Distracted driving is a threat to traffic safety that can result in more traffic crashes. Although previous studies have been conducted to explore the relationship between driver distraction and hazardous driving actions, few studies are available to identify the causation between them. Thus, the study intended to evaluate the causal effects of distraction on hazardous driving actions at intersections based on the crash data extracted from the Crash Report Sampling System (2021-2022). The multinomial logit model was employed to reveal the factors contributing to driver distraction. Then, propensity score weighting was adopted to balance the factor distributions between distraction and non-distraction cases to identify the causal effects on hazardous actions. Results indicated that 1) the propensity of distraction is relevant to factors such as the driver\'s age, gender, vehicle type, speed limit, area, weather, and light condition, 2) driver distraction can significantly increase the probability of risky actions including speeding, running red lights, failing to obey stop signs, failing to yield, following too closely, and 3) the causal effects show great diversity for different distraction types. The findings serve to understand the influence mechanism of distraction on specific crash risks and develop countermeasures to reduce distraction and hazardous driving actions.

Electroencephalography (EEG) is a non-invasive method used to track human brain activity over time. The time-locked EEG to an external event is known as event-related potential (ERP). ERP can be a biomarker of human perception and other cognitive processes. The success of ERP research depends on the laboratory conditions and attentiveness of the test subjects. Specifically, the inability to control experimental variables has reduced ERP research in the real world. This study collected EEG data under various experimental circumstances within an auditory oddball paradigm experiment to enable the use of ERP as an active biomarker in normal laboratory conditions. Then, ERP epochs were analyzed to identify unfocused epochs, affected by typical artifacts and external distortion. For the initial comparison, the ability of four unsupervised machine learning algorithms (MLAs) was evaluated to identify unfocused epochs. Then, their accuracy was compared with the human inspection and a current EEG analysis tool (EEGLab). All four MLAs were typically 95-100% accurate. In summary, our analysis finds that humans might miss subtle differences in the regular ERP patterns, but MLAs could efficiently identify those. Thus, our analysis suggests that unsupervised MLAs perform better for detecting unfocused ERP epochs compared with the other two standard methods.

OBJECTIVE: Virtual Reality (VR) is a successful distraction method for reducing procedure-related pain in children, though it has never been studied during otomicroscopy. Therefore, we investigated the efficacy of VR as a distraction method during otomicroscopy.
METHODS: This Randomised Control Trial (RCT) included 60 children aged 4-15 years. The patients were randomised to receive distraction by VR, tablet, or no distraction. Procedure-related pain was scored by patients and compared with previous examinations.
RESULTS: Patients\' experience with otomicroscopy was significantly improved with VR compared to tablet (p < 0.05) and no distraction (p < 0.01). Pain scores did not differ significantly between groups.
CONCLUSIONS: VR did not reduce pain scores, but it improved the children\'s experience with otomicroscopy without causing significant adverse outcomes.

Regulatory efforts are hypothesized to affect associations between emotions and physiology (i.e., concordance) to facilitate adaptive functioning. Assessing the role of coping on physiological-emotional concordance during ecologically relevant scenarios can elucidate whether concordance can serve as a biomarker of risk or resilience. The present study assessed self-reported coping as a moderator of minute-to-minute associations between autonomic nervous system activity and emotions (i.e., physiological-emotional concordance) in caregivers (N = 97) and adolescents (N = 97; ages 10-15) during a dyadic conflict task. Models included physiological variables (sympathetic, skin conductance level [SCL]; and parasympathetic, respiratory sinus arrhythmia [RSA]) and their interaction (SCL × RSA) as predictors of emotions, with coping variables as moderators. Caregivers\' use of primary control coping (e.g., problem solving and emotional expression) and secondary control coping (e.g., cognitive reappraisal and acceptance) use in response to family stress predicted more positive emotional experiences during the laboratory conflict task. Adolescents\' use of secondary control coping moderated the SCL-emotion association, such that increases in momentary SCL were associated with more positive emotion ratings for youth reporting higher secondary control coping. For youth who report more adaptive trait-level coping skills, momentary changes in SCL may reflect active engagement and attentiveness to facilitate more positive emotional experiences. Findings advance our understanding of the interrelationships between physiological responses and psychological experiences during relevant, interactive scenarios. Autonomic responses are differentially related to affective states depending on the coping strategies that adolescents employ, suggesting that concordance may be associated with intervention targets (i.e., coping skills).

