Update on the management of first episode primary spontaneous pneumothorax in an Australian hospital network.

International guidelines and recent research favour a less interventional approach to primary spontaneous pneumothorax (PSP). A retrospective clinical audit of 68 first-episode PSP was undertaken at a major tertiary teaching hospital network in Melbourne, Australia, found that most patients presenting with a moderate to large pneumothorax received initial intercostal catheter insertion (56%), though many (81%) would have met criteria for consideration of conservative management. The results suggest continued deviation from clinical guidelines in the management of PSP.

Are the advantages of chess expertise on visuo-spatial working-memory capacity domain specific or domain general?

Chess experts have repeatedly demonstrated exceptional recall of chessboards, which is weakened by disruption of the chessboard. However, chess experts still perform better than novices when recalling such disrupted chessboards, suggesting a somewhat generalized expertise effect. In the current study, we examined the extent of this generalized expertise effect on early processing of visuo-spatial working memory (VSWM), by comparing 14 chess experts (Elo rating > 2000) and 15 novices on a change-detection paradigm using disrupted chessboards, where attention had to be selectively deployed to either visual or spatial features, or divided across both features. The paradigm differed in the stimuli used (domain-specific chess pieces vs. novel visual shapes) to evaluate domain-general effects of chess expertise. Both experts and novices had greater memory discriminability for chess stimuli than for the unfamiliar stimuli, suggesting a salience advantage for familiar stimuli. Experts, however, demonstrated better memory discriminability than novices not only for chess stimuli presented on these disrupted chessboards, but also for novel, domain-general stimuli, particularly when detecting spatial changes. This expertise advantage was greater for chessboards with supra-capacity set sizes. For set sizes within the working-memory capacity, the expertise advantage was driven by enhanced selective attention to spatial features by chess experts when compared to visual features. However, any expertise-related VSWM advantage disappeared in the absence of the 8 × 8 chessboard display, which implicates the chessboard display as an essential perceptual aspect facilitating the "expert memory effect" in chess, albeit one that might generalize beyond strictly domain-relevant stimuli.

Raising the bar: improving methodological rigour in cognitive alcohol research.

BACKGROUND AND AIMS: A range of experimental paradigms claim to measure the cognitive processes underpinning alcohol use, suggesting that heightened attentional bias, greater approach tendencies and reduced cue-specific inhibitory control are important drivers of consumption. This paper identifies methodological shortcomings within this broad domain of research and exemplifies them in studies focused specifically on alcohol-related attentional bias. ARGUMENT AND ANALYSIS: We highlight five main methodological issues: (i) the use of inappropriately matched control stimuli; (ii) opacity of stimulus selection and validation procedures; (iii) a credence in noisy measures; (iv) a reliance on unreliable tasks; and (v) variability in design and analysis. This is evidenced through a review of alcohol-related attentional bias (64 empirical articles, 68 tasks), which reveals the following: only 53% of tasks use appropriately matched control stimuli; as few as 38% report their stimulus selection and 19% their validation procedures; less than 28% used indices capable of disambiguating attentional processes; 22% assess reliability; and under 2% of studies were pre-registered. CONCLUSIONS: Well-matched and validated experimental stimuli, the development of reliable cognitive tasks and explicit assessment of their psychometric properties, and careful consideration of behavioural indices and their analysis will improve the methodological rigour of cognitive alcohol research. Open science principles can facilitate replication and reproducibility in alcohol research.

Never forget a face: Verbalization facilitates recollection as evidenced by flexible responding to contrasting recognition memory tests.

