Psychomotor Performance Research Articles

Commentary.

It was a great tribute to be awarded the 2022 Jay A. Heidbrink Award from the American Dental Society of Anesthesiology (ADSA). As part of that award, it is also my honor to select a “Landmark Article,” a contribution to the dental anesthesia literature that was of significance to the field.I am pleased to choose an article by Norman Trieger, DMD, MD, (1929-2012) published in Anesthesia Progress in 1969. Those of us with greying hair remember Norm as a consummate gentleman and scholar. Younger readers may recognize the name which headlines the Continuing Education Article in each Anesthesia Progress publication.Dr. Trieger, a Phi Beta Kappa at Emory University, completed his dental degree and oral surgery residency at Harvard School of Dental Medicine. He subsequently joined the faculty at UCLA before returning to his childhood home in New York City to become the long-standing professor and chairman of the Department of Dentistry and Oral and Maxillofacial Surgery at the Montefiore Medical Center and Albert Einstein College of Medicine, where he also earned his medical degree. Dr. Trieger was a Fellow in General Anesthesia of the ADSA as well as a past president and editor of Anesthesia Progress. He helped develop the first American Dental Association (ADA) guidelines for teaching intravenous (IV) moderate sedation for dentists. He was an early supporter of a specialty in anesthesiology for dentistry, having authored the first ADA specialty application which was not submitted due to opposition from oral surgery at the time.Dr. Trieger was also a prolific researcher. One of his enduring contributions to the field became known as the Trieger Test. The test is a semi-objective measure of psychomotor recovery from sedation or general anesthesia. As this presented article points out, it was a modification of the Bender Motor Gestalt Test. I have used the Trieger Test in several of my own and my graduate students' research projects as new sedatives have been released or different techniques studied to help determine the duration of recovery needed to return to baseline psychomotor function. Oral surgeons, as they were known at the time before “maxillofacial” was added to their name, were really the pioneers of office-based anesthesia and the rapid recovery techniques that we all use today. In the early days, IV barbiturates for deep sedation and general anesthesia were commonly used as sole agents. We speak of the “Wild West” of office-based anesthesia today, but that technique could really lead to an anesthesia rodeo where only tooth extraction could be completed and more delicate dentistry impossible.One of the fascinating aspects of this article to me is that the actual data from the initial study are not presented. The data are referenced from an article in Anesthesia and Analgesia which I found and read. The data is, in fact, included in that article, and much of the same language in the Anesthesia Progress article is taken directly from the Anesthesia and Analgesia article, also co-authored by Dr. Trieger. This is a practice that would surely not be allowed today unless the article was part of a review of other published articles.Dr. Trieger made significant contributions to oral surgery, dental anesthesiology, moderate sedation for general dentists, and to the dental and medical professions. This early manuscript is but a small piece of his legacy.Respectfully submitted,This continuing education (CE) program is designed for dentists who desire to advance their understanding of pain and anxiety control in clinical practice. After reading the designated article, the participant should be able to evaluate and utilize the information appropriately in providing patient care.The American Dental Society of Anesthesiology (ADSA) is accredited by the American Dental Association and Academy of General Dentistry to sponsor CE for dentists and will award CE credit for each article completed. You must answer 3 of the 4 questions correctly to receive credit.Submit your answers online at www.adsahome.org. Click on “On Demand CE.”CE questions must be completed within 3 months and prior to the next issue.

Cooking Groups for Older Adults: Implications for Functional Abilities

ABSTRACT Occupational therapists utilize cooking groups to optimize intrinsic capacity and functional ability, but there is a lack of scientific evaluation. This quasi-experimental study aimed to investigate the effect of a cooking group on cognitive, emotional, psychomotor, and interpersonal performance in older adults. Nineteen participants with chronic conditions were recruited to attend ten consecutive cooking sessions. Large Allen Cognitive Level Screen-5 (LACLS-5), Thai Geriatric Depression Scale (TGDS-15), psychomotor speed test and interpersonal communication observation were used. The results showed significant improvement in the study outcomes. Therefore, the cooking groups have improved cooperative capacity through engaging the older adults’ functional abilities.