UNASSIGNED: A 2-year follow-up study.
UNASSIGNED: To evaluate the effectiveness of modified halo-pelvic Ilizarov distraction assembly in the management of patients with severe kyphoscoliosis.
UNASSIGNED: Severe and rigid scoliosis curves are always a challenge for operating surgeons. Preoperative correction through halo-pelvic devices successfully minimizes the severity of the curve; however, cumbersome complications are also reported with its use. Modified assembly could be safe for these cases.
UNASSIGNED: Patients with severe kyphoscoliosis having coronal Cobb angle >90° were applied with modified halo-pelvic Ilizarov distraction assembly preoperatively. The modified assembly consisted of a pelvic component and halo ring, and distraction was given at the rate of 2-3 mm/day for 6-12 weeks. Complete clinical assessments along with pulmonary function tests were performed, and scoliosis series X-ray images were assessed for coronal and sagittal Cobb angle and other spinopelvic parameters before applying the assembly and during 2 years of follow-up.
UNASSIGNED: Thirty-four patients (age, 9-27 years; male/female ratio of 18:16) were included. The coronal and sagittal Cobb angles were 116°±16.2° and 84°±28.3°, respectively. Correction rates obtained through modified halo-pelvic assembly were nearly 52% (p=0.001) in coronal and 40% (p=0.001) in sagittal Cobb angles, with improvement in height (p=0.001). Apical vertebral translation and coronal balance were also improved significantly (p=0.001). Further improvements in all the parameters were obtained after definitive surgery, with improvements in the forced expiratory volume in 1 second (p =0.002) and forced vital capacity (p=0.001).
UNASSIGNED: Our modified halo-pelvic Ilizarov distraction assembly can achieve good correction in severe spinal deformities without significant risk to neurology, has fewer complications, and promotes good patient compliance.

BACKGROUND: Routine vaccination procedures, while crucial for public health, can induce pain, fear, and anxiety in children. Distraction techniques such as virtual reality and kaleidoscope have been proposed to alleviate these negative experiences during vaccinations.
OBJECTIVE: This study aimed to compare the effectiveness of virtual reality and kaleidoscope as distraction methods in reducing pain, fear, and anxiety during routine vaccination in children aged 48 months.
METHODS: This randomized controlled trial allocated children aged 48 months receiving the measles-mumps-rubella vaccine into three groups: virtual reality (n = 42), kaleidoscope (n = 42), and control (n = 42).
METHODS: The study was conducted in a pediatric clinic.
METHODS: The study included a total of 126 children aged 48 months.
METHODS: Pain and fear levels were assessed by both researchers and children before and after the vaccination procedure, while anxiety was evaluated by children after vaccination. Pain was measured using the Wong Baker Faces Pain Rating Scale, fear with the Children\'s Fear Scale, and anxiety with the Child Anxiety Scale-State Version.
RESULTS: Post-vaccination pain, fear, and anxiety scores were significantly lower in the kaleidoscope group compared to both the virtual reality and control groups (p < .05).
CONCLUSIONS: Using kaleidoscope during vaccination in 48-month-old children effectively reduced pain, fear, and anxiety. Integrating kaleidoscope as a distraction method during routine vaccination procedures may enhance the vaccination experience and potentially improve adherence to vaccination schedules.
BACKGROUND: Clinical trials number is NCT0611XXXX.

BACKGROUND: Virtual reality (VR) distraction can be used during peripheral intravenous catheter (PIC) insertion. The vein imaging devices are recommended for increasing PIC success.
OBJECTIVE: This study aimed to evaluate the effect of a Veinlite PEDI2 and passive VR distraction on the first attempt at PIC insertion success, duration of insertion, emotional behavior, pain, fear, and anxiety associated with PIC insertion in children aged 4-10 years in the pediatric emergency department.
METHODS: The study was conducted with a total of 160 children who were assigned to groups (control, vein imaging, VR, and vein imaging with VR) through stratified randomization. The duration and number of attempts for PIC insertion were recorded. The children\'s emotional state, fear, and anxiety were evaluated before and after the procedure. After the procedure, pain was evaluated using the Wong-Baker FACES and Color Analog Scale. The mean scores obtained from the scales were compared using the Kruskal-Wallis test.
RESULTS: The PIC success rate on the first attempt was 80-85% in the groups. A significant difference was found between the groups in terms of total emotional behavior scores (KW = 21.608, df = 3, p < 0.001). There were statistically significant differences among the groups in emotional behavior, pain, and anxiety scores after the procedure, while no difference was observed in fear scores (KW = 6.485, df = 3, p = 0.09).
CONCLUSIONS: VR distraction effectively reduced pain and anxiety, while the Veinlite PEDI2 did not affect the first attempt at PIC insertion or duration.
CONCLUSIONS: VR and Veinlite PEDI2 can be used for PIC insertion-related pain and anxiety (ClinicalTrials.gov: NCT06243419).

