OBJECTIVES: Asymmetric or unilateral hearing loss (AHL) may cause irreversible changes in the processing of acoustic signals in the auditory system. We aim to provide a comprehensive view of the auditory processing abilities for subjects with acquired AHL, and to examine the influence of AHL on speech perception under difficult conditions, and on auditory temporal and intensity processing. DESIGN: We examined peripheral and central auditory functions for 25 subjects with AHL resulting from vestibular schwannoma, and compared them to those from 24 normal-hearing controls that were matched with the AHL subjects in mean age and hearing thresholds in the healthy ear. Besides the basic hearing threshold assessment, the tests comprised the detection of tones and gaps in a continuous noise, comprehension of speech in babble noise, binaural interactions, difference limen of intensity, and detection of frequency modulation. For the AHL subjects, the selected tests were performed separately for the healthy and diseased ear. RESULTS: We observed that binaural speech comprehension, gap detection, and frequency modulation detection abilities were dominated by the healthy ear and were comparable for both groups. The AHL subjects were less sensitive to interaural delays, however, they exhibited a higher sensitivity to sound level, as indicated by lower difference limen of intensity and a higher sensitivity to interaural intensity difference. Correlations between the individual test scores indicated that speech comprehension by the AHL subjects was associated with different auditory processing mechanisms than for the control subjects. CONCLUSIONS: The data suggest that AHL influences both peripheral and central auditory processing abilities and that speech comprehension under difficult conditions relies on different mechanisms for the AHL subjects than for normal-hearing controls.

• MeSH
• Adult MeSH
• Hearing Loss, Unilateral * physiopathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Speech Perception * physiology   MeSH
• Aged MeSH
• Auditory Perception physiology   MeSH
• Auditory Threshold * MeSH
• Case-Control Studies MeSH
• Neuroma, Acoustic * physiopathology   complications   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

AIMS: To explore all medication administration errors (MAEs) throughout the entire process of medication administration by nurses in the inpatient setting, to describe their prevalence, and to analyse associated factors, including deviation from the good practice standards. BACKGROUND: Worldwide, MAEs are very common and regarded as a serious risk factor to inpatient safety. Nurses assume an essential role in the hospital setting during the administration of medications. DESIGN: The prospective observational study was carried out in accordance with the STROBE guidance. METHODS: This study was conducted in four regional hospitals from June to August 2021. MAEs were collected when nurses administered medications to the adult inpatients during the morning, noon, and evening medication rounds at the internal, surgical, and follow-up care departments in each hospital over three consecutive days. Direct observation by the multidisciplinary team was employed. MAEs were classified as major MAEs (from the potentially most serious and common to all drug forms), specific MAEs (specific to a drug form), and procedural MAEs (e.g., patient identification, hygiene standards, or generic drug substitution). Predictors of either major MAE or specific MAE frequency were analysed using the generalised linear model and the decision tree model. RESULTS: Overall, 58 nurses administering medication to 331 inpatients at 12 departments were observed. In total, 6356 medication administrations were observed, of which 461 comprised major MAEs, 1497 specific MAEs, and 12,045 procedural MAEs. The predictors of the occurrence of major MAEs and specific MAEs were the specific hospital, the nurse's length of practice (less than 2 years), and two procedural MAEs (the unclear prescription and the wrong strength). CONCLUSIONS: Non-adherence to the standard processes in healthcare facilities for prescribing and administering drugs increased the prevalence of severe MAEs. Determinants of MAE occurrence such as incorrect prescriptions or limited experience of nurses should be considered. IMPLICATION FOR THE PROFESSION AND PATIENT CARE: The identified determinants of MAE should be considered by hospital stakeholders in their support programs to reduce the level of burden for nurses during medication administration. PATIENT OR PUBLIC CONTRIBUTION: Neither patients nor public was not involved in the design, data collection, or dissemination plans of this study. The researchers observed nurse care delivery at medical departments acting as passive participants.

• MeSH
• Adult MeSH
• Hospitalization * statistics & numerical data   MeSH
• Middle Aged MeSH
• Humans MeSH
• Medication Errors * nursing   statistics & numerical data   prevention & control   MeSH
• Nursing Staff, Hospital statistics & numerical data   MeSH
• Prospective Studies MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Observational Study MeSH

