Effectiveness of submucosal turbinoplasty in refractory obstructive rhinitis: a prospective comparative trial.

OBJECTIVE: Refractory inferior turbinate hypertrophy requires a surgical approach to address symptomatic complaints. Submucosal approaches demonstrated their efficacy in restoring respiratory function and respecting the nasal mucosa. Microdebrider-assisted turbinoplasty (MAT) tools effectively reduces the soft tissue, exploiting a very different principle from the kinetic energy of radiofrequency. Thus, we aimed to compare the microdebrider-assisted turbinoplasty and the quantum molecular resonance (QMR) to assess patients' perspectives and respiratory outcomes. METHODS: Subjects with persistent bilateral nasal blockage due to inferior turbinates hypertrophy were prospectively recruited from the University Medical Center. We randomly assigned the patients to each treatment and performed symptom evaluation via the visual analog score and endoscopic assessment at baseline and 30-, 90-, and 180-day post-treatment. RESULTS: Seventy participants completed the evaluations, 35 in MAT and 35 in the QMR group. Nasal complaints were significantly reduced after 1 month using both methods. Although the MAT group reported higher postoperative bleeding and edema than QMR group, similar significant reductions were seen for turbinate size at long-term follow-up. Conversely, the MAT group reported greater VAS outcomes than QMR from the first postoperative month. In addition, MAT showed a longer operating time, although this difference was not statistically significant (p < 0.05). CONCLUSION: MAT allows effective control of nasal symptoms by reducing the size of turbinates in patients with lower turbinate hypertrophy. Although QMR may cause fewer postoperative complications, functional results are comparable to long-term follow-up.

Memory for positional movements as a component of the visuospatial working memory.

Though the Corsi block-tapping task (CBT) is widely used for assessing visuospatial memory, information about what exactly it measures is still debated. We investigated such issue by observing how motor, visual, and spatial secondary tasks affect the performance on three versions of the CBT. Results showed a double dissociation pattern, wherein two motor secondary tasks had larger effects when the CBT was administered by the examiner tapping on the blocks. A spatial secondary task had larger effects when the CBT was administered by automatically illuminating the blocks. Finally, a visual secondary task had larger effects on a two-dimensional, computerized version of the CBT. These findings suggest that memory for movements plays a relevant role in the CBT, and are especially relevant due to their implications for assessment of brain-damaged patients, besides providing further evidence of a fractionation of visuospatial memory into multiple subcomponents.

Energy and New Economic Approach for Nearly Zero Energy Hotels.

The paper addresses an important long-standing question in regards to the energy efficiency renovation of existing buildings, in this case hotels, towards nearly zero-energy (nZEBs) status. The renovation of existing hotels to achieve a nearly zero-energy (nZEBs) performance is one of the forefront goals of EU's energy policy for 2050. The achievement of nZEBs target for hotels is necessary not only to comply with changing regulations and legislations, but also to foster competitiveness to secure new funding. Indeed, the nZEB hotel status allows for the reduction of operating costs and the increase of energy security, meeting the market and guests' expectations. Actually, there is not a set national value of nZEBs for hotels to be attained, despite the fact that hotels are among the most energy-intensive buildings. This paper presents the case study of the energy retrofit of an existing historical hotel located in southern Italy (Syracuse) in order to achieve nZEBs status. Starting from the energy audit, the paper proposes a step-by-step approach to nZEBs performance, with a perspective on the costs, in order to identify the most effective energy solutions. Such an approach allows useful insights regarding energy and economic-financial strategies for achieving nZEBs standards to highlighted. Moreover, the results of this paper provide, to stakeholders, useful information for quantifying the technical convenience and economic profitability to reach an nZEBs target in order to prevent the expenses necessary by future energy retrofit programs.

New protocol for dissociating visuospatial working memory ability in reaching space and in navigational space.

