Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Metacognition for hearing in noise: a comparison between younger and older adults

: Metacognition entails knowledge of one's own cognitive skills, perceived self-efficacy and locus of control when performing a task, and performance monitoring. Age-related changes in metacognition have been observed in metamemory, whereas their occurrence for hearing remained unknown. We tested 30 older and 30 younger adults with typical hearing, to assess if age reduces metacognition for hearing sentences in noise. Metacognitive monitoring for older and younger adults was overall comparable. In fact, the older group achieved better monitoring for words in the second part of the phrase. Additionally, only older adults showed a correlation between performance and perceived confidence. No age differentiation was found for locus of control, knowledge or self-efficacy. This suggests intact metacognitive skills for hearing in noise in older adults, alongside a somewhat paradoxical overconfidence in younger adults. These findings support exploiting metacognition for older adults dealing with noisy environments, since metacognition is central for implementing self-regulation strategies

Spontaneous head-movements improve sound localization in aging adults with hearing loss

International audienceMoving the head while a sound is playing improves its localization in human listeners, in children and adults, with or without hearing problems. It remains to be ascertained if this benefit can also extend to aging adults with hearing-loss, a population in which spatial hearing difficulties are often documented and intervention solutions are scant. Here we examined performance of elderly adults (61–82 years old) with symmetrical or asymmetrical age-related hearing-loss, while they localized sounds with their head fixed or free to move. Using motion-tracking in combination with free-field sound delivery in visual virtual reality, we tested participants in two auditory spatial tasks: front-back discrimination and 3D sound localization in front space. Front-back discrimination was easier for participants with symmetrical compared to asymmetrical hearing-loss, yet both groups reduced their front-back errors when head-movements were allowed. In 3D sound localization, free head-movements reduced errors in the horizontal dimension and in a composite measure that computed errors in 3D space. Errors in 3D space improved for participants with asymmetrical hearing-impairment when the head was free to move. These preliminary findings extend to aging adults with hearing-loss the literature on the advantage of head-movements on sound localization, and suggest that the disparity of auditory cues at the two ears can modulate this benefit. These results point to the possibility of taking advantage of self-regulation strategies and active behavior when promoting spatial hearing skills

The impact of a visual spatial frame on real sound-source localization in virtual reality

International audienceStudies on audiovisual interactions in sound localization have primarily focused on the relations between the spatial position of sounds and their perceived visual source, as in the famous ventriloquist effect. Much less work has examined the effects on sound localization of seeing aspects of the visual environment. In this study, we took advantage of an innovative method for the study of spatial hearing-based on real sounds, virtual reality and real-time kinematic tracking-to examine the impact of a minimal visual spatial frame on sound localization. We tested sound localization in normal hearing participants (N = 36) in two visual conditions: a uniform gray scene and a simple visual environment comprising only a grid. In both cases, no visual cues about the sound sources were provided. During and after sound emission, participants were free to move their head and eyes without restriction. We found that the presence of a visual spatial frame improved hand-pointing in elevation. In addition, it determined faster first-gaze movements to sounds. Our findings show that sound localization benefits from the presence of a minimal visual spatial frame and confirm the importance of combining kinematic tracking and virtual reality when aiming to reveal the multisensory and motor contributions to spatial-hearing abilities

P@k-en-redes

Resumen tomado de la publicaciónSe presenta un Programa de transición que nace de una necesidad en un centro escolar. Parte de una base teórica y legal, pasando a un análisis de la realidad, donde lo más productivo es una autocrítica sobre la labor docente. Se exponen las necesidades que tiene el centro en el día a día y por último se establecen puntos prácticos, que son realmente el diseño del programa cuya finalidad es un tránsito ordenado entre ambas etapas educativas.AndalucíaES