New measures of number line estimation performance reveal children's ordinal understanding of numbers.

Children's performance on the number line estimation task, often measured by the percentage of absolute error, predicts their later mathematics achievement. This task may also reveal (a) children's ordinal understanding of the target numbers in relation to each other and the benchmarks (e.g., endpoints, midpoint) and (b) the ordinal skills that are a necessary precursor to children's ability to understand the interval nature of a number line as measured by percentage of absolute error. Using data from 104 U.S. kindergartners, we measured whether children's estimates were correctly sequenced across trials and correctly positioned relative to given benchmarks within trials at two time points. For both time points, we found that each ordinal error measure revealed a distinct pattern of data distribution, providing opportunities to tap into different aspects of children's ordinal understanding. Furthermore, children who made fewer ordinal errors scored higher on the Test of Early Mathematics Ability and showed greater improvement on their interval understanding of numbers as reflected by a larger reduction of percentage of absolute error from Time 1 to Time 2. The findings suggest that our number line measures reveal individual differences in children's ordinal understanding of numbers, and that such understanding may be a precursor to their interval understanding and later mathematics performance.

Relational language influences young children's number relation skills.

Relational language is thought to influence mathematical skills. This study examines the association between relational language and number relation skills-knowledge of cardinal, ordinal, and spatial principles-among 104 U.S. kindergartners (5.9 years; 44% boys; 37% White, 25% Black, 14% Asian, 24% other) in the 2017-2018 academic year. Controlling for general verbal knowledge, executive function, and counting and number identification skills, relational language predicted later number relation skills, specifically number line estimation, ß = .30. Relational language did not differentially predict number line estimation performance in children with low or high number relation skills, likely due to the restricted ranges of data within subgroups. Number relation skills, specifically number line estimation and number ordering, may be a pathway between relational language and mathematical skills.

Detection of Norovirus Variant GII.4 Hong Kong in Asia and Europe, 2017-2019.

We report a new norovirus GII.4 variant, GII.4 Hong Kong, with low-level circulation in 4 Eurasia countries since mid-2017. Amino acid substitutions in key residues on the virus capsid associated with the emergence of pandemic noroviruses suggest that GII.4 Hong Kong has the potential to become the next pandemic variant.

Barriers to advance care planning: a qualitative study of seriously ill Chinese patients and their families.

BACKGROUND: Advance care planning (ACP) facilitates identification and documentation of patients' treatment preferences. Its goal aligns with that of palliative care - optimizing quality of life of seriously ill patients. However, concepts of ACP and palliative care remain poorly recognized in Chinese population. This study aims at exploring barriers to ACP from perspective of seriously ill patients and their family caregivers. METHODS: This is a qualitative study conducted in a Palliative Day Care Centre of Hong Kong between October 2016 and July 2017. We carried out focus groups and individual interviews for the seriously ill patients and their family caregivers. A semi-structured interview guide was used to explore participants' experiences and attitudes about ACP. Qualitative content analysis was adopted to analyze both manifest content and latent content. RESULTS: A total of 17 patients and 13 family caregivers participated in our study. The qualitative analysis identified four barriers to ACP: 1) limited patients' participation in autonomous decision making, 2) cognitive and emotional barriers to discussion, 3) lack of readiness and awareness of early discussion, and 4) unprepared healthcare professionals and healthcare system. CONCLUSIONS: Participations of seriously ill patients, family caregivers and healthcare workers in ACP initiation are lacking respectively. A series of interventions are necessary to resolve the barriers.

Use of Human Intestinal Enteroids to Detect Human Norovirus Infectivity.

Tools to detect human norovirus infectivity have been lacking. Using human intestinal enteroid cultures inoculated with GII.Pe-GII.4 Sydney-infected fecal samples, we determined that a real-time reverse transcription PCR cycle threshold cutoff of 30 may indicate infectious norovirus. This finding could be used to help guide infection control.

Outcomes of central hepatectomy versus extended hepatectomy.