Several studies have demonstrated that the processing of visuospatial memory for locations in reaching space and in navigational space is supported by independent systems, and that the coding of visuospatial information depends on the modality of the presentation (i.e., sequential or simultaneous). However, these lines of evidence and the most common neuropsychological tests used by clinicians to investigate visuospatial memory have several limitations (e.g., they are unable to analyze all the subcomponents of this function and are not directly comparable). Therefore, we developed a new battery of tests that is able to investigate these subcomponents. We recruited 71 healthy subjects who underwent sequential and simultaneous navigational tests by using an innovative sensorized platform, as well as comparable paper tests to evaluate the same components in reaching space (Exp. 1). Consistent with the literature, the principal-component method of analysis used in this study demonstrated the presence of distinct memory for sequences in different portions of space, but no distinction was found for simultaneous presentation, suggesting that different modalities of eye gaze exploration are used when subjects have to perform different types of tasks. For this purpose, an infrared Tobii Eye-Tracking X50 system was used in both spatial conditions (Exp. 2), showing that a clear effect of the presentation modality was due to the specific strategy used by subjects to explore the stimuli in space. Given these findings, the neuropsychological battery established in the present study allows us to show basic differences in the normal coding of stimuli, which can explain the specific visuospatial deficits found in various neurological conditions.

A Lack of Focus, Not Task Avoidance, Makes the Difference: Work Routines in Procrastinators and Non-Procrastinators.

Procrastination may be seen as the outcome of a learning history of delaying the onset of task execution and its completion, both in terms of time and effort. In this study, we examined the performance of 55 university students who carried out two writing tasks consisting of summarizing two academic papers, each within a different time slot (i.e., five vs. three days to complete). The two assignments were part of the class activity and were perceived by participants as homogeneous in terms of text appreciation and difficulty, therefore making the two conditions comparable. The Pure Procrastination Scale was used to categorize subjects as high and low procrastinators, and to compare their performances. Results show that students who report more procrastination behaviors tend to increase their productivity as the deadline approaches, while low procrastinators are more productive throughout the time at their disposal, with peak activity during the intermediate day. Such a strategy was consistent across two deadlines (five vs. three days), and the difference between the two subgroups can be ascribed to the task-oriented coping style, which seems to be lacking in high-procrastinators.

Rostering in Air Traffic Control: A Narrative Review.

Most Air Traffic Controllers (ATCOs) must cover uninterrupted work shifts for 24 h a day, seven days a week. The proper planning of a shift schedule requires consideration of at least three elements: the specific characteristics of the controller task, the physiological needs of the operator, and the definition of rest periods within rostering. We reviewed the literature for providing comprehensive guidance on the main requirements for the construction of a shift schedule for ATCOs. Our considerations are organized according to a rationale reflecting the most important criteria for the construction of the schedule: namely, the organization of rest periods conceptualized as intervals between cycles of shifts, intervals between individual shifts, and breaks within the shift. The suggested parameters could be used to construct shift schedules within a variation margin that depends on individual contexts of application.

High Definition Three-Dimensional Exoscope (VITOM 3D) in E.N.T. Surgery: A Systematic Review of Current Experience.

Over the last decade, technological growth has developed new devices for more precise surgery based on improved maneuverability, minimally invasive approaches, and magnification of the operating field. In this context, the exoscope has opened a new phase for more accurate and safer microsurgery, improving the perception of the volume of objects and the depth of structures for planning, targeting, and controlling fine movements. The exoscope could be used for middle ear, transcanal, transmastoid, and craniotomy procedures that require two-handed dissection, both to perform both totally VITOM-based techniques and coupled to traditional procedures with an operating microscope or endoscope. In addition, the VITOM 3D system allows the surgeon to work with high-definition images, which is essential in facial nerve surgery or submandibular salivary stone or tear surgery approaches, where magnification plays a fundamental role in surgical success and in reducing operating times. The 3D exoscope approach could also be included in traditional transoral procedures for oropharyngeal carcinoma. The exoscope may provide a relevant approach in teaching surgeons and nurses, allowing adequate training in non-oncological surgical procedures such as a tonsillectomy or lateral pharyngoplasty.

Obsessive-Compulsive Disorder in PANS/PANDAS in Children: In Search of a Qualified Treatment-A Systematic Review and Metanalysis.

