Distraction Test Research Articles

A 10-min novel technique for involutional entropion: Mini-incisional continuous ligation everting sutures

To introduce a novel technique of mini-incisional continuous ligation everting sutures for correction of involutional entropion and report the surgical outcome. A retrospective case series. Eighty-five eyelids of 77 patients who underwent correction of involutional lower lid entropion using mini-incisional continuous ligation everting sutures were included in this study. The medical records of patients with at least 24 months of follow-up after surgery were reviewed. We collected information on demographic and clinical characteristics, including sex, age at surgery, duration of follow-up, horizontal lid laxity, surgical outcomes, and complications. Main outcome measures were success of surgery, recurrence rate, time to recurrence, and risk factors for recurrence. The median (interquartile range) age at the time of surgery was 72.0 (65.5-78.0) years and the median (interquartile range) follow-up duration was 24.0 (24.0-42.5) months. Thirty-seven eyelids (43.5%) showed horizontal eyelid laxity on a lid distraction test The surgical outcome was successful in the majority of patients (94.1%) with a recurrence rate of 5.9% in the 2 years after surgery. Only female sex was significantly correlated with recurrence of entropion (odds ratio 9.466, 95% confidence interval 1.022 to 87.670, P = 0.048). This novel technique is a promising surgical modality for correction of lower lid involutional entropion because of its ease of application, simplicity, compatibility with anticoagulants, and low recurrence rate.

Is Nice knot suture comparable to wire for cerclage fixation? A biomechanical performance study

Cerclage fixation is a known orthopedic technique shown to be beneficial for circumferential augmentation when screw fixation cannot be used or is undesirable. However, ongoing advances in suture materials and knot techniques exist, and there is a paucity of evidence existing which evaluates comparisons between the two. The objective of this study was to investigate the strength and durability of cerclage fixation between the Nice knot suture technique and monofilament wire. Static displacement over time and compression load testing were analyzed. Compression testing was conducted with the Jamar Hydraulic Hand Dynamometer. Distraction testing was conducted using the Instron test system with its associated program. The Nice knot was tied using number 2 and number 5 FiberWire (Arthrex) and compared to monofilament wire. Clinical failure (displacement of 10 mm), absolute failure (opening of the knot or material failure), maximum compression achieved, and steady state compression maintained were the outcomes of interest. Double-stranded monofilament wire produces maximum consistent compression of 90 kg, followed by single-stranded monofilament wire (60 kg). Number 5 FiberWire has a higher maximum compression load than number 2 FiberWire (50 kg vs. 22 kg), but it is lower than that of the double-stranded monofilament wire constructs. When compared to the single-stranded monofilament construct, the number 5 FiberWire Nice knot is comparable (P < .05). Average steady state compression achieved after 10 minutes of resting showed double-stranded monofilament wire to be 65 kg compared to single- stranded monofilament wire at 42 kg, which when, compared to suture, number 5 FiberWire measured at 15 kg and number 2 FiberWire at 8 kg. Average tension results from Instron distraction testing showed the double-stranded monofilament wire construct was able to withstand greater forces up to a displacement of 6 mm, after which the number 5 FiberWire Nice knot was stiffer. Number 5 FiberWire shows the most linear tension relationship, revealing it more efficiently withstands elastic forces. Load to failure was higher in the number 5 FiberWire Nice knot construct than that in both the monofilament wire constructs. The modes of failure for the Nice knot were always at the knot suture interface rather than at the knot. We propose this suture technique to be a viable alternative method for cerclaging to fix upper limb long-bone fractures.

Lateral tarsal strip procedure for involutional ectropion: A retrospective analysis of 85 cases and a comprehensive literature review

PurposeTo evaluate the postoperative effect of the lateral tarsal strip (LTS) procedure in treating lower eyelid involutional ectropion. MethodsA retrospective study was performed on 85 eyelids in 67 patients with involutional ectropion who underwent LTS procedure. Pre- and postoperative lower eyelid laxity and ocular symptoms as well as perioperative complications were evaluated. Snap back test was performed to evaluate the elasticity of lateral canthal tendon loosening and, a lower lid distraction test was performed to evaluate the degree of severity before surgery. Ocular surface diseases were evaluated by the Ocular Surface Disease Index (OSDI), and symptoms including conjunctivitis, corneal ulcer, dry eye syndrome, and ocular pain were recorded. All patients were evaluated within one week and during the follow-up period of 4.2 ​± ​8.3 months. Furthermore, we reviewed the studies that also investigated the surgical effect of the LTS procedure in the literature from 1979 to 2019. ResultsThe success rate was 95%. Only four eyelids required a second surgical intervention. Seventy-three (86%) eyelids had an excellent position after surgery, 9 (11%) only little improvement, and three had no improvement. No significant difference was found in the postoperative effects between different degrees of ectropion (p ​> ​0.05). No statistical correlation was found between surgical improvements and the ectropion severity (P ​> ​0.05). Fifty-two out of 85 eyes had no discomfort after the surgery. Mild complications included epiphora in 13 eyes (three cases caused by lacrimal punctum eversion), ocular pain in 12 eyes, wound hemorrhage in 12 eyes, and edema in 9 eyelids immediately after surgery, in which 91.2% (n ​= ​21) disappeared within one week and did not need any further treatment. ConclusionsThe lateral tarsal strip procedure can provide an aesthetically pleasing result for correcting the mild to moderate lower eyelid ectropion while maintaining decent eyelid function.

Quantification of the Psychoacoustic Effect of Noise from Small Unmanned Aerial Vehicles.

This paper presents the results of a study evaluating the human perception of the noise produced by four different small quadcopter unmanned aerial vehicles (UAVs). This study utilised measurements and recordings of the noise produced by the quadcopter UAVs in hover and in constant-speed flight at a fixed altitude. Measurements made using a ½″ microphone were used to calculate a range of different noise metrics for each noise event. Noise recordings were also made using a spherical microphone array (an Eigenmike system). The recordings were reproduced using a 3D sound reproduction system installed in a large anechoic chamber located at The University of Auckland. Thirty-seven participants were subjected to the recordings and asked to rate their levels of annoyance in response to the noise, and asked to perform a simple cognitive task in order to assess the level of distraction caused by the noise. This study discusses the noise levels measured during the test and how the various noise metrics relate to the annoyance ratings. It was found that annoyance strongly correlates with the sound pressure level and loudness metrics, and that there is a very strong correlation between the annoyance caused by a UAV in hover and in flyby at the same height. While some significant differences between the distraction caused by the UAV noise for different cases were observed in the cognitive distraction test, the results were inconclusive. This was likely due to a ceiling effect observed in the participants’ test scores.

Invited Discussion on: “Standardized Three-Dimensional Lateral Distraction Test: Its Reliability to Assess Medial Canthal Tendon Laxity”

Invited Discussion on: “Standardized Three-Dimensional Lateral Distraction Test: Its Reliability to Assess Medial Canthal Tendon Laxity”

A novel standardized distraction test to evaluate lower eyelid tension using three-dimensional stereophotogrammetry.

Standardized pre-operative assessment of the lower eyelid tension is essential to determine the optimal surgical technique. However, quantitative analysis using the conventional distraction test is inaccurate and user-dependent. Our purpose was to introduce a novel, standardized three-dimensional distraction test for measuring lower eyelid tension and to determine its standard values in a Caucasian population. In 94 participants (50 men and 44 women; age 21-85 years), a 15.9-g weighted eyelid hook was used to pull down the lower eyelid. Two three-dimensional images were acquired with a VECTRA M3 stereophotogrammetry device-one in the neutral position without a hook and the other in the distracted position with the eyelid hook. The images of all participants in both positions were measured twice by a single observer. There was no clinical (>1 mm) or statistically significant difference between the two repeated measurements of all the inter-landmark linear distances in both positions (P≥0.05, respectively). The mean distracted displacement between the neutral and distracted position for margin reflex distance was 5.50±1.53 mm, without any age-specific difference (P=0.08); however, a significant gender-specific difference was observed as men had significantly greater displacement than women (P<0.001). Our proposed standardized three-dimensional distraction test for assessing lower eyelid tension using an eyelid hook and a simple landmark-based system seems to provide high reliability. This novel and simple method might be helpful for the preoperative planning of eyelid surgeries.

Standardized Three-Dimensional Lateral Distraction Test: Its Reliability to Assess Medial Canthal Tendon Laxity

BackgroundAssessment of MCT laxity is critical to the surgery options. Our study aimed to analyze the reliability of measuring medial canthal tendon (MCT) laxity by using a novel standardized three-dimensional lateral distraction test (3D-LDT).MethodsForty-eight Caucasian volunteers (25 males and 23 females, 96 eyes) between 22 and 84 years of age (55.6 ± 18.6 years old) were included in our study. From a neutral position, the lower eyelid was gently pulled laterally along a horizontal line to define the most distracted position of the lower punctum. Both in the neutral and distracted position, standardized 3D images were acquired for each subject by two observers, and each image were measured twice by two raters. Four landmarks and six corresponding linear measurements were evaluated for intra-rater, inter-rater, and inter-method reliability.ResultsIntra-rater, inter-rater and inter-method reliability analyses of 3D-LDT revealed an intraclass correlation of more than 95%, a mean absolute difference of less than 1 mm, and a technical error of measurement of less than 1 mm. Measurements of relative error (2.59–12.04%) and relative technical error (1.83–16.05%) for the inter-landmarks distance from pupil center to the lower punctum were higher than those from limbus nasal center to the lower punctum (6.13–30.39 and 4.34–26.85%, respectively).ConclusionsThis study provided high reliability of the three-dimensional lateral distraction test (3D-LDT) for assessing medial canthal tendon (MCT) laxity, which were never evaluated by digital imaging system.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Prevalence of sacroiliac joint dysfunction in college students

Introduction and Aim: Sacroiliac (SI) joint is considered as one of the pain generators in students. Sacroiliac joint dysfunction is one of the common sources of low back pain, and many times the SI joint dysfunction mis-lead as the lumbar problem. Students who sit for longer duration cause stress in the sacroiliac joint. So, this study intended to investigate the prevalence and the contributing risk factors amongst students’ population with work-related musculoskeletal problems and also to identify the percentage of SI joint involvement in them.Materials and Methods: The study was conducted with 590 students from a private paramedical college, involving full time college students, with age group of 17-27 years, no recent falls or those not on current medications related to any musculoskeletal problems, and students without any congenital problems. Evaluation was done using Nordic musculoskeletal questionnaire along with a self-developed demographic questionnaire. The involved students were assessed using questionnaire and sacroiliac joint tests to identify the SI Joint dysfunction. Provocation tests included i) Sacroiliac joint distraction test, ii) SI Compression test iii) Thigh thrust test iv) Faber’s test and v) Gaenslen’s Test. Inference considered was presence of pain in more than 3 test indicates Sacroiliac joint involvement. On completion of assessment, a thank you card was given to all the volunteer students participated in the study. The collected data was filled and analyzed.Results: The study results showed that students with lower back pain also had complaints of neck pain. It was also noted that about 30% of the individuals were positive to the sacroiliac joint tests, among them 93 participants complained of low back pain.Conclusion: This study concluded that 61% of individuals were suffering with musculoskeletal disorders in the selected population. Around 30% of the low back pain participants complained of sacroiliac joint dysfunctions.

Lower Eyelid Horizontal Tightening in Prostaglandin Associated Periorbitopathy.

To determine the effect of chronic topical use of prostaglandin analogs for glaucoma on lower eyelid tension. A prospective case-control study was performed. Lower eyelid tension was measured in a group of glaucoma patients (73 eyelids) using prostaglandin analogs and a paired control group (87 eyelids). Seven glaucoma patients with unilateral use of prostaglandin analogs had the lower eyelid tension of the exposed side compared with the contralateral eyelid. Eyelid tension was digitally measured in photographs in neutral position and after manual downward traction in the center of the eyelid (modified distraction test). Duration of drug exposition, age, use of other topical medication and other prostaglandin-associated periorbitopathy signs as long eyelashes, eyelid hyperemia, eyelid pigmentation, and deepening of upper eyelid sulcus were recorded for analysis. Mean lower eyelid tension in prostaglandin group was significantly higher than in control group: distraction 5.26 mm (SD 1.52) versus 6.80 mm (SD 1.29) (p < 0.001). On the unilateral prostaglandin use intragroup comparison, mean lower eyelid distraction in prostaglandin side was 4.24 mm (SD 1.80) and in control side was 6.79 mm (SD 1.63) (p < 0.012). Beta blocker and carbonic anhydrase inhibitor concomitant use was associated with lower eyelid tension measures in prostaglandin users. Presence of long eyelashes was associated with higher eyelid tension. All other measured variables did not demonstrate interaction with eyelid tension. Chronic topical use of prostaglandin analogs for glaucoma is associated with lower eyelid tightening.

Teaching Physiotherapy Students Physical Examination Skills by Using Photogrammetry: A Randomized Control Trial of 3- Versus 2-Dimensional Images.

Education research explains how healthcare professional training could be more efficient and effective by integrating simulation technology. Despite its relevance in training medical students, the evidence of its effectiveness in the manual skill training of physiotherapy students remains limited. The aim of this study was to compare the effectiveness of 3-dimensional (3D) images of real objects produced by photogrammetry and traditional 2-dimensional (2D) images when introducing manual therapy skills to undergraduate physiotherapy students via an online course. In a randomized controlled trial, a group of first-year physiotherapy bachelor honor degree students participated in a 2-hour online course on 3 manual assessment skills: cervical compression, distraction, and flexion-rotation tests. They demonstrated 2 sets of learning materials, including either 3D images of real rotating objects using close-range photogrammetry (experimental group) or traditional 2D images (control group). After their respective training, an Objective Structured Clinical Evaluation procedure was conducted to demonstrate their knowledge about the techniques. A standardized 9-item practical performance test was used as the primary outcome measure for the analyses. Seventy-seven students participated in the study. The average Objective Structured Clinical Evaluation score for the experimental group (n = 40) was 41.3/50 (±3.9) and the control group (n = 37) was 39.1/50 (±4.5, P = 0.02). For learning 3 cervical spine assessment skills, this study shows that photogrammetry creates 3D images of real rotating objects that are more effective than 2D images for first-year physiotherapy students.

Best Practices for Clinical Evaluation of Sacroiliac Joint Pain: AnEvidence-to-Practice Review

Sacroiliac joint (SIJ) pain serves as an under-recognized source of chronic low back pain. Improvement in the accuracy SIJ pain diagnosis lends a higher likelihood of appropriate treatment measures, better patient outcomes and decreased out-of-pocket costs. Therefore, the overall purpose of the guiding paper was to systematically review and synthesize evidence associated with the clinical diagnosis of SIJ pain. Searches of 5 electronic databases revealed 758 studies, nonetheless only 6 studies met final inclusion criteria. Studies included in the guiding systematic review were assessed for methodological quality using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Evidence suggests pain provocation tests including distraction, compression, thigh thrust, sacral thrust, and Gaenslen’s are useful individually at diagnosing sacroiliac joint pain. The thigh thrust test was most sensitive and the distraction test was most specific. Furthermore, the compression test carried the strongest positive likelihood ratio. The highest likelihood ratio was reported when three or more of the following pain provocation tests were positive: distraction, compression, thigh thrust, sacral thrust, and Gaenslen’s test for both the right and left sides. A comparable likelihood ratio was found when any two of the remaining four tests were positive after excluding the left and right-side applications of the Gaenslen’s test. Research suggests using the McKenzie evaluation to exclude pain of disc origin preceding the performance of pain provocation tests in an effort to further reduce false positives. Safe, effective, and efficient diagnostic evaluation techniques are essential to the provision of high-quality patient care.

Distracting stimuli evoke ventral tegmental area responses in rats during ongoing saccharin consumption.

Disruptions in attention, salience and increased distractibility are implicated in multiple psychiatric conditions. The ventral tegmental area (VTA) is a potential site for converging information about external stimuli and internal states to be integrated and guide adaptive behaviours. Given the dual role of dopamine signals in both driving ongoing behaviours (e.g., feeding) and monitoring salient environmental stimuli, understanding the interaction between these functions is crucial. Here, we investigate VTA neuronal activity during distraction from ongoing feeding. We developed a task to assess distraction exploiting self‐paced licking in rats. Rats trained to lick for saccharin were given a distraction test, in which three consecutive licks within 1 s triggered a random distractor (e.g. light and tone stimulus). On each trial they were quantified as distracted or not based on the length of their pauses in licking behaviour. We expressed GCaMP6s in VTA neurons and used fibre photometry to record calcium fluctuations during this task as a proxy for neuronal activity. Distractor stimuli caused rats to interrupt their consumption of saccharin, a behavioural effect which quickly habituated with repeat testing. VTA neural activity showed consistent increases to distractor presentations and, furthermore, these responses were greater on distracted trials compared to non‐distracted trials. Interestingly, neural responses show a slower habituation than behaviour with consistent VTA responses seen to distractors even after they are no longer distracting. These data highlight the complex role of the VTA in maintaining ongoing appetitive and consummatory behaviours while also monitoring the environment for salient stimuli.

