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The present article problematizes faculty relationships within academic departments by applying critical race theory (counterstorytelling) to generate equity cases promoting racial healing. These equity cases illustrate the utility of an emergent typology, the equity paradox. More specifically, the equity paradox describes the web of reprisals endured by faculty of color who advocate for the authentic actualization of university-sponsored diversity goals. Each case is a fictional collage of counterstories created by the co-authors and informed by actual events personally experienced or directly witnessed. This approach allowed for ample complexity, authenticity, and utility because many faculty of color will relate to aspects of these case studies. Simultaneously, administrators and colleagues will gain insights into how racism impacts their colleagues of color. We integrate the racial healing and mattering construct throughout the equity cases to illustrate how racism impacts the individual, communal, and systemic functioning of academic departments. We conclude with implications for departmental transformation to redress the social, emotional, and professional harm of racism and reconstruct professional environments that foster healing and mattering among faculty of color.

This inquiry unearths the stratified nature of racial harm in higher education by applying counterstorytelling to fashion an equity case study on racial harm. Racial harm consists of four conditions (hyper-cognition, hyper-isolation, hyper-distress, and hyper-reactivity) brought on by persistent exposure to racial discrimination embedded subtlety within academic departments as a series of racialized conflicts (diversity & curriculum clashes, and relational & power dynamics). To advance the use of qualitative research to end racism in higher education, we offer a true-telling framework, a guide for talking back, a research typology to unearth the pandemic of racism infecting faculty relations.

Objective: To reduce the gap between old and new eye-tracking studies in aviation by raising the interest of the scientific community in some of the pioneering works. We present two emblematic case...

A brief introduction of unexpected occurrences of diseases that can become epidemic or pandemic such as what happened with COVID-19 is made. Current and anticipated global impact of the disease, characteristics and reported cases in China are described. Possible explanations and factors that may contribute or be responsible for possible transmission of diseases in the dental clinic are offered as well as emphasis on the need to exercise infection control strategies and special precautions to minimize Disease transmission are emphasized; additional precautions to implement for treating individuals that have been diagnosed of being infected with COVID-19 are given, as well as emphasis on the possibilities of treating asymptomatic patients; Advice on existence of protocols prepared by health organizations such as the US. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) are stressed and the lector is advised to visit websites that are available from CDC with detail information pertinent to protocols Health Care Providers can follow. Ideal recommendations as well as minimal recommendations to be followed by oral health care personnel and protection equipment are given. General facts related to survival of the COVID-19 virus that need to be taken into consideration are offered and precautions that health experts have recommended are also summarized.

Background Ureaplasma urealyticum is a fastidious bacteria which lacks a cell wall. Extragenital infections are rare in immunocompetent adults. There are few literature reports of perinephric abscess. We present a case of non-resolving multifocal “culture-negative” abscesses in a hypogammaglobulinemic adult female due to U. urealyticum. Case presentation 66-year-old female with a one-week history of fever, malaise and new right hip and leg pain. Past medical history was notable for chronic pancytopenia secondary to in remission B cell follicular lymphoma, ESRD on intermittent hemodialysis with bilateral nephrostomy tubes and Crohn’s. CT abdomen/pelvis revealed a small left perinephric hematoma and proximal right femur fluid collection. Persistent right thigh pain led to additional ultrasound with anterior thigh collection and CT revealed an irregular rim-enhancing fluid collection in the left posterior pararenal space. Antimicrobial therapy included ertapenem and vancomycin followed by meropenem, trimethoprim-sulfamethoxazole, daptomycin and metronidazole in setting of persistent culture-negative results and clinical deterioration. Following detection of U. urealyticum by 16S rDNA PCR in both left pararenal and right trochanteric bursa abscesses doxycycline was started. Despite this, the patient died four days later. Conclusions Disseminated infection by U. urealyticum has been documented in immunocompromised adult patients with few reports of perinephric abscess. We propose that ascending genitourinary route led to perinephric abscess. The multiple disseminated fluid collections make it highly suspicious for hematogenous spread given the lack of radiographic enhancement to suggest contiguous spread. Diagnosis and treatment of U. urealyticum-disseminated infection is extremely challenging as culture is laborious and not routinely performed. Furthermore, the lack of cell wall renders beta-lactams and vancomycin ineffective and therefore requirement for “atypical” coverage. Early diagnosis and treatment are key to prevent further complications and death.

Objective To assess the sensitivity of an electroencephalographic (EEG)-based index, the prefrontal beta power, to quantify the mental workload in surgeons in real scenarios. Such EEG-based index might offer unique and unbiased measures of overload, a crucial factor when designing learning and training surgical programs. Design The experiment followed a 2 × 2 × 2 within subjects design with 3 factors: (1) Surgical Role during the surgery (primary surgeon vs. assistant surgeon), (2) the Surgical Procedure (laparo-endoscopic single-site [LESS] surgery vs. multiport laparoscopic surgery [MPS]), and (3) the Suturing Techniques (interrupted vs. continuous suture). Setting The study was carried out at the Advanced Multi-Purpose Simulation and Technological Innovation Complex situated at IAVANTE (Granada, Spain). Methods Four surgical teams (primary surgeon and assistant surgeon, experts in MPS) performed 8 surgical exercises on porcine models, under different task complexities. They performed 2 suturing techniques (continuous and interrupted), employing a low complex procedure (MPS) and a high complex procedure (LESS). Surgeons acted as the primary surgeon during half of the exercises, and, as the assistant surgeon, during the rest of them. Simultaneously, we monitored EEG prefrontal EEG beta power spectra of both surgeons, using 2 synchronized wearable EEG devices. We also collected performance and subjective data. Results Surgical complexity modulated prefrontal beta power. LESS surgery caused significant higher prefrontal beta power for both suturing techniques for both surgical roles which indicates higher demands than MPS. Perceived task complexity, overall surgical evaluation, and laparoscopic execution time confirmed EEG-based results. Finally, subjective ratings of surgical complexity differentiated between surgical roles within the same exercise, even when prefrontal beta power did not. Conclusions To detect mental overload when surgeons are engaged with complex surgeries, real or simulated, is still guesswork. EEG-based indices have great potential as objective and nonintrusive measures to assess mental overload in surgeons. Furthermore, EEG-based indices might play a relevant role in monitoring surgeons and residents’ cognitive state during their training.

