Search

Objectives Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis.Setting Prospective, international, multicentre, observational cohort study.Participants Patients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative).Primary outcome 30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.Results This study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787).Conclusions Patients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups.Trial registration number NCT04323644

Objectives The psychological impact of the COVID-19 pandemic on doctors is a significant concern. Due to the emergence of multiple pandemic waves, longitudinal data on the impact of COVID-19 are vital to ensure an adequate psychological care response. The primary aim was to assess the prevalence and degree of psychological distress and trauma in frontline doctors during the acceleration, peak and deceleration of the COVID-19 first wave. Personal and professional factors associated with psychological distress are also reported.Design A prospective online three-part longitudinal survey.Setting Acute hospitals in the UK and Ireland.Participants Frontline doctors working in emergency medicine, anaesthetics and intensive care medicine during the first wave of the COVID-19 pandemic in March 2020.Primary outcome measures Psychological distress and trauma measured using the General Health Questionnaire-12 and the Impact of Events-Revised.Results The initial acceleration survey distributed across networks generated a sample of 5440 doctors. Peak and deceleration response rates from the original sample were 71.6% (n=3896) and 56.6% (n=3079), respectively. Prevalence of psychological distress was 44.7% (n=1334) during the acceleration, 36.9% (n=1098) at peak and 31.5% (n=918) at the deceleration phase. The prevalence of trauma was 23.7% (n=647) at peak and 17.7% (n=484) at deceleration. The prevalence of probable post-traumatic stress disorder was 12.6% (n=343) at peak and 10.1% (n=276) at deceleration. Worry of family infection due to clinical work was the factor most strongly associated with both distress (R2=0.06) and trauma (R2=0.10).Conclusion Findings reflect a pattern of elevated distress at acceleration and peak, with some natural recovery. It is essential that policymakers seek to prevent future adverse effects through (a) provision of vital equipment to mitigate physical and psychological harm, (b) increased awareness and recognition of signs of psychological distress and (c) the development of clear pathways to effective psychological care.Trial registration number ISRCTN10666798.

Brain injuries can significantly impact mental processes and lead to hidden disabilities not easily detectable. Traditional methods for assessing these impacts are imprecise, leading to unreliable prevalence estimates and treatments with uncertain effectiveness. Immersive virtual reality has shown promise for assessment, but its use as a standalone tool is rare. Our research focused on developing and validating a standalone immersive virtual reality classification system for unilateral spatial neglect, a condition common following brain injury characterized by inattention to one side of space. Our study involved 51 brain injury inpatients and 30 controls, all engaging with 'The Attention Atlas', an immersive virtual reality game for testing visual search skills. Our classification system aimed to identify patients with neglect, 'minor atypicality' (indicative of inattention not consistent enough to be labelled as neglect) or non-neglect. This categorization was based on a simple mathematical definition, utilizing gameplay to describe spatial orientation (to the left or right side) and attentional challenge (indicative of search inefficiency). These metrics were benchmarked against a normative model to detect atypical visual search, which refers to gameplay beyond the usual bounds. The combination of neglected side, orientation and challenge factors was used to categorize neglect. We discovered a strong correlation between atypical visual search patterns and neglect risk factors, such as middle cerebral artery stroke, parietal injuries and existing neglect diagnoses (Poisson regression incidence rate ratio = 7.18, 95% confidence interval = 4.41-11.90). In our study, immersive virtual reality-identified neglect in one-fourth of the patients ( n = 13, 25.5%), minor atypicality in 17.6% ( n = 9) and non-neglect in the majority, 56.9% ( n = 29). This contrasts with standard assessments, which detected neglect in 17.6% ( n = 9) of cases and had no intermediate category. Our analysis determined six categories of neglect, the most common being left hemispace neglect with above-median orientation and challenge scores. Traditional assessments were not significantly more accurate (accuracy = 84.3%, P = 0.06) than a blanket assumption of non-neglect. Traditional assessments were also relatively insensitive in detecting immersive virtual reality-identified neglect (53.8%), particularly in less severe cases and those involving right-side inattention. Our findings underline the effectiveness of immersive virtual reality in revealing various dimensions of neglect, surpassing traditional methods in sensitivity and detail and operating independently from them. To integrate immersive virtual reality into real-world clinical settings, collaboration with healthcare professionals, patients and other stakeholders is crucial to ensure practical applicability and accessibility., Competing Interests: The authors declare a potential perceived competing financial interest. The Attention Atlas and independent neglect classifier have been the topic of discussions for potential commercialization during the Bionics Queensland Challenge 2020, within Griffith University and within the Gold Coast University Hospital., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Guarantors of Brain.)

