Attentional Bias Modification: Single Session Effects on Behavioural and Neurological Measures with High and Low Self-Esteem

The central idea of Attentional Bias Modification (ABM) has been that it can directly alter attentional biases by the use of computerized training procedures. Although ABM has advanced theoretically and methodologically in recent research, its clinical efficacy has been mixed. However the current study argues the strong potential for ABM to contribute as a psychological intervention, to the reduction of the formation of negative attentional biases. As contemporary models of depression and current literature reviews have emphasised the role of low self-esteem (SE) in the aetiology of depressive disorders, the current study investigated the causal role of SE on ABM efficacy. An independent groups design investigated behavioural and neurological differences in response to affective words based on participants Rosenberg Self-Esteem (RSES) scores. Forty participants (28 female) from a non-clinical sample completed a standard or ABM dotprobe task with 200 negative-neutral affective word pairs shown. Later, 10 words of both valence were memorised. Lastly, a delayed free recall task required participants to recall the 20 words. Event Related Potentials (ERP’s) were recorded using a 256 channel dense-array electroencephalogram (EEG) in three separate pre-defined regions of interest, across the 200-280, 320-400, and 600-900ms epochs. Response times and word recall data were also gathered. In the three regions of interest, amplitude was not significantly different between the 2 SE groups, when in different dot-probe conditions. Therefore no interaction effect of SE and dot-probe condition was found. However in the prefrontal line, the dot-probe task had a significant main effect on amplitude, this was reflected by an increased presence of the N2 ERP potential as the negative stimuli caused greater conflict of expectations in attentional deployment. There was also a significant effect of time and SE on amplitude, which reflected initial modulations from the stimuli viewed as positive amplitudes in the first epoch, but decreased amplitude as the modulation from stimuli reduced. In relation to behaviour results, there were no significant differences in the number of words recalled, or response bias between groups, in terms of negative word valence. Overall the results did not support the underlying assumptions of the ABM paradigm, however two potential factors were unaccounted for, being the effects of individual amounts of attentional control, and the large regional distribution that processes of SE are diversely performed in. Both past and future research which fail to successful apply a single session ABM dot probe task can discount self-esteem as a potential moderator

Can Expert-level Cognition be Rapidly Acquired? The Effect of a Human Factors-based Virtual Reality Trainer on Non-Technical Skills in the Operating Theatre

Background Restrictions to real-life experiences in surgical training can hinder skill acquisition. Factors such as large student-to-teacher ratios, equipment limitations, or pandemics can reduce access to expert cognition and pedagogical guidance that is required by novices. Additionally, high quality pedagogy from workshops, lectures, and boot camps are not accessible enough and cannot be attended during pandemic restrictions. Therefore, Non-Technical Skills (NTS) of Operating Theatre (OT) teams need more training content that can provide simulations for training purposes. Patient safety and undesired event prevention can be improved by a scenario-driven approach that is built upon practice and feedback to scaffold cognitive skills for OT trainees. An NTS virtual reality training tool was created and compared to existing theory-based content. Method Eighty-two undergraduate surgical students were asked different scenarios and showed decision-making is not distinct as a factor of course year, to generally concur with previous findings. A Task Analysis of a surgical procedure and the OT environment was formed, and 3 experts in surgery were interviewed with thematic analysis of data. The design and creation of the virtual reality instrument then occurred with 360-degrees OT videos. Then, a two groups comparison of a one-hour session with before, during, and after intervention measures compared 14 3rdyear operating theatre practitioners. Verbal Protocol Analysis (VPA) of the trainees’ sessions were paired with Situation Awareness Global Assessment Technique (SAGAT) scores and rankings for a written decision-making scenario. Post-session reflections were analysed using Interpretative Phenomenological Analysis(IPA)to understand how they experienced the materials and common occurrences between participants. Results Thematic analysis of expert interviews revealed rich mental models, tacit knowledge, and purposeful augmentation of NTS as a countermeasure when teaching. This allowed insight into what non-technical elements were feasible when incorporated into a headset. The main VPA findings from the 14 OT trainees suggested significant increase of verbalization around Teamwork and Communication(p=0.028). Within this NTS category, significantly more verbalizations for shared mental models for the experimental condition occurred (p=0.018).Additionally, a significant increase in transformation of cue meaning to improve understanding of the environment occurred, compared to control condition (p=0.02).However, SAGAT scores showed no significant differences in 23 questions for both conditions, this may be a limit in both conditions’ presentation delivery as items in the videos are difficult to identify. Conclusions Significant results in specific and not all are as highlight complexities in NTS training but is a step towards improved support for OT staff to improve awareness and safety during surgery. Although supposed homogenous technical skills, large variations in participants’ decision-making strategies and perceptions of cues may have confounded the intervention effects. During intervention, the control condition used past experiences to contextually interpret theory to strengthen their schemata in more concrete rather than abstract forms. Real-life scenarios in the experimental condition reduced this need therefore applied their feedback to actual events shown, which may increase transfer of skill to real-life. More sessions over a longer period could observe stronger improvements in the same directions in the current results. Overall, the intervention was equal to or greater than the control condition promoting further research on a greater timeframe and audience