Eslicarbazepine acetate (ESL) is a sodium channel blocker indicated for partial-onset seizures with or without secondary generalization, at a single daily dose. There are very few publications on the levels of ESL metabolites in real clinical practice.To describe the serum levels of licarbazepine (main metabolite of ESL) in patients with refractory epilepsy in real clinical practice. To evaluate the influence of age, sex, and polytherapy on levels and adverse effects.This study involved a retrospective analysis of patients diagnosed with epilepsy treated with ESL for whom plasma levels of licarbazepine were available, measured by spectrophotometry.Sixty-four patients were included. One patient had licarbazepine levels of 0 (admitted not taking the drug) was not analyzed. Mean licarbazepine levels of 7.66 µg/mL (400 mg/day dose), 16.56 µg/mL (800-mg dose), and 20.80 µg/mL (1200 mg) were significantly different. There was a significant correlation between daily dose and serum levels (p 0.05) and between the concentration/dose ratio and lower to higher doses (p 0.05). Pharmacokinetic variability (coefficient of variation for the concentration/dose ratio) was 33.2%. We found a decrease in the concentration/dose ratio in the 1200 mg/day dose, compared to lower doses. We did not find differences by sex or intake of other antiepileptic inducers or metabolic inhibitors. Fifteen patients (23.8%) had mild nonsymptomatic hyponatremia.These results suggest that it is not necessary to routinely determine licarbazepine levels. In specific cases, licarbazepine levels can be useful to assess adherence to treatment and for personalized dose adjustment.

The elderly, children, and people with disabilities are among vulnerable users who can benefit the most from the autonomous vehicles (AVs). Yet, most AV concepts discussed in the past decade, including the AutomotiveUI conferences, seem to focus on the mobility needs of younger and middle-aged drivers, who are the overeducated working population, technological enthusiasts, and above middle-class users. In that regard, the third workshop on Localization vs. Internalization aims to explore these disparities, identify the accessibility barriers and search for research approaches that can increase the accessibility opportunities of the vulnerable AV end-users. Built upon the findings from the previous workshops, which focused on diversity, inclusion and differences among cultures regarding AV-related research approaches, the purpose of the present workshop is to provide an in-depth insight into the state of global AV research and identify areas that still need to be explored to increase the AV accessibility, locally and internationally.

Ibrutinib, an irreversible and specific Bruton's tyrosine kinase (BTK) inhibitor, leads to complete inhibition of IgE/FceRI-BTK degranulation of human basophils without affecting the signaling via G-protein coupled receptors (C5a, fMLP) [1;2]. Since autoantibodies in chronic spontaneous urticaria (CSU) either against the IgE/FceRI complex or IgE play a relevant role in CSU [3;4], ibrutinib could, therefore, be a promising asset in basophil assays [5]. This in-vitro study aimed to differentiate between FceRI dependent and independent pathways in autoimmune CSU (aiCSU).

Leprosy (Hansen’s disease) is caused by Mycobacterium leprae. It affects the skin and peripheral nerves. Incidence and prevalence are underestimated due to challenges in diagnosis and unfamiliarity with the disease in Canada. Untreated disease can lead to permanent nerve damage with subsequent loss of function. We present a case of Hansen’s disease with delay in diagnosis and treatment. A 31-year-old female recent immigrant from the Philippines presented with a 2-year history of a palpable erythematous rash on her face and arms. She had a diagnosis of cryoglobulinemic vasculitis associated with her chronic hepatitis B. A course of topical corticosteroids did not alleviate symptoms. The rash had a waxing and waning pattern that was felt to mirror her antiviral therapy. Although hepatitis B cryoglobulinemia has been reported in the remote literature, further studies have failed to illustrate that it is a significant cause of cryoglobulinemia. Retrospective analysis of the case identified that anchoring to the initial diagnosis was the reason for delay in diagnosis and treatment.