Verbal facilitation occurs when describing a face improves its subsequent recognition; but there are several theoretical explanations debated in the literature. The results of the present studies support a relatively unrestricted, parsimonious theory that verbal facilitation occurs because describing a face supports recollection of several different facets of the face-viewing experience. This recollection is then demonstrated by flexibly responding to two competing types of recognition task demands. Participants studied a list of faces and, following each face, performed a nonverbalization task (Experiment 1) or described its features or traits (Experiment 2). Two subsequent recognition tests included intact faces, new faces, and conjunctions (each of which recombined features of two studied faces). Inclusion test instructions emphasized featural information: respond "yes" to both intact and conjunction faces (both of which contained studied features), but "no" to new faces. Exclusion test instructions emphasized configural information: respond "yes" only to intact faces (which were the only test items that matched studied configurations), and "no" to both conjunctions and new faces. Both yes/no responses and confidence ratings supported our hypothesis that verbalization improved discrimination between (a) conjunctions and new faces in the inclusion test, and (b) intact faces and conjunctions in the exclusion test. Additional secondary responses about face type elucidated that verbalization at study improves the ability to recollect either featural or configural information, depending on which type of response the recognition test required. We discuss these findings about practical applications of improved face memory in real-world contexts.

Holistic processing and unitization in face recognition memory.

Voluminous research supports holistic processing of faces. However, little is known about how holistic processing affects recognition of newly learned faces, a question of importance for improving performance in police lineups and other real-world tasks. Drawing on cognitive and neuropsychological research, we suggest that holistic processing facilitates the formation of unitized representations that support discrimination between old and new faces-including new faces that contain old parts-through a unidimensional familiarity signal. In the absence of holistic processing, face recognition is based on relational representations that are relatively difficult to encode, but which allow flexible recognition decisions based on match-mismatch detection to be made. Unlike unitized representations, relational representations can support judgments that newly encountered faces match previously experienced faces in some respects (e.g., some of their features) and yet not in others (e.g., other features, global configuration). Four experiments clarified the relationship of holistic processing to the formation of unitized and relational representations of faces. By manipulating the extent of holistic processing while controlling for the overall level of recognition performance, we demonstrate qualitative effects of holistic processing on how recognition decisions are made with faces. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Victorian Comprehensive Cancer Centre lung cancer clinical audit: collecting the UK National Lung Cancer Audit data from hospitals in Australia.

BACKGROUND: Clinical audit may improve practice in cancer service provision. The UK National Lung Cancer Audit (NLCA) collects data for all new cases of thoracic cancers. AIM: To collect similar data for our Victorian patients from six hospitals within the Victorian Comprehensive Cancer Centre and associated Western and Central Melbourne Integrated Cancer Service. METHODS: We conducted a retrospective audit of all newly diagnosed patients with lung cancer and mesothelioma in 2013 across the six Victorian Comprehensive Cancer Centre/Western and Central Melbourne Integrated Cancer Service hospitals. The objectives were to adapt the NLCA data set for use in the Australian context, to analyse the findings using descriptive statistics and to determine feasibility of implementing a routine, ongoing audit similar to that in the UK. Individual data items were adapted from the NLCA by an expert steering committee. Data were collated from the Victorian Cancer Registry, Victorian Admitted Episodes Dataset and individual hospital databases. Individual medical records were audited for missing data. RESULTS: Eight hundred and forty-five patients were diagnosed across the sites in 2013. Most were aged 65-80 (55%) and were male (62%). Most had non-small-cell lung cancer (81%) with 9% diagnosed with small cell lung cancer and 2% with mesothelioma. Data completeness varied significantly between fields. For those with higher levels of completeness, headline indicators of clinical care were comparable with NLCA data. The Victorian population seem to lack access to specialist lung cancer nurse services. CONCLUSION: Lung cancer care at participating hospitals appeared to be comparable with the UK in 2013. In future, prospective data collection should be harmonised across sites and correlated with survival outcomes. One area of concern was a lack of documented access to specialist nursing services.

Patients hospitalized with an infective exacerbation of bronchiectasis unrelated to cystic fibrosis: Clinical, physiological and sputum characteristics.

