Alignment and Fixation in Revision Total Knee Arthroplasty With Press-Fit, Offset, Diaphyseal-Engaging Stem Extensions, and Eccentric Reaming Technique.

BACKGROUND: A revision total knee arthroplasty must control limb alignment, often to address the cause of failure. Press-fit stems that engage the diaphysis with cement restricted to the metaphysis constitute one fixation technique. These long stems restrict coronal alignment of the prosthesis and as a result reduce the likelihood of extreme malposition. For the same reasons, long stems can make it difficult to manipulate alignment and achieve a specific coronal alignment angle. Nevertheless, femoral stems with a tight diaphyseal fit may still occupy a small range of varus-valgus positions due to the conical distal femoral metaphysis. Pulling the reamer toward the lateral endosteum increases femoral component coronal alignment toward a valgus direction and pushing the reamer medially increases alignment in a more varus direction. A straight stem, in combination with a medially directed reaming, would result in a femoral component that overhangs medially, but an offset stem can recenter the femoral component and maintain the desired alignment. We hypothesized that diaphyseal fit plus this reaming technique can control limb coronal alignment and provide fixation. METHODS: This was a retrospective clinical and long-leg radiographic study of consecutive revision total knee arthroplasties with minimum 2-year follow-up. Outcomes were correlated with New Zealand Joint Registry data to identify rerevisions of 111 consecutive revision knee arthroplasties, 92 after exclusions, at a minimum 2-year (range, 2 to 10) follow-up. RESULTS: Mean femoral and tibial canal fill exceeded 91% on antero-posterior and lateral radiographs. The mean hip-knee-ankle angle was 179.6o (174.9-184.0) with 80% within ± 3o of neutral. The hip-ankle axis crossed the central Kennedy zone in 76.5% of cases and the other 24.6% crossed the inner medial and inner lateral zones. Tibial components: 99.0% ± 3o. Femoral components: 89.5% within ± 3o. There were 5 knees that failed due to infection, 3 from femoral loosening, and 1 due to recurvatum instability from polio. CONCLUSIONS: This study describes a surgical plan and technique for achieving target coronal alignment with press-fit diaphyseal fixation. It is the only series of revision knee arthroplasties with diaphyseal press-fit stems to report canal fill in 2 planes and coronal alignment on full-length radiographs.

Supply and Transport Limitations on Phosphorus Losses from Agricultural Fields in the Lower Great Lakes Region, Canada.

Phosphorus (P) mobilization in agricultural landscapes is regulated by both hydrologic (transport) and biogeochemical (supply) processes interacting within soils; however, the dominance of these controls can vary spatially and temporally. In this study, we analyzed a 5-yr dataset of stormflow events across nine agricultural fields in the lower Great Lakes region of Ontario, Canada, to determine if edge-of-field surface runoff and tile drainage losses (total and dissolved reactive P) were limited by transport mechanisms or P supply. Field sites ranged from clay loam, silt loam, to sandy loam textures. Findings indicate that biogeochemical processes (P supply) were more important for tile drain P loading patterns (i.e., variable flow-weighted mean concentrations ([]) across a range of flow regimes) relative to surface runoff, which trended toward a more chemostatic or transport-limited response. At two sites with the same soil texture, higher tile [] and greater transport limitations were apparent at the site with higher soil available P (STP); however, STP did not significantly correlate with tile [] or P loading patterns across the nine sites. This may reflect that the fields were all within a narrow STP range and were not elevated in STP concentrations (Olsen-P, ≤25 mg kg). For the study sites where STP was maintained at reasonable concentrations, hydrology was less of a driving factor for tile P loadings, and thus management strategies that limit P supply may be an effective way to reduce P losses from fields (e.g., timing of fertilizer application).

Auditory context-dependent distraction by unexpected visual stimuli.