BACKGROUND: Several treatment options have been proposed for pediatric acute-onset neuropsychiatric syndrome/pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANS/PANDAS). Still, no clear therapeutic protocol has been recognized to prevent these neuropsychiatric diseases. The study aims to report on the literature evidence and different treatment strategies related to these disorders. METHODS: We analyzed the last 20 years' English language literature and performed a comprehensive review of the PANS/PANDAS treatment, including studies reporting OCD outcomes post-treatment follow-up. RESULTS: We covered 11 articles in our systematic literature review for a total of 473 patients, of which four studies included 129 surgical subjects and seven papers with 326 medically treated patients. Pooled outcomes analysis, surgical and medical treatment reported an OCD reduction, but no statistical significance was obtained (p < 0.05 for both). CONCLUSIONS: Surgical therapy in selected patients can lead to promising results, although further evidence is needed. On the other hand, the role of medical therapy remains controversial, often due to the lack of univocal curative protocols and variable responses depending on the drug used and the timing of administration. Therefore, further investigations are necessary to clarify the most appropriate therapeutic procedure.

Endoscopic Endonasal Repair of Congenital Choanal Atresia: Predictive Factors of Surgical Stability and Healing Outcomes.

Background: To assess the long-term outcomes and independent predictors of surgical success of a one-stage minimally invasive surgical procedure for congenital choanal atresia (C.C.A.). Methods: a retrospective multicentric study was conducted between 2010 and 2022. An endonasal endoscopic approach was performed in 38 unilateral or bilateral C.C.A. children. All the patients were clinically and radiologically assessed and followed for at least 2 years. Seven outcome measures were applied. Consequently, surgical success was correlated with all the independent variables reported. Results: 18/38 (47.36%) patients presented normal postoperative healing, 8/38 (21.05) had moderate restenosis (<50%), while 12/38 (31.57%) cases were severe (>50%), requiring a surgical revision. No statistical significance was found for average hospital stay between stenosis >50% and <50% patients (p = 0.802) and postoperative pain (p = 0.075); instead, the severe restenosis group demonstrated a higher delay of breast suction (p < 0.001). Among the independent variables predictors of surgical success, the presence of Charge syndrome and rhinopharyngeal stenosis demonstrated higher risks for surgical revision (OR: 4.00, 95% CI: 0.57−28.01, and OR: 2.75, 95% CI: 0.55−13.69, respectively). On the contrary, the hypoplastic inferior turbinate and bilateral C.C.A. showed a lower risk for severe restenosis by a higher endoscopic surgical space and creating a single larger opening (OR: 0.88, 95% CI: 0.22−3.52, and OR: 0.45, 95% CI: 0.10−2.08). Conclusion: Several independent variables could influence the surgical success after C.C.A. endoscopic repair; however, more high-quality evidence is needed to generate an effective predictive model.

Sensitivity of the Spatial Distribution of Fixations to Variations in the Type of Task Demand and Its Relation to Visual Entropy.

Ocular activity is known to be sensitive to variations in mental workload, and recent studies have successfully related the distribution of eye fixations to the mental load. This study aimed to verify the effectiveness of the spatial distribution of fixations as a measure of mental workload and its sensitivity to different types of demands imposed by the task: mental, temporal, and physical. To test the research hypothesis, two experimental studies were run: Experiment 1 evaluated the sensitivity of an index of spatial distribution (Nearest Neighbor Index; NNI) to changes in workload. A sample of 30 participants participated in a within-subject design with different types of task demands (mental, temporal, physical) applied to Tetris game; Experiment 2 investigated the accuracy of the index through the analysis of 1-min epochs during the execution of a visual-spatial task (the "spot the differences" puzzle game). Additionally, NNI was compared to a better-known ocular mental workload index, the entropy rate. The data analysis showed a relation between the NNI and the different workload levels imposed by the tasks. In particular: Experiment 1 demonstrated that increased difficulty, due to higher temporal demand, led to a more dispersed pattern with respect to the baseline, whereas the mental demand led to a more grouped pattern of fixations with respect to the baseline; Experiment 2 indicated that the entropy rate and the NNI show a similar pattern over time, indicating high mental workload after the first minute of activity. That suggests that NNI highlights the greater presence of fixation groups and, accordingly, the entropy indicates a more regular and orderly scanpath. Both indices are sensitive to changes in workload and they seem to anticipate the drop in performance. However, the entropy rate is limited by the use of the areas of interest, making it impossible to apply it in dynamic contexts. Conversely, NNI works with the entire scanpath and it shows sensitivity to different types of task demands. These results confirm the NNI as a measure applicable to different contexts and its potential use as a trigger in adaptive systems implemented in high-risk settings, such as control rooms and transportation systems.

