The Graded Incomplete Letters Test (GILT): a rapid test to detect cortical visual loss, with UK Biobank implementation.

Impairments of object recognition are core features of neurodegenerative syndromes, in particular posterior cortical atrophy (PCA; the 'visual-variant Alzheimer's disease'). These impairments arise from damage to higher-level cortical visual regions and are often missed or misattributed to common ophthalmological conditions. Consequently, diagnosis can be delayed for years with considerable implications for patients. We report a new test for the rapid measurement of cortical visual loss - the Graded Incomplete Letters Test (GILT). The GILT is an optimised psychophysical variation of a test used to diagnose cortical visual impairment, which measures thresholds for recognising letters under levels of increasing visual degradation (decreasing "completeness") in a similar fashion to ophthalmic tests. The GILT was administered to UK Biobank participants (total n=2,359) and participants with neurodegenerative conditions characterised by initial cortical visual (PCA, n=18) or memory loss (typical Alzheimer's disease, n=9). UK Biobank participants, including both typical adults and those with ophthalmological conditions, were able to recognise letters under low levels of completeness. In contrast, participants with PCA consistently made errors with only modest decreases in completeness. GILT sensitivity to PCA was 83.3% for participants reaching the 80% accuracy cut-off, increasing to 88.9% using alternative cut-offs (60% or 100% accuracy). Specificity values were consistently over 94% when compared to UK Biobank participants without or with documented visual conditions, regardless of accuracy cut-off. These first-release UK Biobank and clinical verification data suggest the GILT has utility in both rapidly detecting visual perceptual losses following posterior cortical damage and differentiating perceptual losses from common eye-related conditions.

"A conservative technique for fractured implant abutment screw retrieval on an internal connection implant: proof of concept (PoC)".

INTRODUCTION: Broken screw removal from the implant connection is a common but challenging process. Several proposed methods and technical solutions may result in unsuccessful removal; thus, a novel, more conservative, risk-free method is proposed as a first attempt. DESCRIPTION OF THE CASE: The proposal is to use a silicon restoration holder to be twisted counterclockwise on the dried surface of the broken fragment inside the implant connection. This method, within the limitations of a minimal case series, yielded 100% results; however, despite previous attempts with less con- servative techniques, this approach showed no efficacy. CONCLUSION: This article aims to promote the use of silicon restoration holders as a minimally invasive first attempt at broken screw retrieval treatment before considering other options.

Author's response to Letter-to-the-Editor from Chang JS. concerning: "Benefit of respiratory gating in the Danish Breast Cancer Group partial breast irradiation trial".

We appreciate Chang JS.'s interest in the article: "Benefit of respiratory gating in the Danish Breast Cancer Group partial breast irradiation trial". The author's response corroborates the statements and comments of Chang JS.

Dyslexics Exhibit an Orthographic, Not a Phonological Deficit in Lexical Decision.

Dyslexia is theorized to be caused by phonological deficits, visuo-attentional deficits, or some combination of the two. The present study contrasted phonological and visuo-attentional theories of dyslexia using a lexical decision task administered to adult participants with and without dyslexia. Homophone and pseudo-homophone stimuli were included to explore whether the two groups differed in their reliance on phonological encoding. Transposed-letter stimuli, including both TL neighbors and TL non-words, measured potential orthographic impairment predicted by visuo-attentional deficit theories. The findings revealed no significant difference in response time or accuracy between the groups for the homophone and pseudo-homophone stimuli. However, dyslexics were significantly slower and less accurate in their responses to the TL stimuli than controls. Thus, dyslexics presented deficits consistent with visuo-attentional theories, but not with the phonological deficit theory.

Cracking the Code: Interpreting Content and Phrases Used in Maternal-Fetal Medicine Fellowship Letters of Recommendation.