OBJECTIVES: Annotating carious lesions on images is challenging. For artificial intelligence (AI) applications, the aggregation of heterogeneous multi-examiner annotations into one single annotation (e.g. via majority voting, MV) is usually needed. We assessed different aggregation strategies for multi-examiner annotations of primary proximal carious lesions on orthoradial radiographs and Near-Infrared Light Transillumination (NILT) images. METHODS: A total of 1007 proximal surfaces from 522 extracted posterior teeth were assessed by five dentists. Histological analysis provided the gold standard. Surfaces were classified as (1) sound, (2) enamel lesion or (3) dentin lesion. Four label aggregation strategies - MV, Weighted Majority Voting (WMV), Dawid-Skene (DS), and multi-annotator competence estimation (MACE) - were applied to unimodal (radiographs, NILT) and multimodal (combined) datasets. The area under the receiver operating characteristic curve (AUROC) was the primary outcome metric. RESULTS: According to the gold standard, 637 (63 %) surfaces were sound, 280 (28 %) showed carious lesions limited to the enamel, and 90 (9 %) showed lesions extending into the dentin. For radiographs, aggregation using MACE outperformed MV, WMV and DS significantly across all lesion depths (p < 0.002). For NILT, MACE significantly outperformed MV across all lesion depths (p < 0.001) and DS for enamel and dentin lesions (p ≤ 0.002). In the multimodal dataset, DS outperformed the other label aggregation strategies across all lesion depths significantly (p < 0.05). CONCLUSIONS: The commonly applied MV may be suboptimal. There is a need for informed application of specific aggregation strategies, depending on the dataset characteristics. CLINICAL SIGNIFICANCE: Most AI applications for dental image analysis are trained on a single annotation, usually resulting from aggregated multi-examiner annotations of each image. However, since these annotations are usually aggregated in an in vivo setting where no definitive ground truth is available, the choice of aggregation strategy plays a crucial role.

• MeSH
• Dentin pathology   diagnostic imaging   MeSH
• Humans MeSH
• Image Processing, Computer-Assisted * methods   MeSH
• Radiography, Dental MeSH
• ROC Curve MeSH
• Transillumination MeSH
• Artificial Intelligence MeSH
• Dental Caries * diagnostic imaging   pathology   MeSH
• Dental Enamel diagnostic imaging   pathology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

BACKGROUND: Recent years show an exponential increased interest ("renaissance") in the use of psychedelics for the treatment of mental disorders and broader. Some of these treatments, such as psilocybin for depression, are in the process of formal regulation by regulatory bodies in the US (FDA) and Europe (EMA), and as such on the brink of real-world implementation. In the slipstream of these developments increasing commercial initiatives are taking shape. The European Psychiatric Association (EPA) acknowledges both the therapeutic potential of psychedelic substances and the challenges for both research and clinical implementation. Steps need to be taken toward a well-balanced policy based upon sound scientific evidence and research, aiming at safe, ethical responsible integration of psychedelic therapy available for all patients who can potentially benefit. METHODS: In this EPA policy paper, we highlight the potential benefits, and also the challenges of psychedelic treatments, which can be relevant for the future real-world implementation of these treatments. RESULTS: In addition to an overview of the current evidence and hypotheses of working mechanisms of psychedelic treatment, this policy paper specifically highlights the importance of the psychosocial components of the treatment as well as the ethical and professional aspects playing a role in real-world implementation. CONCLUSIONS: Four recommendations are formulated for further research and clinical implementation.

• MeSH
• Mental Disorders * drug therapy   MeSH
• Hallucinogens * therapeutic use   MeSH
• Humans MeSH
• Psilocybin therapeutic use   pharmacology   MeSH
• Psychiatry MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Europe MeSH

BACKGROUND: Despite efforts to improve undergraduate clinical pharmacology & therapeutics (CPT) education, prescribing errors are still made regularly. To improve CPT education and daily prescribing, it is crucial to understand how therapeutic reasoning works. Therefore, the aim of this study was to gain insight into the therapeutic reasoning process. METHODS: A narrative literature review has been performed for literature on cognitive psychology and diagnostic and therapeutic reasoning. RESULTS: Based on these insights, The European Model of Therapeutic Reasoning has been developed, building upon earlier models and insights from cognitive psychology. In this model, it can be assumed that when a diagnosis is made, a primary, automatic response as to what to prescribe arises based on pattern recognition via therapy scripts (type 1 thinking). At some point, this response may be evaluated by the reflective mind (using metacognition). If it is found to be incorrect or incomplete, an alternative response must be formulated through a slower, more analytical and deliberative process, known as type 2 thinking. Metacognition monitors the reasoning process and helps a person to form new therapy scripts after they have chosen an effective therapy. Experienced physicians have more and richer therapy scripts, mostly based on experience and enabling conditions, instead of textbook knowledge, and therefore their type 1 response is more often correct. CONCLUSION: Because of the important role of metacognition in therapeutic reasoning, more attention should be paid to metacognition in CPT education. Both trainees and teachers should be aware of the possibility to monitor and influence these cognitive processes. Further research is required to investigate the applicability of these insights and the adaptability of educational approaches to therapeutic reasoning.

