COVID-19 vaccination in pregnancy: A quantitative and qualitative analysis of the effect of strong public health messaging in an Australian cohort.

BACKGROUND: SARS-CoV-2 infection in pregnancy predisposes women and their offspring to adverse health outcomes, while internationally reported rates of vaccination uptake remain low. Our study objective was to quantify the uptake of COVID-19 vaccination in pregnant women, and to assess their attitudes toward vaccination in pregnancy with both quantitative and qualitative analyses. MATERIALS AND METHODS: This is a prospective, cross-sectional survey at Australia's largest quaternary level maternity centre. A total of 351 pregnant women, at 6-42 weeks gestation receiving antenatal care at our hospital, completed an online voluntary, anonymous, 17 question survey. This was conducted during a five-week period in November to December 2021. The main outcome measures were demographic data, prior SARS-CoV-2 infection and COVID-19 vaccination status, knowledge and attitudes surrounding COVID-19 disease and vaccination in pregnancy. RESULTS: High rates of COVID-19 vaccination were observed in this pregnant population. Of the 351 respondents, 82% had received at least one dose of the COVID 19-vaccination. This increased compared to estimates of 15% in June 2021 which were obtained from the hospital's electronic health record. CONCLUSIONS: Our survey demonstrates that a strong public health campaign with clear messaging regarding the beneficial effects of COVID-19 vaccination in pregnancy can lead to high vaccination uptake rates.

Proton pump inhibitor use and the risk of peritoneal dialysis associated peritonitis.

BACKGROUND: The use of proton-pump inhibitors (PPI) has been associated with an increased risk of developing spontaneous bacterial peritonitis in patients with cirrhosis. Whether PPI use confers a similar risk in developing peritonitis in peritoneal dialysis (PD) patients remains unclear. AIM: To assess whether PPI use is associated with an increased risk of PD peritonitis. METHODS: Patients on PD were retrospectively identified. Data such as PPI use during PD, underlying diagnoses, comorbidities, and baseline serum tests were collected. Univariable and multivariable analysis was conducted using logistic regression to assess whether PPI use and other factors were associated with PD peritonitis. RESULTS: Fifty-seven patients were identified with a median (interquartile range (IQR)) age of 65.0 (51.5-74.0) years. The median (IQR) time on PD was 29.0 (17.5-45.0) months. Twenty-eight patients were on a PPI during PD. Fifty-seven percent of the PPI group went on to develop peritonitis, compared with 31% of patients without PPI exposure (odds ratio (OR) = 2.96; 95% confidence interval (CI): 1.00, 8.78; P = 0.050). Months on PD (OR = 1.03; 95% CI: 1.00, 1.06; P = 0.026), serum urea (OR = 0.88; 95% CI: 0.80, 0.97; P = 0.017), congestive cardiac failure (OR = 5.44; 95% CI: 1.29, 23.00; P = 0.021) and renovascular disease (OR = 14.59; 95% CI: 1.68, 126.67; P = 0.015) were identified as possible risk factors for peritonitis on univariable analysis. Following adjustment for covariates, serum urea, but not PPI use, was associated with PD peritonitis (OR = 0.87; 95% CI: 0.78, 0.98; P = 0.020). CONCLUSION: PPI use during PD was not associated with peritonitis. Due to the small number of patients and the limited number of studies investigating the effect of PPI use on PD peritonitis, further research is needed.

Investigating the Usability of a Head-Mounted Display Augmented Reality Device in Elementary School Children.

