Percepções de familiares sobre uma rede de cuidados de saúde mental infantojuvenil / Family perceptions about a children's mental health network / Percepciones familiares sobre una red de atención de salud mental infantojuvenil

Este artigo pretende conhecer como a rede de cuidados em saúde tem se operacionalizado a partir da percepção de familiares de crianças com demanda de cuidado em saúde mental (SM). Foram realizados dois grupos focais, um com familiares da Atenção Básica (AB) e outro com familiares do Centro de Atenção Psicossocial Infantojuvenil (CAPSij), totalizando 15 participantes. Seguiu-se com a análise lexical do tipo classificação hierárquica descendente, com o auxílio do software R Interface, a fim de análises multidimensionais de textos e questionários (IRaMuTeQ), resultando em cinco classes: A Pílula Mágica; Forças e Fraquezas dos serviços; Procurando por ajuda; Aceitando o diagnóstico da criança e Onde procurei ajuda. Os resultados apontam para dificuldades presentes na AB em identificar e manejar situações de Saúde Mental Infantojuvenil (SMIJ), por meio de uma lógica ainda medicalizante. Ressalta-se que a escola é apresentada como lugar de destaque na produção da demanda por cuidado e a família ainda é pouco convocada à construção das ações. Conclui-se, então, que avanços ainda são necessários para operacionalização de um cuidado pautado nas diretrizes da política de SMIJ.(AU)

This article aims to know how the healthcare network has been operationalized from the perception of family members of children with demand for mental health care (MH). Two focus groups were held, one with family members from Primary Care (PC) and the other with family members from the Child Psychosocial Care Center (CAPSij), totaling 15 participants. A lexical analysis of the descending hierarchical classification type was performed with the help of the software R Interface for multidimensional analyzes of texts and questionnaires (IRAMUTEQ), resulting in five classes: The Magic Pill; Strengths and Weaknesses of services; Looking for help; Accepting the child's diagnosis; and Where did I look for help. The results point to difficulties present in PC in identifying and managing situations of mental health in children and adolescents (MHCA), with a medicalization logic. Note that the school is presented as a prominent place in producing the demand for care, and the family is still not very much involved in the actions. It is, thus, concluded that advances are still needed for operationalization of care guided by MHCA policy guidelines.(AU)

Este artículo tuvo por objetivo conocer cómo opera una red asistencial a partir de la percepción de familiares de niños con demanda de atención en salud mental (SM). Se realizaron dos grupos focales, uno con familiares de Atención Primaria (AP) y otro con familiares del Centro de Atención Psicosocial Infantojuvenil (CAPSij), totalizando 15 participantes. Se realizó análisis léxico del tipo clasificación jerárquica descendente con la ayuda del software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRAMUTEQ), lo que resultó en cinco clases: "La píldora mágica"; "Fortalezas y debilidades de los servicios"; "En busca de ayuda"; "Aceptar el diagnóstico del niño" y "¿Dónde busqué ayuda?". Los resultados apuntan las dificultades presentes en AP para identificar y manejar situaciones de salud mental infantojuvenil (SMIJ) mediante una lógica aún medicalizante. La escuela tiene un lugar destacado en la producción de la demanda de cuidados y la familia aún no está muy involucrada en la construcción de acciones. Se concluye que se necesitan avances para ofertar una atención guiada por lineamientos de la política del SMIJ.(AU)

On the Extended Generalized Inverted Kumaraswamy Distribution.

In this work, we provide a new generated class of models, namely, the extended generalized inverted Kumaraswamy generated (EGIKw-G) family of distributions. Several structural properties (survival function (sf), hazard rate function (hrf), reverse hazard rate function (rhrf), quantile function (qf) and median, s th raw moment, generating function, mean deviation (md), etc.) are provided. The estimates for parameters of new G class are derived via maximum likelihood estimation (MLE) method. The special models of the proposed class are discussed, and particular attention is given to one special model, the extended generalized inverted Kumaraswamy Burr XII (EGIKw-Burr XII) model. Estimators are evaluated via a Monte Carlo simulation (MCS). The superiority of EGIKw-Burr XII model is proved using a lifetime data applications.