• MeSH
• Pharmacology, Clinical education   MeSH
• Clinical Reasoning * MeSH
• Clinical Competence MeSH
• Drug Prescriptions standards   MeSH
• Humans MeSH
• Medication Errors prevention & control   MeSH
• Metacognition MeSH
• Education, Medical, Undergraduate MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

Pomalé oscilace (< 1 Hz), pozorovatelné v EEG zejména v nejhlubší fázi spánku, se pojí s řadou příznivých fyziologických procesů. Během poslední dekády se etablovala nová nefarmakologická metoda jejich podpory pomocí akustických stimulů, tzv. zpětnovazebná akustická stimulace. Spící je při ní vystaven zvukům, nejčastěji růžovému šumu, synchronizovanému s vlastní endogenní neurální aktivitou. Článek seznamuje čtenáře s touto neuromodulační technikou a shrnuje její dosud známé účinky na mikrostrukturu spánku, paměť a vybrané fyziologické procesy. Zmíněn je také možný terapeutický potenciál, limity metody a směřování výzkumu.

Slow oscillations (< 1 Hz), visible in the EEG, especially during the deepest sleep, are associated with many beneficial physiological processes. During the last decade, a new non-pharmacological method of their enhancement using acoustic stimuli, the so-called closed-loop acoustic stimulation, has become established. This technique consists of bursts of sound, most frequently pink noise, presented in synchrony with the endogenous neural activity of the sleeper. This review introduces this neuromodulation method and summarizes its effects on sleep microstructure, memory and selected physiological processes. The possible therapeutic potential, limits of the method, as well as possible future research directions are discussed.

Východiská: Medikačné chyby sú častejšie hlásené z nemocničného prostredia. Avšak môžeme ich identifikovať aj v zariadeniach sociálnych služieb. Najčastejšie ide o nesprávne riedenie lieku, nesprávne uchovávanie lieku, podanie lieku v nesprávnej dávke a v nesprávnom čase, nesprávnu techniku podania lieku, podanie exspirovaného lieku. Výsledky výskumov dokazujú, že medikačné chyby sú globálnym problém verejného zdravia. Cieľ: identifikovať kritické miesta rizikového správania sa sestier v príprave a podávaní liekov pre os obyvateľom zariadenia sociálnych služieb. Súbor a metódy: Do súboru bolo zaradených 5 sestier s priemernou dĺžkou praxe v povolaní sestra 29,4 rokov. Uskutočnili sme priame pozorovanie v rozsahu piatich pracovných dní. Celkový počet pozorovaní bolo 675. Počet pozorovaných javov bol 9. Použili sme metódu frekvenčnej analýzy pozorovaných javov. Výsledky sme interpretovali ako priemerné relatívne skóre. Výsledky: Z analýzy dát vyplynulo zistenie, že kritickým miestom v príprave a v podávaní liekov per os v zariadení sociálnych služieb je kontrola nežiaducich účinkov liekov, poučenie osoby a kontrola užitia liekov. Najviac medikačných chýb sme zaznamenali v tretí pracovný deň. Záver: Odhalené rizikové správanie sa sestier v príprave a podávaní liekov sú výzvou pre zmeny v procesoch realizovaných v zariadení sociálnych služieb. Prospektívne je potrebné realizovať väčšie multicentrické štúdie

Backround: Medication errors are more commonly reported from the hospital setting. However, they can also be identified in social service settings. The most common are incorrect dilution of the medicine, incorrect storage of the medicine, administration of the medicine in the wrong dose and at the wrong time, incorrect technique of administration of the medicine, administration of exspirated medicine. Research findings show that medication errors are a global public health problem. Objective: Identify critical points of nurses' risky behaviors in the preparation and administration of medications to residents of a social service facility. Participants and methods: Five nurses with an average length of experience in the nursing profession of 29.4 years were included in the cohort. We conducted direct observation over a period of five working days. The total number of observations was 675. The number of observed phenomena was 9. We used the method of frequency analysis of observed phenomena. We interpreted the results as mean relative scores. Results: The data analysis revealed the finding that the critical point in the preparation and administration of per os medications in a social service facility is the control of adverse drug reactions, the instruction of the person, and the control of the use of medications. The highest number of medication errors were observed on the third working day. Conclusion: The revealed risky behaviors of nurses in the preparation and administration of medications are a challenge for changes in the processes implemented in the social services facility. Larger multicentre studies with longer observation periods are prospectively needed

• MeSH
• Medical Errors MeSH
• Medication Errors MeSH
• Nursing Homes MeSH
• Surveys and Questionnaires MeSH
• Social Welfare MeSH