UNASSIGNED: Audiovisual distraction is a potentially good technique to reduce medical treatment procedure-related fear and anxiety among children. However, few studies have assessed its effectiveness.
UNASSIGNED: To conduct a systematic review and meta-analysis for evaluating the effectiveness of audiovisual distraction in reducing pain anxiety in pediatrics.
UNASSIGNED: Randomized control trials and experimental studies that reported the use of audiovisual distraction during medical/dental treatments among children aged 3-8 years, used the Face, Legs, Activity, Cry, Consolability (FLACC) scale to assess pain, and were published between 2005-2021 and in English were retrieved from PubMed, Scopus, and Web of Science. A random-effects model was used for evidence analysis.
UNASSIGNED: A total of four studies were included in the systematic review and meta-analysis: two were from South Asia and one each were from Africa and North America. Three of these studies were randomized control trials. The variability among the studies was high. Three of the four studies found that AV techniques were significantly effective in reducing pain during procedures compared with the control group (P < 0.00001), while one study found no difference; the cumulative evidence in the forest plot was similar.
UNASSIGNED: Cumulative evidence suggests that the use of audiovisual distraction is an effective strategy in reducing medical/dental procedures-related pain anxiety among children aged 3-8 years. However, evidence on this is currently limited, and thus further studies are required using various AD techniques and on different populations to substantiate these findings.
UNASSIGNED: None.
UNASSIGNED: PROSPERO (Ref no.: CRD42021245874).

UNASSIGNED: The use of sedation during interventional procedures has continued to rise resulting in increased costs, complications and reduced validity during diagnostic injections, prompting a search for alternatives. Virtual reality (VR) has been shown to reduce pain and anxiety during painful procedures, but no studies have compared it to a control and active comparator for a pain-alleviating procedure. The main objective of this study was to determine whether VR reduces procedure-related pain and other outcomes for epidural steroid injections (ESI).
UNASSIGNED: A randomized controlled trial was conducted in 146 patients undergoing an ESI at 6 hospitals in Thailand and the United States. Patients were allocated to receive immersive VR with local anesthetic, sedation with midazolam and fentanyl plus local anesthetic, or local anesthetic alone. The primary outcome was procedure-related pain recorded on a 0-10 scale. Other immediate-term outcome measures were pain from a standardized subcutaneous skin wheal, procedure-related anxiety, ability to communicate, satisfaction, and time to discharge. Intermediate-term outcome measures at 4 weeks included back and leg pain scores, function, and success defined as a ≥2-point decrease in average leg pain coupled with a score ≥5/7 on a Patient Global Impression of Change scale.
UNASSIGNED: Procedure-related pain scores with both VR (mean 3.7 (SD 2.5)) and sedation (mean 3.2 (SD 3.0)) were lower compared to control (mean 5.2 (SD 3.1); mean differences -1.5 (-2.7, -0.4) and -2.1 (-3.3, -0.9), respectively), but VR and sedation scores did not significantly differ (mean difference 0.5 (-0.6, 1.7)). Among secondary outcomes, communication was decreased in the sedation group (mean 3.7 (SD 0.9)) compared to the VR group (mean 4.1 (SD 0.5); mean difference 0.4 (0.1, 0.6)), but neither VR nor sedation was different than control. The trends favoring sedation and VR over control for procedure-related anxiety and satisfaction were not statistically significant. Post-procedural recovery time was longer for the sedation group compared to both VR and control groups. There were no meaningful intermediate-term differences between groups except that medication reduction was lowest in the control group.
UNASSIGNED: VR provides comparable benefit to sedation for procedure-related pain, anxiety and satisfaction, but with fewer side effects, superior communication and a shorter recovery period.
UNASSIGNED: Funded in part by grants from MIRROR, Uniformed Services University of the Health Sciences, U.S. Dept. of Defense, grant # HU00011920011. Equipment was provided by Harvard MedTech, Las Vegas, NV.

UNASSIGNED: Symptomatic distal interphalangeal joint osteoarthritis is a common joint disease that causes hand disability and reduces quality of life. There are few conservative treatment options for this condition. The purpose of this study was to investigate the effect of traction treatment on symptomatic distal interphalangeal joint osteoarthritis.
UNASSIGNED: This prospective, longitudinal study involved multiple time-series observations and within-subject controls. The most painful distal interphalangeal joints in patients with hand osteoarthritis were treated by daily, 15-min joint traction at home using a finger trap orthosis. The corresponding contralateral digits were used as within-subject controls. The primary outcome measure was two-point pinch strength, and the secondary outcome measures were radiographic findings and treatment adherence. Longitudinal and pairwise comparison analyses of the treated and control digits examined improvements in two-point pinch strength at months 1, 3, and 6 from baseline. The durability of treatment effects after treatment discontinuation was investigated at month 12.
UNASSIGNED: Eighteen treated digits and 18 corresponding control digits were eligible for analysis. There was a significant increase in two-point pinch strength after 1-month traction, and this increase was maintained until month 6 despite the absence of radiographic changes. Compared to controls, significant improvement in two-point pinch strength relative to baseline was seen at every observation time point, with a moderate to large effect size. There was no time-treatment interaction. Treatment adherence was high. At months 3 and 6, around 60-80 % of digits were voluntarily treated. Pinch strength was comparable between months 6 and 12, with greater improvement than in the control group.
UNASSIGNED: Joint traction treatment can improve pinch strength in symptomatic distal interphalangeal joint osteoarthritis. Larger, randomized studies on traction treatment and the effect on hand function are warranted.