Quality of Life After Total LaryngectomyVoice-Related Quality of Life After Total Laryngectomy: Systematic Review and Meta-Analysis.

BACKGROUND: To compare voice rehabilitation-related quality of life among patients surgically treated for total laryngectomy and rehabilitated with esophageal (EV) and tracheoesophageal (TEV) voice. METHODS: A systematic literature review of articles from the past 20 years was conducted, and only full-text English articles comparing VTE and EV results in laryngectomized patients were included. RESULTS: We provided 15 articles for a total of 1085 laryngectomized patients undergoing voice rehabilitation, of which 869 (80.1%) were treated with voice prosthesis while 216 (19.9%) to esophageal speech. Pooled VHI outcomes showed a significantly better score for the TEV group than EV one (31.93±12.11 versus 35.39±20.6; P = 0.003), but no significant difference was recorded at VrQoL (8.27±5.98 versus 9.27±2.02; P = 0.19). CONCLUSION: TEV and EV are both effective procedures in voice rehabilitation after laryngectomy. Although TEV allows for significantly better speech performance, it does not necessarily correlate with a high VrQoL.

Switching between goals mediates the attentional blink effect.

Humans are fundamentally limited in processing information from the outside world. This is particularly evident in the attentional blink (AB), the impaired ability to identify the second of two targets presented in close succession. We report findings from three experiments showing that the AB is significantly reduced when observers are set to achieve one single goal (reporting combinations of the two targets) instead of separate goals (reporting the two targets). This finding raises questions about the nature of AB, and suggests that processes involved in goal-switching must be taken into account by theories of the AB phenomenon.

Procedural errors in air traffic control: effects of traffic density, expertise, and automation.

INTRODUCTION: Air traffic management requires operators to frequently shift between multiple tasks and/or goals with different levels of accomplishment. Procedural errors can occur when a controller accomplishes one of the tasks before the entire operation has been completed. The present study had two goals: first, to verify the occurrence of post-completion errors in air traffic control (ATC) tasks; and second, to assess effects on performance of medium term conflict detection (MTCD) tools. METHODS: There were 18 military controllers who performed a simulated ATC task with and without automation support (MTCD vs. manual) in high and low air traffic density conditions. During the task, which consisted of managing several simulated flights in an enroute ATC scenario, a trace suddenly disappeared "after" the operator took the aircraft in charge, "during" the management of the trace, or "before" the pilot's first contact. RESULTS: In the manual condition, only the fault type "during" was found to be significantly different from the other two. On the contrary, when in the MTCD condition, the fault type "after" generated significantly less errors than the fault type "before." Additionally, automation was found to affect performance of junior controllers, whereas seniors' performance was not affected. DISCUSSION: Procedural errors can happen in ATC, but automation can mitigate this effect. Lack of benefits for the "before" fault type may be due to the fact that operators extend their reliance to a part of the task that is unsupported by the automated system.

Spatial Pattern of Eye Fixations and Evidence of Ultradian Rhythms in Aircraft Pilots.

INTRODUCTION: Eye fixations can be distributed in three ways: randomly, in clusters, and regularly. However, there is always a continuum among these types, because these spatial patterns are the result of a process evolving over time. The focus of the present work was to study the changes over time observed in the Nearest Neighbor Index (NNI), an index derived from the spatial distribution of eye fixations that has been reported to be sensitive to variations in mental workload. Of particular interest are periodic changes in the ultradian timescale (an ultradian rhythm is a recurrent period or cycle repeated throughout a 24-h circadian day). METHODS: Data from a previously reported experiment were further analyzed using temporal spectral analysis, which is one of the most commonly used techniques for studying measurements collected at regularly spaced intervals of time. RESULTS: An ultradian rhythm with a periodicity between 2 and 15 min was found, which is compatible with results obtained by analyzing reaction times in prolonged vigilance tasks. DISCUSSION: The identification of a periodicity in the allocation of mental resources should be considered in the design of automation support that is dynamically matched to mental workload.