Prenatal listening experience reportedly modulates how humans process speech at birth, but little is known about how speech perception develops throughout the perinatal period. The present experiment assessed the neural event-related potentials (ERP) and mismatch responses (MMR) to native vowels in 99 neonates born between 32 and 42 weeks of gestation. The vowels elicited reliable ERPs in newborns whose gestational age at time of experiment was at least 36 weeks and 1 day (36 + 1). The ERPs reflected spectral distinctions between vowel onsets from age 36 weeks + 6 days and durational distinctions at vowel offsets from age 37 weeks + 6 days. Starting at age 40 + 4, there was evidence of neural discrimination of vowel length, indexed by a negative MMR response. The present findings extend our understanding of the earliest stages of speech perception development in that they pinpoint the ages at which the cortex reliably responds to the phonetic characteristics of individual speech sounds and discriminates a native phoneme contrast. The age at which the brain reliably differentiates vowel onsets coincides with what is considered term age in many countries (37 weeks + 0 days of gestational age). Future studies should investigate to what extent the perinatal maturation of the cortical responses to speech sounds is modulated by the ambient language.

• MeSH
• Acoustic Stimulation * methods   MeSH
• Electroencephalography * MeSH
• Evoked Potentials physiology   MeSH
• Phonetics * MeSH
• Gestational Age * MeSH
• Humans MeSH
• Infant, Premature physiology   MeSH
• Infant, Newborn MeSH
• Speech Perception * physiology   MeSH
• Evoked Potentials, Auditory physiology   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Infant, Newborn MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

It has long been known that environmental conditions, particularly during development, affect morphological and functional properties of the brain including sensory systems; manipulating the environment thus represents a viable way to explore experience-dependent plasticity of the brain as well as of sensory systems. In this review, we summarize our experience with the effects of acoustically enriched environment (AEE) consisting of spectrally and temporally modulated complex sounds applied during first weeks of the postnatal development in rats and compare it with the related knowledge from the literature. Compared to controls, rats exposed to AEE showed in neurons of several parts of the auditory system differences in the dendritic length and in number of spines and spine density. The AEE exposure permanently influenced neuronal representation of the sound frequency and intensity resulting in lower excitatory thresholds, increased frequency selectivity and steeper rate-intensity functions. These changes were present both in the neurons of the inferior colliculus and the auditory cortex (AC). In addition, the AEE changed the responsiveness of AC neurons to frequency modulated, and also to a lesser extent, amplitude-modulated stimuli. Rearing rat pups in AEE leads to an increased reliability of acoustical responses of AC neurons, affecting both the rate and the temporal codes. At the level of individual spikes, the discharge patterns of individual neurons show a higher degree of similarity across stimulus repetitions. Behaviorally, rearing pups in AEE resulted in an improvement in the frequency resolution and gap detection ability under conditions with a worsened stimulus clarity. Altogether, the results of experiments show that the exposure to AEE during the critical developmental period influences the frequency and temporal processing in the auditory system, and these changes persist until adulthood. The results may serve for interpretation of the effects of the application of enriched acoustical environment in human neonatal medicine, especially in the case of care for preterm born children.

• MeSH
• Acoustic Stimulation * MeSH
• Acoustics MeSH
• Inferior Colliculi growth & development   physiology   MeSH
• Rats MeSH
• Humans MeSH
• Neurons physiology   MeSH
• Neuronal Plasticity * physiology   MeSH
• Animals, Newborn MeSH
• Auditory Pathways * growth & development   physiology   MeSH
• Auditory Perception MeSH
• Auditory Cortex * growth & development   physiology   MeSH
• Age Factors MeSH
• Environment MeSH
• Animals MeSH
• Check Tag
• Rats MeSH
• Humans MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

Parallel fibers (PFs) in the cerebellar cortex are involved in a series of coordinated responses in the fear conditioning paradigm induced by footshock. However, whether footshock can activate cerebellar climbing fibers (CFs) remains unclear. In this study, we recorded calcium (Ca2+) activity in CFs by optical fiber photometry in the cerebellar vermis lobule IV/V of freely moving mice with footshock stimulation. We found that the activation of CFs in the lobule IV/V was highly correlated with footshock stimulation but not with the sound stimulation used as a control. This result suggests that afferent information from CFs might be associated with the motor initiation of fear-related behaviors or fear emotion itself. Thus, our results suggest that a characteristic CF signal in the cerebellar cortex might be related to fear processing or footshock-related behaviors (such as startle responses or pain sensation).

• MeSH
• Electroshock MeSH
• Cerebellar Cortex physiology   MeSH
• Cerebellum physiology   MeSH
• Mice, Inbred C57BL * MeSH
• Mice MeSH
• Fear * physiology   MeSH
• Animals MeSH
• Check Tag
• Male MeSH
• Mice MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH