bluuebunny/crossref_metadata_2025_split huggingface dataset:
Developing process measures in value-based healthcare: the case of aortic valve disease
Authors: Akmaz Berdel , Zipfel Nina , Bal Roland A , Rensing Benno J W M , Daeter Edgar J , van der Nat Paul B 
Published: November 2019

BackgroundAs process measures can be means to change practices, this article presents process measures that impact on outcome measures for surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) within value-based healthcare.MethodsDesk research and observations of patient trajectories were performed to map the processes involved in TAVR and SAVR. Semistructured interviews were conducted with healthcare professionals (n=8) and patients (n=2) to explore which processes were most important in relation to a standard set of outcome measures that was already monitored. Additionally, open interviews (n=2) were held to prioritise results. A focus group was performed for validation of the formulated process measures. Numerical data for these measures was not collected.ResultsProcess maps of the full cycle of care of TAVR and SAVR treatments in theory and in practice were developed. 28 processes were found important by interview participants due to their expected impact on patient-relevant outcomes. Seven processes were prioritised to be most important and were formulated into 12 process measures for both TAVR and SAVR: ‘Number of times that deficient information provision to SAVR patients causes negative outcomes’, ‘Type of TAVR/SAVR prosthesis’, ‘Brand of TAVR prosthesis’, ‘Number of times the frailty score of a TAVR/SAVR patient >75 years is measured’, ‘Time between TAVR/SAVR surgery indication and surgery’, ‘Number of times that anticoagulants are stopped within 3 days before surgery’, ‘Time in hours between TAVR/SAVR surgery and permanent pacemaker implantation’ and ‘Percentage of standardised pain measurements’.ConclusionThis study proposes an addition of select process measures to standard sets of outcome measures to improve healthcare quality. It illustrates a clear method for identifying process measures with impact on health outcomes in the future.
Large-scale empirical optimisation of statistical control charts to detect clinically relevant increases in surgical site infection rates
Authors: Ilieş Iulian , Anderson Deverick J , Salem Joseph , Baker Arthur W , Jacobsen Margo , Benneyan James C 
Published: November 2019

ObjectiveSurgical site infections (SSIs) are common costly hospital-acquired conditions. While statistical process control (SPC) use in healthcare has increased, limited rigorous empirical research compares and optimises these methods for SSI surveillance. We sought to determine which SPC chart types and design parameters maximise the detection of clinically relevant SSI rate increases while minimising false alarms.DesignSystematic retrospective data analysis and empirical optimisation.MethodsWe analysed 12 years of data on 13 surgical procedures from a network of 58 community hospitals. Statistically significant SSI rate increases (signals) at individual hospitals initially were identified using 50 different SPC chart variations (Shewhart or exponentially weighted moving average, 5 baseline periods, 5 baseline types). Blinded epidemiologists evaluated the clinical significance of 2709 representative signals of potential outbreaks (out of 5536 generated), rating them as requiring ‘action’ or ‘no action’. These ratings were used to identify which SPC approaches maximised sensitivity and specificity within a broader set of 3600 individual chart variations (additional baseline variations and chart types, including moving average (MA), and five control limit widths) and over 32 million dual-chart combinations based on different baseline periods, reference data (network-wide vs local hospital SSI rates), control limit widths and other calculation considerations. Results were validated with an additional year of data from the same hospital cohort.ResultsThe optimal SPC approach to detect clinically important SSI rate increases used two simultaneous MA charts calculated using lagged rolling baseline windows and 1 SD limits. The first chart used 12-month MAs with 18-month baselines and best identified small sustained increases above network-wide SSI rates. The second chart used 6-month MAs with 3-month baselines and best detected large short-term increases above individual hospital SSI rates. This combination outperformed more commonly used charts, with high sensitivity (0.90; positive predictive value=0.56) and practical specificity (0.67; negative predictive value=0.94).ConclusionsAn optimised combination of two MA charts had the best performance for identifying clinically relevant small but sustained above-network SSI rates and large short-term individual hospital increases.
‘Whatever you cut, I can fix it’: clinical supervisors’ interview accounts of allowing trainee failure while guarding patient safety
Authors: Klasen Jennifer M , Driessen Erik , Teunissen Pim W , Lingard Lorelei A 
Published: November 2019

