Working Memory Capacity and Executive Attention as Predictors of Distracted Driving

The present study empirically examined the effects of working memory capacity (WMC) and executive attention on distracted driving. Study 1 examined whether a Grocery List Task (GLT) distractor would load onto WMC. Forty-three participants completed a series of WMC tasks followed by the GLT. They then completed two driving trials: driving without the GLT and driving while completing the GLT. It was hypothesized that WMC would positively correlate with GLT performance. A bivariate correlation indicated that WMC was positively associated with performance on the GLT. Study 2 tested a series of distractor tasks (GLT, Tone Monitoring, and Stop Signal) to examine whether these three distractor tasks were also related to WMC, and if each of the distractor tasks would result in poor driving performance. Eighty-four participants were randomly assigned to the distractor conditions. Results indicated that GLT was related to WMC, but Tone Monitoring was not related to WMC. Also, engaging in each of the three distractor tasks led to significantly poorer driving performance. Study 3 evaluated whether rainy or clear weather conditions would affect the relationship between WMC and distracted driving using the same three distractor tasks (GLT, Tone Monitoring, and Stop Signal) as used in Study 2. Ninety-six participants were randomly assigned to the distractor conditions. Results showed that engaging in GLT while driving led to slower braking response times compared to not engaging in GLT driving while driving. Furthermore, WMC moderated the degree to which distraction impaired performance. The present findings clearly indicate that all three distractor tasks had a deleterious effect on driving performance. Furthermore, this effect of distraction on driving depends on many factors, including the type of distraction, the driving performance measure, and the individual\u27s cognitive capabilities. Both theoretical and practical implications are discussed and directions for future research are presented

A Biological Model of Object Recognition with Feature Learning

Previous biological models of object recognition in cortex have been evaluated using idealized scenes and have hard-coded features, such as the HMAX model by Riesenhuber and Poggio [10]. Because HMAX uses the same set of features for all object classes, it does not perform well in the task of detecting a target object in clutter. This thesis presents a new model that integrates learning of object-specific features with the HMAX. The new model performs better than the standard HMAX and comparably to a computer vision system on face detection. Results from experimenting with unsupervised learning of features and the use of a biologically-plausible classifier are presented

Evaluating virtual reality simulators as a training tool for minimally invasive surgery

Minimally invasive surgery offers a number of advantages over traditional open surgeries, including faster patient recovery time, fewer side effects, and improved cosmesis. However, there are also a number of difficulties involved with performing this type of surgery, including poor visuo-spatial mapping, poor depth perception, and mechanical difficulties (e.g., the fulcrum effect). Considering the decrease in residency training hours required for surgical trainees in 2011 (Rajaram et al., 2014), it is essential that surgical trainees employ training methods that would best result in high accuracy and efficiency. Simulator-based training addresses many of the issues of traditional master-apprentice surgical training methods (e.g., observer bias among those assessing trainee performance, the requirement of supervision from an expert surgeon who may not always be readily available, especially in remote surgical training centers). Virtual reality simulators such as LapSim and SimPraxis provide objective, accurate measures of performance, such as instrument angle and economy of movement. Additionally, simulators such as SimPraxis also evaluate knowledge-based performance, as well as technical performance. This is essential, because successful surgery does not depend solely on speed and efficiency of surgical techniques, but also on the quality of decision-making (e.g., should he/she convert to open surgery? Should he/she cut the tissue/organ?; Craig, Klein, Griswold, Gaitonde, McGill, & Halldorsson, 2012; Tran, Gupta, Poniatowski, Alanee, Dall’Era, & Sweet, 2013). Human factors methods such as task analysis can be used to identify the critical pieces of knowledge required for successful surgery (Craig et al., 2012). These pieces of information can then be used to inform development of a knowledge-based training module. Additionally, because certain studies suggest that simulators primarily benefit novice learners over intermediate or expert learners (Fairhust, Strickland, & Maddern, 2011), the present authors also suggest adaptive training, which would provide simpler tasks to novice surgical trainees and then become increasingly difficult as trainees achieve criterion-levels of performance. The advantages of adaptive training in simulated surgery are predicted to be consistent with previous findings involving “intelligent training systems” used in other domains such as combat training (Craig et al., 2012; Ryder, Santarelli, Scolatero, Hicinbothom, & Zachary, 2000). The present authors present a view on simulated surgical training that is consistent with Ryder et al. (2000) and Craig et al. (2012). We suggest incorporating knowledge-based models into current simulator-based training, as well as the addition of adaptive training to tailor training at the individual level

