Search

Background: National quality measures set goals for diabetes management. Hispanic populations are higher risk for diabetes and associated complications, especially low-income communities. Research suggests free clinics provide suboptimal diabetes management. Our quality improvement project aims to improve diabetes management in the Hispanic free clinic population., Methods: Clínica Latina's volunteer medical students and physicians serve predominantly uninsured Spanish-speaking patients. Established diabetes patients that attended clinic during the study were included. Data was collected regarding patients' diabetes care for two months, then analyzed compared to quality metrics. We implemented paper checklists and electronic medical record (EMR) smart phrases for volunteers to utilize in managing diabetes., Results: 32 patients were included in the study. At baseline, 78% had an A1C check in the past 3 months, 81% were on a statin. In the past year, 81% had a lipid panel, 19% had an eye exam, 63% had a diabetic foot exam, 53% had a urine microalbumin-creatinine screening. After interventions, 97% had an A1C check, 93% were on a statin, 91% had a lipid panel, 31% had an eye exam, 75% had a foot exam, 63% had a urine microalbumin-creatinine. Patients with an LDL < 100 increased from 62 to 66%. The mean A1C did not statistically significantly change. Volunteer smart phrase utilization increased from 37 to 59.1%., Conclusion: We implemented a checklist and EMR smart phrase to optimize diabetes management in a student-run Hispanic free clinic, which improved quality metrics. Low-resource clinics serving Spanish-speaking populations may benefit from similar interventions to improve diabetic care., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

We sought to assess COVID-19 vaccination rates, as well as attitudes and beliefs towards the vaccine, of patients in a Spanish-speaking student-run free clinic in Columbus, Ohio. A cross-sectional study was performed. Surveys were distributed to all individuals over 18 years who presented to La Clínica Latina between July, 2022 and September, 2022. A convenience sample was used: patients in the waiting room and their accompanying family members or friends were invited to participate. Subjects were excluded if under the age of 18 or over the age of 75, or if non-Spanish speaking. Of the 158 individuals who agreed to participate in our study, 146 responded to the question regarding vaccination status, revealing 90.4% of respondents had received a COVID-19 vaccination. Most respondents learned about the vaccine from social media (26.4%) or television (22.7%). The majority of participants sought answers to questions surrounding the vaccine by asking their doctor (49.1%). The most common reason among unvaccinated participants for not undergoing vaccination was fear of an adverse reaction to the vaccine (n = 11). We found that a large proportion (90.4%) of individuals seeking care at a Spanish-speaking free clinic were vaccinated against COVID-19. Our study also provides perspective on the means of health knowledge acquisition and behaviors in this predominantly Latinx patient population in central Ohio. We can utilize our results to optimize and tailor clinic services and initiatives for COVID-19 boosters to meet the needs of this community., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Inequitable follow-up of abnormal cancer screening tests may contribute to racial/ethnic disparities in colon and breast cancer outcomes. However, few multi-site studies have examined follow-up of abnormal cancer screening tests and it is unknown if racial/ethnic disparities exist., Objective: This report describes patterns of performance on follow-up of abnormal colon and breast cancer screening tests and explores the extent to which racial/ethnic disparities exist in public hospital systems., Design: We conducted a retrospective cohort study using data from five California public hospital systems. We used multivariable robust Poisson regression analyses to examine whether patient-level factors or site predicted receipt of follow-up test., Main Measures: Using data from five public hospital systems between July 2015 and June 2017, we assessed follow-up of two screening results: (1) colonoscopy after positive fecal immunochemical tests (FIT) and (2) tissue biopsy within 21 days after a BIRADS 4/5 mammogram., Key Results: Of 4132 abnormal FITs, 1736 (42%) received a follow-up colonoscopy. Older age, Medicaid insurance, lack of insurance, English language, and site were negatively associated with follow-up colonoscopy, while Hispanic ethnicity and Asian race were positively associated with follow-up colonoscopy. Of 1702 BIRADS 4/5 mammograms, 1082 (64%) received a timely biopsy; only site was associated with timely follow-up biopsy., Conclusion: Despite the vulnerabilities of public-hospital-system patients, follow-up of abnormal cancer screening tests occurs at rates similar to that of patients in other healthcare settings, with colon cancer screening test follow-up occurring at lower rates than follow-up of breast cancer screening tests. Site-level factors have larger, more consistent impact on follow-up rates than patient sociodemographic traits. Resources are needed to identify health system-level factors, such as test follow-up processes or data infrastructure, that improve abnormal cancer screening test follow-up so that effective health system-level interventions can be evaluated and disseminated., (© 2022. The Author(s).)

