Comparison of effect of CTG + STan with CTG alone on emergency Cesarean section rate: STan Australian Randomized controlled Trial (START)

OBJECTIVE

To investigate whether use of ST analysis of the fetal electrocardiogram (STan) as an adjunct to continuous cardiotocography (CTG) reduces the rate of emergency Cesarean section (EmCS) compared with CTG alone.

METHODS

This was a randomized controlled trial of patients with a singleton fetus in cephalic presentation at ≥ 36 weeks' gestation, requiring continuous electronic fetal monitoring during labor at a tertiary maternity hospital in Adelaide, Australia, between January 2018 and July 2021. Participants were randomized to undergo CTG + STan or CTG alone. The calculated sample size was 1818 participants. The primary outcome was EmCS. Secondary outcomes included metabolic acidosis, a composite adverse perinatal outcome, and other maternal and neonatal morbidity and safety outcomes.

RESULTS

The present study enrolled 970 women, of whom 967 were included in the primary analysis. EmCS occurred in 107/482 (22.2%) deliveries in the CTG + STan arm and in 107/485 (22.1%) in the CTG arm (adjusted relative risk, 1.02 (95% CI, 0.81-1.27); P = 0.89). There was no difference in the rate of adverse maternal or neonatal outcomes between arms.

CONCLUSIONS

The addition of STan as an adjunct to continuous CTG did not reduce the EmCS rate. The smaller-than-anticipated sample size meant that this study was underpowered to detect absolute differences of ≤ 5% and, therefore, this negative finding could be due to a Type-2 error. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Behavioral genetics of temporal framing: Heritability of time perspective and its common genetic bases with major personality traits

OBJECTIVE

The present study aimed to provide a seminal behavioral genetic analysis of time perspectives (TPs). Moreover, we intended to investigate the magnitude of genetic vs. environmental components of the well-established assocations between TPs and personality features.

BACKGROUND

Individual differences in temporal framing processes, referred to as TPs, are vital psychological and behavioral outcomes. Although proponents of TP theory emphasize mainly environmental origins of the tendencies to adopt certain TPs, research provides evidence for marked associations between the temporal dimensions and major personality traits that are known to be heritable. Hence, it was essential to empirically verify these claims.

METHOD

The article reports an analysis of genetic and environmental components of variance in TPs based on a study adopting a twin design, conducted on a sample of 393 pairs of twins (135 monozygotic and 258 dizygotic).

RESULTS

Multivariate Cholesky decomposition supported an EA model assuming impacts of both unshared environmental factors (E) and additive genetic factors (A) across all TP dimensions, suggesting that the effects of shared environment on TPs are plausibly negligible. Heritability indices of TPs ranged between 0.51 for Present-Fatalistic and 0.62 for Present-Hedonistic, suggesting that the majority of the variance in TPs stems from genetic influences. Substantial genetic correlations were found between TPs and the Big Five personality traits.

CONCLUSIONS

The findings provide further evidence for conceptualizing TPs as biologically based personality traits and challenge the claims that TP is mainly a product of culture, education, and personal experiences.

Performance, Hemodynamics, and Stress in a Two-Day Vigilance Task: Practical and Theoretical Implications

OBJECTIVE

To explore vigilance task performance, cerebral blood flow velocity (CBFV), workload, and stress in a within-subjects, two-session experiment.

BACKGROUND

Vigilance, or sustained attention, tasks are often characterized by a decline in operator performance and CBFV with time on task, and high workload and stress. Though performance is known to improve with practice, past research has not included measures of CBFV, stress, and workload in a within-subjects multi-session design, which may also provide insight into ongoing theoretical debate.

METHOD

Participants performed a vigilance task on two separate occasions. Performance, CBFV, workload, and self-reported stress were measured.

RESULTS

Within each session, results were consistent with the vigilance profile found in prior research. Across sessions, performance improved but the time on task decrement remained. Mean CBFV and workload ratings did not differ between sessions, but participants reported significantly less distress, worry, and engagement after session two compared to one.

CONCLUSION

Though practice may not disrupt the standard vigilance profile, it may serve to improve overall performance and reduce stress. However, repeated exposure may have negative implications for engagement and mind-wandering.

APPLICATION

It is important to better understand the relationship between experience, performance, physiological response, and self-reported stress and workload in vigilance because real-world environments often require operators to do the same task over many occasions. While performance improvement and reduced distress is an encouraging result, the decline in engagement requires further research. Results across sessions fail to provide support to the mind-wandering theory of vigilance.

FMRI study of implicit emotional face processing in patients with MDD with melancholic subtype

Introduction

The accurate perception of facial expressions plays a vital role in daily life, allowing us to select appropriate responses in social situations. Understanding the neuronal basis of altered emotional face processing in patients with major depressive disorder (MDD) may lead to the appropriate choice of individual interventions to help patients maintain social functioning during depressive episodes. Inconsistencies in neuroimaging studies of emotional face processing are caused by heterogeneity in neurovegetative symptoms of depressive subtypes. The aim of this study was to investigate brain activation differences during implicit perception of faces with negative and positive emotions between healthy participants and patients with melancholic subtype of MDD. The neurobiological correlates of sex differences of MDD patients were also examined.

Methods

Thirty patients diagnosed with MDD and 21 healthy volunteers were studied using fMRI while performing an emotional face perception task.