Clinical examination of the sacroiliac joint

Introduction: Sacroiliac joint (SIJ) can be a nociceptive source of the pain in lower back. Clinical diagnosis of SIJ pain remains yet problematic. The cause of SIJ pain is multifactorial. The pain may be a result of an inflammatory disease, arthrosis, traumatic injury, infectious process or overload. The potential role in SIJ examination have pain provocation tests. Objective: To review and further discuss the validity of some of the mostly used clinical provocation tests such as Distraction test, Thigh Thrust test, Compression test, Sacral Thrust test, Patrick’s (FABER), Gaenslen’s test, Standing Flexion Test, Gillet Test and Shimpi Prone test. Method: A literature search was conducted using PubMed. Reviewed were studies between 2005 and 2020 in English, Slovak and Czech with keywords: sacroiliac joint, sacroiliac assessment, provocation tests. The methodology of studies was not considered. Discussion: It is challenging to determine whether SIJ is the actual source of the pain by using only one of the provocation tests. Therefore, it is beneficial to combine more compression tests, what will also increase the validity of testing. Other widely used SIJ tests are palpation test, however their validity is poor.

Floppy eyelids: sleeping patterns of spouses as indicators of laterality

Floppy eyelids are usually asymmetrical, and more severe on the side the patient sleeps on. This has been related to the mechanical basis of this entity’s pathophysiology. Patients who exhibit floppy eyelid syndrome (FES) tend to suffer from obstructive sleep apnea and other sleeping disorder such as snoring; therefore, their spouses are likely to be found sleeping facing away from them. In this study, we aim to assess this correlation between FES laterality and the spouse’s sleeping side. 185 patients with floppy eyelid were assessed. Upper lids were pulled cephalad towards the orbital rim to assess which side everted and was more floppy. Based on the upper lid distraction test, a prediction was made to which side of the bed the spouse slept on. 185 patients with floppy eyelid syndrome were assessed, 160 male patients and 25 females, at an average age of 68. All 25 female patients, and 117 of the male patients, had spouses that slept in the same bed. Their side of sleep was predicted correctly in 87% of cases. The physician extrapolated the spouse slept on the opposite side facing away from the snoring spouse and was correct in 91% of cases. There is a high correlation between FES laterality and the patient’s spouse’s sleeping side. These data strengthen the mechanical etiology, and can also be used to confirm the worse-affected side in FES patients.

Cellphone addiction explains how cellphones impair learning for lecture materials

SummaryStudents' cellphone use has been related to poorer learning, possibly due to greater distraction. This study investigated whether cellphone‐related anxiety, addiction, and disconnection were related to distraction and learning as well as how practical educational policies could minimize negative effects. Participants (N = 218) watched a video lecture and were divided into two groups: cellphone‐allowed for academic use (Use‐Cellphone Group) and no cellphone instruction (No‐Instruction Group). During the lecture, participants received several anonymous text messages and overt distracted was measured. Learning was assessed via a test following the video. Our findings showed that participants in the Use‐Cellphone Group experienced a greater degree of distraction and worse test performance than those in the No‐Instruction Group. Only cellphone addiction and distractedness played key roles in impacting the effects of condition on test performance. Thus, allowing cellphones in class may exacerbate existing cellphone addiction behaviors and impair learning.

