bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tracking intermediate performance of vigilant attention using multiple eye metrics
Authors: Abe Takashi , Mishima Kazuo , Kitamura Shingo , Hida Akiko , Inoue Yuichi , Mizuno Koh , Kaida Kosuke , Nakazaki Kyoko , Motomura Yuki , Maruo Kazushi , Ohta Toshiko , Furukawa Satoshi , Dinges David F , Ogata Katsuhiko 
Published: February 2020

Abstract
Vigilance deficits account for a substantial number of accidents and errors. Current techniques to detect vigilance impairment measure only the most severe level evident in eyelid closure and falling asleep, which is often too late to avoid an accident or error. The present study sought to identify ocular biometrics of intermediate impairment of vigilance and develop a new technique that could detect a range of deficits in vigilant attention (VA). Sixteen healthy adults performed well-validated Psychomotor Vigilance Test (PVT) for tracking vigilance attention while undergoing simultaneous recording of eye metrics every 2 hours during 38 hours of continuous wakefulness. A novel marker was found that measured VA when the eyes were open—the prevalence of microsaccades. Notably, the prevalence of microsaccades decreased in response to sleep deprivation and time-on-task. In addition, a novel algorithm for detecting multilevel VA was developed, which estimated performance on the PVT by integrating the novel marker with other eye-related indices. The novel algorithm also tracked changes in intermediate level of VA (specific reaction times in the PVT, i.e. 300–500 ms) during prolonged time-on-task and sleep deprivation, which had not been tracked previously by conventional techniques. The implication of the findings is that this novel algorithm, named “eye-metrical estimation version of the PVT: PVT-E,” can be used to reduce human-error-related accidents caused by vigilance impairment even when its level is intermediate.
Social Factors, Disability, and Depressive Symptoms in Adults With Chronic Pain
Authors: Solé Ester , Racine Mélanie , Tomé-Pires Catarina , Galán Santiago , Jensen Mark P. , Miró Jordi 
Published: February 2020

Objectives:The primary aim of this study was to better understand the role that social factors (ie, social support, satisfaction in participation with social roles, social isolation, and self-perceived ability to perform social roles and activities) play in pain-related interference and depressive symptoms in adults with chronic pain. Moreover, this study also examined if sex exerts a moderating role in these associations.Materials and Methods:In this cross-sectional study, 364 adults with chronic pain participated: 133 were university students and 231 were individuals from the community. University students completed a paper-and-pencil survey and individuals from the community responded to a web-based survey. Both surveys included the same questions assessing sociodemographic, pain characteristics, pain-related interference, depressive symptoms, and social factors.Results:Only satisfaction in participation in usual social roles and self-perceived ability for participating in such social roles contributed independently, significantly, and negatively to the prediction of pain interference, whereas all 4 social factors made independent and significant contributions to the prediction of depressive symptoms. Satisfaction with participation in usual social roles, self-perceived social ability, and social support were negatively related to depressive symptoms, whereas social isolation was positively related. The results also indicated that sex moderated the associations between social factors and depressive symptoms, but not between social factors and pain interference.Discussion:The study provides important new findings regarding the associations between social factors and physical and psychological functioning of individuals with chronic pain, supporting biopsychosocial models.
Anatomical Study of Lumbar Artery Perforators in Male Subjects
Authors: Thomas Jordan , Waxweiler Charlotte , Leveque Raphaël , Cuylits Nicolas 
Published: February 2020

Introduction:
The lumbar artery perforator (LAP) flap takes an important place in lumbosacral reconstruction and in breast reconstruction. Although studies on the location of lumbar perforators in women are common, no anatomical study has focused solely on male subjects. Our objective is to facilitate the surgical approach to the LAP flap in male subjects by precisely ascertaining the characteristics of the perforators.

Methods:
We performed a retrospective review of computed tomographic angiography images of a cohort of 30 patients evaluating the perforator position from the 4 lumbar arteries. In addition, 4 characteristics were studied: the length, the diameter, the path of the lumbar pedicle, and the thickness of tissues available for transfer.

Results:
One hundred five lumbar perforating vessels were analyzed on 60 posterior hemi-bodies, of which 86% came from the third and fourth lumbar arteries. The average location was situated 7.4 cm from the midline and in a 6-cm vertical wide area. The position of the lumbar perforator was independent of body mass index, abdominal circumference, and subject size. Our results, compared to previous studies, show no difference in this position between men and women.