Results

Comparing general face activation irrespective of emotional content, the intensity of BOLD signal was significantly decreased in the left thalamus, right supramarginal gyrus, right and left superior frontal gyrus, right middle frontal gyrus, and left fusiform gyrus in patients with melancholic depression compared to healthy participants. We observed only limited mood-congruence in response to faces of differing emotional valence. Brain activation in the middle temporal gyrus was significantly increased in response to fearful faces in comparison to happy faces in MDD patients. Elevated activation was observed in the right cingulate for happy and fearful faces, in precuneus for happy faces, and left posterior cingulate cortex for all faces in depressed women compared to men. The Inventory for Depressive Symptomatology (IDS) score was inversely correlated with activation in the left subgenual gyrus/left rectal gyrus for sad, neutral, and fearful faces in women in the MDD group. Patients with melancholic features performed similarly to controls during implicit emotional processing but showed reduced activation.

Discussion and conclusion

This finding suggests that melancholic patients compensate for reduced brain activation when interpreting emotional content in order to perform similarly to controls. Overall, frontal hypoactivation in response to implicit emotional stimuli appeared to be the most robust feature of melancholic depression.

Epididymal leiomyoadenomatoid tumor: A case report of a rare benign paratesticular mass

Primary tumors of the epididymis are rare and commonly benign in nature. Leiomyoadenomatoid tumors are a rare subvariant of adenomatoid tumors that combines features of leiomyomas. Tumor histology is notable for tubular spaces lined by mesothelial cells with a proliferative spindle cell component. To the best of our knowledge, few cases have been reported in the literature. We report a case of leiomyoadenomatoid tumor in a 58-year-old male.

Gaming experience predicts UAS operator performance and workload in simulated search and rescue missions

Unmanned aircraft systems (UAS) operator training and selection procedures are still being refined to effectively address challenges related to performance, workload, and stress in UAS operation. Research suggests that experience with commercial videogames may test skills relevant to modern UAS operation. This study investigated the ability of videogame experience to predict operator performance, workload, and stress. Forty-nine participants performed 9 trials of a simulated search and rescue mission. It was expected that participants who more frequently played videogames would report lower levels of distress and workload, higher task engagement, and better overall performance. Results showed that gaming experience was negatively correlated with subjective workload and positively correlated with multiple measures of performance. Furthermore, nearly all observed gender-related differences were not present when gaming experience was controlled for. These results have implications for the role of gaming experience in remotely operated systems operator recruitment, selection, and training. Practitioner summary: This study examined how gaming experience influences UAS operator success in simulated search and rescue missions. Participants reported on their experience playing videogames before completing multiple experimental trials on a desktop computer. Results indicated that experience playing videogames significantly impacted performance, workload, and stress.

Experimental considerations of acute heat stress assays to quantify coral thermal tolerance

Understanding the distribution and abundance of heat tolerant corals across seascapes is imperative for predicting responses to climate change and to support novel management actions. Thermal tolerance is variable in corals and intrinsic and extrinsic drivers of tolerance are not well understood. Traditional experimental evaluations of coral heat and bleaching tolerance typically involve ramp-and-hold experiments run across days to weeks within aquarium facilities with limits to colony replication. Field-based acute heat stress assays have emerged as an alternative experimental approach to rapidly quantify heat tolerance in many samples yet the role of key methodological considerations on the stress response measured remains unresolved. Here, we quantify the effects of coral fragment size, sampling time point, and physiological measures on the acute heat stress response in adult corals. The effect of fragment size differed between species (Acropora tenuis and Pocillopora damicornis). Most physiological parameters measured here declined over time (tissue colour, chlorophyll-a and protein content) from the onset of heating, with the exception of maximum photosynthetic efficiency (F_v/F_m) which was surprisingly stable over this time scale. Based on our experiments, we identified photosynthetic efficiency, tissue colour change, and host-specific assays such as catalase activity as key physiological measures for rapid quantification of thermal tolerance. We recommend that future applications of acute heat stress assays include larger fragments (> 9 cm²) where possible and sample between 10 and 24 h after the end of heat stress. A validated high-throughput experimental approach combined with cost-effective genomic and physiological measurements underpins the development of markers and maps of heat tolerance across seascapes and ocean warming scenarios.

I love the way you love me: Responding to partner’s love language preferences boosts satisfaction in romantic heterosexual couples

Chapman’s Love Languages hypothesis claims that (1) people vary in the ways they prefer to receive and express affection and (2) romantic partners who communicate their feelings congruent with their partner’s preferences experience greater relationship quality. The author proposes five distinct preferences and tendencies for expressing love, including: Acts of Service, Physical Touch, Words of Affirmation, Quality Time and Gifts. In the present study partners (N = 100 heterosexual couples) completed measures assessing their preferences and behavioral tendencies for a) expressions of love and b) reception of signs of affection, for each of the five proposed “love languages”. Relationship satisfaction, sexual satisfaction and empathy were also assessed. The degree of the within-couple mismatch was calculated separately for each individual based on the discrepancies between the person’s felt (preferred) and their partner’s expressed love language. The joint mismatch indicator was a sum of discrepancies across the five love languages. Matching on love languages was associated with both relationship and sexual satisfaction. In particular, people who expressed their affection in the way their partners preferred to receive it, experienced greater satisfaction with their relationships and were more sexually satisfied compared to those who met their partner’s needs to lesser extent. Empathy was expected to be a critical factor for better understanding of and responding to the partner’s needs. Results provided some support for this hypothesis among male but not female participants.