Background: Racial/ethnic disparities in anticoagulation management are well established. Differences in warfarin monitoring can contribute to these disparities and should be measured., Objective: We assessed for differences in international normalized ratio (INR) monitoring by race/ethnicity and language preference across safety-net care systems serving predominantly low-income, ethnically diverse populations., Design: Cross-sectional analysis of process and safety data shared from the Safety Promotion Action Research and Knowledge Network (SPARK-Net) initiative, a consortium of five California safety-net hospital systems., Participants: Eligible patients were at least 18 years old, received warfarin for at least 56 days during the measurement period from July 2015 to June 2017, and had INR testing in an ambulatory care setting at a participating healthcare system., Main Measures: We conducted a scaled Poisson regression for adjusted rate ratio of having at least one INR checked per 56-day time period for which a patient had a warfarin prescription. Adjusting for age, sex, healthcare system, and insurance status/type, we assessed for racial/ethnic and language disparities in INR monitoring., Key Results: Of 8129 patients, 3615 (44%) were female; 1470 (18%), Black/African American; 3354 (41%), Hispanic/Latinx; 1210 (15%), Asian; 1643 (20%), White; and 452 (6%), other. Three thousand five hundred forty-nine (45%) were non-English preferring. We did not observe statistically significant disparities in the rate of appropriate INR monitoring by race/ethnicity or language; the primary source of variation was by healthcare network. Older age, female gender, and uninsured patients had a slightly higher rate of appropriate INR monitoring, but differences were not clinically significant., Conclusions: We did not find a race/ethnicity nor language disparity in INR monitoring; safety-net site was the main source of variation., (© 2021. The Author(s) under exclusive licence to Society of General Internal Medicine.)

Introduction and Hypothesis: Obstetric fistulas have devastating consequences for women. Although surgical repair is largely successful in closing the defect, many women with successful fistula closure report persistent urinary incontinence. Our study is aimed at characterizing incontinence after successful fistula repair and its impact on quality of life., Methods: This cross-sectional study enrolled women with a history of successful obstetric fistula closure with (n = 51; cases) or without (n = 50; controls) persistent urinary incontinence. Data were collected in Mekelle, Ethiopia, between 2016 and 2018. All cases underwent clinical evaluation and completed questionnaires characterizing the type, severity, and impact of incontinence., Results: Cases were significantly more likely to have acquired their fistula at an earlier age and with their first vaginal delivery compared with controls. Almost all cases reported both stress (98%) and urgency (94%) incontinence, and half reported constant urinary leakage (49%) despite successful fistula closure. Of cases who completed urodynamic evaluation (n = 22), all had genuine stress incontinence and none had detrusor overactivity. All cases reported moderate to severe (80.4%) or very severe (19.6%) incontinence (measured by ICIQ-SF) and this had a moderate to severe negative impact on their quality of life (as measured by ICIQ-QoL). Although history of suicidal ideation was not significantly different between the groups, among those with suicidal ideation, cases were more likely to report having made a plan and/or attempted to commit suicide., Conclusions: When urinary incontinence persists after successful fistula closure, it tends to be severe and of mixed etiology and has a significant negative impact on quality of life and mental health.

