exert important downstream effects on consumer behavior.

Development and psychometric evaluation of the Anticipated Food Scarcity Scale (AFSS).

Mass media extensively inform societies about events threatening the global food supply (e.g., pandemics or Brexit). Consumers exposed to such communication may perceive food resources as becoming scarcer. In line with an evolutionary account, these perceptions can shift decision-making in domains such as food preferences or prosociality. However, existing literature has solely focused on actual and past food insecurity experiences threatening mostly low-income families, thus neglecting the future-oriented perceptions among the general population. This paper broadens the food insecurity research scope by developing a new construct-anticipated food scarcity (AFS)-which is defined as the perception that food resources are becoming less available (in the future). We have developed and psychometrically validated the 8-item Anticipated Food Scarcity Scale (AFSS) in eight studies (N = 1333). The 8-item AFSS is unidimensional and has good psychometric qualities. The scale is sensitive to food scarcity cues and, therefore, can be used in experimental research. Moreover, its relatively narrow set of items makes it an exceptionally potent tool for use in online surveys, field settings, and lab studies. Taken together, the AFSS presents an alternative approach to food scarcity measurement in affluent societies and, consequently, can foster novel research on food waste, prosocial behaviors, and other similar topic areas.

Neurological implications of COVID-19: a review of the science and clinical guidance.

COVID-19 is a significant global health burden. The pulmonary morbidity and mortality of COVID-19 is well described, however, there is mounting evidence of neurological manifestations of SARS-CoV-2, which may be of prognostic significance. This paper summarises the available evidence in order to provide clinicians with a concise summary of the peripheral and central neurological manifestations of COVID-19, discusses specific issues regarding the management of chronic neurological disease in the context of the pandemic, and provides a summary of the thrombotic implications of the disease for the neurologist.

Reliability of venous blood gas sodium, potassium and creatinine.

OBJECTIVE: To determine the level of correlation between sodium, potassium and creatinine readings between point-of-care venous blood gas (VBG) and laboratory biochemistry measurements (LBM). METHODS: Data was obtained from three Monash Health (one of the largest health networks in metropolitan Melbourne) emergency departments. 16,527 VBGs were matched with LBM for sodium, 16,437 for potassium and 8,597 for creatinine. Pearson correlation and further subgroup analyses were carried out to explore if acid-base imbalance affected sodium, potassium or creatinine reliability in VBG. RESULTS: The range of VBG values showed more variation in comparison to LBM. There was good correlation (r>0.8, p<0.001) between measured values with the exception of potassium in acidaemia, however, there was consistent and statistically significant difference in measured values. CONCLUSIONS: The small mean differences across all three parameters observed although statistically significant are unlikely to be clinically significant. With minor calibrations, this would be an easily corrected problem. As such, we recommend that sodium, potassium and creatinine measurements can be used interchangeably between the VBG and LBM, with the exception of potassium levels in acidaemia. Potassium levels in acidaemia should be used with caution due to lower correlation.

A roundtable on responsible innovation with autologous stem cells in Australia, Japan and Singapore.

We report on a roundtable event hosted in Singapore that sought to identify some of the ethical and regulatory challenges in translating autologous cell-based interventions, particularly those claiming to involve stem cells, into safe and effective therapies and to propose some solutions to encourage responsible innovation with these products. Challenges are identified in the three areas of cell manufacturing and processing, innovative uses of autologous cells in clinical practice and standards of evidence. Proposed solutions are discussed within a co-operative model of statutory laws and regulations that can enable product development with autologous cells and professional codes and standards that can encourage ethical conduct in clinical practice. Future research should be directed toward establishing regional networks for the development of internationally consistent standards in manufacturing and ethical codes of conduct for innovating with stem cells, and other autologous cells, and fostering ongoing exchange between jurisdictions.

Survival outcomes of younger men (< 55 years) undergoing radical prostatectomy.

BACKGROUND: The aim of the paper is to investigate the outcomes of patients younger than 55 years in Victoria, Australia undergoing radical prostatectomy (RP) for prostate cancer. MATERIALS AND METHODS: Data on all men undergoing RP in Victoria between January 1, 2004 and December 31, 2014 were obtained from the Victorian Cancer Registry. Tumor characteristics including Gleason grade, stage of disease (based on final pathology specimen), and cause of death were also obtained. Statistical analysis was performed using Chi-square test, Cox proportional hazards method, and Kaplan-Meier analysis. RESULTS: A total of 14,686 men underwent RP during the defined period. Of these men 109 were aged 35-44 years and 1,998 were aged 45-54 years. Men aged 35-44 years and 45-54 years were compared against men aged 55-74 years. The majority of men between the ages of 35 years and 44 years, and 45 years and 54 years had higher rates of Gleason ≤ 7 disease compared with men aged between 55 years and 74 years (92.7% vs. 86.8% vs. 79.3%; P < 0.01) and ≤ T2 disease (82.6% vs. 75.6% vs. 49.9%; P < 0.01) but similar median prostate-specific antigen values. On a multivariate analysis adjusting for Gleason score, T stage, and prostate-specific antigen, men aged 45-54 years and 55-64 years had 67% and 46% increase in overall survival, respectively, compared to men aged 65-74 years; but these differences were not seen in the 35-44 year age group. There were no differences in prostate cancer specific deaths between the groups. The 5- and 10-year overall survival outcomes were both higher for men aged 45-54 years compared to mean aged 55-74 years (97.9% vs. 95.9% and 94.9% vs. 85.3). CONCLUSION: Men aged 45-54 years undergoing RP had better overall survival compared to men aged 55-74 years, but these effects were not seen in men aged 35-44 years. There were no differences in prostate cancer specific survival in these groups.