Driver fatigue can impair performance as much as alcohol does. It is the most important road safety concern, causing thousands of accidents and fatalities every year. Thanks to technological developments, wearable, single-channel EEG devices are now getting considerable attention as fatigue monitors, as they could help drivers to assess their own levels of fatigue and, therefore, prevent the deterioration of performance. However, the few studies that have used single-channel EEG devices to investigate the physiological effects of driver fatigue have had inconsistent results, and the question of whether we can monitor driver fatigue reliably with these EEG devices remains open. Here, we assessed the validity of a single-channel EEG device (TGAM-based chip) to monitor changes in mental state (from alertness to fatigue). Fifteen drivers performed a 2-h simulated driving task while we recorded, simultaneously, their prefrontal brain activity and saccadic velocity. We used saccadic velocity as the reference index of fatigue. We also collected subjective ratings of alertness and fatigue, as well as driving performance. We found that the power spectra of the delta EEG band showed an inverted U-shaped quadratic trend (EEG power spectra increased for the first hour and half, and decreased during the last thirty minutes), while the power spectra of the beta band linearly increased as the driving session progressed. Coherently, saccadic velocity linearly decreased and speeding time increased, suggesting a clear effect of fatigue. Subjective data corroborated these conclusions. Overall, our results suggest that the TGAM-based chip EEG device is able to detect changes in mental state while performing a complex and dynamic everyday task as driving.

Background CyBorD (cyclophosphamide, bortezomib, and dexamethasone) is an effective regimen for the treatment of patients with newly diagnosed immunoglobulin light chain (AL) amyloidosis. CyBorD can induce rapid hematologic responses (HRs). However, it remains inadequate to enhance outcomes in high-risk groups. In addition, minimal information is available on the impact of minimal residual disease (MRD) in overall survival. Patients and Methods All consecutive patients with newly diagnosed AL amyloidosis treated with CyBorD from January 2012 to August 2018 were evaluated. HR and organ response was assessed as per standard guidelines. Further, MRD was evaluated by multiparameter flow cytometry in patients with confirmed complete response (CR). Results After a median of 4 cycles, HR was seen in 31 (91.2%) cases, including CR in 9 (26.5%), very good partial response in 9 (26.5%), and partial response in 13 patients (38.2%). Organ response at 6 months was documented in 11 (32.4%) cases. With respect to cardiac response, a > 30% decrease of NT-proBNP was observed in 4 (19%) of 21 evaluable cases (NTproBNP > 650 ng/L) at a median of 6 months. The median progression-free survival was 26.7 months. Patients who achieved CR exhibited a better overall survival compared with those without CR (P = .001). No difference on overall or progression-free survival among cases achieving CR irrespective of their MRD status was observed (P > .05). Conclusions In summary, CyBorD showed a ≥ very good partial response rate of 53% with 26.5% achieving CR, which is similar to that seen in previous studies. In addition, MRD negativity assessed by multiparameter flow cytometry in patients with CR resulted in no difference on survival outcomes.

Task (over-)load imposed on surgeons is a main contributing factor to surgical errors. Recent research has shown that gaze metrics represent a valid and objective index to asses operator task load in non-surgical scenarios. Thus, gaze metrics have the potential to improve workplace safety by providing accurate measurements of task load variations. However, the direct relationship between gaze metrics and surgical task load has not been investigated yet. We studied the effects of surgical task complexity on the gaze metrics of surgical trainees. We recorded the eye movements of 18 surgical residents, using a mobile eye tracker system, during the performance of three high-fidelity virtual simulations of laparoscopic exercises of increasing complexity level: Clip Applying exercise, Cutting Big exercise, and Translocation of Objects exercise. We also measured performance accuracy and subjective rating of complexity. Gaze entropy and velocity linearly increased with increased task complexity: Visual exploration pattern became less stereotyped (i.e., more random) and faster during the more complex exercises. Residents performed better the Clip Applying exercise and the Cutting Big exercise than the Translocation of Objects exercise and their perceived task complexity differed accordingly. Our data show that gaze metrics are a valid and reliable surgical task load index. These findings have potential impacts to improve patient safety by providing accurate measurements of surgeon task (over-)load and might provide future indices to assess residents’ learning curves, independently of expensive virtual simulators or time-consuming expert evaluation.

Background: This paper is a summary of the proceedings of the International Association of Paediatric Dentistry Bangkok Conference on early childhood caries (ECC) held in 3-4 November 2018. Aim: The paper aims to convey a global perspective of ECC definitions, aetiology, risk factors, societal costs, management, educational curriculum, and policy. Design: This global perspective on ECC is the compilation of the state of science, current concepts, and literature regarding ECC from worldwide experts on ECC. Results: Early childhood caries is related to frequent sugar consumption in an environment of enamel adherent, acid-producing bacteria in a complex biofilm, as well as developmental defects of enamel. The seriousness, societal costs, and impact on quality of life of dental caries in pre-school children are enormous. Worldwide data show that ECC continues to be highly prevalent, yet infrequently treated. Approaches to reduce the prevalence include interventions that start in the first year of a child's life, evidence-based and risk-based management, and reimbursement systems that foster preventive care. Conclusions: This global perspective on ECC epidemiology, aetiology, risk assessment, global impact, and management is aimed to foster improved worldwide understanding and management of ECC.