BackgroundLearning is in delicate balance with safety, as faculty supervisors try to foster trainee development while safeguarding patients. This balance is particularly challenging if trainees are allowed to experience the educational benefits of failure, acknowledged as a critical resource for developing competence and resilience. While other educational domains allow failure in service of learning, however, we do not know whether or not this strategy applies to clinical training.MethodsWe conducted individual interviews of clinical supervisors, asking them whether they allowed failure for educational purposes in clinical training and eliciting their experiences of this phenomenon. Participants’ accounts were descriptively analysed for recurring themes.ResultsTwelve women and seven men reported 48 specific examples of allowing trainee failure based on their judgement that educational value outweighed patient risk. Various kinds of failures were allowed: both during operations and technical procedures, in medication dosing, communication events, diagnostic procedures and patient management. Most participants perceived minimal consequences for patients, and many described their rescue strategies to prevent an allowed failure. Allowing failure under supervision was perceived to be important for supporting trainee development.ConclusionClinical supervisors allow trainees to fail for educational benefit. In doing so, they attempt to balance patient safety and trainee learning. The educational strategy of allowing failure may appear alarming in the zero-error tolerant culture of healthcare with its commitment to patient safety. However, supervisors perceived this strategy to be invaluable. Viewing failure as inevitable, they wanted trainees to experience it in protected situations and to develop effective technical and emotional responses. More empirical research is required to excavate this tacit supervisory practice and support its appropriate use in workplace learning to ensure both learning and safety.
Factors associated with civilian and police officer injury during 10 years of officer-involved shooting incidents
Authors: Paddock Ellen , Jetelina Katelyn Kassarjian , Bishopp Stephen A , Gabriel Kelley Pettee , Reingle Gonzalez Jennifer Marie 
Published: November 2019

BackgroundPrevious officer-involved shooting (OIS) research has focused primarily on antecedents to fatal shootings, with few studies investigating injury more broadly. Our study examined the factors associated with fatal or non-fatal injury to both civilians and officers during OIS incidents, to better understand how harm might be reduced in the most extreme law enforcement scenarios.MethodsData included 281 officers involved in 177 unique shooting incidents recorded by Dallas Police Department between 2005 and 2015. Bivariate logistic regression and multivariable generalised estimation equation analyses were used to investigate incident characteristics associated with fatal or non-fatal injury to civilians and officers.ResultsCivilian injury occurred in 61% and officer injury in 14% of unique OIS incidents. In adjusted models, multiple shooting officers increased the odds of injury to both civilians (adjusted OR (AOR): 3.22, 95% CI 1.39 to 7.50) and officers (AOR 4.73, 95% CI 1.64 to 13.65). Odds of civilian injury were also significantly higher during the daytime and among non-Hispanic white compared with non-Hispanic black and Hispanic/Latina/o civilians, although a majority of OIS incidents (79%) involved non-Hispanic black or Hispanic/Latino/a civilians. Odds of officer injury were significantly higher for detectives compared with patrol (AOR=9.32, 95% CI 1.85 to 47.03) and during off-duty versus on-duty shootings (AOR=5.23, 95% CI 1.37 to 19.99).ConclusionsBoth civilians and officers are at risk for injury during OIS incidents, though to different degrees and with unique risk factors. Additional research is needed to understand whether these results are replicated elsewhere and to further understand the mechanisms of injury.
Cenomanian–Turonian drowning of the Arabian Carbonate Platform, the İnişdere section, Adıyaman, SE Turkey
Authors: Mulayim O. , Yilmaz O. I. , Sarı B. , Tasli K. , Wagreich M. 
Published: November 2019

