A 5-week Digital Intervention to Reduce Attention Problems in Children With ADHD: A Double-Blind Randomized Controlled Trial.

OBJECTIVE: Growing evidence suggests digital interventions may provide neurocognitive benefits for children with ADHD. This study aimed to investigate the efficacy of a digital attention intervention in children with ADHD. METHOD: In this double-blind randomized controlled trial 55 children with ADHD (5-9 years) were allocated to the intervention (N = 28) or control program (N = 27). Both programs were delivered via touchscreen tablets at home 5 days a week for 5 weeks. The primary outcome was change in the Test of Variables of Attention (TOVA) Attention Comparison Score (ACS) from pre- to post-intervention. RESULTS: Participants who received the intervention had significantly greater improvements in the TOVA ACS from pre- to post-intervention than those in the control (p < .044). No intervention effects were observed on secondary outcomes assessing executive functioning, ADHD symptoms, or functional impairment. CONCLUSION: Collectively these findings provide insufficient evidence for the implementation of digital attention interventions for children with ADHD.

Overexposure to ultraviolet radiation in solar urticaria.

A man in his 50s was diagnosed with solar urticaria following monochromated light testing that demonstrated exquisite photosensivity to ultraviolet (UV) A, UV B (UVB) and visible light.Treatment options for this photodermatosis are limited; UVB phototherapy is one modality that can be appropriate in some patients. This is administered at very low doses in a controlled environment to induce skin hardening.1 To self-treat his condition, the patient used a commercial sunbed on two occasions several days apart. He noted an immediate flare of solar urticaria after first use with associated dizziness. Following the second use, he felt generally unwell and was witnessed to lose consciousness and displayed jerky movements of his limbs while a passenger in a car. Investigations including a head MRI and an EEG were normal; an anoxic seizure caused by a flare of solar urticaria was later confirmed.Solar urticaria is a rare photodermatosis that is poorly understood and difficult to treat. The condition has a significant impact on the quality of life of patients. Severe cases can be associated with systemic symptoms that could be life-threatening.

Epidemiology and assessment of Hepatitis B positive children in Western Australia.

AIM: To describe the characteristics of patients with chronic hepatitis B (CHB) presenting to a tertiary paediatric hospital in Perth, Western Australia. Review of implementation of previous follow-up recommendations for the cohort was also undertaken. METHOD: A retrospective data analysis of all individuals aged between 0 and 17 years presenting to the tertiary children's hospital who were hepatitis B surface antigen (HBsAg) positive over 8 years (2013-2020). Demographic features, clinical progress and follow up are described, including proportion transferred to adult services. RESULTS: Seventy-four patients were identified to have CHB; mean age at diagnosis 11 years; standard deviation 4 years; 41 (55%) male. Cultural and ethnolinguistic diversity was high; 74% (n = 55) were from refugee-like backgrounds. Many did not demonstrate English proficiency (23/40; 75%) and 7 (10%) Australian born including 4 patients who were Aboriginal. Most patients (58%) with CHB were in the hepatitis B e antigen-positive chronic infection phase with no intervention provided. Seventeen children had undergone liver ultrasonography and one underwent liver biopsy; none received antiviral treatment. Follow up was concerning; 28 (38%) had at least one clinic non-attendance, 24 (32%) lost to follow-up and interpreter utilisation was poorly documented. Thirty-nine (53%) were transferred to adult services with only 56% attending follow-up. CONCLUSION: CHB burden is higher in those from culturally and ethnolinguistically diverse backgrounds. There is a significant loss to follow-up and suboptimal transfer to adult services. Improved recall, education and referral processes are necessary to overcome language, socioeconomic and cultural barriers. Although childhood complications are infrequent, longitudinal monitoring is crucial to prevent long-term complications and adult morbidity.

Evidence of Hematoma Prevention After Facelift.

Hematoma is a common complication after facelift procedures. Multiple factors have been shown to increase the risk of hematoma formation, such as male gender, anticoagulant medication use, perioperative hypertension, increased intrathoracic pressure, and operative technique. The purpose of this manuscript is to provide an overview of existing literature to provide surgeons with evidence-based recommendations on how to minimize hematoma risk during facelift surgery. A literature search for hematoma and facelift surgery was performed that identified 478 unique manuscripts. Abstracts were reviewed, excluding articles not describing facelift surgery, those written before 1970, studies with a sample size of fewer than 5 patients, non-English studies, and those that did not provide postoperative hematoma rates. Forty-five articles were included in this text, with their recommendations. Measures such as the prophylactic management of pain, nausea, and hypertension, the use of fibrin glue tissue sealants, the use of local anesthesia rather than general anesthesia, and strict blood pressure control of at least <140 mmHg were found to significantly reduce hematoma formation. Quilting sutures has shown benefit in some high-risk patients. Measures such as drains, compression dressings, perioperative use of selective serotonin reuptake inhibitors, and perioperative steroids had no significant effect on hematoma formation. In addition to appropriate patient selection and careful intraoperative hemostasis, many adjunct measures have been shown to reduce postoperative hematoma formation in facelift procedures.