BACKGROUND: Letters of recommendation for Maternal-Fetal Medicine(MFM) fellowship are a critical part of the applicant selection process. However, data regarding best practices for how to write LOR for MFM is limited. Similarly, within letters of recommendation, differences in the 'code' or meaning of summative words/phrases used at the end of letters of recommendation are seen between surgery, pediatrics and medicine. However, data regarding code MFM Letters of recommendation are quite limited. OBJECTIVE: We sought to describe what Maternal-Fetal Medicine program directors value in letters of recommendation for fellowship applicants and how PDs interpret commonly used summative words/phrases. STUDY DESIGN: After IRB exemption, subject matter experts developed an e-survey querying the importance of various letters of recommendation 'best practices' described by other specialties. Content and face validation were performed prior to dissemination. This cross-sectional survey was administered to MFM program directors in February 2023. The primary outcome was the relative importance of letters of recommendation content areas. Secondary outcomes included the strength of each summative 'code' phrase. Descriptive analysis was performed and principal component analysis (PCA) was then used to reduce the list of phrases to their underlying dimensions. Statistical analysis was performed by SPSS 29.0. RESULTS: Of 104 MFM program directors sent the survey, 70 (67%) responded. MFM program directors reviewed an average of 78 applications (SD, 30) with 60% writing ≥3 letters/year. Ninety-one percent of respondents noted that letters of recommendation are important/very important in shaping impressions of an applicant. Respondents reported the depth of interaction with an applicant, the applicant's specific behavior traits, the applicant's abilities and a summative statement including strength of the recommendation as important content for MFM fellowship letters of recommendation. Letter length, use of bold/italics, and restating the applicant's curriculum vitae were considered not important. Following PCA with varimax rotation, 14 specific phrases used in letters of recommendation were reduced to 5 themes: high qualitative assessments, average qualitative assessments, objective metrics, exceeding expectations and grit. These themes accounted for 64.6% of the variance in the model (KMO 0.7, Bartlett's Test of Sphericity p<0.01). Phrases that respondents considered positive included: 'Top 5%', 'Want to keep', and 'highest recommendation', (all mean score≥4.5/5), while 'expected level', 'showed improvement', and '2nd quartile' were negatively associated code words (all mean score <2.5/5). CONCLUSIONS: MFM program directors reported that descriptions of an applicant's abilities, behavior traits, and depth of the writer's interactions with the applicant were all important components of an MFM fellowship letters of recommendation. Letter length, bold/italics, and highlights from the CV were not important. A clear 'code' emerged regarding summative phrases included in letters of recommendation. Dissemination of these data might help less experienced letter writers send a clearer message and ensure all letter writers have a shared mental model.

Overcoming the High Error Rate of Composite DNA Letters-Based Digital Storage through Soft-Decision Decoding.

Composite DNA letters, by merging all four DNA nucleotides in specified ratios, offer a pathway to substantially increase the logical density of DNA digital storage (DDS) systems. However, these letters are susceptible to nucleotide errors and sampling bias, leading to a high letter error rate, which complicates precise data retrieval and augments reading expenses. To address this, Derrick-cp is introduced as an innovative soft-decision decoding algorithm tailored for DDS utilizing composite letters. Derrick-cp capitalizes on the distinctive error sensitivities among letters to accurately predict and rectify letter errors, thus enhancing the error-correcting performance of Reed-Solomon codes beyond traditional hard-decision decoding limits. Through comparative analyses in the existing dataset and simulated experiments, Derrick-cp's superiority is validated, notably halving the sequencing depth requirement and slashing costs by up to 22% against conventional hard-decision strategies. This advancement signals Derrick-cp's significant role in elevating both the precision and cost-efficiency of composite letter-based DDS.

Font Matters: Deciphering the Impact of Font Types on Attention and Working Memory.

Introduction Various types of fonts such as serif, sans serif, and script are used during writing and reading, which can affect the reader's attention and working memory, though there is only a subtle difference at the end of the letter. The study aimed to see the effect of font type on working memory and attention. Methods The study included healthy male adults between 18 and 40 years of age. After taking all the necessary precautions, a letter cancellation test and 2-back task in serif, sans serif, and script font types were done to evaluate subjects' attention and working memory. Results A total of 30 subjects participated in the study. The letter cancellation task (LCT) was statistically significant (P<0.05) between the three groups, where the time taken to complete the task was the shortest for serif fonts, indicating heightened attention to serif fonts. However, the accuracy of the N-back test did not show statistically significant differences (P>0.05) among the three font groups, indicating no significant change in working memory. Conclusion The type of font used can impact the reader's attention, with Times New Roman font demonstrating greater attention, particularly in the context of the letter cancellation task.

Letter to the editor on "in vitro & in silico study of hypoglycaemic potential of pterocarpus marsupium heartwood extract".

The Short Communication "In vitro & in silico study of hypoglycemic potential of Pterocarpus marsupium heartwood extract" published in Natural Product Research is praised for its depth of inquiry and exploration of hypoglycemic and antioxidant properties. However, there are areas for refinement, such as clearer definitions of key terms related to type 2 diabetes mellitus, updated literature review, improved organization and contextualization of the Results and Discussion section, and a more balanced discussion of the study's implications.

Changes and challenges in the residency application process in obstetrics and gynecology.

Faculty career advisors who guide applicants applying to obstetrics and gynecology residency programs need updated information and resources, given the constant changes and challenges to the residency application process. Initial changes included standardization of the application timeline and interview processes. More recent changes included the utilization of a standardized letter of evaluation, initiation of program signaling, second look visit guidelines, and updated sections in the Electronic Residency Application Service. Challenges in advising include the unmatched applicant and the applicant who is couples matching in the era of program signaling. Additional considerations include applying with the current status of reproductive health law restrictions and preparing for a new residency application platform. The Undergraduate Medical Education Committee of the Association of Professors of Gynecology and Obstetrics provides this updated guide of the prior 2021 resource for advisors to increase confidence in advising students, boost professional fulfillment with advising activities, and aid in satisfaction with advising resources. This guide covers the continuing challenges and future opportunities in the resident application process.

