Exogenous capture accounts for fundamental differences between prosaccade and antisaccade performance

Oculomotor circuits generate eye movements based on the physical salience of objects and current behavioral goals, exogenous and endogenous influences, respectively. However, the interactions between exogenous and endogenous mechanisms and their dynamic contributions to target selection have been difficult to resolve because they evolve extremely rapidly. In a recent study (Salinas et al., 2019), we achieved the necessary temporal precision using an urgent variant of the antisaccade task wherein motor plans are initiated early and choice accuracy depends sharply on when exactly the visual cue information becomes available. Empirical and modeling results indicated that the exogenous signal arrives ~80 ms after cue onset and rapidly accelerates the (incorrect) plan toward the cue, whereas the informed endogenous signal arrives ~25 ms later to favor the (correct) plan away from the cue. Here, we scrutinize a key mechanistic hypothesis about this dynamic, that the exogenous and endogenous signals act at different times and independently of each other. We test quantitative model predictions by comparing the performance of human participants instructed to look toward a visual cue versus away from it under high urgency. We find that, indeed, the exogenous response is largely impervious to task instructions; it simply flips its sign relative to the correct choice, and this largely explains the drastic differences in psychometric performance between the two tasks. Thus, saccadic choices are strongly dictated by the alignment between salience and behavioral goals.

Advances in “Omics” Approaches for Improving Toxic Metals/Metalloids Tolerance in Plants

Food safety has emerged as a high-urgency matter for sustainable agricultural production. Toxic metal contamination of soil and water significantly affects agricultural productivity, which is further aggravated by extreme anthropogenic activities and modern agricultural practices, leaving food safety and human health at risk. In addition to reducing crop production, increased metals/metalloids toxicity also disturbs plants’ demand and supply equilibrium. Counterbalancing toxic metals/metalloids toxicity demands a better understanding of the complex mechanisms at physiological, biochemical, molecular, cellular, and plant level that may result in increased crop productivity. Consequently, plants have established different internal defense mechanisms to cope with the adverse effects of toxic metals/metalloids. Nevertheless, these internal defense mechanisms are not adequate to overwhelm the metals/metalloids toxicity. Plants produce several secondary messengers to trigger cell signaling, activating the numerous transcriptional responses correlated with plant defense. Therefore, the recent advances in omics approaches such as genomics, transcriptomics, proteomics, metabolomics, ionomics, miRNAomics, and phenomics have enabled the characterization of molecular regulators associated with toxic metal tolerance, which can be deployed for developing toxic metal tolerant plants. This review highlights various response strategies adopted by plants to tolerate toxic metals/metalloids toxicity, including physiological, biochemical, and molecular responses. A seven-(omics)-based design is summarized with scientific clues to reveal the stress-responsive genes, proteins, metabolites, miRNAs, trace elements, stress-inducible phenotypes, and metabolic pathways that could potentially help plants to cope up with metals/metalloids toxicity in the face of fluctuating environmental conditions. Finally, some bottlenecks and future directions have also been highlighted, which could enable sustainable agricultural production.

Service use, clinical outcomes and user experience associated with urgent care services that use telephone-based digital triage: a systematic review

ObjectiveTo evaluate service use, clinical outcomes and user experience related to telephone-based digital triage in urgent care.DesignSystematic review and narrative synthesis.Data sourcesMedline, Embase, CINAHL, Web of Science and Scopus were searched for literature published between 1 March 2000 and 1 April 2020.Eligibility criteria for selecting studiesStudies of any design investigating patterns of triage advice, wider service use, clinical outcomes and user experience relating to telephone based digital triage in urgent care.Data extraction and synthesisTwo reviewers extracted data and conducted quality assessments using the mixed methods appraisal tool. Narrative synthesis was used to analyse findings.ResultsThirty-one studies were included, with the majority being UK based; most investigated nurse-led digital triage (n=26). Eight evaluated the impact on wider healthcare service use following digital triage implementation, typically reporting reduction or no change in service use. Six investigated patient level service use, showing mixed findings relating to patients’ adherence with triage advice. Evaluation of clinical outcomes was limited. Four studies reported on hospitalisation rates of digitally triaged patients and highlighted potential triage errors where patients appeared to have not been given sufficiently high urgency advice. Overall, service users reported high levels of satisfaction, in studies of both clinician and non-clinician led digital triage, but with some dissatisfaction over the relevance and number of triage questions.ConclusionsFurther research is needed into patient level service use, including patients’ adherence with triage advice and how this influences subsequent use of services. Further evaluation of clinical outcomes using larger datasets and comparison of different digital triage systems is needed to explore consistency and safety. The safety and effectiveness of non-clinician led digital triage also needs evaluation. Such evidence should contribute to improvement of digital triage tools and service delivery.PROSPERO registration numberCRD42020178500.