BACKGROUND: Central hepatectomy (CH) is more difficult than extended hepatectomy (EH) and is associated with greater morbidity. In this modern era of liver management with aims to prevent post-hepatectomy liver failure (PHLF), there is a need to assess outcomes of CH as a parenchyma-sparing procedure for centrally located liver tumors. METHODS: A total of 178 major liver resections performed by specialist surgeons from two Australian tertiary institutions between June 2009 and March 2017 were reviewed. Eleven patients had CH and 24 had EH over this study period. Indications and perioperative outcomes were compared between the groups. RESULTS: The main indication for performing CH was colorectal liver metastases. There was no perioperative mortality in the CH group and four (16.7%) in the EH group (P = 0.285). No group differences were found in median operative time [CH vs. EH: 450 min (290-840) vs. 523 min (310-860), P = 0.328], intraoperative blood loss [850 mL (400-1500) vs. 650 mL (100-2000), P = 0.746] or patients requiring intraoperative blood transfusion [1 (9.1%) vs. 7 (30.4%), P = 0.227]. There was a trend towards fewer hepatectomy-specific complications in the CH group [3 (27.3%) vs. 13 (54.2%), P = 0.167], including PHLF (CH vs. EH: 0 vs. 29.2%, P = 0.072). Median length of stay was similar between groups [CH vs. EH: 9 days (5-23) vs. 12 days (4-85), P = 0.244]. CONCLUSIONS: CH has equivalent postoperative outcomes to EH. There is a trend towards fewer hepatectomy-specific complications, including PHLF. In appropriate patients, CH may be considered as a safe parenchyma-sparing alternative to EH.

Self-competence in death work among health and social care workers: a region-wide survey in Hong Kong.

BACKGROUND: According to the Quality of Death Index, Hong Kong is lagging behind many other Western and Asian countries in the category of palliative and healthcare. To ensure the provision of high-quality palliative care, it is important to explore the self-competence of health and social care workers in coping with death work including palliative care. This region-wide study aims to assess the level of self-competence with a validated Self-Competence in Death Work Scale (SC-DWS) and examine its correlates. METHODS: The SC-DWS was administered to a cross-sectional convenience sample of health and social care workers across eight healthcare institutions between January and October 2016. Total scores for the 16-item SC-DWS and its Existential and Emotional subscales were calculated. We then examined sociodemographic variables (e.g., age, profession, place of employment) in relation to the total and subscale scores using multiple linear regression. Coding was conducted on responses to a final open-ended question asking about the personal views of the workers towards their self-competence in death work. RESULT: We collected data from 885 health and social care workers. Mean score of the SC-DWS was 60.16 (range: 16 - 80), while its Existential and Emotional subscales scored 37.90 (range: 10 - 50) and 14.46 (range: 4 - 20) respectively. Four categories of personal view towards self-competence in death work including (1) personal resources; (2) existential challenges and coping; (3) emotional challenges and coping; and (4) personal recommendations on improving self-competence were identified. In multivariate analyses, workers aged 50 or above, divorced, working in Hospice A, Rehabilitation Hospital B (where a quality improvement initiative in end-of-life care was implemented) and Acute Hospital B (a Christian institution with strong caring culture) and with personal bereavement experience had significantly higher scores, whereas nurses scored significantly lower than less-educated personal care assistants. CONCLUSION: There is still room for improvement in self-competence in death work among health and social care workers, particularly the young, nurses and those working in acute hospitals. Future initiatives should involve identifying barriers in individual healthcare institutions. Training of the provision of palliative care is necessary.

The outcomes of central hepatectomy versus extended hepatectomy: a systematic review and meta-analysis.

BACKGROUND: Central hepatectomy (CH) is a relatively uncommon liver resection technique. It is generally perceived as a more complex operation than extended hepatectomies (EH), with potentially higher associated morbidity. The outcomes of CH compared with EH is not well defined and there is a need to reassess. METHODS: A systematic literature search was conducted in PubMed, MEDLINE, EMBASE and Web of Science according to PRISMA guidelines for studies on the treatment of liver tumours with CH published from 1972 until February 2017. Outcomes of patients undergoing CH were assessed and compared to those undergoing EH. RESULTS: 18 publications including 1380 CH were included for analysis. Mortality rates after CH ranged from 0 to 9%. There were 20 (1.4%) deaths after CH and the most common cause of death was post-hepatectomy liver failure (PHLF). Morbidity rates varied between 12 and 61% and 316 (23%) post-operative events were reported. Analysis of five comparative studies showed similar mortality between CH and EH groups (OR: 0.64, 95% CI = 0.24-1.70, p = 0.37). There were significantly fewer overall post-operative complications in the CH group (OR: 0.38, 95% CI = 0.28-0.51, p < 0.001) and reduced PHLF was found in the CH group compared to EH (OR: 0.53, 95% CI = 0.29-0.98, p = 0.04). The rates of post-hepatectomy biliary complications were similar between groups (OR: 0.98, 95% CI = 0.51-1.88, p = 0.96). Mean length of stay (days) was shorter in the CH group (MD: -2.67, 95% CI = -4.93 to -0.41, p = 0.02). CONCLUSION: CH appears to have similar post-operative mortality rates compared to EH but is associated with fewer post-operative complications, including PHLF and shorter overall length of stay.