Research findings indicate that when a task-irrelevant stimulus feature deviates from an otherwise predictable pattern, participants performing a categorization task exhibit slower responses (deviance distraction). This deviance distraction effect reflects the violation of the sensory predictions generated by the cognitive system. In this study, we sought to examine for the first time whether these predictions can be incidentally modulated by the auditory environment. Participants categorized the duration (short vs long) of a colored shape (red square or blue circle) while instructed to disregard the stimulus' visual features and the sound played in the background (two distinct chords played by different instruments). While the two visual stimuli shapes were equiprobable across the task, one was highly likely (p=.882) and the other rare (p=.118) in one auditory context and vice versa in the other context. Our results showed that participants were significantly slower in the duration judgement task whenever the stimulus was unexpected within a given auditory context (context-dependent distraction), and that the reset of their sensory predictions was completed upon the trial following a change of context. We conclude that object features and environmental context are processed in relation to each other and that sensory predictions are produced in relation to the environmental context, evidencing the first demonstration of auditory context-dependent modulation of attention.

Autistic traits specific to communication ability are associated with performance on a Mooney face detection task.

Difficulties in global face processing have been associated with autism. However, autism is heterogenous, and it is not known which dimensions of autistic traits are implicated in face-processing difficulties. To address this gap in knowledge, we conducted two experiments to examine how identification of Mooney face stimuli (stylized, black-and-white images of faces without details) related to the six subscales of the Comprehensive Autistic Trait Inventory in young adults. In Experiment 1, regression analyses indicated that participants with poorer communication skills had lower task sensitivity when discriminating between face-present and face-absent images, whilst other autistic traits had no unique predictive value. Experiment 2 replicated these findings and additionally showed that autistic traits were linked to a reduced face inversion effect. Taken together, these results indicate autistic traits, especially communication difficulties, are associated with reduced configural processing of face stimuli. It follows that both reduced sensitivity for identifying upright faces amongst similar-looking distractors and reduced susceptibility to face inversion effects may be linked to relatively decreased reliance on configural processing of faces in autism. This study also reinforces the need to consider the different facets of autism independently.

Visuospatial cueing differences as a function of autistic traits.

Atypical orienting of visuospatial attention in autistic individuals or individuals with a high level of autistic-like traits (ALTs) has been well documented and viewed as a core feature underlying the development of autism. However, there has been limited testing of three alternative theoretical positions advanced to explain atypical orienting - difficulty in disengagement, cue indifference, and delay in orienting. Moreover, research commonly has not separated facilitation (reaction time difference between neutral and valid cues) and cost effects (reaction time difference between invalid and neutral cues) in orienting tasks. We addressed these limitations in two experiments that compared groups selected for Low- and High-ALT levels on exogenous and endogenous versions of the Posner cueing paradigm. Experiment 1 showed that High-ALT participants exhibited a significantly reduced cost effect compared to Low-ALT participants in the endogenous cueing task, although the overall orienting effect remained small. In Experiment 2, we increased task difficulty of the endogenous task to augment cueing effects. Results were comparable to Experiment 1 regarding the finding of a reduced cost effect for High-ALT participants on the endogenous cueing task and additionally demonstrated a reduced facilitation effect in High-ALT participants on the same task. No ALT group differences were observed on an exogenous cueing task included in Experiment 2. These findings suggest atypical orienting in High-ALT individuals may be attributable to general cue indifference, which implicates differences in top-down attentional processes between Low- and High-ALT individuals. We discuss how indifference to endogenous cues may contribute to social cognitive differences in autism.

A review of behavioral evidence for hemispheric asymmetry of visuospatial attention in autism.

Most individuals show a small bias towards visual stimuli presented in their left visual field (LVF) that reflects right-hemispheric specialization of visuospatial functions. Moreover, this bias is altered by some neurodevelopmental disorders, suggesting they may be linked to changes in hemispheric asymmetry. To examine whether autism potentially alters hemispheric asymmetry, we conducted a systematic search of scientific databases to review existing literature on the link between autism and alterations in visuospatial bias. This search identified 13 publications that had explored this issue using a wide range of experimental designs and stimuli. Evidence of reduced LVF bias associated with autism was most consistent for studies examining attentional bias or preference measured using tasks such as line bisection. Findings for studies examining attentional performance (e.g., reaction time) were more equivocal. Further investigation is called for, and we make several recommendations for how this avenue of research can be extended.