Trust in the Danger Zone: Individual Differences in Confidence in Robot Threat Assessments

Effective human–robot teaming (HRT) increasingly requires humans to work with intelligent, autonomous machines. However, novel features of intelligent autonomous systems such as social agency and incomprehensibility may influence the human’s trust in the machine. The human operator’s mental model for machine functioning is critical for trust. People may consider an intelligent machine partner as either an advanced tool or as a human-like teammate. This article reports a study that explored the role of individual differences in the mental model in a simulated environment. Multiple dispositional factors that may influence the dominant mental model were assessed. These included the Robot Threat Assessment (RoTA), which measures the person’s propensity to apply tool and teammate models in security contexts. Participants (N = 118) were paired with an intelligent robot tasked with making threat assessments in an urban setting. A transparency manipulation was used to influence the dominant mental model. For half of the participants, threat assessment was described as physics-based (e.g., weapons sensed by sensors); the remainder received transparency information that described psychological cues (e.g., facial expression). We expected that the physics-based transparency messages would guide the participant toward treating the robot as an advanced machine (advanced tool mental model activation), while psychological messaging would encourage perceptions of the robot as acting like a human partner (teammate mental model). We also manipulated situational danger cues present in the simulated environment. Participants rated their trust in the robot’s decision as well as threat and anxiety, for each of 24 urban scenes. They also completed the RoTA and additional individual-difference measures. Findings showed that trust assessments reflected the degree of congruence between the robot’s decision and situational danger cues, consistent with participants acting as Bayesian decision makers. Several scales, including the RoTA, were more predictive of trust when the robot was making psychology-based decisions, implying that trust reflected individual differences in the mental model of the robot as a teammate. These findings suggest scope for designing training that uncovers and mitigates the individual’s biases toward intelligent machines.

Perfectionism Moderates the Effects of Goal-Realızatıon on Post-Competition Mood in Amateur Runners

Perfectionism impacts how athletes evaluate their performance. However, little is known about how perfectionistic strivings and perfectionistic concerns interplay with athletes' anticipated and actual performance in predicting mood after the competition. Thus, we conducted a study with amateur runners [n = 152, (72 female, 80 male); Mean±SD age = 34.71 ± 9.57] taking part in a competitive 10-kilometer street run. Perfectionism was measured before the run, while the measurement of mood was taken during the post-competition week. Mood was operationalized in the 3D model of mood, distinguishing between energetic arousal, tense arousal, and hedonic tone. Regression analysis showed that specific patterns of associations between perfectionism and goal-realization explain 17-21% of variance in the dimensions of mood. Higher pleasure after the run was predicted by lower perfectionistic concerns and better conversion of anticipated performance into actual performance. In predicting energy and tension, moderating effects of perfectionistic strivings, perfectionistic concerns, and conversion rate were observed. Johnson-Neyman technique revealed that only athletes low in perfectionistic concerns were able to benefit from lower tension when they met or exceeded their goals for the run. The higher athletes' perfectionistic strivings and conversion rate the more pronounced effects we observed for affect-energization. Results support the idea of perfectionistic reactivity, where the negative consequences of perfectionism can be observed in a lack of positive reactions to positive events. We also suggest that such a response to meeting or exceeding one's goal may contribute to the development of athlete burnout and hinder the development athlete engagement.

Let Complexity Bring Clarity: A Multidimensional Assessment of Cognitive Load Using Physiological Measures

The effects of cognitive load on driver behavior and traffic safety are unclear and in need of further investigation. Reliable measures of cognitive load for use in research and, subsequently, in the development and implementation of driver monitoring systems are therefore sought. Physiological measures are of interest since they can provide continuous recordings of driver state. Currently, however, a few issues related to their use in this context are not usually taken into consideration, despite being well-known. First, cognitive load is a multidimensional construct consisting of many mental responses (cognitive load components) to added task demand. Yet, researchers treat it as unidimensional. Second, cognitive load does not occur in isolation; rather, it is part of a complex response to task demands in a specific operational setting. Third, physiological measures typically correlate with more than one mental state, limiting the inferences that can be made from them individually. We suggest that acknowledging these issues and studying multiple mental responses using multiple physiological measures and independent variables will lead to greatly improved measurability of cognitive load. To demonstrate the potential of this approach, we used data from a driving simulator study in which a number of physiological measures (heart rate, heart rate variability, breathing rate, skin conductance, pupil diameter, eye blink rate, eye blink duration, EEG alpha power, and EEG theta power) were analyzed. Participants performed a cognitively loading n-back task at two levels of difficulty while driving through three different traffic scenarios, each repeated four times. Cognitive load components and other coinciding mental responses were assessed by considering response patterns of multiple physiological measures in relation to multiple independent variables. With this approach, the construct validity of cognitive load is improved, which is important for interpreting results accurately. Also, the use of multiple measures and independent variables makes the measurements (when analyzed jointly) more diagnostic-that is, better able to distinguish between different cognitive load components. This in turn improves the overall external validity. With more detailed, diagnostic, and valid measures of cognitive load, the effects of cognitive load on traffic safety can be better understood, and hence possibly mitigated.