Quickert procedure for involutional lower eyelid entropion: a multi-centre study

Background: Involutional entropion is the inward turning of the eyelid margin and commonly happens in the inferior eyelids in elderly people. The prevalence is as high as 2.1% in people ≥ 60 years old and more common in women than men. This condition may cause ocular surface irritation and discomfort secondary to contact between cilia and the ocular surface. Several etiological factors are suspected to be important causes of involutional entropion. One of them was horizontal eyelid laxity. Quickert Procedure is one of the surgical interventions recommended to correct involutional lower eyelid entropion in the elderly Asian population with 0% of recurrent entropion in a recent study by Miyamoto et al.Methods: This is a descriptive retrospective study of 16 involutional lower eyelid entropion patients (18 eyelids) that needed surgical correction.  About ten males and six females were undergone Quickert procedure to correct the involutional entropion. Patients were assessed postoperatively for 24 months to evaluate the recurrence entropion, cosmetic, and functional improvement. Data were analyzed by SPSS version 20 for Windows.Results: This study included 16 patients, with mean age was 69.8 years old which range from 62-85 years old. They consisted of 9 (56.0%) patients were male, and the rest was female (44.0%). Eleven (61.0%) patients were with left eye laterality, and 10 (63.0%) patients found without anticoagulant consumption. All patients (100.0%) had positive snapback test and achieved &gt;6 mm in distraction test. After surgical intervention, no patients (0.0%) were found to experience recurrence of involutional entropion nor ocular discomfort due to prior surgery.Conclusion: A detailed assessment of the etiology, accurate preoperative evaluation, and precision in addressing patients underlying eyelid anatomic abnormalities are needed in the selection of appropriate surgical procedures to correct entropion.

Clinical and Radiographic Presentation of Capsular Iatrogenic Hip Instability After Previous Hip Arthroscopy

Background: The clinical and radiographic features of iatrogenic hip instability following hip arthroscopy have been described. However, the prevalence of presenting symptoms and associated imaging findings in patients with hip instability has not been reported. Purpose: To detail the prevalence of clinical and magnetic resonance arthrogram (MRA) findings in a cohort of patients with isolated hip instability and to determine midterm patient-reported outcomes in this patient population. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively reviewed patients from 2014 to 2016 who underwent an isolated capsular repair in the revision hip arthroscopy setting. Patients were excluded if they underwent any concomitant procedures, such as labral repair, reconstruction, femoral osteoplasty, or any other related procedure. Several clinical data points were reviewed, including painful activities, mechanical symptoms, subjective instability, Beighton scores, axial distraction testing (pain, toggle, and apprehension), and distractibility under anesthesia. Patient-reported outcomes—including modified Harris Hip Score, Hip Outcome Score–Sports Subscale, Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function Computer Adaptive Test, and a return patient hip questionnaire—were collected pre- and postoperatively. Pre-revision radiographs were obtained, and lateral center-edge angle and alpha angle were measured on anteroposterior and frog-leg lateral views, respectively. Pre-revision MRAs were reviewed and evaluated for capsular changes. Capsular changes were defined as follows: 0, normal; 1, capsular redundancy; 2, focal capsular rent; and 3, gross extravasation of fluid from the capsule. Results: A total of 31 patients met inclusion criteria (5 male, 26 female; 14 right and 17 left hips). The mean age of patients was 36 years (range, 20-58 years). Overall, 27 (87%) reported hip pain with activities of daily living, and 31 (100%) experienced pain with sports or exercise. In addition, 24 (77%) had at least 1 positive finding on axial distraction testing. All patients had evidence of capsular changes on review of pre-revision MRAs. Out of 31 patients, 23 (74%) were available for follow-up at a minimum of 3.3 years and a mean ± SD of 4.6 ± 0.8 years. On average, modified Harris Hip Score improved by 20.3, Hip Outcome Score–Sports Subscale by 25.1, and PROMIS Physical Function Computer Adaptive Test by 6.4. Additionally, 20 (87%) patients reported improved or much improved physical ability, and 18 (78%) reported improved or much improved pain. Conclusion: The current study suggests that patients with hip instability demonstrate high rates of pain with activities of daily living and exercise, positive findings on axial distraction testing, and evidence of capsular changes on magnetic resonance imaging. Furthermore, these patients improve with revision surgery for capsular repair at midterm follow-up.

Pain memory in patients with chronic pain versus asymptomatic individuals: A prospective cohort study.

The main objective of this study was to assess pain memory as well as long-term episodic memory, both in patients with chronic pain (CP) and in asymptomatic participants (AP). A prospective cohort study design was used. Sixty-eight participants were divided into two groups: CP (n=34) and AP (n=34). The protocol consisted of taking eight tests, four painful provocation tests and four distracting tests, and completing a memory test on the order of the tests at the end of the experiment and at 1-month post-experiment. Patients with CP showed acceptable concordance in the classification, in ascending order from lower to higher pain perception, both post-experiment and 1-month post-experiment (κ=0.41-0.60, p<.001). No differences were found regarding recall of the order of the tests, but differences were found in painful tests isolated only post-experiment in the CP group with a moderate effect size (p<.05, d=0.77). Patients with CP had a more reliable memory than AP in relation to the memory of the pain caused experimentally until at least 1month after the experiment. Interspersing distraction tests appeared to result in increased complexity and difficulty in coding and decoding information in patients with CP, leading to similar reliable long-term memory consolidation in comparison with AP. Treatments directed towards chronic pain should consider the influence of painful memories and their establishment towards long-term explicit episodic memories in patients with chronic pain, as well as the influence of cognitive-evaluative and affective-motivational variables on memory. Not causing pain while implementing a treatment whose objective is to reduce pain could reduce the probability of developing new painful memories in patients with chronic pain.

