Nevin Manimala

Atten Percept Psychophys. 2021 Aug 25. doi: 10.3758/s13414-021-02354-6. Online ahead of print.

ABSTRACT

Attention is dynamic, constantly shifting between different locations – sometimes imperfectly. How do goal-driven expectations impact dynamic spatial attention? A previous study (Dowd & Golomb, Psychological Science, 30(3), 343-361, 2019) explored object-feature binding when covert attention needed to be either maintained at a single location or shifted from one location to another. In addition to revealing feature-binding errors during dynamic shifts of attention, this study unexpectedly found that participants sometimes made correlated errors on trials when they did not have to shift attention, mistakenly reporting the features and location of an object at a different location. The authors posited that these errors represent “spatial lapses” attention, which are perhaps driven by the implicit sampling of other locations in anticipation of having to shift attention. To investigate whether these spatial lapses are indeed anticipatory, we conducted a series of four experiments. We first replicated in Psychological Science, 30(3), the original finding of spatial lapses, and then showed that these spatial lapses were not observed in contexts where participants are not expecting to have to shift attention. We then tested contexts where the direction of attentional shifts was spatially predictable, and found that participants lapse preferentially to more likely shift locations. Finally, we found that spatial lapses do not seem to be driven by explicit knowledge of likely shift locations. Combined, these results suggest that spatial lapses of attention are induced by the implicit anticipation of making an attentional shift, providing further insight into the interplay between implicit expectations, dynamic spatial attention, and visual perception.

PMID:34435320 | DOI:10.3758/s13414-021-02354-6

J Robot Surg. 2021 Aug 26. doi: 10.1007/s11701-021-01291-8. Online ahead of print.

ABSTRACT

Since 2000, robotic-assisted surgery has rapidly expanded into almost every surgical sub-specialty. Despite the popularity of robotic surgery across the United States, a national consensus for standardized training and education of robotic surgeons or surgical teams remains absent. In this quality improvement initiative, a novel, stepwise iterative Robotic Assistant Surgical Training (RAST) curriculum was developed to broaden and standardize robotic bedside assistant training. Thirteen voluntary participants, capable of fulfilling the bedside assistant role, were evaluated to determine if RAST enhanced the learner’s self-perceived level of confidence and comfort in their role as bedside assistant. A pre- and post-RAST training survey and a between-stages repeated-measures survey were conducted. All learner participants reported statistically significant increases in confidence and comfort after RAST training, (p = < 0.001), and between each stage, F (2, 24 = 60.47, p < .001; [Formula: see text] = 0.834). Participant feedback regarding curriculum improvement was obtained, suggesting the desire for more training and practice, in smaller groups of 2-3 participants. One hundred percent of participants felt RAST was beneficial and that it should be implemented as standardized training during onboarding for all robotic bedside assistants. Thus, a standardized, stepwise iterative robotic bedside assistant curriculum increases learner preparedness, comfort, and confidence, safely away from the patient bedside.

PMID:34435279 | DOI:10.1007/s11701-021-01291-8

Dig Dis Sci. 2021 Aug 25. doi: 10.1007/s10620-021-07215-8. Online ahead of print.

ABSTRACT

BACKGROUND/AIMS: Inadequate bowel preparation leads to poor outcomes in colonoscopy. Prior investigations have demonstrated improved bowel preparation with pre-procedural educational videos. We aimed to determine whether an interactive, online educational video could improve bowel preparation scores in an outpatient population.

METHODS: We performed a prospective, endoscopist-blinded, randomized controlled trial at our hospital-based outpatient endoscopy center. Eligible patients were randomized to two groups. Both groups received standard verbal and written instructions, while the intervention group also received access to an interactive, online video. The primary outcome was improvement in the bowel preparation scores graded using the Boston bowel prep score (BBPS). Secondary outcomes included adenoma detection rate, total number of polyps detected, patient satisfaction, pre-procedure anxiety, and complication rates.

RESULTS: The difference in BBPS in the intervention group (8) compared to the control group (7.6) did not meet statistical significance in our primary outcome of improvement in BBPS (p = 0.076). However, on subgroup analysis, there was a statistically significant improvement in BBPS in the intervention group among African Americans (p = 0.007) and patients older than 65 (p = 0.026). Those in the intervention arm rated pre-procedural materials “very easy” to understand significantly more often than in the control arm (p = 0.018).

