From tablet to table: How augmented reality influences food desirability.

Augmented reality (AR) technology has generated enormous industry investment and buzz, with the food and beverage sector quickly embracing this technology in an effort to enhance the customer experience. However, academic research has only just begun to empirically explore how and why this technology might influence consumer judgements and behaviors in such contexts. Across two field studies involving consequential behavior and two controlled laboratory studies, we find that AR's unique ability to visually superimpose objects onto a real-time environment increases consumers' ability to mentally simulate consuming a pictured food, which in turn increases their desire and purchase likelihood of the food item. Further, we find the increased mental simulation produced by AR is itself preceded and driven by an increased sense of personal relevance of the food items. Supplementary Information: The online version contains supplementary material available at 10.1007/s11747-022-00919-x.

Differential effects of androgens, estrogens and socio-sexual context on sexual behaviors in the castrated male goat.

The behavioral and endocrine activation of sexual behaviors exhibited by male goats, especially self-enurination (SE), is poorly understood. In the first experiment, to assess the influence of socio-sexual context on SE in bucks, the effects of distance from does, the presence of estrous versus non-estrous does and the presence of another buck on SE and courtship frequencies of intact male goats (bucks; n = 12) were tested using a unique behavior test apparatus. For experiments 2 and 3, to test the relative contributions of sex steroid hormones and socio-sexual context on SE, castrated male goats (wethers; n = 20) were randomly divided into five groups and injected for seven weeks with one of the following: 25 mg testosterone propionate (T), 25 mg dihydrotestosterone propionate (DHT), 100 µg estradiol benzoate (E), 100 µg E and 25 mg DHT (E + DHT), or oil (CON). The effects of these treatments on frequency of SE and courtship were assessed using the behavior test apparatus (social scenarios) adapted from the findings in experiment 1. In one scenario, a wether could observe (from 4.6 m) a buck and estrous female (doe) together in a wire mesh holding pen. In a different scenario, the wether could observe (from the same distance) a buck that could only court the estrous doe through a wire mesh barrier. Finally, to observe the effects of steroid treatment on mounting and ejaculation frequencies, in addition to SE and courtship, each wether was placed in a pen with an estrous doe for 10 min. After a five-week, treatment-washout period, wethers were randomly assigned to different treatment groups and retested. In experiment 1, bucks that were distanced from females displayed more SEs than those with fence-line contact, while those with fence-line contact displayed more bouts of courtship (P < 0.05). In experiments 2 and 3, courtship frequencies displayed in all three scenarios were greater than CON only for groups exposed to estrogen directly or via aromatization (T, E + DHT, E; P < 0.05). Frequencies of SE exhibited during behavior tests in which the wether was watching were greater than CON only for androgen-treated groups (T, E + DHT, DHT; P < 0.05). In contrast, when the wether was free to interact with the female, only the DHT group displayed SE at a higher frequency than CON (P < 0.05). Treatment had no effect on mount frequencies in this test scenario, however ejaculation frequencies were highest for T and E + DHT (P < 0.05). These studies suggest that the courtship behaviors of the male goat are estrogen-dependent. However, SE appears to be activated by androgens. It was also demonstrated that social context contributes as much to behavior expression as steroid treatment, as in social scenario 2 some sexual behaviors were displayed in similar frequencies across groups, despite differing sex steroid treatments.

Alternate-day dosing with statins.

The duration of the cholesterol-lowering effect of statins is considerably longer than the duration of the pharmacokinetic half-life of these drugs. The long duration of pharmacologic effects provides the rational for the efficacy of intermittent dosing that provides nearly the equivalent low-density lipoprotein cholesterol reduction compared with daily dosing. Review of studies comparing alternate-day dosing with daily dosing of statins indicates that the magnitude of low-density lipoprotein cholesterol reduction with alternate-day dosing is nearly the same, with obvious cost savings. It is possible that the adverse effects of statins, such as myalgia or diabetes, may be related to the cumulative amount of drug ingested over time, and if so, the adverse effects may be decreased by alternate-day dosing.

The use of sub-anesthetic intravenous ketamine and adjuvant dexmedetomidine when treating acute pain from CRPS.