Time for work: Analyzing the role of time perspectives in work attitudes and behaviors

Previous research has provided strong evidence for a pronounced role of time perspective (TP) in various areas of human functioning, including cognitive processes, mental and physical health, environmental behaviors, and relationship quality. The aim of the present study was to investigate the role of individual differences in TP in work-related attitudes and behaviors. In a sample of 200 office workers, we administered a set of questionnaires measuring TPs, job satisfaction, work engagement, Organizational Citizenship Behavior (OCB) and Counterproductive Work Behavior (CWB). Additionally, we controlled for the Big Five personality traits which may be related to the work-related outcomes of interest. Analyses of the data revealed that Future-Positive TP predicted more desired work-related outcomes, i.e., higher job satisfaction, work engagement, and OCB, and lower CWB. An opposite pattern of associations was observed for Present-Fatalistic, Deviation from Balanced Time Perspective, and (partially) for Future-Negative TPs. The vast majority of these effects were still significant after controlling for personality traits. Using path modelling we also demonstrated that the effects of TPs on work behaviors (OCB and CWB) are mostly mediated by job satisfaction and engagement. The present results suggest that TP theory may prove to be a useful tool in organizational psychology for understanding individual differences in work behaviors.

Finding the Next Resident Physicians in the COVID-19 Global Pandemic: An Applicant Survey on the 2020 Virtual Urology Residency Match

OBJECTIVE

To assess interviewing applicant perceptions of a virtual urology residency interview in the setting of changes mandated by COVID-19 and to determine applicant preference for virtual or in person interviews. Applicant perceptions of multiple interview components were queried to identify program specific and interview modality specific strengths or weaknesses in the 2020 to 2021 Urology Match.

METHODS

A 12 question multiple choice and free text survey was emailed to 66 virtually interviewed applicants for open residency positions at a metropolitan training program after conclusion of interviews. Items of interest included interview type preference, overall interview impression, and recommendations for improvement.

RESULTS

A total of 50 of 66 (76%) applicants completed the survey corresponding to approximately 11% of the 2020 national urology applicant pool. A total of 49 of 50 (96%) respondents assessed faculty interaction and the virtual platform positively. A total of 38 of 50 (76%) was satisfied with their resident interaction and 32 of 50 (64%) applicants stated they were able to satisfactorily evaluate the site and program. Ultimately, 39 of 50 (78%) respondents would have preferred an in person interview to our virtual interview. Respondents cited challenges in assessing program culture and program physical site virtually.

CONCLUSION

The majority of survey respondents indicated a preference for in person interviews. A smaller proportion of applicants preferred virtual interviews citing their convenience and lower cost. Efforts to improve the virtual interview experience may focus on improving applicant-resident interaction and remote site assessment.

The ANT Executive Control Index: No Evidence for Temporal Decrement

OBJECTIVE

This study tested whether indices of executive control, alertness, and orienting measured with Attention Network Test (ANT) are vulnerable to temporal decrement in performance.

BACKGROUND

Developing the resource theory of sustained attention requires identifying neurocognitive processes vulnerable to decrement. Executive control processes may be prone to impairment in fatigue states. Such processes are also highlighted in alternative theories. Determining the role of executive control in vigilance can both advance theory and contribute to practical countermeasures for decrement in human factors contexts.

METHOD

In Study 1, 80 participants performed the standard ANT for an extended duration of about 55 to 60 min. Study 2 (160 participants) introduced manipulations of trial blocking and stimulus degradation intended to increase resource depletion. Reaction time and accuracy measures were analyzed. Subjective stress and workload were assessed in both studies.

RESULTS

In both studies, the ANT induced levels of subjective workload and task disengagement consistent with previous sustained attention studies. No systematic decrement in any performance measure was observed.

CONCLUSION

Executive control assessed by the ANT is not highly vulnerable to temporal decrement, even when task demands are elevated. Future work should differentiate executive control processes; proactive control may be more implicated in sustained attention decrement than in reactive control.

APPLICATION

Designing systems and interfaces to reduce executive control demands may be generally beneficial but will not directly mitigate temporal performance decrement. Enhancing design guidelines and neuroergonomic methods for monitoring operator attention requires further work to identify key neurocognitive processes for decrement.

The search for causality of personality-chronotype associations: insights from a one-year longitudinal study of adolescents

Associations between certain personality traits and individual differences in diurnal preferences, referred to as morningness-eveningness, are well established from cross-sectional studies. However, it is unclear whether personality affects diurnal preference, diurnal preference affects personality, or some third factor influences both. The current study assessed the Big Five personality traits and morningness-eveningness in a one-year, two-wave longitudinal design, in a sample of 169 Polish high school students (59% females), aged 16-17 years (M = 16.80, SD = 0.39) during the first wave of measurement. During the second wave the participants were respectively 1 year older. Cross lagged panel analyses were run to determine wave 1 predictors of wave 2 variables. Cross-sectional analyses replicated the association between morningness and conscientiousness that has been reliably found in previous studies, but the cross-lagged paths between these variables were nonsignificant. These two traits appear to be intrinsically linked to one another by adolescence, possibly as a consequence of genetic influences that shape temperament earlier in childhood. In contrast, emotional stability and morningness were not significantly correlated in wave 1 cross-sectional data, but a significant relationship was found in the cross-lagged panel analysis. Wave 1 emotional stability predicted wave 2 morningness, although wave 1 morningness did not predict personality. We tentatively suggest that there may be a causal effect of personality on diurnal preference, associated with avoidance strategies for coping with academic stress as the high school years approach their end. More neurotic individuals may cope with their aversion to classes by distracting themselves with evening pursuits, such as use of the internet. Further work might examine in more depth how contextual stressors interact with personality to affect daily activities at different times of the day.

