Medicine and Health Sciences Commons^™

Scissor-Type Knife Improves The Safety Of Endoscopic Submucosal Dissection (Esd) Among Endoscopists Without Experience In Esd: A Randomized Ex Vivo Study, Kavel Visrodia, Tarek Sawas, Liam Zakko, Juan Reyes Genere, Cadman Leggett, Lori Lutzke, Kenneth K. Wang

2020-Current year OA Pubs

No abstract provided.

Opening Pandora’S Box From Readmissions To Transitional Care Patient-Centered Outcome Measures, Mathew J. Reeves, Michele C. Fritz, Ifeyinwa Osunkwo, Corita R. Grudzen, Lewis L. Hsu, Jing Li, Raymona H. Lawrence, Janet Prvu Bettger

Health Policy & Community Health: Faculty Publications

Background:

Measuring the effectiveness of transitional care interventions has historically relied on health care utilization as the primary outcome. Although the Care Transitions Measure was the first outcome measure specifically developed for transitional care, its applicability beyond the hospital-to-home transition is limited. There is a need for patient-centered outcome measures (PCOMs) to be developed for transitional care settings (ie, TC-PCOMs) to ensure that outcomes are both meaningful to patients and relevant to the particular care transition. The overall objective of this paper is to describe the opportunities and challenges of integrating TC-PCOMs into research and practice.

Methods and Results:

This …

Daratumumab In Patients With Bortezomib-Refractory Proliferative Glomerulonephritis With Monoclonal Immunoglobulin Deposits., Salem Almaani, Samir V Parikh, Anjali A Satoskar, Naresh Bumma, Brad H Rovin, Nidhi Sharma, Yvonne Efebera, Isabelle Ayoub

Ambulatory and Primary Care Articles

No abstract provided.

Modulation Of The Acute Post-Anterior Cruciate Ligament Rupture Intra-Articular Environment Via Recruitment Of Marrow-Derived Stem Cells To Promote Bone Tunnel Healing In Acl Reconstruction, Kevin C. Baker, Samantha Hartner, Mackenzie M. Fleischer, Michael D. Newton, William B. Acker, Perry Altman, Christopher Bush, Tristan Maerz, Asheesh Bedi

Conference Presentation Abstracts

Acute, post-injury peripheral blood mobilization therapy with a CXCR4 antagonist improved bone tunnel healing and graft integration following ACL reconstruction surgery in a rat model.

Creation And Implementation Of An Intraoperative Lidocaine Infusion Protocol For Gastric Surgery, Kayla Donnay, Eric Howard, Lindsey Krueger, Linda Mcdonald, Kyle Nelson

Conference Presentation Abstracts

Background: The recent opioid epidemic in the United States has damaged the country’s public health system and led to devastating patient outcomes. Healthcare providers are responsible to do their part in reducing these negative consequences. The purpose of this quality improvement project was to develop and implement an evidence-based protocol for an intraoperative lidocaine infusion during gastric surgery. The project consisted of five parts: (1) development of an evidenced-based Intraoperative Lidocaine Infusion Protocol, (2) education of the anesthesia team, (3) collection of baseline data, (4) implementation of the Intraoperative Lidocaine Infusion Protocol and (5) evaluation of the results. Method: Baseline …

Examining Enhanced Recovery After Surgery (Eras) Protocol Compliance, Joseph Vecore, Jonathon Baich, Linda Mcdonald

Conference Presentation Abstracts

Background: The development of enhanced recovery after surgery (ERAS) protocols have allowed for improved patient outcomes by utilizing a multimodal approach. The use of ERAS for surgical procedures reduces perioperative complications that could lead to increased morbidity, mortality, and length of stay. Additionally, by utilizing a multimodal approach, ERAS protocols help limit opioid use during the perioperative period. The purpose of this quality improvement project was to examine the rate of compliance to the ERAS protocol during colorectal surgery at Beaumont Hospital- Royal Oak. The different levels of compliance were evaluated for their effects on the following patient outcomes: opioid …

Milk Exosomes: Nature's Abundant Nanoplatform For Theranostic Applications, Benilde Adriano, Nycol Cotto, Neeraj Chauhan, Meena Jaggi, Subhash C. Chauhan, Murali M. Yallapu

