No / There is interest in deriving case-mix adjusted standardised mortality ratios so that comparisons between healthcare providers, such as hospitals, can be undertaken in the controversial belief that variability in standardised mortality ratios reflects quality of care. Typically standardised mortality ratios are derived using a fixed effects logistic regression model, without a hospital term in the model. This fails to account for the hierarchical structure of the data - patients nested within hospitals - and so a hierarchical logistic regression model is more appropriate. However, four methods have been advocated for deriving standardised mortality ratios from a hierarchical logistic regression model, but their agreement is not known and neither do we know which is to be preferred. We found significant differences between the four types of standardised mortality ratios because they reflect a range of underlying conceptual issues. The most subtle issue is the distinction between asking how an average patient fares in different hospitals versus how patients at a given hospital fare at an average hospital. Since the answers to these questions are not the same and since the choice between these two approaches is not obvious, the extent to which profiling hospitals on mortality can be undertaken safely and reliably, without resolving these methodological issues, remains questionable.

Yes / Previous studies have shown markedly lower birth weight among infants of South Asian origin compared with those of White European origin. Whether such differences mask greater adiposity in South Asian infants and whether they persist across generations in contemporary UK populations is unclear. Our aim was to compare birth weight, skinfold thickness and cord leptin between Pakistani and White British infants and to investigate the explanatory factors, including parental and grandparental birthplace. METHODS: We examined the differences in birth weight and skinfold thickness between 4649 Pakistani and 4055 White British infants born at term in the same UK maternity unit and compared cord leptin in a subgroup of 775 Pakistani and 612 White British infants. RESULTS: Pakistani infants were lighter (adjusted mean difference -234 g 95% CI -258 to -210) and were smaller in both subscapular and triceps skinfold measurements. The differences for subscapular and triceps skinfold thickness (mean z-score difference -0.27 95% CI -0.34 to -0.20 and -0.23 95% CI -0.30 to -0.16, respectively) were smaller than the difference in birth weight (mean z-score difference -0.52 95% CI -0.58 to -0.47) and attenuated to the null with adjustment for birth weight (0.03 95% CI -0.03 to 0.09 and -0.01 95% CI -0.08 to 0.05, respectively). Cord leptin concentration (indicator of fat mass) was similar in Pakistani and White British infants without adjustment for birth weight, but with adjustment became 30% higher (95% CI 17% to 44%) among Pakistani infants compared with White British infants. The magnitudes of difference did not differ by generation. CONCLUSIONS: Despite being markedly lighter, Pakistani infants had similar skinfold thicknesses and greater total fat mass, as indicated by cord leptin, for a given birth weight than White British infants. Any efforts to reduce ethnic inequalities in birth weight need to consider differences in adiposity and the possibility that increasing birth weight in South Asian infants might inadvertently worsen health by increasing relative adiposity.

No / Studies of diagnostic accuracy often report paired tests for sensitivity and specificity that can be pooled separately to produce summary estimates in a meta-analysis. This was done recently for a systematic review of radiographers' reporting accuracy of plain radiographs. The problem with pooling sensitivities and specificities separately is that it does not acknowledge any possible (negative) correlation between these two measures. A possible cause of this negative correlation is that different thresholds are used in studies to define abnormal and normal radiographs because of implicit variations in thresholds that occur when radiographers' report plain radiographs. A method that allows for the correlation that can exist between pairs of sensitivity and specificity within a study using a random effects approach is the bivariate model. When estimates of accuracy as a fixed-effects model were pooled separately, radiographers' reported plain radiographs in clinical practice at 93% (95% confidence interval (CI) 92-93%) sensitivity and 98% (95% CI 98-98%) specificity. The bivariate model produced the same summary estimates of sensitivity and specificity but with wider confidence intervals (93% (95% CI 91-95%) and 98% (95% CI 96-98%), respectively) that take into account the heterogeneity beyond chance between studies. This method also allowed us to calculate a 95% confidence ellipse around the mean values of sensitivity and specificity and a 95% prediction ellipse for individual values of sensitivity and specificity. The bivariate model is an improvement on pooling sensitivity and specificity separately when there is a threshold effect, and it is the preferred method of choice.