Evolution of Primary Research Studies in Digital Interventions for Mental Well-Being Promotion from 2004 to 2023: A Bibliometric Analysis of Studies on the Web of Science

Research into digital interventions for mental well-being promotion has grown in recent years, fuelled by the need to improve mental health prevention strategies and respond to challenges arising from the coronavirus (COVID-19) pandemic. This bibliometric analysis provides a structured overview of publication trends and themes in primary research studies reporting an array of digital interventions indexed at WoS from 2004 to 2023. Bibliometric data were collected on a sample of 1117 documents and analysed using the Biblioshiny package. Supplemental network visualisation analysis was conducted using VosViewer. The study, based on Web of Science and Scopus databases, indicates a marked increase in publications post-2020. There were seven groups of research themes clustered around “Mindfulness”, “Anxiety”, “COVID-19”, “Acceptance and Commitment Therapy”, “Depression”, “Web-based”, and “Positive Psychology”. Further, results demonstrated the growth of specific themes (e.g., mindfulness, mhealth), the defining impact of COVID-19 studies, and the importance of both randomised controlled trials and formative research. Overall, research in the field is still early in its development and is expected to continue to grow. Findings highlight the field’s dynamic response to societal and technological changes, suggesting a future trajectory that leans increasingly on digital platforms for mental health promotion and intervention. Finally, study limitations and implications for future studies are discussed

Effectiveness of immersive virtual reality in surgical training—A randomized control trial

Purpose: Surgical training methods are evolving with the technological advancements, including the application of virtual reality (VR) and augmented reality. However, 28 to 40% of novice residents are not confident in performing a major surgical procedure. VR surgery, an immersive VR (iVR) experience, was developed using Oculus Rift and Leap Motion devices (Leap Motion, Inc, San Francisco, CA) to address this challenge. Our iVR is a multisensory, holistic surgical training application that demonstrates a maxillofacial surgical technique, the Le Fort I osteotomy. The main objective of the present study was to evaluate the effect of using VR surgery on the self-confidence and knowledge of surgical residents. Materials and Methods: A multisite, single-blind, parallel, randomized controlled trial (RCT) was performed. The participants were novice surgical residents with limited experience in performing the Le Fort I osteotomy. The primary outcome measures were the self-assessment scores of trainee confidence using a Likert scale and an objective assessment of the cognitive skills. Ninety-five residents from 7 dental schools were included in the RCT. The participants were randomly divided into a study group of 51 residents and a control group of 44. Participants in the study group used the VR surgery application on an Oculus Rift with Leap Motion device. The control group participants used similar content in a standard PowerPoint presentation on a laptop. Repeated measures multivariate analysis of variance was applied to the data to assess the overall effect of the intervention on the confidence of the residents. Results: The study group participants showed significantly greater perceived self-confidence levels compared with those in the control group (P = .034; α = 0.05). Novices in the first year of their training showed the greatest improvement in their confidence compared with those in their second and third year. Conclusions: iVR experiences improve the knowledge and self-confidence of the surgical residents

Eliciting Co-Creation Best Practices of Virtual Reality Reusable e-Resources

Immersive experiential technologies find fertile grounds to grow and support healthcare education. Virtual, Augmented, or Mixed reality (VR/AR/MR) have proven to be impactful in both the educational and the affective state of the healthcare student’s increasing engagement. However, there is a lack of guidance for healthcare stakeholders on developing and integrating virtual reality resources into healthcare training. Thus, the authors applied Bardach’s Eightfold Policy Analysis Framework to critically evaluate existing protocols to determine if they are inconsistent, ineffective, or result in uncertain outcomes, following systematic pathways from concepts to decision-making. Co-creative VR resource development resulted as the preferred method. Best practices for co-creating VR Reusable e-Resources identified co-creation as an effective pathway to the prolific use of immersive media in healthcare education. Co-creation should be considered in conjunction with a training framework to enhance educational quality. Iterative cycles engaging all stakeholders enhance educational quality, while co-creation is central to the quality assurance process both for technical and topical fidelity, and tailoring resources to learners’ needs. Co-creation itself is seen as a bespoke learning modality. This paper provides the first body of evidence for co-creative VR resource development as a valid and strengthening method for healthcare immersive content development. Despite prior research supporting co-creation in immersive resource development, there were no established guidelines for best practices