The patient voice: More than a tick box exercise?

BACKGROUND: Patient and public involvement (PPI) in healthcare professional education is important, yet publications often provide insufficient detail about the types of involvement patients undertake and the level of autonomy that they have. This study details the factors that promote or hinder PPI within a university healthcare professional education setting and the types of activities members conducted. METHODS: PPI activities were described and mapped against a framework for PPI in healthcare professional education. Semi-structured interviews with PPI group members explored the motivators, enablers and barriers that influence involvement. FINDINGS: The framework highlighted that the PPI group were involved in a range of activities, yet they received limited training for their role and were infrequently involved in planning the activities. When interviewed, PPI members did not consider that these factors were the important promoters or barriers to involvement, instead emphasising five themes: (1) their individual characteristics, (2) factors relating to the university organisation, (3) relationships between themselves, faculty and students, (4) time in their role and (5) evidence of their impact. DISCUSSION AND CONCLUSION: Supporting PPI members whilst working, rather than provision of formal training was considered most empowering for group members. This was mediated through having enough time in their role to develop supportive relationships with faculty, which in turn promoted self-confidence and increased autonomy. This should be considered when making PPI appointments. Small changes in processes during education planning can make it easier for PPI members to bring their own agenda forward and promote equity during education decision making.

All Vomit Is Not Viral.

Duplication cysts are congenital malformations of the gastrointestinal tract. They are rare, occurring in 1 in 4,500 births.1 Although the age of symptomatic onset is typically 2 years, current literature shows reports of presentation from newborn to adulthood. Presentation of duplication cysts may vary widely and can occur during outbreaks of acute infectious gastroenteritis cases. Thus, it is important to consider these cysts in the differential diagnosis of the vomiting child. We report the case of a 7-year-old boy with persistent bilious vomiting who was found to have a bilobed duplication cyst. [Pediatr Ann. 2023;52(7):e273-e276.].

Decision Regret in Plastic Surgery: A Summary.

Patient decision regret can occur following elective healthcare decisions. The current era is focused on patient-reported outcomes, and decision regret is another metric by which surgeons can and should measure postoperative results. Patients who experience decision regret after elective procedures can often blame themselves, the surgeon, or the clinical practice, and this can lead to downstream psychological and economic consequences for all parties involved. Methods: A literature search was conducted on PubMed using the following search terms: (aesthetic surgery) AND (decision regret), (rhinoplasty) AND (decision regret), (face-lift) AND (decision regret), (abdominoplasty) AND (decision regret), (breast augmentation) AND (decision regret), (breast reconstruction) AND (decision regret), (FACE-Q) AND (rhinoplasty), (BREAST-Q) AND (breast augmentation). The following article types were included in the search: randomized controlled trials, meta-analysis, and systematic reviews. Results: After review of the literature, preoperative education, decisional tools, and postoperative complications were found to be the most important factors affecting decision regret after surgery. Conclusions: A better understanding of the factors associated with decision regret can help surgeons provide more effective preoperative counseling and prevent postoperative decision regret. Plastic surgeons can use these tools within a context of shared decision-making and ultimately increase patient satisfaction. Decision regret for plastic surgical procedures was mainly in the context of breast reconstruction. The differences in medical necessity create unique psychological challenges, emphasizing the need for more studies and a better understanding of the topic for other elective and cosmetic surgery procedures.

A Survey of Speech-Language Pathologists' and Teachers' Perceptions of Collaborative Service Delivery.