Conclusions:
The LAP flap is useful for regional reconstructions and as a free flap for both women and men. We provide male-specific tracking values for the dissection of lumbar perforating vessels. Dominant perforators were found to be situated in a wide region of 4 cm × 6 cm in the lumbosacral region at 7.4 cm from the midline.
Deep Neural Network-Based Method for Detecting Obstructive Meibomian Gland Dysfunction With in Vivo Laser Confocal Microscopy
Authors: Maruoka Sachiko , Tabuchi Hitoshi , Nagasato Daisuke , Masumoto Hiroki , Chikama Taiichiro , Kawai Akiko , Oishi Naoko , Maruyama Toshi , Kato Yoshitake , Hayashi Takahiko , Katakami Chikako 
Published: February 2020

Purpose:
To evaluate the ability of deep learning (DL) models to detect obstructive meibomian gland dysfunction (MGD) using in vivo laser confocal microscopy images.

Methods:
For this study, we included 137 images from 137 individuals with obstructive MGD (mean age, 49.9 ± 17.7 years; 44 men and 93 women) and 84 images from 84 individuals with normal meibomian glands (mean age, 53.3 ± 19.6 years; 29 men and 55 women). We constructed and trained 9 different network structures and used single and ensemble DL models and calculated the area under the curve, sensitivity, and specificity to compare the diagnostic abilities of the DL.

Results:
For the single DL model (the highest model; DenseNet-201), the area under the curve, sensitivity, and specificity for diagnosing obstructive MGD were 0.966%, 94.2%, and 82.1%, respectively, and for the ensemble DL model (the highest ensemble model; VGG16, DenseNet-169, DenseNet-201, and InceptionV3), 0.981%, 92.1%, and 98.8%, respectively.

Conclusions:
Our network combining DL and in vivo laser confocal microscopy learned to differentiate between images of healthy meibomian glands and images of obstructive MGD with a high level of accuracy that may allow for automatic obstructive MGD diagnoses in patients in the future.
Comparison of a New Swept-Source Anterior Segment Optical Coherence Tomography and a Scheimpflug Camera for Measurement of Corneal Curvature
Authors: Zhang Ting , Zhou Yijing , Young Charlotte Aimee , Chen Aiming , Jin Guangming , Zheng Danying 
Published: February 2020

Purpose:
To evaluate the agreement of corneal curvature measured by a newly introduced swept-source anterior segment optical coherence tomography (CASIA2) and Pentacam (Oculus, Wetzlar, Germany).

Methods:
Corneal curvature was measured in 49 healthy subjects (age: 24.8 ± 4.36) by using CASIA2 and Pentacam. Repeatability was evaluated for CASIA2, and agreement between the CASIA2 and Pentacam was assessed. The coefficient of repeatability, the relative coefficient of repeatability, the range of the limits of agreement were analyzed, and Bland–Altman plots were performed to assess the interdevice agreement of measurement.

Results:
For the intradevice reliability of the CASIA2, the mean difference between the 2 examinations was from 0.02 to 0.14 D for the corneal curvatures and the limits of agreement range was from 0.45 to 2.42 D for the corneal curvatures; there was no statistically significant difference found between the first and second examinations obtained from CASIA2 (P > 0.05). For agreement between the 2 devices, the Bland–Altman analysis of the posterior corneal curvature showed a mean difference of 0.16 D (P = 0.047) in the flat posterior corneal curvature and 0.16 D (P = 0.046) in the steep posterior corneal curvature. For the measurement of anterior corneal curvature and true net power (TNP) with the Pentacam and CASIA2, there was no significant difference in the flat anterior corneal curvature (P = 0.585), steep anterior corneal curvature (P = 0.274), flat TNP (P = 0.685), and steep TNP (P = 0.447).

Conclusions:
Our study indicated generally good agreement of corneal curvature measurement by using Pentacam and CASIA2. We consequently expect no difference in clinical outcome when measurements for corneal curvature, especially anterior corneal curvature and TNP, are performed with either of the devices.
A Case-Control Study of Keratoconus Risk Factors
Authors: Moran Sarah , Gomez Ludovic , Zuber Kevin , Gatinel Damien 
Published: February 2020

Purpose:
To evaluate risk factors associated with keratoconus in a case-control setting.

Methods:
This single center, prospective, case-control study was carried out from May 2014 to November 2017 at the Rothschild Foundation (Paris, France). Two hundred two patients with keratoconus and 355 control patients were investigated and followed by a single ophthalmologist. Data regarding multiple variables were gathered, including eye rubbing, pattern of eye rubbing, dominant hand, allergies, history of dry eye, screen time, sleep position, and night-time work.