Augmenting reality via head-mounted displays (HMD-AR) is an emerging technology in education. The interactivity provided by HMD-AR devices is particularly promising for learning, but presents a challenge to human activity recognition, especially with children. Recent technological advances regarding speech and gesture recognition concerning Microsoft's HoloLens 2 may address this prevailing issue. In a within-subjects study with 47 elementary school children (2nd to 6th grade), we examined the usability of the HoloLens 2 using a standardized tutorial on multimodal interaction in AR. The overall system usability was rated "good". However, several behavioral metrics indicated that specific interaction modes differed in their efficiency. The results are of major importance for the development of learning applications in HMD-AR as they partially deviate from previous findings. In particular, the well-functioning recognition of children's voice commands that we observed represents a novelty. Furthermore, we found different interaction preferences in HMD-AR among the children. We also found the use of HMD-AR to have a positive effect on children's activity-related achievement emotions. Overall, our findings can serve as a basis for determining general requirements, possibilities, and limitations of the implementation of educational HMD-AR environments in elementary school classrooms.

Atrio-esophageal Fistula Secondary to Atrial Fibrillation Ablation: A Case Report.

BACKGROUND: An atrio-esophageal fistula is an exceedingly rare but devastating complication of atrial fibrillation (AF) ablation procedures. Delays to diagnosis and definitive treatment herald a poor prognosis, with the development of catastrophic neurological injury or death secondary to cerebral air emboli. A high level of suspicion is essential to improve recognition of this rare but devastating condition. CASE REPORT: A 59-year-old man presented to the emergency department with an acute stroke and reduced consciousness. This presentation was preceded by an uncomplicated AF ablation 19 days prior and a subsequent emergency department attendance within a few days of his procedure, where he had presented with a history of new chest pain and reflux symptoms. Imaging revealed intra-cranial and intra-cardiac air, which was attributed to an uncontrolled atrio-esophageal fistula. Treatment options were limited by the patient's clinical instability and the patient was eventually palliated after developing catastrophic brain injury due to extensive cerebral air emboli. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Patients typically first present to the emergency department with new symptoms of either gastroesophageal reflux or chest pain, therefore, early recognition by emergency physicians is vital. Characteristic symptoms alongside a recent history of a cardiac ablation procedure should prompt additional diagnostic imaging to look for evidence of an atrio-esophageal fistula.

Studying Gaze Behavior to Compare Three Different Hazard Perception Tasks.

OBJECTIVE: The aim of the current study was to compare the traditional, verbal, and motoric tasks regarding their contributions to hazard perception measurement. BACKGROUND: Traditional hazard perception tasks require the participants to respond to filmed traffic conflicts in an imprecise way, such as by pressing a button. More sophisticated tasks include either verbal specification or motoric localization of the perceived hazards. The present study investigated the participants' gaze behavior when they were provided with an identical set of traffic animations but were instructed to perform one of three types of hazard perception tasks. METHOD: In an eye tracking study, 69 drivers were shown animated traffic scenarios and instructed to perform the traditional (press button), verbal, or speeded motoric localization hazard perception task. Eye tracking revealed whether and when the participant had fixated a certain hazard cue. RESULTS: The participants in the traditional task group were slower to fixate emerging hazards, but quicker to respond to them than the participants of the verbal and the motoric groups. As a specific benefit, the verbal task differentiated between different types of failures. CONCLUSION: Additional verbal or speeded motoric localization tasks seem to have increased the participants' alertness when watching the animations. The verbal task provides valuable additional information regarding the participants' performance. To approximate real-life hazard perception ability, it is recommended that researchers and practitioners use a combination of different hazard perception tasks for assessment and training.

Perceived discrimination and markers of cardiovascular risk among low-income African American youth.

OBJECTIVES: Our study examines the relationship between perceived discrimination and levels of C-reactive protein and blood pressure in low-income youth ages 10-15 years old. METHODS: Data were collected from 10 to 15 year old focal children and their mothers. Face-to-face interviews were implemented to collect data on stressors including experiences of everyday discrimination from youth. High sensitivity CRP in dried blood spot samples and diastolic and systolic blood pressure were also collected at the time of the interview. RESULTS: Perceived discrimination among youth was significantly associated with higher levels of CRP, systolic, and diastolic blood pressure. CRP, systolic, and diastolic blood pressure remained significant after controlling for age-adjusted BMI, waist circumference, and other factors. CONCLUSIONS: Discrimination is a salient risk factor for inflammation and cardiovascular health. Early life course inflammation and cardiovascular reactivity are important candidate pathways through which the repeated exposure to discrimination for minority group members contributes to racial and economic health inequities in adulthood.

