Publications by authors named "Ehsan Kazemnezhad Leili"

13 Publications

  • Page 1 of 1

Endotracheal Tube Duration in Elderly Patients after the Coronary Artery Bypass Grafting Surgery.

Tanaffos 2020 Jul;19(3):235-242

Critical Care Nursing, Dr. Heshmat Hospital, Guilan University of Medical Sciences, Rasht, Iran.

Background: In elderly patients, the management of the endotracheal tube after coronary artery bypass graft (CABG) can be challenging because they often have complex comorbidities. This study was done to determine endotracheal tube duration in elderly patients after CABG.

Materials And Methods: This retrospective study was conducted on 397 patients aged over 65 years under mechanical ventilation after CABG. Patients in two groups of endotracheal tube duration of less than 8 h and more than 8 h were compared. Medical records were used for data gathering. Descriptive statistics, Mann-Whitney U, Kruskal-Wallis test, and logistic regression model were used for data analysis.

Results: Endotracheal tube duration was 9.9± 5.89 h in elderly patients. According to the results of the Mann-Whitney U test, there was a significant difference between the two groups in terms of the history of smoking (p = 0.023), history of diabetes (p= 0.062), left ventricular ejection fraction (p= 0.028), and type of operation in terms of emergency and non-emergency (p= 0.069). The logistic regression model showed predictive variables of the endotracheal tube duration after CABG in elderly patients over 65 years, including the history of smoking (1.179- 4.543, CI: 95%, β=0.839, and, p=0.015), history of myocardial infarction (0.188- 1.019, CI: 95%, p= 0.055, β= -0.827), and the left ventricular ejection fraction less than 50% (0.202-0752, CI: 95%, p= 0.005, β= -0.943).

Conclusion: Considering the predictive factors, the duration of the postoperative endotracheal tube can play an important role in the careful care of elderly patients after CABG.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008409PMC
July 2020

Predictors of Length of Stay in Intensive Care Unit after Coronary Artery Bypass Grafting: Development a Risk Scoring System.

Braz J Cardiovasc Surg 2021 Feb 1;36(1):57-63. Epub 2021 Feb 1.

Critical Care Nursing, Dr. Heshmat Hospital, Guilan University of Medical Sciences, Rasht, Iran.

Introduction: To determine predictors of length of stay (LOS) in the intensive care unit (ICU) after coronary artery bypass grafting (CABG) and to develop a risk scoring system were the objectives of this study.

Methods: In this retrospective study, 1202 patients' medical records after CABG were evaluated by a research-made checklist. Tarone-Ware test was used to determine the predictors of patients' LOS in the ICU. Cox regression model was used to determine the risk factors and risk ratios associated with ICU LOS.

Results: The mean ICU LOS after CABG was 55.27±17.33 hours. Cox regression model showed that having more than two chest tubes (95% confidence interval [CI] 1.005-1.287, Relative Risk [RR]=1.138), occurrence of atelectasis (95% CI 1.000-3.007, RR=1.734), and occurrence of atrial fibrillation after CABG (95% CI 1.428-2.424, RR=1.861) were risk factors associated with longer ICU LOS. The discrimination power of this set of predictors was demonstrated with an area under the receiver operating characteristic curve and it was 0.69. A simple risk scoring system was developed based on three identified predictors that can raise ICU LOS.

Conclusion: The simple risk scoring system developed based on three identified predictors can help to plan more accurately a patient's LOS in hospital for CABG and can be useful in managing human and financial resources.
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http://dx.doi.org/10.21470/1678-9741-2019-0405DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918390PMC
February 2021

Investigation of short-term prognosis of fragmented QRS complexes in patients with acute myocardial infarction in two groups that received invasive and fibrinolytic therapy.

Indian Heart J 2020 Jan - Feb;72(1):46-51. Epub 2020 Jan 22.

Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran. Electronic address:

Background: Studies have shown that the primary causes of death in patients with acute coronary syndrome are arrhythmias and heart failure. The aim of this study is to evaluate the short-term prognosis of fragmented QRS (f-QRS) in patients with acute myocardial infarction (MI).

Methods: This study was a prospective and longitudinal analytic study performed on all patients with acute MI admitted to Rasht Heshmat Hospital Emergency during 2018-2019. Serial Electrocardiography (ECG) was performed in the emergency room after patient admission and was repeated 24 h after percutaneous coronary intervention and fibrinolytic therapy, as well as at the time of patient discharge. Short-term prognosis of f-QRS in patients was evaluated by a cardiologist within admission, 40 days after hospitalization and three months later again.

Results: In this study, 453 patients with MI were evaluated in two treatment methods of fibrinolytic and invasive with and without f-QRS. Based on the data of this study, the four study groups had no statistically significant difference in arrhythmia (p = 0.196). In addition, the effect of study groups on left ventricular ejection fraction index was not statistically significant (p = 0.597). The probability of adverse outcomes occurrence was not statistically significant among the four groups (p = 0.07).

Conclusion: The final results of this study showed that there was no significant difference between the four study groups and arrhythmia status. Therefore, f-QRS was not introduced as an independent predictor of arrhythmia in patients with acute MI.
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http://dx.doi.org/10.1016/j.ihj.2020.01.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231857PMC
January 2021

Addiction to the Internet and mobile phones and its relationship with loneliness in Iranian adolescents.

Int J Adolesc Med Health 2018 Dec 4;33(1). Epub 2018 Dec 4.

Instructor and Faculty Member, Department of Nursing, Faculty of Nursing and Midwifery Ramsar, Babol University of Medical Sciences, Babol, Iran.

Introduction: Addiction to the Internet and mobile phones in adolescents could be related to loneliness. However, less research has been conducted on this topic in developing countries. This study aimed to examine addiction to the Internet and mobile phones and its relationship with loneliness in adolescents in Iran.

Method: This was a cross-sectional and analytic study that was conducted between 2015 and 2016 in Rasht, in the north of Iran. Subjects were selected through cluster sampling from female and male teens who were studying in the public and private schools. The Kimberly's Internet Addiction Test, Cell phone Overuse Scale (COS), and the University of California , Los Angeles (UCLA) Loneliness Scale were used for data collection.

Results: The mean age of participants was 16.2 ± 1.1 year. The mean of addiction to the Internet was 42.2 ± 18.2. Overall, 46.3% of the subjects reported some degrees of addiction to the Internet. The mean of addiction to mobile phones was 55.10 ± 19.86. The results of this study showed that 77.6% (n = 451) of the subjects were at risk for addiction to mobile phones, and 17.7% (n = 103) of them were addicted to their use. The mean of loneliness was 39.13 ± 11.46 in the adolescents. Overall, 16.9% of the subjects obtained a score higher than mean in loneliness. A statistically significant direct relationship was found between addiction to the Internet and loneliness in the adolescents (r = 0.199, p = 0.0001). The results also showed a statistically significant direct relationship between addiction to mobile phones and loneliness in the adolescents (r = 0.172, p = 0.0001).

Conclusion: The results of this study revealed that a high percentage of adolescents who have some degrees of addiction to the Internet and mobile phones experience loneliness, and there are relationships between these variables.
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http://dx.doi.org/10.1515/ijamh-2018-0035DOI Listing
December 2018

Burning Mouth Syndrome: A Comparative Cross-sectional Study.

Contemp Clin Dent 2018 Sep;9(Suppl 2):S256-S260

Department Oral Pathology, Faculty of Dentistry, Birjand University of Medical Sciences, Birjand, Iran.

Background And Aim: Burning mouth syndrome (BMS) may be defined as a burning sensation in the oral mucosa usually unaccompanied by clinical signs. Multiple conditions have been attributed to a burning sensation. The aim of this study was to determine the role of age and sex in BMS.