PURPOSE: The purpose of this study was to compare speech-language pathologists' (SLPs) and teachers' perceptions of collaborative service delivery in a school setting. METHOD: We created a survey for SLPs and teachers that included demographic questions and questions about the use of collaborative service delivery models, identification of collaborative partners, and perceived barriers to collaboration. Eighty-seven SLPs and 77 teachers responded to the survey from 28 states. We analyzed the data using mixed methods. RESULTS: The majority of SLPs reported that they used a combination of collaborative and noncollaborative service delivery models. Teachers also reported that the SLP at their school used collaborative and noncollaborative service delivery models. When asked to report on their collaboration experience generally, teachers rated their experience with collaboration more positively than SLPs. Teachers also were not as likely to identify SLPs as collaborative partners when compared with SLPs who identified teachers as collaborative partners. Finally, teachers and SLPs reported similar barriers to implementing a collaborative service delivery model. However, SLPs identified roles and responsibilities and training on collaboration as barriers to collaboration more than teachers. CONCLUSIONS: This study compared SLPs' and teachers' perceptions of collaborative service delivery in schools. The similarities and differences between SLPs and teachers can be used to help facilitate change in the use of collaborative service delivery models.

Damage characteristics of fabrics created by TASER probes.

TASER® weapons are conducted energy weapons (CEWs) that are frequently used by police departments around the world. CEWs can be deployed in two methods: drive stun application and probe deployment. This study aims to examine damages caused by TASER devices on fabrics and whether types of fabric material and TASER models could contribute to different damage features. Three types of white fabric were used, including 100% cotton, 100% polyester, and 65:35 polyester-cotton blend. Three models: TASER X26P, TASER X2, and TASER 7 were shot onto each type of fabric, with five repetitions each. Each damaged area on the fabric caused by a probe is a sample (n = 90) and was examined with a Keyence digital microscope. Images were captured by the Keyence microscope and measurements were recorded, including damage dimensions, fabric condition, evidence of burning, and extra findings. The presence of fused yarn ends was found to be statistically significant across the fabric types, and no damage features were found that may assist in the identification of TASER models. Other damage features including damage dimensions, discoloration, and fiber deformation were not found to be showing apparent differences according to statistical analysis. The conclusions made by this research should be used with caution due to the small sample size.

TASER CEW distance determination for models X26P, X2, and TASER 7.

TASER weapons, classified as Conducted Energy Weapons (CEWs) are used by law enforcement as electrical, non-lethal weapons. A CEW's long distance method of deployment launches two barbed probes that embed into the target, before electricity is cycled from one probe to the other. The resulting muscle contractions help incapacitate the intended target. Currently, there is no research on the accuracy of variability of CEW probe spread in determining the distance of the shooter. Thus, in this study, a method of distance determination for TASER models X26P, X2, and TASER 7 was established to help estimate the relative locations of individuals during crime scene reconstruction. Each of four probe cartridge types were launched for six repetitions towards vertical cardboard targets from three different distances (n = 72). The probe spread on the targets was measured for each cartridge and plotted against CEW-To-Target (CTT) distance. Linear regression trendlines and standard deviations were generated for each cartridge type. Results demonstrated probe spread distances to be proportional to probe launch angles, and greater CTT distances resulted in greater standard deviation. Standard error of the estimate was calculated for all four linear regression equations and their ability to predict CTT distance when given probe spread measurements. The mean standard error values appeared acceptable for the X2 (0.460 m), TASER 7 CQ (0.273 m), and X26P (0.322 m) CEW models, while the mean error calculated for the TASER 7 Standoff model (0.846 m) was considerably greater. We expect our findings will help establish a reliable method of distance determination for CEWs, and perhaps with a larger sample size, more thoroughly examine the accuracy of the linear regression equations. CEW distance determination has the potential to provide support in contextualizing crime scene reconstruction with further research. By providing distance estimations alongside a standardized guide of error allowance, it would be possible to induce how far apart individuals were at the time a CEW was fired, within the calculated window of deviation, and in a statistical degree of confidence.

The Psychological Impact of Aesthetic Surgery: A Mini-Review.

The purpose of this summary is to outline the available research on the psychological factors associated with aesthetic surgery. Aesthetic procedures such as abdominoplasty, breast augmentation, face lift, and rhinoplasty are shown to have unique preoperative and postoperative psychological factors. Depression and anxiety may occur after aesthetic procedures with an increased incidence in patients with certain depression prone personality traits. The pre-existing psychology of patients is also an important contributing factor to consider when evaluating surgical candidates. Pre-existing mood disorders such as depression and anxiety are shown with higher incidence in individuals pursuing aesthetic procedures and can predispose such individuals to worsening mood symptoms postoperatively. This article aims to equip surgeons with a better understanding of the common psychological factors seen in the field of aesthetic surgery, so patients can be better supported throughout all parts of the surgical process.

Colorectal Cancer and Purinergic Signalling: An Overview.