Results:
After multivariable analysis, the following variables showed significant results: eye rubbing with knuckles [odds ratio (OR) = 8.29; 95% confidence interval (CI): 3.92–18.26, P < 0.001] or fingertips (OR = 5.34; 95% CI: 2.44–12.21, P < 0.001), a history of dry eye (OR = 4.16; 95% CI: 2.3–7.7; P < 0.001), male sex (OR = 4.16; 95% CI: 1.47–11.89; P < 0.001), screen time (OR = 1.02; 95% CI: 1.01–1.04; P < 0.001), prone sleep position (OR = 11.63; 95% CI: 3.88–38.16), and side sleep position (OR = 10.17, 95% CI 3.84–33.73).

Conclusions:
This study shows a strong correlation between eye rubbing and keratoconus, particularly when rubbing is performed with the knuckles. Additional associations were identified which may merit future investigation as risk factors, including sleep position, night-time work, and screen time.
Efficacy of Mobile Health for Self-management of Cardiometabolic Risk Factors
Authors: Delva Sabianca , Waligora Mendez Kyra J. , Cajita Mia , Koirala Binu , Shan Rongzi , Wongvibulsin Shannon , Vilarino Valerie , Gilmore Danielle R. , Han Hae-Ra 
Published: February 2020

Background
Although mobile health (mHealth) technologies are burgeoning in the research arena, there is a lack of mHealth interventions focused on improving self-management of individuals with cardiometabolic risk factors (CMRFs).

Objective
The purpose of this article was to critically and systematically review the efficacy of mHealth interventions for self-management of CMRF while evaluating quality, limitations, and issues with disparities using the technology acceptance model as a guiding framework.

Methods
PubMed, CINAHL, EMBASE, and Lilacs were searched to identify research articles published between January 2008 and November 2018. Articles were included if they were published in English, included adults, were conducted in the United States, and used mHealth to promote self-care or self-management of CMRFs. A total of 28 articles were included in this review.

Results
Studies incorporating mHealth have been linked to positive outcomes in self-management of diabetes, physical activity, diet, and weight loss. Most mHealth interventions included modalities such as text messaging, mobile applications, and wearable technologies. There was a lack of studies that are (1) in resource-poor settings, (2) theoretically driven, (3) community-engaged research, (4) measuring digital/health literacy, (5) measuring and evaluating engagement, (6) measuring outcomes related to disease self-management, and (7) focused on vulnerable populations, especially immigrants.

Conclusion
There is still a lack of mHealth interventions created specifically for immigrant populations, especially within the Latino community—the largest growing minority group in the United States. In an effort to meet this challenge, more culturally tailored mHealth interventions are needed.
Predictive accuracy of lymphocyte-to-monocyte ratio and monocyte-to-high-density-lipoprotein-cholesterol ratio in determining the slow flow/no-reflow phenomenon in patients with non–ST-elevated myocardial infarction
Authors: Kalyoncuoglu Muhsin , Biter Halil İbrahim , Ozturk Semi , Belen Erdal , Can Mehmet Mustafa 
Published: February 2020

Objective
To investigate whether inflammation based scores including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR) and monocyte to high-density lipoprotein cholesterol (HDL-C) ratio (MHR) predict the slow flow (SF)/no-reflow (NR) phenomenon comparatively in patients with non–ST-elevated Myocardial Infarction
(NSTEMI) undergoing percutaneous coronary intervention (PCI).

Methods
Current study is retrospective designed and includes 426 NSTEMI patients (mean age of 56.8 ± 11.4 years). The patients were grouped into non slow flow/no-reflow and slow flow/no-reflow groups according to postintervention thrombolysis in myocardial infarction flow grade.

Results
The slow flow/no-reflow group had significantly higher MHR and lower LMR values than the non slow flow/no-reflow group (P < 0.01 and P < 0.01, respectively). Lower LMR [odds ratio (OR): 0.659, P < 0.01] and higher MHR (OR: 1.174, P = 0.04) were independent predictors of slow flow/no-reflow phenomenon in model 1 and 2 multivariate analyses, respectively. Furthermore, left ventricular ejection fraction (LVEF) (OR: 0.934, P = 0.01; OR: 0.930, P < 0.01), smoking (OR: 2.279, P = 0.03; OR: 2.118, P = 0.04), Syntax score (1.038, P = 0.04; 1.046, P = 0.01) and high thrombus grade (OR: 7.839, P < 0.01; OR: 8.269, P < 0.01), independently predicted the slow flow/no-reflow development in both multivariate analysis models, respectively. The predictive performance of LMR and MHR was not different (P = 0.88), but both predictive powers were superior to NLR (P < 0.01 and P = 0.03, respectively).