School of Medicine Publications

Exosomes are a unique subpopulation of naturally occurring extracellular vesicles which are smaller intracellular membrane nanoparticle vesicles. Exosomes have proven to be excellent nanocarriers for carrying lipids, proteins, mRNAs, non-coding RNAs, and DNAs, and disseminating long-distance intercellular communications in various biological processes. Among various cell-line or biological fluid derived exosomes, milk exosomes are abundant in nature and exhibit many nanocarrier characteristics favorable for theranostic applications. To be an effective delivery carrier for their clinical translation, exosomes must inbuilt loading, release, targeting, and imaging/tracking characteristics. Considering the unmet gaps of milk exosomes in theranostic technology it is essential to focus the …

Continuous Glucose Monitoring, Type 2 Diabetes And Hemoglobin A1c: An Integrative Review, Kimberly Dawn Fairchild

Doctoral Dissertations and Projects

Continuous glucose monitors (CGMs) are used to measure a patient’s glucose levels every few minutes around the clock. According to the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), CGMs are mostly used by Type 1 Diabetes Mellitus patients, but research has shown that Type 2 DM patients can benefit from them as well (Ida et al., 2019; NIDDK, 2017). Glucose levels can change over hours or days, and seeing the trends by using a CGM will help patients make more informed decisions about the food they eat and how much they exercise, and the type and amount …

Examining The Impact Of Healthcare Providers In Relation To Gaining Patient's Acceptance And Initiation Of The Hpv Vaccine: An Integrative Review, Millie Elizabeth Knox

Doctoral Dissertations and Projects

The human papillomavirus (HPV) is a prevalent virus and the most common sexually transmitted infection (STI) worldwide. Nearly 80 million people, approximately one in four, are currently infected in the United States (US). Given that HPV infections affects over 20 million Americans with possible life-threatening consequences, the importance of adhering to the recommended two-dose or three-dose vaccination series has a significant impact on cancer prevention. Research studies have suggested that adolescents and young adults are at an increased risk of STIs and low HPV vaccination rates. For this integrative review, the target population was adolescents to young adults, ages 9-26 …

Preventing Malaria In Western Kenya Through Educational Interventions And Treatment Combination Of Indoor Residual Spraying With Insecticide Treated Mosquito Nets: An Integrated Review, Banis Nyokabi Githinji

Doctoral Dissertations and Projects

Over the years, several Malaria prevention strategies have been deployed in western Kenya with the aim of reducing malaria infection rates. However, those rates continue to be disproportionally higher in western Kenya compared to other regions of the country. The objective of this review is to determine factors that contribute to higher malaria infection rates in western Kenya compared to other regions in the country. The review will also examine past literature to determine if combining educational interventions with treatment interventions offers greater protection against malaria compared to treatment interventions alone. First, the project will compare the geographic and human …

Feasibility Of Biosimilar Integration In Oncology Practice, Kelley Duncan Mayden

Doctoral Dissertations and Projects

The therapeutic value of biologics is of extreme importance in the treatment of most major cancers. Biologics account for half of the oncologic pharmacology market. As the population of the United States ages, the demand for biologics is expected to increase. The future supply of biologics may be prohibited by cost. Biosimilar biologics are highly similar to existing Food and Drug Administration-licensed biologics and have the potential to meet biological demand. Market introduction of biosimilars at a lower cost than reference biologics creates an opportunity for reducing the nation’s financial burden. Despite the obvious gains from biosimilar use, adoption into …

Strategies To Decrease Cauti Rates In Hospitalized Patients: An Integrative Review, Katie Nichole Robinson

Doctoral Dissertations and Projects

Catheter-associated urinary tract infections (CAUTI) are proven to be a leading cause of infection within hospital systems and are caused by the use of indwelling urinary catheters. Diagnosis is made through additional urine testing and the infection requires treatment with antibiotics. The question within this integrative review was “What are effective strategies to decrease CAUTI rates in adult patients who are hospitalized?” During this integrative review, several strategies were examined to evaluate their effects on CAUTI rates on hospitalized adult patients requiring urinary drainage devices. Those strategies focused mainly on CAUTI bundles including proper insertion, early removal and external urinary …

Cd148 Deficiency In Fibroblasts Promotes The Development Of Pulmonary Fibrosis, Konstantin Tsoyi, Xiaoliang Liang, Giulia De Rossi, Stefan W Ryter, Kevin Xiong, Sarah G Chu, Xiaoli Liu, Bonna Ith, Lindsay J Celada, Freddy Romero, Matthew J Robertson, Anthony J Esposito, Sergio Poli, Souheil El-Chemaly, Mark A Perrella, Yuanyuan Shi, James Whiteford, Ivan O Rosas

Faculty, Staff and Students Publications

Rationale: CD148/PTRJ (receptor-like protein tyrosine phosphatase η) exerts antifibrotic effects in experimental pulmonary fibrosis via interactions with its ligand syndecan-2; however, the role of CD148 in human pulmonary fibrosis remains incompletely characterized.