Introduccion: Adherence to guidelines on the periendoscopic management of antiplatelet therapy (APT) has not been analyzed in detail. Our aim was to assess adherence to guidelines in patients referred to our Endoscopy Unit on a case-by-case basis, describing in detail the detected deviations and identifying areas of improvement. Patients and methods: Cross-sectional study of outpatients consecutively scheduled for an unsedated upper or lower gastrointestinal endoscopy between January and June 2015. Patients on anticoagulant therapy were excluded. Results: 675 patients were evaluated, including 91 (13.5%) patients on APT [upper GI endoscopy 25 (27.5%), lower GI endoscopy 66 (72.5%)] Contrary to the clinical guidelines, aspirin was discontinued in 25 of the 77 patients previously prescribed the drug (32.5%) but this modification was patient's own decision in 11 cases. Most of the apparent deviations in the management of clopidogrel and dual antiplatelet therapy (DAPT) were not true non-adherence cases. The Primary Care physician modified an APT prescribed by another physician in 8 of 9 cases (88.9%), always in cases with aspirin. No relationship was found between the endoscopic procedure's predicted risk of bleeding or the patient's thrombotic risk and modification of therapy. Discussion: In many patients, the peri-procedural management of APT goes against current guidelines, but some of these inconsistencies cannot be considered true deviations from practice. Identified areas for improvement are increasing patient awareness about APT, disseminating the guidelines in Primary Care, and underscoring the significance of thrombotic risk related to APT withdrawal. (C) 2019 Elsevier Espana, S.L.U. All rights reserved.

To determine the effect of a 30-minute application of cold pack in soleus muscle in muscular force and fatigue after 1, 3, and 7 days after subjection to 2 hours of ischemia...

Infrared thermography, thanks to technological developments and lowering prices, is now getting considerable attention as a potential arousal monitor in the safety industry. Nasal skin temperature might be a valid index to track physiological variations due to reduced arousal levels, and its use could prevent a drowsiness-related deterioration of performance. However, the few studies that have investigated nasal skin temperature in applied settings have had inconsistent results. Here, we assessed the validity of nasal skin temperature to monitor changes in arousal levels (from alertness to drowsiness). The participants performed a 2-h simulated driving task while we simultaneously recorded their nasal skin temperature, brain activity (we used frontal delta electroencephalographic [EEG] activity as the reference index of alertness), and driving performance (speeding time). For those variables, we calculated growth curve models. We also collected subjective ratings of alertness and fatigue before and after the driving session. We found that the nasal skin temperature showed a cubic trajectory (it increased for the first 75 min, and then it began to decrease, but such deceleration gradually diminished over time). As expected, frontal delta EEG activity showed an inverted U-shaped quadratic trend (EEG power increased for the first hour and half, and gradually decreased during the last thirty minutes). The speeding time exhibited a similar pattern of change. Subjective sleepiness and fatigue increased after the task. Overall, our results suggest that nasal skin temperature seems to be a valid measure of arousal variations while performing a complex and dynamic everyday task.

The appropriate using of biomedical devices is an important factor when talking about patient safety, owing to the fact that can reduce the amount of adverse events due to human mistakes. With this purpose, institutions that offer health services draw on arrangements like giving periodic training or quick guides implementation. Seizing the great acceptance of information technologies and its benefits, a mobile application was developed as an easy access tool, which offer two components to medical and support staff. The first one allows access to operation, cleaning and troubleshooting quick guides, replacing the traditional printed ones and expediting problems solving when is not necessary a technician. The second component use Virtual Reality to emulate biomedical devices functioning. This tool gives flexibility and independence in training to users, besides it facilitate learning process due to virtual device disposing.

Although sleep complaints are often reported in patients with fibromyalgia syndrome (FMS), there is no conclusive evidence that these complaints represent symptomatic disorders of sleep physiology. Thus, the question of the role of sleep disturbances as an etiological or maintenance factor in FMS remains open. This study identifies the subjective and objective characteristics of sleep disturbances in adult women diagnosed with FMS. We carried out a systematic review of publications since 1990, the publication year of the American College of Rheumatology criteria of FMS. We selected empirical studies comparing sleep characteristics of adult women with FMS and healthy women or women with rheumatic diseases. We identified 42 articles. Patients with FMS were more likely to exhibit sleep complaints and also a less efficient, lighter and fragmented sleep. The evidence of a FMS signature on objective measures of sleep is inconsistent, however, as the majority of studies lacks statistical power. Current evidence cannot confirm the role played by sleep physiology in the pathogenesis or maintenance of FMS symptoms; nonetheless, it is clear that sleep disturbances are present in this syndrome.

Surgeons’ overload is one of the main causes of medical errors that might compromise patient safety. Due to the drawbacks of current options to monitor surgeons’ load, new, sensitive, and objective indices of task (over)load need to be considered and tested. In non-health-care scenarios, intraocular pressure (IOP) has been proved to be an unbiased physiological index, sensitive to task complexity (one of the main variables related to overload), and time on task. In the present study, we assessed the effects of demanding and complex simulated surgical procedures on surgical and medical residents’ IOP. Thirty-four surgical and medical residents and healthcare professionals took part in this study (the experimental group, N = 17, and the control group, N = 17, were matched for sex and age). The experimental group performed two simulated bronchoscopy procedures that differ in their levels of complexity. The control group mimicked the same hand-eye movements and posture of the experimental group to help control for the potential effects of time on task and re-measurement on IOP. We measured IOP before and after each procedure, surgical performance during procedures, and perceived task complexity. IOP increased as consequence of performing the most complex procedure only in the experimental group. Consistently, residents performed worse and reported higher perceived task complexity for the more complex procedure. Our data show, for the first time, that IOP is sensitive to residents’ task load, and it could be used as a new index to easily and rapidly assess task (over)load in healthcare scenarios. An arousal-based explanation is given to describe IOP variations due to task complexity.