Prediction of mood and risk appraisals from trait measures: Two studies of simulated driving

Two contrasting hypotheses concerning the relationship between personality and mood are distinguished. First, broad traits may relate to emotional temperament, and so predict mood across situations. Second, the interactionist approach to personality implies that narrow, context specific traits may sometimes be the most powerful predictors of mood within situations. This article reports correlations between mood and broad and narrow trait measures, the Eysenck Personality Inventory (EPI; Eysenck and Eysenck, 1964) and the Driving Behaviour Inventory (DBI; Gulian, Matthews, Glendon, Davies and Debney, 1989), within the context of vehicle driving. Mood was measured with the UWIST Mood Adjective Checklist (UMACL; Matthews, Jones and Chamberlain, 1990), in two samples before and after a simulated drive. One sample (N = 73) performed a ‘passive’ drive, in which little interaction with other traffic was required. The second sample (N = 93) performed an ‘active’ driving task, in which subjects had to decide when to overtake other vehicles. Results showed that the DBI traits were more strongly related to mood than EPI traits, particularly following the active drive. The DBI Dislike of Driving scale was the strongest single predictor of post‐drive mood. Prior to the drive, subjects also rated accident risk, driving skill, and judgement, for themselves and for a ‘peer’ driver of similar age and sex. Analysis of these data in the combined sample (N = 166) showed that the DBI was the more consistent predictor of self‐ratings of risk and driving competence, although some relationships between ratings and the EPI were found. Again, the DBI Dislike of Driving scale was the strongest single predictor of self‐ratings. Drivers scoring high on this scale seem immune to drivers' general bias towards rating themselves as safer and more competent than their peers. It is concluded that narrow traits are more predictive than broad traits within the driving context. Data are consistent with the transactional model of driver stress, which proposes that dislike of driving is derived from negative secondary appraisals.

Personality variable differences between disease clusters

Previous studies of personality and health have focused mainly on the influence of psychological factors on single diseases such as cancer and coronary heart disease (CHD), thereby neglecting the problem of comorbidity (i.e. the combination of different diseases). The main focus of the present study was the discrimination between single‐ and multiple‐disease conditions on the basis of personality traits. An extensive battery of personality scales implicated in health was administered to a sample of n=5133 individuals of both genders between the ages of 40 and 65. Subjects also reported their health or illness status. A factor analysis of the personality scales yielded five dimensions clearly interpretable as “Emotional Lability”, “Type A Behaviour”, “Behavioural Control”, “Locus of Control over Diseases”, and “Psychoticism”. Hierarchical cluster analyses of the subsample of participants who reported suffering from more than one disease led to eight clusters representing individuals with different combinations of diseases. Generally, there were very few significant differences between healthy and single‐disease participants with regard to personality. However, mean factor scores calculated for “Emotional Lability” were higher across the multiple‐disease groups than in the healthy and single‐disease groups. No other personality factor showed this trend. In general the results reported here show the important role negative affectivity (e.g. Emotional Lability, Neuroticism, Depression) plays in differentiating between single and multiple diseases. Copyright © 2003 John Wiley & Sons, Ltd.

Combined intra- and extra-peritoneal bladder perforation following rectal impalement injury

A 62-year-old male presented with abdominal pain and hematuria following impalement of the rectum with a wooden foreign object. CT imaging showed air and fluid in the peritoneum prompting the patient to undergo abdominal exploration. An anterior rectal perforation was discovered along with dual bladder lacerations of the posterior wall and dome. The patient underwent a diverting colostomy and primary bladder repair. Post-operative course was uncomplicated and bladder repair was followed via cystograms with catheter removal 2 months post-operatively. Four months after the injury the patient underwent colostomy closure and remains with normal bladder and bowel function at 21-month follow-up.

Destructive domino: Subcutaneous self-implanted penile foreign body implicated in rule-out penile fracture

41-year-old male presented with significant penile swelling following sexual intercourse. Two years earlier while incarcerated, the patient self-inserted a 1.5 cm subcutaneous penile foreign body (FB) made from a domino piece. An original concern for penile fracture was successfully ruled out by penile ultrasound, and computed tomography ruled out deep infection. Bloodwork otherwise revealed leukocytosis, and the patient was admitted for intravenous antibiotics and observation. Penile cellulitis and hematoma clinically improved, and the FB did not require removal. At 18 month follow up, the patient maintains normal urological and sexual function.

Overload and automation-dependence in a multi-UAS simulation: Task demand and individual difference factors

Future unmanned aerial systems (UAS) operations will require control of multiple vehicles. Operators are vulnerable to cognitive overload, despite support from system automation. This study tested whether attentional resource theory predicts impacts of cognitive demands on performance measures, including automation-dependence and stress. It also investigated individual differences in response to demands. One-hundred and 1 university student participants performed a multi-UAS simulation mission incorporating 2 surveillance tasks. Cognitive demands and level of automation (LOA) of key tasks were manipulated between-subjects. Results were partially consistent with predictions. Higher task demands impaired performance and elevated distress and workload, as expected. Higher LOA produced greater dependence on automation, but failed to mitigate workload. It was expected that, as the automation was quite reliable, participants would attempt to conserve resources by depending more on automation under high demand. In fact, the opposite tendency was observed. Individuals high in conscientiousness were especially likely to override the automation under high demand, apparently taking charge personally. Neuroticism and distress were also associated with performance, but results did not fit a resource theory interpretation. Thus, understanding impacts of overload in the multi-UAS context requires understanding operator strategy as well as resource insufficiency. Findings have implications for system design, and operator selection and training. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Comparing the effect of STan (cardiotocographic electronic fetal monitoring (CTG) plus analysis of the ST segment of the fetal electrocardiogram) with CTG alone on emergency caesarean section rates: study protocol for the STan Australian Randomised controlled Trial (START)

BACKGROUND

Cardiotocography is almost ubiquitous in its use in intrapartum care. Although it has been demonstrated that there is some benefit from continuous intrapartum fetal monitoring using cardiotocography, there is also an increased risk of caesarean section which is accompanied by short-term and long-term risks to the mother and child. There is considerable potential to reduce unnecessary operative delivery with up to a 60% false positive diagnosis of fetal distress using cardiotocography alone. ST analysis of the fetal electrocardiogram is a promising adjunct to cardiotocography alone, and permits detection of metabolic acidosis of the fetus, potentially reducing false positive diagnosis of fetal distress.

