Computer-based Program Research Articles

Development of computer-based program for Instructors in teaching Hangeul as a second and foreign language

이 연구에서는 한국어 교육 현장에서 현행 교육 환경 및 매체 자료 활용의 한계를 극복하여 한글을 효과적으로 교육하는 데 도움이 되는 수업용 컴퓨터 프로그램을 개발, 제시하는 것을 목적으로 한다. 목표 항목의 제시를 분명히 하고 교수자의 설명을 보조하는 데 도움이 되는 교수 자용 보조 자료를 개발하는 것이다. 이를 위해 한글 교육에서 보조 자료의 필요성을 선행 연구 결과를 통해 검토하고, 한국어 학습자의 한글 자모 오류 분석을 통해 이들을 프로그램 구성에 반영하였다. 교재에 나타난 한글 교육에서는 교육 내용, 교육 제시 순서, 연습 활동의 유형 등에서 차이를 보여 보조 매체 자료 선택에 제약이 따름을 알 수 있었다. 한국어 학습자가 범하는 오류는 자모의 자형, 음절 구성 시 모아쓰기에서 많이 나타났다. 이에 프로그램 내용에 이를 적극적으로 반영하되, 교수 매체 설계 시 유의해야 하는 단순성, 일관성의 원리에 따라 전체 디자인, 글꼴, 색상의 단계로 구성을 하였다. 이 연구 결과로서 개발된 프로그램은 한글 교육 내용의 범위와 절차, 방법 등 교수 환경에 큰 영향을 받지 않고 교실 현장에서 바로 적용 가능하다는 점에서 의의가 있다고 하겠다.

The influence of computer-based cognitive flexibility training on subjective cognitive well-being after stroke: A multi-center randomized controlled trial.

BackgroundStroke can result in cognitive complaints that can have a large impact on quality of life long after its occurrence. A number of computer-based training programs have been developed with the aim to improve cognitive functioning. Most studies investigating their efficacy used only objective outcome measures, whereas a reduction of subjective cognitive complaints may be equally important for improving quality of life. A few studies used subjective outcome measures but were inconclusive, partly due to methodological shortcomings such as lack of proper active and passive control groups.ObjectiveThe aim of the current study was to investigate whether computer-based cognitive flexibility training can improve subjective cognitive functioning and quality of life after stroke.MethodsWe performed a randomized controlled double blind trial (RCT). Adults (30–80 years old) who had a stroke 3 months to 5 years ago, were randomly assigned to either an intervention group (n = 38), an active control group (i.e., mock training; n = 35), or a waiting list control group (n = 24). The intervention and mock training consisted of 58 half-hour sessions within 12 weeks. The primary subjective outcome measures were cognitive functioning (Cognitive Failure Questionnaire), executive functioning (Dysexecutive Functioning Questionnaire), quality of life (Short Form Health Survey), instrumental activities of daily living (IADL; Lawton & Brody IADL scale), and participation in society (Utrecht Scale for Evaluation of Rehabilitation-Participation). Secondary subjective outcome measures were recovery after stroke, depressive symptoms (Hospital Anxiety Depression Scale—depression subscale), fatigue (Checklist Individual Strength—Fatigue subscale), and subjective cognitive improvement (exit list). Finally, a proxy of the participant rated the training effects in subjective cognitive functioning, subjective executive functioning, and IADL.Results and conclusionsAll groups improved on the two measures of subjective cognitive functioning and subjective executive functioning, but not on the other measures. These cognitive and executive improvements remained stable 4 weeks after training completion. However, the intervention group did not improve more than the two control groups. This suggests that improvement was due to training-unspecific effects. The proxies did not report any improvements. We, therefore, conclude that the computer-based cognitive flexibility training did not improve subjective cognitive functioning or quality of life after stroke.

Achieving Drug and Alcohol Abstinence Among Recently Incarcerated Homeless Women: A Randomized Controlled Trial Comparing Dialectical Behavioral Therapy-Case Management With a Health Promotion Program.

Homeless female ex-offenders (homeless female offenders) exiting jail and prison are at a critical juncture during reentry and transitioning into the community setting. The purpose of the study was to compare the effect of a dialectical behavioral therapy-case management (DBT-CM) program with a health promotion (HP) program on achieving drug and alcohol abstinence among female parolees/probationers residing in the community. We conducted a multicenter parallel randomized controlled trial with 130 female parolees/probationers (aged 19-64 years) residing in the community randomly assigned to either DBT-CM (n = 65) or HP (n = 65). The trial was conducted in four community-based partner sites in Los Angeles and Pomona, California, from February 2015 to November 2016. Treatment assignment was carried out using a computer-based urn randomization program. The primary outcome was drug and alcohol use abstinence at 6-month follow up. Analysis was based on data from 116 participants with complete outcome data. Multivariable logistic regression revealed that the DBT-CM program remained an independent positive predictor of decrease in drug use among the DBT-CM participants at 6 months (p = .01) as compared with the HP program participants. Being non-White (p < .05) and having higher depressive symptom scores (p < .05) were associated with lower odds of drug use abstinence (i.e., increased the odds of drug use) at 6 months. DBT-CM increased drug and alcohol abstinence at 6-month follow-up, compared to an HP program.

Effect of an internet-based sexually transmitted infection testing and results service on diagnoses and testing uptake: a single-blind, randomised controlled trial

BackgroundSexually transmitted infection (STI) self-sampling kits accessed via the internet (e-STI testing) is recommended despite a limited evidence base. We aimed to evaluate the effect of an e-STI testing service (chlamydia, gonorrhoea, HIV, and syphilis) on diagnoses and testing uptake, when delivered alongside usual care. MethodsIndividuals aged 16–30 years, resident in two London boroughs, with at least one sexual partner in the previous 12 months and willing to test, were recruited in community settings. An independent computer-based randomisation programme allocated participants to an e-STI testing service (intervention) or a website with signposting to local sexual health clinics (control). Primary outcomes at 6 weeks were diagnosis of any STI and completion of any STI test. 3000 participants were required to detect a relative risk of 3·5 for STI diagnoses, with 90% power at a 5% level of significance, allowing for 10% losses to follow up. Laboratory staff and outcome assessors were blinded to treatment allocation. All analyses were intention to treat. We used multivariate imputation by chained equations (MICE) for the primary analyses. All participants provided written informed consent. Ethics approval was granted by the National Research Ethics Service Committee London-Camberwell St Giles (ref 14/LO/1477). This trial is registered with Current Controlled Trials, number ISRCTN13354298. Findings2072 participants were randomised (after nine exclusions, 1031 intervention, 1032 control, mean age 23 years, SD 3·6). Response rate was 84%. 1031 participants were analysed in the intervention and 1032 in the control group. At 6 weeks, 50·0% of the intervention group completed an STI test compared with 26·6% of the control group (relative risk 1·87, 95% CI 1·63–2·15; p<0·0001). 2·8% of the intervention group versus 1·4% of the control group were diagnosed with an STI (2·10, 0·94–4·70; p=0·079). The proportions of participants treated were 1·1% for intervention and 0·7% for controls (1·72, 0·71–4·16; p=0·231). No heterogeneity was observed in pre-specified subgroup analyses. Time to test was lower in the intervention arm than in the control arm (restricted mean 28·8 days [SE 0·5] vs 36·5 [0·4], p<0·0001). No differences were observed for time to treatment. InterpretationThe findings show that e-STI testing increased testing uptake. We were underpowered for the analyses of STI diagnoses and STI cases treated but our estimates suggested effects in the expected direction. Future service innovations may ensure that gains in testing and diagnoses translate into similar gains in cases treated. e-STI services require long-term evaluation. FundingGuy's and St Thomas' Charity.