Complex regional pain syndrome (CRPS) is a pain condition of the extremities that presents with pain and allodynia, decreased range of motion, swelling and skin changes. There are 2 forms of CRPS - Type I which does not have demonstrable nerve lesions and Type 2, which has evidence of obvious nerve damage. Management of refractory CRPS has been challenging. Some studies have revealed that the N-methyl-D-aspartic acid receptor (NMDAR) may be involved in the etiology of the pain in CRPS and perhaps that a NMDA receptor antagonist like ketamine is a potential treatment for CRPS. However, the side effect profile of ketamine is concerning, and limiting the adverse effects of the drug is beneficial. Dexmedetomidine is an alpha 2 agonist similar to clonidine with analgesic properties that can be used in combination with ketamine to provide additional analgesia in CRPS. This case describes the treatment of acute pain symptoms from Chronic Regional Pain Syndrome-Type 1 (CRPS-1) with sub-anesthetic intravenous infusion of ketamine with adjunct dexmedetomidine. A 47-year-old female patient presented with severe pain, burning and allodynia from CRPS-1 refractory to conventional therapy. She was then admitted to a monitored bed, received a sub-anesthetic intravenous infusion of ketamine with adjunct dexmedetomidine for 19 hours and subsequently discharged with complete resolution of her pain and associated symptoms. Here, the synergistic effect of the ketamine and dexmedetomidine together is shown to provide excellent symptom relief while decreasing the total ketamine administered. The combination minimized unwanted side effects and eliminated the need for intensive care unit admission secondary to anesthetic doses of ketamine.

Double-blinded, placebo-controlled, prospective randomized trial evaluating the efficacy of paravertebral block with and without continuous paravertebral block analgesia in outpatient breast cancer surgery.

BACKGROUND: Paravertebral block (PVB) is an effective alternative to general anesthesia for breast cancer surgery. Continuous paravertebral block (CPVB) anesthesia may extend postoperative analgesia at home and improve quality of early postoperative recovery of breast cancer patients. PURPOSE: This double-blinded randomized trial was conducted to compare degree of pain, nausea, mood, level of symptom distress, and time to return to normal daily activity between PVB and PVB + CPVB in patients undergoing outpatient breast cancer surgery. PATIENTS AND METHODS: Between July 2003 and April 2008 we randomly assigned 94 (73 evaluable) patients in a 1:1:1 ratio with early breast cancer to single injection PVB followed by CPVB infusion of 0.1% or 0.2% ropivacaine vs placebo (saline) for 48 hours postoperatively for unilateral breast cancer surgery without reconstruction. The primary study endpoint was the degree of pain, nausea, mood state, level of symptom distress, and recovery time. RESULTS: Of the 468 patients assessed for eligibility, 94 consented and 21 with incomplete data or follow-up were excluded, leaving 73 subjects for analysis. There was no clinically significant difference in degree of postoperative pain, nausea, mood state, level of symptom distress, or return to normal activity among the three study groups. CONCLUSION: The current study does not support the routine use of continuous paravertebral catheter anesthesia in patients undergoing operative treatment for breast cancer.

Pathophysiologic mechanisms, diagnosis, and management of dapsone-induced methemoglobinemia.

Dapsone is a leprostatic agent commonly prescribed for the treatment of patients with leprosy, malaria, and a variety of blistering skin diseases, including dermatitis herpetiformis. Methemoglobinemia, a potentially life-threatening condition in which the oxygen-carrying capacity of blood in body tissues is reduced, is a known adverse effect of dapsone use. The authors report a case of dapsone-induced methemoglobinemia observed in the emergency department during routine workup for contact dermatitis in a patient with celiac disease. The pathophysiologic mechanisms, diagnosis, and management of dapsone-induced methemoglobinemia are discussed.

An exploratory comparison of medication lists at hospital admission with administrative database records.