METHODS

This study will be a single-centre, parallel-group, randomised controlled trial, conducted over 3 years. The primary hypothesis will be that the proportion of women with an emergency caesarean section on ST analysis will not equal that for women on cardiotocography monitoring alone. Participants will be recruited at the Women's and Children's Hospital, a high-risk specialty facility with approximately 5000 deliveries per annum. A total of 1818 women will be randomised to the treatment or conventional arm with an allocation ratio of 1:1, stratified by parity. The primary outcome is emergency caesarean section (yes/no). Statistical analysis will follow standard methods for randomised trials and will be performed on an intention-to-treat basis. Secondary maternal and neonatal outcomes will also be analysed. Additional study outcomes include psychosocial outcomes, patient preferences and cost-effectiveness.

DISCUSSION

Approximately 20% of Australian babies are delivered by emergency caesarean section. This will be the first Australian trial to examine ST analysis of the fetal electrocardiogram as an adjunct to cardiotocography as a potential method for reducing this proportion. The trial will be among the first to comprehensively examine ST analysis, taking into account the impact on psychosocial well-being as well as cost-effectiveness. This research will provide Australian evidence for clinical practice and guideline development as well as for policy-makers and consumers to make informed, evidence-based choices about care in labour.

TRIAL REGISTRATION

ANZCTR, ACTRN1261800006268 . Registered on 19 January 2018.

A Comparison of the Effects of 45-minute Aerobic Training and Cognitive Task Solving on Transient Mood States in a Female Student Sample

BACKGROUND

The beneficial effects of moderate-intensity physical exercise on mood are well established. Students in higher education are a group vulnerable to stress who may benefit from aerobic exercise classes. The present study broadens existing findings by testing the impact on mood of a 45-minute-long aerobic training session, conducted in a naturalistic setting.

METHOD

A three-dimensional mood assessment that distinguished hedonic tone (pleasantness of mood) from energetic and tense arousal dimensions was used for assessment of pre- and post-training mood in a sample of women (n = 120) taking part in a 45-minute aerobic training. A control group (n = 120) performed cognitive tasks.

RESULTS

Physical but not cognitive activity elevated mood on all three dimensions, but the effect size was largest for energetic arousal. It was also found that mood improvements in terms of energy and tension change were strongest for individuals initially low in hedonic tone.

CONCLUSIONS

The finding supports the hypothesis that successful completion of an exercise session in a naturalistic setting may enhance mood in female students. At a practical level, the study suggests that exercise classes may help students cope with the mood impairments resulting from demanding cognitive activities, leading to potential educational benefits.

Dangerous intersections? A review of studies of fatigue and distraction in the automated vehicle

The impacts of fatigue on the vehicle driver may change with technological advancements including automation and the increasing prevalence of potentially distracting in-car systems. This article reviews the authors' simulation studies of how fatigue, automation, and distraction may intersect as threats to safety. Distinguishing between states of active and passive fatigue supports understanding of fatigue and the development of countermeasures. Active fatigue is a stress-like state driven by overload of cognitive capabilities. Passive fatigue is produced by underload and monotony, and is associated with loss of task engagement and alertness. Our studies show that automated driving reliably elicits subjective symptoms of passive fatigue and also loss of alertness that persists following manual takeover. Passive fatigue also impairs attention and automation use in operators of Remotely Piloted Vehicles (RPVs). Use of in-vehicle media has been proposed as a countermeasure to fatigue, but such media may also be distracting. Studies tested whether various forms of phone-based media interacted with automation-induced fatigue, but effects were complex and dependent on task configuration. Selection of fatigue countermeasures should be guided by an understanding of the form of fatigue confronting the operator. System design, regulation of level of automation, managing distraction, and selection of fatigue-resilient personnel are all possible interventions for passive fatigue, but careful evaluation of interventions is necessary prior to deployment.

Vigilance and Automation Dependence in Operation of Multiple Unmanned Aerial Systems (UAS): A Simulation Study

OBJECTIVE

This simulation study investigated factors influencing sustained performance and fatigue during operation of multiple Unmanned Aerial Systems (UAS). The study tested effects of time-on-task and automation reliability on accuracy in surveillance tasks and dependence on automation. It also investigated the role of trait and state individual difference factors.

BACKGROUND

Warm's resource model of vigilance has been highly influential in human factors, but further tests of its applicability to complex, real-world tasks requiring sustained attention are necessary. Multi-UAS operation differs from standard vigilance paradigms in that the operator must switch attention between multiple subtasks, with support from automation.

METHOD

131 participants performed surveillance tasks requiring signal discrimination and symbol counting with a multi-UAS simulation configured to impose low cognitive demands, for 2 hr. Automation reliability was manipulated between-groups. Five Factor Model personality traits were measured prior to performance. Subjective states were assessed with the Dundee Stress State Questionnaire.