Two Immersive Virtual Reality Tasks for the Assessment of Spatial Orientation in Older Adults with and Without Cognitive Impairment: Concurrent Validity, Group Comparison, and Accuracy Results.

OBJECTIVE: Spatial disorientation is common in Alzheimer's disease (AD), Mild Cognitive Impairment (MCI), and preclinical individuals with AD biomarkers. However, traditional neuropsychological tests lack ecological validity for the assessment of spatial orientation and to date, there is still no gold standard. The current study aimed to determine the validity and accuracy of two virtual reality tasks for the assessment of spatial orientation. METHODS: We adapted two spatial orientation tasks to immersive virtual environments: a "survey to route" task in which participants had to transfer information from a map to their body position within a maze [Spatial Orientation in Immersive Virtual Environment Test (SOIVET) Maze], and an allocentric-type, route learning task, with well-established topographic landmarks (SOIVET Route). A total of 19 MCI patients and 29 cognitively healthy older adults aged 61-92 participated in this study. Regular neuropsychological assessments were used for correlation analysis and participant performances were compared between groups. Receiver Operating Characteristic (ROC) curve analysis was performed for accuracy. RESULTS: The SOIVET Maze correlated with measures of visuoperception, mental rotation, and planning, and was not related to age, educational level, or technology use profile. The SOIVET Route immediate correlated with measures of mental rotation, memory, and visuoconstruction, and was influenced only by education. Both tasks significantly differentiated MCI and control groups, and demonstrated moderate accuracy for the MCI diagnosis. CONCLUSION: Traditional neuropsychological assessment presents limitations and immersive environments allow for the reproduction of complex cognitive processes. The two immersive virtual reality tasks are valid tools for the assessment of spatial orientation and should be considered for cognitive assessments of older adults.

Does the risk of major customer need to be balanced? The role of customer concentration in corporate governance.

In the operation and management of the company, major customers may affect a supplier firm's level of governance. The goal of our study is investigating whether a major customer acts as an important role in corporate governance in emerging markets and exposing the mechanism that how major customers affect corporate decision-making. There is a growing body of literature involving studies about the effect of customer concentration on firm performance of western countries. Few studies have recognized to what degree does customer concentration satisfy the sustainable development of supplier firm. Using a sample of Chinese listed firms, we found a nonlinear relationship between customer concentration and risk-taking, corporate policies and firm performance. Evidence shows that the effect of customer concentration in China resembles an inverted U-shaped curve and major customers are crucial in financial and investment policies. Our results help to provide a broader perspective on the role of major customers, giving a deep explanation about the role of customer concentration in corporate governance.

Spatial orientation assessment in preschool children: Egocentric and allocentric frameworks.

Spatial orientation is an important function in daily life because it allows us to reach a target place when moving through our environment, using self-centered (egocentric) or environmental information (allocentric). Compared to other cognitive functions, spatial orientation has been studied less in preschool ages. Some brain areas, such as the hippocampus and the temporal as well as the parietal and frontal cortices, are involved in spatial orientation. Therefore, when these brain regions are altered in neurological conditions or in atypical development in children, we would expect impairment of spatial abilities. The aim of this study is to review studies, published in recent years, that use egocentric and allocentric spatial orientation tasks for assessing spatial memory in preschool children, with the final goal of finding out which tests could be included in a clinical neuropsychological evaluation. We observed that although egocentric spatial orientation emerges first during development, allocentric spatial orientation tasks are employed at very early ages. Most of these tasks are performed in real environments, allowing children's self-movements and using environmental modifications, but technologies such as virtual or augmented reality are increasingly used. Other aspects are discussed, such as the lack of consensus in the nomenclature, the difficulty of tracing the course of development of spatial orientation, or the ecological validity of the tests used. We finally observed that there is greater interest in studying the allocentric framework than the egocentric one, which makes it difficult to compare the use of the two frames of reference during a neuropsychological evaluation in preschool-aged children.

Do Carolina chickadees (Poecile carolinensis) and tufted titmice (Baeolophus bicolor) use predator eyes in risk assessment?