Lateralized displays reveal the perceptual locus of the syllable transposition effect in Korean.

Studies of letter transposition effects in alphabetic scripts provide compelling evidence that letter position is encoded flexibly during reading, potentially during an early, perceptual stage of visual word recognition. Recent studies additionally suggest similar flexibility in the spatial encoding of syllabic information in the Korean Hangul script. With the present research, we conducted two experiments to investigate the locus of this syllabic transposition effect. In Experiment 1, lexical decisions for foveal stimulus presentations were less accurate and slower for four-syllable nonwords created by transposing two syllables in a base word as compared to control nonwords, replicating prior evidence for a transposed syllable effect in Korean word recognition. In Experiment 2, the same stimuli were presented to the right and left visual hemifields (i.e., RVF and LVF), which project both unilaterally and contralaterally to each participant's left and right cerebral hemisphere (i.e., LH and RH) respectively, using lateralized stimulus displays. Lexical decisions revealed a syllable transposition effect in the accuracy and latency of lexical decisions for both RVF and LVF presentations. However, response times for correct responses were longer in the LVF, and therefore the RH, as compared to the RVF/LH. As the LVF/RH appears to be selectively sensitive to the visual-perceptual attributes of words, the findings suggest that this syllable transposition effect partly finds its locus within a perceptual stage of processing. We discuss these findings in relation to current models of the spatial encoding of orthographic information during visual word recognition and accounts of visual word recognition in Korean.

Metabolic dysfunction-associated fatty liver disease and low muscle strength: A comment.

The diagnosis of non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated fatty liver disease only on the basis of laboratory parameter score such as Hepatic Steatosis Index which includes liver enzymes, gender, basal metabolic index, and presence of diabetic mellitus is not sufficient to exclude other causes of deranged liver enzymes especially medications and autoimmune related liver diseases. As the guideline suggests ultrasound is the preferred first-line diagnostic procedure for imaging of NAFLD, as it provides additional diagnostic information and the combination of biomarkers/scores and transient elastography might confer additional diagnostic accuracy and evident from previous similar studies too.

The word superiority effect overcomes crowding.

Crowding and the word superiority effect are two perceptual phenomena that influence reading. The identification of the inner letters of a word can be hindered by crowding from adjacent letters, but it can be facilitated by the word context itself (the word superiority effect). In the present study, strings of four-letters (words and non-words) with different inter-letter spacings (ranging from an optimal spacing to produce crowding to a spacing too large to produce crowding) were presented briefly in the periphery and participants were asked to identify the third letter of the string. Each word had a partner word that was identical except for its third letter (e.g., COLD, CORD) so that guessing as the source of the improved performance for words could be ruled out. Unsurprisingly, letter identification accuracy for words was better than non-words. For non-words, it was lowest at closer spacings, confirming crowding. However, for words, accuracy remained high at all inter-letter spacings showing that crowding did not prevent identification of the inner letters. This result supports models of "holistic" word recognition where partial cues can lead to recognition without first identifying individual letters. Once the word is recognized, its inner letters can be recovered, despite their feature loss produced by crowding.

Exploring predictive markers for liver failure post-hepatectomy in hepatocellular carcinoma patients.

This letter to the editor addresses the study titled "Predictive value of NLR, Fib4, and APRI in the occurrence of liver failure after hepatectomy in patients with hepatocellular carcinoma" by Kuang et al in the World Journal of Gastrointestinal Surgery. The study acknowledges the comprehensive patient data analysis while suggesting that there is a need for further discussion on the clinical applicability of these markers across diverse patient populations. This letter recommends prospective studies for validation and considers the influence of confounding factors. This finding underscores the significance of this study in improving hepatocellular carcinoma management.

Rational Engineering of Escherichia coli Nissle 1917 as Live Biotherapeutic to Degrade Uremic Toxin Precursors.

Uremic toxins (UTs) are microbiota-derived metabolites that accelerate the progression of kidney damage in patients with chronic kidney disease (CKD). One of the major UTs involved in CKD progression is p-cresol-sulfate (PCS), derived from dietary l-tyrosine (l-Tyr). Here, we engineered a probiotic strain of Escherichia coli Nissle 1917, to convert l-Tyr to the nontoxic compound p-coumaric acid via tyrosine ammonia lyase (TAL). First, a small metagenomic library was assessed to identify the TAL with the greatest whole-cell activity. Second, accessory genes implicated in the import of l-Tyr and export of PCA were overexpressed to enhance l-Tyr degradation by 106% and 56%, respectively. Last, random mutagenesis coupled to a novel selection and screening strategy was developed that identified a TAL variant with a 25% increase in whole-cell activity. Taken together, the final strain exhibits a 183% improvement over initial whole-cell activity and provides a promising candidate to degrade l-Tyr mediated PCS accumulation.