Objectives: We investigated the role of CD148 in the profibrotic phenotype of fibroblasts in idiopathic pulmonary fibrosis (IPF).

Methods: Conditional CD148 fibroblast-specific knockout mice were generated and exposed to bleomycin and then assessed for pulmonary fibrosis. Lung fibroblasts (mouse lung and human IPF lung), and precision-cut lung slices from human patients with IPF were isolated and subjected to experimental treatments. A CD148-activating 18-aa mimetic peptide (SDC2-pep) derived from …

Deep Learning-Based Mixed-Dimensional Gaussian Mixture Model For Characterizing Variability In Cryo-Em, Muyuan Chen, Steven J Ludtke

Faculty, Staff and Students Publications

Structural flexibility and/or dynamic interactions with other molecules is a critical aspect of protein function. Cryogenic electron microscopy (cryo-EM) provides direct visualization of individual macromolecules sampling different conformational and compositional states. While numerous methods are available for computational classification of discrete states, characterization of continuous conformational changes or large numbers of discrete state without human supervision remains challenging. Here we present e2gmm, a machine learning algorithm to determine a conformational landscape for proteins or complexes using a three-dimensional Gaussian mixture model mapped onto two-dimensional particle images in known orientations. Using a deep neural network architecture, e2gmm can automatically resolve the …

Utilizing Structured Worksheets To Strengthen Resident Teaching On The Ob/Gyn Clerkship, Matthew R Carroll, Charlie C Kilpatrick, Grace Johnson, Neelima Sukhavasi, Bani M Ratan

Faculty, Staff and Students Publications

OBJECTIVE: To determine if structured worksheets can aid resident teaching on the obstetrics and gynecology (OB/GYN) clerkship.

DESIGN: We developed structured worksheets to aid residents in teaching medical students. In this pilot study, we measured the impact of the material by conducting end of clerkship focus groups between October 2017 to June 2018 and administering surveys to medical students who had recently completed the clerkship. We performed analyses of the focus group transcriptions for positive and negative themes and analyzed questionnaire data utilizing unpaired t-test and chi-square test to determine whether resident use of structured worksheets influenced student perception of …

The Immunoregulatory Landscape Of Human Tuberculosis Granulomas, Evan Li, Antony Rodriguez, Amber U Luong, David Allen, John Morgan Knight, Farrah Kheradmand, David B Corry

Faculty, Staff and Student Publications

The allergic airway diseases chronic rhinosinusitis (CRS), allergic fungal rhinosinusitis (AFRS), asthma, allergic bronchopulmonary mycosis/aspergillosis (ABPM/A), and cystic fibrosis (CF) share a common immunological signature marked by T H 2 and TH 17 cell predominant immune responses, the production of IgE antibody, and atypical inflammatory cell infiltrate that includes eosinophils and other innate immune effector cells. Severe forms of these disorders have long been recognized as being related to hypersensitivity reactions to environmental fungi. Increasingly however,environmental fungi are assuming a more primary role in the etiology of these disorders, with airway mycosis, a type of non-invasive airway fungal infection,recognized as …

Thioredoxin Reductase Is A Major Regulator Of Metabolism In Leukemia Cells, Sheelarani Karunanithi, Ruifu Liu, Yongchun Hou, Giancarlo Gonzalez, Natasha Oldford, Anne Jessica Roe, Nethrie Idipilly, Kalpana Gupta, Chandra Sekhar Amara, Satwikreddy Putluri, Grace Kyueun Lee, Juan Valentin-Goyco, Lindsay Stetson, Stephen A Moreton, Vasanta Putluri, Shyam M Kavuri, Yogen Saunthararajah, Marcos De Lima, Gregory P Tochtrop, Nagireddy Putluri, David N Wald