Materials And Methods: A total of 195 consecutive patients with BMS and 95 healthy patients without burning sensation were recruited in this study. Patients with BMS had experienced oral, burning sensations for at least 6 months without oral clinical signs, and with a normal blood count. Multiple logistic regression analyses were utilized to define the main predictors.

Results: Menopause, candidiasis, psychological disorders, job status, denture, and dry mouth were significantly frequent in BMS patients. Multivariate logistic regression indicated age (odds ratio (OR) =1.12, 95% confidence interval (CI): 1.08-1.15, < 0.0001) and sex (OR = 3.14, 95% CI: 1.4-6.7, < 0.002) significantly increase the odds of BMS. Psychological disorders (OR = 3.39, 95% CI: 1.2-9.5, < 0.02) and candidiasis remain as predictive factors. Ultimately, age was defined as a critical predictor. Moreover, we can therefore predict that a 60-year-old woman with psychological disorders is 25 times more likely to suffer from BMS than a man 10 years younger who has no psychological disorder.

Conclusion: Age and sex were the main predictors in BMS. Psychological disorders and candidiasis were significantly associated with the occurrence of BMS.
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http://dx.doi.org/10.4103/ccd.ccd_175_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6169285PMC
September 2018

Early detection of nonneurologic organ failure in patients with severe traumatic brain injury: Multiple organ dysfunction score or sequential organ failure assessment?

Indian J Crit Care Med 2016 Oct;20(10):575-580

Department of Neurosurgery, Poursina Hospital, Guilan University of Medical Science, Guilan, Iran.

Objective: The aim of this study is to compare the discriminant function of multiple organ dysfunction score (MODS) and sequential organ failure assessment (SOFA) components in predicting the Intensive Care Unit (ICU) mortality and neurologic outcome.

Materials And Methods: A descriptive-analytic study was conducted at a level I trauma center. Data were collected from patients with severe traumatic brain injury admitted to the neurosurgical ICU. Basic demographic data, SOFA and MOD scores were recorded daily for all patients. Odd's ratios (ORs) were calculated to determine the relationship of each component score to mortality, and area under receiver operating characteristic (AUROC) curve was used to compare the discriminative ability of two tools with respect to ICU mortality.

Results: The most common organ failure observed was respiratory detected by SOFA of 26% and MODS of 13%, and the second common was cardiovascular detected by SOFA of 18% and MODS of 13%. No hepatic or renal failure occurred, and coagulation failure reported as 2.5% by SOFA and MODS. Cardiovascular failure defined by both tools had a correlation to ICU mortality and it was more significant for SOFA (OR = 6.9, CI = 3.6-13.3, < 0.05 for SOFA; OR = 5, CI = 3-8.3, < 0.05 for MODS; AUROC = 0.82 for SOFA; AUROC = 0.73 for MODS). The relationship of cardiovascular failure to dichotomized neurologic outcome was not significant statistically. ICU mortality was not associated with respiratory or coagulation failure.

Conclusion: Cardiovascular failure defined by either tool significantly related to ICU mortality. Compared to MODS, SOFA-defined cardiovascular failure was a stronger predictor of death. ICU mortality was not affected by respiratory or coagulation failures.
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http://dx.doi.org/10.4103/0972-5229.192042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5073771PMC
October 2016

Effect of Intravenous Intraoperative Esmolol on Pain Management Following Lower Limb Orthopedic Surgery.

Korean J Pain 2015 Jul 1;28(3):198-202. Epub 2015 Jul 1.

Qazvin University of Medical Sciences, Qazvin, Iran.

Background: Lack of proper control of acute postoperative pain often leads to lingering or chronic pain. Several studies have emphasized the role of beta-blockers in reducing postoperative pain. Esmolol is a selective short-acting beta-blocker that produces few side effects. The purpose of this study was to examine the effect of intravenous intraoperative esmolol on postoperative pain reduction following orthopedic leg fracture surgery.