Stakeholder management strategies employed on building projects procured by private corporate organisations in south-western Nigeria

PurposeAdvocates of structured stakeholder management (SM) processes have emphasized the use of the appropriate strategies as the most important process in SM. Yet, research effort in this regard in developing countries has been inadequate. The purpose of the study was to examine the SM strategies used on building projects procured by private corporate organisations in south-western Nigeria to enhance project performance.Design/methodology/approachThe study used a census survey to select 30 projects managers who indicated (from 106 who responded to a first stage questionnaire) that they have participated in structured SM in the study area between 2008 and 2017. A second-stage questionnaire was designed to elicit information from the respondents. Data analysis was done with the use of frequency, percentile and mean score (MS) and analysis of variance (ANOVA).FindingsStakeholders with high power and high interest were managed with the use of “collaborate/partner” strategy (MS = 3.86), stakeholders with high power and low interest were “kept satisfied” (MS = 4.09), stakeholders with low power and high interest were managed by using “keep them informed regularly” strategy (MS = 4.10) and stakeholders with low power and low interest were managed using “monitor and respond when necessary” strategy (M = 3.94). Further results show that static stakeholders with high power were managed by using the “monitor constantly” strategy (MS = 4.11), stakeholders with high power, high legitimacy and high urgency were managed by adopting the “keep satisfied” strategy (MS = 4.26), to manage non-supportive stakeholders, project managers adopted the “keep satisfied” strategy (MS = 4.18) and supportive stakeholders were managed by using “involved” strategy (MS = 4.02). More results showed that there is no significant difference in the opinion of project managers on SM strategies employed irrespective of procurement method.Practical implicationsThe study provided a guide to project managers on the appropriate SM strategies to use for future projects.Originality/valueThe study was an attempt to appraise the SM strategies in relation to the procurement methods and their relationship with project performance.

Psychosocial Risk and Health Behaviors as Predictors of Clinical Events in Patients Wait-Listed for a New Heart: Results from 7 Years of Follow-Up

We examined the long-term relationship of psychosocial risk and health behaviors on clinical events in patients awaiting heart transplantation (HTx). Psychosocial characteristics (e.g., depression), health behaviors (e.g., dietary habits, smoking), medical factors (e.g., creatinine), and demographics (e.g., age, sex) were collected at the time of listing in 318 patients (82% male, mean age = 53 years) enrolled in the Waiting for a New Heart Study. Clinical events were death/delisting due to deterioration, high-urgency status transplantation (HU-HTx), elective transplantation, and delisting due to clinical improvement. Within 7 years of follow-up, 92 patients died or were delisted due to deterioration, 121 received HU-HTx, 43 received elective transplantation, and 39 were delisted due to improvement. Adjusting for demographic and medical characteristics, the results indicated that frequent consumption of healthy foods (i.e., foods high in unsaturated fats) and being physically active increased the likelihood of delisting due improvement, while smoking and depressive symptoms were related to death/delisting due to clinical deterioration while awaiting HTx. In conclusion, psychosocial and behavioral characteristics are clearly associated with clinical outcomes in this population. Interventions that target psychosocial risk, smoking, dietary habits, and physical activity may be beneficial for patients with advanced heart failure waiting for a cardiac transplant.

First and Second Wave Dynamics of Emergency Department Utilization during the COVID-19 Pandemic: a retrospective study

Background: Since the COVID-19 pandemic, there has been a decrease in emergency department(ED) utilization. Although this has been thoroughly characterized for the first wave(FW), studies during the second wave(SW) are limited. We examined the changes in ED utilization between the FW and SW, compared to 2019 reference periods. Methods: We performed a retrospective analysis of ED utilization in 3 Dutch hospitals in 2020. The FW and SW (March until June and September until December, respectively) were compared to the reference periods in 2019. ED visits were labeled as (non)COVID suspected. Findings: During the FW and SW ED visits decreased by 20.3% and 15.3%, respectively, when compared to reference periods in 2019. During both waves high urgency visits significantly increased with 3.1% and 2.1%, and admission rates (ARs) increased with 5.0% and 10.4%. Trauma related visits decreased by 5.2% and 3.4%. During the SW we observed less COVID-related visits compared to the FW (4,407 vs 3,102 patients). COVID related visits were significantly more often in higher need of urgent care and ARs where at least 24.0% higher compared to non COVID visits. Interpretation: During both COVID-19 waves ED visits were significantly reduced, with the most distinct decline during the FW. ED patients were more often triaged as high urgent and the ARs were increased compared to the reference period in 2019, reflecting a high burden on ED resources. These findings indicate the need to gain more insight into motives of patients to delay or avoid emergency care during pandemics and prepare EDs for future pandemics.