Most research connecting task performance and neural activity to date has been conducted in laboratory conditions. Thus, field studies remain scarce, especially in extreme conditions such as during real flights. Here, we investigated the effects of flight procedures of varied complexity on the in-flight EEG activity of military helicopter pilots. Flight procedural complexity modulated the EEG power spectrum: highly demanding procedures (i.e., takeoff and landing) were associated with higher EEG power in the higher frequency bands, whereas less demanding procedures (i.e., flight exercises) were associated with lower EEG power over the same frequency bands. These results suggest that EEG recordings may help to evaluate an operator's cognitive performance in challenging real-life scenarios, and thus could aid in the prevention of catastrophic events.

Background Premature infants are exposed to high levels of noise in the neonatal intensive care unit (NICU). Purpose This study evaluated the effect of a relaxing music therapy intervention composed by artificial intelligence on respiratory rate, systolic and diastolic blood pressure, and heart rate. Methods A double-blind, randomized, controlled trial was conducted in the NICUs of 2 general public hospitals in Andalusia, Spain. Participants were 17 healthy premature infants, randomly allocated to the intervention group or the control group (silence) at a 1:1 ratio. To be included in the study, the subjects were to be 32 to 36 weeks of gestation at birth (M= 32.33; SD = 1.79) and passed a hearing screening test satisfactorily. The intervention lasted 20 minutes, 3 times a day for 3 consecutive days, while infants were in the incubator. Infants' heart rate, respiratory rate, and blood pressure were assessed before and after each intervention session. Results After each session, the respiratory rate decreased in the experimental group (main between-groups effect (F1,13 = 6.73, P = .022, ηpartial = 0.34). Across the sessions, the heart rate increased in the control group (main between-groups effect, F1,11 = 5.09, P = .045, ηpartial = 0.32). Implications for research Future studies can use this music intervention to assess its potential effects in premature infants. Implications for practice Nurses can apply the relaxing music intervention presented in this study to ameliorate the impact of the stressful environment on premature infants.

The lack of physical activity and increasing time spent in sedentary behaviours during childhood place importance on developing low cost, easy-toimplement school-based interventions to increase physical activity among children. The PREVIENE Project will evaluate the effectiveness of five innovative, simple, and feasible interventions (active commuting to/from school, active Physical Education lessons, active school recess, sleep health promotion, and an integrated program incorporating all 4 interventions) to improve physical activity, fitness, anthropometry, sleep health, academic achievement, and health-related quality of life in primary school children. The PREVIENE Project will provide the information about the effectiveness and implementation of different school-based interventions for physical activity promotion in primary school children., The PREVIENE Project was funded by the Spanish Ministry of Economy and Competitiveness (DEP2015-63988-R, MINECO-FEDER). MAG is supported by grants from the Spanish Ministry of Economy and Competitiveness

Head circumference in infants has been reported to predict brain size, total grey matter volume (GMV) and neurocognitive development. However, it is unknown whether it has predictive value on regional and subcortical brain volumes. We aimed to explore the relationship between several head circumference measurements since birth and distributions of GMV and subcortical volumes at later childhood. We examined seventy-four, Caucasian, singleton, term-born infants born to mothers randomised to receive fish oil and/or 5-methyltetrahydrofolate or placebo prenatal supplementation. We assessed head circumference at birth and at 4 and 10 years of age and cognitive abilities at 7 years of age. We obtained brain MRI at 10 years of age, on which we performed voxel-based morphometry, cortical surface extraction and subcortical segmentation. Analyses were controlled for sex, age, height, weight, family status, laterality and total intracranial volume. Prenatal supplementation did not affect head circumference at any age, cognitive abilities or total brain volumes. Head circumference at 4 years presented the highest correlation with total GMV, white matter volume and brain surface area, and was also strongly associated with GMV of frontal, temporal and occipital areas, as well as with caudate nucleus, globus pallidus, putamen and thalamus volumes. As relationships between brain volumes in childhood and several outcomes extend into adulthood, we have found that ages between 0 and 4 years as the optimal time for brain growth; postnatal factors might have the most relevant impact on structural maturation of certain cortical areas and subcortical nuclei, independent of prenatal supplementation.

Objective To assess the sensitivity of gaze-based metrics in detecting cognitive demands imposed by surgical procedures. We analyzed urologists' gaze entropy and velocity while performing 2 standardized high-fidelity simulated stone procedures with different levels of complexity. Methods Using a wearable eye tracker device (mounted onto an eyeglass frame), we measured gaze entropy and velocity in 15 urologists, members of the Andalusian health-care system, while they performed an extraction of a stone in the bladder (low complexity) and an extraction of a stone in the lumbar ureter (high complexity). We also collected performance and subjective data. Results Gaze entropy and velocity were significantly higher when surgeons performed the most complex surgical procedure: the visual exploration pattern became less stereotyped (ie, more random) and faster. Surgeons' performance and perceived task complexity differed accordingly, confirming the gaze-based results. Conclusion Gaze-based metrics might have great potential as objective and nonintrusive indices to assess surgeons' cognitive (over)load, potentially being a complementary assessment tool to quantify the learning curve for surgical procedures.

