The Impact of Feedback Modalities and the Influence of Cognitive Load on Interpersonal Communication in Nonclinical Settings: Experimental Study Design

BACKGROUND

The escalating demands of modern health care systems, combined with the emotional toll of patient care, have led to an alarming increase in physician burnout rates. This burnout, characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment, can hinder doctors' ability to connect with patients effectively. Moreover, the cognitive load arising from information overload and the need for multitasking can further hinder doctors' ability to connect with patients effectively. Understanding the complex relationship between physician burnout and cognitive load is crucial for devising targeted interventions that enhance physician well-being and promote effective physician-patient interactions. Implementing strategies to alleviate burnout and cognitive load can lead to improved health care experiences and patient outcomes.

OBJECTIVE

Our study explores the interplay between physician burnout and its potential impact on interpersonal communication, particularly focusing on the role of cognitive load using a pilot study in a nonclinical setting involving nonclinical participants.

METHODS

This study uses an experimental design to evaluate 3 feedback tools (haptic, visual, and postvisit summary) and measure the cognitive load they impose on nonclinical participants in a nonclinical environment. The NASA Task Load Index, a widely accepted measure of cognitive load, was used to quantify the cognitive load associated with the feedback tools. The study used a within-subject design, meaning participants experienced all 3 feedback methods. A sample of 18 nonclinical participants was selected using counterbalancing techniques.

RESULTS

Postsession feedback not only enhancing performance but also mitigating the influence of cognitive load as compared with real-time feedback (haptic+visual). Participants with interview experience showed lower cognitive load levels when exposed to real-time feedback as compared with novice users. In contrast, postsession feedback was more effective for novice users. In addition, cognitive workload emerged as a moderating factor in the relationship between feedback tools and their impact on performance, particularly in terms of speaking balance and pace. This moderating effect suggests that the correlation between feedback tool efficacy and performance varies based on an individual's cognitive load while using the feedback tool. The comparison of postfeedback with haptic feedback yielded a Z score of -3.245 and a P value of .001, while the comparison with visual feedback resulted in a Z score of -2.940 and a P value of .003. These outcomes underscore a significant disparity in the means between postsession feedback and real-time feedback (haptic+visual), with postsession feedback indicating the lowest mean score.

CONCLUSIONS

Through the examination of various feedback tools, this study yields significant and insightful comparisons regarding their usability and appropriateness in nonclinical settings. To enhance the applicability of these findings to clinical environments, further research encompassing diverse participant cohorts and clinical scenarios is warranted.

Vitis Methods to Understand and Develop Strategies for Diagnosis and Sustainable Control of Grapevine Trunk Diseases

Vitis vinifera is affected by many diseases every year, depending on causal agents, susceptibility of cultivars, and climate region. Some are caused by a single agent, such as gray mold caused by Botrytis cinerea or powdery mildew caused by Erysiphe necator. Others result from the actions of a complex of pathogens such as grapevine trunk diseases (GTDs). GTDs are presently among the most devastating diseases in viticulture worldwide because both the economic losses and the long-term sustainability of vineyards are strongly affected. The complexity of GTDs results from the diversity of associated fungi, the undetermined period of latency within the vine (asymptomatic status), the erratic foliar symptom expression from one year to the next, and, probably correlated with all of these points, the lack of efficient strategies to control them. Distinct methods can be beneficial to improve our knowledge of GTDs. In vitro bioassays with cell suspensions, calli, foliar discs, full leaves, or plantlets, and in vivo natural bioassays with cuttings, grafted plants in the greenhouse, or artificially infected ones in the vineyard, can be applied by using progressive integrative levels of in vitro and in vivo, depending on the information searched. In this review, the methods available to understand GTDs are described in terms of experimental procedures, main obtained results, and deliverable prospects. The advantages and disadvantages of each model are also discussed.