Cognitive Impairment Among Patients with Chronic Immune Thrombocytopenia

Introduction: Immune thrombocytopenia (ITP) is an autoimmune disease associated with autoantibody-mediated platelet destruction and impaired platelet production, resulting in thrombocytopenia and high bleeding risk. Fatigue and impairment of both memory and concentration are also common in ITP, theoretically due to acute neural inflammation, microbleeding, and thrombotic occlusions of small blood vessels in the brain. However, little is known about the nature and severity of cognitive impairment in patients with chronic ITP. Tests from the Cogstate Brief Battery (CBB) and composite scores computed from these have a high sensitivity to cognitive dysfunction in clinical and clinical trial contexts. The aim of this analysis was to assess cognitive impairment among difficult-to-treat patients with ITP. Methods: Participants (N=60) in the ongoing, global phase 1/2 study (NCT03395210) assessing the safety and efficacy of the Bruton tyrosine kinase inhibitor rilzabrutinib in ITP, were eligible for cognitive testing at baseline. In the CBB, the Detection test (DET) measured psychomotor function, the Identification test (IDN) measured attention, the One Card Learning test (OCL) measured visual learning, and the One Back test (ONB) measured working memory. For each participant, prior to rilzabrutinib treatment, the score on each test was compared with age-matched normative data to produce a standardized score (Z-score). Z-scores measure the distance between an observed value and a reference mean using standard deviation units and can be positive or negative, indicating that the observed value lies above or below the mean, respectively. Z-scores ≤-1 denoted impairment. Descriptive summary statistics, including mean Z-scores for individual tests and composite cognitive scores (Psychomotor/Attention, Learning/Memory), and level of impairment are presented. Relationships between cognitive impairment and demographics, concomitant medication, and medical history were also explored. Results: At baseline, the 49 patients with CBB assessments had a mean age of 50 years, 57% were females, and 71% had an ITP duration of ≥3 years; 14 patients each had concomitant corticosteroids or thrombopoietin receptor agonists (TPO-RA) and 7 patients had both concomitant therapies. Medical history included hypertension (n=17), depression/anxiety (n=8), diabetes (n=7), and stroke/CNS bleeding (n=1). Mean Z-scores for the psychomotor function, attention, and working memory tests were below age-matched healthy norms (Table 1). The degree of impairment was substantial for the psychomotor function and attention tests and composite scores. Impairment was also large for the working memory test, whereas performance on the visual learning test was close to normal. The level of impairment followed the same pattern, with top rates for the attention (67% of patients), followed by psychomotor function (53% of patients), working memory (39% of patients), and visual learning (16% of patients) tests. Psychomotor/Attention impairment was greater (69% of patients) than Learning/Memory (43% of patients; Table 1) and occurred irrespective of biological/clinical characteristics (Figure 1). More than half of patients aged <65 years, with no concomitant ITP medication, and those with no medical history had a "Clinically Important Cognitive Impairment". Conclusion: This report provides evidence of cognitive impairment in patients with ITP. The cognitive impairment was moderate in magnitude for Psychomotor/Attention, and mild for Learning/Memory. Further, the observed impairment appeared to be irrespective of biological/clinical characteristics and unrelated to concomitant use of corticosteroids or TPO-RA. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

P126 The impact of inadequate sleep and breaking up sitting during the day on simulated driving performance

Abstract Introduction Inadequate sleep and prolonged sitting are both associated with a reduction in psychomotor functioning, a cognitive process crucial for the safety critical task of driving. Regular bouts of light-intensity physical activity have been shown to improve psychomotor function. However, it is unknown if breaking up sitting during the day can improve psychomotor functioning for the task of driving, particularly during the commute home when drivers may be at a higher risk of fatigue. Method Healthy participants (n=81, 49%female, age 23.6 ± 4.5 years ) participated in a 7-day laboratory study (1 adaptation, 5 experimental, 1 recovery). Participants were randomly allocated to a condition: sitting and 9-h sleep (Sit9; n=22), breaking up sitting 9-h sleep (Sit9; n=19), sitting and 5-h sleep (Sit5; n=21) and breaking up sitting 5-h sleep (Break5; n=19). Participants allocated the breaking up sitting conditions completed 3-min of light-intensity walking every 30 minutes between 09:00-17:00h, while participants in the sitting group remained seated. Driving performance was measured via speed and lane variability during a 20-min simulated drive at 08:10 and 17:30 for the 5 experimental days. Results Mixed model analyses revealed no significant interaction effects between condition and time of commute between Sit9, Break9, Sit5 and Break5 for driving performance. Discussion Breaking up sitting did not improve driving performance during the commute home. These findings highlight that light-intensity walking may not be adequate to overcome the effects of inadequate sleep on diving performance. Future studies should explore if higher intensity physical activity produce changes in driving performance.