Background: Interest is growing in interventions to address social needs in clinical settings. However, little is known about patients' perceptions and experiences with these interventions., Objective: To evaluate patients' experiences and patient-reported outcomes of a primary care-based intervention to help patients connect with community resources using trained volunteer advocates., Design: Qualitative telephone interviews with patients who had worked with the volunteer advocates. Sample and recruitment targets were equally distributed between patients who had at least one reported success in meeting an identified need and those who had no reported needs met, based on the database used to document patient encounters., Participants: One hundred two patients., Interventions: Patients at the study clinic were periodically screened for social needs. If needs were identified, they were referred to a trained volunteer advocate who further assessed their needs, provided them with resource referrals, and followed up with them on whether their need was met., Approach: Thematic analysis was used to code the data., Key Results: Interviewed patients appreciated the services offered, especially the follow-up. Patients' ability to access the resource to which they were referred was enhanced by assistance with filling out forms, calling community resources, and other types of navigation. Patients also reported that interacting with the advocates made them feel listened to and cared for, which they perceived as noteworthy in their lives., Conclusions: This patient-reported information provides key insights into a human-centered intervention in a clinical environment. Our findings highlight what works in clinical interventions addressing social needs and provide outcomes that are difficult to measure using existing quantitative metrics. Patients experienced the intervention as a therapeutic relationship/working alliance, a type of care that correlates with positive outcomes such as treatment adherence and quality of life. These insights will help design more patient-centered approaches to providing holistic patient care.

Introduction: By mid-century, global atmospheric carbon dioxide concentration ([CO 2 ]) is predicted to reach 600 μmol mol -1 with global temperatures rising by 2 °C. Rising [CO 2 ] and temperature will alter the growth and productivity of major food and forage crops across the globe. Although the impact is expected to be greatest in tropical regions, the impact of climate-change has been poorly studied in those regions., Objectives: This experiment aimed to understand the effects of elevated [CO 2 ] (600 μmol mol -1 ) and warming (+ 2 °C), singly and in combination, on Panicum maximum Jacq. (Guinea grass) metabolite and transcript profiles., Methods: We created a de novo assembly of the Panicum maximum transcriptome. Leaf samples were taken at two time points in the Guinea grass growing season to analyze transcriptional and metabolite profiles in plants grown at ambient and elevated [CO 2 ] and temperature, and statistical analyses were used to integrate the data., Results: Elevated temperature altered the content of amino acids and secondary metabolites. The transcriptome of Guinea grass shows a clear time point separations, with the changes in the elevated temperature and [CO 2 ] combination plots., Conclusion: Field transcriptomics and metabolomics revealed that elevated temperature and [CO 2 ] result in alterations in transcript and metabolite profiles associated with environmental response, secondary metabolism and stomatal function. These metabolic responses are consistent with greater growth and leaf area production under elevated temperature and [CO 2 ]. These results show that tropical C 4 grasslands may have unpredicted responses to global climate change, and that warming during a cool growing season enhances growth and alleviates stress.

This study investigated geographic variation in potentially preventable medical outcomes that might be used to monitor access to high-quality medical care in the behavioral health population. Analyzing public and non-public data sources from California on adults admitted between 2009 and 2011 to all non-federal licensed medical inpatient (N = 6,603,146) or emergency department units (N = 21,011,958) revealed that 33.6% of nearly 1 million potentially preventable hospitalizations and 9.8% of 1.5 million potentially preventable emergency department visits were made by people with mental or substance use disorder diagnoses. Across California counties or county groups (N = 36), a higher preventable hospitalization rate in the behavioral health population was associated with higher poverty, higher primary care safety net utilization, and fewer mental health providers. Although further validation is required, rates of potentially preventable encounters, particularly hospitalizations, may be useful measures of access to high-quality care in the behavioral health population.

Background: Weight gain and other metabolic sequelae of antipsychotic medications can lead to medication non-adherence, reduced quality of life, increased costs, and premature mortality. Of the approaches to address this, behavioral interventions are less invasive, cost less, and can result in sustained long-term benefits., Objective: We investigated behavioral weight management interventions for veterans with mental illness across four medical centers within the Veterans Affairs (VA) Healthcare System., Design: We conducted a 12-month, multi-site extension of our previous randomized, controlled study, comparing treatment and control groups., Participants: Veterans (and some non-veteran women) diagnosed with mental illness, overweight (defined as having a BMI over 25), and required ongoing antipsychotic therapy., Interventions: One group received "Lifestyle Balance" (LB; modified from the Diabetes Prevention Program) consisting of classes and individual nutritional counseling with a dietitian. A second group received less intensive "Usual Care" (UC) consisting of weight monitoring and provision of self-help., Main Measures: Participants completed anthropometric and nutrition assessments weekly for 8 weeks, then monthly. Psychiatric, behavioral, and physical assessments were conducted at baseline and months 2, 6, and 12. Metabolic and lipid laboratory tests were performed quarterly., Key Results: Participants in both groups lost weight. LB participants had a greater decrease in average waist circumference [F(1,1244) = 11.9, p < 0.001] and percent body fat [F(1,1121) = 4.3, p = 0.038]. Controlling for gender yielded statistically significant changes between groups in BMI [F(1,1246) = 13.9, p < 0.001]. Waist circumference and percent body fat decreased for LB women [F(1,1243) = 22.5, p < 0.001 and F(1,1221) = 4.8, p = 0.029, respectively]. The majority of LB participants kept food and activity journals (92%), and average daily calorie intake decreased from 2055 to 1650 during the study (p < 0.001)., Conclusions: Behavioral interventions specifically designed for individuals with mental illness can be effective for weight loss and improve dietary behaviors. "Lifestyle Balance" integrates well with VA healthcare's patient-centered "Whole Health" approach. ClinicalTrials.gov identifier NCT01052714.