Direct Control of Cell Cycle Gene Expression by Proto-oncogene Product ACTR, and Its Autoregulation Underlies Its Transforming Activity

ACTR (also called AIB1 and SRC-3) was identified as a coactivator for nuclear receptors and is linked to multiple types of human cancer due to its frequent overexpression. However, the molecular mechanism of ACTR oncogenicity and its function independent of nuclear receptors remain to be defined. We demonstrate here that ACTR is required for both normal and malignant human cells to effectively enter S phase. RNA interference-mediated depletion and chromatin immunoprecipitation assays show that endogenous ACTR directly controls the expression of genes important for initiation of DNA replication, which include cdc6, cdc25A, MCM7, cyclin E, and Cdk2. Moreover, consistent with its critical role in cell cycle control, ACTR expression appears to be cell cycle regulated, which involves E2F. Interestingly, ACTR is recruited to its own promoter at the G1/S transition and activates its own expression, suggesting a positive feedback mechanism for ACTR action in the control of cell cycle progression and for its aberrant expression in cancers. Importantly, overexpression of ACTR alone transforms human mammary epithelial cells, which requires its association with E2F. These findings reveal a novel role for ACTR in cell cycle control and support the notion that the ability of aberrant ACTR to deregulate the cell cycle through E2F underlies its oncogenicity in human cancers

Statin use and adverse effects among adults \u3e 75 years of age: Insights from the Patient and Provider Assessment of Lipid Management (PALM) registry

Background: Current statin use and symptoms among older adults in routine community practice have not been well characterized since the release of the 2013 American College of Cardiology/American Heart Association guideline. Methods and results: We compared statin use and dosing between adults \u3e75 and ≤75 years old who were eligible for primary or secondary prevention statin use without considering guideline-recommended age criteria. The patients were treated at 138 US practices in the Patient and Provider Assessment of Lipid Management (PALM) registry in 2015. Patient surveys also evaluated reported symptoms while taking statins. Multivariable logistic regression models examined the association between older age and statin use and dosing. Among 6717 people enrolled, 1704 (25%) were \u3e75 years old. For primary prevention, use of any statin or high-dose statin did not vary by age group: any statin, 62.6% in those \u3e75 years old versus 63.1% in those ≤75 years old (P=0.83); high-dose statin, 10.2% versus 12.3% in the same groups (P=0.14). For secondary prevention, older patients were slightly less likely to receive any statin (80.1% versus 84.2% [P=0.003]; adjusted odds ratio, 0.81; 95% confidence interval, 0.66-1.01 [P=0.06]), but were much less likely to receive a high-intensity statin (23.5% versus 36.2% [PP=0.0001]). Among current statin users, older patients were slightly less likely to report any symptoms (41.3% versus 46.6%; P=0.003) or myalgias (27.3% versus 33.3%; Conclusions: Overall use of statins was similar for primary prevention in those aged \u3e75 years versus younger patients, yet older patients were less likely to receive high-intensity statins for secondary prevention. Statins appear to be similarly tolerated in older and younger adult

Patient-reported reasons for declining or discontinuing statin therapy: Insights from the PALM registry

Background: Many adults eligible for statin therapy for cardiovascular disease prevention are untreated. Our objective was to investigate patient‐reported reasons for statin underutilization, including noninitiation, refusal, and discontinuation.Methods and Results: This study included the 5693 adults recommended for statin therapy in the PALM (Patient and Provider Assessment of Lipid Management) registry. Patient surveys evaluated statin experience, reasons for declining or discontinuing statins, and beliefs about statins and cardiovascular disease risk. Overall, 1511 of 5693 adults (26.5%) were not on treatment. Of those not on a statin, 894 (59.2%) reported never being offered a statin, 153 (10.1%) declined a statin, and 464 (30.7%) had discontinued therapy. Women (relative risk: 1.22), black adults (relative risk: 1.48), and those without insurance (relative risk: 1.38) were most likely to report never being offered a statin. Fear of side effects and perceived side effects were the most common reasons cited for declining or discontinuing a statin. Compared with statin users, those who declined or discontinued statins were less likely to believe statins are safe (70.4% of current users vs. 36.9% of those who declined and 37.4% of those who discontinued) or effective (86.3%, 67.4%, and 69.1%, respectively). Willingness to take a statin was high; 67.7% of those never offered and 59.7% of patients who discontinued a statin would consider initiating or retrying a statin.Conclusions: More than half of patients eligible for statin therapy but not on treatment reported never being offered one by their doctor. Concern about side effects was the leading reason for statin refusal or discontinuation. Many patients were willing to reconsider statin therapy if offered