DARPP-32/protein phosphatase 1 regulates Rasgrp2 as a novel component of dopamine D1 receptor signaling in striatum

Dopamine regulates psychomotor function by D1 receptor/PKA-dependent phosphorylation of DARPP-32. DARPP-32, phosphorylated at Thr34 by PKA, inhibits protein phosphatase 1 (PP1), and amplifies the phosphorylation of other PKA/PP1 substrates following D1 receptor activation. In addition to the D1 receptor/PKA/DARPP-32 signaling pathway, D1 receptor stimulation is known to activate Rap1/ERK signaling. Rap1 activation is mediated through the phosphorylation of Rasgrp2 (guanine nucleotide exchange factor; activation) and Rap1gap (GTPase-activating protein; inhibition) by PKA. In this study, we investigated the role of PP1 inhibition by phospho-Thr34 DARPP-32 in the D1 receptor-induced phosphorylation of Rasgrp2 and Rap1gap at PKA sites. The analyses in striatal and NAc slices from wild-type and DARPP-32 knockout mice revealed that the phosphorylation of Rasgrp2 at Ser116/Ser117 and Ser586, but not of Rasgrp2 at Ser554 or Rap1gap at Ser441 or Ser499 induced by a D1 receptor agonist, is under the control of the DARPP-32/PP1. The results were supported by pharmacological analyses using a selective PP1 inhibitor, tautomycetin. In addition, analyses using a PP1 and PP2A inhibitor, okadaic acid, revealed that all sites of Rasgrp2 and Rap1gap were regulated by PP2A. Thus, the interactive machinery of DARPP-32/PP1 may contribute to efficient D1 receptor signaling via Rasgrp2/Rap1 in the striatum.

Protocol for a mobile laboratory study of co-administration of cannabis concentrates with a standard alcohol dose in humans.

Cannabis is commonly used among people who drink alcohol, yet evidence on acute effects of co-use is conflicting. Two important variables that may influence the effects of cannabis and alcohol are cannabinoid content (i.e., the ratio of cannabidiol [CBD] and 9-tetrahydrocannabinol [THC]) as well as the order of use (i.e., cannabis before alcohol vs. alcohol before cannabis). Research is mixed regarding the acute imapct of cannabis on alcohol consumption and intoxication, with some studies suggesting additive effects of alcohol and cannabis, and others demonstrating negligible effects of combining these substances. Further complicating this, high-THC-content cannabis concentrates are increasingly popular on the legal-market, but to our knowledge, no studies have explored concentrate and alcohol co-use. In addition to cannabinoid content, order of use may influence intoxication and other acute effects, but is also understudied. Co-use studies typically administer a fixed dose of alcohol before cannabis, and there is a lack of data on the acute effects of cannabis before alcohol. Thus, there is a need for experimental co-use studies exploring the impact of cannabinoid content (particularly of highly potent cannabis concentrates) and order effects on intoxication. This study uses a federally-compliant mobile laboratory procedure to explore the effects of co-administration of legal-market cannabis concentrates with a moderate alcohol dose (.8g/kg) in a sample of community participants who regularly use alcohol and cannabis. The study will also explore alcohol and cannabis order effects (cannabis before alcohol vs. alcohol before cannabis). Outcomes are objective intoxication (measured using blood cannabinoid level, heart rate, psychomotor performance and breath alcohol level [BrAC]) and subjective intoxication (assessed via self-report measures). Overall, this study may influence harm-reduction recommendations for individuals who drink alcohol and use cannabis.