Optimization of a standardized letter of recommendation for faculty who wish to support candidates applying to surgical training programs.

Letters of recommendation (LORs) play an important role in applicant selection for graduate medical education programs. LORs may be of increasing importance in the evaluation of applicants given the recent change of the USMLE Step 1 to pass/fail scoring and the relative lack of other objective measures by which to differentiate and stratify applicants. Narrative letters of recommendation (NLORs), although widely used, have certain limitations, namely variability in interpretation, introduction of gender/race bias, and performance inflation. Standardized letters of recommendation (SLOR) have been proposed as a potential corrective to these limitations. We conducted a series of semi-structured interviews and focus groups to gather perspectives from letter writers and readers to inform methods for improving information elicited by SLORs from which we collected and analyzed data using the constant comparative method and a process of iterative coding. We applied our findings to the development of a novel SLOR for use in surgical residency program applications and were subsequently invited to help revise existing SLORs for a surgical post-graduate training program.

Effects of vitamin family members on insulin resistance and diabetes complications.

The following letter to the editor highlights the article "Effects of vitamin D supplementation on glucose and lipid metabolism in patients with type 2 diabetes mellitus and risk factors for insulin resistance" in World J Diabetes 2023 Oct 15; 14 (10): 1514-1523. It is necessary to explore the role of vitamin family members in insulin resistance and diabetes complications.

Differences in discharge letter content: oncologists' vs. home care physicians' needs.

PURPOSE: To compare the details, oncologists include in discharge letters with what home care physicians need. Although discharge letters are important to share patients' information for home palliative care, few studies have compared the details, especially patients' emotions, regarding what oncologists include in discharge letters and home care physicians' needs. METHODS: This cross-sectional study was conducted by sending anonymous, self-administered questionnaires to 500 certified oncologists (OCs) and 500 directors of home care supporting clinics (HCs) in Japan between March and May 2023. The survey considered 20 potential items found in discharge letters, and compared rates of OCs including these items and HCs needs. RESULTS: Of 310 valid responses, 186 were from OCs (average age: 47.7; 29 females) and 124 from HCs (average age: 55.4; 9 females). Major items with lower inclusion rates for OCs included patients' emotions regarding medical conditions (58.4% in OCs vs. 92.6% in HCs, p < 0.001), families' emotions regarding medical conditions (60.0 vs. 92.6%, respectively, p < 0.001), patients' perceptions regarding medical conditions (84.9 vs. 94.3%, respectively, p = 0.011), families' perceptions regarding medical conditions (84.3 vs. 95.1%, respectively, p = 0.004), and potential late-onset treatment-related adverse events (79.3 vs. 92.6%, respectively, p = 0.002). Conversely, OCs included patients' activities of daily living more frequently (96.2 vs. 90.2%, respectively, p = 0.031). CONCLUSION: Transitioning to home-based palliative care may necessitate accurate information and consideration of patients' and families' perceptions and emotions regarding medical conditions in discharge letters for continuous provision of high-quality care.

Brain reserve affects the expression of cognitive reserve networks.

Cognitive reserve (CR) explains differential susceptibility of cognitive performance to neuropathology. However, as brain pathologies progress, cognitive decline occurs even in individuals with initially high CR. The interplay between the structural brain health (= level of brain reserve) and CR-related brain networks therefore requires further research. Our sample included 142 individuals aged 60-70 years. National Adult Reading Test intelligence quotient (NART-IQ) was our CR proxy. On an in-scanner Letter Sternberg task, we used ordinal trend (OrT) analysis to extract a task-related brain activation pattern (OrT slope) for each participant that captures increased expression with task load (one, three, and six letters). We assessed whether OrT slope represents a neural mechanism underlying CR by associating it with task performance and NART-IQ. Additionally, we investigated how the following brain reserve measures affect the association between NART-IQ and OrT slope: mean cortical thickness, total gray matter volume, and brain volumes proximal to the areas contained in the OrT patterns. We found that higher OrT slope was associated with better task performance and higher NART-IQ. Further, the brain reserve measures were not directly associated with OrT slope, but they affected the relationship between NART-IQ and OrT slope: NART-IQ was associated with OrT slope only in individuals with high brain reserve. The degree of brain reserve has an impact on how (and perhaps whether) CR can be implemented in brain networks in older individuals.