PURPOSE: Gait during obstacle negotiation is adapted in visually normal subjects whose vision is temporarily and unilaterally blurred or occluded. This study was conducted to examine whether gait parameters in individuals with long-standing deficient stereopsis are similarly adapted. METHODS: Twelve visually normal subjects and 16 individuals with deficient stereopsis due to amblyopia and/or its associated conditions negotiated floor-based obstacles of different heights (7-22 cm). Trials were conducted during binocular viewing and monocular occlusion. Analyses focused on foot placement before the obstacle and toe clearance over it. RESULTS: Across all viewing conditions, there were significant group-by-obstacle height interactions for toe clearance (P < 0.001), walking velocity (P = 0.003), and penultimate step length (P = 0.022). Toe clearance decreased (approximately 0.7 cm) with increasing obstacle height in visually normal subjects, but it increased (approximately 1.5 cm) with increasing obstacle height in the stereo-deficient group. Walking velocity and penultimate step length decreased with increasing obstacle height in both groups, but the reduction was more pronounced in stereo-deficient individuals. Post hoc analyses indicated group differences in toe clearance and penultimate step length when negotiating the highest obstacle (P < 0.05). CONCLUSIONS: Occlusion of either eye caused significant and similar gait changes in both groups, suggesting that in stereo-deficient individuals, as in visually normal subjects, both eyes contribute usefully to the execution of adaptive gait. Under monocular and binocular viewing, obstacle-crossing performance in stereo-deficient individuals was more cautious when compared with that of visually normal subjects, but this difference became evident only when the subjects were negotiating higher obstacles; suggesting that such individuals may be at greater risk of tripping or falling during everyday locomotion.

PURPOSE: A recent study suggested that updated spectacles could increase fall rate in frail older people. The authors hypothesized that the increased risk may be due to changes in spectacle magnification. The present study was conducted to assess the effects of spectacle magnification on step negotiation. METHODS: Adaptive gait and visual function were measured in 10 older adults (mean age, 77.1 +/- 4.3 years) with the participants' optimal refractive correction and when blurred with +1.00, +2.00, -1.00, and -2.00 DS lenses. Adaptive gait measurements for the leading and trailing foot included foot position before the step, toe clearance of the step edge, and foot position on the step. Vision measurements included visual acuity, contrast sensitivity, and stereoacuity. RESULTS: The blur lenses led to equal decrements in visual acuity and stereoacuity for the +1.00 and -1.00 DS and the +2.00 and -2.00 DS lenses. However, they had very different effects on step negotiation compared with the optimal correction. Positive-blur lenses led to an increased distance of the feet from the step, increased vertical toe clearance and reduced distance of the leading heel position on the step. Negative lenses led to the opposite of these changes. CONCLUSIONS: The step negotiation changes did not mirror the effects of blur on vision, but were driven by the magnification changes of the lenses. Steps appear closer and larger with positive lenses and farther away and smaller with negative ones. Magnification is a likely explanation of the mobility problems some older adults have with updated spectacles and after cataract surgery.

This study investigated stable-isotope ratio evidence of weaning for the late Anglo-Saxon population of Raunds Furnells, Northamptonshire, UK. delta(15)N and delta(13)C values in rib collagen were obtained for individuals of different ages to assess the weaning age of infants within the population. A peak in delta(15) N values at about 2-year-old, followed by a decline in delta(15) N values until age three, indicates a change in diet at that age. This change in nitrogen isotope ratios corresponds with the mortality profile from the site, as well as with archaeological and documentary evidence on attitudes towards juveniles in the Anglo-Saxon period. The pattern of delta(13) C values was less clear. Comparison of the predicted age of weaning to published data from sites dating from the Iron Age to the 19th century in Britain reveals a pattern of changing weaning practices over time, with increasingly earlier commencement and shorter periods of complementary feeding in more recent periods. Such a change has implications for the interpretation of socioeconomic changes during this period of British history, since earlier weaning is associated with decreased birth spacing, and could thus have contributed to population growth.

In this study human color constancy was tested for two-dimensional (2D) and three-dimensional (3D) setups with real objects and lights. Four different illuminant changes, a natural selection task and a wide choice of target colors were used. We found that color constancy was better when the target color was learned as a 3D object in a cue-rich 3D scene than in a 2D setup. This improvement was independent of the target color and the illuminant change. We were not able to find any evidence that frequently experienced illuminant changes are better compensated for than unusual ones. Normalizing individual color constancy hit rates by the corresponding color memory hit rates yields a color constancy index, which is indicative of observers' true ability to compensate for illuminant changes.