Effects of alcohol intoxication on driving performance, confidence in driving ability, and psychomotor function: a randomized, double-blind, placebo-controlled study

RationaleAlcohol-induced driving impairment can occur with any departure from a zero-blood alcohol concentration (BAC). Because intoxication is characterised by impaired judgement, drivers under the influence of alcohol may overestimate their capacity to safely operate a vehicle.ObjectivesThis study examined the effects of alcohol on driving performance, four-choice reaction time (FCRT), and self-rated confidence in driving ability. It specifically focused on alcohol doses equal to commonly enforced legal BAC limits (i.e. 0.05% and 0.08%).MethodsA randomized, double-blind, placebo-controlled design was utilised. Seventeen participants were tested in three conditions: placebo and two alcohol conditions aiming for BACs of 0.05% and 0.08%. Participants underwent a baseline FCRT task and a 1-h simulated highway driving task before completing another FCRT task and rated their confidence in their driving ability.ResultsThe high and low alcohol dose conditions resulted in a mean BAC of 0.07%, and 0.04%, respectively (n = 17). The high BAC treatment significantly increased standard deviation of lateral position (SDLP) by 4.06 ± 5.21 cm and standard deviation of speed (SDS) by 0.69 ± 0.17 km/h relative to placebo, while confidence in driving ability remained unchanged across treatments. FCRT performance was impaired by the high BAC treatment (all < 0.01), but there we no significant differences between placebo and low BAC conditions.ConclusionsThe findings of this study show that driving performance and associated psychomotor functioning become significantly impaired below legally permissible driving limits in some jurisdictions. We identified a dissociation between driving performance and subjective awareness of impairment. Despite a significantly diminished driving ability at 0.07% BAC, drivers were unaware of their impairment.

Genetic polymorphism in BIN1 rather than APOE is associated with poor recognition memory among men without dementia

Although several genetic polymorphisms have been linked with the risk of Alzheimer’s disease, less is known about their impact on cognitive performance among cognitively healthy individuals. Our aim was to investigate the association of the genetic variant, rs744373 in the bridging integrator 1 gene (BIN1), the strongest genetic risk factor for Alzheimer’s disease after the APOE ε4 allele, with different cognitive domains among non-demented older men. Cognitive function was measured using the CogState Brief Battery, which assessed cognitive performance across four domains: psychomotor function, visual attention, recognition memory and working memory. Linear regression analysis revealed that individuals with the BIN1 risk allele performed poorly on the recognition memory task as compared to those without the risk allele. However, this was in contrast with the individuals who harboured the APOE ε4 risk allele as they displayed better performance on the recognition task in comparison to those without the ε4 risk allele. To the best of our knowledge, this is the first study that demonstrates genetic variation in BIN1 to be a better predictor of recognition memory than APOE, which remains the biggest genetic risk factor for Alzheimer’s disease.

Aldehyde dehydrogenase 2-associated changes in pharmacokinetics, locomotor function and peripheral glutamic acid and gamma-aminobutyric acid levels during acute alcohol intoxication in male mice.

The insufficiency of human aldehyde dehydrogenase 2 (ALDH2) has been consistently associated with high blood acetaldehyde levels and impaired locomotor function during acute alcohol intoxication. The ALDH2-associated change in peripheral glutamic acid (Glu) and gamma-aminobutyric acid (GABA) levels and its correlation with pharmacokinetics and psychomotor function remain unclear. In this study, ALDH2*2 mice were used to build an acute alcohol intoxication model after intraperitoneal administration. The blood ethanol and acetaldehyde concentrations were analyzed to generate concentration-time curves at two doses of alcohol (2.0 and 4.0 g/kg). The dose of 4.0 g/kg was selected in accordance with the preliminary behavioral evaluation result to perform the following behavioral tests (e.g. the rotarod test, the open field test, and the Y-maze test), so as to assess locomotor activity, anxiety and cognitive ability. Plasma Glu and GABA levels were determined through enzyme-linked immunosorbent assays. The results suggested that the ALDH2*2 mice had highly accumulated acetaldehyde levels, impaired locomotor activity and anxiety-like emotion but unimpaired cognitive function, compared to the wild type (WT) mice. The plasma Glu level and the ratio of Glu/GABA in the alcohol-treated WT and ALDH2*2 groups decreased from 2 to 5 h after intraperitoneal administration, whereas the GABA level did not change significantly. The blood alcohol concentration in the WT and ALDH2*2 mice was positively correlated with plasma Glu level, whereas the blood acetaldehyde level was found as the opposite. We speculate that the decline degree of Glu/GABA ratio could be associated with psychomotor retardation and needs to be further investigated.