First Report of Ilyonectria robusta Associated with Black Foot Disease of Grapevine in Southern Brazil

In August 2012, symptoms of black foot disease were observed on 21-year-old grapevines (Vitis labrusca cv. Bordô; own-rooted cultivar) at Nova Pádua city, Rio Grande do Sul state, Brazil. Symptomatic plants showed reduced vigor, vascular lesions, decline and death of vines, and necrotic lesions on roots. Isolation of fungi associated with necrotic root tissue was made on potato dextrose agar (PDA) medium containing 0.5 g L^-1 streptomycin sulfate. Cultures were incubated at 25°C for 7 days in darkness, and single-spore cultures were obtained from the colonies emerging from the diseased tissue. For morphological characterization, cultures were transferred to PDA and spezieller nährstoffarmer agar (SNA) medium with addition of two pieces of 1 cm² filter paper. One representative isolate (Cy9UFSM) was used for morphological and molecular characterization and pathogenicity confirmation. After 10 days growth on PDA at 20°C in the dark, colonies were umber to chestnut in color (3), appeared cottony to felty in texture, and sporulated profusely. After 5 weeks on SNA and under dark conditions at 20°C, cultures formed macroconidia predominantly on simple conidiophores, 1 to 3 septate, with both ends slightly rounded. Macroconidia varied in size depending on the number of cells as follows: one-septate (23-) 27.7 (-31) × (4.5-) 5.8 (-7) μm; two-septate (26-) 30.1 (-34) × (5-) 5.6 (-6) μm; and three-septate (24-) 31.2 (-35) × (5-) 5.8 (-6.5) μm. Microconidia were observed and did not have a visible hilum (6-) 11.2 (-17) × (3.5-) 4.2 (-5) μm (n = 30 observations per structure). Brown, thick-walled globose to subglobose chlamydospores were produced abundantly on PDA, (8.5-) 13.8 (-17) μm. To confirm the species, primer pairs H3-1a and H3-1b (2) were used to amplify a portion the histone H3 gene. Sequence of this region showed 98% similarity with a reference sequence for Ilyonectria robusta (A.A. Hildebr.) A. Cabral & Crous (GenBank Accession No. JF735530). Thus, both morphological and molecular criteria supported identification of the strain as I. robusta. This isolate was deposited in GenBank as accession KF633172. To confirm pathogenicity, 4-month-old rooted cuttings of Vitis labrusca cv. Bordô were inoculated by immersing roots in a conidial suspension (10⁶ ml^-1) for 60 min. After inoculation, the cuttings were planted in 1-L bags containing commercial substrate (MecPlant). Thirty days later, each plant was re-inoculated by applying 40 ml of a conidial suspension (10⁶ ml^-1) to the commercial substrate. Ten single-vine replicates were used for each isolate, and 10 water-inoculated vines were included as controls. After 4 months, the inoculated plants showed a 22.5% reduction of root mass, with root and crown necrosis, browning of vessels, and 20% mortality. Control plants treated with water remained symptomless. The fungus was re-isolated from blackened tissue of wood from the basal end of rooted cuttings, thereby satisfying Koch's postulates. I. robusta was first associated with black foot disease of grapevine in Portugal in 2012 (1). To our knowledge, this is the first report in southern Brazil of I. robusta associated with black foot disease of grapevine. References: (1) A. Cabral et al. Mycol. Prog. 11:655, 2012. (2) N. L. Glass et al. Appl. Environ. Microbiol. 61:1323, 1995. (3) R. W. Rayner. A mycological colour chart. Commonwealth Mycological Institute and British Mycological Society, 1970.

Hsp70 protein levels and thermotolerance in Drosophila subobscura: a reassessment of the thermal co-adaptation hypothesis

Theory predicts that geographic variation in traits and genes associated with climatic adaptation may be initially driven by the correlated evolution of thermal preference and thermal sensitivity. This assumes that an organism's preferred body temperature corresponds with the thermal optimum in which performance is maximized; hence, shifts in thermal preferences affect the subsequent evolution of thermal-related traits. Drosophila subobscura evolved worldwide latitudinal clines in several traits including chromosome inversion frequencies, with some polymorphic inversions being apparently associated with thermal preference and thermal tolerance. Here we show that flies carrying the warm-climate chromosome arrangement O(3+4) have higher basal protein levels of Hsp70 than their cold-climate O(st) counterparts, but this difference disappears after heat hardening. O(3+4) carriers are also more heat tolerant, although it is difficult to conclude from our results that this is causally linked to their higher basal levels of Hsp70. The observed patterns are consistent with the thermal co-adaptation hypothesis and suggest that the interplay between behaviour and physiology underlies latitudinal and seasonal shifts in inversion frequencies.