No evidence for superior distractor filtering amongst individuals high in autistic-like traits.

Autistic individuals and individuals with high levels of autistic-like traits often show better visual search performance than their neurotypical peers. The present work investigates whether this advantage stems from increased ability to filter out distractors. Participants with high or low levels of autistic-like traits completed an attentional blink task in which trials varied in target-distractor similarity. The results showed no evidence that high levels of autistic-like traits were associated with superior distractor filtering (indexed by the difference in the size of the attentional blink across the high- and low-similarity distractors). This suggests that search advantages seen in previous studies are likely linked to other mechanisms such as enhanced pre-attentive scene processing, better decision making, or more efficient response selection.

Ethics in practice: the state of the debate on promoting the social value of global health research in resource poor settings particularly Africa.

BACKGROUND: Promoting the social value of global health research undertaken in resource poor settings has become a key concern in global research ethics. The consideration for benefit sharing, which concerns the elucidation of what if anything, is owed to participants, their communities and host nations that take part in such research, and the obligations of researchers involved, is one of the main strategies used for promoting social value of research. In the last decade however, there has been intense debate within academic bioethics literature seeking to define the benefits, the beneficiaries, and the scope of obligations for providing these benefits. Although this debate may be indicative of willingness at the international level to engage with the responsibilities of researchers involved in global health research, it remains unclear which forms of benefits or beneficiaries should be considered. International and local research ethics guidelines are reviewed here to delineate the guidance they provide. METHODS: We reviewed documents selected from the international compilation of research ethics guidelines by the Office for Human Research Protections under the US Department of Health and Human Services. RESULTS: Access to interventions being researched, the provision of unavailable health care, capacity building for individuals and institutions, support to health care systems and access to medical and public health interventions proven effective, are the commonly recommended forms of benefits. The beneficiaries are volunteers, disease or illness affected communities and the population in general. Interestingly however, there is a divide between "global opinion" and the views of particular countries within resource poor settings as made explicit by differences in emphasis regarding the potential benefits and the beneficiaries. CONCLUSION: Although in theory benefit sharing is widely accepted as one of the means for promoting the social value of international collaborative health research, there is less agreement amongst major guidelines on the specific responsibilities of researchers over what is ethical in promoting the social value of research. Lack of consensus might have practical implications for efforts aimed at enhancing the social value of global health research undertaken in resource poor settings. Further developments in global research ethics require more reflection, paying attention to the practical realities of implementing the ethical principles in real world context.

Magnitude of sex differences in visual search varies with target eccentricity.

A recent meta-analysis found no support for the popular theory that superior visuospatial ability in males is attributable to their relatively greater hemispheric asymmetry of neural functions. However, the issue of whether differences in hemispheric laterality could account for differences in visual perception between the sexes has not been systematically investigated. Visual search is an ideal task for such an investigation, as target-position can be systematically varied across the visual field allowing for a detailed analysis of how performance varies with visual field and eccentricity. We recruited 539 undergraduate participants (150 male) and administered a visual search task that required them to identify the presence of a uniquely-oriented triangle amongst distractors. Crucially, target location was systematically varied over the visual field across trials. Males displayed both superior accuracy and shorter reaction time when targets were presented in the left visual field, whilst sex differences systematically diminished when the target was located further rightward. These behavioural results are in line with the notion that greater hemispheric asymmetry in males influences task performance to a varying extent across the visual field, and illustrates the importance of considering task parameters and the influence of sex in behavioural research.

The Comprehensive Autistic Trait Inventory (CATI): development and validation of a new measure of autistic traits in the general population.