Sleep disturbances play an important role in the exacerbation of pain and other troubling symptoms reported by patients with fibromyalgia (FM). The objective of this trial was to analyze the efficacy of a cognitive-behavioral therapy for insomnia (CBT-I) versus a sleep hygiene (SH) education program at improving sleep and other clinical manifestations in FM. Sixty-four FM women with insomnia were randomly assigned to the CBT-I or the SH groups, and 59 completed the treatments (30 in the CBT-I group and 29 in the SH group). Participants completed several self-report questionnaires at pre-, post-treatment and follow-ups. The CBT-I group reported significant improvements at post-treatment in several sleep variables, fatigue, daily functioning, pain catastrophizing, anxiety and depression. The SH group only improved significantly in subjective sleep quality. Patients in the CBT-I group showed significantly greater changes than those in the SH group in most outcome measures. The findings underscore the usefulness of CBT-I in the multidisciplinary management of FM.

110 Background: Cancer-related-fatigue (CRF) is the most debilitating symptom in patients with advanced cancer. Physical activity (PA) improves CRF with lower adherence in advanced cancer. Dexamethasone (Dex) improves CRF but has long-term side effects. The purpose of the study was to determine whether a brief course of Dex improves adherence to PA for CRF management. Methods: Advanced cancer patients with CRF ≥ 4/10 on Edmonton Symptom Assessment Scale (ESAS) were eligible. Patients were randomized to either 4mg of Dex (LoDex) or 8mg of Dex (HiDex) orally BID for 7 days Plus standardized aerobic and resistance exercise for 4 weeks. Change in the Functional Assessment of Chronic Illness-Fatigue (FACIT-F) fatigue subscale from baseline to Day 8 (primary outcome) and Day 29 were assessed. Secondary outcomes included changes in fatigue (ESAS, PROMIS, MFSI), Sleep Quality (PSQI), fasting blood glucose, and myopathy. Results: Total evaluable patients were 60 (31 LoDex and 29 HiDex arms). The study was feasible (N = 60/67 were evaluable); 84% and 65% LoDex, and 96% and 68% Hi Dex were adherent to aerobic and resistance exercise, respectively [All Patients were adherent to study medication]. There was no significant difference in grade 3+ AE’s between the two arms (P = 0. 92). The FACIT fatigue subscale Cohen’s d in Lo Dex was 0.90 (P < 0.001) and 0.94(P < 0.001); and Hi Dex was 0.86(P < 0.001); and 1.05(P < 0.001) at Day 8 and Day 29, respectively. Similar improvement was found for ESAS Fatigue (P < 0.001), MFSI total (P = 0.005), and PROMIS –fatigue total (P = 0.005). Mixed model analysis showed significant improvement in FACIT-F fatigue scores at Day 8 (P = 0.0006), Day 15 (P = 0.0002), and D (P = 0.0018). There was no significant difference between the two arms at Day 8 and Day 29 in fatigue scores, myopathy, fasting blood glucose levels, symptom distress, and sleep quality scores. Conclusions: Short course of dexamethasone Plus physical activity resulted in sustained and robust improvement in CRF outcomes for upto 3 weeks after discontinuation of steroids suggesting possible priming effects of steroids helped to sustain physical activity. Further larger studies are justified. Clinical trial information: NCT02491632.

Sleep-related disorders are common in patients with chronic obstructive pulmonary disease (COPD) and, possibily, other lung disorders. Exercise has been shown to improve sleep disturbances. In patients with COPD, pulmonary rehabilitation (PR) produces important health benefits with improvement in symptoms, exercise tolerance, and quality of life. However, the effect of PR on sleep quality remains unknown. The aim of this observational study was to evaluate sleep quality in patients with chronic lung disease and the role of PR as a non-pharmacologic treatment to improve sleep. Sixty-four patients with chronic lung disease enrolled in an 8-week comprehensive PR program, and completed the study (48% male; obstructive [72%], restrictive [20%], mixed [8%]; 44% on supplemental oxygen). Baseline spirometry [mean (SD)]: FEV1% pred = 48.9 (17.4), FVC% pred = 72.5 (18.1), and FEV1/FVC% = 53.1 (18.9). Exercise tolerance and questionnaires related to symptoms, health-related quality of life (HRQL), and sleep quality using the Pittsburgh Sleep Quality Index (PSQI) were obtained before and after PR. 58% reported poor sleep quality (PSQI5) at baseline. Sleep quality improved by 19% (p = 0.017) after PR, along with significant improvements in dyspnea, exercise tolerance, self-efficacy, and HRQL. Sleep quality in patients with chronic lung disease was poor. In addition to expected improvements in symptoms, exercise tolerance, and HRQL after PR, the subgroup of patients with COPD had a significant improvement in sleep quality. These findings suggest that PR may be an effective, non-pharmacologic treatment option for sleep problems in patients with COPD.

Lung cancer is the leader malignancy worldwide accounting 1.5 millions of deaths every year. In the United States the 5 year-overall survival is less than 20% for all the newly diagnosed patients. Cisplatin-based cytotoxic chemotherapy for unresectable or metastatic NSCLC patients in the first line of treatment, and docetaxel in the second line, have achieved positive results but with limited benefit in overall survival. Targeted therapies for EGFR and ALK mutant patients have showed better results when compared with chemotherapy, nevertheless most of patients will fail and need to be treated with chemotherapy if they still have a good performance status.