Faculty, Staff and Students Publications

Despite the fact that AML is the most common acute leukemia in adults, patient outcomes are poor necessitating the development of novel therapies. We identified that inhibition of Thioredoxin Reductase (TrxR) is a promising strategy for AML and report a highly potent and specific inhibitor of TrxR, S-250. Both pharmacologic and genetic inhibition of TrxR impairs the growth of human AML in mouse models. We found that TrxR inhibition leads to a rapid and marked impairment of metabolism in leukemic cells subsequently leading to cell death. TrxR was found to be a major and direct regulator of metabolism in AML …

Factors Influencing Emergency Medicine Residency Choice: Diversity, Community, And Recruitment Red Flags, Paul L Weygandt, Laura Smylie, Edgardo Ordonez, Jaime Jordan, Arlene S Chung

Faculty, Staff and Students Publications

BACKGROUND: Emergency medicine (EM) applicants consider many factors when selecting residency programs. Prior studies have demonstrated that applicants consider geography as well as modifiable/nonmodifiable program factors. Less attention, however, has been paid to underrepresented groups. Additionally, the prevalence and characteristics of "red flags," or factors that may lead an applicant to lower a program's rank or not rank it at all, remain unknown in EM. Our objective was to describe the factors that influence current EM-bound medical students' residency selection focusing on underrepresented applicants and red flags encountered during the recruitment process.

METHODS: We conducted a mixed-methods survey study of …

Metabolomics Profiling Of Patients With A-Β+ Ketosis-Prone Diabetes During Diabetic Ketoacidosis, Farook Jahoor, Jean W Hsu, Paras B Mehta, Kelly R Keene, Ruchi Gaba, Surya Narayan Mulukutla, Eunice Caducoy, W Frank Peacock, Sanjeet G Patel, Rasmus Bennet, Ake Lernmark, Ashok Balasubramanyam

Faculty, Staff and Students Publications

When stable and near-normoglycemic, patients with “A−β+” ketosis-prone diabetes (KPD) manifest accelerated leucine catabolism and blunted ketone oxidation, which may underlie their proclivity to develop diabetic ketoacidosis (DKA). To understand metabolic derangements in A−β+ KPD patients during DKA, we compared serum metabolomics profiles of adults during acute hyperglycemic crises, without (n = 21) or with (n = 74) DKA, and healthy control subjects (n = 17). Based on 65 kDa GAD islet autoantibody status, C-peptide, and clinical features, 53 DKA patients were categorized as having KPD and 21 type 1 diabetes (T1D); 21 nonketotic patients were categorized as …

Sugar-Sweetened Beverage Consumption May Modify Associations Between Genetic Variants In The Chrebp (Carbohydrate Responsive Element Binding Protein) Locus And Hdl-C (High-Density Lipoprotein Cholesterol) And Triglyceride Concentrations, Danielle E Haslam, Gina M Peloso, Melanie Guirette, Fumiaki Imamura, Traci M Bartz, Achilleas N Pitsillides, Carol A Wang, Ruifang Li-Gao, Jason M Westra, Niina Pitkänen, Kristin L Young, Mariaelisa Graff, Alexis C Wood, Kim V E Braun, Jian'an Luan, Mika Kähönen, Jessica C Kiefte-De Jong, Mohsen Ghanbari, Nathan Tintle, Rozenn N Lemaitre, Dennis O Mook-Kanamori, Kari North, Mika Helminen, Yasmin Mossavar-Rahmani, Linda Snetselaar, Lisa W Martin, Jorma S Viikari, Wendy H Oddy, Craig E Pennell, Frits R Rosendall, M Arfan Ikram, Andre G Uitterlinden, Bruce M Psaty, Dariush Mozaffarian, Jerome I Rotter, Kent D Taylor, Terho Lehtimäki, Olli T Raitakari, Kara A Livingston, Trudy Voortman, Nita G Forouhi, Nick J Wareham, Renée De Mutsert, Steven S Rich, Joann E Manson, Samia Mora, Paul M Ridker, Jordi Merino, James B Meigs, Hassan S Dashti, Daniel I Chasman, Alice H Lichtenstein, Caren E Smith, Josée Dupuis, Mark A Herman, Nicola M Mckeown