Determination of the relative economic impact of different molecular-based laboratory algorithms for respiratory viral pathogen detection, including Pandemic (H1N1), using a secure web based platform

<p>Abstract</p> <p>Background</p> <p>During period of crisis, laboratory planners may be faced with a need to make operational and clinical decisions in the face of limited information. To avoid this dilemma, our laboratory utilizes a secure web based platform, Data Integration for Alberta Laboratories (DIAL) to make near real-time decisions.</p> <p>This manuscript utilizes the data collected by DIAL as well as laboratory test cost modeling to identify the relative economic impact of four proposed scenarios of testing for Pandemic H1N1 (2009) and other respiratory viral pathogens.</p> <p>Methods</p> <p>Historical data was collected from the two waves of the pandemic using DIAL. Four proposed molecular testing scenarios were generated: A) Luminex respiratory virus panel (RVP) first with/without US centers for Disease Control Influenza A Matrix gene assay (CDC-M), B) CDC-M first with/without RVP, C) RVP only, and D) CDC-M only. Relative cost estimates of different testing algorithm were generated from a review of historical costs in the lab and were based on 2009 Canadian dollars.</p> <p>Results</p> <p>Scenarios A and B had similar costs when the rate of influenza A was low (< 10%) with higher relative cost in Scenario A with increasing incidence. Scenario A provided more information about mixed respiratory virus infection as compared with Scenario B.</p> <p>Conclusions</p> <p>No one approach is applicable to all conditions. Testing costs will vary depending on the test volume, prevalence of influenza A strains, as well as other circulating viruses and a more costly algorithm involving a combination of different tests may be chosen to ensure that tests results are returned to the clinician in a quicker manner. Costing should not be the only consideration for determination of laboratory algorithms.</p

Measurement of low‐density lipoprotein cholesterol levels in primary and secondary prevention patients: Insights from the PALM registry

Background The 2013 American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults recommended testing low-density lipoprotein cholesterol ( LDL -C) to identify untreated patients with LDL -C ≥190 mg/dL, assess lipid-lowering therapy adherence, and consider nonstatin therapy. We sought to determine whether clinician lipid testing practices were consistent with these guidelines. Methods and Results The PALM (Patient and Provider Assessment of Lipid Management) registry enrolled primary and secondary prevention patients from 140 US cardiology, endocrinology, and primary care offices in 2015 and captured demographic data, lipid treatment history, and the highest LDL -C level in the past 2 years. Core laboratory lipid levels were drawn at enrollment. Among 7627 patients, 2787 (36.5%) had no LDL -C levels measured in the 2 years before enrollment. Patients without chart-documented LDL -C levels were more often women, nonwhite, uninsured, and non-college graduates (all P\u3c0.01). Patients without prior lipid testing were less likely to receive statin treatment (72.6% versus 76.0%; P=0.0034), a high-intensity statin (21.5% versus 24.3%; P=0.016), nonstatin lipid-lowering therapy (24.8% versus 27.3%; P=0.037), and had higher core laboratory LDL -C levels at enrollment (median 97 versus 92 mg/dL; P\u3c0.0001) than patients with prior LDL -C testing. Of 166 individuals with core laboratory LDL -C levels ≥190 mg/dL, 36.1% had no LDL -C measurement in the prior 2 years, and 57.2% were not on a statin at the time of enrollment. Conclusions In routine clinical practice, LDL -C testing is associated with higher-intensity lipid-lowering treatment and lower achieved LDL -C level

Melioidosis in the Philippines.

The first documented case of melioidosis in the Philippines occurred in 1948. Since then, there have been sporadic reports in the literature about travelers diagnosed with melioidosis after returning from the Philippines. Indigenous cases, however, have been documented rarely, and under-reporting is highly likely. This review collated all Philippine cases of melioidosis published internationally and locally, as well as unpublished case series and reports from different tertiary hospitals in the Philippines. In total, 25 papers and 41 cases were identified. Among these, 23 were indigenous cases (of which 20 have not been previously reported in the literature). The most common co-morbidity present was diabetes mellitus, and the most common presentations were pulmonary and soft tissue infections. Most of the cases received ceftazidime during the intensive phase, while trimethoprim-sulfamethoxazole was given during the eradication phase. The known mortality rate was 14.6%, while 4.9% of all cases were reported to have had recurrence. The true burden of melioidosis in the country is not well defined. A lack of awareness among clinicians, a dearth of adequate laboratories, and the absence of a surveillance system for the disease are major challenges in determining the magnitude of the problem