Competing features influence children's attention to number.

Spontaneous focus on numerosity (SFON), an attentional process that some consider distinct from number knowledge, predicts later mathematical skills. Here we assessed the "spontaneity" and malleability of SFON using a picture-matching task. We asked children to view a target picture and to choose which of four other pictures matched the target. We tested whether attention to number (defined as number-based matches) was affected by (a) age, (b) the presence of very noticeable (or salient) features among alternative match choices, and (c) the examiner's use of motor actions to emphasize numerosity. Although adults attended to number more frequently than did preschoolers, the salience of competing features affected responses to number in both age groups. Specifically, number-based matches were more likely when alternative choices matched the target on features of low versus high salience (e.g., the relative location within a picture frame vs. color). In addition, adults' attention to number was more frequent if their first exposure to number-based matches occurred with alternative choices that matched the target on low salience features. This order by salience interaction was not observed among children. Simply observing motor actions that emphasized number (i.e., tapping stimuli) did not enhance children's attention to number. The results extend previous findings on SFON and provide evidence for the contextual influences on, and malleability of, attention to number.

Is the damage of cartilage a global or localized phenomenon in hip dysplasia, measured by dGEMRIC?

BACKGROUND: The mechanism of damage in osteoarthritis is believed to be multifactorial where mechanical and biological factors are important in its initiation and progression. Hip dysplasia is a classic model of increased mechanical loading on cartilage attributable to insufficient acetabular coverage that leads to osteoarthritis. If the damage is all attributable to direct mechanical damage then one initially would expect only local, not global changes. QUESTIONS/PURPOSES: We hypothesize that in hip dysplasia although the elevated cumulative contact stresses are localized, the damage to cartilage is biologically mediated, therefore, biochemical changes will be global. METHODS: Thirty-two patients with symptomatic hip dysplasia were scanned using a 1.5-T MRI scanner. We used a high-resolution three-dimensional dGEMRIC technique to characterize the distribution of cartilage damage in dysplastic hips. High-resolution isotropic acquisition was reformatted around the femoral neck axis and the dGEMRIC index was calculated separately for femoral and acetabular cartilages. Joint space widths also were evaluated in each reformatted slice. Each hip was characterized by the presence or absence of joint migration and by Tönnis grade. RESULTS: The global dGEMRIC index correlated with the dGEMRIC indices of individual regions with the highest correlations occurring in the anterosuperior to posterosuperior regions. The corresponding correlations for joint space width were uniformly lower, suggesting that tissue loss is a more local phenomenon. Higher Tönnis grades and hips with joint migration were associated with lower dGEMRIC indices. CONCLUSIONS: The dGEMRIC index shows a global decrease, whereas tissue loss is more localized. This suggests that hip osteoarthritis in acetabular dysplasia is a biologically mediated event that affects the entire joint.

Resisting the urge to calculate: The relation between inhibitory control and perceptual cues in arithmetic performance.