Automated fault-management in a simulated spaceflight micro-world.

BACKGROUND: As human spaceflight missions extend in duration and distance from Earth, a self-sufficient crew will bear far greater onboard responsibility and authority for mission success. This will increase the need for automated fault management (FM). Human factors issues in the use of such systems include maintenance of cognitive skill, situational awareness (SA), trust in automation, and workload. This study examine the human performance consequences of operator use of intelligent FM support in interaction with an autonomous, space-related, atmospheric control system. METHODS: An expert system representing a model-base reasoning agent supported operators at a low level of automation (LOA) by a computerized fault finding guide, at a medium LOA by an automated diagnosis and recovery advisory, and at a high LOA by automate diagnosis and recovery implementation, subject to operator approval or veto. Ten percent of the experimental trials involved complete failure of FM support. RESULTS: Benefits of automation were reflected in more accurate diagnoses, shorter fault identification time, and reduced subjective operator workload. Unexpectedly, fault identification times deteriorated more at the medium than at the high LOA during automation failure. Analyses of information sampling behavior showed that offloading operators from recovery implementation during reliable automation enabled operators at high LOA to engage in fault assessment activities CONCLUSIONS: The potential threat to SA imposed by high-level automation, in which decision advisories are automatically generated, need not inevitably be counteracted by choosing a lower LOA. Instead, freeing operator cognitive resources by automatic implementation of recover plans at a higher LOA can promote better fault comprehension, so long as the automation interface is designed to support efficient information sampling.

Shifting attention across near and far spaces: implications for the use of hands-free cell phones while driving.

In three experiments, participants performed two tasks concurrently during driving. In the peripheral detection task, they responded manually to visual stimuli delivered through a LED placed on the internal rear mirror; in the conversation task, they were engaged in a conversation with a passenger, or through earphone-operated, loudspeaker-operated, or hand-held cell phones. Results showed that drivers were slower at responding to the visual stimuli when conversing through a hand-held cell phone or an earphone-operated cell phone than when conversing through a loudspeaker-operated cell phone or with a passenger. These results suggest that due to the brain coding the space into multiple representations, devices that make phone conversations taking place in the near, personal space make drivers slower at responding to visual stimuli, compared to devices that make the conversation occurring in a far space.

ASTEF: a simple tool for examining fixations.

In human factors and ergonomics research, the analysis of eye movements has gained popularity as a method for obtaining information concerning the operator's cognitive strategies and for drawing inferences about the cognitive state of an individual. For example, recent studies have shown that the distribution of eye fixations is sensitive to variations in mental workload---dispersed when workload is high, and clustered when workload is low. Spatial statistics algorithms can be used to obtain information about the type of distribution and can be applied over fixations recorded during small epochs of time to assess online changes in the level of mental load experienced by the individuals. In order to ease the computation of the statistical index and to encourage research on the spatial properties of visual scanning, A Simple Tool for Examining Fixations has been developed. The software application implements functions for fixation visualization, management, and analysis, and includes a tool for fixation identification from raw gaze point data. Updated information can be obtained online at www.astef.info, where the installation package is freely downloadable.

Crossing the pillars of Hercules: the role of spatial frames of reference in error making.

This paper introduces a perspective accounting for errors that may occur as a result of the human interaction with the three-dimensional (3D) space. Particularly, we are interested in errors that are caused by cognitively crossing the boundary between peripersonal and extrapersonal space. Several behavioural, neurophysiological, and neuropsychological perspectives are reviewed in order to develop the theoretical framework on which our ideas are founded. We argue that cognitively crossing the boundary implies switching from one frame of reference to another, which, as a consequence, implies specific costs. The results of five experiments (overall involving 76 participants) support our hypothesis, suggesting the existence of different action-oriented spatial frames of reference.