Colorectal cancer (CRC) is among the most common cancers and exhibits a high fatality rate. Gut inflammation is related to CRC, with loss of homeostasis in immune cell activities. The cells of the innate and adaptive immune system, including macrophages, neutrophils, mast cells, and lymphocytes, are present in most solid tumors. Purinergic signaling allows for communication between immune cells within the tumor microenvironment (TME) and can alter the TME to promote tumor progression. This system is regulated by the availability of extracellular purines to activate purinoceptors (P1 and P2) and is tightly controlled by ectonucleotidases (E-NPP, CD73/CD39, ADA) and kinases, which interact with and modify nucleotides and nucleosides availability. In this review, we compiled articles detailing the relationship of the purinergic system with CRC progression. We found that increased expression of CD73 leads to the suppression of effector immune cell functions and tumor progression in CRC. The P1 family purinoceptors A1, A2A, and A2B were positively associated with tumor progression, but A2B resulted in increased cancer cell apoptosis. The P2 family purinoceptors P2X5, P2X7, P2Y2, P2Y6, and P2Y12 were factors primarily associated with promoting CRC progression. In summary, CD39/CD73 axis and the purinergic receptors exhibit diagnostic and prognostic value and have potential as therapeutic targets in CRC.

Manifestation of TASER drive stun burn marks on fabrics.

The TASER® is a type of conducted energy weapon (CEW) used with increasing frequency by law enforcement to subdue subjects in circumstances where compliance is necessary. When operated in the drive stun method of deployment, the electrodes at the head of this CEW are intended to make direct contact with a surface, generating heat and light which may result in burn marks as a by-product of the electrical discharge that occurs. This research aims to tackle a crucial gap in CEW research that fails to address the appearance of burn marks on fabrics. A drive stun duration (DSD) of 1, 3, and 5 s was used with three TASER models (X26P, X2, & TASER 7) on three fabrics (white 100% cotton, 100% polyester, 35:65 cotton-polyester blend) with an underlying backing of pork hock. Using a Keyence VHX-6000 confocal microscope, high magnification images were taken to observe any qualitative changes to the fabric. On polyester fabric, with increasing DSD, darker brown discoloration occurred. Additionally, on polyester fabric, the spatial orientation of the burn marks corresponded with that of the electrodes at the muzzle of each TASER model. These features enabled the correct identification of the TASER model and DSD on polyester fabric in the blind tests performed. Evidence of burn marks on cotton and blend fabrics were both limited and inconsistent such that no features were sufficiently unique to link them to any TASER model or DSD. Despite this, overall features such as discoloration and the formation of holes on these fabric types may be sufficiently unique to suggest the use of a CEW.

Catastrophic Fibromuscular Dysplasia Presenting with Concomitant Bilateral Renal Infarction, Vertebral Artery Dissection, and Mesenteric Ischaemia.

Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory disorder of the arterial wall muscular layer which can lead to arterial stenosis, occlusion, and dissection. Clinical presentations of FMD vary depending on the arterial territories involved, often leading to diagnostic challenges. This case report describes an exceptionally unusual presentation of FMD, not previously described, affecting a previously fit and well 37-year-old female presenting with bilateral renal infarction, sequential vertebral artery dissections, mesenteric ischaemia, and the requirement for continued renal replacement. This report highlights how unusual presentations of FMD can mask the underlying diagnosis. Early consideration of FMD in a differential diagnosis can guide an effective management strategy, including appropriate imaging and multi-speciality involvement.

An immune correlate of SARS-CoV-2 infection and severity of reinfections

BackgroundAn immune correlate of protection from SARS-CoV-2 infection is urgently needed. MethodsWe used an ongoing household cohort with an embedded transmission study that closely monitors participants regardless of symptom status. Real-time reverse-transcription polymerase chain reaction (RT-PCR) and Enzyme-linked immunosorbent assays (ELISAs) were used to measure infections and seropositivity. Sequencing was performed to determine circulating strains of SARS-CoV-2. We investigated the protection associated with seropositivity resulting from prior infection, the anti-spike antibody titers needed for protection, and we compared the severity of first and second infections. ResultsIn March 2021, 62.3% of the cohort was seropositive. After March 2021, gamma and delta variants predominated. Seropositivity was associated with 69.2% protection from any infection (95% CI: 60.7%-75.9%), with higher protection against moderate or severe infection (79.4%, 95% CI: 64.9%-87.9%). Anti-spike titers of 327 and 2,551 were associated with 50% and 80% protection from any infection; titers of 284 and 656 were sufficient for protection against moderate or severe disease. Second infections were less severe than first infections (Relative Risk (RR) of moderated or severe disease: 0.6, 95% CI: 0.38-0.98; RR of subclinical disease:1.9, 95% CI: 1.33-2.73). ConclusionsPrior infection-induced immunity is protective against infection when predominantly gamma and delta SARS-CoV-2 circulated. The protective antibody titers presented may be useful for vaccine policy and control measures. While second infections were somewhat less severe, they were not as mild as ideal. A strategy involving vaccination will be needed to ease the burden of the SARS-CoV-2 pandemic.