Previous studies have found that Carolina chickadees and tufted titmice use a predator's head orientation to determine risk, taking fewer seeds from a feeder if an avian predator model's head is facing the feeder while ignoring the head orientation. In addition to head orientation, eyes are a cue of predator risk. In the current study, I examined whether or not chickadees and titmice used the presence of eyes of a predator model to determine when to forage for food. Plastic owl models, with their eyes covered or uncovered, were presented to wild flocks of chickadees and titmice. To test whether or not chickadees and titmice would respond to the presence of eyes, the number of seeds taken and the calling behavior of birds were compared between the two types of predator presentations (eyes covered or uncovered). Chickadees and titmice took fewer seeds when the eyes were uncovered than when they were covered. Chickadees also gave significantly more introductory notes, often used in association with the presence of predators or risk, in their calls when the eyes were visible than when the eyes of the predator model were covered. The results indicate that chickadees and titmice can use the presence of eyes on predators to determine predation risk and possibly use eye gaze to determine where a predator is looking.

Verbal Reports Influence on Pilot Flight Performance and Mental Stress Under Spatial Disorientation.

BACKGROUND: Circumstances in flight can adversely affect a pilots spatial abilities and lead to spatial disorientation (SD), increasing the potential for fatal accidents. To systematically understand the impact of SD, it is important to quantitatively and qualitatively analyze pilots flight performance and mental stress, and to verify the effectiveness of verbal reports (VR) in enabling pilots to deal with an SD situation. This study investigated the effects of VR execution and type of SD on flight performance and mental stress.METHODS: SD simulation experiments were conducted on 30 Air Force fighter pilots (15 in the VR group and 15 in the non-VR group) with electrocardiography (ECG) sensors attached. The pilots gave their VRs by immediately verbalizing their attention to instrument information and six potentially disorientating scenarios were implemented in each flight phase. Flight performance was analyzed using instructor evaluation and self-evaluation scores, and mental stress was measured using heart rate variability (HRV) and perceived distress score.RESULTS: In maintaining flight performance, the VR group, respectively, had 8% and 10% higher scores for altitude and speed than the non-VR group. The self-evaluation scores were lowest for Coriolis, while Graveyard Spin was scored lowest in the instructor evaluations. Regarding mental stress, the VR group tended to have higher HFs and lower LF/HF ratios among HRV measures than the non-VR group, and an 11% lower perceived distress score. The highest perceived distress score was for Coriolis.DISCUSSION: We suggest that pilots can be assisted to understand and overcome SD situations through VR.Kang Y, Yun MH, Kim S. Verbal reports influence on pilot flight performance and mental stress under spatial disorientation. Aerosp Med Hum Perform. 2020; 91(12):948955.

Impairment of cyclopean surface processing by disparity-defined masking stimuli.

Binocular disparity signals allow for the estimation of three-dimensional shape, even in the absence of monocular depth cues. The perception of such disparity-defined form depends, however, on the linkage of multiple disparity measurements over space. Performance limitations in cyclopean tasks thus inform us about errors arising in disparity measurement and difficulties in the linkage of such measurements. We used a cyclopean orientation discrimination task to examine the perception of disparity-defined form. Participants were presented with random-dot sinusoidal modulations in depth and asked to report whether they were clockwise or counter-clockwise rotated. To assess the effect of different noise structures on measurement and linkage processes, task performance was measured in the presence of binocular, random-dot masks, structured as either antiphase depth sinusoids, or as random distributions of dots in depth. For a fixed number of surface dots, the ratio of mask-to-surface dots was varied to obtain thresholds for orientation discrimination. Antiphase masks were found to be more effective than random depth masks, requiring a lower mask-to-surface dot ratio to inhibit performance. For antiphase masks, performance improved with decreased cyclopean frequency, increased disparity amplitude, and/or an increase in the total number of stimulus dots. Although a cross-correlation model of disparity measurement could account for antiphase mask performance, random depth masking effects were consistent with limitations in relative disparity processing. This suggests that performance is noise-limited for antiphase masks and complexity-limited for random masks. We propose that use of differing mask types may prove effective in understanding these distinct forms of impairment.

