bluuebunny/crossref_metadata_2025_split huggingface dataset:
Temporal Metrics of Multisensory Processing Change in the Elderly
Authors: Basharat Aysha , Mahoney Jeannette R. , Barnett-Cowan Michael 
Published: August 2019

Abstract
Older adults exhibit greater multisensory response time (RT) facilitation by violating the race model more than young adults; this is commonly interpreted as an enhancement in perception. Older adults typically exhibit wider temporal binding windows (TBWs) and points of subjective simultaneity (PSS) that typically lie farther from true simultaneity as compared to young adults when simultaneity judgment (SJ) and temporal-order judgment (TOJ) tasks are utilized; this is commonly interpreted as an impairment in perception. Here we explore the relation between the three tasks in order to better assess audiovisual multisensory temporal processing in both young and older adults. Our results confirm previous reports showing that audiovisual RT, TBWs and PSSs change with age; however, we show for the first time a significant positive relation between the magnitude of race model violation in young adults as a function of the PSS obtained from the audiovisual TOJ task (r: 0.49, p: 0.007), that is absent in older adults (r: 0.13, p: 0.58). Furthermore, we find no evidence for the relation between race model violation as a function of the PSS obtained from the audiovisual SJ task in both young (r: −0.01, p: 0.94) and older adults (r: 0.1, p: 0.66). Our results confirm previous reports that (i) audiovisual temporal processing changes with age; (ii) distinct processes are likely involved in simultaneity and temporal-order perception; and (iii) common processing between race model violation and temporal-order judgment is impaired in the elderly.
Barriers and Facilitators to Hypertension Control Following Participation in a Church-Based Hypertension Intervention Study
Authors: Heinert Sara , Escobar-Schulz Sandra , Jackson Maya , Del Rios Marina , Kim Sarah , Kahkejian Jennica , Prendergast Heather 
Published: August 2019

Purpose: Hypertension is the primary risk factor for development of cardiovascular complications. Community-initiated interventions have proven effective in reducing cardiovascular disease risk among individuals who might otherwise face barriers to care. The purposes of this study were to gain feedback on a church-based hypertension intervention study and assess barriers and facilitators to hypertension control after participation in the study. Design: Qualitative study of 4 focus groups. Setting: Focus groups took place at 4 churches in primarily minority neighborhoods of Chicago, Illinois, in summer 2017. Participants: Thirty-one community members participated in the focus groups. Method: The Community Targeting of Uncontrolled Hypertension (CTOUCH) study was a church-based screening, brief intervention, and referral for treatment program for hypertension. Following the study completion, participants were invited to join a focus group to provide feedback on the study and discuss barriers and facilitators to hypertension control. The authors used the Framework Method to analyze the data. Results: Community Targeting of Uncontrolled Hypertension was well received by participants, particularly the awareness of their individual blood pressure and subsequent education on risk modification. The most common facilitators for hypertension control were social support, knowing how to control hypertension, and community resources. The most common barriers to hypertension control were lack of hypertension knowledge, negative primary care experiences, and lack of disease awareness. Conclusion: Knowledge of barriers and facilitators can inform areas of success and opportunities for improvement in community-based hypertension programs including future renditions in CTOUCH.
Influence of pelvic sagittal tilt on 3-dimensional bone coverage in total hip arthroplasty: a simulation analysis
Authors: Ueno Takuro , Kabata Tamon , Kajino Yoshitomo , Takagi Tomoharu , Ohmori Takaaki , Yoshitani Junya , Tsuchiya Hiroyuki 
Published: August 2019

Background: In total hip arthroplasty with computer navigation assistance, cup orientation is generally determined according to the coordinate system relative to the functional pelvic plane (FPP). However, there is a large difference in the cup anteversion between a posterior pelvic tilt relative to the computed tomography (CT) table in the sagittal plane and anterior pelvic tilt, even when the cup is set at the same orientation angle according to each FPP. The present study analysed this difference from the viewpoint of 3-dimensional (3D) coverage of the acetabular component (3D coverage) to determine how the 3D acetabular coverage is altered with changes in pelvic sagittal tilt. Methods: We analysed 3D-simulated acetabular coverage measured in 3D pelvic models reconstructed from the preoperative CT data of 50 patients. In each patient, we created 5 pelvic models with a sagittal tilt of 10° increments between 20° anterior tilt and 20° posterior tilt relative to the CT table. Results: We found that 3D coverage decreased as the pelvis tilted posteriorly. Particularly, there were significant differences between the pelvis with 20° anterior tilt and that with neutral tilt ( p < 0.001). There was also a difference between the pelvis with neutral tilt and that with a 20° posterior tilt ( p < 0.01). The mean decrease in 3D coverage between the pelvis with neutral tilt and that with 20° posterior tilt was 7.2 ± 1.6%. Conclusions: We found that 3D coverage differed among pelvis with different sagittal tilts when the cup orientation angle was determined according to FPP.
Dermatologists’ perceptions on the utility and limitations of teledermatology after examining 55,000 lesions
Authors: Giavina Bianchi Mara , Santos Andre , Cordioli Eduardo 
Published: August 2019