Distinguishing animal fats from plant oils in archaeological residues is not straightforward. Characteristic plant sterols, such as beta-sitosterol, are often missing in archaeological samples and specific biomarkers do not exist for most plant fats. Identification is usually based on a range of characteristics such as fatty acid ratios, all of which indicate that a plant oil may be present, none of which uniquely distinguish plant oils from other fats. Degradation and dissolution during burial alter fatty acid ratios and remove short-chain fatty acids, resulting in degraded plant oils with similar fatty acid profiles to other degraded fats. Compound-specific stable isotope analysis of delta(13)C(18:0) and delta(13)C(16:0), carried out by gas chromatography/combustion/isotope ratio mass spectrometry (GC/C/IRMS), has provided a means of distinguishing fish oils, dairy fats, ruminant and non-ruminant adipose fats, but plant oils are rarely included in these analyses. For modern plant oils where C(18:1) is abundant, delta(13)C(18:1) and delta(13)C(16:0) are usually measured. These results cannot be compared with archaeological data or data from other modern reference fats where delta(13)C(18:0) and delta(13)C(16:0) are measured, as C(18:0) and C(18:1) are formed by different processes resulting in different isotopic values. Eight samples of six modern plant oils were saponified, releasing sufficient C(18:0) to measure the isotopic values, which were plotted against delta(13)C(16:0). The isotopic values for these oils, with one exception, formed a tight cluster between ruminant and non-ruminant animal fats. This result complicates the interpretation of mixed fatty residues in geographical areas where both animal fats and plant oils were in use.

PURPOSE: To evaluate whether the Amblyopia and Strabismus Questionnaire (A&SQ) is a suitable instrument for the assessment of vision-related quality-of life (VR-QoL) in individuals with strabismus and/or amblyopia. METHODS: The A&SQ was completed by 102 individuals, all of whom had amblyopia, strabismus, or both. Rasch analysis was used to evaluate the usefulness of individual questionnaire items (i.e., questions); the response-scale performance; how well the items targeted VR-QoL; whether individual items showed response bias, depending on factors such as whether strabismus was present; and dimensionality. RESULTS: Items relating to concerns about the appearance of the eyes were applicable only to those with strabismus, and many items showed large ceiling effects. The response scale showed disordered responses and underused response options, which improved after the number of response options was reduced from five to three. This change improved the discriminative ability of the questionnaire (person separation index increased from 1.98 to 2.11). Significant bias was found between strabismic and nonstrabismic respondents. Separate Rasch analyses conducted for subjects with and without strabismus indicated that all A&SQ items seemed appropriate for individuals with strabismus (Rasch infit values between 0.60 and 1.40), but several items fitted the model poorly in amblyopes without strabismus. The AS&Q was not found to be unidimensional. CONCLUSIONS: The findings highlight the limitations of the A&SQ instrument in the assessment of VR-QoL in subjects with strabismus and especially in those with amblyopia alone. The results suggest that separate instruments are needed to quantify VR-QoL in amblyopes with and without strabismus.

Bei Kreativen Gruppentreffen (KGT) versammeln sich Mitarbeitende einer Institution in regelmäßigen Abständen in einer Kleingruppe unter der Leitung eines Moderators zum gemeinsamen, konstruktiven Bearbeiten individueller, aktueller, beruflicher Probleme und zur Findung praktikabler, zeitnah realisierbarer Lösungsstrategien zum Wohle des Einzelnen und damit des Gesamtsystems. Kreative Gruppentreffen sind dabei eine Kombination aus Anteilen der Teamsupervision und der Kollegialen Beratung unter bewusstem Einbeziehen bildnerisch-gestalterischer Methodik, die ihre Wurzeln in der Kunsttherapie hat. Im bildnerischen Explorationsraum kann durch Probehandeln Selbsterfahrung gesammelt werden und Lösungsstrategien für konkrete berufliche Schwierigkeiten erarbeitet und ausprobiert werden. Als exemplarische Berufsgruppe dienen Lehrkräfte. Ziel ist das Steigern der Zufriedenheit der Mitarbeiter, was sich positiv auf deren Leistungsbereitschaft niederschlägt. / "Creative groupmeetings" are a new methode of supervision including elements of selfreflection with the help of different methods of art-therapy.