Assessment of the musculoskeletal performance with squat tests and performance-oriented measurements in older adults.

BACKGROUND: Balance and mobility impairments, declined musculoskeletal strength and performance, limited range of motion, and poor flexibility are fairly common among older adults. OBJECTIVES: To determine the lower extremity muscle force and to verify the correlation with the gait characteristics and balance in community dwelling older adults. METHODS: Seventy-five adults with a mean age of 75.07 ± 6.28 years were included in the study. All participants were evaluated with the following tests: half squat (HS), decline squat (DS), foot print analysis (step length, step wide, stride length, walking velocity and cadence) and Tinetti Performance Oriented Mobility Assessment (POMA). RESULTS: HS and DS test scores were significantly correlated with Tinetti Balance and Gait Assessment scores and gait characteristics, except step wide (p< 0.01). The results of this study showed that the participants who have higher scores in the squat tests, showed higher scores in terms of POMA (p< 0.01). CONCLUSION: Appropriate and direct assessment of lower limb power and performance in balance and gait tests should be done to identify functioning of the older adults. Half and eccentric decline squat tests used in this study were useful, cheap and easy. The squat tests can be used to determine the relationship between balance and gait characteristics, in addition to predicting the musculoskeletal performance in older adults.

A bedside application-based assessment of spatial orientation and memory: approaches and lessons learned.

Spatial orientation and memory deficits are an often overlooked and potentially powerful early marker for pathological cognitive decline. Pen-and-paper tests for spatial abilities often do not coincide with actual navigational performance due to differences in spatial perspective and scale. Mobile devices are becoming increasingly useful in a clinical setting, for patient monitoring, clinical decision-making, and information management. The same devices have positional information that may be useful for a scale appropriate point-of-care test for spatial ability. We created a test for spatial orientation and memory based on pointing within a single room using the sensors in mobile phone. The test consisted of a baseline pointing condition to which all other conditions were compared, a spatial memory condition with eyes-closed, and two body rotation conditions (real or mental) where spatial updating were assessed. We examined the effectiveness of the sensors from a mobile phone for measuring pointing errors in these conditions in a sample of healthy young individuals. We found that the sensors reliably produced appropriate azimuth and elevation pointing angles for all of the 15 targets presented across multiple participants and days. Within-subject variability was below 6° elevation and 10° azimuth for the control condition. The pointing error and variability increased with task difficulty and correlated with self-report tests of spatial ability. The lessons learned from the first tests are discussed as well as the outlook of this application as a scientific and clinical bedside device. Finally, the next version of the application is introduced as an open source application for further development.

Texting while walking: An expensive switch cost.

Texting while walking has been highlighted as a dangerous behavior that leads to impaired judgment and accidents. This impairment could be due to task switching which involves activation of the present task and the inhibition of the previous task. However, the relative contributions of these processes and their brain activity have not yet been studied. We addressed this gap by asking participants to discriminate the orientation of an oncoming human shape in a virtual environment while they were: i) walking on a treadmill, or ii) texting while walking on a treadmill. Participants' performance (i.e., correctly identifying if a walker would pass them to their left or right) and electroencephalography (EEG) data was collected. Unsurprisingly, we found that participants performed better while they were only walking than when texting while walking. However, we also found that the diminished performance is differently related to task set inhibition and task set activation in the two conditions. The alpha oscillations, which can be used as an index of task inhibition, have a significantly different relation to performance in the two conditions, the relation being negative when subjects are texting. This may indicate that the more inhibition is needed, the more the performance is affected by texting. To our knowledge, this is the first study to investigate the brain signature of task switching in texting while walking. This finding is the first step in identifying the source of impaired judgment in texting pedestrians and in finding viable solutions to reduce the risks.

Hole superiority effect with 3D figures formed by binocular disparity.

