Multifactorial falls prevention programmes for older adults presenting to the Emergency Department with a fall: systematic review and meta-analysis.

Background: Falls are a leading cause of emergency department (ED) presentations in older adults. Objective: To determine whether multifactorial falls prevention interventions are effective in preventing falls, fall injuries, ED re-presentations and hospital admissions in older adults presenting to the ED with a fall. Design: Systematic review and meta-analyses of randomised control trials (RCTs). Methods: Four health-related electronic databases were searched (inception to June 2018) with two independent reviewers determining inclusion, assessing study quality and undertaking data extraction. Study selection: RCTs of multifactorial falls prevention interventions targeting community dwelling older adults (≥ 60 years) presenting to the ED with a fall and providing quantitative data on at least one of the review outcomes. Results: Twelve studies involving 3,986 participants, from six countries, were eligible for inclusion. Studies were of variable methodological quality. The multifactorial interventions were heterogeneous, though the majority included components such as education, referral to relevant healthcare services, home modifications, exercise, and medication changes. Meta-analyses demonstrated a non-significant reduction in falls (rate ratio=0.78; 95% CI 0.58, 1.05) with multi-factorial falls prevention programs. Multi-factorial interventions did not significantly affect the number of fallers (risk ratio=1.02; 95% CI 0.88, 1.18), rate of fractured neck of femur (risk ratio=0.82; 95% CI 0.53, 1.25), fall-related ED presentations (rate ratio=0.99; 95% CI 0.84, 1.16), or hospitalisations (rate ratio=1.14; 95% CI 0.69, 1.89). Conclusions: There is insufficient evidence to support the use of multifactorial falls interventions to prevent falls or hospital utilisation in older people presenting to ED following a fall. Further research targeting this population group is required

Genome-wide association meta-analysis of corneal curvature identifies novel loci and shared genetic influences across axial length and refractive error.

Corneal curvature, a highly heritable trait, is a key clinical endophenotype for myopia - a major cause of visual impairment and blindness in the world. Here we present a trans-ethnic meta-analysis of corneal curvature GWAS in 44,042 individuals of Caucasian and Asian with replication in 88,218 UK Biobank data. We identified 47 loci (of which 26 are novel), with population-specific signals as well as shared signals across ethnicities. Some identified variants showed precise scaling in corneal curvature and eye elongation (i.e. axial length) to maintain eyes in emmetropia (i.e. HDAC11/FBLN2 rs2630445, RBP3 rs11204213); others exhibited association with myopia with little pleiotropic effects on eye elongation. Implicated genes are involved in extracellular matrix organization, developmental process for body and eye, connective tissue cartilage and glycosylation protein activities. Our study provides insights into population-specific novel genes for corneal curvature, and their pleiotropic effect in regulating eye size or conferring susceptibility to myopia

Whole-genome sequencing reveals host factors underlying critical COVID-19

Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2,3,4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease

Effects of experience on the coordination of internally and externally timed soccer kicks

The authors investigated differences in the soccer kick between 8 experienced and 10 less experienced participants in 2 different task conditions (kicking a stationary ball or a moving ball at a target). The experienced participants were more accurate than their less experienced counterparts, whereas there were no differences in maximum foot velocity between groups or between conditions. When compared with their performance in the stationary condition, participants kicked the moving ball with a smaller range of movement at the knee of the kicking leg, maintaining a proximodistal coordination pattern. Because of their significantly shorter knee-flexion phase, the participants in the experienced group displayed a significantly shorter time between initiation of the forward swing of the kick and ball contact than that of those in the less experienced group. The rapid knee flexion may have been a strategy of exploiting passive dynamics to increase accuracy rather than velocity. Members of both groups showed a proximodistal initiation sequence in the kicking leg, which suggests that players can acquire that coordination pattern with relatively little structured practice and that further practice leads to improvement possibly through the increased exploitation of passive dynamics. Copyright © 2007 Heldref Publications

A soil moisture accounting-procedure with a Richards' equation-based soil texture-dependent parameterization

Given a time-series of potential evapotranspiration and rainfall data, there are at least two approaches for estimating vertical percolation rates. One approach involves solving Richards' equation (RE) with a plant uptake model. An alternative approach involves applying a simple soil moisture accounting procedure (SMAP) based on a set of conceptual stores and conditional statements. It is often desirable to parameterize distributed vertical percolation models using regional soil texture maps. This can be achieved using pedotransfer functions when applying RE. However, robust soil texture based parameterizations for more simple SMAPs have not previously been available. This article presents a new SMAP designed to emulate the response of a one-dimensional homogenous RE model. Model parameters for 231 different soil textures are obtained by calibrating the SMAP model to 20 year time-series from equivalent RE model simulations. The results are then validated by comparing to an additional 13 years of simulated RE model data. The resulting work provides a new simple two parameter (% sand and % silt) SMAP, which provides consistent vertical percolation data as compared to RE based models. Results from the 231 numerical simulations are also found to be qualitatively consistent with intuitive ideas concerning soil texture and soil moisture dynamics. Vertical percolation rates are found to be highest in sandy soils. Sandy soils are found to provide less water for evapotranspiration. Surface runoff is found to be more important in soils with high clay content

Controlling picolitre droplet impact dynamics by tailoring the solid subsurface

The oscillatory dynamics of picolitre water droplets following impact onto a range of hydrophobic surfaces is found to be influenced by the underlayer stiffness and thickness. The relative contributions of surface functionality versus subsurface hardness have been decoupled by utilising plasmachemical surface functionalisation and underlayer crosslinking respectively. Higher oscillation frequencies are measured for softer and thicker films, which correlates to a larger surface deformation around the liquid droplet contact line

Valuing Water Quality as a Function of Water Quality Measures

Employing a unique and rich data set of water quality attributes in conjunction with detailed household characteristics and trip information, we develop a mixed logit model of recreational lake usage and undertake thorough model specification and fitting procedures to identify the best set of explanatory variables, and their functional form for the estimated model. Our empirical analysis shows that individuals are responsive to the full set of water quality measures used by biologists to identify the impaired status of lakes. Thus, changes in these quality measures are not simply a scientific exercise, but they also translate into changes in the recreational usage patterns and well-being of individual households. Willingness-to-pay (WTP) estimates are reported based on improvements in these physical measures. Copyright 2009, Oxford University Press.