Performance of artificial intelligence in bariatric surgery: comparative analysis of ChatGPT-4, Bing, and Bard in the American Society for Metabolic and Bariatric Surgery textbook of bariatric surgery questions.

BACKGROUND: The American Society for Metabolic and Bariatric Surgery (ASMBS) textbook serves as a comprehensive resource for bariatric surgery, covering recent advancements and clinical questions. Testing artificial intelligence (AI) engines using this authoritative source ensures accurate and up-to-date information and provides insight in its potential implications for surgical education and training. OBJECTIVES: To determine the quality and to compare different large language models' (LLMs) ability to respond to textbook questions relating to bariatric surgery. SETTING: Remote. METHODS: Prompts to be entered into the LLMs were multiple-choice questions found in "The ASMBS Textbook of Bariatric Surgery, second Edition. The prompts were queried into 3 LLMs: OpenAI's ChatGPT-4, Microsoft's Bing, and Google's Bard. The generated responses were assessed based on overall accuracy, the number of correct answers according to subject matter, and the number of correct answers based on question type. Statistical analysis was performed to determine the number of responses per LLMs per category that were correct. RESULTS: Two hundred questions were used to query the AI models. There was an overall significant difference in the accuracy of answers, with an accuracy of 83.0% for ChatGPT-4, followed by Bard (76.0%) and Bing (65.0%). Subgroup analysis revealed a significant difference between the models' performance in question categories, with ChatGPT-4's demonstrating the highest proportion of correct answers in questions related to treatment and surgical procedures (83.1%) and complications (91.7%). There was also a significant difference between the performance in different question types, with ChatGPT-4 showing superior performance in inclusionary questions. Bard and Bing were unable to answer certain questions whereas ChatGPT-4 left no questions unanswered. CONCLUSIONS: LLMs, particularly ChatGPT-4, demonstrated promising accuracy when answering clinical questions related to bariatric surgery. Continued AI advancements and research is required to elucidate the potential applications of LLMs in training and education.

Harnessing artificial intelligence in bariatric surgery: comparative analysis of ChatGPT-4, Bing, and Bard in generating clinician-level bariatric surgery recommendations.

BACKGROUND: The formulation of clinical recommendations pertaining to bariatric surgery is essential in guiding healthcare professionals. However, the extensive and continuously evolving body of literature in bariatric surgery presents considerable challenge for staying abreast of latest developments and efficient information acquisition. Artificial intelligence (AI) has the potential to streamline access to the salient points of clinical recommendations in bariatric surgery. OBJECTIVES: The study aims to appraise the quality and readability of AI-chat-generated answers to frequently asked clinical inquiries in the field of bariatric and metabolic surgery. SETTING: Remote. METHODS: Question prompts inputted into AI large language models (LLMs) and were created based on pre-existing clinical practice guidelines regarding bariatric and metabolic surgery. The prompts were queried into 3 LLMs: OpenAI ChatGPT-4, Microsoft Bing, and Google Bard. The responses from each LLM were entered into a spreadsheet for randomized and blinded duplicate review. Accredited bariatric surgeons in North America independently assessed appropriateness of each recommendation using a 5-point Likert scale. Scores of 4 and 5 were deemed appropriate, while scores of 1-3 indicated lack of appropriateness. A Flesch Reading Ease (FRE) score was calculated to assess the readability of responses generated by each LLMs. RESULTS: There was a significant difference between the 3 LLMs in their 5-point Likert scores, with mean values of 4.46 (SD .82), 3.89 (.80), and 3.11 (.72) for ChatGPT-4, Bard, and Bing (P < .001). There was a significant difference between the 3 LLMs in the proportion of appropriate answers, with ChatGPT-4 at 85.7%, Bard at 74.3%, and Bing at 25.7% (P < .001). The mean FRE scores for ChatGPT-4, Bard, and Bing, were 21.68 (SD 2.78), 42.89 (4.03), and 14.64 (5.09), respectively, with higher scores representing easier readability. CONCLUSIONS: LLM-based AI chat models can effectively generate appropriate responses to clinical questions related to bariatric surgery, though the performance of different models can vary greatly. Therefore, caution should be taken when interpreting clinical information provided by LLMs, and clinician oversight is necessary to ensure accuracy. Future investigation is warranted to explore how LLMs might enhance healthcare provision and clinical decision-making in bariatric surgery.

