Executive attentional resources in timing: Effects of inhibitory control and cognitive aging.

This research is based on an executive resource theory of timing, which postulates that time perception relies on specialized attentional resources that support executive cognitive functions. In 4 experiments, older and younger participants performed a timing task and an executive task emphasizing inhibitory control under both single-task and dual-task conditions. The timing task in each experiment was serial temporal production. The executive tasks, representing different types of inhibitory control, were the flanker task (Experiment 1), the number-letter task (Experiment 2), the go/no-go task (Experiment 3), and the antisaccade task (Experiment 4). The results showed (a) a pattern of bidirectional interference in each experiment, in that the concurrent inhibition tasks interfered with timing performance and concurrent timing interfered with inhibition performance, (b) the older participants demonstrated a stronger bidirectional interference effect relative to younger participants in 3 experiments, and (c) weaker versions of the inhibition tasks produced weaker interference effects. These findings support the idea that temporal processing relies on executive attentional resources.

Nutrition assessment and management in advanced liver disease.

Malnutrition commonly complicates the course of patients with cirrhosis and has a multifactorial etiology. Despite the important role that nutrition plays in the prognosis of those with cirrhosis, the nutrition assessment process can be challenging in this setting. A number of tools are available to aid in the nutrition assessment of the cirrhotic patient; however, none are without limitations. Although the assessment process can be difficult, the ability to properly manage the nutrient needs of the patient presents an additional set of challenges because of the catabolic nature of the disease process and common occurrence of anorexia and other symptoms leading to poor oral intake. In this review, the nutrition assessment tools and general guidelines for nutrition management in patients with advanced liver disease are discussed to promote recognition of the nutrition issues affecting this patient population and lead to their improved survival and reduced morbidity.

Lions Clubs International Foundation Core Four Photoscreening: results from 17 programs and 400,000 preschool children.

INTRODUCTION: Photoscreening programs for preschool vision screening have been promoted by Lions Clubs International Foundation (LCIF) via their 17 Core Four grant project awards since 1999. Results from 15 Core Four grant programs in the United States and one in Taiwan are presented here. METHODS: Photoscreening was modeled after the Tennessee program and instituted statewide in each area. Programs were given latitude with respect to screening instrument and referral criteria, but a partnering academic institution and medical director were expected. Preschool children were screened by volunteers; referred children were examined by community optometrists and ophthalmologists who returned results to each program's coordinating center. Outcome data included number of children screened, referral rate, follow-up rate, and positive predictive value, which was generally determined using AAPOS-defined vision screening criteria. RESULTS: All but one program used the MTI photoscreener (it chose not to participate); photoscreening referral criteria were standard for 13 programs. Through December 2004, more than 400,000 preschool children had been screened. The referral rate for programs using the MTI photoscreener averaged 5.2% (range, 3.7-12.6%). The predictive value of a positive photoscreen was 80%. Overall, 54% of referred children received follow-up examinations. Follow-up rate was the largest variable: 4 programs, screening nearly 250,000 children, had follow-up rates 70% or greater; 10 programs had follow-up data from fewer than 40% of referred children. CONCLUSIONS: Volunteer-led photoscreening programs can be instituted in other locations, including overseas, with high levels of effectiveness. Limitations include the possibility of poor success and variable attention to follow-up.

Sensitivity of photoscreening to detect high-magnitude amblyogenic factors.

PURPOSE: To determine the sensitivity of a unique pupil-size based set of referral criteria of the MTI PhotoScreener(Medical Technology and Innovations, Inc, Cedar Falls, Iowa) to detect high magnitude refractive error. METHODS: The photoscreening photographs of 949 preschool children previously analyzed were reevaluated with the new referral criteria. The original photographs had been obtained from pediatricians' offices and public health and Women, Infants, and Children's (WIC) clinics. The results of this analysis were compared with the gold standard clinical examination and cycloplegic refraction. Sensitivities were calculated for amblyogenic factors based on the magnitude of the refractive error. RESULTS: For 26 patients with anisometropia, the sensitivity to detect anisometropia increased from 46% for +1.25 or greater spherical interocular difference to 100% for +2.50 spherical intraocular difference. For 36 patients with hypermetropia in at least 1 meridian ranging from +3.75 to +7.50 D, sensitivity increased from 53% to detect +3.75 D or greater to 70% for +5.00 D or greater. The sensitivity to detect hypermetropia of +5.75 D or greater was 100%. These criteria detected 82% of patients with astigmatism greater than or equal to +3.00 D, and 100% of patients with astigmatism greater than +3.50 D. CONCLUSION: It is crucial that screening programs avoid over-referrals caused by high false-positive screening rates. The sensitivity of our new criteria increases with higher magnitude refractive error; patients with moderate and severe amblyogenic factors are almost never missed. While the sensitivity to detect lower magnitude refractive error is poor, the amblyogenic impact of such errors remains to be determined.