BACKGROUND: Traits and characteristics qualitatively similar to those seen in diagnosed autism spectrum disorder can be found to varying degrees in the general population. To measure these traits and facilitate their use in autism research, several questionnaires have been developed that provide broad measures of autistic traits [e.g. Autism-Spectrum Quotient (AQ), Broad Autism Phenotype Questionnaire (BAPQ)]. However, since their development, our understanding of autism has grown considerably, and it is arguable that existing measures do not provide an ideal representation of the trait dimensions currently associated with autism. Our aim was to create a new measure of autistic traits that reflects our current understanding of autism, the Comprehensive Autism Trait Inventory (CATI). METHODS: In Study 1, 107 pilot items were administered to 1119 individuals in the general population and exploratory factor analysis of responses used to create the 42-item CATI comprising six subscales: Social Interactions, Communication, Social Camouflage, Repetitive Behaviours, Cognitive Rigidity, and Sensory Sensitivity. In Study 2, the CATI was administered to 1068 new individuals and confirmatory factor analysis used to verify the factor structure. The AQ and BAPQ were administered to validate the CATI, and additional autistic participants were recruited to compare the predictive ability of the measures. In Study 3, to validate the CATI subscales, the CATI was administered to 195 new individuals along with existing valid measures qualitatively similar to each CATI subscale. RESULTS: The CATI showed convergent validity at both the total-scale (r ≥ .79) and subscale level (r ≥ .68). The CATI also showed superior internal reliability for total-scale scores (α = .95) relative to the AQ (α = .90) and BAPQ (α = .94), consistently high reliability for subscales (α > .81), greater predictive ability for classifying autism (Youden's Index = .62 vs .56-.59), and demonstrated measurement invariance for sex. LIMITATIONS: Analyses of predictive ability for classifying autism depended upon self-reported diagnosis or identification of autism. The autistic sample was not large enough to test measurement invariance of autism diagnosis. CONCLUSIONS: The CATI is a reliable and economical new measure that provides observations across a wide range of trait dimensions associated with autism, potentially precluding the need to administer multiple measures, and to our knowledge, the CATI is also the first broad measure of autistic traits to have dedicated subscales for social camouflage and sensory sensitivity.

Attracting and retaining health workers in rural areas: investigating nurses' views on rural posts and policy interventions.

BACKGROUND: Kenya has bold plans for scaling up priority interventions nationwide, but faces major human resource challenges, with a lack of skilled workers especially in the most disadvantaged rural areas. METHODS: We investigated reasons for poor recruitment and retention in rural areas and potential policy interventions through quantitative and qualitative data collection with nursing trainees. We interviewed 345 trainees from four purposively selected Medical Training Colleges (MTCs) (166 pre-service and 179 upgrading trainees with prior work experience). Each interviewee completed a self-administered questionnaire including likert scale responses to statements about rural areas and interventions, and focus group discussions (FGDs) were conducted at each MTC. RESULTS: Likert scale responses indicated mixed perceptions of both living and working in rural areas, with a range of positive, negative and indifferent views expressed on average across different statements. The analysis showed that attitudes to working in rural areas were significantly positively affected by being older, but negatively affected by being an upgrading student. Attitudes to living in rural areas were significantly positively affected by being a student at the MTC furthest from Nairobi. During FGDs trainees raised both positive and negative aspects of rural life. Positive aspects included lower costs of living and more autonomy at work. Negative issues included poor infrastructure, inadequate education facilities and opportunities, higher workloads, and inadequate supplies and supervision. Particular concern was expressed about working in communities dominated by other tribes, reflecting Kenya's recent election-related violence. Quantitative and qualitative data indicated that students believed several strategies could improve rural recruitment and retention, with particular emphasis on substantial rural allowances and the ability to choose their rural location. Other interventions highlighted included provision of decent housing, and more rapid career advancement. However, recently introduced short term contracts in named locations were not favoured due to their lack of pension plans and job security. CONCLUSIONS: This study identified a range of potential interventions to increase rural recruitment and retention, with those most favored by nursing students being additional rural allowances, and allowing choice of rural location. Greater investment is needed in information systems to evaluate the impact of such policies.