CONCLUSIONS: Use of an interactive, online educational video for bowel preparation did not lead to improvement in overall BBPS. However, among patients at higher risk for inadequate bowel preparation, such as African Americans and elderly patients, there may be a benefit.

PMID:34435269 | DOI:10.1007/s10620-021-07215-8

Clin Oral Investig. 2021 Aug 25. doi: 10.1007/s00784-021-04148-4. Online ahead of print.

ABSTRACT

OBJECTIVES: To make an in vitro assessment of fracture resistance of weakened and non-weakened teeth receiving intraradicular reinforcement using Rebilda bundled glass fiber-reinforced composite posts (GT), Rebilda conventional glass fiber posts (RP), or both systems combined (GT + RP).

MATERIALS AND METHODS: Eighty sound bovine incisors were prepared and divided randomly into eight groups as follows: (a) nWnR: without simulating weakness, and without intraradicular reinforcement; (b) WnR: simulating weakness, but without intraradicular reinforcement; (c) nWGT: without simulating weakness, but with GT; (d) WGT: simulating weakness, and with GT; (e) nWRP: without simulating weakness, but with RP; (f) WRP: simulating weakness, and with RP; (g) nWGTRP: without simulating weakness, but with GT + RP; (h) WGTRP: simulating weakness, and with GT + RP. The specimens were subjected to the load-to-fracture test using the DL-2000MF universal testing machine. The finite element method assessed the mechanical behavior and stress distribution in endodontically treated teeth.

RESULTS: The groups nWGTRP and WGTRP presented the best results in the load-to-fracture test, with the former being better than the latter, but with no statistically significant difference (P > 0.05). However, there was a significant difference between these and the other groups (P < 0.05), except for nWRP. Stress distribution inside the canal wall was different among the groups, with promising mechanical behavior for nWGTRP and nWRP.

CONCLUSIONS: The Rebilda conventional fiber post (RP), combined with the Rebilda bundled glass fiber-reinforced composite post (GT) improves the resistance and stress distribution of immature teeth.

CLINICAL RELEVANCE: Longitudinal fracture is less frequent in teeth restored with GT and RP posts.

PMID:34435252 | DOI:10.1007/s00784-021-04148-4

Int J Implant Dent. 2021 Aug 26;7(1):86. doi: 10.1186/s40729-021-00365-4.

ABSTRACT

BACKGROUND: Nowadays, due to the esthetic and social demands of patients, conventional staged protocols seem to be increasingly replaced by faster, one-step protocols. The purpose of the present systematic review is to assess the peri-implant soft tissue changes after immediate implant placement and provisionalization (IIPP) comparing patients treated with or without a sub-epithelial connective tissue graft (SCTG) when replacing a single tooth in the esthetic region.

METHODS: The present systematic review was written following the PRISMA checklist. Immediate implants placed with a connective tissue graft and without one were compared. The researched primary outcomes were the mid-buccal mucosa level (MBML) facial soft tissue thickness (FSTT) and marginal bone loss (MBL). The weighted mean differences (WMD) were estimated for all three outcomes.

RESULTS: The change in the mid-buccal mucosa level in the intervention group was significantly higher (WMD 0.54; 95% CI 0.33-0.75), with no indication of heterogeneity (I² = 16%). The facial soft tissue thickness increased significantly in the intervention group (WMD 0.79; 95% CI 0.37-1.22). The marginal bone loss was significantly higher in the control group (WMD 0.13; 95% CI 0.07-0.18), with no indication of heterogeneity (I² = 0%).

CONCLUSIONS: The results of the meta-analyses showed a statistically significant reduced change of the marginal bone loss and vestibular recession, as well as higher soft tissue thickness, when a graft was used. The included studies had a short observation time; therefore, studies with longer follow-ups are needed to confirm these findings.

PMID:34435229 | DOI:10.1186/s40729-021-00365-4

Pediatr Radiol. 2021 Aug 25. doi: 10.1007/s00247-021-05169-7. Online ahead of print.

ABSTRACT

BACKGROUND: The diagnostic value of cardiac magnetic resonance imaging (MRI) employing the 2018 Lake Louise criteria in pediatric and adolescent patients with acute myocarditis is undefined.

OBJECTIVE: To evaluate the diagnostic value of the Lake Louise criteria in pediatric and adolescent patients with suspected acute myocarditis and to show the utility of cardiac MRI for follow-up in this patient cohort.