Clinical management of immune-related adverse events following immunotherapy treatment in patients with non-small cell lung cancer.

The advent of checkpoint blockade-based immunotherapy is rapidly changing the management of lung cancer. Whereas past anticancer drugs' primary toxicity was hematologic, the newer agents have primarily autoimmune toxicity. Thus, it is no longer enough for oncology practitioners to be skilled only in hematology. They must also understand management of autoimmune conditions, leveraging the skills of the rheumatologist, endocrinologist and gastroenterologist in the process. Herein we describe the mechanism of action and toxicities associated with immune checkpoint blockade in patients with lung cancer and provide a framework for management of adverse events.

The role of emoticons in sarcasm comprehension in younger and older adults: Evidence from an eye-tracking experiment.

We present an eye-tracking experiment examining moment-to-moment processes underlying the comprehension of emoticons. Younger (18-30) and older (65+) participants had their eye movements recorded while reading scenarios containing comments that were ambiguous between literal or sarcastic interpretations (e.g., But you're so quick though). Comments were accompanied by wink emoticons or full stops. Results showed that participants read earlier parts of the wink scenarios faster than those with full stops, but then spent more time reading the text surrounding the emoticon. Thus, readers moved more quickly to the end of the text when there was a device that may aid interpretation but then spent more time processing the conflict between the superficially positive nature of the comment and the tone implied by the emoticon. Interestingly, the wink increased the likelihood of a sarcastic interpretation in younger adults only, suggesting that perceiver-related factors play an important role in emoticon interpretation.

The interplay between control processes and feature relevance: Evidence from dual-task methodology.

Neuropsychological studies suggest a distinction between (a) semantic knowledge and (b) control processes that shape the retrieval of conceptual information to suit the task or context. These aspects of semantic cognition are specifically impaired in patients with semantic dementia and semantic aphasia, respectively. However, interactions between the structure of knowledge and control processes that are expected during semantic retrieval have not been fully characterised. In particular, domain-general executive resources may not have equal relevance for the capacity to promote weak yet task relevant features (i.e., "controlled retrieval) and to ignore or suppress distracting information (i.e., "selection"). Here, using a feature selection task, we tested the contribution of featural relevance to semantic performance in healthy participants under conditions of divided attention. Healthy participants showed greater dual-task disruption as the relevance value of the distractor feature linearly increased, supporting the emerging view that semantic relevance is one of the organising principles of the structure of semantic representation. Moreover, word frequency, and inter-correlational strength affected overall performance, but they did not show an interaction with dual-task conditions. These results suggest that domain-general control processes, disrupted by divided attention, are more important to the capacity to efficiently avoid distracting information during semantic decision-making than to the promotion of weak target features. The present study therefore provides novel information about the nature of the interaction between structured conceptual knowledge and control processes that support the retrieval of appropriate information and relates these results to a new theoretical framework, termed controlled semantic cognition.

Comparison of the eating behaviour and dietary consumption in older adults with and without visual impairment.

Globally, a high prevalence of obesity and undernutrition has been reported in people with visual impairment (VI) who have reported multi-factorial obstacles that prevent them from achieving a healthy diet, such as having restricted shopping and cooking abilities. The present study is the first to investigate the relationship between VI and dietary consumption using a representative sample size, standardised methods to categorise VI and a detailed analysis of dietary consumption. Ninety-six participants with VI and an age-matched control group of fifty participants were recruited from across the UK. All participants were aged 50 years or over. The participants completed a 24-h food recall for a period of 3 d. The participants also answered questions about their abilities to shop for and cook food as well as their knowledge of healthy eating. The participants with VI in this sample consumed significantly fewer energy content and other nutrients than is recommended for their age group and when compared with an age-matched control group. The participants with VI mainly made food choices irrespective of nutritional value. The results of the present study highlight for the first time that a large proportion of older adults with VI in the UK are undernourished. These results suggest local and government-led initiatives should be implemented to support the diets of older adults in the UK, and these initiatives could include healthy eating workshops, café clubs or skills training and rehabilitation.