Abstract

The Cenomanian–Turonian carbonate ramp in the Adıyaman Region of SE Turkey (Northern Arabian Platform) records an abrupt shift from benthic carbonate deposits to pelagic deposits near the Cenomanian–Turonian boundary event (CTBE) in the İnişdere stratigraphic section and surrounding borehole sections. A positive δ
13
C excursion of up to 2.15% is recorded in carbonate and organic carbon deposited around the CTBE and provides evidence of a direct link between the CTBE and oceanic anoxic events and the demise of the shallow carbonate production in the Derdere Formation. The microfacies analyses, biostratigraphic dating and palaeoenvironmental interpretations suggest that the platform was drowned near the CTBE as a result of changing environmental conditions. The microfacies indicating significant deepening show a contemporaneity to equivalent surfaces globally and thus strongly support an isochronous formation of Cenomanian–Turonian facies by eustatic sea-level changes. Anoxia spreading over the platform drastically reduced the carbonate production as observed in the studied sections and, therefore, resulted in a reduction in carbonate accumulation rates. Regional/local subsidence and a coeval sea-level rise during the late Cenomanian to early Turonian interval were the cause of the drowning of the platform, including regional anoxia at the northern Arabian platform linked to the Cenomanian–Turonian oceanic anoxic event (OAE2).
Learned large field-of-view imaging with thin-plate optics
Authors: Peng Yifan , Sun Qilin , Dun Xiong , Wetzstein Gordon , Heidrich Wolfgang , Heide Felix 
Published: November 2019

Typical camera optics consist of a system of individual elements that are designed to compensate for the aberrations of a single lens. Recent computational cameras shift some of this correction task from the optics to post-capture processing, reducing the imaging optics to only a few optical elements. However, these systems only achieve reasonable image quality by limiting the field of view (FOV) to a few degrees - effectively ignoring severe off-axis aberrations with blur sizes of multiple hundred pixels.
In this paper, we propose a lens design and learned reconstruction architecture that lift this limitation and provide an order of magnitude increase in field of view using only a single thin-plate lens element. Specifically, we design a lens to produce spatially shift-invariant point spread functions, over the full FOV, that are tailored to the proposed reconstruction architecture. We achieve this with a mixture PSF, consisting of a peak and and a low-pass component, which provides residual contrast instead of a small spot size as in traditional lens designs. To perform the reconstruction, we train a deep network on captured data from a display lab setup, eliminating the need for manual acquisition of training data in the field. We assess the proposed method in simulation and experimentally with a prototype camera system.
We compare our system against existing single-element designs, including an aspherical lens and a pinhole, and we compare against a complex multielement lens, validating high-quality large field-of-view (i.e. 53°) imaging performance using only a single thin-plate element.
Insight Into the Mechanism of Macroreentrant Atrial Tachycardia With Cycle Length Alternans Using Ultrahigh Density Mapping System
Authors: Zhang Jinlin , Zheng Liangrong , Zhou Dongchen , Zhao Anquan , Tang Cheng , Zhang Yonghua , Su Xi 
Published: November 2019

Background:
Atrial tachycardia (AT) with cycle length (CL) alternans is a rare phenomenon. We aimed to identify the characteristics and precise mechanism of this special category of ATs by using an ultrahigh density mapping system.

Methods:
We identified 7 ATs with alternating CL in a total of 478 ATs from 2 institutions mapped with an ultrahigh density mapping system. Activation maps were performed for long CL (289±35 ms; mapping points, 21 520±11 103) and short CL (251±18 ms; mapping points,17 594±8059) separately.

Results:
We classified ATs with CL alternans into 2 types. Type 1: There existed 2 potential loops with different routes. CL alternans resulted from an intermittently 2:1 conducting block within the channel of the smaller loop. Type 2: CL alternans resulted from different conduction velocity through 2 closely spaced gaps within preexisting linear lesions. Catheter ablation successfully terminated all the 7 ATs.