Faculty, Staff and Students Publications

BACKGROUND: ChREBP (carbohydrate responsive element binding protein) is a transcription factor that responds to sugar consumption. Sugar-sweetened beverage (SSB) consumption and genetic variants in the

METHODS: Data from 11 cohorts from the Cohorts for Heart and Aging Research in Genomic Epidemiology consortium (N=63 599) and the UK Biobank (N=59 220) were used to quantify associations of SSB consumption, genetic variants, and their interaction on HDL-C and triglyceride concentrations using linear regression models. A total of 1606 single nucleotide polymorphisms within or near

RESULTS: In a meta-analysis, rs71556729 was significantly associated with higher HDL-C concentrations only among the highest SSB consumers …

Dysphagia Should Be Reported As A Separate Legacy Outcome Measure After Anterior Cervical Discectomy And Fusion, Philip Zakko, Rafid Kasir, Nai-Wei Chen, Daniel K. Park

Conference Presentation Abstracts

INTRODUCTION: Dysphagia is a common complication after anterior cervical discectomy and fusion (ACDF) but is not a routinely asked question in legacy patient-reported outcome measures. This study looks to see whether there are associations between dysphagia and legacy outcome measures. METHODS: We retrospectively reviewed 168 patients who underwent ACDF surgery from 2017 to 2019 at a single institution. Demographics, anthropometric data, Neck disability index (NDI), visual analog scale (VAS) pain scores, PROMIS-Health and -Mental scores, Charlson Comorbidities Index (CCI), and Eating Assessment Tool (EAT-10) were obtained for each patient preop and 1, 3, 6, and 12 months postop. Repeated measure …

Enhancing The Teaching Environment: 3-Year Follow-Up Of A Resident-Led Residents-As-Teachers Program, Bani M Ratan, Grace J Johnson, Amanda C Williams, Jocelyn T Greely, Charlie C Kilpatrick

Faculty, Staff and Students Publications

BACKGROUND: Previous faculty-driven residents-as-teachers (RAT) models have had limited efficacy and sustainability.

OBJECTIVE: To evaluate the acceptability and effects of a

METHODS: In October 2016, obstetrics and gynecology (OB/GYN) residents at a large academic institution implemented a resident-led RAT program, consisting of a steering committee of peer-selected residents with 2 faculty mentors who planned education-focused resident didactics and journal clubs, organized resident involvement in clerkship activities, and recognized residents who excelled in teaching as Distinguished Educators (DEs). From July 2016 through June 2019, using the Kirkpatrick Model, we evaluated the program with annual resident surveys assessing self-perception of 13 teaching …

Transcriptional Milestones In Dictyostelium Development, Mariko Katoh-Kurasawa, Karin Hrovatin, Shigenori Hirose, Amanda Webb, Hsing-I Ho, Blaž Zupan, Gad Shaulsky

Faculty, Staff and Students Publications

Dictyostelium development begins with single-cell starvation and ends with multicellular fruiting bodies. Developmental morphogenesis is accompanied by sweeping transcriptional changes, encompassing nearly half of the 13,000 genes in the genome. We performed time-series RNA-sequencing analyses of the wild type and 20 mutants to explore the relationships between transcription and morphogenesis. These strains show developmental arrest at different stages, accelerated development, or atypical morphologies. Considering eight major morphological transitions, we identified 1371 milestone genes whose expression changes sharply between consecutive transitions. We also identified 1099 genes as members of 21 regulons, which are groups of genes that remain coordinately regulated despite …

A Critical Analysis On Mexican Americans Associated With Gangs Living In San Antonio, Texas, Rubi Guadalupe Gonzales

Open Access Theses & Dissertations

The U.S has a major national concern of mass incarceration. Mass incarceration poses a threat to achieve health equity as there are many adverse health effects documented related to incarceration (i.e., posttraumatic stress disorder, depression, anxiety, hypertension, diabetes, asthma, hepatitis, HIV, tuberculosis, etc.,). There is a great need to conduct research on incarceration with a critical lens. The present study examined the incarceration trajectories of Mexican American men who were associated with gangs during their youth and lived in the west side of San Antonio. This cohort of males were followed at three different timepoints in their life using retrospective …

Translation And Validation Of The Spanish Version Of The Quality Of Life Inventory For Adolescents (Qolie-Ad-48), Perla Michelle Martinez