The persistence of attention-deficit/hyperactivity disorder (ADHD) into adulthood, particularly in women, is an unresolved question. Using a diverse, prospectively followed female sample (ADHD: n = 140; comparison: n = 88), we examined (a) informant (parent- vs. self-report) and (b) symptom threshold (DSM-IV cutoffs vs. a developmentally referenced criterion [DRC]) with respect to estimates of ADHD persistence into young adulthood (M = 19.6 years). We also ascertained the linkages of ADHD status (as measured by each informant and via the different symptom cutoffs) with impairment in key outcome domains. Informant diagnostic concordance was significant but small (κ = 0.22). Via parent report, more childhood-ascertained probands (44 %) than comparison participants (1 %) met full ADHD criteria in adulthood (p < 0.001, ϕ = 0.47); parallel results were found via self-report (22 % vs. 2 %; p < 0.001, ϕ = 0.28). As expected, DRC designations yielded higher persistence estimates than DSM cutoffs. With control of key covariates, parent-reported ADHD was independently associated with poor outcomes on eight of nine measures but self-reported ADHD was associated only with low math scores. Also, participants who met the DRC cutoff but not the higher DSM threshold showed similar impairment to DSM-diagnosed participants, far greater than that of participants who met neither cutoff. A lowered symptom threshold in adulthood compared to childhood appears justified.

Background: Electrocardiographic conduction abnormalities following transcatheter aortic valve replacement (TAVR) with the Edwards-Sapien valve (ESV) are not uncommon and may be transient. We sought to examine the clinical time-course of conduction abnormalities after TAVR with ESV and determine risk factors for persistent abnormalities., Methods: In this single-center prospective study, 116 consecutive patients underwent implantation of the ESV after approval by the Food and Drug Administration (FDA). Demographic, clinical, and intra-procedural variables were collected in a registry, including ECGs before, immediately after, and at discharge from hospital. Conduction abnormalities were analyzed including PR interval lengthening, QRS widening, left bundle branch block (LBBB), and high-grade AV block., Results: There were 92 patients included in the analysis. A total of 41 new conduction abnormalities were observed in 31 (34 %) patients: 7 new PR prolongation, 14 QRS widening, 14 new LBBB, and 5 high-grade AV block requiring permanent pacemaker. Of the 41 new CAs, 11 (27 %) were transient; of the transient abnormalities, 9 (82 %) resolved within 24 h of the index procedure. Chronic kidney disease was a risk factor for the development of a persistent abnormality and for need for PPM. Antegrade approach was associated with the development of persistent LBBB and persistent QRS widening., Conclusions: A significant proportion of conduction abnormalities after ESV implantation improved prior to discharge from the hospital, usually within 24 h. CKD is associated with persistence of abnormalities and with need for PPM. Antegrade approach increases risk for new intraventricular conduction delays, including LBBB.