Background: Deficits in visuospatial attention, known as neglect, are common following brain injury, but underdiagnosed and poorly treated, resulting in long-term cognitive disability. In clinical settings, neglect is often assessed using simple pen-and-paper tests. While convenient, these cannot characterise the full spectrum of neglect. This protocol reports a research programme that compares traditional neglect assessments with a novel virtual reality attention assessment platform: The Attention Atlas (AA)., Methods/design: The AA was codesigned by researchers and clinicians to meet the clinical need for improved neglect assessment. The AA uses a visual search paradigm to map the attended space in three dimensions and seeks to identify the optimal parameters that best distinguish neglect from non-neglect, and the spectrum of neglect, by providing near-time feedback to clinicians on system-level behavioural performance. A series of experiments will address procedural, scientific, patient, and clinical feasibility domains., Results: Analyses focuses on descriptive measures of reaction time, accuracy data for target localisation, and histogram-based raycast attentional mapping analysis; which measures the individual's orientation in space, and inter- and intra-individual variation of visuospatial attention. We will compare neglect and control data using parametric between-subjects analyses. We present example individual-level results produced in near-time during visual search., Conclusions: The development and validation of the AA is part of a new generation of translational neuroscience that exploits the latest advances in technology and brain science, including technology repurposed from the consumer gaming market. This approach to rehabilitation has the potential for highly accurate, highly engaging, personalised care.

Background: In neurorehabilitation, problems with visuospatial attention, including unilateral spatial neglect, are prevalent and routinely assessed by pen-and-paper tests, which are limited in accuracy and sensitivity. Immersive virtual reality (VR), which motivates a much wider (more intuitive) spatial behaviour, promises new futures for identifying visuospatial atypicality in multiple measures, which reflects cognitive and motor diversity across individuals with brain injuries., Methods: In this pilot study, we had 9 clinician controls (mean age 43 years; 4 males) and 13 neurorehabilitation inpatients (mean age 59 years; 9 males) recruited a mean of 41 days post-injury play a VR visual search game. Primary injuries included 7 stroke, 4 traumatic brain injury, 2 other acquired brain injury. Three patients were identified as having left sided neglect prior to taking part in the VR. Response accuracy, reaction time, and headset and controller raycast orientation quantified gameplay. Normative modelling identified the typical gameplay bounds, and visuospatial atypicality was defined as gameplay beyond these bounds., Results: The study found VR to be feasible, with only minor instances of motion sickness, positive user experiences, and satisfactory system usability. Crucially, the analytical method, which emphasized identifying 'visuospatial atypicality,' proved effective. Visuospatial atypicality was more commonly observed in patients compared to controls and was prevalent in both groups of patients-those with and without neglect., Conclusion: Our research indicates that normative modelling of VR gameplay is a promising tool for identifying visuospatial atypicality after acute brain injury. This approach holds potential for a detailed examination of neglect., (© 2023. The Author(s).)

Background: Healthcare workers (HCWs) are at high risk of SARS-CoV-2 infection. Effective use of personal protective equipment (PPE) reduces this risk. We sought to determine the prevalence and predictors of self-reported access to appropriate PPE (aPPE) for HCWs in the UK during the COVID-19 pandemic., Methods: We conducted cross sectional analyses using data from a nationwide questionnaire-based cohort study administered between December 2020-February 2021. The outcome was a binary measure of self-reported aPPE (access all of the time vs access most of the time or less frequently) at two timepoints: the first national lockdown in the UK in March 2020 (primary analysis) and at the time of questionnaire response (secondary analysis)., Results: Ten thousand five hundred eight HCWs were included in the primary analysis, and 12,252 in the secondary analysis. 35.2% of HCWs reported aPPE at all times in the primary analysis; 83.9% reported aPPE at all times in the secondary analysis. In the primary analysis, after adjustment (for age, sex, ethnicity, migration status, occupation, aerosol generating procedure exposure, work sector and region, working hours, night shift frequency and trust in employing organisation), older HCWs and those working in Intensive Care Units were more likely to report aPPE at all times. Asian HCWs (aOR:0.77, 95%CI 0.67-0.89 [vs White]), those in allied health professional and dental roles (vs those in medical roles), and those who saw a higher number of COVID-19 patients compared to those who saw none (≥ 21 patients/week 0.74, 0.61-0.90) were less likely to report aPPE at all times. Those who trusted their employing organisation to deal with concerns about unsafe clinical practice, compared to those who did not, were twice as likely to report aPPE at all times. Significant predictors were largely unchanged in the secondary analysis., Conclusions: Only a third of HCWs in the UK reported aPPE at all times during the first lockdown and that aPPE had improved later in the pandemic. We also identified key determinants of aPPE during the first UK lockdown, which have mostly persisted since lockdown was eased. These findings have important implications for the safe delivery of healthcare during the pandemic., (© 2022. The Author(s).)