Open Access Theses & Dissertations

Background: In 1999, an instrument was developed to assess quality of life (QoL) among adolescences with epilepsy. To our knowledge there is not a validated Spanish version of this questionnaire. There is a gap in the literature about QoL and epilepsy among speaking Spanish populations. Objectives: 1) To conduct an English-Spanish translation of the QOLIE-AD-48; 2) to evaluate the reliability of the Spanish version of the QoLIE-AD-48; and 3) to assess the validity of the Spanish version of the QoLIE-AD-48. Method: Phase 1 translation: Methods followed the published work of Sousa and Rojjanasrirat (2010). Phase 2 Pilot study: the sample …

Surveillance Of Ticks And Associated Pathogens In Central Texas, Alexa Mendoza

Open Access Theses & Dissertations

Background: Ticks are the second most common vector of human and veterinary pathogens, after mosquitoes, which results in a number of different diseases around the world. These diseases, referred to as tick-borne diseases (TBDs), are increasing in their prevalence around the world as the geographical distribution of ticks change due to environmental and human factors. Increased testing for pathogens and a better comprehension of their relationship to different tick species will be crucial in deepening our understanding of TBDs and protecting our human and animal populations. Increasing surveillance of ticks and the potential pathogens they may be vectors for and …

Neurovascular Regulation In Diabetic Retinopathy And Emerging Therapies, Liyang Ji, Hong Tian, Keith A Webster, Wei Li

Faculty, Staff and Students Publications

Diabetic retinopathy (DR) is the leading cause of vision loss in working adults in developed countries. The disease traditionally classified as a microvascular complication of diabetes is now widely recognized as a neurovascular disorder resulting from disruption of the retinal neurovascular unit (NVU). The NVU comprising retinal neurons, glia and vascular cells coordinately regulates blood flow, vascular density and permeability to maintain homeostasis. Disturbance of the NVU during DR can lead to vision-threatening clinical manifestations. A limited number of signaling pathways have been identified for intercellular communication within the NVU, including vascular endothelial growth factor (VEGF), the master switch for …

The Role Of Calcium Ions In Signaling And Regulation Of Efflux Pump Genes In Staphylococcus Aureus, Amy Rebecca Nava

Open Access Theses & Dissertations

Calcium ions (Ca2+) play an important role in eukaryote cell signaling and regulation of physiological functions. Although evidence of a similar role for Ca2+ in prokaryotes has been difficult to demonstrate, there is mounting evidence that Ca2+ acts as a cell regulator in bacteria. The purpose of this study was to investigate Ca2+ signaling and the effect of Ca2+ on gene expression of various multidrug resistant (MDR) efflux pumps and their regulator MgrA in Staphylococcus aureus and clinically isolated MRSA. We hypothesized that the presence of Ca2+ increased gene expression of multidrug resistance pumps, LmrS, NorA, and the regulator, MgrA. …

Underreporting On The Mmpi-2-Rf Extends To Extra-Test Measures Of Suicide Risk, Lauren R Khazem, Katrina A Rufino, Megan L Rogers, Austin J Gallyer, Thomas E Joiner, Joye C Anestis

Staff and Researcher Publications

Detection of under-reporting in suicide risk assessment remains a significant concern in clinical practice. The aim of this research is to examine whether under-reporting based on elevated MMPI-2-RF K-r and L-r scale scores may aid in identifying patients with suppressed scores on SUI and extra-test measures of suicide risk. We anticipated that, in voluntarily admitted psychiatric inpatients (N=1,011) and individuals receiving outpatient services in a university-affiliated psychology clinic (N=521), those indicated as under-reporting would produce lower mean scores across SUI and extra-test measures of suicide risk, and that the magnitudes of the associations between SUI and …

Test-Retest Of The 5-Minute Psychomotor Vigilance Test, Katharine Dennison

All Graduate Plan B and other Reports, Spring 1920 to Spring 2023

The purpose of this study was to evaluate the reliability of many variables in the 5-minute Psychomotor Vigilance Test (PVT). Many studies have looked at the validity of a 5-minute PVT, but few so far have looked at reliability. For this study, 13 adult females who worked 12-hr shifts were recruited to complete a two trial day study. The first trial day, the subjects submitted health questionnaire followed by a self-reported sleepiness scale and then a 5-minute PVT. The second trial session the subjects only competed the sleepiness scale followed by the 5-minute PVT. After analyzing the data, it was …