Methods: In a clinical trial, 82 patients between 20-65 years of age with tibia fractures and American Society of Anesthesiologists (ASA) physical status I & II who underwent surgery were divided into two groups. Group A received esmolol and group B received normal saline. Postoperative pain was measured at three time points: entering the recovery unit, and at 3 h and 6 h following surgery, using the Visual Analogue Scale (VAS). A P value of < 0.05 was considered significant.

Results: Mean VAS scores at all three time points were significantly different between the two test groups (P = 0.02, P = 0.0001, and P = 0.0001, respectively). The consumption of pethidine was lower in group A than in group B (P = 0.004) and the duration of its effect was significantly longer in time (P = 0.026).

Conclusions: Intravenous intraoperative esmolol is effective in the reduction of postoperative pain following leg fracture surgery. It reduced opioid consumption following surgery and delayed patient requests for analgesics.
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http://dx.doi.org/10.3344/kjp.2015.28.3.198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4500784PMC
July 2015

Depressive symptoms effect on self care behavior during the first month after myocardial infarction.

Glob J Health Sci 2015 Jan 26;7(4):382-91. Epub 2015 Jan 26.

Social Determinants of Health Research Center (SDHRC), School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran.

Aim: To determine the effect of severity of depression symptoms on self care behavior in 15th and 30th day after myocardial infarction (MI).

Materials & Methods: Gathering data for this cross sectional study was done by Beck depression and self care behavior questionnaires in a heart especial hospital in Rasht in north of Iran .Sample size was 132 after MI patients and data collected from June 2011 to January 2012.

Results: Scores of depression symptoms in 15th and 30th day after MI and score of self care behavior in these days had significant difference (P<0.0001) .Spearman test showed self care behavior had significant relationship with depression symptoms (P<0.0001). GEE model also showed with control of socio demographic and illness related factors, depression symptoms can decrease self care behavior scores (P<0.001).

Conclusion: Severity of depression symptoms increase in 15th to 30th day after MI .This issue can affect on self care behavior. This issue is emphasized on nurses' notice to plan suitable self care program for these patients.
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http://dx.doi.org/10.5539/gjhs.v7n4p382DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4802175PMC
January 2015

Reproducibility of peripapillary retinal nerve fiber layer thickness measurements with cirrus HD-OCT in glaucomatous eyes.

Int J Ophthalmol 2015 18;8(1):113-7. Epub 2015 Feb 18.

Guilan University of Medical Sciences, Rasht 4139637459, Iran.

Aim: To assess the reproducibility of Cirrus high-definition optical coherence tomography (HD-OCT; Carl Zeiss Meditec, Dublin, CA, USA) for analysis of peripapillary retinal nerve fiber layer (RNFL) thickness in glaucomatous eyes.

Methods: Forty-five eyes (one eye from each glaucomatous patient) were imaged with Cirrus HD-OCT. Each eye was imaged three times by two separate operators. Intraclass correlation coefficient (ICC), coefficient of variation (CV), and test-retest variability were evaluated for both intraobserver and interobsever measurements.

Results: In intraobserver measurements, the average RNFL thickness ICC was 0.983. CV and test-retest variability were 2.3% and 4.4 µm respectively. In quadrants ICC ranged from 0.886 to 0.956, the lowest associated with nasal quadrant and CV ranged from 3.6% to 7.7%. In interobsever measurements, the average RNFL thickness ICC was 0.979. CV and test-retest variability were 2.4% and 4.5 µm respectively. In quadrants ICC ranged from 0.886 to 0.957, the lowest associated with nasal quadrant and CV ranged from 3.8% to 8.6%.

Conclusion: The reproducibility of Cirrus OCT for RNFL thickness is sufficiently good to be useful clinically as a measure of glaucoma progression.
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http://dx.doi.org/10.3980/j.issn.2222-3959.2015.01.21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4325253PMC
February 2015

Reproducibility of optical coherence tomography retinal nerve fiber layer thickness measurements before and after pupil dilation.