Functional analysis of schizophrenia genes using GeneAnalytics program and integrated databases

Schizophrenia (SCZ) is a chronic debilitating neuropsychiatric disorder with multiple risk factors involving numerous complex genetic influences. We examined and updated a master list of clinically relevant and susceptibility genes associated with SCZ reported in the literature and genomic databases dedicated to gene discovery for characterization of SCZ genes. We used the commercially available GeneAnalytics computer-based gene analysis program and integrated genomic databases to create a molecular profile of the updated list of 608 SCZ genes to model their impact in select categories (tissues and cells, diseases, pathways, biological processes, molecular functions, phenotypes and compounds) using specialized GeneAnalytics algorithms. Genes for schizophrenia were predominantly expressed in the cerebellum, cerebral cortex, medulla oblongata, thalamus and hypothalamus. Psychiatric/behavioral disorders incorporating SCZ genes included ADHD, bipolar disorder, autism spectrum disorder and alcohol dependence as well as cancer, Alzheimer's and Parkinson's disease, sleep disturbances and inflammation. Function based analysis of major biological pathways and mechanisms associated with SCZ genes identified glutaminergic receptors (e.g., GRIA1, GRIN2, GRIK4, GRM5), serotonergic receptors (e.g., HTR2A, HTR2C), GABAergic receptors (e.g., GABRA1, GABRB2), dopaminergic receptors (e.g., DRD1, DRD2), calcium-related channels (e.g., CACNA1H, CACNA1B), solute transporters (e.g., SLC1A1, SLC6A2) and for neurodevelopment (e.g., ADCY1, MEF2C, NOTCH2, SHANK3). Biological mechanisms involving synaptic transmission, regulation of membrane potential and transmembrane ion transport were identified as leading molecular functions associated with SCZ genes. Our approach to interrogate SCZ genes and their interactions at various levels has increased our knowledge and insight into the disease process possibly opening new avenues for therapeutic intervention.

Efficacy of Seren@ctif, a Computer-Based Stress Management Program for Patients With Adjustment Disorder With Anxiety: Protocol for a Controlled Trial.

BackgroundAdjustment disorder with anxiety (ADA) is the most frequent and best characterized stress-related psychiatric disorder. The rationale for prescription of benzodiazepine monotherapy is a public health issue. Cognitive behavioral stress management programs have been studied in many countries. Several reports have shown beyond reasonable doubt their efficiency at reducing perceived stress and anxiety symptoms and improving patient quality of life. Considering the number of people who could benefit from such programs but are unable to access them, self-help programs have been offered. First presented as books, these programs became enriched with computer-based and digital supports. Regrettably, programs for stress management based on cognitive behavioral therapy (CBT), both face-to-face and digital support, have been only minimally evaluated in France. To our knowledge, the Seren@ctif program is the first French language self-help program for stress management using digital supports.ObjectiveThe aim of this study is to assess the effectiveness of a 5-week standardized stress management program for reducing anxiety conducted via eLearning (iCBT) or through face-to-face interviews (CBT) with patients suffering from ADA compared with a wait list control group (WLC). These patients seek treatment in a psychiatric unit for anxiety disorders at a university hospital. The primary outcome is change in the State Trait Anxiety Inventory scale trait subscale (STAI-T) between baseline and 2-month visit.MethodsThis is a multicenter, prospective, open label, randomized controlled study in 3 parallel groups with balanced randomization (1:1:1): computer-based stress management with minimal contact (not fully automated) (group 1), stress management with face-to-face interviews (group 2), and a WLC group that receives usual health care from a general practitioner (group 3). Programs are based on standard CBT principles and include 5 modules in 5 weekly sessions that include the following topics: stress and stress reaction and assessment; deep respiration and relaxation techniques; cognitive restructuring, mindfulness, and acceptance; behavioral skills as problem solving; and time management, healthy behaviors, and emotion regulation. In the Internet-based group, patients have minimal contact with a medical professional before and after every session. In the first session, a flash memory drive is supplied containing videos, audio files, a self-help book portfolio in the form of an eGuide, and log books providing the exercises to be completed between 2 sessions. The patient is encouraged to practice a 20-minute daily exercise 5 or 6 times per week. In the face-to-face group, patients receive the same program from a therapist with 5 weekly sessions without digital support. Interviews and self-assessments were collected face-to-face with the investigator.ResultsThe feasibility of this program is being tested, and results show good accessibility in terms of acceptance, understanding, and treatment credibility. Results are expected in 2018.ConclusionsTo our knowledge, this is the first French study to examine the effectiveness of a computer-based stress management program for patients with ADA. The Seren@ctif program may be useful within the framework of a psychoeducative approach. It could also be advised for people suffering from other diseases related to stress and for people with a clinical level of perceived stress.Trial RegistrationClinicaltrials.gov NCT02621775; https://clinicaltrials.gov/ct2/show/NCT02621775 (Archived by WebCite at http://www.webcitation.org/6tQrkPs1u)

6.28 The Study of Computerized Executive Function Training on Children With Attention-Deficit/Hyperactivity Disorder (ADHD) in Shanghai

The deficits in executive functions (EF) seem to play a role in ADHD. This study focuses on computer-based programs designed to promote executive function training in children with ADHD and to explore whether they improve the deficits in executive functions and clinical behaviors.

Computer-Based Prevention and Intervention to Reduce Substance Use in Youth.

Computer-based programs for substance use prevention and intervention among youth are on the ascendancy. Whether delivered by computer per se or by electronic tablet or smartphone, technology-driven programs are harmonious with how young people access information and interact with their worlds. This review examines recent evidence on computer-based programs aimed at substance use among youth, with particular attention to results from randomized trials. Outcome studies of computer-based, substance use-related programs published over the past 5 years reveal mixed results amidst diverse intervention approaches and delivery settings. Many studies are marred by high attrition. Notable in the recent literature is the international nature of technology-driven substance use prevention and intervention programs. With some exceptions, most programs appear to not have been customized for their recipient populations. Though few in number, the highest-quality studies of computer-based programs show positive outcomes in reduced substance use rates. Based on recent findings, considerable work needs to happen before computer-delivered approaches are a proven means for reducing substance use among youth. Original programs, expressly developed for subgroups of youth, are in short supply. Though controlled designs are becoming commonplace, too many studies of computer-based programs suffer from flaws-including high rates of attrition-that limit the discovery of positive outcomes.

S194 The role of the cerebellum in movement disorders

Objectives Although movement disorders like Parkinson’s Disease (PD) or dystonia have traditionally been regarded as basal ganglia dysfunction, recent evidence has emerged of cerebellar involvement in the pathophysiology of these movement disorders. Methods Patients with PD, dystonia and healthy controls (HC) underwent fMRI during an interception of a moving target. Effective connectivity (EC) and its modulation by behavioural outcome in a network comprised of the cerebellum, BG, and other cortical areas was studied, too. Results (i) In patients with PD, despite having similar hit ratios, the PD failed more often than the HC to postpone their actions until the right moment and to adapt their behaviour from one trial to the next. We found more activation in the right cerebellar lobule VI in HC than in PD during successful trials. Successful trial-to-trial adjustments were associated with higher activity in the right putamen and lobule VI of the cerebellum in HC. (ii) In patients with dystonia, left cerebellar lobule VI was used as the seed for the psychophysiologic interaction model. In addition of lower performance in the task itself, we found decreased connectivity of the above specified seed to basal ganglia complex. Discussion We propose that PD and dystonia are a large scale dysfunction, involving not only cortico-basal ganglia-thalamo-cortical pathways, but cortico-ponto-cerebello-thalao-cortical loop as well. Significance Further research leading to the delineation of other brain areas active during this behaviour in addition to computer-based neuro-rehabilitation programs could improve the movement disorders patients performance.

A Novel Computer Oculomotor Rehabilitation (COR) Program for Mild Traumatic Brain Injury (mTBI).

Individuals with traumatic brain injury (TBI) manifest a wide range of visual dysfunctions. One of the most prevalent involves the oculomotor system, which includes version, vergence, and accommodation. However, until recently, there has been no comprehensive, computer-based program for remediation of these oculomotor deficits. We present such an oculomotor rehabilitation program that has been tested in a clinical trial in patients having TBI with a high degree of success based on before-and-after objective system recordings, performance measures, and related visual symptomotology. The basic program components include a versatile stimulus package incorporating the attentional paradigm of rapid serial visual presentation (RSVP), the ability to add a visual and/or auditory distractor to the training to increase difficulty level (“task loading”), automated assessment of RSVP errors, and automated assessment of visual performance over the training period. Program limitations and future directions are also considered.

L’entraînement de la mémoire de travail est-il bénéfique pour les enfants présentant un trouble déficit de l’attention/hyperactivité ?

IntroductionChildhood attention-deficit/hyperactivity disorder is known to be associated with impairment across multiple domains, including social, familial, emotional and academic functioning. Available therapies, and in particular medical treatment, fail to produce lasting improvement in academic and learning outcomes. In this context, recent years have seen a growing interest of experts and practitioners for computer-based cognitive training programs. Indeed, it has been proposed that repeated training of specific executive functions may result in lasting benefits for children with ADHD, especially in the school setting. Cogmed RoboMemo, a program targeting working memory, is the cognitive training that has been the most extensively studied. Literature findingsMeta-analyses have established that the vast majority of children with ADHD present with decreased performance levels compared to typically developing children when performing working memory tasks. Working memory deficits, in turn, have been linked with classroom inattention and decreased academic performance. Based on these findings, models describing working memory deficits as a core feature of ADHD, accounting both for inattentive and hyperactive symptoms, have been proposed. In this theoretical context, interventions specifically targeting working memory deficits in ADHD appear as particularly promising. However, despite this solid theoretical background, meta-analyses of randomized controlled trials relying on the Cogmed RoboMemo program have consistently failed to evidence significant therapeutic effects on key targets, including ADHD symptoms or academic performance. These results suggest that early reports of clinical efficacy with non-blinded assessors were confounded by placebo and expectancy effects. DiscussionDifferent hypotheses have been proposed to explain this lack of significant therapeutic effect. First, it has been observed that Cogmed RoboMemo primarily targets the storage/rehearsal capacity of the child, whereas children with ADHD appear mostly impaired when performing tasks with a strong central executive load (i. e. requiring manipulation and dynamic updating of information). The Cogmed cognitive training program may therefore simply focus on the wrong element of working memory in the context of ADHD. Second, authors have questioned whether RoboMemo practice truly results in increased working memory capacity, proposing that children may simply learn task-specific strategies that they are unable to use in a broader context. In line with this idea, it has also been suggested that training in a non-ecological situation could be insufficient, if children with ADHD do not also learn strategies to apply the capacity acquired in the class context. Finally, one recent randomized control trial suggests that potential methodological limitations (lack of follow-up and/or limited training intensity) may have prevented previous studies from documenting the beneficial effects of the Cogmed program. ConclusionsMeta-analyses available to date indicate that claims regarding the academic, behavioral, and learning benefits associated with Cogmed RoboMemo are unsupported in ADHD. New studies with a follow-up assessment are needed to ensure that beneficial long-term effects of the program have not been overlooked. The development and evaluation of new cognitive training programs targeting the central executive component of working memory is warranted. More research is also necessary to help understand how working memory capacity of children with ADHD could be in improved in an ecological context.

Retrospective analysis of the effect of aflibercept loading dose on the retinal vessel diameters in patients with treatment-naive neovascular AMD

Background: To evaluate the effects of intravitreal aflibercept (IVA) on retinal vessel diameters in patients with neovascular age-related macular degeneration (AMD).Design, setting, and participants: A retrospective study conducted at the Kutahya Dumlupinar University Faculty of Medicine included 15 eyes of 15 patients with treatment naive neovascular AMD.Methods: All eyes received IVA injections once per month for 3 months; untreated contralateral eyes were used as controls. The central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), and artery-vein ratio (AVR) values were measured using a computer-based program before the first IVA injection and 30 days after the first, second, and third injections. The main outcome measurements were the central macular thickness (CMT), best-corrected visual acuity (BCVA), choroidal thickness, CRAE, CRVE, and AVR.Results: Significant vasoconstriction of the retinal arterioles was observed in all eyes treated with IVA when compared to baseline (p = 0.009). However, no significant differences were found for CRVE or AVR throughout the study period in treated eyes. In the control group, all parameters measured during each visit were similar to baseline measurements (p > 0.05). The mean BCVA significantly improved at the end of the loading dose of IVA, when compared to baseline (p = 0.006). After the IVA injections, the mean CMT and choroidal thickness were significantly reduced at all visits, compared to baseline (p < 0.001).Conclusions: The current study showed that IVA led to significant retinal arteriolar vasoconstriction and choroidal thinning, which may cause reduced retinal blood flow.