RESULTS

Performance accuracy on the more demanding surveillance task showed a vigilance decrement, especially when automation reliability was low. Dependence on automation on this task declined over time. State but not trait factors predicted performance. High distress was associated with poorer performance in more demanding task conditions.

CONCLUSIONS

Vigilance decrement may be an operational issue for multi-UAS surveillance missions. Warm's resource theory may require modification to incorporate changes in information processing and task strategy associated with multitasking in low-workload, fatiguing environments.

APPLICATION

Interface design and operator evaluation for multi-UAS operations should address issues including motivation, stress, and sustaining attention to automation.

Workload and Performance: Associations, Insensitivities, and Dissociations

OBJECTIVE

The aim of this study was to distill and define those influences under which change in objective performance level and the linked cognitive workload reflections of subjective experience and physiological variation either associate, dissociate, or are insensitive, one to another.

BACKGROUND

Human factors/ergonomics frequently employs users' self-reports of their own conscious experience, as well as their physiological reactivity, to augment the understanding of changing performance capacity. Under some circumstances, these latter workload responses are the only available assessment information to hand. How such perceptions and physiological responses match, fail to match, or are insensitive to the change in primary-task performance can prove critical to operational success. The reasons underlying these associations, dissociations, and insensitivities are central to the success of future effective human-machine interaction.

METHOD

Using extant research on the relations between differing methods of workload assessment, factors influencing their association, dissociation, and insensitivity are identified.

RESULTS

Dissociations and insensitivities occur more frequently than extant explanatory theories imply. Methodological and conceptual reasons for these patterns of incongruity are identified and evaluated.

APPLICATION

We often seek convergence of results in order to provide coherent explanations as bases for future prediction and practical design implementation. Identifying and understanding the causes as to why different reflections of workload diverge can help practitioners toward operational success.

Association of anthropometric status and residential locality factors with cognitive scores of 4-6-year-old children in Kwazulu-Natal, South Africa

Background

The Asenze study has the long-term goal of promoting better physical, cognitive and psychosocial functioning of children in a rural area in KwaZulu-Natal, 50 km from Durban with a view to planning interventions to promote growth and development for very young children. The specific objective in this paper was to provide information for the Child Health and Development project of the Valley Trust to assist with intervention planning. The broader goal was to assess developmental delays in communities ravaged by the HIV epidemic.The Asenze study was designed in two phases from 2008 and 2012. The current paper reports on 1581 4-6years old children in the baseline phase (2008-2010) in the five adjacent tribal areas in the study area.

Method

The participants included all the 4 - 6 year olds whose parents had consented to inclusion in the project and their caregivers. Data were derived from a brief questionnaire administered in the homes of participants, and subsequently from medical and psychological assessments of the children and their caregivers at the Asenze clinic. The association between child factors and other factors (geographic area, socioeconomic status (SES), parental level of education, the child's pre-school education) on the one hand and, the child's cognitive performance (as measured by the Grover Counter and subtests of the KABC-11) were analysed. Linear regression models were employed to determine which predictor variables of interest in a model were associated with the children's cognitive scores as the dependent variables.

Results

Based on the data, the principal factors associated with children's cognitive outcomes were height-for-age z-score (HAZ), preschool education and the area of residence, Generally children who had low cognitive scores were more often stunted (as defined by the WHO anthropometric tables), had not had pre-school education, and came from areas less favourable in terms of local infrastructure and access to employment opportunities and arable land.

Conclusion

The finding from this cross-sectional analysis of baseline data showed that in addition to height for age and pre-school education, which are commonly thought to impact on cognition, the local authority area where the children lived was associated with their scores on cognitive tests. This has implications for intervention planning. The functioning of local government in promoting the type of community development which will protect the rights of children should be taken into account.

Metacognition, Hardiness, and Grit as Resilience Factors in Unmanned Aerial Systems (UAS) Operations: A Simulation Study

Operators of Unmanned Aerial Systems (UAS) face a variety of stress factors resulting from both the cognitive demands of the work and its broader social context. Dysfunctional metacognitions including those concerning worry may increase stress vulnerability, whereas personality traits including hardiness and grit may confer resilience. The present study utilized a simulation of UAS operation requiring control of multiple vehicles. Two stressors were manipulated independently in a within-subjects design: cognitive demands and negative evaluative feedback. Stress response was assessed using both subjective measures and a suite of psychophysiological sensors, including the electroencephalogram (EEG), electrocardiogram (ECG), and hemodynamic sensors. Both stress manipulations elevated subjective distress and elicited greater high-frequency activity in the EEG. However, predictors of stress response varied across the two stressors. The Anxious Thoughts Inventory (AnTI: Wells, 1994) was generally associated with higher state worry in both control and stressor conditions. It also predicted stress reactivity indexed by EEG and worry responses in the negative feedback condition. Measures of hardiness and grit were associated with somewhat different patterns of stress response. In addition, within the negative feedback condition, the AnTI meta-worry scale moderated relationships between state worry and objective performance and psychophysiological outcome measures. Under high state worry, AnTI meta-worry was associated with lower frontal oxygen saturation, but higher spectral power in high-frequency EEG bands. High meta-worry may block adaptive compensatory effort otherwise associated with worry. Findings support both the metacognitive theory of anxiety and negative emotions (Wells and Matthews, 2015), and the Trait-Stressor-Outcome (TSO: Matthews et al., 2017a) framework for resilience.

Metastatic Colorectal Adenocarcinoma in a Bifid Ureter

Background: Secondary malignancies of the ureter are uncommon. We report the diagnosis and management of metastatic colon cancer to the bifurcation of a bifid ureter.