Conclusion
The MHR and LMR may be useful inflammatory biomarkers for identifying high-risk individuals for the development of slow flow/no reflow in NSTEMI patients who underwent PCI.
Digital Single-operator Cholangioscopy (DSOC) Improves Interobserver Agreement (IOA) and Accuracy for Evaluation of Indeterminate Biliary Strictures
Authors: Sethi Amrita , Tyberg Amy , Slivka Adam , Adler Douglas G. , Desai Amit P. , Sejpal Divyesh V. , Pleskow Douglas K. , Bertani Helga , Gan Seng-Ian , Shah Raj , Arnelo Urban , Tarnasky Paul R. , Banerjee Subhas , Itoi Takao , Moon Jong Ho , Kim Dong Choon , Gaidhane Monica , Raijman Isaac , Peterson Bret T. , Gress Frank G. , Kahaleh Michel 
Published: February 2020

Background:
Visual characteristics seen during digital single-operator cholangioscopy (DSOC) have not been validated. The aim of this 2-phase study was to define terminology by consensus for the visual diagnosis of biliary lesions to develop a model for optimization of the diagnostic performance of DSOC.

Materials and Methods:
In phase 1 (criteria identification), video-cholangioscopy clips were reviewed by 12 expert biliary endoscopists, who were blinded to the final diagnosis. Visual criteria were consolidated into the following categories: (1) stricture, (2) lesion, (3) mucosal features, (4) papillary projections, (5) ulceration, (6) abnormal vessels, (7) scarring, (8) pronounced pit pattern.
During the second phase (validation), 14 expert endoscopists reviewed DSOC (SpyGlass DS, Boston Scientific) clips using the 8 criteria to assess interobserver agreement (IOA) rate.

Results:
In phase 1, consensus for visual findings were categorized into 8 criteria titled the “Monaco Classification.” The frequency of criteria were: (1) presence of stricture—75%, (2) presence of lesion type—55%, (3) mucosal features—55%, (4) papillary projections—45%, (5) ulceration—42.5%, (6) abnormal vessels—10%, (7) scarring—40%, and (8) pronounced pit pattern—10%. The accuracy on final diagnosis based on visual impression alone was 70%.
In phase 2, the IOA rate using Monaco Classification criteria ranged from slight to fair. The presumptive diagnosis IOA was fair (κ=0.31, SE=0.02), and overall diagnostic accuracy was 70%.

Conclusions:
The Monaco classification identifies 8 visual criteria for biliary lesions on single-operator digital cholangioscopy. Using the criteria, the IOA and diagnostic accuracy rate of DSOC is improved compared with prior studies.
Hypobetalipoproteinemia and abetalipoproteinemia: liver disease and cardiovascular disease
Authors: Welty Francine K. 
Published: February 2020

Purpose of review
Several mutations in the apolipoprotein (apo) B, proprotein convertase subtilisin kexin 9 (PCSK9) and microsomal triglyceride transfer protein genes result in low or absent levels of apoB and LDL cholesterol (LDL-C) in plasma which cause familial hypobetalipoproteinemia (FHBL) and abetalipoproteinemia (ABL). Mutations in the angiopoietin-like protein 3 ANGPTL3 gene cause familial combined hypolipidemia (FHBL2). Clinical manifestations range from none-to-severe, debilitating and life-threatening disorders. This review summarizes recent genetic, metabolic and clinical findings and management strategies.

Recent findings
Fatty liver, cirrhosis and hepatocellular carcinoma have been reported in FHBL and ABL probably due to decreased triglyceride export from the liver. Loss of function mutations in PCSK-9 and ANGPTL3 cause FHBL but not hepatic steatosis. In 12 case–control studies with 57 973 individuals, an apoB truncation was associated with a 72% reduction in coronary heart disease (odds ratio, 0.28; 95% confidence interval, 0.12–0.64; P = 0.002). PCSK9 inhibitors lowered risk of cardiovascular events in large, randomized trials without apparent adverse sequelae.

Summary
Mutations causing low LDL-C and apoB have provided insight into lipid metabolism, disease associations and the basis for drug development to lower LDL-C in disorders causing high levels of cholesterol. Early diagnosis and treatment is necessary to prevent adverse sequelae from FHBL and ABL.
Cracking the Code for Quality
Authors: DiCuccio Margaret Hardt , Colbert Alison M. , Triolo Pamela Klauer , Schreiber James B. , Dean Bonnie 
Published: February 2020

OBJECTIVE
The aim of this study was to describe the complex relationships among patient safety culture, nurse demographics, advocacy, and patient outcomes.