MATERIALS AND METHODS: Forty-three patients (age range: 8-21 years) with suspected acute myocarditis and 13 control patients who underwent cardiac MRI were retrospectively analyzed. T2-weighted and late gadolinium enhancement imaging were performed in all patients. T1 and T2 mapping were available in 26/43 patients (60%). The Lake Louise criteria were assessed. In 27/43 patients (63%), cardiac MRI follow-up was available. Receiver operating characteristic analysis, Pearson’s correlation coefficient and paired Student’s t-test were used for statistical analysis.

RESULTS: In the total cohort, the Lake Louise criteria achieved a sensitivity of 86% (95% confidence interval [CI]: 72-95%) and a specificity of 100% (95% CI: 79-100%) for the diagnosis of acute myocarditis. In the subgroup of patients with available mapping parameters, the diagnostic performance of the Lake Louise criteria was higher when mapping parameters were implemented into the score (area under the receiver operating characteristic curve: 0.944 vs. 0.870; P=0.033). T2 relaxation times were higher in patients with admission to the intermediate care unit and were associated with the length of intermediate care unit stay (r=0.879, P=0.049). Cardiac MRI markers of active inflammation decreased on follow-up examinations (e.g., T1 relaxation times: 1,032±39 ms vs. 975±33 ms, P<0.001; T2 relaxation times: 58±5 ms vs. 54±5 ms, P=0.003).

CONCLUSION: The Lake Louise criteria have a high diagnostic performance for the diagnosis of acute myocarditis and are a valuable tool for follow-up in pediatric and adolescent patients. The mapping techniques enhance the diagnostic performance of the 2018 Lake Louise criteria.

PMID:34435226 | DOI:10.1007/s00247-021-05169-7

Pediatr Radiol. 2021 Aug 25. doi: 10.1007/s00247-021-05159-9. Online ahead of print.

ABSTRACT

BACKGROUND: Unnecessary imaging is a potential cost driver in the United States health care system.

OBJECTIVE: Using a clinical decision support tool, we determined the percentage of low-utility non-contrast head computed tomography (CT) examinations on emergency patients and calculated the prospective cost implications of providing low-value imaging using time-driven activity-based costing at an academic quaternary pediatric hospital.

MATERIALS AND METHODS: A clinical decision support tool for imaging, CareSelect (National Decision Support Co., Madison, WI), was integrated in silent mode into the electronic health record from September 2018 through August 2019. Each non-contrast head CT order received a score from the clinical decision support tool based on the American College of Radiology Appropriateness Criteria. Descriptive statistics for all levels of appropriateness scores were compiled with an emphasis on low-utility exams. A micro-costing assessment was conducted using time-driven activity-based costing on head CT without contrast examinations.

RESULTS: Within the 11-month time period, 3,186 head CT examinations without contrast were ordered for emergency center patients. Among these orders, 28% (896/3,186) were classified as low-utility studies. The base case CT pathway time was 43 min and base case total cost was $193.35. The base case opportunity cost of these low-utility exams extrapolated annually amounts to $188,902 for our institution.

CONCLUSION: Silent mode implementation of a clinical decision support tool resulted in 28% of head CT non-contrast exams on emergency patients being graded as low-utility studies. Prospective cost implications resulted in an annual base case cost of $188,902 to Texas Children’s Hospital.

PMID:34435225 | DOI:10.1007/s00247-021-05159-9

Support Care Cancer. 2021 Aug 26. doi: 10.1007/s00520-021-06498-x. Online ahead of print.

ABSTRACT

PURPOSE: To examine self-reported (30-day) sleep versus nightly actigraphy-assessed sleep concordance in long-term survivors of childhood cancer.

METHODS: Four hundred seventy-seven participants enrolled in the St. Jude Lifetime Cohort (53.5% female, median (range) age 34.3 (19.3-61.6) years, 25.4 (10.9-49.3) years from diagnosis) completed the Pittsburgh Sleep Quality Index and ≥ 3 nights of actigraphy. Participants had neurocognitive impairment and/or a self-reported prolonged sleep onset latency (SOL). Self-reported 30-day sleep and nightly actigraphic sleep measures for sleep duration, SOL, and sleep efficiency (SE) were converted into ordinal categories for calculation of weighted kappa coefficients. General linear models estimated associations between measurement concordance and late effects.