Changes in Lower Lid Position after Standard Phacoemulsification Cataract Surgery.

Purpose:To evaluate the changes on the position of the lower lid after phacoemulsification surgery using objective methods.Methods:This prospective study evaluated the lower lid position of cataract carriers who underwent to phacoemulsification surgery from January to May 2017. Data were collected on demographics, type of anesthesia, duration of the surgical procedure, and duration of the speculum remained in place. Standardized digital photographs of the patient's face in primary gaze position were obtained preoperatively and 1, 30, 90, and 180 days, postoperatively. The data were analyzed on the distraction test, distance of the lower lacrimal punctum from the inner canthus, and margin reflex distance 2 (MRD2). Comparative and correlation statistical analyses involving preoperative and postoperative measurements were performed.Results:One hundred twelve cataract patients comprised the study sample. There were 68 (60.7%) females with a median age of 74 (interquartile range, 70–81) years old. The mean distraction test value before surgery was 7 ± 2 mm and 6.8 ± 1.8 mm 180 days postoperatively (P = 0.02). The mean lacrimal lower punctum distance changed from 5 ± 1.1 mm preoperatively to 5.4 ± 1 mm at 180 days postoperatively (P = 0.06). The mean MRD2 preoperatively was 5 ± 1 mm and increased to 5.4 ± 0.9 mm 180 days after surgery (P = 0.02). The duration of surgery and the duration that speculum remained in place were not correlated to MRD2 (P = 0.7; P = 0.98).Conclusions:There is a mild lower lid laxity after phacoemulsification reflected by slight increased lacrimal lower punctum distance to the inner canthus and MRD2. Lacrimal lower punctum distance and MRD2 vary along the study and remained altered at 180 days after surgery, while distraction test tends to recover to similar preoperative levels. Although lid laxity is common in elderly cataract carriers, even a short procedure as phacoemulsification can mildly increase flaccidity.

Considerations for the development of a driver distraction safety rating system for new vehicles

Drivers engage in a wide range of non-driving related tasks while driving that have potential to distract to them and compromise their safety. These include interactions with infotainment systems built into the vehicle by vehicle manufacturers. These systems enable the performance of communication, entertainment, navigation and internet browsing tasks. Performing these tasks can degrade driving performance and increase crash risk. Not all infotainment technologies in new vehicles are equal in terms of their potential to distract. This paper documents the findings of a study commissioned by the Victorian Department of Transport to determine the feasibility of developing a test protocol for rating the distraction potential of new vehicles entering the Australian market. A literature review, consultation with expert international researchers and industry representatives, and workshops, were conducted in order to determine those elements of the HMI design of infotainment systems that should be assessed, identify suitable candidate test methods for assessing the visual and cognitive load imposed on drivers when performing infotainment tasks, and derive options for a distraction rating system. In addition, safety/rating assessment program reviews and a cost-benefit analysis of introducing a distraction rating system were undertaken. Eight potential distraction test methods were discerned from the literature and consultation. It was concluded that the most suitable test protocol for a distraction rating system involves the use of an HMI design checklist in combination with measurement of the visual and cognitive load imposed on drivers when performing specific infotainment tasks, using the VOT and DRT, respectively. Eight options for introducing a distraction safety rating as a consumer or NCAP distraction rating are presented. Each option builds upon the previous, with the first option being the development of voluntary guidelines (where vehicle manufacturers work to these guidelines on a voluntary basis) to option eight, where NCAPs incorporate a distraction rating in the overall vehicle safety rating. The benefits of introducing a highly effective (best case) distraction rating system are estimated to result in a road crash saving of approximately AU$28 per ‘improved/low distraction’ vehicle per year.