The Influence of Service Quality and Company Image to Customer Loyalty through Corporate Customer Satisfaction on XXX Group

To increase economic growth through infrastructure development in Indonesia, the Government is accelerating projects that are considered strategic and have high urgency to be realized in a short period. XXX Group which is one of the large cement companies in Indonesia is a great opportunity because PSN will use a large amount of cement in its work. But XXX Group is not alone in the cement market, many competitors compete to get PSN (Project National Stategic), so each company uses a surefire strategy in marketing its products both in terms of service quality and by improving the company's image in the eyes of customers so that customers are satisfied with XXX Group and will increase customer loyalty. The purpose of this research is to know and analyze the influence of service quality and company image directly on customer loyalty and the indirect influence of service quality and company image on customer loyalty through customer satisfaction at XXX Group. The type of data used is quantitative in the form of primary and secondary data. The population of this study is a company that makes purchases as many as 42 projects and the sample recall used is a saturated sample so that all populations are used into samples. The data analysis method used is to use the structural equation model by using Smart PLS 3.0 program. The results showed the quality of service has a positive and significant effect on customer loyalty, the company's image has a positive and significant effect on customer loyalty. The quality of service has a positive and significant effect on customer satisfaction, the image has a positive and significant effect on customer satisfaction. Customer satisfaction has a positive and significant effect on customer loyalty. Customer satisfaction mediates the influence of service quality and company image in shaping customer loyalty. Coefficient of determining the influence of service quality and company image on customer loyalty (R2) by 97.6% and coefficient of determining the influence of service quality and company image on customer loyalty through customer satisfaction (R2) by 99.0% Keywords: Service Quality, Company Image, Customer Satisfaction, Customer Loyalty.

The effect of photodynamic therapy on the wound process dynamics in patients with purulent hand diseases

Despite the progress in modern surgery, the number of patients with purulent finger and hand diseases keeps growing these days in the clinical practice of surgeons. In recent years, there has been a tendency to develop more severe forms of panaritium and phlegmon in an increasingly young contingent of patients. Increasingly, doctors refuse to use the classical method of managing a postoperative wound of the hand involving the installation of drainage tubes. This phenomenon is polygenic and calls for special attention due to the frequent deplorable consequences of a treatment failure. The high urgency of this issue in Moscow Hospital No. 4 has become a rationale to study the effect of photodynamic therapy (PDT) on the course of the wound process in patients with this pathology.The purpose of this work is to develop a technique to advance the treatment outcomes for patients with purulent finger and hand diseases in case of open postoperative wound treatment.This study includes a comparative analysis of the wound process dynamics in 49 (49.5%) patients who underwent a photodynamic therapy session in the postoperative period and in 50 (50.5%) patients who received an open wound treatment after the operation. Photodynamic therapy was performed on the second postsurgical day by a laser apparatus “Atkus-2” (wave length 661 nm) with a gel form of the chlorinseries photosensitizer photoditazin in the form of an application at the rate of 1 g ml per 3–5 cm2 of the wound surface. The power density was chosen in the range of 0.1–1 W / cm2, and the time of exposure to the wound varied from 30 to 400 seconds, depending on the area of the wound.To assess the dynamics of the wound process in the postoperative period, we took measurements of all the patients’ wound areas on the 1st and 5th days, monitored the gross impression daily. In the patients who received PDT, we observed an earlier wound cleansing and remitting of the inflammatory process, acceleration of the edge epithelization, and earlier appearance of the granulation tissue by an average of 2 days. In the group of patients who were treated with PDT in the postoperative period, on the 5th day, the wound defect decreased by an average of 1 cm2, which amounted to 22.4%, in the control group – by 18%. The analysis of cytological and morphological patterns also revealed an accelerated switch from the inflammatory stage of the wound process to the reparative one - the reparative processes in the PDT group began earlier by 2 days. The microbiological analysis of wound exudate showed a downregulation of microflora after a PDT session - only in 6 cases pathogens were identified in the repeated seeding, which amounted to 12.24% of the group compared to 38% of the control group. After a session of photodynamic therapy, patients noted a significant reduction in pain, including during dressings. The pain syndrome immediately after the session decreased by 2–3 points. By the 5th day it became moderate – 4–5 points. In the control group, this indicator on the 2nd day was 8 points, decreasing by the 5th day to 6 points. For all analyzed indicators, the groups had statistically significant differences (p <0.001). Acceleration of postoperative wounds healing enabled to shorten the inpatient stay by 6 days and bring a vast improvement to the treatment quality for this group of patients, which allows considering photodynamic therapy as a high potential method for postoperative treatment of purulent finger and hand diseases.