Background: Patients with limited English proficiency (LEP) may be at risk for medical errors and worse health outcomes. Language concordance between patient and provider has been shown to improve health outcomes for Spanish-speaking patients. Nearly 40 % of Hispanics, a growing population in the United States, are categorized as having limited English proficiency. Many medical schools have incorporated a medical Spanish curriculum to prepare students for clinical encounters with LEP patients., Objective: To describe the current state of medical Spanish curricula at United States medical schools., Methods: The Latino Medical Student Association distributed an e-mail survey comprising 39 items to deans from each U.S. medical school from July 2012 through July 2014. This study was IRB-exempt., Results: Eighty-three percent (110/132) of the U.S. medical schools completed the survey. Sixty-six percent (73/110) of these schools reported offering a medical Spanish curriculum. In addition, of schools with no curriculum, 32 % (12/37) planned to incorporate the curriculum within the next two years. Most existing curricula were elective, not eligible for course credit, and taught by faculty or students. Teaching modalities included didactic instruction, role play, and immersion activities. Schools with the curriculum reported that the diverse patient populations in their respective service areas and/or student interest drove course development. Barriers to implementing the curriculum included lack of time in students' schedules, overly heterogeneous student language skill levels, and a lack of financial resources. Few schools reported the use of validated instruments to measure language proficiency after completion of the curriculum., Conclusions: Growing LEP patient populations and medical student interest have driven the implementation of medical Spanish curricula at U.S. medical schools, and more schools have plans to incorporate this curriculum in the near future. Studies are needed to reveal best practices for developing and evaluating the curriculum.

Aiming to evaluate responses in terms of growth rates, physiological parameters, and degree of sensitivity to SO2 and SPMFe in Eugenia uniflora L. (Myrtaceae, a C3 species) and Clusia hilariana Schlecht (Clusiaceae, a CAM species); saplings were exposed to emissions from a pelletizing factory for 7 months. The species were distributed along a transect (200, 500, 800, 1400, and 1700 m away from the emission source), and analyses were performed after 71, 118, and 211 days of exposure to the pollutants. E. uniflora received higher superficial deposition of particulate iron. The highest total iron foliar contents were observed 200 m away from the emission source in both plant species, while the highest total sulfur foliar contents were observed 200 m away in C. hilariana and 800 m away in E. uniflora. E. uniflora presented decreased values of height growth rate, number of necrotic leaves, chlorophyll analysis (SPAD index) and transpiration, in relation to the distances from the emission source. C. hilariana showed decreased values of height growth rate, number of leaves, number of necrotic leaves, total ionic permeability, stomatal conductance, transpiration, net CO2 assimilation, and total dry matter, in relation to distances from the emission source. In relation to the days of exposure, both species presented increased number of necrotic leaves and foliar phytotoxicity index, and decreased values in the chlorophyll analysis. The two native plant species, both of which occur in the Brazilian Restinga, showed damage when exposed to emissions from an iron ore pelletizing factory. C. hilariana was considered the most sensitive species due to the decreased values in a higher number of variables after exposition.

IMPACT (Improving Mood--Promoting Access to Collaborative Treatment) has a large body of evidence demonstrating its effectiveness for treating late-life depression in clients enrolled in a clinical research study, but little is known about how well the collaborative care model translates into treatment provided in a public mental health setting. This evaluation examines the influence of clinical and demographic characteristics in 112 older adults treated for late-life depression through publicly funded IMPACT in a large San Francisco Bay Area county. Depression severity decreased for 85% of clients between enrollment and treatments' end and 46% of clients realized a 50% reduction in symptom severity. Depression severity at enrollment, number of treatment sessions attended, ethnicity, and gender reliably predicted depression severity at the end of treatment. Men, clients attending more therapy sessions, and clients without substance abuse diagnoses had an increased likelihood of realizing a 50% reduction in symptoms. Results highlight the success of this evidence-based treatment program offered through the public mental health system but suggest that the demographic and clinical characteristics of the population being treated must be considered when adopting evidence-based practices.

Background/Aims Desmoid tumors (DTs) are rare, locally invasive neoplasms that may affect 10-25% of familial adenomatous polyposis (FAP) patients. Our aim was to evaluate incidence and clinical presentation among our patients, the potential impact on FAP outcome and to discuss treatment. Materials and methods Charts from 133 FAP (1977-2013) were reviewed. Patients with DTs were separated to retrieve demographic, clinical and management data. Follow-up was focused on disease evolution causing complications or death. Results 19 (14.3%) DTs were diagnosed, either after previous trauma (16) or during FAP surgery (3). This group comprised 8 men (42.1%) and 11 women (57.9%) with an average age of 32.9 years. Intervals from surgical trauma to DTs ranged from 7 to 60 months. ECMs were detected in 12 (63.1%) patients. DTs were located in the abdominal wall (8), abdominal cavity (8), abdominal wall and cavity (2) and left arm (1). Five patients (26.3%) referred family history of DTs. Patients presented severe complications such as small bowel obstruction (4) and hydronephrosis (2), being directly responsible for death in three patients. Conclusions (1) DTs developed in 14.3% of FAP, mostly after surgical trauma; (2) 30% caused severe morbidity; (3) identification of clinical risk factors may help surgeons to develop screening and therapeutic decisions.