BACKGROUND AND OBJECTIVE: Bronchiectasis is a growing health burden both globally and in Australasia. Associated with repeated respiratory infections, the disease often results in hospital admission, impaired quality of life, reduced lung function and shortened life expectancy. We describe the local clinical, physiological and sputum characteristics in patients hospitalized with an infective exacerbation of bronchiectasis. METHODS: This study examined the medical records of all 61 adults admitted to a metropolitan Australian hospital with an infective exacerbation of bronchiectasis in a calendar year. RESULTS: Baseline characteristics include: mean (SD) age of participants was 66 (14) years; 56% were women and 42% were current or ex-smokers. The majority had other coexisting medical conditions, with asthma in 44%, COPD in 59% and both asthma and COPD in 31%. Seventy-two percent were on regular inhaled medication, 23% on cyclical antibiotics and 26% undertook regular respiratory physiotherapy. Bronchodilator reversibility was present in 17% and small airway reversibility in 41%. Sputum demonstrated normal flora in 17%, Pseudomonas aeruginosa in 32%, Haemophilus influenzae in 15% and both organisms in 17%. Mean numbers of exacerbations per year requiring hospitalization was 2.3. Sixty-two percent of subjects had an Index of Relative Socio-Economic Disadvantage in deciles 1-5. Risk factors for exacerbations included a history of asthma or COPD, documented small airway reversibility and presence of P. aeruginosa. CONCLUSION: Patients hospitalized with an infective exacerbation of bronchiectasis are predominantly older with co-morbidities and of lower socio-economic status. Presence of P. aeruginosa was a risk factor for repeated exacerbations, as was a history of asthma, COPD or small airway reversibility.

Memory and functional brain differences in a national sample of U.S. veterans with Gulf War Illness.

Roughly 26-32% of U. S. veterans who served in the 1991 Persian Gulf War report suffering from chronic health problems. Memory complaints are regularly reported by ill Gulf War veterans (GWV), but limited data verify their complaints. This study investigated episodic memory and brain function in a nationally representative sample of GWV, using a face-name memory task and functional magnetic resonance imaging during encoding. A syndrome classification system was used to subdivide ill GWV into the three major Gulf War Illness syndrome types, "impaired cognition" (GWV-1), "confusion ataxia" (GWV-2), and "central pain" (GWV-3). Memory and brain function of ill GWV were contrasted to deployed and nondeployed well GWV controls (GWV-C). Ill GWV exhibited impaired memory function relative to GWV-C but the patterns of functional brain differences varied. Brain activation differentiated the GWV-C from the ill GWV. The different syndrome types also differed from one another in several brain regions. Additionally, the current study was the first to observe differences in brain function between deployed and nondeployed GWV-C. These results provide (1) evidence of memory impairment in ill GWV and differentiate the syndrome types at a functional neurobiological level, and (2) the role of deployment in the war on brain function.

Implementation and first-year results of an antimicrobial stewardship program at a community hospital.

PURPOSE: The implementation of an antimicrobial stewardship program (ASP) at a small community hospital affiliated with an accountable care organization (ACO) is described, including a report on first-year program outcomes. SUMMARY: With no infectious diseases (ID)-trained pharmacists on staff, a 155-bed hospital formed an ASP by restructuring its clinical pharmacy services. One full-time pharmacist led the program; nine full- or part-time pharmacists-none of whom had residency training-shared ASP responsibilities on a weekly rotation. Under a contract with a private medical group, an ID physician reviewed cases with ASP pharmacists for up to two hours each weekday. ASP interventions and tracking and reporting of outcomes were done primarily by pharmacists. Monitoring of pharmacy purchases in the first year of the program indicated an annualized 26% decrease in overall antimicrobial expenditures from prior-year spending, with a nearly 18% decrease in defined daily doses per 1000 patient-days. Total first-year direct cost savings attributed to the ASP were estimated at $145,353. Pharmacist-initiated conversions of patients from i.v. to oral antimicrobial therapy increased by 688% (p < 0.0001). Overall, the rate of ID physician acceptance of ASP-recommended interventions (mainly streamlining of therapy, limiting the duration of therapy to a specific stop date, and discontinuation of nonindicated drugs) was 74%. CONCLUSION: An ASP was implemented at a small ACO-affiliated community hospital by a team of pharmacists without specialized ID training. During the first year of the program, antimicrobial expenditures were reduced and there was a significant increase in pharmacist-initiated i.v.-to-oral conversions.