Conclusions:
Ultrahigh density mapping provides an opportunity to delineate the precise mechanism of AT with CL alternans. Intermittent conduction block or slowing of a channel was essential for the maintenance of AT.
Determinants of Patient and Surrogate Experiences With Acute Care Research Consent: A Key Informant Interview Study
Authors: Scicluna Victoria M. , Goldkind Sara F. , Mitchell Andrea R. , Pentz Rebecca D. , Speight Candace D. , Silbergleit Robert , Dickert Neal W. 
Published: November 2019

Background
Informed consent for acute myocardial infarction and stroke research is challenging. Time for enrollment decisions is limited, patients and family are usually stressed, and being asked to participate in research is often unexpected. Despite these barriers, patients and surrogates have reported a preference for prospective involvement in research decisions and generally positive views of the consent process. It is unknown what drives positive or negative consent experiences. These data are crucial to making consent processes more context appropriate.

Methods and Results
We conducted a qualitative interview study with 27 patients and surrogates enrolled in acute myocardial infarction and stroke trials in the past 5 years. Purposive sampling from the P‐CARE (Patient‐Centered Approaches to Research Enrollment) study was based on participant characteristics and responses to initial patient‐centered interviews. In‐depth interviews used open‐ended questions to explore factors influencing consent experiences. Qualitative descriptive analysis was performed utilizing a multilevel coding strategy. Participants identified specific researcher behaviors as important, including expressions of respect, professionalism, and nonpressuring communication. Participants preferred consent conversations focused on risks/benefits and the trial protocol. They had varying views of consent forms and communicated several reasons the form was valuable unrelated to informational content. Participants also valued postenrollment interactions as opportunities to ask questions and learn about the study.

Conclusions
Barriers to consent in acute myocardial infarction and stroke trials are unavoidable, but participants identified productive ways to demonstrate respect for patients during enrollment conversations. These include key researcher behaviors, concentrating consent discussions on what participants find most important, and structured postenrollment follow‐up.
Global Burden of Small Vessel Disease–Related Brain Changes on MRI Predicts Cognitive and Functional Decline
Authors: Jokinen Hanna , Koikkalainen Juha , Laakso Hanna M. , Melkas Susanna , Nieminen Tuomas , Brander Antti , Korvenoja Antti , Rueckert Daniel , Barkhof Frederik , Scheltens Philip , Schmidt Reinhold , Fazekas Franz , Madureira Sofia , Verdelho Ana , Wallin Anders , Wahlund Lars-Olof , Waldemar Gunhild , Chabriat Hugues , Hennerici Michael , O’Brien John , Inzitari Domenico , Lötjönen Jyrki , Pantoni Leonardo , Erkinjuntti Timo 
Published: November 2019

Background and Purpose—
Cerebral small vessel disease is characterized by a wide range of focal and global brain changes. We used a magnetic resonance imaging segmentation tool to quantify multiple types of small vessel disease–related brain changes and examined their individual and combined predictive value on cognitive and functional abilities.

Methods—
Magnetic resonance imaging scans of 560 older individuals from LADIS (Leukoaraiosis and Disability Study) were analyzed using automated atlas- and convolutional neural network–based segmentation methods yielding volumetric measures of white matter hyperintensities, lacunes, enlarged perivascular spaces, chronic cortical infarcts, and global and regional brain atrophy. The subjects were followed up with annual neuropsychological examinations for 3 years and evaluation of instrumental activities of daily living for 7 years.

Results—

The strongest predictors of cognitive performance and functional outcome over time were the total volumes of white matter hyperintensities, gray matter, and hippocampi (
P
<0.001 for global cognitive function, processing speed, executive functions, and memory and
P
<0.001 for poor functional outcome). Volumes of lacunes, enlarged perivascular spaces, and cortical infarcts were significantly associated with part of the outcome measures, but their contribution was weaker. In a multivariable linear mixed model, volumes of white matter hyperintensities, lacunes, gray matter, and hippocampi remained as independent predictors of cognitive impairment. A combined measure of these markers based on
Z
scores strongly predicted cognitive and functional outcomes (
P
<0.001) even above the contribution of the individual brain changes.