BACKGROUND: Medication reconciliation is recognized as important, but no one method has been recommended. Research has shown that the most common medication reconciliation errors are attributable to omitted medications and doses. The pharmacy claims aggregator used in this evaluation is a private company that gathers pharmacy claims data from disparate pharmacy benefit managers into a secure repository (hereafter referred to as the claims database) under contracts with public and private health plans. A web interface for the repository can be used by subscribing health systems and health care providers to view patient-level pharmacy claims data to support patient care. At the time of this study, the claims database contained information from 5 public and private health insurance programs covering approximately 500,000 enrollees in Arizona. OBJECTIVE: To compare current medication lists (medication name and strength) collected by patient interview upon admission at a medical center with those collected by a company that aggregates pharmacy claims data. METHODS: This study was a retrospective chart review. A list of 300 patients was produced by a medical center using random number generation for patients who were (a) admitted to the medical center from January 1, 2007, through June 30, 2007; (b) aged 18 years or older; and (c) enrollees of health plans that send pharmacy claims data to the claims database. The first 100 patients on this list who were found in the claims database were included in the study sample. Patient-reported current medication information recorded on the medical center's admission medication reconciliation form was compared with the current medication information in the claims database at the time of admission. Medications, including prescription drugs, over-the-counter (OTC) products, supplements, and herbals, were considered current in the medication reconciliation form based on patient reports of medications still being taken upon admission to the medical center. Medications were considered current in the claims database if the most recent fill date plus days supply was equal to or greater than the hospital admission date. Data were collected by an investigator on a standardized data collection form designed for this evaluation. The investigator gathered information from the medical center for each study patient and then queried each patient in the claims database to record data. These 2 medication lists were matched, and discrepancies were noted both at the patient-drug level and at the patient level. Rates of omissions and discrepancies were calculated for each information source, and the McNemar chi-square test for binomial proportions in matched-pair data was used to assess the statistical significance of differences between information sources. RESULTS: Of the 100 patients, a total of 78 patients had medication reconciliation records in their medical center charts that could be compared with claims data. A total of 280 medications were listed for these 78 patients, with 196 medications recorded in the claims database and 131 recorded on the medication reconciliation form. At the patient-drug level, significantly more medications and strengths were listed in the claims database than in the medication reconciliation form (medications: 70.0% of 280 vs. 46.8% of 280, respectively; strengths: 100.0% of 196 vs. 71.8% of 131, respectively; both comparisons P < 0.001). One-half of the medications omitted in the claims database (42 of 84) were OTC medications. On a patient level, there was no significant between-source difference in the proportion of patients who had at least 1 missing medication (44.9% claims vs. 52.6% medication reconciliation form, P = 0.337), but there was a significant difference in the proportion of patients for whom at least 1 strength was missing (0.0% claims vs. 23.1% medication reconciliation form, P < 0.001). All medications and strengths matched in 24 of 78 (30.8%) patients. CONCLUSION: Information collected using a claims database produced a more complete list of medication names and strengths than that compiled upon admission interviews at the medical center. However, the claims database did not contain information about medications that were not reimbursed by insurance. The most accurate method of obtaining the complete medication list may be to combine these 2 techniques.

Sevoflurane provides earlier tracheal extubation and assessment of cognitive recovery than isoflurane in patients undergoing off-pump coronary artery bypass surgery.

OBJECTIVE: To determine whether sevoflurane, because of its lower blood/gas partition coefficient, compared with isoflurane as the primary anesthetic agent, allows earlier tracheal extubation and assessment of cognitive function after off-pump coronary artery bypass (OPCAB) surgery. DESIGN: Prospectively, patients were randomly assigned to receive sevoflurane or isoflurane as their primary anesthetic. Intraoperative opioids were limited to 5 microg/kg of fentanyl. SETTING: Two university hospitals with active cardiac surgery programs. PARTICIPANTS: One hundred one OPCAB surgery patients who met inclusionary and exclusionary criteria participated with institutional review board approval. INTERVENTIONS: Mini-Mental Status Examination, Memory Recall Test, and Observer Assessment of Anxiety and Sedation scales were administered preoperatively, postextubation, at 90 minutes, and between 12 to 24 hours. Pain scores were obtained every 15 minutes after extubation for 90 minutes. MEASUREMENTS AND MAIN RESULTS: Sevoflurane patients were extubated earlier than isoflurane patients (Sevo, 176 +/- 217 minutes and Iso, 257 +/- 279 min, p = 0.02). Although both agents produced similar postanesthetic cognitive profiles, cognitive testing occurred approximately 90 minutes earlier in the sevoflurane group. Verbal rating scale for pain scores >5 were more frequent for sevoflurane than isoflurane patients (p = 0.03). CONCLUSIONS: Both sevoflurane and isoflurane may be safely used as maintenance agents in OPCAB. Sevoflurane has the advantage of allowing earlier extubation and evaluation of cognitive and neurologic function after OPCAB.