Objectives: To investigate differences in sleep quality between Hispanics of Mexican descent (HMD) and Non-Hispanic Whites (NHW) and evaluate the effect of acculturation to the US lifestyle in sleep health. We hypothesize that the detrimental effect of acculturation on health outcomes will impact sleep quality among HMD. Design: We performed a population-based random digit dialing telephone survey to determine sleep quality in HMD and NHW. We collected from 3667 subjects, demographics, previous diagnosis of depression or anxiety, past treatment for sleep disorders, the Pittsburgh Sleep Quality Index (PSQI) and the Short Acculturation Scale for Hispanics. Results: The prevalence of poor sleep quality (PSQI > 5) was 64.4% for HMD and 64.3% for NHW (p = 0.93). A prior diagnosis of depression or anxiety was an independent predictor of poor sleep quality in both groups (OR 3.4 and 2.7 for HMD and NHW. Ethnicity was not a predictor of poor sleep quality in HMD or NHW. Acculturation was not a predictor of poor sleep quality in HMD. However, highly acculturated young HMD males had significantly more prevalence of poor sleep quality compared to NHW (64.8% vs. 49.8%, p < 0.001). Conclusion: The absence of sleep quality differences in a large sample of HMD and NHW living in San Diego County is contrary to current data of having poorer sleep quality among Latinos. We found that neither ethnicity nor acculturation were predictors of poor sleep quality in HMD. However, we demonstrated a highly prevalent poor sleep quality among the two ethnic groups. The finding of significantly lower sleep quality in young highly acculturated HMD men may represent the heterogeneity of ethnicity related to sleep. Programs to improve sleep quality in subjects with depression and/or anxiety, and in young highly-acculturated HMD seems warranted.

Background Despite the growing interest concerning the laparo-endoscopic single-site surgery (LESS) procedure, LESS presents multiple difficulties and challenges that are likely to increase the surgeon's cognitive cost, in terms of both cognitive load and performance. Nevertheless, there is currently no objective index capable of assessing the surgeon cognitive cost while performing LESS. We assessed if gaze-based indices might offer unique and unbiased measures to quantify LESS complexity and its cognitive cost. We expect that the assessment of surgeon's cognitive cost to improve patient safety by measuring fitness-for-duty and reducing surgeons overload. Methods Using a wearable eye tracker device, we measured gaze entropy and velocity of surgical trainees and attending surgeons during two surgical procedures (LESS vs. multiport laparoscopy surgery [MPS]). None of the participants had previous experience with LESS. They performed two exercises with different complexity levels (Low: Pattern Cut vs. High: Peg Transfer). We also collected performance and subjective data. Results LESS caused higher cognitive demand than MPS, as indicated by increased gaze entropy in both surgical trainees and attending surgeons (exploration pattern became more random). Furthermore, gaze velocity was higher (exploration pattern became more rapid) for the LESS procedure independently of the surgeon's expertise. Perceived task complexity and laparoscopic accuracy confirmed gaze-based results. Conclusion Gaze-based indices have great potential as objective and non-intrusive measures to assess surgeons' cognitive cost and fitness-for-duty. Furthermore, gaze-based indices might play a relevant role in defining future guidelines on surgeons' examinations to mark their achievements during the entire training (e.g. analyzing surgical learning curves).

Fatigue is a major contributing factor to operational errors. Therefore, the validation of objective and sensitive indices to detect fatigue is critical to prevent accidents and catastrophes. Whereas tests based on saccadic velocity (SV) have become popular, their sensitivity in the military is not yet clear, since most research has been conducted in laboratory settings using not fully validated instruments. Field studies remain scarce, especially in extreme conditions such as real flights. Here, we investigated the effects of real, long flights on SV. We assessed five newly commissioned military helicopter pilots during their aviation training. Pilots flew Sikorsky S-76C helicopters, under instrumental flight rules, for more than 2 h (ca. 150 min). Eye movements were recorded before and after the flight with an eye tracker using a standard guided-saccade task. We also collected subjective ratings of fatigue. SV significantly decreased from the Pre-Flight to the Post-Flight session in all pilots by around 3% (range: 1-4%). Subjective ratings showed the same tendency. We provide conclusive evidence about the high sensitivity of fatigue tests based on SV in real flight conditions, even in small samples. This result might offer military medical departments a valid and useful biomarker of warfighter physiological state.

39 Background: Environment is important component of communication skills. Physicians’ communication style including attire may influence patient perceptions. Previous studies mostly based on pictures of providers in different attires provide conflicting evidence. This RCT aimed to explore the effects of physician attire on patients’ perceptions of compassion, professionalism and physician preference. Hypothesis was that patients will perceive the doctor in formal attire as more compassionate than the doctor wearing casual attire. Methods: 105 English speaking adult follow-ups at outpatient supportive care center, were randomized to watch 2 standardized, 3-minute video vignettes, with similar script, depicting a routine clinic encounter. In one video, physician was wearing formal attire with tie and buttoned up white coat, while in the other, physician was in casual attire without a tie or white coat. Actors and patients were all blinded to purpose of the study. Investigators were blinded to the videos watched by patients. After viewing each video, patients completed validated questionnaires rating their perception of physician compassion (0 = best, 50 = worst) and professionalism (5 = poor, 25 = very good). Patients were also asked to rate their preference for the physician. Results: There were no significant differences between formal and casual attire for compassion [median (IQR), 25 (10, 31) vs 20 (8, 27); P = 0.31] and professionalism, [17 (13, 21) vs 18 (14, 22); P = 0.42]. 32 (30%) patients preferred formal, 33 (31%) preferred casual attire and 40 (38 %) patients had no preference. Subgroup analysis did not show significant differences among age, sex, marital status and education level for compassion, professionalism and physician preference. Conclusions: Doctor’s attire did not have an effect on patients’ perception of physicians’ level of compassion and professionalism. Dress code also did not influence the patients’ preference for their doctor or their trust and confidence in the doctor’s ability to provide care. There is need for more RCTs in area of communication skills specifically to better understand the impact of different attires on patient perceptions. Clinical trial information: NCT03168763.