A comprehensive psychometric analysis of autism-spectrum quotient factor models using two large samples: Model recommendations and the influence of divergent traits on total-scale scores.

The Autism-Spectrum Quotient (AQ) is a psychometric scale that is commonly used to assess autistic-like traits and behaviors expressed by neurotypical individuals. A potential strength of the AQ is that it provides subscale scores that are specific to certain dimensions associated with autism such as social difficulty and restricted interests. However, multiple psychometric evaluations of the AQ have led to substantial disagreement as to how many factors exist in the scale, and how these factors are defined. These challenges have been exacerbated by limitations in study designs, such as insufficient sample sizes as well as a reliance on Pearson, rather than polychoric, correlations. In addition, several proposed models of the AQ suggest that some factors are uncorrelated, or negatively correlated, which has ramifications for whether total-scale scores are meaningfully interpretable-an issue not raised by previous work. The aims of the current study were to provide: (a) guidance as to which models of the AQ are viable for research purposes, and (b) evidence as to whether total-scale scores are adequately interpretable for research purposes. We conducted a comprehensive series of confirmatory factor analyses on 11 competing AQ models using two large samples drawn from an undergraduate population (n = 1,702) and the general population (n = 1,280). Psychometric evidence largely supported using the three-factor model described by Russell-Smith et al. [Personality and Individual Differences 51(2), 128-132 (2011)], but did not support the use of total-scale scores. We recommend that researchers consider using AQ subscale scores instead of total-scale scores. Autism Res 2020, 13: 45-60. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: We examined 11 different ways of scoring subscales in the popular Autism-Spectrum Quotient (AQ) questionnaire in two large samples of participants (i.e., general population and undergraduate students). We found that a three-subscale model that used "Social Skill," "Patterns/Details," and "Communication/Mindreading" subscales was the best way to examine specific types of autistic traits in the AQ. We also found some weak associations between the three subscales-for example, being high on the "Patterns/Details" subscale was not predictive of scores on the other subscales. This means that meaningful interpretation of overall scores on the AQ is limited.

What determines the efficacy of forced-air warming systems? A manikin evaluation with upper body blankets.

BACKGROUND: Forced-air warming has gained acceptance as an effective means to prevent perioperative hypothermia. However, little is known about the influence of air flow and air temperature at the nozzle and the influence of heat distribution in the blankets on the efficacy of these systems. METHODS: We conducted a manikin study with heat flux transducers using five forced-air warming systems to determine the factors that are responsible for heat transfer from the blanket to the manikin. RESULTS: There was no relation between air temperature at the nozzle of the power unit and the resulting heat transfer. There was also no relation between the air flow at the nozzle of the power unit and the resulting heat transfer. However, all blankets performed best at high air flows above 19 L/s. The heat exchange coefficient, the mean temperature gradient between the blanket and the manikin correlated positively with the resulting heat transfer and the difference between the minimal and maximal blanket temperature correlated negatively with the resulting heat transfer. CONCLUSIONS: The efficacy of forced-air warming systems is primarily determined by the blanket. Modern power units provide sufficient heat energy to maximize the ability of the blanket to warm the patient. Optimizing blanket design by optimizing the mean temperature gradient between the blanket and the manikin (or any other surface) with a very homogeneous temperature distribution in the blanket will enable the manufacturers to develop better forced-air warming systems.

"But you have to start somewhere .": Nurses' perceptions of what is required to provide quality neonatal care in selected hospitals, Kenya.