Case Presentation: A 59-year-old man presented with diffuse metastasis with right hydronephrosis in both renal moieties of a partially duplicated system and an enhancing lesion within the proximal common ureter. Ureteral biopsy was positive for colorectal adenocarcinoma. The patient was subsequently started on palliative chemoradiation.

Conclusion: The ureter is a rare location for hematogenous/lymphatic metastases. When a ureteral mass is present on imaging, ureteroscopy should be performed to characterize the extent of tumor and to rule out secondary malignancy.

Prostate Cancer Screening Trends After United States Preventative Services Task Force Guidelines in an Underserved Population

Purpose: Prostate cancer screening is a controversial topic. We examined trends in Prostate Specific Antigen (PSA) testing in an underserved population before and after the United States Preventative Services Task Force (USPSTF) recommendation against screening.

Methods: Data were collected on all PSA and cholesterol screening tests from 2008 to 2014. We examined the trend of these tests and prostate biopsies while comparing this data to lipid panel data to adjust for changes in patient population.

Results: A decrease in PSA screening was observed from 2010 through 2014, with the greatest decline in 2012. The age group most affected was patients aged 55–69 years. The amount of prostate biopsies during this period decreased as well.

Conclusions: Decreased rates of PSA screening were observed in our urban hospital population that preceded the publication of the USPSTF guidelines. The incidence of prostate biopsies decreased in this timeframe. It now remains to be demonstrated whether decreased PSA screening rates impact the diagnosis of and ultimately the survival from prostate cancer.

Change in practice: a qualitative exploration of midwives' and doctors' views about the introduction of STan monitoring in an Australian hospital

BACKGROUND

The present study examines the introduction of an innovation in intrapartum foetal monitoring practice in Australia. ST-Analysis (STan) is a technology that adds information to conventional fetal monitoring (cardiotocography) during labour, with the aim of reducing unnecessary obstetric intervention. Adoption of this technology has been controversial amongst obstetricians and midwives, particularly as its use necessitates a more invasive means of monitoring (a scalp clip), compared to external monitoring from cardiotocography alone. If adoption of this technology is going to be successful, then understanding staff opinions about the implementation of STan in an Australian setting is an important issue for maternity care providers and policy makers.

METHODS

Using a maximum variation purposive sampling method, 18 interviews were conducted with 10 midwives and 8 doctors from the Women's and Children's Hospital, South Australia to explore views about the introduction of the new technology. The data were analysed using Framework Analysis.

RESULTS

Midwives and doctors indicated four important areas of consideration when introducing STan: 1) philosophy of care; 2) the implementation process including training and education; 3) the existence of research evidence; and 4) attitudes towards the new technology. Views were expressed about the management of change process, the fit of the new technology within the current models of care, the need for ongoing training and the importance of having local evidence.

CONCLUSIONS

These findings, coupled with the general literature about introducing innovation and change, can be used by other centres looking to introduce STan technology.

Enhancing the effectiveness of human-robot teaming with a closed-loop system

With technological developments in robotics and their increasing deployment, human-robot teams are set to be a mainstay in the future. To develop robots that possess teaming capabilities, such as being able to communicate implicitly, the present study implemented a closed-loop system. This system enabled the robot to provide adaptive aid without the need for explicit commands from the human teammate, through the use of multiple physiological workload measures. Such measures of workload vary in sensitivity and there is large inter-individual variability in physiological responses to imposed taskload. Workload models enacted via closed-loop system should accommodate such individual variability. The present research investigated the effects of the adaptive robot aid vs. imposed aid on performance and workload. Results showed that adaptive robot aid driven by an individualized workload model for physiological response resulted in greater improvements in performance compared to aid that was simply imposed by the system.

Osteoporotic hip fractures in Black South Africans: a regional study

Osteoporotic hip fractures are thought to be rare in Blacks however, this study from South Africa shows a significant increase in the number of hip fracture in Blacks. With the expected increase in older people, osteoporotic fractures will pose a major health problem and screening guidelines needed to be implemented.

INTRODUCTION

Developing countries are predicted to bear the burden of osteoporosis in the coming decades. This study was undertaken to review earlier reports that osteoporotic hip fractures are rare in Black Africans.

METHODS

In an observational study, the incidence rates and relative risk ratios (RRR) of osteoporotic hip fractures were calculated in the Black population, aged 60 years and older, residing in the eThekwini region of South Africa. All Black subjects, presenting with a minimal trauma hip fracture to five public hospitals in the region, entered the study. Descriptive statistics were applied to show differences in age and sex.

RESULTS

Eighty-seven subjects were enrolled in the study with a mean age of 76.5 ± 10.5 years and the sex ratio of women to men was 2.5:1. Although men were younger than women, this was not significant (74.2 ± 12.3 vs. 77.4 ± 9.6 years, p = 0.189). The age-adjusted rate was 69.2 per 100,000 p.a. for women and 73.1 per 100,000 p.a. for men. There was a significant increase in the relative risk ratios for hip fractures after the age of 75 years in the total cohort and in women and men. Except for the 65-69-year age group, there was no significant difference in the age-adjusted RRR between women and men.

CONCLUSION

This study represents the largest number of hip fractures recorded in Black Africans. Although the incidence rate is approximately tenfold higher than previously recorded, it remains amongst the lowest globally. A national registry inclusive of private and public sector is required to establish the true incidence rate of hip fractures in Black Africans.