Background: The number of different antimicrobial recommendations between hospital trusts for the same indication in England is unknown., Aim: We aimed to evaluate the heterogeneity of antimicrobial recommendations for seven common inpatient infections across hospital trusts in England and evaluate changes to recommendations following introduction of national (National Institute for Healthcare and Excellence, NICE) and international (WHO) antimicrobial guidelines., Methods: Guidelines published on the MicroGuide smartphone application were collected from December 2017 to February 2018 and re-evaluated between December 2019 and February 2020. The following indications were assessed: community-acquired pneumonia (CAP) CURB65 score ≥3, hospital-acquired pneumonia (HAP), infective exacerbation of chronic obstructive pulmonary disease (iCOPD), cellulitis, uncomplicated urinary tract infection (uUTI), intra-abdominal infection (IAI) and sepsis of unknown source (SUS). On follow-up, compliance against WHO WATCH antibiotic and NICE recommendations was evaluated., Results: Guidelines were obtained predominantly from England. Antibiotic regimens between hospitals became increasingly diverse across indications in the following order: uUTI, cellulitis, iCOPD, CAP, HAP, IAI and SUS. A piperacillin/tazobactam-based regimen was recommended in HAP (59%), SUS (39%) and IAI (30%). After 2 years, 107 changes were made to 357 antibiotic regimen recommendations; the overall number of regimens using piperacillin-tazobactam and WHO WATCH antibiotics remained similar. Compliance of recommendations with NICE guidelines as follows: iCOPD (100% adherent), uUTI (98%), cellulitis (90%), CAP (43%) and HAP (27%)., Conclusion: The heterogeneity of antibiotic recommendations increased as the indicated infection was more severe, with broader underlying bacterial causes. Piperacillin-tazobactam remains favoured in antibiotic regimens, despite not recommended in WHO and NICE guidance., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Aims: The Australian Health Survey 2011 to 2013 indicated that Western Australian women had good iodine status, suggesting adequate consumption of iodine from food, however, little is known about pregnant women in this state. The aim was to investigate the iodine-containing food practices of Western Australian pregnant women., Methods: Pregnant women attending antenatal clinics at a public tertiary hospital in Perth, Western Australia, were invited to complete a questionnaire investigating consumption of key iodine food sources and knowledge of iodine-containing foods. Food frequency data were entered into FoodWorks based on the Australian Food and Nutrition Database 2007., Results: A total of 425 women took part in the study with a mean (SD) age of 29.4 (5.5) years. Sixty percent of women reported consuming bread at least daily. Only 37.6% of women used iodised salt, but the median (25, 75 percentile) iodine intake of these women was 183 (142, 267) μg/day compared to 148 (100, 228) μg/day of iodine from food only. Ethnicity was associated with iodised salt use: 76% of Asian women compared with 33% of Caucasian women. Three quarters of the women did not know if any foods are required to be fortified with iodine., Conclusion: The iodine-containing food practices of pregnant women in this state suggest a risk of insufficiency. The present study is limited by the use of a semi-quantitative and non-validated food frequency questionnaire, thus assessment of the iodine intake and status of pregnant women representative of the ethnic mix of Western Australia is recommended., (© 2019 Dietitians Association of Australia.)