This study aimed to verify the capacity of Tradescantia pallida in the biomonitoring of air pollution in urban areas with different traffic intensities and under varying environmental conditions. Experiments were carried out in Ribeirão Preto, in the Southeastern Brazil, with more than 660,000 inhabitants and a fleet of more than 485,000 motor vehicles. Ten seedlings of T. pallida were exposed in three areas in the city, differing in traffic vehicle flow, in two seasons (wet and dry). At the end of each sampling period, which lasted 4 months, samples of leaves were collected, and the content of As, Ba, Ca, Cd, Cr, Cu, Fe, Hg, Mg, Mn, P, Pb, S, and Zn was determined by inductively coupled plasma mass spectroscopy (ICP-MS). The same elements were determined in soil samples for a seasonal characterization in conjunction with secondary data of environmental parameters. Additionally, micronucleus assay with early pollen tetrad cells of Tradescantia (Trad-MN) was conducted by collecting flower buds and analyzing the micronuclei frequencies in pollen mother cells. Although pollutant levels in air were below the Brazilian legal limits, plants exposed in the high-traffic flow area presented higher concentrations of elements related to vehicle emissions, especially under dry conditions, and higher micronuclei frequency in pollen mother cells. These results show the sensitivity of T. pallida to low-level urban air pollution and its suitability as bioindicator for trace elements. This alternative tool for biomonitoring can serve as a support methodology for the adoption of more restrictive public environmental policies in Brazil and extendible to other developing countries.

The DNA repair machinery plays a key role in maintaining genomic stability by preventing the emergence of mutations. Furthermore, the -93G>A polymorphism in the MLH1 gene has been associated with an increased risk of developing colorectal cancer. Therefore, the aim of this study was to examine the expression pattern and effect of this polymorphism in normal and tumour samples from patients with colorectal cancer. The MLH1 -93G>A (rs1800734) polymorphism was detected by PCR-RFLP in 49 cases of colorectal cancer. MLH1 expression was investigated using real-time quantitative PCR. The results indicate a significant decrease in MLH1 expression in tumour samples compared to their normal counterparts. The MLH1 gene was also significantly repressed in samples from patients who had some degree of tumour invasion into other organs. Similarly, those patients who were in a more advanced tumour stage (TNM III and IV) exhibited a significant reduction in MLH1 gene expression. Finally, the mutant genotype AA of MLH1 was associated with a significant decrease in the expression of this gene. This finding suggests that this polymorphism could increase the risk of developing colorectal cancer by a defective mismatch repair system, particularly through the loss of MLH1 expression in an allele-specific manner.

Patients with posttraumatic stress disorder (PTSD) can show declines in working memory. A dual-task design was used to determine whether these impairments are linked to executive control limitations. Participants performed a Sternberg memory task with either one or four letters. In the dual-task condition, the maintenance period was filled with an arrow flanker task. PTSD patients were less accurate on the working memory task than were controls, especially in the dual-task condition. In the single-task condition, both groups showed similar patterns of brain potentials from 300 to 500 ms when discriminating old and new probes. However, when taxed with an additional task, the event-related potentials (ERPs) of the PTSD group no longer differentiated old and new probes. In contrast, interference resolution processes in both the single- and dual-task conditions of the flanker task were intact. The lack of differentiation in the ERPs reflects impaired working memory performance under more difficult, dual-task conditions. Exacerbated difficulty in performing a working memory task with concurrent task demands suggests a specific limitation in executive control resources in PTSD.

Much research concerning attention has focused on changes in the perceptual qualities of objects while attentional states were varied. Here, we address a complementary question--namely, how perceived location can be altered by the distribution of sustained attention over the visual field. We also present a new way to assess the effects of distributing spatial attention across the visual field. We measured magnitude judgments relative to an aperture edge to test perceived location across a large range of eccentricities (30°), and manipulated spatial uncertainty in target locations to examine perceived location under three different distributions of spatial attention. Across three experiments, the results showed that changing the distribution of sustained attention significantly alters known foveal biases in peripheral localization.