Expertise and processing distorted structure in chess.

A classic finding in research on human expertise and knowledge is that of enhanced memory for stimuli in a domain of expertise as compared to either stimuli outside that domain, or within-domain stimuli that have been degraded or distorted in some way. However, we do not understand how experts process degradation or distortion of stimuli within the expert domain (e.g., a face with the eyes, nose, and mouth in the wrong positions, or a chessboard with pieces placed randomly). Focusing on the domain of chess, we present new fMRI evidence that when experts view such distorted/within-domain stimuli, they engage an active search for structure-a kind of exploratory chunking-that involves a component of a prefrontal-parietal network linked to consciousness, attention and working memory.

Memory impairment exhibited by veterans with Gulf War Illness.

Roughly 26-32% of US veterans, who served in the first Gulf War, report suffering from chronic health problems ( Golomb, 2008 , Proceedings of the National Academies of Science, 105, 4295). The present study investigated the memory deficits reported by these ill Gulf War veterans (GWV) using a face-name associative memory paradigm administered during functional magnetic resonance imaging (fMRI). The fMRI data confirmed memory performance on the memory task to be related to the amount of activation in the left hippocampus observed during the study. In addition, ill-GWV demonstrated decreased memory performance relative to unaffected GWV on this memory test, providing evidence of memory deficits using an objective measure of memory.

Effect of perceptual load on semantic access by speech in children.

PURPOSE: To examine whether semantic access by speech requires attention in children. METHOD: Children (N = 200) named pictures and ignored distractors on a cross-modal (distractors: auditory-no face) or multimodal (distractors: auditory-static face and audiovisual-dynamic face) picture word task. The cross-modal task had a low load, and the multimodal task had a high load (i.e., respectively naming pictures displayed on a blank screen vs. below the talker's face on his T-shirt). Semantic content of distractors was manipulated to be related vs. unrelated to the picture (e.g., picture "dog" with distractors "bear" vs. "cheese"). If irrelevant semantic content manipulation influences naming times on both tasks despite variations in loads, Lavie's (2005) perceptual load model proposes that semantic access is independent of capacity-limited attentional resources; if, however, irrelevant content influences naming only on the cross-modal task (low load), the perceptual load model proposes that semantic access is dependent on attentional resources exhausted by the higher load task. RESULTS: Irrelevant semantic content affected performance for both tasks in 6- to 9-year-olds but only on the cross-modal task in 4- to 5-year-olds. The addition of visual speech did not influence results on the multimodal task. CONCLUSION: Younger and older children differ in dependence on attentional resources for semantic access by speech.

Cognitive mechanisms of false facial recognition in older adults.

Older adults show elevated false alarm rates on recognition memory tests involving faces in comparison to younger adults. It has been proposed that this age-related increase in false facial recognition reflects a deficit in recollection and a corresponding increase in the use of familiarity when making memory decisions. To test this hypothesis, we examined the performance of 40 older adults and 40 younger adults on a face recognition memory paradigm involving three different types of lures with varying levels of familiarity. A robust age effect was found, with older adults demonstrating a markedly heightened false alarm rate in comparison to younger adults for "familiarized lures" that were exact repetitions of faces encountered earlier in the experiment, but outside the study list, and therefore required accurate recollection of contextual information to reject. By contrast, there were no age differences in false alarms to "conjunction lures" that recombined parts of study list faces, or to entirely new faces. Overall, the pattern of false recognition errors observed in older adults was consistent with excessive reliance on a familiarity-based response strategy. Specifically, in the absence of recollection older adults appeared to base their memory decisions on item familiarity, as evidenced by a linear increase in false alarm rates with increasing familiarity of the lures. These findings support the notion that automatic memory processes such as familiarity remain invariant with age, while more controlled memory processes such as recollection show age-related decline.