Background: Iodine requirements increase during pregnancy and although national recommendations for daily iodine supplementation (150 µg) exist, there is no research related to the uptake of these recommendations by pregnant women in Western Australia., Aims: To investigate the use of iodine-containing supplements and associations with their use in a sample of Western Australian pregnant women., Materials and Methods: A cross-sectional study was conducted on pregnant women attending antenatal clinics in a public tertiary hospital for women and neonates in Perth during 2012 and 2013 (n = 425). Women completed a self-administered questionnaire. Frequencies and percentages were obtained for categorical variables and χ 2 tests conducted to assess associations between iodine-containing supplement use and sociodemographic and pregnancy-related factors., Results: A total of 24% of pregnant women reported using iodine-containing supplements prior to pregnancy compared to 66% during the previous two months. Age and maternal income were associated with use prior to pregnancy only (P = 0.004 and P = 0.031) and first pregnancy was associated with use during pregnancy only (P = 0.006). Ethnicity and reporting use in the first two trimesters were associated with the use of iodine supplements both in the year prior to pregnancy (P = 0.002 and P = 0.020, respectively) and during pregnancy (P < 0.001 and P = 0.001, respectively)., Conclusions: Two-thirds of women reported use of iodine-containing supplements during pregnancy, within the range reported for other Australian states. One-quarter reported use prior to pregnancy. Public health strategies are required to promote awareness of the importance of iodine and supplementation both before and during the entire pregnancy., (© 2018 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Context: While music is being increasingly used as a surgical intervention, the types of music used and the reasons underlying their selection remain inconsistent. Empirical research into the efficacy of such musical interventions is therefore problematic., Objective: To provide clear guidelines for musical selection and employment in surgical interventions, created through a synthesis of the literature. The aim is to examine how music is implemented in surgical situations, and to provide guidance for the selection and composition of music for future interventions., Methods: English language quantitative surgical intervention studies from Science Direct, ProQuest, and Sage Journals Online, all published within the last 10 years and featuring recorded music, were systematically reviewed. Variables investigated included: the time the intervention was performed, the intervention length, the outcomes targeted, music description (general and specific), theoretical frameworks underlying the selection of the music, whether or not a musical expert was involved, participant music history, and the participants' feedback on the chosen music., Results: Several aspects contribute to the lack of scientific rigour regarding music selection in this field, including the lack of a theoretical framework or frameworks, no involvement of musical experts, failure to list the music tracks used, and the use of vague and subjective terms in general music descriptions. Patients are frequently allowed to select music (risking both choosing music that has an adverse effect and making study replication difficult), and patient music history and listening habits are rarely considered. Crucially, five primary theoretical frameworks underlying the effectiveness of music arose in the literature (distraction, relaxation, emotional shift, entrainment, and endogenous analgesia), however music was rarely selected to enhance any of these mechanisms., Conclusions: Further research needs to be conducted to ensure that music is selected according to a theoretical framework and more rigorous and replicable methodology. Music interventions can be made more effective at improving psychological states and reducing physiological arousal by selecting music conducive to specific mechanisms, and also by considering at what point during the surgical experience the music would be most effective. Greater involvement of music experts in interventions would help to ensure that the most appropriate music was chosen, and that it is clearly and precisely described., (Copyright © 2018. Published by Elsevier Ltd.)

Background: Acute kidney injury (AKI) is common in hospitalized patients. Despite the progress that has been made in the last decade, early identification of AKI cases remains a challenge. In recent years, electronic AKI alert (e-AKI alert) systems have been tested and are usually based on changes in serum creatinine (Cr) values. However, these methods do not include one of the common scenarios, i.e. when there is no available preadmission Cr value available for a patient to compare and hence an e-AKI alert cannot be issued. Therefore, it is essential to have an alternative algorithm to produce e-AKI alerts in such scenarios., Method: We have developed e-AKI alert algorithms which compare serum Cr values at presentation with previous results, within KDIGO AKI guideline-specified classifications. However, where a comparator is not available, we have produced a 'population-based reference Cr value' age and sex matched from 137,000 serum Cr values extracted from blood tests in general practice from our Telepath system., Results: Cr results were split by gender, and then within each group the Cr were stratified according to year of age. The median Cr for each individual year of age was identified and plotted versus age to give separate graphs for males and females that gave excellent fits (R(2)) to cubic regressions., Conclusion: Population-based estimated reference Cr measurements from community blood test results is a more robust method of baseline Cr value estimation in generating potential e-AKI alerts to help early recognition and treatment of AKI cases leading to improved outcome., (© 2014 S. Karger AG, Basel.)