"A hole is nothing at all, but it can break your neck." In a similar fashion to the danger illustrated by this folk paradox, concave regions pose difficulties to theories of visual shape perception. We can readily identify their shapes, but according to principles of how observers determine part boundaries, concavities in a planar surface should have very different figural shapes from the ones that we perceive. In three experiments, we tested the hypothesis that observers perceive local image features differently in simulated 3-D concave and convex regions but use them to arrive at similar shape percepts. Stimuli were shape-from-shading images containing regions that appeared either concave or convex in depth, depending on their orientation in the picture plane. The results show that concavities did not benefit from the same global object-based attention or holistic shape encoding as convexities and that the participants relied on separable spatial dimensions to judge figural shape in concavities. Concavities may exploit a secondary process for shape perception that allows regions composed of perceptually independent features to ultimately be perceived as gestalts.

To identify and evaluate socio-psychological factors that are associated with differences in substance abuse prevalence between non-acculturated and acculturated Florida youth, we employed t-test and logistic regression to analyze self-reported data from 63,000 middle and high school student participants in the 2004 Florida Youth Substance Abuse Survey. Questionnaire items covered socio-demographics, tobacco, alcohol, and illicit substance use; and perceptions and attitudes toward drug use. The outcome variables were past 30 day use of "any illicit drug." The key independent variable was language used at home (English/Another language). The covariates were 32 socio-psychological factors that are considered risk and protective factors for adolescent drug abuse. Findings support the growing body of evidence suggesting that acculturation status is a strong predictor of substance use among adolescents. This effect may be mediated principally through the family and peer/individual psychosocial domains. The findings may have important implications for the design and implementation of drug prevention programs targeting teenagers.

Background: The awkward visual and physical interface of video-endoscopic surgery (VES) has been shown to increase the physical workload of the surgeon, yet there is a lack of objective information on the mental effort and stress demanded by VES techniques. This study addresses the hypothesis that VES is more stressful than open surgery using an ergonomic analysis of surgical tasks in a laboratory setting., Methods: A portable ergonomic work station was developed using a software Virtual Instrument (VI) interfaced with electronic hardware to compare the mental workload of 28 surgeons. The task was knot tying. The independent variable was work condition: rest, open technique, or VES technique. Dependent variables were tonic skin conductance level (SCL), electrooculogram (EOG), and subjective reports of concentration (CON) and stress (STR). Statistical analysis used nonparametric methods., Results: Subjects tied fewer knots using the VES technique (p < 0.05). The SCL increased progressively from rest to the open task to the VES task (p < 0.05), correlating with the subjects' reported increase in mental stress level (p < 0.05). Eye blinks decreased from rest to the open task (p < 0.05), consistent with the subjects' reported increase in level of mental concentration. From the open to the VES task, eye blinks increased (p < 0.05), as would be expected given the greater demands of the VES task. Experienced subjects demonstrated less variability in SCL levels across tasks., Conclusions: VES technique requires greater concentration and places greater mental stress on surgeons than to open surgery. More experience with VES may decrease this effect. Studies are needed to improve the human-technology interface the stress.

Background: Laparoscopic surgery may be kinder to the patient, but it is more demanding on the surgeon. Fixed trocar positions often require the surgeon to work with instruments at awkward angles to their body. We studied the effect of horizontal and vertical laparoscopic instrument working angle on the surgeon's thumb, forearm, and shoulder muscle work., Methods: Electronyographic (EMG) signals were collected from the thenar compartment (TH), flexor digitorum superficialis (FDS), and deltoid (DEL) muscles of the dominant arm of eighth surgeons while they were closing a standard pistol-grip disposable laparoscopic grasper against a fixed resistance of 3 N. With the aid of a special testing bench, the instruments' position was randomly changed among 15 degrees, 45 degrees, and 75 degrees of horizontal angulation relative to the surgeons' sagital plane, and 15 degrees, 45 degrees, and 75 degrees degrees of vertical angulation relative to a horizontal plane. EMG signals were rectified and smoothed using analogue circuitry and digitally sampled at l0 Hz using a National Instruments DAQCard-700 connected to a Macintosh PowerBook 5300c running LabVIEW software. Statistical analysis was carried out by analysis of variance (ANOVA)., Results: The effects of vertical and horizontal working angles on the muscle effort were as follows: TH (horizontal, N.S.; vertical, N.S.), FDS (horizontal, p 45 degrees to the surgeon's sagital plane significantly increases the workload of the flexor digitorium superficialis and deltoid muscles. The deltoid muscle is also adversely affected by vertical angulation of the instrument. The instrument working angle has no effect on the thenar muscles. Whenever possible, laparoscopic surgeons should strive to place their instruments and trocars so as to minimize extreme horizontal or vertical displacement of their hands away from a resting position of comfort.

Background: The Society of American Gastrointestinal Endoscopic Surgeons (SAGES) Task Force on Ergonomics conducted a subjective and objective assessment of ergonomic problems associated with laparoscopic instrument use. The goal was to assess the prevalence, causes, and consequences of operational difficulties associated with the use of laparoscopic instruments., Methods: A questionnaire was distributed asking respondents to rate the frequency with which they experienced pain, stiffness, or numbness in several body areas after laparoscopic operations. An ergonomics station was assembled to quantify forearm and thumb muscle workload. Processed electromyogram (EMG) signals were acquired from 27 volunteer surgeon subjects while they completed simulated surgical tasks using a hemostat and an Ethicon laparoscopic grasper, with the aid of an endoscopic trainer and video monitoring system., Results: Of 149 surgeons responding to the questionnaire, 8% to 12% reported frequent pain in the neck and upper extremities associated with laparoscopic surgery. The ergonomics station demonstrated that the peak and total muscle effort of forearm and thumb muscles were significantly greater (p < 0.01) when the grasping task was performed using the laparoscopic instrument rather than the hemostat., Conclusion: These findings indicate that laparoscopic surgical technique is more taxing on the surgeon.

Background: Laparoscopic surgery has not been widely established in developing countries due to the lack of access to training and lack of money. We describe our experience using on-site training programs to efficiently teach and propagate laparoscopic surgery in Leon, Nicaragua; La Paz, Bolivia; and Santa Cruz, Bolivia., Methods: A group of well-trained and motivated local surgeons was identified in each country as the initial target for teaching. Participants were taught basic and advanced laparoscopic surgery during on-site didactics, animal laboratories, and proctoring sessions. Follow-up courses were held until the target group of surgeons was capable of independently teaching and supervising laparoscopic surgery among other surgeons in each country., Results: Multiple technical and logistic difficulties were encountered. In Leon, Nicaragua, and La Paz, Bolivia, a total of eight surgeons were fully trained and proctored in laparoscopic cholecystectomy. In La Paz and Santa Cruz, Bolivia, a total of seven surgeons were instructed in advanced laparoscopic procedures. To date, over 180 patients have undergone laparoscopic cholecystectomy or advanced procedures with a morbidity similar to that reported in literature series in the United States., Conclusions: Our experience demonstrates that in spite of numerous limitations, basic and laparoscopic surgery can be efficiently and safely taught in developing countries. Many lessons were learned in how to safely and efficiently use laparoscopic equipment and instruments within strict financial constraints.

An easily constructed, low-capacitive coupling volume coil based on the van Vaals-Bergman coaxial cable coil for high field imaging is described. The coil (designated "lambda coil") was constructed using two 5/4 length 50 omega coaxial cables matched to a 50 omega transmission line with LC bridge balun. The standing wave on the single 5/4 lambda length coaxial cable provides two points of current maxima in oppositional direction. Therefore, the four current elements necessary for effective B1 field generation can be obtained by two 5/4 lambda length coaxial cables arranged analogous to 1/2 lambda T-antenna. Capacitive coupling between the coil elements and conductive samples (i.e. animals) is minimized by simply retaining the shield of the coaxial cable for the area of voltage maxima. The lambda coil exhibited excellent performance as a volume coil with a high quality factor and highly homogeneous rf fields. Because of its dramatically simple architecture and excellent performance, the lambda coil configuration appears to be an economical alternative to the original van Vaals-Bergman design, especially for research facilities with a high field magnet and limited bore space.