The virtual asthma guideline e-learning program: learning effectiveness and user satisfaction.

Background/AimsEffective educational tools are important for increasing adherence to asthma guidelines and clinical improvement of asthma patients. We developed a computer-based interactive education program for asthma guideline named the Virtual Learning Center for Asthma Management (VLCAM). We evaluated the usefulness of program in terms of its effects on user awareness of asthma guideline and level of satisfaction.MethodsPhysicians-in-training at tertiary hospitals in Korea were enrolled in a cross-sectional questionnaire survey. The e-learning program on asthma guideline was conducted over a 2-week period. We investigated changes in the awareness of asthma guideline using 35-item self-administered questionnaire aiming at assessing physicians’ knowledge, attitude, and practice. Satisfaction with the program was scored on 4-point Likert scales.ResultsA total of 158 physicians-in-training at six tertiary hospitals completed the survey. Compared with baseline, the overall awareness obtained from the scores of knowledge, attitude, and practice was improved significantly. Participants were satisfied with the VLCAM program in the following aspects: helpfulness, convenience, motivation, effectiveness, physicians’ confidence, improvement of asthma management, and willingness to recommend. All items in user satisfaction questionnaires received high scores over 3 points. Moreover, the problem-based learning with a virtual patient received the highest user satisfaction among all parts of the program.ConclusionsOur computer-based e-learning program is useful for improving awareness of asthma management. It could improve adherence to asthma guidelines and enhance the quality of asthma care.

Rehabilitation of emergent awareness of errors post traumatic brain injury: A pilot intervention

ABSTRACTImpaired awareness of errors is common following traumatic brain injury (TBI) and can be a barrier to successful rehabilitation. The objective of this study was to develop and evaluate a computer-based intervention programme aimed at improving error awareness in individuals with TBI. A further aim was to explore its effects on metacognitive awareness and variability of performance. Participants were 11 individuals with TBI and impaired error awareness who performed a sustained attention task twice-weekly for four weeks. The intervention consisted of audio-visual feedback-on-errors during the sustained attention task. Six participants received audio-visual feedback-on-error, five did not receive feedback. Emergent and metacognitive awareness were measured pre- and post-intervention. Between-groups comparisons of emergent awareness from pre- to post-intervention showed that audio-visual feedback-on-error improved emergent awareness compared to no feedback-on-error. Some changes in metacognitive awareness of executive behaviours as a result of feedback were observed. Audio-visual feedback-on-error improved emergent awareness in individuals with TBI following a four-week/eight-session intervention. This improvement was not observed in the no-feedback group. This pilot intervention is not a stand-alone treatment but it has potential to be usefully incorporated into cognitive or clinical rehabilitation programmes to improve emergent awareness.

Efficacy of a computer-based cognitive training program in older people with subjective memory complaints: a randomized study

ABSTRACTObjective: the aim of this study was to investigate the effect of computer-assisted cognitive training in healthy older adults with subjective memory complaints.Methods: Forty older adults, mean age (standard deviation) = 66.4 (5.6) with subjective memory complaints, were included in this study. Participants were randomly assigned to an integrated psychostimulation program (IPP) (N = 17), a computerized cognitive training (CCT) (N = 12) or a control group (N = 11). The training was applied for 8 weeks (90 min/d, 4 d/week for IPP, and 60 min/d, 4 d/week for CCT). Effectiveness was evaluated with a neuropsychological assessment battery, used before and after the implementation of the cognitive training.Results: According to the data analysis, with analysis of covariance (ANCOVA), we found a statistically significant change in the majority of the cognitive variables measured before and after the experimental conditions compared with the control group. Although, according to a paired t-test, the IPP was more effective in the improvement of cognitive functioning in the participants. Additionally, a decrease in anxiety symptoms was observed after the cognitive intervention in IPP and CCT conditions.Conclusion: Our findings suggested that cognitive training of moderate intensity, supported by a web platform, could lead to significant improvements in cognitive and psychological well-being in older people with subjective memory complaints.