Subtle visual manipulations to the presentation of mathematical notation influence the way that students perceive and solve problems. While there is a consistent impact of perceptual cues on students' problem-solving, other cognitive skills such as inhibitory control may interact with perceptual cues to affect students' arithmetic problem-solving performance. We present an online experiment in which college students completed a version of the Stroop task followed by arithmetic problems in which the spacing between numbers and operators was either congruent (e.g., 2 + 3×4) or incongruent (e.g., 2+3 × 4) to the order of precedence. We found that students were comparably accurate between problem types but might have spent longer responding to problems with congruent than incongruent spacing. There was no main effect of inhibitory control on students' performance on these problems. However, an exploratory analysis on a combined performance measure of accuracy and response time revealed an interaction between problem type and inhibitory control. Students with higher inhibitory control performed better on congruent versus incongruent problems, whereas students with lower inhibitory control performed worse on congruent versus incongruent problems. Together, these results suggest that the relation between inhibitory control and arithmetic performance may not be straightforward. Furthermore, this work advances perceptual learning theory and contributes new findings on the contexts in which perceptual cues, such as spacing, influence arithmetic performance.

Participatory Design for Cognitive Science: Examples From the Learning Sciences and Human-Computer Interaction.

Given the recent call to strengthen collaboration between researchers and relevant practitioners, we consider participatory design as a way to advance Cognitive Science. Building on examples from the Learning Sciences and Human-Computer Interaction, we (a) explore what, why, who, when, and where researchers can collaborate with community members in Cognitive Science research; (b) examine the ways in which participatory-design research can benefit the field; and (c) share ideas to incorporate participatory design into existing basic and applied research programs. Through this article, we hope to spark deeper discussions on how cognitive scientists can collaborate with community members to benefit both research and practice.

Effectiveness of the Eyesi Surgical Simulator for ophthalmology trainees: systematic review and meta-analysis.

OBJECTIVE: The Eyesi Surgical Simulator (VRmagic, Mannheim, Germany) is the most commonly used ophthalmic virtual reality surgical simulator. While studies have demonstrated improved trainee skill acquisition with simulation-based training tools, a systematic review and meta-analysis evaluating Eyesi specifically has yet to be conducted. The aim of this study was to meta-analyze studies comparing Eyesi with other methods of technical skill teaching for trainees. METHODS: MEDLINE, Embase, and CENTRAL databases were searched. Articles included compared Eyesi Surgical Simulator use with alternative methods of technical skill training for medical students or residents. A pairwise meta-analysis using inverse variance random effects was performed. Standardized mean differences (SMDs) were used as the primary outcome measure to account for differences in surgical skill evaluation tools. RESULTS: From 207 citations, 8 studies with 108 learners using Eyesi and 123 learners not using Eyesi were included. Improvements in technical skill scores were significantly greater with the use of Eyesi (3 studies; SMD = 2.02; 95% CI, 1.47-2.57; p < 0.001; I2 = 0%). There was a significant reduction in the number of learners experiencing post-training technical errors in the Eyesi group (5 studies: odds ratio = 0.43; 95% CI, 0.20-0.90; p = 0.03; I2 = 30%). There were no significant differences in post-training time to task completion between groups (3 studies; SMD = 1.96; 95% CI, -1.96-5.88; p = 0.33; I2 = 97%). CONCLUSIONS: The Eyesi Surgical Simulator may improve technical skill acquisition (grade: low certainty of evidence) and decrease technical errors (grade: very low certainty of evidence) during cataract surgery among trainees. Further prospective studies evaluating Eyesi modules with standardized scoring systems is warranted.

Test of Times New Roman: effects of font type on mathematical performance.

Mathematics is presented in a variety of font types across materials (e.g., textbooks, online problems); however, little is known about the effects of font type on students' mathematical performance. Undergraduate students (N = 121) completed three mathematical tasks in a one-hour online session in one of three font conditions: Times New Roman (n = 45), Kalam (n = 41), or handwriting (n = 35). We examined whether font type impacted students' performance, as measured by accuracy and response time, on the Perceptual Math Equivalence Task, error identification task, and equation-solving task. Compared to students in the Kalam and handwriting conditions, students in the Times New Roman condition were less accurate on the Perceptual Math Equivalence Task in which they judged whether two expressions were equivalent or not equivalent. We did not find differences between conditions in performance on error identification and equation-solving tasks. The findings have implications for research and practice. Specifically, researchers and educators may choose font types in which they present mathematics information with consideration, as font types may impact students' mathematical processing and performance.

The Impacts of Three Educational Technologies on Algebraic Understanding in the Context of COVID-19.