J Ophthalmic Vis Res 2014 Jan;9(1):38-43

Eye Research Center, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran.

Purpose: To evaluate the intra- and interobserver reproducibility of peripapillary retinal nerve fiber layer (RNFL) thickness measurements before and after pupil dilation using spectral-domain optical coherence tomography (SD-OCT).

Methods: In this observational case series, 44 eyes of 44 healthy subjects were scanned by two trained operators on the same day, using Cirrus SD-OCT (Carl Zeiss Meditec, Dublin, CA, USA). Three scans were obtained before and after pupil dilation by each operator. Mean ± standard deviation (SD) and coefficient of variation (CV) were used for description of results and variation of measurements respectively. Intraclass correlation coefficients (ICC) and Bland-Altman plots were used to evaluate validation and limits of agreement.

Results: Overall, 23 female and 21 male subjects with mean age of 36.9±8.8 (range, 20 to 50) years were enrolled. Mean RNFL thickness before pupil dilation was 92.6±7.2 (CV, 7.8%) and 92.4±6.8 (CV, 7.4%) µm by operator one and two, respectively. After pupil dilation, mean RNFL thickness was 92.7±7.9 (CV, 8.5%) and 92.0±7.5 (CV=8.2%) µm by observer one and two, respectively. ICCs ranged from 0.900 to 0.996. Mean absolute error of the two operators was less than 4.1µm. There were no significant differences in quadrant thicknesses before and after dilation. Interestingly, mean signal strength was not significantly affected by pupil dilation.

Conclusion: In normal subjects with clear media, peripapillary RNFL thickness measurements using Cirrus SD-OCT have high inter- and intraobserver reproducibility before and after pupil dilation. Pupil dilation may not be necessary in all subjects to obtain reproducible RNFL thickness measurements.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4074472PMC
January 2014

Evaluation of chest and abdominal injuries in trauma patients hospitalized in the surgery ward of poursina teaching hospital, guilan, iran.

Arch Trauma Res 2013 1;1(4):161-5. Epub 2013 Feb 1.

Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, IR Iran.

Background: Trauma, especially chest and abdominal trauma are increasing due to the growing number of vehicles on the roads, which leads to an increased incidence of road accidents. Urbanization, industrialization and additional problems are the other associated factors which accelerate this phenomenon. A better understanding of the etiology and pattern of such injuries can help to improve the management and ultimate the outcomes of these patients.

Objectives: This study aimed to evaluate the patients with chest and abdominal trauma hospitalized in the surgery ward of Poursina teaching hospital, Guilan, Iran.

Patients And Methods: In this cross-sectional study, the data of all chest and abdominal trauma patients hospitalized in the surgery ward of Poursina teaching hospital were collected from March 2011 to March 2012. Information about age, gender, injured areas, type of injury (penetrating or blunt), etiology of the injury, accident location (urban or rural) and patients' discharge outcomes were collected by a questionnaire.

Results: In total, 211 patients with a mean age of 34.1 ± 1.68 years was entered into the study. The most common cause of trauma was traffic accidents (51.7%). Among patients with chest trauma, 45 cases (35.4%) had penetrating injuries and 82 cases (64.6%) blunt lesions. The prevalence of chest injuries was 35.5% and rib fractures 26.5%. In chest injuries, the prevalence of hemothorax was 65.3%, pneumothorax 2.7%, lung contusion 4% and emphysema 1.3%, respectively. There were 24 cases (27.9%) with abdominal trauma which had penetrating lesions and 62 cases (72.1%) with blunt lesions. The most common lesions in patients with penetrating abdominal injuries were spleen (24.2%) and liver (12.1%) lesions. The outcomes of the patients were as follow: 95.7% recovery and 4.3% death. The majority of deaths were observed among road traffic victims (77.7%).