We examine the importance of the maintenance and reinvention of tradition to the food choices described by Mexican-American focus group participants recruited from nutritional health settings in central Texas. The pressures experienced while coping with changes in their food environment, such as shift-work and working outside the home, and transformations experienced in the food production system, provided structural barriers and opportunities to the reformation of the cultural tools employed in their food-related behaviors. Food choices varied along temporal and value dimensions, and along the process-oriented stages of food choice identified by Marjorie DeVault, namely provisioning, processing and feeding. Eating was added to DeVault's stages to capture the importance participants placed on the health consequences of consumption, and to describe how tradition was employed to enable and rationalize food choices across these stages and dimensions. We also identify how coping with new pressures fro...

The objective of this work was to evaluate the filter bag technique (FBT) in an ANKOM 200 fiber analyzer to assess its accuracy for the determination of acid and neutral detergent fiber (ADF and NDF, respectively) contents in common ruminant feeds from the temperate region of Argentina. The evaluation was done in a ring test of 4 laboratories. The 3 Argentine laboratories were from the College of Agronomy, University of Buenos Aires, the College of Agricultural Sciences of the Catholic University of Argentina, and the Balcarce Agricultural Experiment Station of the National Institute of Agricultural Technology (INTA). The fourth laboratory was from the Department of Animal Science of Cornell University, Ithaca, NY. The feeds utilized were soybean meal expeller, whole sunflower seed, corn grain, herbages of alfalfa, ryegrass, tall wheatgrass, weeping lovegrass, guinea and barley grasses, and silages of corn and of a natural grassland. Results indicated that values obtained in the 4 laboratories were consistent regardless of the laboratory where the analyses were performed. It was concluded that the FBT in the ANKOM instrument gave satisfactory results when used for the determination of both ADF and NDF across samples having a wide range of fiber contents, and that the among-laboratories variability of this methodology was low.

Driving is a task mainly reliant on the visual system. Most of the time, while driving, our eyes are constantly focusing and refocusing between the road and the dashboard or near and far traffic. Thus, prolonged driving time should produce visual fatigue. Here, for the first time, we investigated the effects of driving time, a common inducer of driver fatigue, on two ocular parameters: the accommodative response (AR) and the intraocular pressure (IOP). A pre/post-test design has been used to assess the impact of driving time on both indices. Twelve participants (out of 17 recruited) completed the study (5 women, 24.42±2.84years old). The participants were healthy and active drivers with no visual impairment or pathology. They drove for 2h in a virtual driving environment. We assessed AR and IOP before and after the driving session, and also collected subjective measures of arousal and fatigue. We found that IOP and AR decreased (i.e., the accommodative lag increased) after the driving session (p=0.03 and p

Fatigue at the wheel has been strongly related to car accidents. Traditionally, this phenomenon has been studied in laboratory conditions by means of performance testing. Here, we aimed to improve road safety assessing driver fatigue at the wheel in real scenarios. For this purpose, we have built BioTracker®: a flexible non invasive platform. A smartphone and a microcontroller unit are the core of sysetm. In this paper, we describe BioTracker®, and we present some examples of its implementation.

The great usefulness of remote recording of biomedical signals in most aspects of daily life has generated an increasing interest in this field. Traditionally, monitoring devices from clinical enviroments are bulky, intrusive, and expensive. Thus, the development of wearable, mobile, and low-cost applications is desirable. Nevertheless, recent improvements in open-hardware allow developing low cost devices and portable designs for biosignal monitoring in out-of-lab applications, such as sports, leisure, e-Health, etc. This paper presents a low-cost wearable system able to simultaneously record electrical brain and heart activity (i.e. electroencephalography and electrocardiography). The system is able to send biomedical data to a platform for remote analyses. Both software and hardware are open-source. We assessed the system for its validity and reliability in a real road environment.

Saccadic and pupillary responses are reliable indices of arousal decrement (e.g. fatigue), that might be exploited to improve work schedule guidelines. In this study, we tested the sensitivity of a short 30-s oculomotor test to detect diurnal arousal variations. Twelve participants (5 females, 7 males, 37.7+-11.9 years) volunteered to be assessed every hour (66+-20 min) for three consecutive working days, during their regular office-hours. We used a fully automated testing system, the FIT 2000 Fitness Impairment Tester (Pulse Medical Instruments Inc., Rockville, MD, USA), to measure and record saccadic peak velocity, pupil diameter, and latency and amplitude of the pupillary light reflex. In addition, we collected subjective levels of arousal using the Stanford Sleepiness Scale, and body core temperature. We analyzed the data using a linear mixed model approach for longitudinal data. Both saccadic velocity and subjective alertness decreased over the course of a day, while body core temperature increased (all p-values.05). The data also weakly suggested an increase of the pupil diameter (p 07). The findings support the use of oculomotor indices in the assessment of arousal and fatigue in applied settings.