Background: Kenya has one of the highest rates of neonatal mortality in the world at 22/1,000 live births. Improving the quality of newborn care would greatly improve survival rates. There is an increasing consensus that strong health systems are key to achieving improved health outcomes. However, there is significantly less agreement on what to strengthen in low and middle-income countries such as Kenya. As nurses are the main caregivers in many inpatient settings, efforts aimed at improving the quality of facility care for sick newborn babies need to take into account nurses views and opinions. Our intent in this paper is to describe the current state of the nursing environment and what would be required to improve the quality of those environs from nurses' perspectives. Methods: Between January 2017 and March 2018, we collected data through non-participant observations, unsolicited conversations and review of admission registers. We also conducted 29 individual in-depth interviews with nurses working in the newborn units (NBU) of a public sector hospital (n=10), a private sector hospital (n=11) and a faith-based hospital (n=8).  The interviews were digitally audio recorded, transcribed verbatim and, together with observation notes, analysed using thematic content analysis. Results: Nurses as frontline care givers and intervention intermediaries, irrespective of their work contexts, have similar aspirations, needs and expectations from the health systems of how they should be supported to provide quality inpatient care for newborns. These are about the structure of the work environment, especially human resources for health, and the consequences of inadequate structure. They are also about how care is organised and systems that respond to emergencies. Conclusion: Interventions and investments to improve quality need to be directed towards experienced based co-design where we listen to the problems that nurses experience.

Autistic-traits, not anxiety, modulate implicit emotional guidance of attention in neurotypical adults.

Although autistic and anxious traits are positively correlated, high levels of autistic traits are associated with poorer emotional guidance of attention (EGA) whilst high levels of anxious traits are associated with greater EGA. In order to better understand how these two trait dimensions influence EGA, we simultaneously examined the effects of anxiety and autistic traits in neurotypical adults on target identification in an attentional blink task. Analyses indicated that implicit EGA is attenuated in individuals with higher levels of autistic traits, but largely unaffected by variation in anxious traits. Our results suggest that anxiety plays a comparatively limited role in modulating implicit EGA and reinforces the importance of disentangling correlated individual differences when exploring the effects of personality, including emotional predisposition, on attention.

Respiratory syncytial virus infection and disease in infants and young children observed from birth in Kilifi District, Kenya.

BACKGROUND: In developing countries, there are few data that characterize the disease burden attributable to respiratory syncytial virus (RSV) and clearly define which age group to target for vaccine intervention. METHODS: Six hundred thirty-five children, recruited during the period 2002-2003, were intensively monitored until each experienced 3 epidemics of RSV infection. RSV infection was diagnosed using immunofluorescence of nasal washing specimens collected at each episode of acute respiratory infection. Incidence estimates were adjusted for seasonality of RSV exposure. RESULTS: For 1187 child-years of observation (CYO), a total of 409 (365 primary and 82 repeat) episodes of RSV infection were identified. Adjusted incidence estimates of lower respiratory tract infection (LRTI), severe LRTI, and hospital admission were 90 cases per 1000 CYO, 43 cases per 1000 CYO, and 10 cases per 1000 CYO, respectively, and corresponding estimates among infants were 104 cases per 1000 CYO, 66 cases per 1000 CYO, and 13 cases per 1000 CYO, respectively. The proportion of cases of all-cause LRTI, and severe LRTI and hospitalizations attributable to RSV in the cohort was 13%, 19%, and 5%, respectively. Fifty-five percent to 65% of RSV-associated LRTI and severe LRTI occurred in children aged >6 months. The risk of RSV disease following primary symptomatic infection remained significant beyond the first year of life, and one-quarter of all reinfections were associated with LRTI. CONCLUSIONS: RSV accounts for a substantial proportion of the total respiratory disease in this rural population; we estimate that 85,000 cases of severe LRTI per year occur in infants in Kenya. The majority of this morbidity occurs during late infancy and early childhood--ages at which the risk of disease following infection remains significant. Disease resulting from reinfection is common. Our results inform the debate on the target age group and effectiveness of a vaccine.

Modulating attentional biases of adults with autistic traits using transcranial direct current stimulation: A pilot study.