Contrasting patterns of phenotypic variation linked to chromosomal inversions in native and colonizing populations of Drosophila subobscura

In fewer than two decades after invading the Americas, the fly Drosophila subobscura evolved latitudinal clines for chromosomal inversion frequencies and wing size that are parallel to the long-standing ones in native Palearctic populations. By sharp contrast, wing shape clines also evolved in the New World, but the relationship with latitude was opposite to that in the Old World. Previous work has suggested that wing trait differences among individuals are partially due to the association between chromosomal inversions and particular alleles which influence the trait under consideration. Furthermore, it is well documented that a few number of effective individuals founded the New World populations, which might have modified the biometrical effect of inversions on quantitative traits. Here we evaluate the relative contribution of chromosomal inversion clines in shaping the parallel clines in wing size and contrasting clines in wing shape in native and colonizing populations of the species. Our results reveal that inversion-size and inversion-shape associations in native and colonizing (South America) populations are generally different, probably due to the bottleneck effect. Contingent, unpredictable evolution was suggested as an explanation for the different details involved in the otherwise parallel wing size clines between Old and New World populations of D. subobscura. We challenge this assertion and conclude that contrasting wing shape clines came out as a correlated response of inversion clines that might have been predicted considering the genetic background of colonizers.

Lipid profile and redox status in high performance rhythmic female teenagers gymnasts

BACKGROUND

The aim of the present study is to evaluate the lipid profile and some parameters of oxi-redox status in a group of teenage female athletes. All gymnasts of the Portuguese National Team of Rhythmic (n=20) were included in the study. A group of untrained healthy female adolescents, matched for age, was also included (n=28).

METHODS

Auxology, nutritional status and body composition were evaluated as well as biological parameters, dietary and training habits. Statistics included descriptive analysis, t-Student and Mann-Whitney for comparative study, and Pearson and Spearman correlations, according to variable distribution.

RESULTS

Chronological age was 14.3+/-1.7 and 14.6+/-1,7 years, respectively for gymnasts and untrained adolescents. Gymnasts showed lower body mass index (p<0.001) and fat mass (p<0.001) and also a hypoenergetic diet, with higher supply in protein (p<0.05) and saturated fat (p<0.01). Lipid profile showed higher HDL-cholesterol (p<0.01) and lower apo B values (p<0.001) in gymnasts, compared to untrained. Red blood cell's enzymes studied were higher for transmembrane NADH reductase of ferricyanide (TMR), (p<0.01), methaemoglobin reductase (MetHbRed), (p<0.01), and low-molecular weight protein tyrosine phosphatase (LMW-PTP), (p<0.0001) in untrained adolescents. Susceptibility of LDL to peroxidation (LDL-TBARS) were higher in gymnasts (76.3+/-20.3 microM/l versus 35+/-21.7 microM/l), (p<0.001). Correlations were positive and significant in both gymnasts and untrained, between LDL-TBARS and LDL-cholesterol (r=0.674, p<0.01 and r=0.544, p<0.05 respectively) and apolipoprotein B (r=0.721, p<0.001 and r=0.659, p<0.01, respectively). LDL-TBARS were negative and significatively correlated to TMR (t=-0.608; p<0.01) only in gymnasts.

CONCLUSIONS

The authors conclude that the practice of intense physical exercise in rhythmic gymnasts induces a compromise of nutritional status and unbalanced food habits. The intensive exercise also induces not only a protective lipid profile, but also a higher lipid peroxidation. Further prospective studies are important to evaluate the influence of intensive training on atherosclerosis development.

Leukocyte activation, erythrocyte damage, lipid profile and oxidative stress imposed by high competition physical exercise in adolescents

BACKGROUND

The aim of this study was to evaluate and to compare the lipid profile and the levels of leukocyte activation, red blood cell (RBC) damage and of oxidative stress in two groups of adolescents, with similar body mass index: high competition swimmers and adolescents practising moderate regular physical exercise.

METHODS

As markers of leukocyte activation, we measured plasma lactoferrin, elastase and granulocyte-monocyte colony stimulating factor. We studied RBC membrane band 3 profile and membrane-bound hemoglobin, as markers of RBC damage and aging; total and differential leukocyte count and RBC count, hematocrit, hemoglobin concentration and hematimetric indexes were also measured. Lipid profile included the evaluation of triglycerides (TG), total cholesterol (Chol), high-density lipoprotein cholesterol (HDLc), low-density lipoprotein cholesterol (LDLc), apolipoproteins AI and B (Apo AI and B), and lipoprotein (a) (Lp(a)). To evaluate oxidative stress, lipoperoxidation products and total antioxidant capacity were measured.

RESULTS

We found that high competition adolescents presented increased plasma levels of leukocyte activation products, increased RBC damage suggesting aging and premature removal, and higher oxidative stress. Lipid profile showed some risk and some protective changes.

CONCLUSIONS

Our data suggest that high competition exercise, by imposing a higher and sustained oxidative and proteolytic stress, may contribute in the future to a higher risk of cardiovascular disease. We believe these findings warrant a reevaluation of current views in the intensity, duration and regularity of physical exercise, and that the evaluation of leukocyte activation products, RBC damage, oxidative stress and lipid profile may represent good markers to establish putative protective thresholds.

LDL peroxidation in adolescent female gymnasts

Physical exercise may in vivo promote an increase of free radical formation. Low-density lipoproteins (LDL) are highly susceptible to oxidation, probably because of their high polyunsaturated fatty acid content, since lipid oxidation is an important factor in the genesis and development of atherosclerosis. The aim of the present study is to evaluate the effect in a group of adolescent gymnasts, of intense and regular physical exercise on lipid profile and redox status.

POPULATION

All members of the Portuguese National Team of Rhythm Gymnastics (1996) (n = 20).

METHODS

1. Clinical evaluation 1.1 Anthropometric evaluation: weight, height, triceps, biceps, subscapular and supra- and supra-iliac skinfolds. NCHS were used as the standard of reference for weight and height, and Frisancho for the sum of skinfolds; 1.2. Evaluation of nutritional status (Quetelet body mass index) and body composition (Durnin and Siri). 2. Evaluation of biological parameters: a blood sample was collected after 12 hours fasting and 24 hours detraining, to evaluate: 2.1 Lipid profile: total cholesterol, high (HDL) and low (LDL) density lipoproteins, triglycerides, apolipoproteins A1 and B, were measured using internationally recommended laboratory methods; 2.2. Plasma trace elements: zinc, copper and selenium, by atomic absorption; 2.3 Red blood cell enzymes; transmembranar reductase (TMR), metahemoglobin reductase (MethaHbRed) and acid phosphatase, by spectrophotometry; 2.4. Redox status: MDA and MDA-LDL were evaluated by spectrophotometry. 3. Evaluation of eating habits: 24 hr recall.

RESULTS

Chronological age is 14.3 +/- 1.7 years. Nutritional assessment shows a mean value for height near the 50th percentile (99% +/- 3.8), and low mean values respectively for BMI (89.3% +/- 9) and sum of triceps and subscapular skinfolds (51.9% +/- 14). Study of lipid profile shows low mean values for total cholesterol (162.3 mg/dl +/- 27.7) LDL-cholesterol (87.6 mg/dl +/- 22.6) and Apo B (64.4 mg/dl +/- 11.5), but high values for HDL-cholesterol (61.3 mg/dl +/- 14.5) and Apo A1 (173.1 mg/dl +/- 25.1). We observe higher values for total cholesterol and LDL-cholesterol in those with lower Cu plasmatic levels. We also observe a negative significative correlation between MDA-LDL and Zn (r = -0.469), Cu (r = -0.524) and RTM (r = -0.608).

CONCLUSIONS

The AA concluded that in this group of gymnasts intense physical exercise induces, a favorable lipid profile, but a clear susceptibility to LDL peroxidation in those with lower plasma Cu and Zn values. It is possible that the negative correlation observed between MDA-LDL and TMR is caused by higher consumption of TMR induced by the action of exercise on the oxidative system.

Acid phosphatase, genetic polymorphism and cardiovascular risk factors in a pediatric population

BACKGROUND

Although the clinical expression of cardiovascular disease usually occurs in adulthood, it is unanimously accepted that atherosclerosis begins in the pediatric age. Because of the early onset of the disease, it is of great importance to screen for major risk factors since pre-school age, especially in risk families. Recent investigations have shown a great interest not only in studying the classic risk factors, but also in the evaluation of oxidative stress and the main antioxidant defense systems. The major cause of this interest is the knowledge of the deleterious effect of reactive oxygen species on lipids, the endothelial membrane of arteries and, finally, on the occurrence of cardiovascular disease.

POPULATION AND METHODS

51 children of both genders, aged 9-12 years, randomly selected from a rural community, were observed. A possible association between low molecular acid phosphatase genetic polymorphism of the erythrocyte and the prooxidant status markers (epinephrine oxidase and low molecular protein phosphotyrosine phosphatase from the erythrocyte), some enzymatic systems of the body antioxidant defense (transmembranar reductase of ferricyanide and metahemoglobin reductase) and finally some intermediate phenotypes of cardiovascular disease (lipid profile and blood pressure) were studied.

RESULTS

The study of prooxidant status markers and antioxidant enzymes shows significant differences for acid phosphatase and epinephrine oxidase activities in relation to low molecular acid phosphatase genetic polymorphism, the highest values observed being in those homozygous to the B allele (p < 0.05). The inter-relation study between variables showed, among other things, a significant inverse correlation between acid phosphatase and transmembrane reductase and a direct correlation between apolipoprotein B, acid phosphatase and metahemoglobin reductase. A positive family history for cardiovascular disease also showed a direct and significant correlation to total cholesterol, LDL-cholesterol and apolipoprotein B.

CONCLUSIONS

The polymorphic variants of low molecular acid phosphatase and protein phosphotyrosine phosphatase with greater activity are strongly associated, not with the classic parameters of cardiovascular risk factors, but with oxidative stress indicators, such as low molecular protein phosphotyrosine phosphatase and epinephrine oxidase. Family history indicators of cardiovascular risk are clearly associated, since early ages, to some conventional risk factors, such as lipid profile and blood pressure.

Genetic and environmental factors regulating blood pressure in childhood: prospective study from 0 to 3 years

OBJECTIVES

Blood pressure (BP) regulation depends on the interaction between multiple environmental and genetic factors. Of these, BP sensitivity to dietary sodium intake has been one that has been investigated in adults but not in children. The aim of the present study was to investigate, prospectively, the BP profile in relation to different genetic and hormonal factors, in the first 3 years of life.

POPULATION AND METHODS

Thirty-nine children born at term following normal pregnancies, with uncomplicated neonatal periods, were randomly selected to take part in the study. BP, weight and length were evaluated every 3 months from birth to 3 years. At the age of 12 months, haptoglobin phenotypes and plasma active renin concentration were determined as well as random urine evaluation of aldosterone, cAMP, dopamine and digoxin-like immunoreactive substances (DLIS). Family history of cardio-vascular diseases was also recorded.

RESULTS

Systolic BP (SBP) demonstrated a gradual increase until the age of 6 months with little variation up to 36 months. Tracking of SBP values was also observed from the first year as infants with high values (above the 75 percentile) maintained this tendency up to, at least, the age of 36 months. The comparison between SBP and diastolic BP (DBP) according haptoglobin phenotypes demonstrated that SBP was systematically higher in allele 1, with apparently an increasing tendency with age, although the differences did not have statistical significance. The comparative study between haptoglobin phenotypes, with correction for the covariates fractional excretion of sodium and potassium, showed that allele 1 carriers had significantly lower plasma renin and urine aldosterone and cAMP concentrations than allele 2, but dopamine excretion was found to be higher in allele 1 than in allele 2. There were no differences among variables relating to family history of cardiovascular disease.

CONCLUSIONS

There was an early tracking process of BP values from the first 6 months of life which persists through, at least, to the age of 36 months. Differences in sodium handling between haptoglobin 1 and 2 phenotypes were already present in early childhood, although no significant repercussion in BP values could be demonstrated in the 3-year duration of this study.