Digital ink and differentiated subjective ratings for cognitive load measurement in middle childhood.

BACKGROUND: New methods are constantly being developed to adapt cognitive load measurement to different contexts. However, research on middle childhood students' cognitive load measurement is rare. Research indicates that the three cognitive load dimensions (intrinsic, extraneous, and germane) can be measured well in adults and teenagers using differentiated subjective rating instruments. Moreover, digital ink recorded by smartpens could serve as an indicator for cognitive load in adults. AIMS: With the present research, we aimed at investigating the relation between subjective cognitive load ratings, velocity and pressure measures recorded with a smartpen, and performance in standardized sketching tasks in middle childhood students. SAMPLE: Thirty-six children (age 7-12) participated at the university's laboratory. METHODS: The children performed two standardized sketching tasks, each in two versions. The induced intrinsic cognitive load or the extraneous cognitive load was varied between the versions. Digital ink was recorded while the children drew with a smartpen on real paper and after each task, they were asked to report their perceived intrinsic and extraneous cognitive load using a newly developed 5-item scale. RESULTS: Results indicated that cognitive load ratings as well as velocity and pressure measures were substantially related to the induced cognitive load and to performance in both sketching tasks. However, cognitive load ratings and smartpen measures were not substantially related. CONCLUSIONS: Both subjective rating and digital ink hold potential for cognitive load and performance measurement. However, it is questionable whether they measure the exact same constructs.

The relation of representational competence and conceptual knowledge in female and male undergraduates.

Background: Representational competence is commonly considered a prerequisite for the acquisition of conceptual knowledge, yet little exploration has been undertaken into the relation between these two constructs. Using an assessment instrument of representational competence with vector fields that functions without confounding topical context, we examined its relation with N = 515 undergraduates' conceptual knowledge about electromagnetism. Results: Applying latent variable modeling, we found that students' representational competence and conceptual knowledge are related yet clearly distinguishable constructs (manifest correlation: r = .54; latent correlation: r = .71). The relation was weaker for female than for male students, which could not be explained by measurement differences between the two groups. There were several students with high representational competence and low conceptual knowledge, but only few students with low representational competence and high conceptual knowledge. Conclusions: These results support the assumption that representational competence is a prerequisite, yet insufficient condition for the acquisition of conceptual knowledge. We provide suggestions for supporting learners in building representational competence, and particularly female learners in utilizing their representational competence to build conceptual knowledge. Supplementary Information: The online version contains supplementary material available at 10.1186/s40594-023-00435-6.

Reviewing Accuracy of First Trimester Screening for Preeclampsia Using Maternal Factors and Biomarkers.

Preeclampsia is a common and important complication of pregnancy, one with potentially significant morbidity and even mortality to both mother and baby. Identifying those at high risk of developing the condition is helpful as there is evidence that the incidence of preeclampsia can be reduced with low dose aspirin taken in pregnancy. Accurately predicting the risk of preeclampsia allows for more targeted aspirin prophylaxis and a greater opportunity for early detection of maternal and/or fetal complications associated with impaired placentation through a schedule of enhanced antenatal surveillance. Traditional preeclampsia prediction models use maternal characteristics and risk factors and have been shown to be of low predictive value. Multiparametric screening tests combine patient characteristics with serum biomarkers and ultrasound Doppler indices and have been shown to be more effective at detecting those at high risk of preeclampsia - more specifically, early-onset preeclampsia (onset of preeclampsia <34 weeks' gestation). Multiparametric screening has now been validated in different populations. The true cost effectiveness of a multiparametric screening model for preeclampsia screening is not yet fully known and will vary depending on the clinical setting. Despite the growing body of evidence for its improved detection rates, first trimester preeclampsia screening using multiparametric models is not widely implemented and is not part of the recommendations for antenatal screening from most international bodies. The International Federation of Gynecology and Obstetrics has advised universal preeclampsia screening using maternal risk factors and biomarkers and has strongly encouraged its promotion worldwide. Various barriers to implementation must be considered such as the immediate cost of equipment and training, the need for audit and quality control, and the expected benefit to the population. Low to middle income settings may require a pragmatic approach to the implementation of multiparametric screening given limited resources.