While neurotypical individuals over-attend to the left-side of centrally-presented visual stimuli, this bias is reduced in individuals with autism/high levels of autistic traits. Because this difference is hypothesized to reflect relative reductions in right-hemisphere activation, it follows that increasing right-hemisphere activation should increase leftward bias. We administered transcranial direct current stimulation (tDCS) over the right posterior parietal cortex to individuals with low levels (n = 19) and high levels (n = 19) of autistic traits whilst they completed a greyscales task. Anodal tDCS increased leftward bias for high-trait, but not low-trait, individuals, while cathodal tDCS had no effect. This outcome suggests that typical attentional patterns driven by hemispheric lateralization could potentially be restored following right-hemisphere stimulation in high-trait individuals. Autism Res 2018, 11: 385-390. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Attentional differences between individuals with and without autism may reflect differences in underlying activation of the left and right hemispheres. In this study, we combine an attentional task that reflects relative hemispheric activation with non-invasive cortical stimulation, and show that attentional differences between healthy individuals with low and high levels of autistic-like traits can be reduced. This outcome is encouraging, and suggests that other aspects of attention in autism (e.g., face processing) may stand to benefit from similar stimulation techniques.

Metabolic acidosis and other determinants of hemoglobin-oxygen dissociation in severe childhood Plasmodium falciparum malaria.

Metabolic acidosis is a common complication of severe malaria caused by Plasmodium falciparum. The factors contributing to the acidosis were assessed in 62 children with severe falciparum malaria (cases) and in 29 control children who had recently recovered from mild or moderate malaria. The acidosis was largely caused by the accumulation of both lactic and 3-hydroxybutyric acids. The determinants of oxygen release to the tissues were also examined; although there was no difference between cases and controls in respect of 2,3-bisphosphoglycerate and mean corpuscular hemoglobin concentration, there was a marked increase in P(50) in the cases, caused by pyrexia, low pH, and base deficit. There was substantial relative or actual hypoglycemia in many cases. The relationship of these observations to therapeutic strategy is discussed.

Perioperative thermal insulation.

Perioperative hypothermia remains a common problem during anesthesia and surgery. Unfortunately, the implementation of new minimally invasive surgical procedures has not lead to a reduction of this problem. Heat losses from the skin can be reduced by thermal insulation to avoid perioperative hypothermia. However, only a small amount of information is available regarding the physical properties of insulating materials used in the Operating Room (OR). Therefore, several materials using validated manikins were tested. Heat loss from the surface of the manikin can be described as:"Q = h . DeltaT . A" where Q = heat flux, h = heat exchange coefficient, DeltaT = temperature gradient between the environment and surface, and A = covered area. Heat flux per unit area and surface temperature were measured with calibrated heat flux transducers. Environmental temperature was measured using a thermoanemometer. The temperature gradient between the surface and environment (DeltaT) was varied and "h" was determined by linear regression analysis as the slope of "DeltaT" versus heat flux per unit area. The reciprocal of the heat exchange coefficient defines the insulation. The insulation values of the materials varied between 0.01 Clo (plastic bag) to 2.79 Clo (2 layers of a hospital duvet). Given the range of insulating materials available for outdoor activities, significant improvement in insulation of patients in the OR is both possible and desirable.

Threatening faces fail to guide attention for adults with autistic-like traits.

Individuals diagnosed with autistic spectrum conditions often show deficits in processing emotional faces relative to neurotypical peers. However, little is known about whether similar deficits exist in neurotypical individuals who show high-levels of autistic-like traits. To address this question, we compared performance on an attentional blink task in a large sample of adults who showed low- or high-levels of autistic-like traits on the Autism Spectrum Quotient. We found that threatening faces inserted as the second target in a rapid serial visual presentation were identified more accurately among individuals with low- compared to high-levels of autistic-like traits. This is the first study to show that attentional blink abnormalities seen in autism extend to the neurotypical population with autistic-like traits, adding to the growing body of research suggesting that autistic-related patterns of behaviors extend into a subset of the neurotypical population. Autism Res 2017, 10: 311-320. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.