The current study investigated the effectiveness of three distinct educational technologies-two game-based applications (From Here to There and DragonBox 12+) and two modes of online problem sets in ASSISTments (an Immediate Feedback condition and an Active Control condition with no immediate feedback) on Grade 7 students' algebraic knowledge. More than 3,600 Grade 7 students across nine in-person and one virtual schools within the same district were randomly assigned to one of the four conditions. Students received nine 30-minute intervention sessions from September 2020 to March 2021. Hierarchical linear modeling analyses of the final analytic sample (N = 1,850) showed significantly higher posttest scores for students who used From Here to There and DragonBox 12+ compared to the Active Control condition. No significant difference was found for the Immediate Feedback condition. The findings have implications for understanding how game-based applications can affect algebraic understanding, even within pandemic pressures on learning.

Effect of muscle fatigue of the thoracic erector spinae on neuromuscular control when performing the upper extremity functional tasks in people with adolescent idiopathic scoliosis.

Adolescent idiopathic scoliosis (AIS) disrupts spinal alignment and increases the intrinsic demand for active stabilization to maintain postural stability. Understanding the paraspinal muscle fatigability and its effects on spinal alignment and kinematics informs the importance of paraspinal muscle endurance for postural stability. This study aims to investigate the effects of fatigue of thoracic erector spinae on the spinal muscle activity and spinal kinematics in individuals with scoliosis. Spinal muscle activity, posture and mobility measured by electromyography and surface tomography were compared between 15 participants with scoliosis and 15 age- and gender-matched healthy controls during unilateral shoulder flexion and abduction with and without holding a 2-kg weight and performed before and after a fatigue task (prone isometric chest raise). No between-groups difference was found for the spinal extensor endurance. Erector spinae activity at the convex side of AIS group was significantly higher than that at their concave side and than that of healthy controls during shoulder elevations, regardless of the fatigue status. Significant decreases in translational and rotational mobility were found at convex side of AIS group during weighted abduction tasks after fatigue. In contrast, a significant increase in rotational mobility was demonstrated at convex side of AIS participants during weighted flexion tasks after fatigue. Our results revealed a comparable level of spinal extensor endurance between individuals with or without AIS. The increase in muscle activation post-fatigue provides no additional active postural stability but may increase the risk of back pain over the convex side in individuals with scoliosis. Findings highlight imbalances in muscles and the potential implications in optimising neuromuscular activation and endurance capacity in the rehabilitation for AIS patients. Future research is needed to investigate if endurance training of the convex-sided back extensors could optimize the impaired neuromuscular control in the AIS patients.

Impact of Different Artificial Intelligence User Interfaces on Lung Nodule and Mass Detection on Chest Radiographs.

Purpose: To explore the impact of different user interfaces (UIs) for artificial intelligence (AI) outputs on radiologist performance and user preference in detecting lung nodules and masses on chest radiographs. Materials and Methods: A retrospective paired-reader study with a 4-week washout period was used to evaluate three different AI UIs compared with no AI output. Ten radiologists (eight radiology attending physicians and two trainees) evaluated 140 chest radiographs (81 with histologically confirmed nodules and 59 confirmed as normal with CT), with either no AI or one of three UI outputs: (a) text-only, (b) combined AI confidence score and text, or (c) combined text, AI confidence score, and image overlay. Areas under the receiver operating characteristic curve were calculated to compare radiologist diagnostic performance with each UI with their diagnostic performance without AI. Radiologists reported their UI preference. Results: The area under the receiver operating characteristic curve improved when radiologists used the text-only output compared with no AI (0.87 vs 0.82; P < .001). There was no difference in performance for the combined text and AI confidence score output compared with no AI (0.77 vs 0.82; P = .46) and for the combined text, AI confidence score, and image overlay output compared with no AI (0.80 vs 0.82; P = .66). Eight of the 10 radiologists (80%) preferred the combined text, AI confidence score, and image overlay output over the other two interfaces. Conclusion: Text-only UI output significantly improved radiologist performance compared with no AI in the detection of lung nodules and masses on chest radiographs, but user preference did not correspond with user performance.Keywords: Artificial Intelligence, Chest Radiograph, Conventional Radiography, Lung Nodule, Mass Detection© RSNA, 2023.

Effects of B1 inhomogeneity correction for three-dimensional variable flip angle T1 measurements in hip dGEMRIC at 3 T and 1.5 T.