Augmented Reality for Presenting Real-Time Data During Students' Laboratory Work: Comparing a Head-Mounted Display With a Separate Display.

Multimedia learning theories suggest presenting associated pieces of information in spatial and temporal contiguity. New technologies like Augmented Reality allow for realizing these principles in science laboratory courses by presenting virtual real-time information during hands-on experimentation. Spatial integration can be achieved by pinning virtual representations of measurement data to corresponding real components. In the present study, an Augmented Reality-based presentation format was realized via a head-mounted display and contrasted to a separate display, which provided a well-arranged data matrix in spatial distance to the real components and was therefore expected to result in a spatial split-attention effect. Two groups of engineering students (N = 107; Augmented Reality vs. separate display) performed six experiments exploring fundamental laws of electric circuits. Cognitive load and conceptual knowledge acquisition were assessed as main outcome variables. In contrast to our hypotheses and previous findings, the Augmented Reality group did not report lower extraneous load and the separate display group showed higher learning gains. The pre- and posttest assessing conceptual knowledge were monitored by eye tracking. Results indicate that the condition affected the visual relevancy of circuit diagrams to final problem completion. The unexpected reverse effects could be traced back to emphasizing coherence formation processes regarding multiple measurements.

Hazard Perception, Presence, and Simulation Sickness-A Comparison of Desktop and Head-Mounted Display for Driving Simulation.

Driving simulators are becoming increasingly common in driver training and assessment. Since virtual reality is generally regarded as an appropriate environment for measuring risk behavior, simulators are also used to assess hazard perception, which is considered to be one of the most important skills for safe driving. Simulators, which offer challenges that are indeed comparable to driving in real traffic, but at a very low risk of physical injury, have the potential to complement theoretical and practical driver trainings and tests. Although configurations and fidelity differ considerably between driving simulators, studies comparing the impact of their distinct features on driving performance and test validity remain rare. In this context, prior research demonstrated that a wider field of view (three monitors compared to a single monitor) led to earlier speed adjustments in response to potential hazards-especially for experienced drivers. The wider field of view was assumed to cause the drivers to be more present in the virtual world, which in turn provoked more natural scanning of the road and therefore, earlier hazard detection in experienced drivers. Research on spatial presence in other contexts support this assumption. The present experiment investigated whether this effect could be enhanced by an even more immersive presentation technique for driving simulation: a head-mounted display (HMD). Moreover, we studied the interplay between display mode, sense of presence and simulation sickness. Eighty experienced and less experienced drivers completed six simulation-based hazard perception scenarios, which were displayed either via a triple-monitor set-up or an HMD. Results indicate that the experienced drivers showed very similar driving and risk behavior as the inexperienced drivers in both experimental conditions. However, there were significant differences between the two display conditions. The use of an HMD resulted in a clearer and more abrupt speed reduction, more virtual presence, and a higher degree of simulation sickness. However, the interrelation between these three variables could not be conclusively clarified in the present study and thus represents a research aim that could be addressed in future studies.

Applying the transtheoretical model to exercise: a systematic and comprehensive review of the literature.