Effects of pleasant sound on overnight sleep condition: A crossover randomized study

It is desirable to improve sleep quality since poor sleep results in decreases in work productivity and increases in risks of lifestyle-related diseases. Sleep spindles in sleep EEG are waveforms that characterize non-REM sleep Stage 2 (Stage N2). Music therapy has been adopted as a non-pharmacological therapy for sleep quality improvement; however, few studies mention the relationship between music during sleep and spindles. We conducted a crossover randomized study to investigate music's effects on spindles and sleep parameters. Polysomnography (PSG) was performed on 12 adult males with sleep difficulties over three nights, during which they were exposed to three different acoustic environments–silent, white noise, and pleasant sounds–throughout the night, in a crossover randomized setting. Half of the participants with large WASO were defined as the sleep maintenance difficulty group. We investigated whether pleasant sounds shortened sleep onset latency (SOL) and increased the number of spindles (SN) and spindle density (SD) compared to white noise, using silent as the reference. The spindles were detected using the previously reported automatic spindle detection algorithm. After one patient was excluded due to data corruption, a total of 11 participants, including the sleep maintenance difficulty group (n = 5), were analyzed. For all participants, SOL was not significantly shorter with pleasant sound than with white noise (p = 0.683); for the sleep maintenance difficulty group, SOL tended to be shorter with pleasant sound than with white noise (p = 0.060). Compared to white noise, the SN increased in pleasant sound for 7 of 11 (4 of 5 in the sleep maintenance difficulty group), and SD increased for 5 of 11 (3 of 5 in the sleep maintenance difficulty group). The results suggest that all-night background sound exposure may affect SN and SD. Future research should investigate whether background sound exposure reduces sleep-related distress, achieves sound sleep, or improves daytime psychomotor function.

QEEG markers of superior shooting performance in skilled marksmen: An investigation of cortical activity on psychomotor efficiency hypothesis

For elite performers, psychomotor behavior's success or failure can be traced to differences in brain dynamics. The psychomotor efficiency hypothesis suggests refined cortical activity through 1) selective activation of task-relevant processes and 2) inhibition of non-essential processes. The use of electroencephalography (EEG) has been applied to investigate psychomotor performance's neural processes. The EEG markers that reflect an elevation of psychomotor efficiency include left temporal alpha (T3 alpha), frontal midline theta (Fm theta), sensorimotor rhythm (SMR), and the coherence between frontal and left temporal regions. However, the relationship between elite performers' task-relevant and non-essential neural processes is still not well understood. Therefore, this study aimed to explore how each task-relevant and inhibition of non-essential processes contribute to superior psychomotor behavior. Thirty-five highly skilled marksmen were recruited to perform 30 shots in the shooting task while the EEG was recorded. The marksmen were divided into two groups (superior & inferior) based on a median split of shooting performance. The superior group exhibited higher accuracy and precision, with a reduction in movement jerk. EEG measures revealed that the superior group exhibited higher SMR before the trigger pull than the inferior group. In addition, the superior group demonstrated reduced Fz-T3 coherence in their bull's eye shots than the missed shots. These results suggest that the superior group exhibited less effortful engagement of task-relevant processes and lower interference from non-essential cortical regions than the inferior group. The study's overall findings support the psychomotor efficiency hypothesis. When comparing highly skilled performers, the slight differences in brain dynamics ultimately contribute to the success or failure of psychomotor performance.