BACKGROUND
Why has healthcare lagged behind other industries in improving quality? Little nursing research exists that explores the multifactorial relationships that impact quality.

METHODS
A convenience sample of 1045 nurses from 40 medical/surgical units was analyzed using a correlational cross-sectional design with secondary data analysis. Data sources included survey results for patient safety culture, nurse perceptions of patient advocacy, and patient experience and fall and pressure ulcer rates.

RESULTS
Significant findings included a positive correlation between patient safety culture and advocacy and a negative correlation between safety culture, advocacy, and years of experience as a nurse. No significant correlations were found between safety culture and patient outcomes or advocacy and patient outcomes.

CONCLUSIONS
Newer nurses were more positive about safety culture and advocacy, whereas experienced nurses were overall less positive.
Clinical Impact of Warmed Intravenous Saline in Sickle Cell Patients With Vasoocclusive Episodes
Authors: Quarrie Renee P. , Stoner Michael J. , Choueiki Julie M. , Bonsu Bema K. , Cohen Daniel M. 
Published: February 2020

Objectives
In children with sickle cell disease treated for vasoocclusive episodes (VOEs), it is unknown if the temperature of infused fluids impacts clinical outcomes. We compared infusions of warmed and nonwarmed saline for treatment of VOE. We also assessed the tolerability and feasibility of infusing warmed saline in patients with VOEs.

Methods
Patients aged 4 to 21 years with sickle cell disease presenting to the emergency department with VOE were randomized to infusions of warmed (37.5°C, experimental arm) versus nonwarmed (22°C–24°C, controls) saline. Intravenous opioids were administered according to previously established guidelines. We compared hospital admission rates, pain scores, disposition times, dosages of opioid, and comfort.

Results
Eighty of 92 visits were eligible (40 per arm). The mean age of enrollees was 14 years, and 53% were female. Hospital admission rates were comparable (63% experimental arm and 55% control arm, P = 0.5). Pain score reduction (−2.9 and −2.6, P = 0.52), median morphine equivalents (0.23 mg/kg and 0.25 mg/kg, P = 0.58), and mean treatment-to-disposition times (158 minutes and 155 minutes, P = 0.85) were also similar. Global comfort was higher in children who received warmed saline (4 vs 3, P = 0.01). There were no adverse events reported in patients who received warmed saline.

Conclusions
It is feasible and tolerable to infuse warmed saline for the treatment of VOE, and it is well tolerated. Patient comfort was higher in those patients who received warmed saline, but there was no improvement in admission rates, disposition times, pain scores, and opioid dosages.
Soft-Tissue Reconstruction after Composite Vertebrectomy and Chest Wall Resection for Spinal Tumors
Authors: Mericli Alexander F. , Murariu Daniel , Nemir Stephanie , Rhines Laurence D. , Walsh Garrett , Adelman David M. , Baumann Donald P. , Butler Charles E. 
Published: February 2020

Background:
Oncologic resections involving both the spine and chest wall commonly require immediate soft-tissue reconstruction. The authors hypothesized that reconstructions of composite resections involving both the thoracic spine and chest wall would have a higher complication rate than reconstructions for resections limited to the thoracic spine alone.

Methods:
The authors performed a retrospective analysis of all consecutive patients who underwent a thoracic vertebrectomy and soft-tissue reconstruction from 2002 to 2017. Patients were divided into two groups: those whose defect was limited to the thoracic spine and those who required a composite resection involving the chest wall.

Results:
One hundred patients were included. Composite resection patients had larger defects, as indicated by a greater incidence of multilevel vertebrectomies (70.2 percent versus 17 percent; p = 0.001). Thoracic spine patients were older (58.2 ± 10.4 years versus 48.6 ± 13.9 years; p < 0.001) and had a greater incidence of metastatic disease (88.7 percent versus 38.3 percent; p = 0.001). Univariate and multivariate logistic regression analyses demonstrated that composite resections were not significantly associated with a higher rate of surgical, medical, or overall complications. Multivariate logistic regression analysis of composite resection subgroup demonstrated that flap separation of the spinal cord from the intrapleural space was protective against complications (OR, 0.22; 95 percent CI, 0.05 to 0.81; p = 0.03).

Conclusions:
Despite the large defect size in composite resection patients, there was no increase in complications compared to thoracic spine patients. In composite resection patients, separating the exposed spinal cord from the intrapleural space with well-vascularized soft tissue was protective against complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, II.