Delayed gadolinium-enhanced MRI of cartilage is a technique for studying the development of osteoarthritis using quantitative T(1) measurements. Three-dimensional variable flip angle is a promising method for performing such measurements rapidly, by using two successive spoiled gradient echo sequences with different excitation pulse flip angles. However, the three-dimensional variable flip angle method is very sensitive to inhomogeneities in the transmitted B(1) field in vivo. In this study, a method for correcting for such inhomogeneities, using an additional B(1) mapping spin-echo sequence, was evaluated. Phantom studies concluded that three-dimensional variable flip angle with B(1) correction calculates accurate T(1) values also in areas with high B(1) deviation. Retrospective analysis of in vivo hip delayed gadolinium-enhanced MRI of cartilage data from 40 subjects showed the difference between three-dimensional variable flip angle with and without B(1) correction to be generally two to three times higher at 3 T than at 1.5 T. In conclusion, the B(1) variations should always be taken into account, both at 1.5 T and at 3 T.

Nasoalveolar molding: prevalence of cleft centers offering NAM and who seeks it.

INTRODUCTION: Nasoalveolar molding (NAM) is a treatment option available for early cleft care. Despite the growing debate about the efficacy of nasoalveolar molding, questions remain regarding its prevalence and the demographic characteristics of families undergoing this technique prior to traditional cleft surgery. OBJECTIVES: To determine the number of teams currently offering nasoalveolar molding and to identify salient clinical and sociodemographic variables in infants and families who choose nasoalveolar molding compared with those who choose traditional cleft care across three well-established cleft centers. RESULTS: Via phone surveys, 89% of the U.S. cleft teams contacted revealed that nasoalveolar molding is available at 37% of these centers. Chart reviews and phone correspondence with caregivers indicate that the average distance to the cleft center was 65.5 miles and caregiver age averaged 30.9 ± 5.7 years. Of families who chose nasoalveolar molding, 85% received total or partial insurance coverage. No difference in caregiver education, income, or distance to the clinic between treatment groups was found. On average, infants receiving nasoalveolar molding and cleft surgery had larger clefts and had more clinic visits than infants receiving traditional cleft surgery. Infants who were firstborn and those who did not have other siblings were more likely to receive nasoalveolar molding than were infants who were residing with other siblings. CONCLUSIONS: Currently more than one-third of U.S. cleft centers offer nasoalveolar molding. Although the cleft size was larger in the nasoalveolar molding group, no treatment group differences in education, income, and distance to the clinic were found.

Enhanced Recovery After Surgery Protocol in Minimally Invasive Lumbar Fusion Surgery Reduces Length of Hospital Stay and Inpatient Narcotic Use.

Background: The application of enhanced recovery after surgery (ERAS) has the potential to improve outcomes, hasten patient recovery, and reduce costs. ERAS has been applied to spine surgery for several years, but data are limited around the impact of ERAS on minimally invasive spine surgery, specifically. The authors report their experience implementing a multimodal ERAS protocol for patients receiving minimally invasive transforaminal lumbar interbody fusion. Methods: The ERAS protocol was implemented at The Valley Hospital Hospital in Ridgewood, New Jersey in January 2020. Following implementation, all patients receiving minimally invasive transforaminal lumbar interbody fusion by a single surgeon were studied. The authors analyze the impact of the protocol on length of stay (LOS), disposition post discharge, and opioid consumption postoperatively in the inpatient and outpatient settings. Results: Sixteen patients were enrolled in the protocol and compared with 17 historical controls. LOS was significantly shorter in the ERAS cohort (1.6 vs. 2.4 days, P = 0.022). There was no significant difference between the groups with respect to disposition; the majority of patients were discharged to home without need for in-home medical services. Patients in the ERAS cohort consumed significantly fewer opioid analgesics postoperatively in the inpatient setting (51 mg morphine milligram equivalents vs. 320 mg morphine milligram equivalents, P = 0.00016). On average, patients in the ERAS cohort were prescribed fewer opioids analgesics post discharge. Conclusions: ERAS application to minimally invasive transforaminal lumbar interbody fusion was safe and effective, significantly reducing LOS and inpatient opioid consumption. These data reflect the importance of uniformly applying a multimodal ERAS protocol to accelerate recovery and reduce narcotic use.