The Underlying Mechanisms of Handwriting of Individuals with Autism Spectrum Disorder: A Scoping Review

ABSTRACT Integration of cognitive, sensory, and motoric processes is essential for the production of handwriting, however, challenging for children and youth with Autism Spectrum Disorder (ASD). The objective of this scoping review is to identify potential underlying mechanisms of handwriting of children and youth with ASD by reviewing cognitive, sensory, and motoric body functions as predictors of their handwriting. The International Classification of Functioning, Disability, and Health – Children and Youth version was used to structure the analysis. Eleven studies (0.9%) met inclusion criteria. Results show that linguistic functions, psychomotor functions, motor control functions, and motor reflex functions predict handwriting of children and youth with ASD. This suggests these body functions are underlying mechanisms of handwriting of children and youth with ASD, encouraging future research to test these body functions as potential pathways to handwriting intervention for children and youth with ASD. Findings suggest a bottom-up approach to the development of handwriting interventions for children and youth with ASD.

Executive dysfunction in affective disorders: differences in bipolar affective disorder and depressive episode

Aim. To identify the differences in executive function (inhibitory control, working memory, cognitive flexibility) between patients with bipolar affective disorder and depressive episode.Materials and methods. A total of 72 patients with affective disorders aged 20–40 years were examined. Of them, 30 patients had bipolar affective disorder, a current episode of mild or moderate depression, and 42 patients had a mild, moderate, and severe depressive episode without symptoms of psychosis. The executive function was evaluated using PsyToolkit, a set of software tools for programming psychological experiments. Computerized Go/ No–go tasks (assessment of inhibitory control and psychomotor functions), the Corsi block-tapping test (assessment of visual and spatial working memory capacities), and the Stroop Color and Word Test (assessment of cognitive flexibility) were used.Results. An intergroup comparison of patients revealed that patients with bipolar disorder significantly more often demonstrated false button press in the Go/No–go task (p = 0.043); however, they exhibited a greater working memory capacity in the Corsi block-tapping test (p = 0.049) compared with patients with a depressive episode.Conclusion. Important data were obtained regarding the specifics of executive dysfunction depending on the type of affective disorder. The presented data expand and supplement available information about the cognitive characteristics of patients with bipolar affective disorder and depressive episode, which may be useful in clinical practice and serve a focus of future research.

Old versus new antihistamines: Effects on cognition and psychomotor functions.

Antihistamines (AHs) are the most widely long-term therapeutic option to manage allergic diseases. This research aimed to study the effects of long-term administration of AHs: on cognitive (memory, mood, attention, sleep and executive function) and psychomotor performance. This prospective, observational study for a total duration of 30 months was carried out at the Dermatology OPD in adult patients with dermatological condition who were newly prescribed either chlorpheniramine (4 mg, BD), levocetirizine (10 mg, OD), fexofenadine (180 mg, OD) or bepotastine (10 mg, BD) for at least 28 days as per inclusion and exclusion criteria after taking written informed consent. A detailed history of the patients, memory (using PGI memory scale) and psychomotor functions, Brief Mood Introspection Scale and Epworth Sleepiness Scale were assessed at baseline, 1 week and 4 weeks. Data obtained were analysed using paired sample t-test and one-way ANOVA followed by post hoc analysis (P-value <0.05 statistically significant). A total of 22 in chlorpheniramine group, 23 in levocetirizine group, 20 in fexofenadine group and 18 in bepotastine group were analysed. Chlorpheniramine and levocetirizine had deteriorating effects on cognitive and psychomotor performance, whereas fexofenadine and bepotastine showed positive effect on various cognitive and psychometric tasks. The study results showed chlorpheniramine and levocetirizine to be having sedative effects, whereas fexofenadine was nonsedating. In bepotastine group, no effect on sleep was observed. No significant difference in mood scores was observed in between chlorpheniramine, levocetirizine and fexofenadine groups. In bepotastine group, arousal calm and positive tired scores increased at 4 week as compared to baseline. Patients with dermatological illnesses can be prescribed fexofenedine and bepotastine, as compared to chlorpheniramine and levocetirizine, and their cognitive and psychological functions should be evaluated periodically with suitable tests.