The global-first theory of topological perception claims that topological perception is prior to the perception of local features (e.g., Chen, 1982, 2005). Our previous studies demonstrated a hole superiority effect (HSE): Figures with holes are more detectable than figures without holes. Such an HSE was shown with figures formed by either orientation-defined texture (Zhang, 2009) or a black-and-white contrast (Meng, Cui, Zhou, Chen, & Ma, 2012). The present study used binocular disparity as one more organizing factor for testing the abstract nature of the HSE, indicating holes, as a typical kind of topological invariance, are represented in vision independent of the features that were forming the holes. The disparity-forming figures were well controlled for luminance, spatial frequency, subjective contours, and other nontopological factors, which are commonly considered as counter explanations against the topological theory.

Hearing in Real-Life Environments (HERE): Structure and Reliability of a Questionnaire on Perceived Hearing for Older Adults.

OBJECTIVES: The ability to hear in a variety of social situations and environments is vital for social participation and a high quality of life. One way to assess hearing ability is by means of self-report questionnaire. For questionnaires to be useful, their measurement properties, based on careful validation, have to be known. Only recently has consensus been reached concerning how to perform such validation and been published as COSMIN (consensus-based standards for the selection of health status measurement instruments) guidelines. Here the authors use these guidelines to evaluate the measurement properties of the "Hearing in Real-Life Environments" (HERE) questionnaire, a newly developed self-report measure that assesses speech perception, spatial orientation, and the social-emotional consequences of hearing impairment in older adults. The aim is to illustrate the process of validation and encourage similar examinations of other frequently used questionnaires. DESIGN: The HERE questionnaire includes 15 items with a numeric rating scale from 0 to 10 for each item and allows the assessment of hearing with and without hearing aids. The evaluation was performed in two cohorts of community-dwelling older adults from Finland (n = 581, mean 82 years) and the United Kingdom (n = 50, mean 69 years). The internal structure of the questionnaire and its relationship to age, hearing level, and self-reported and behavioral measures of speech perception was assessed and, when possible, compared between cohorts. RESULTS: The results of the factor analysis showed that the HERE's internal structure was similar across cohorts. In both cohorts, the factor analysis showed a satisfactory solution for three factors (speech hearing, spatial hearing, and socio-emotional consequences), with a high internal consistency for each factor (Cronbach's α's for the factors from 0.90 to 0.97). Test-retest analysis showed the HERE overall mean score to be stable and highly replicable over time (intraclass correlation coefficient = 0.86, standard error of measurement of the test score = 0.92). The HERE overall mean score correlated highly with another self-report measure of speech perception, the Speech Spatial Qualities of Hearing questionnaire (standardized regression coefficient [ß] = -0.75, p < 0.001), moderately highly with behaviorally assessed hearing level (best-ear average: ß = 0.45 to 0.46), and moderately highly with behaviorally measured intelligibility of sentences in noise (ß = -0.50, p < 0.001). CONCLUSIONS: Using the COSMIN guidelines, the authors show that the HERE is a valid, reliable, and stable questionnaire for the assessment of self-reported speech perception, sound localization, and the socio-emotional consequences of hearing impairment in the context of social functioning. The authors also show that cross-cultural data collected using different data collection strategies can be combined with a range of statistical methods to validate a questionnaire.

Two new virtual reality tasks for the assessment of spatial orientation: preliminary results of tolerability, sense of presence and usability / Duas novas tarefas de realidade virtual para avaliação da orientação espacial: resultados preliminares de tolerabilidade, sensação de presença e usabilidade

Abstract Spatial orientation is a cognitive domain frequently impaired in Alzheimer's Disease and can be one of its earliest symptoms. Objective: This paper describes the results of tolerability, sense of presence and usability of two immersive virtual reality tasks for the assessment of spatial orientation, using VR headset in adults. Methods: 31 healthy adults recruited from university and the local community performed two experimental immersive virtual reality tasks of spatial orientation: the SOIVET-Maze for the assessment of allocentric to egocentric spatial abilities and the SOIVET-Route for the assessment of spatial memory and landmark recognition. Participants completed questionnaires about sense of presence, cybersickness symptoms, technology use profile and motion sickness history. Usability measures were assessed by spontaneous feedback from participants. Results: All participants were able to understand the task instructions and how to interact with the system. Both tasks seemed to induce a strong sense of presence, as assessed by the Witmer and Singer Presence Questionnaires (M=128 and 143 for SOIVET-Maze and SOIVET-Route, respectively). The SOIVET-Route had a small numeric advantage over the SOIVET-Maze tolerability scores assessed by the Cybersickness Questionnaire (M=4.19, SD=5.576 and M=3.52, SD=6.418 for SOIVET-Maze and SOIVET-Route respectively). Also, there were no drop-outs on the SOIVET-Route due to tolerability issues, unlike the SOIVET-Maze, which had two drop-outs. However, this difference was not statistically significant (Z= -.901, p= 0.368, Wilcoxon signed-rank test).