Background: There is limited data and literature on the issue of cardiac troponin test requesting by general practitioners (GPs). It was therefore our aim to audit the cardiac troponin test requests made by GPs in our community with a view to develop an informed strategy for assay provision and reporting of results., Methods: A retrospective audit was undertaken of data in our laboratory database for all cardiac troponin T (cTnT) tests requested by GPs between January and June 2005. A prospective audit was then carried out between July and December 2005 using the telephone interview method. The number and distribution of tests, the reasons for the request and the intended action by the GPs were quantified., Results: Forty-five of 46 of the results of both the retrospective and prospective audits were negative based on the 99th percentile level with less than 10% imprecision (cTnT <0.03 microg/L). During the one-year study period, we had requests from 24 general practices with a mean and mode of two and one requests per general practice respectively. The most common reason for the request was found to be chest pain that had occurred more than 24 h ago., Conclusion: Bearing in mind the limitations of an audit study, our findings obviate the use of cTnT in general practice. We suggest that the laboratory should liase with the GP and advise referral for specialist care if clinical suspicion of acute coronary syndrome is high.

A novel methylcellulose-immobilized restricted access media column with strong cation-exchange groups on an internal surface (MC-SCX) was evaluated for the direct injection analysis of basic polar drugs in plasma by column-switching liquid chromatography/mass spectrometry (LC/MS). Analytical conditions, including an automated pretreatment step and MS detection, were optimized for a series of basic drugs (doxepin, desipramine, imipramine, nortriptyline, amitriptyline, clomipramine). On-line pretreatment with the MC-SCX column followed by fast gradient analysis using a C18 column resulted in a total analysis cycle time of 7 min for each spiked plasma sample. More than 150 plasma samples spiked with target compounds were measured without compromising MS detection (relative standard deviations less than 11% for all compounds, and regression coefficients greater than 0.99)., (2005 John Wiley & Sons, Ltd.)

Performance in migraine with and without visual aura, non-specific headache and headache-free control groups was measured using a visual search task. Data from groups with high and low visual discomfort were also gathered. No pattern, 2 c/deg, 15 c/deg and a grey field were used in different background conditions. Presentation of patterned backgrounds slowed performance for all groups with the 2 c/deg pattern producing greatest interference. Performance of headache groups did not differ from that of the control group in any condition. The high visual discomfort group responded significantly more slowly than other groups with the 2 c/deg background. It was concluded that the presence of visual discomfort, reported on an everyday basis was a better indicator of heightened sensory sensitivity than the occurrence of migraine with or without aura.

Unpleasant somatic and perceptual side effects can be induced when viewing striped repetitive patterns, such as a square wave or a page of text. This sensitivity is greater in participants with higher scores on a scale of visual discomfort. In three experiments the effect that this sensitivity has on performance efficiency in a reading-like visual search task was investigated. In experiments 1 and 2, the 'global' structure of the patterns was manipulated to produce a square-wave, a checkerboard, and a plaid pattern. It was found that the group that suffered severe visual discomfort took significantly longer than other groups to perform the task, with interference greatest with presentation of the square-wave-like pattern. This supports the prediction of greatest distraction of visual attention from the local target elements with presentation of the pattern structure inducing greatest visual discomfort. In experiment 3, the internal pattern components were manipulated and task difficulty reduced. A no-interference and two interference patterns, one with a global characteristic only and the second made up of distracting line elements, containing global and local components were used. The global pattern structure produced interference effects on the visual-search task. All groups performed with the same speed and accuracy on the task involving the no-interference pattern, a finding attributed to reduced task difficulty. McConkie and Zola's model of visual attention was used to explain these results.

The spatial parameters underlying a novel illusion of relative motion are characterized. A simple stimulus composed of two sine-wave gratings was sufficient to generate the illusion. We measured the response of subjects to rapid, small-amplitude oscillations of this stimulus behind a fixation point. The effect was clearly strongest for acute angles between the gratings, but only when spatial frequency was between 6 and 11 cpd. We surmise that activity in the grating cells of the primate visual cortex (von der Heydt, Peterhans, & Dursteler, 1992) might be the cause of the illusion. The illusion is potentially an important tool in understanding how higher cortical areas combine disparate motion signals.

Detection thresholds were obtained for a 2 degrees Gaussian-blurred spot flashed for 200 ms on an 8.9 degrees white adapting field of 1070 trolands. The spot's contrast was represented in an L-, M-, and S-cone contrast space. Detection thresholds were obtained for many vectors close to specific but theoretically important planes within this space. A three-dimensional surface was fitted to the data generated by the probability summation of three mechanisms, each a weighted sum of cone contrasts. The fit revealed a red-green chromatic mechanism driven by delta L/L--delta M/M with no S-cone input that was 1 order of magnitude more sensitive than the two other mechanisms. The latter consisted of a luminance mechanism with little S-cone input and a blue-yellow chromatic mechanism with the S cone opposed to L and M cones.