Series of virtual light therapy interventions for fatigue: a feasibility pilot study protocol for a series of personalised (N-of-1) trials

IntroductionFatigue is one of the most commonly recorded patient symptoms that can result in deficits in aspects of psychomotor functioning, cognition, work performance and mood. Research shows that bright light...

Basic Life Support Guidance for Caregivers of NICU Graduates: Evaluation of Skill Transfer after Training

Abstract Background Intensivists indeed discharge neonatal intensive care unit (NICU) graduates after a period of physiological stability. There is, however, a real risk of life-threatening events at home. Survival after such episodes depends on time from arrest to initiation of basic life support (BLS). It is rational to train parents who would be first responders. We sought to measure objectively and prospectively, effect of BLS training on parents of NICU graduates on the psychomotor, cognitive, and affective domains of human learning. Methods After face-to-face training sessions, proportion of home caregivers who obtained 100% marks on a pretested performance checklist for psychomotor skills of BLS on a mannequin were measured. Two other domains of learning and number of attempts required to obtain desirable results were also analyzed. Results Median (interquartile range [IQR]) birth weight of the high-risk neonates was 1,050 g (930, 1570) and median gestational age was 29 (IQR 28, 33) weeks. More than 75% of parents had no prior exposure to BLS training. Among 46 trained caregivers, 80.4% achieved the desired score of 5 in the psychomotor performance checklist on the first attempt. A maximum of two attempts was required to reeducate and achieve score of 5 in the remaining caregivers. Forty-two (91.3%) caregivers obtained full marks on cognitive domain test. All caregivers responded positively toward affective domain questionnaire. Conclusion It is possible to train parents in BLS measures and demonstrate their psychomotor skills on a mannequin effectively. No parents who were approached refused training or indicated anxiety in learning the skills required.

Management of Cerebropontine Angle Tumors on Total Intravenous Anaesthesia Facilitating Neuromuscular Monitoring: A Retrospective Observational Study

Background: With the increasing trend of IONM in neurosurgery the role of total intravenous anaesthesia has gained upper hand in the practice of neuro anaesthesia. Propofol based TIVA techniques facilitates rapid recovery of consciousness and psychomotor function with lower incidence of post-operative nausea and vomiting. It also facilitates satisfactory IONM monitoring while maintaining the adequate depth of anaesthesia. Available literature focuses on the surgical aspects with IONM. Few studies are available, which compare TIVA with general anaesthesia that too without IONM. Earlier TIVA for IONM has been studied in patients undergoing kyphoscoliosis correction surgery. This study was conducted to evaluate the efficacy of TIVA in facilitating IONM in resection of intracranial masses and to study its effects on hemodynamics and post op recovery. Methods: In our retrospective study of 23 cases, patients undergoing intracranial tumor mass excision surgeries requiring IONM were given standardized general anaesthesia using intubating dose of short acting muscle relaxant and further maintenance of anaesthesia was done using infusion of propofol and dexmeditomidine with the minimal inhalational agents. IONM was recorded successfully. Results: 18 patients were haemodyanamically stable. 3 patients had intermittent episodes of bradycardia, and 2 patients had hypotension. Three patients elicited dampened response requiring reduction in anaesthetic dose. Six patients exhibited delayed recovery. Conclusion: TIVA with propofol and dexmeditomidine is a good anaesthetic modality to facilitate IONM in resection of intracranial masses.

Voltage-clamp evidence of GABAA receptor subunit-specific effects: pharmacodynamic fingerprint of chlornordiazepam, the major active metabolite of mexazolam, as compared to alprazolam, bromazepam, and zolpidem.