Chess masters show a hallmark of face processing with chess.

Face processing has several distinctive hallmarks that researchers have attributed either to face-specific mechanisms or to extensive experience distinguishing faces. Here, we examined the face-processing hallmark of selective attention failure--as indexed by the congruency effect in the composite paradigm--in a domain of extreme expertise: chess. Among 27 experts, we found that the congruency effect was equally strong with chessboards and faces. Further, comparing these experts with recreational players and novices, we observed a trade-off: Chess expertise was positively related to the congruency effect with chess yet negatively related to the congruency effect with faces. These and other findings reveal a case of expertise-dependent, facelike processing of objects of expertise and suggest that face and expert-chess recognition share common processes.

The neural organization of perception in chess experts.

The human visual system responds to expertise, and it has been suggested that regions that process faces also process other objects of expertise including chess boards by experts. We tested whether chess and face processing overlap in brain activity using fMRI. Chess experts and novices exhibited face selective areas, but these regions showed no selectivity to chess configurations relative to other stimuli. We next compared neural responses to chess and to scrambled chess displays to isolate areas relevant to expertise. Areas within the posterior cingulate, orbitofrontal cortex, and right temporal cortex were active in this comparison in experts over novices. We also compared chess and face responses within the posterior cingulate and found this area responsive to chess only in experts. These findings indicate that the configurations in chess are not strongly processed by face-selective regions that are selective for faces in individuals who have expertise in both domains. Further, the area most consistently involved in chess did not show overlap with faces. Overall, these results suggest that expert visual processing may be similar at the level of recognition, but need not show the same neural correlates.

Deliberate poisoning with dinitrophenol (DNP): an unlicensed weight loss pill.

A 46-year-old man took a lethal dose of an agent called dinitrophenol (DNP). He presented 11 h after ingestion with loin pain, diarrhoea and vomiting. He rapidly deteriorated with profound hyperthermia, acute renal failure, hyperkalaemia, metabolic acidosis and eventually haemodynamic instability. Despite aggressive supportive measures and rapid sequence induction, he deteriorated and died 21 h after ingestion. DNP is a metabolic poison that acts by uncoupling oxidative phosphorylation, leading to uncontrolled hyperthermia. It is an illegal weight loss agent that is used by body builders and is freely available on many internet websites. This case highlights the potential for patients to obtain and ingest exotic poisons. A summary of currently recommended treatment and a review of the literature on DNP is included, as well as a discussion of therapies that may be effective in treating hyperthermia in this situation.

Patients with coronary disease fail observation status at higher rates than patients without coronary disease.

BACKGROUND: Few studies have evaluated emergency department (ED) observation unit chest pain protocols for optimal patient characteristics and admission rates. At our 35 000-visits/y ED, we implemented a chest pain protocol for our observation unit that allowed emergency physicians to admit patients with known coronary artery disease (CAD). METHODS: We performed a retrospective chart review of all observation unit patients admitted under the chest pain protocol from April 1, 2006, to May 31, 2007. We compared the outcomes of patients who had a history of CAD with those who did not. RESULTS: Five hundred thirty-one patients were admitted to the observation unit under the chest pain protocol for the 14-month study period. Of these patients, 125 (23.5%) had a history of CAD. Patients with a history of CAD had a higher inpatient admission rate ( 24% vs 8.6%; P < .001), higher rate of a positive stress test or positive coronary computed tomographic scan (32.3% vs 6.9%; P < .001), a higher rate of cardiac catheterization (12% vs 5.9%; P = .02), and a higher rate of stent placement or coronary artery bypass graft (CABG) (7.2% vs 2.2%; P = .007). In multivariate analysis, patient history of CAD was an independent predictor of hospital admission (P = .005) and stent placement or CABG (P = .030). CONCLUSION: Patients with known CAD who were admitted to the ED observation unit failed observation status (ie, required hospitalization) and had higher rates of positive testing than those without CAD.