Three questions guided a literature review of the transtheoretical model (TTM) as applied to exercise to address the evidence for stage-matched interventions, the description of priority populations, and the identification of valid TTM measurement tools. One-hundredand-fifty studies were reviewed. Results indicate preliminary support for the use of stage-matched exercise interventions. Most studies have focused on White, middle-class, female populations, limiting the generalizability of their findings. Valid and reliable measures exist for stage of change, decisional balance, processes of change, self-efficacy, and temptations to not exercise; however, more research is needed to refine these measures. Evidence for the construct validity of the TTM as applied to exercise is mixed. When designing and implementing TTM-based exercise interventions, practitioners and policy makers are encouraged to clearly define the term exercise, choose a valid and reliable staging tool, and employ all TTM constructs and not just stage membership.

Assessment of driving expertise using multiple choice questions including static vs. animated presentation of driving scenarios.

Novice drivers have a high collision risk compared to more experienced drivers. The optimization of driving assessment's validity should lead to a better identification of those examinees that need further training before solo driving. The aim of the present two studies was to find out whether the integration of animated traffic scenarios can enhance some quality aspects of selected multiple choice items of the official German driving test. For the first study, we developed a static version of a set of multiple choice questions each containing a computerized still picture of a traffic scenario and a dynamic version that included animated instead of still pictures of the same situations. Driving novices (n=57) and experts (n=63) were presented 22 items either in the static or in the dynamic version. Only the novices benefited from the dynamic presentation. Fifty novices and 50 experts participated in a second longitudinal study including three measurements with parallel tests of the dynamic testing materials at intervals of three to four months. The novices, who were currently attending driving school, improved over time whereas the experts' performance remained stable. The results indicate that animation has positive effects on some quality aspects of driving assessment, but the problem of low criterion validity has to be addressed by the means of further approaches.

Emergency caesarean section: influences on the decision-to-delivery interval.

RCOG/NICE guidelines recommend that, for fetal compromise in labour, delivery should be accomplished ideally within 30 minutes. In this study, we investigated the factors which affect the decision-to-delivery (DD) intervals for emergency caesareans. To achieve this, prospective data were collected for all grade 1 and 2 caesareans performed on a busy labour ward over 12 months. We found that the ratio of labouring women to midwives had a significant effect on the DD intervals, which were significantly prolonged when 1 : 1 care was not provided (P < 0.001). The observed effect resulted exclusively from a prolonged transfer time to theatre. General anesthesia use shortened the DD interval for grade 1 caesareans (P < 0.001) and was more likely to be used during the day shift (P < 0.009). We conclude that midwifery staffing levels and the form of anaesthesia employed influence on DD intervals for the most urgent caesarean sections.

Infectious diseases in wild mice (Mus musculus) collected on and around the University of Pennsylvania (Philadelphia) Campus.

Laboratory mice serve as important models in biomedical research. Monitoring these animals for infections and infestations and excluding causative agents requires extensive resources. Despite advancements in detection and exclusion over the last several years, these activities remain challenging for many institutions. The infections and infestations present in laboratory mouse colonies are well documented, but their mode of introduction is not always known. One possibility is that wild rodents living near vivaria somehow transmit infections to and between the colonies. This study was undertaken to determine what infectious agents the wild mice on the University of Pennsylvania (Philadelphia) campus were carrying. Wild mice were trapped and evaluated for parasites, viruses, and selected bacteria by using histopathology, serology, and PCR-based assays. Results were compared with known infectious agents historically circulating in the vivaria housing mice on campus and were generally different. Although the ectoparasitic burdens found on the 2 populations were similar, the wild mice had a much lower incidence of endoparasites (most notably pinworms). The seroprevalence of some viral infections was also different, with a low prevalence of mouse hepatitis virus among wild mice. Wild mice had a high prevalence of murine cytomegalovirus, an agent now thought to be confined to wild mouse populations. Helicobacter DNA was amplified from more than 90% of the wild mice (59% positive for H. hepaticus). Given the results of this study, we conclude that wild mice likely are not a source of infection for many of the agents that are detected in laboratory mouse colonies at the University of Pennsylvania.