Resumo A orientação espacial é um domínio cognitivo freqüentemente comprometido na doença de Alzheimer e pode ser um dos primeiros sintomas manifestados. Objetivo: Este artigo descreve os resultados de tolerabilidade, sensação de presença e usabilidade de duas tarefas imersivas de realidade virtual para avaliação da orientação espacial, utilizando óculos de RV em adultos. Métodos: 31 adultos saudáveis, ​​recrutados entre estudantes universitários e da comunidade local, realizaram duas tarefas de realidade virtual imersiva para avaliação da orientação espacial: A tarefa SOIVET-Maze para avaliação da capacidade de transposição da orientação alocêntrica para egocêntrica e a tarefa SOIVET-Route para avaliação da memória espacial e reconhecimento de pontos de referência. Os participantes também responderam questionários sobre Sensação de Presença, Sintomas de cybersickness, Perfil de Uso de Tecnologia e Histórico de cinetose. Feedback espontâneo dos participantes foi utilizado como medida de usabilidade. Resultados: Todos os participantes conseguiram compreender as instruções da tarefa e como interagir com o sistema. Ambas tarefas parecem induzir forte sensação de presença, avaliada pelo Questionário de Presença de Witmer e Singer (M=128 e 143 para SOIVET-Maze e SOIVET-Route, respectivamente). A tarefa SOIVET-Route teve uma pequena vantagem numérica em relação à tarefa SOIVET-Maze na pontuação de tolerabilidade avaliada pelo Questionário de Cybersickness (M=4,19, SD=5,576 e M=3,52, SD=6,418 para SOIVET-Maze e SOIVET-Route respectivamente). Além disso, não houve desistências na SOIVET-Route devido a problemas de tolerabilidade, ao contrário da SOIVET-Maze, que teve dois drop-outs. No entanto, essa diferença não foi estatisticamente significativa (Z= -901, p=0,368, teste de postos sinalizados de Wilcoxon)

Visual attention and action: How cueing, direct mapping, and social interactions drive orienting.

Despite considerable interest in both action perception and social attention over the last 2 decades, there has been surprisingly little investigation concerning how the manual actions of other humans orient visual attention. The present review draws together studies that have measured the orienting of attention, following observation of another's goal-directed action. Our review proposes that, in line with the literature on eye gaze, action is a particularly strong orienting cue for the visual system. However, we additionally suggest that action may orient visual attention using mechanisms, which gaze direction does not (i.e., neural direct mapping and corepresentation). Finally, we review the implications of these gaze-independent mechanisms for the study of attention to action. We suggest that our understanding of attention to action may benefit from being studied in the context of joint action paradigms, where the role of higher level action goals and social factors can be investigated.

Attentional accounting: Voluntary spatial attention increases budget category prioritization.

Too often, people fail to prioritize the most important activities, life domains, and budget categories. One reason for misplaced priorities, we argue, is that activities and categories people have frequently or recently attended to seem higher priority than other activities and categories. In Experiment 1, participants were cued to direct voluntary spatial attention toward 1 side of a screen while images depicting different budget categories were presented: 1 category on the cued side and 1 on the noncued side of the screen. Participants rated cued budget categories as higher priority than noncued budget categories. Cued attention also increased perceived distinctiveness, and a mediation model was consistent with the hypothesis that distinctiveness mediates the effect of cued attention on prioritization. Experiment 2 orthogonally manipulated 2 components of a spatial cuing manipulation-heightened visual attention and heightened mental attention-to examine how each influences prioritization. Visual attention and mental attention additively increased prioritization. In Experiment 3, attention increased prioritization even when prioritization decisions were incentivized, and even when heightened attention was isolated from primacy and recency. Across experiments, cued categories were prioritized more than noncued categories even though measures were taken to disguise the purpose of the experiments and manipulate attention incidentally (i.e., as a by-product of an unrelated task). (PsycINFO Database Record

Attentional interference is modulated by salience not sentience.