Recipient-Specific Risk Factors Impairing Patient and Graft Outcome after Pediatric Liver Transplantation—Analysis of 858 Transplantations in 38 Years

(1) Background and Aim: Despite excellent long-term results in pediatric liver transplantation (pLTx), mortality and graft loss still are to be diminished. We aim to describe time-dependent changes and long-term outcome of a large single-center pLTx cohort and to identify independent recipient-related risk factors impairing patient and graft survival. (2) Methods: This is a retrospective single-center study analyzing all pediatric liver transplants from 1983–2020. Risk factors for mortality and graft loss were identified by univariable and multi-linear regression analysis. (3) Results: We analyzed 858 liver transplantations in 705 pediatric patients. Five-year patient/graft survival increased from 60.9%/48.0% (1983–1992) to 97.5%/86.5% (OR = 12.5; p < 0.0001/OR = 6.5; p < 0.0001) (2014–2020). Indications changed significantly over time, with a higher proportion of patients being transplanted for malignancies and metabolic disease and indications of PFIC and α1AT-deficiency declining. The era of transplantation (log7.378/9.657; p < 0.0001) and indication of acute liver failure (log = 1.944/2.667; HR = 2.015/1.772; p = 0.0114/0.002) impairs patient/graft survival significantly in the multivariate analysis. Furthermore, patient survival is worsened by re-transplantation (log = 1.755; HR = 1.744; p = 0.0176) and prolonged waiting times in high-urgency status (log = 2.588; HR = 1.073; p = 0.0026), whereas the indication of biliary atresia improved outcome (log = 1.502; HR = 0.575; p = 0.0315). Graft survival was additionally impaired by pre-existing portal vein thrombosis (log = 1.482; HR = 2.016; p = 0.0330). (4) Conclusions: Despite more complex indications, patient and graft survival after pLTx continue to improve.. Acute liver failure remains the indication with poorest outcome, and listing for high urgency liver transplantation should be considered carefully and early to keep waiting time on HU list short. Furthermore, pre-transplant portal vein thrombosis should be prevented whenever possible to improve graft survival.

Improving triage for children with comorbidity using the ED-PEWS: an observational study

ObjectiveTo assess the value of the Emergency Department–Pediatric Early Warning Score (ED-PEWS) for triage of children with comorbidity.DesignSecondary analysis of a prospective cohort.Setting and patients53 829 consecutive ED visits of children <16 years in three European hospitals (Netherlands, UK and Austria) participating in the TrIAGE (Triage Improvements Across General Emergency departments) project in different periods (2012–2015).InterventionED-PEWS, a score consisting of age and six physiological parameters.Main outcome measureA three-category reference standard as proxy for true patient urgency. We assessed discrimination and calibration of the ED-PEWS for children with comorbidity (complex and non-complex) and without comorbidity. In addition, we evaluated the value of adding the ED-PEWS to the routinely used Manchester Triage System (MTS).Results5053 (9%) children had underlying non-complex morbidity and 5537 (10%) had complex comorbidity. The c-statistic for identification of high-urgency patients was 0.86 (95% prediction interval 0.84–0.88) for children without comorbidity, 0.87 (0.82–0.92) for non-complex and 0.86 (0.84–0.88) for complex comorbidity. For high and intermediate urgency, the c-statistic was 0.63 (0.62–0.63), 0.63 (0.61–0.65) and 0.63 (0.55–0.73) respectively. Sensitivity was slightly higher for children with comorbidity (0.73–0.75 vs 0.70) at the cost of a lower specificity (0.86–0.87 vs 0.92). Calibration was largely similar. Adding the ED-PEWS to the MTS for children with comorbidity improved performance, except in the setting with few high-urgency patients.ConclusionsThe ED-PEWS has a similar performance in children with and without comorbidity. Adding the ED-PEWS to the MTS for children with comorbidity improves triage, except in the setting with few high-urgency patients.