A Social Needs Assessment Tool for an Urban Latino Population.

Unmet social needs contribute significantly to health outcomes, yet they are not routinely assessed in health care settings. Identifying modifiable social needs and feasible tools to assess them may improve health and decrease costs. We conducted 18 focus groups with 115 participants, stratified by age (18-35, 36-64, and 65+), ethnicity (Hispanic, non-Hispanic), and language (English, Spanish) to explore priority social needs, images to depict social need categories, and acceptability of a computer-based program to identify these needs. The top three social need domains were access to care, health promoting behaviors, and family responsibilities. Participants voiced diverse social needs with notable differences across demographic groups. Both the 36-64year old age groups and Spanish-speaking Hispanic patients were disproportionately impacted by unmet social needs. Perceptions regarding use of an interactive computer program to assess social needs varied by age. Most participants noted that a tablet computer was an acceptable venue to share social needs, though a tutorial may be needed for patients in the 65 and older group. Lastly, participants' ranking of icons were compiled to identify recognizable images of social need categories for those with literacy challenges. Unmet social needs were identified across all groups. This composite of information (priority social needs and images to represent them) will allow for creation of a tailored social need screening tool within an urban Hispanic population.

Attention-memory training yields behavioral and academic improvements in children diagnosed with attention-deficit hyperactivity disorder comorbid with a learning disorder.

BackgroundRecent studies have suggested that children with attention-deficit hyperactivity disorder (ADHD) may benefit from computerized cognitive training. Therapy implementation is especially complicated when ADHD is associated with learning disorders (LDs). This study tested the efficacy of a computer-based cognitive training program, namely, computerized cognitive training (CCT), in children with ADHD comorbid with an LD (ADHD-LD), with or without psychostimulant medication.Materials and methodsAfter diagnostic evaluations, 27 children with ADHD-LD (8 unmedicated and 19 medicated) participated in CCT, which is intended to improve attention, memory, reasoning, visual processing, and executive functioning. The participants completed 24 1-hour sessions over 3 months. Neuropsychometric and standardized academic test results before and after training were compared to assess treatment efficacy. Shapiro–Wilk normality tests were applied, and subsequent Wilcoxon tests were used to identify significant differences in pre-versus post-training performance.ResultsAfter CAT, children diagnosed with ADHD-LD showed 1) improvements in trained skills, measured directly within the software and indirectly by external psychometric tests; 2) improvements in attention, memory, and some executive functioning; 3) improvements in academic performance, particularly in mathematics; and 4) reductions in maladaptive behavioral features.ConclusionThe present findings suggest that cognitive training programs should be explored further as potential adjunctive therapies to improve outcomes in children with ADHD-LD.

ROPS designs to protect operators during agricultural tractor rollovers

Although it is well known that properly used Rollover Protective Structures (ROPS) can virtually prevent agricultural tractor rollover fatalities, the U.S. still has hundreds of these fatalities per year. An estimated 1.6 million tractors are not equipped with ROPS. Many of these tractors do not have ROPS commercially available although they were originally designed to support a ROPS. Some tractors have foldable ROPS that are not used properly. Other ROPS, although meet appropriate performance standards, are not effective at eliminating continuous rolls.To meet this need, a Computer-based ROPS Design Program (CRDP) was developed to quickly generate ROPS designs based on agricultural tractor weights and dimensions. The ROPS designed with the CRDP for the Allis Chalmers 5040 tractor successfully passed the SAE J2194 static longitudinal, transverse, and vertical tests. A simple foldable ROPS lift assist was designed and tested to ease in the raising and lowering of ROPS; decreasing the raising torque from 90Nm to less than 50Nm, while also lowering the resisting torque to lower the ROPS. A model to determine the critical ROPS height CRH based on off-road vehicle dimensions and center of gravity (CG) height was developed and evaluated.