Anxiolytic benzodiazepines, due to their clinical effectiveness, are one of the most prescribed drugs worldwide, despite being associated with sedative effects and impaired psychomotor and cognitive performance. Not every GABAA receptor functions in the same manner. Those containing α1 subunits are associated with sleep regulation and have a greater effect on the sedative-hypnotic benzodiazepines, whereas those containing α2 and/or α3 subunits are associated with anxiety phenomena and have a greater effect on the anxiolytic benzodiazepines. Therefore, characterization of the selectivity profile of anxiolytic drugs could translate into a significant clinical impact. The present study pharmacodynamically evaluated chlornordiazepam, the main active metabolite of mexazolam, upon GABAA receptors containing α2 and/or α3, anxiety-related, and those containing an α1 subunit, associated with sleep modulation. As shown by whole-cell patch-clamp data, chlornordiazepam potentiated GABA-evoked current amplitude in α2 and α3 containing receptors without changing the current amplitude in α1 containing receptors. However, current decay time increased, particularly in GABAA receptors containing α1 subunits. In contrast, other anxiolytic benzodiazepines such as alprazolam, bromazepam, and zolpidem, all increased currents associated with GABAA receptors containing the α1 subunit. This novel evidence demonstrates that mexazolam (through its main metabolite chlornordiazepam) has a "pharmacodynamic fingerprint" that correlates better with an anxiolytic profile and fewer sedative effects, when compared to alprazolam, bromazepam and zolpidem, explaining clinical trial outcomes with these drugs. This also highlights the relevance of the pharmacological selectivity over GABAA receptor subtypes in the selection of benzodiazepines, in addition to their clinical performance and pharmacokinetic characteristics.

Effects of alcohol on sleep and nocturnal heart rate: Relationships to intoxication and morning-after effects.

Alcohol consumption produces feelings of well-being and stimulation, but also impairs psychomotor performance, disturbs cardiovascular function and sleep, and can disrupt next-day mood and behavior. A deeper understanding of how the acute effects of alcohol relate to its sleep and morning-after effects is needed to minimize harm resulting from its use. This study examined relationships between the effects of a high dose of alcohol on subjective and psychomotor measures, nocturnal heart rate, sleep quality, and morning-after mood and behavior. We hypothesized that alcohol would produce disturbances in cardiovascular and sleep regulation during the night, which would predict morning-after mood and behavioral performance. Thirty-one men and women participated in two overnight laboratory visits during which they consumed either alcohol (1.0g/kg for men, 0.85 g/kg for women) or placebo (randomized, crossover design). They consumed the beverage from 8 to 9pm, and remained in the laboratory overnight for polysomnographic sleep recording. Subjective and behavioral measures were obtained during consumption and at 7-8am the morning after. Alcohol increased both negative and positive arousal, urge to drink and sedation, and it impaired performance on behavioral tasks. During sleep, alcohol produced expected tachycardia and detriments in sleep quality including decreased total sleep time, sleep efficiency, and altered sleep architecture. Only modest effects on mood or performance were detected the following morning. The acute sedative-like effects of alcohol were related to increases in N2 sleep, but not to other disruptions in sleep or nocturnal heart rate, and neither sleep impairments nor nocturnal heart rate were related to mood or task performance the morning after. The effects of alcohol on sleep and nocturnal heart rate were not strongly related to either its acute or morning-after effects. These findings do not provide strong support for the idea that alcohol-induced sleep disruptions underlie morning-after effects.

UPAYA MENINGKATKAN KETERAMPILAN TEKNIK DASAR PASSING SEPAK BOLA MELALUI MODIFIKASI PERMAINAN CROSSBAR COLOUR

The purpose of this Classroom Action Research is to find out to what extent the Crossbar Color game can increase the effectiveness of learning soccer passing in Grade VII MTs students. NM Addinul Qayyim Kapek, Gunungsari District, West Lombok Regency. Data collection in this Classroom Action Research consists of tests and observations. The subjects of this study were students of class VII MTs. NM Addinul Qayyim Kapek Gunungsari District with a total of 21 students. The instruments in this study were (cognitive) multiple choice tests, (psychomotor) performance tests and (affective) student character observation sheets, and this research was a classroom action research (CAR) In the initial conditions that meet the minimum completeness criteria (KKM) as many as 9 students or 42%, in the first action that meets the minimum completeness criteria (KKM) as many as 15 students or 71% and in the second action which meets the minimum completeness criteria (KKM) as many as 18 students or 85%. Based on the results of the initial conditions, actions I and II show that learning soccer passing through a modification of the crossbar color game can improve student learning outcomes.