RESULTS: Agreements between self-reported and actigraphic measures were slight to fair for sleep duration and SOL measures (k_w = 0.20 and k_w = 0.22, respectively; p < 0.0001) and poor for SE measures (k_w = 0.00, p = 0.79). In multivariable models, severe fatigue and poor sleep quality were significantly associated with greater absolute differences between self-reported and actigraphy-assessed sleep durations (B = 26.6 [p < 0.001] and B = 26.8 [p = 0.01], respectively). Survivors with (versus without) memory impairment had a 44-min higher absolute difference in sleep duration (B = 44.4, p < 0.001). Survivors with, versus without, depression and poor sleep quality had higher absolute discrepancies of SOL (B = 24.5 [p = 0.01] and B = 16.4 [p < 0.0001], respectively). Poor sleep quality was associated with a 12% higher absolute difference in SE (B = 12.32, p < 0.0001).

CONCLUSIONS: Self-reported sleep and actigraphic sleep demonstrated discordance in our sample. Several prevalent late effects were statistically significantly associated with increased measurement discrepancy. Future studies should consider the impacts of late effects on sleep assessment in adult survivors of childhood cancer.

PMID:34435211 | DOI:10.1007/s00520-021-06498-x

Anal Bioanal Chem. 2021 Aug 26. doi: 10.1007/s00216-021-03610-2. Online ahead of print.

ABSTRACT

Additional occurrence data are needed to better understand human exposure to per- and poly-fluoroalkyl substances (PFAS) from commercially available foods in the United States. The Food and Drug Administration’s (FDA) Total Diet Study (TDS) collects foods that are both nationally and regionally distributed. In 2018, 172 processed foods were collected from grocery stores around Lenexa, KS, as part of the TDS national collection. A previously developed method for the analysis of PFAS in foods as part of the TDS regional collection was modified and optimized for these samples. This method was single lab validated using 5 different matrices and method detection limits were calculated. During the analysis of these samples, challenges arose with method blanks and further investigation into statistical methods to distinguish between blank and sample concentrations were done. The confirmation of two short chain PFAS, perfluorobutanoic acid (PFBA) and perfluoropentanoic acid (PFPeA), was not possible using triple quadrupole mass spectrometry and a confirmation method was developed using high-resolution mass spectrometry. This technique was also used to investigate potential detections and interferents that fell within the retention time criteria for positive detections. In the national collection, positive detections of perfluorooctanesulfonic acid (PFOS) and perfluorononanoic acid (PFNA) were found in frozen fish sticks/patties, PFOS and perfluorodecanoic acid (PFDA) in canned tuna, and PFOS in protein powder. Concentrations were all below 150 ppt, and no other detects were confirmed above the method detection limits in any other foods.

PMID:34435208 | DOI:10.1007/s00216-021-03610-2

Ann Work Expo Health. 2021 Aug 26:wxab029. doi: 10.1093/annweh/wxab029. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aims to assess the health effects on mining workers of exposure to chronic intermittent hypoxia (CIH) at high- and very high-altitude mining compared with similar work at lower altitudes in Chile, and it also aims to constitute the baseline of a 5-year follow-up study.

METHODS: We designed a cross-sectional study to assess health conditions in 483 miners working at 2 levels of altitude exposure: 336 working at a very high or high altitude (HA; 247 above 3900-4400 m, and 89 at 3000-3900 m), and 147 below 2400 m. Subjects were randomly selected in two stages. First, a selection of mines from a census of mines in each altitude stratum was made. Secondly, workers with less than 2 years of employment at each of the selected mines were recruited. The main outcomes measured at the baseline were mountain sickness, sleep alterations, hypertension, body mass index, and neurocognitive functions.

RESULTS: Prevalence of acute mountain sickness (AMS) was 28.4% in the very high-altitude stratum (P = 0.0001 compared with the low stratum), and 71.7% experienced sleep disturbance (P = 0.02). The adjusted odds ratio for AMS was 9.2 (95% confidence interval: 5.2-16.3) when compared with the very high- and low-altitude groups. Motor processing speed and spatial working memory score were lower for the high-altitude group. Hypertension was lower in the highest-altitude subjects, which may be attributed to preoccupational screening even though this was not statistically significant.

CONCLUSIONS: Despite longer periods of acclimatization to CIH, subjects continue to present AMS and sleep disturbance. Compromise of executive functions was detected, including working memory at HA. Further rigorous research is warranted to understand long-term health impacts of high-altitude mining, and to provide evidence-based policy recommendations.

PMID:34435202 | DOI:10.1093/annweh/wxab029