When the eyes are converged on a near target, the gain of the vestibulo-ocular reflex (VOR) during a subsequent head rotation is dependent upon both the amount of vergence and the degree to which it is asymmetrical. In conditions without visual feedback, we measured the gain of the VOR in the right eye of observers as they rotated their heads to the right or left while viewing a target placed 22, 32.5 or 200 cm from the centre of head rotation. We then adapted the VOR to the magnifying effects of +5 D lenses, and retested the VOR under the former convergence conditions. We found an inverse relationship such that the greater the VOR gain due to convergence, the less the effect of the rapid adaptation to lenses.

Preattentive texture discrimination was investigated using low spatial frequency texture elements. The contrast between the texture elements and the background was either purely luminance or purely chromatic, or some combination of both these types of contrast. The threshold to discriminate correctly the location of a different textured region was obtained from each subject, as was each subject's threshold to detect the elements of the texture. Using the ratio of texture to element detection as a measure of the effectiveness of texture discrimination, little difference could be found between the perception of luminance or chromatic texture. However, there were large and significant variations among subjects with otherwise normal colour vision.

The kinematics of the horizontal VOR for near fixation demand that VOR gain should change dependent on the target distance and the orientation of the head with respect to the target, or, equivalently, the amount of ocular vergence and the asymmetry of this vergence. Across two experiments, the gain of the VOR was measured in the right eye of humans who rotated their heads to the right or left while viewing a target placed either 22, 32.5 or 200 cm from the center of head rotation, in conditions with and without visual feedback. When the eye was in-line with the target, the measured VOR gain was up to 43% greater than when the eye was in an eccentric position. However, in the eccentric position, higher VOR gains were achieved with visual feedback of the target than without feedback, indicative of a visual component in the compensatory eye movement. Also, by changing the posture of the left eye but keeping the right eye constant, the VOR gain in the right eye was changed substantially during a subsequent head rotation. Hence, the positions of both eyes in their orbits determine the gain of the VOR in each eye.

Because the center of natural head rotation lies some distance behind the centers of eye rotation, the VOR has to operate with a gain substantially above 1 for there to be stable fixation of targets lying near the head. In humans, VOR gain was increased inversely proportional to fixation distance and changed with the angle of the head for very near targets. These effects were also evident when the subject imagined the target. However, this "high-gain" VOR was found to deteriorate substantially at frequencies beyond ca 2.5 Hz. In conditions without visual feedback, the VOR gain enhancement due to near fixation was disrupted by monocular viewing. When the subjects wore lenses to relax or increase accommodation, the lenses were found to have no effect on VOR gain. On the other hand, prisms of equivalent power to the lenses had a large effect whereby gain was adjusted according to the vergence state of the eyes. This suggests that VOR gain modulation is under the direct control of convergence.

Stereoblind subjects show marked monocular asymmetries in both OKN and OKAN, while normal subjects produce more balanced nystagmus. There is a negative relationship between the magnitude of the asymmetries and the magnitude of a binocular contribution to OKN production as measured with dichoptic, strobe illumination. A second experiment with normal subjects corroborated this relationship, revealing a small, but significant asymmetry in these subjects' OKAN. Further, there was no correlation between the monocular nystagmus asymmetries and stereoacuity. The results are explained in terms of subcortical binocular mechanisms.

The perception of three-dimensional attributes of solid objects by twelve-week-old infants was studied. In the first experiment the rates of habituation of fixation to a cube in a fixed orientation, to one which changed in orientation between presentations, and to a sequence of photographs of cubes in different orientations were determined. Habituation rate was also determined for a photograph of a cube in a fixed orientation. No difference was found between the initial fixation times for solids and photographs, or between the habituation curves for the solids in fixed and varying orientation. For the photographs habituation was much greater for the fixed orientation than the varying orientation condition. These data were interpreted as providing strong evidence that the infants were responding to the stimuli on the basis of their three-dimensional attributes. In the second experiment the same discriminations were examined by a recovery-from-habituation technique. One group was habituated to a cube in a fixed orientation and tested for recovery of fixation to a new orientation. A second group was habituated to a photograph of a cube in a single orientation and tested for recovery to a photograph of a new orientation. Both groups showed recovery and the recovery was the same for both conditions. These data demonstrated that the subjects were, after all, capable of discriminating between different orientations of a solid cube, and they provided no further evidence that the infants were perceiving three-dimensional attributes of the stimuli.