Short-term poor glycemic control and retinal microvascular changes in pediatric Type 1 Diabetes patients in Singapore: a pilot study

BackgroundPoor glycemic control in Type 1 Diabetes (T1D) patients is strongly associated with an increased risk of diabetes-related microvascular complications later in life, but it is unclear whether short period of poor glycemic control in children with T1D can cause evident microvascular morphological changes long before any pathological manifestation. Our study aimed to investigate the longitudinal association between poor glycemic control and subsequent changes in retinal microvasculature, in a pilot study of 55 pediatric T1D patients from Singapore after a one-year follow-up.MethodsThis is a hospital-based, exposure-matched and retrospective longitudinal study. A total of 55 T1D patients were included from Singapore KK Women’s and Children Hospital, 28 of whom had poor glycemic control (average glycated hemoglobin [HbA1c] ≥8% during the year) while the other 27 age- and gender-matched subjects had good glycemic control (HbA1c <8%). Retinal photography was taken at diabetes annual screening and images were graded by trained graders using a semi-automated computer-based program (Singapore I Vessel Assessment [SIVA], version 4.0, Singapore Eye Research Institute, Singapore) and a spectrum of retinal vascular parameters (e.g. caliber, tortuosity, branching angle and fractal dimension) were measured quantitatively from 0.5 to 2.0 disc diameters.ResultsThere was no significant difference in ethnicity, duration of T1D, blood pressure, body mass index (BMI) and low-density cholesterol lipoprotein (LDL) between the two groups. Retinal imaging was obtained at the end of 1 year of glycemic control assessment. In multiple linear regression adjusting for ethnicity, BMI, LDL and duration of T1D, patients with poor glycemic control tended to have marginally wider retinal arteriolar caliber (6.0 μm, 95% CI: −0.9, 12.8) and had significantly larger retinal arteriolar branching angle (10.1 degrees, 95% CI: 1.4, 18.9) compared with their age- and gender- matched counterparts with good glycemic control.ConclusionsOur findings showed that abnormal retinal microvascular morphology was evident in pediatric patients with T1D after one-year’s poor glycemic control. Such morphological abnormalities may lead to future development of microvascular complications among T1D pediatric patients with poor glycemic control.

Soft Tissue Changes Measured With Three-Dimensional Software Provides New Insights for Surgical Predictions

Although computer-aided craniofacial reconstructions allow for simulation of hard tissue changes, the prediction of the final soft tissue facial changes remains a challenge. The purpose of the present study was to evaluate the 3-dimensional (3D) soft tissue changes in patients undergoing 2-jaw orthognathic surgery. For the present retrospective cohort study, 40 consecutive patients (11 men and 29 women; mean age 23.5±4.9years) who had undergone 2-jaw orthognathic surgery were selected. We obtained the medical and dental records from 3weeks before surgery and 6months after surgery. We used image processing software to segment, superimpose, and quantify the hard and soft tissue displacements in 3 dimensions before and after surgery at 15 paired locations. The soft tissue and hard tissue changes were determined through quantification of homologous landmark displacements between the preoperative and postoperative computed tomography data. We measured the 3D soft and hard tissue changes and the anteroposterior, inferosuperior, and transverse components of the changes. We quantified the ratios between the soft and hard tissue changes, tested Pearson's correlation between these changes, and developed a predictive regression equation for the observations at each location. We found that soft tissue movement followed the hard tissue movement, with a correlation nearly equal to 0.9 (range 0.85 to 0.98), suggesting that in general the soft tissues of the maxillary and mandibular landmarks are affected similarly by the skeletal movements. The anteroposterior component of the soft tissue 3D displacements followed the hard tissue movement with a ratio greater than 0.9 and with high correlation (r>0.9) in the mandible. The results of the present study provide surgeons with a ratio of hard to soft tissue change and the strength of the correlations, which will allow for more accurate 3D predictions for both midline and lateral structures in bimaxillary orthognathic surgical cases. In addition, predictive equations for various landmarks were developed and can be used in computer-based prediction programs to aid in treatment planning of soft tissue changes.