Conclusions: Considering the fact that road-related accidents are quite predictable and controllable; therefore, the quality promotion of traumatic patients' care, and the road safety should be noted as problems associated with public health.
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http://dx.doi.org/10.5812/atr.7672DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3876503PMC
January 2014

Neuron-specific enolase and S100BB as outcome predictors in severe diffuse axonal injury.

J Trauma Acute Care Surg 2012 Jun;72(6):1654-7

Department of Neurosurgery, Guilan University of Medical Sciences, Rasht, Guilan, Iran.

Background: Diffuse axonal injury (DAI) is a common type of traumatic brain injury, mostly associated with mild changes on computed tomography (CT) scan. Serum biomarkers might be used in the diagnosis and prognosis of this injury type. Our purpose was to determine temporal profile and predictive values of serum concentrations of protein S100BB and neuron-specific enolase (NSE) after DAI.

Methods: Twenty-eight isolated severe DAI patients (Glasgow Coma Scale score ≤ 8) with normal CT were enrolled in the study. Serum levels of S100BB and NSE were determined at 6 hours, 24 hours, 48 hours, and 72 hours after injury, using enzyme-linked immunosorbent assay. Clinical outcome variables of DAI comprised survival at discharge and Glasgow Outcome scale (GOS) after 3 months and also 2 years.

Results: S100BB concentration was maximum in 6 hours after injury (median = 280.75 ng/L) followed by a quick drop. Its value was significantly higher on third day in patients with unfavorable outcome (GOS score = 1-3) versus favorable outcome (GOS score = 4, 5) (p < 0.0001). The values of NSE had mild changes during 3 days; however, these measured values at 72 hours after trauma manifested higher in unfavorable outcome (p < 0.05).

Conclusions: Increased serum concentrations of NSE and S100BB within first 3 days after DAI are associated with poor outcome despite mild CT findings. S100BB level at 72 hours after injury can predict late outcome in DAI patients.

Level Of Evidence: Prognostic study, level III.
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http://dx.doi.org/10.1097/TA.0b013e318246887eDOI Listing
June 2012

Effective factors on linguistic disorder during acute phase following traumatic brain injury in adults.

Neuropsychologia 2012 Jun 5;50(7):1444-50. Epub 2012 Mar 5.

Neurosurgery in Guilan University of Medical Sciences, Guilan Road Trauma Research Center, Rasht 4193713194, Guilan Province, Iran.

Traumatic brain injury (TBI) has been known to be the leading cause of breakdown and long-term disability in people under 45 years of age. This study highlights the effective factors on post-traumatic (PT) linguistic disorder and relations between linguistic and cognitive function after trauma in adults with acute TBI. A cross-sectional design was employed to study 60 post-TBI hospitalized adults aged 18-65 years. Post-traumatic (PT) linguistic disorder and cognitive deficit after TBI were respectively diagnosed using the Persian Aphasia Test (PAT) and Persian version of Mini-Mental State Examination (MMSE) at discharge. Primary post-resuscitation consciousness level was determined using the Glasgow Coma Scale (GCS). Paracilinical data was obtained by CT scan technique. Multiple logistic regression analysis illustrated that brain injury severity was the first powerful significant predictor of PT linguistic disorder after TBI and frontotemporal lesion was the second. It was also revealed that cognitive function score was significantly correlated with score of each language skill except repetition. Subsequences of TBI are more commonly language dysfunctions that demand cognitive flexibility. Moderate, severe and fronto-temporal lesion can increase the risk of processing deficit in linguistic macrostructure production and comprehension. The dissociation risk of cortical and subcortical pathways related to cognitive-linguistic processing due to intracranial lesions can augment possibility of lexical-semantic processing deficit in acute phase which probably contributes to later cognitive-communication disorder.
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http://dx.doi.org/10.1016/j.neuropsychologia.2012.02.029DOI Listing
June 2012