Spatial cueing of attention occurs when attention is oriented by the onset of a stimulus or by other information that creates a bias towards a particular location. The presence of a cue that orients attention can also interfere with participants' reporting of what they see. It has been suggested that this type of interference is stronger in the presence of socially-relevant cues, such as human faces or avatars, and is therefore indicative of a specialised role for perspective calculation within the social domain. However, there is also evidence that the effect is a domain-general form of processing that is elicited equally with non-social directional cues. The current paper comprises four experiments that systematically manipulated the social factors believed necessary to elicit the effect. The results show that interference persists when all social components are removed, and that visual processes are sufficient to explain this type of interference, thus supporting a domain-general perceptual interpretation of interference.

Virtual reality-based assessment of basic laparoscopic skills using the Leap Motion controller.

BACKGROUND: The majority of the current surgical simulators employ specialized sensory equipment for instrument tracking. The Leap Motion controller is a new device able to track linear objects with sub-millimeter accuracy. The aim of this study was to investigate the potential of a virtual reality (VR) simulator for assessment of basic laparoscopic skills, based on the low-cost Leap Motion controller. METHODS: A simple interface was constructed to simulate the insertion point of the instruments into the abdominal cavity. The controller provided information about the position and orientation of the instruments. Custom tools were constructed to simulate the laparoscopic setup. Three basic VR tasks were developed: camera navigation (CN), instrument navigation (IN), and bimanual operation (BO). The experiments were carried out in two simulation centers: MPLSC (Athens, Greece) and CRESENT (Riyadh, Kingdom of Saudi Arabia). Two groups of surgeons (28 experts and 21 novices) participated in the study by performing the VR tasks. Skills assessment metrics included time, pathlength, and two task-specific errors. The face validity of the training scenarios was also investigated via a questionnaire completed by the participants. RESULTS: Expert surgeons significantly outperformed novices in all assessment metrics for IN and BO (p < 0.05). For CN, a significant difference was found in one error metric (p < 0.05). The greatest difference between the performances of the two groups occurred for BO. Qualitative analysis of the instrument trajectory revealed that experts performed more delicate movements compared to novices. Subjects' ratings on the feedback questionnaire highlighted the training value of the system. CONCLUSIONS: This study provides evidence regarding the potential use of the Leap Motion controller for assessment of basic laparoscopic skills. The proposed system allowed the evaluation of dexterity of the hand movements. Future work will involve comparison studies with validated simulators and development of advanced training scenarios on current Leap Motion controller.

Assessing Visuospatial Skills in Parkinson's: Comparison of Neuropsychological Assessment Battery Visual Discrimination to the Judgment of Line Orientation.

OBJECTIVE: Judgment of Line Orientation (JOLO) test is widely used in assessing visuospatial deficits in Parkinson's disease (PD). The neuropsychological assessment battery (NAB) offers the Visual Discrimination test, with age and education correction, parallel forms, and co-normed standardization sample for comparisons within and between domains. However, NAB Visual Discrimination has not been validated in PD, and may not measure the same construct as JOLO. METHOD: A heterogeneous sample of 47 PD patients completed the JOLO and NAB Visual Discrimination within a broader neuropsychological evaluation. Pearson correlations assessed relationships between JOLO and NAB Visual Discrimination performances. RESULTS: Raw and demographically corrected scores from JOLO and Visual Discrimination were only weakly correlated. NAB Visual Discrimination subtest was moderately correlated with overall cognitive functioning, whereas the JOLO was not. CONCLUSIONS: Despite apparent virtues, results do not support NAB Visual Discrimination as an alternative to JOLO in assessing visuospatial functioning in PD.