Conclusions—
Global burden of small vessel disease–related brain changes as quantified by an image segmentation tool is a powerful predictor of long-term cognitive decline and functional disability. A combined measure of white matter hyperintensities, lacunar, gray matter, and hippocampal volumes could be used as an imaging marker associated with vascular cognitive impairment.
The Role of Circulation and Its Changes in Present and Future Atmospheric Rivers over Western North America
Authors: Tan Yaheng , Zwiers Francis , Yang Song , Li Chao , Deng Kaiqiang 
Published: November 2019

AbstractPerformance in simulating atmospheric rivers (ARs) over western North America based on AR frequency and landfall latitude is evaluated for 10 models from phase 5 of the Coupled Model Intercomparison Project among which the CanESM2 model performs well. ARs are classified into southern, northern, and middle types using self-organizing maps in the ERA-Interim reanalysis and CanESM2. The southern type is associated with the development and eastward movement of anomalous lower pressure over the subtropical eastern Pacific, while the northern type is linked with the eastward movement of anomalous cyclonic circulation stimulated by warm sea surface temperatures over the subtropical western Pacific. The middle type is connected with the negative phase of North Pacific Oscillation–west Pacific teleconnection pattern. CanESM2 is further used to investigate projected AR changes at the end of the twenty-first century under the representative concentration pathway 8.5 scenario. AR definitions usually reference fixed integrated water vapor or integrated water vapor transport thresholds. AR changes under such definitions reflect both thermodynamic and dynamic influences. We therefore also use a modified AR definition that isolates change from dynamic influences only. The total AR frequency doubles compared to the historical period, with the middle AR type contributing the largest increases along the coasts of Vancouver Island and California. Atmospheric circulation (dynamic) changes decrease northern AR type frequency while increasing middle AR type frequency, indicating that future changes of circulation patterns modify the direct effect of warming on AR frequency, which would increase ARs (relative to fixed thresholds) almost everywhere along the North American coastline.
Five-year Survival Data on the Role of Endoscopic Endonasal Nasopharyngectomy in Advanced Recurrent rT3 and rT4 Nasopharyngeal Carcinoma
Authors: Wong Eugene Hung Chih , Liew Yew Toong , Loong Siow Ping , Prepageran Narayanan 
Published: November 2019

Aim:Endoscopic endonasal nasopharyngectomy (EEN) for recurrent nasopharyngeal carcinoma (rNPC) is being increasingly used due to the added high magnification, reduced morbidities associated with open procedures and good survival outcomes. Most studies looked at usage of EEN in patients with lower recurrent staging (rT1 and rT2) although more and more surgeons are studying the outcome of EEN in advanced rNPC (rT3 and rT4). The aims of this study were to report the long-term 5-year survival outcome of EEN performed in patients with advanced rNPC, and to determine any prognostic factors for patients’ survival.Methods:All patients who underwent EEN for advanced rNPC between January 2003 and December 2015 inclusive were analyzed. All surgeries were performed in University Malaya Medical Centre in Kuala Lumpur and Queen Elizabeth Hospital in Sabah. We reported the 5-year overall survival (OS), disease-free survival (DFS) and disease-specific survival (DSS) and any related complications and significant prognostic factors.Results:Twelve patients with rNPC (2 rT3 and 10 rT4) were followed-up over a mean duration of 44.8 months (range, 40-440 weeks). The 5-year OS was 50.0% (mean 44.75 months), DFS was 25.0% (mean 35.25 months) and the DSS was 58.3% (mean 43.33 months). No severe operative complications were encountered and no independent prognostic factors for survival outcome were identified.Conclusion:This is the first report in English that exclusively described the long-term 5-year survival data in patients with both rT3 and rT4 recurrent NPC after EEN. The data suggest that EEN is a feasible treatment to improve survival with minimal morbidities in patients with rT3 and rT4 recurrent NPC. However, more studies with larger patient size is recommended.