Virtual reality reusable e-resources for clinical skills training: a mixed-methods evaluation

Virtual reality has long existed, but its wider adoption in education is recent. Studies informed by theoretical underpinned co-creation frameworks and utilization of theoretical informed evaluations are scarce in literature. Thus, this study internationally evaluated the efficacy of three virtual reality reusable e-resources (VRReRs), co-created based on the ASPIRE framework, for teaching clinical skills to university students. The study followed a mixed-methods approach, combining SUS, SUS Presence Questionnaire, TAM, and UTAUT2 with a focus group discussion. Additionally, for one VRReR, a quantitative pre/post evaluation of knowledge and comparison with lecture notes followed. Results demonstrated moderately to highly usability, effectively facilitated a strong sense of presence, confidence while using them, and willingness to continue using VRReRs in the future, while increased knowledge of the learners, highlighted their effectiveness. Although some usability issues were identified, these were considered easy to address. This work evidence, in an international context, that co-created VR resources are highly acceptable and effective, similar to other types of digital or traditional resources developed through participatory inquiry paradigm. By leveraging the benefits of VR technology, VRReRs have the potential to transform and enhance the learning experience in the field of clinical skills, ultimately advancing the digitalization of higher education

Chest Radiograph Scoring Alone or Combined with Other Risk Scores for Predicting Outcomes in COVID-19

Background Radiographic severity may help predict patient deterioration and outcomes from COVID-19 pneumonia. Purpose To assess the reliability and reproducibility of three chest radiograph reporting systems (radiographic assessment of lung edema [RALE], Brixia, and percentage opacification) in patients with proven SARS-CoV-2 infection and examine the ability of these scores to predict adverse outcomes both alone and in conjunction with two clinical scoring systems, National Early Warning Score 2 (NEWS2) and International Severe Acute Respiratory and Emerging Infection Consortium: Coronavirus Clinical Characterization Consortium (ISARIC-4C) mortality. Materials and Methods This retrospective cohort study used routinely collected clinical data of patients with polymerase chain reaction-positive SARS-CoV-2 infection admitted to a single center from February 2020 through July 2020. Initial chest radiographs were scored for RALE, Brixia, and percentage opacification by one of three radiologists. Intra- and interreader agreement were assessed with intraclass correlation coefficients. The rate of admission to the intensive care unit (ICU) or death up to 60 days after scored chest radiograph was estimated. NEWS2 and ISARIC-4C mortality at hospital admission were calculated. Daily risk for admission to ICU or death was modeled with Cox proportional hazards models that incorporated the chest radiograph scores adjusted for NEWS2 or ISARIC-4C mortality. Results Admission chest radiographs of 50 patients (mean age, 74 years ± 16 [standard deviation]; 28 men) were scored by all three radiologists, with good interreader reliability for all scores, as follows: intraclass correlation coefficients were 0.87 for RALE (95% CI: 0.80, 0.92), 0.86 for Brixia (95% CI: 0.76, 0.92), and 0.72 for percentage opacification (95% CI: 0.48, 0.85). Of 751 patients with a chest radiograph, those with greater than 75% opacification had a median time to ICU admission or death of just 1-2 days. Among 628 patients for whom data were available (median age, 76 years [interquartile range, 61-84 years]; 344 men), opacification of 51%-75% increased risk for ICU admission or death by twofold (hazard ratio, 2.2; 95% CI: 1.6, 2.8), and opacification greater than 75% increased ICU risk by fourfold (hazard ratio, 4.0; 95% CI: 3.4, 4.7) compared with opacification of 0%-25%, when adjusted for NEWS2 score. Conclusion Brixia, radiographic assessment of lung edema, and percentage opacification scores all reliably helped predict adverse outcomes in SARS-CoV-2 infection. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Little in this issue

Integrated Molecular Meta-Analysis of 1,000 Pediatric High-Grade and Diffuse Intrinsic Pontine Glioma.

We collated data from 157 unpublished cases of pediatric high-grade glioma and diffuse intrinsic pontine glioma and 20 publicly available datasets in an integrated analysis of >1,000 cases. We identified co-segregating mutations in histone-mutant subgroups including loss of FBXW7 in H3.3G34R/V, TOP3A rearrangements in H3.3K27M, and BCOR mutations in H3.1K27M. Histone wild-type subgroups are refined by the presence of key oncogenic events or methylation profiles more closely resembling lower-grade tumors. Genomic aberrations increase with age, highlighting the infant population as biologically and clinically distinct. Uncommon pathway dysregulation is seen in small subsets of tumors, further defining the molecular diversity of the disease, opening up avenues for biological study and providing a basis for functionally defined future treatment stratification