Introduction Few studies have assessed the perception of teledermatologists about the utility and limitations of teledermatology, especially to diagnose a broad range of skin diseases. This study aimed to evaluate dermatologists’ confidence in teledermatology, its utility and limitations for dermatological conditions in primary care. Methods An analytical study that used a survey for dermatologists who diagnosed 30,916 patients with 55,012 lesions through teledermatology during a 1-year project in São Paulo, Brazil. Results Dermatologists found teledermatology useful for triage and diagnosis, especially for xerotic eczema, pigmentary disorders and superficial infections. Their confidence in teledermatology was statistically higher by the end of the project ( p = 0.0012). Limitations included some technical issues and the impossibility to suggest how soon the patient should be assisted face-to-face by a dermatologist. The most treatable group of diseases by teledermatology was superficial infections (92%). The use of dermoscopy images would significantly increase the confidence to treat atypical naevi and malignant tumours ( p < 0.0001 and p = 0.0003 respectively). Follow-ups by teledermatology or feedback from primary-care physicians would be desirable, according to the dermatologists. Discussion We found it interesting that dermatologists became increasingly confident in teledermatology after the project and how they classified teledermatology as useful for triage, diagnosis and even treatment of most types of skin conditions followed at primary care. Dermoscopy should definitely be added to the photographs, especially for malignant tumours and atypical naevi. Most of the technical limitations found could be solved with a few improvements in the software/platform.
Noninferiority trials with nonadherence to the assigned randomized treatment
Authors: Korn Edward L , Gray Robert J , Freidlin Boris 
Published: August 2019

Background: Nonadherence to treatment assignment in a noninferiority randomized trial is especially problematic because it attenuates observed differences between the treatment arms, possibly leading one to conclude erroneously that a truly inferior experimental therapy is noninferior to a standard therapy (inflated type 1 error probability). The Lachin–Foulkes adjustment is an increase in the sample size to account for random nonadherence for the design of a superiority trial with a time-to-event outcome; it has not been explored in the noninferiority trial setting nor with nonrandom nonadherence. Noninferiority trials where patients have knowledge of a personal prognostic risk score may lead to nonrandom nonadherence, as patients with a relatively high risk may be more likely to not adhere to the random assignment to the (reduced) experimental therapy, and patients with a relatively low risk score may be more likely to not adhere to the random assignment to the (more aggressive) standard therapy. Methods: We investigated via simulations the properties of the Lachin–Foulkes adjustment in the noninferiority setting. We considered nonrandom in addition to random nonadherence to the treatment assignment. For nonrandom nonadherence, we used the scenario where a risk score, potentially associated with the between-arm treatment difference, influences patients’ nonadherence. A sensitivity analysis is proposed for addressing the nonrandom nonadherence for this scenario. The noninferiority TAILORx adjuvant breast cancer trial, where eligibility was based on a genomic risk score, is used as an example throughout. Results: The Lachin–Foulkes adjustment to the sample size improves the operating characteristics of noninferiority trials with random nonadherence. However, to maintain type 1 error probability, it is critical to adjust the noninferiorty margin as well as the sample size. With nonrandom nonadherence that is associated with a prognostic risk score, the type 1 error probability of the Lachin–Foulkes adjustment can be inflated (e.g. doubled) when the nonadherence is larger in the experimental arm than the standard arm. The proposed sensitivity analysis lessens the inflation in this situation. Conclusion: The Lachin–Foulkes adjustment to the sample size and noninferiority margin is a useful simple technique for attenuating the effects of random nonadherence in the noninferiority setting. With nonrandom nonadherence associated with a risk score known to the patients, the type 1 error probability can be inflated in certain situations. A proposed sensitivity analysis for these situations can attenuate the inflation.
‘She’s not obese, she’s a normal 5-year-old and she keeps up with the other kids’: families’ reasons for not attending a family-based obesity management programme
Authors: Povey RC , Cowap LJ , Scholtens K , Forshaw MJ 
Published: August 2019

Aims: To discover the reasons behind invited families’ lack of engagement with a family-based childhood obesity programme in a deprived area. Methods: Interviews were conducted with 10 families who were invited to join the programme, but declined to engage. There were two distinct subgroups of participants: those who had no interest in attending the programme and those who showed initial interest yet did not continue attending. The two subgroups were analyzed separately using inductive thematic analysis, and then compared. Results: Analysis identified eight themes overall. For both groups, when the service was perceived to be not needed (‘I didn’t see how that would help’), the families disengaged with it. For both groups, this perception was partly related to the perceived appearance of their children: either that they were not obese (‘I didn’t think my son was overweight’) or that they were growing into their size. There was also a similarity in both groups that they perceived that they were already following healthy lifestyles. In addition, several of the themes arising from the families who had no initial interest were related to the impact of the letter that parents received detailing the result of their child being weighed and measured at school. This angered parents (‘I was disgusted’), and there was a feeling that the approach was too generic. Conclusion: This study identified a number of potential reasons behind why families may decline to engage with a childhood obesity programme in a deprived area. Across all families, if the programme was perceived as not needed, they would disengage. For those who did not engage at all, the initial communication of the child’s body mass index (BMI) is crucial. Recommendations include taking a more personal and tailored approach for the initial communication and shifting the focus of the programmes onto healthier lifestyles.
Evaluation of an intervention targeting loneliness and isolation for older people in North Wales
Authors: Roberts JR , Windle G 
Published: August 2019

Aims: Age Cymru Gwynedd and Môn provided a service, Cadwyn Môn, which aimed to reduce loneliness and isolation of older people living on Anglesey, North Wales. It involved working with individuals to identify goals, beginning on a one-to-one basis, with the aim of integrating into a wider social setting. The aim of this study was evaluate the impact of Cadwyn Môn on those who received the service. Methods: The evaluation adopted a mixed-methods design. Standardized measures of loneliness, social isolation and well-being were obtained at baseline and follow-up time points, and a qualitative element explored client experiences further. Results: Improvements were observed in all standardized measures. Qualitative interviews also revealed important psychological and lifestyle changes. Conclusions: Given the anticipated rise in loneliness and social isolation alongside an ageing population, this evaluation contributes to understanding the qualities required for interventions to be effective. The findings provide support for the importance of developing individualized interventions that aim to gradually re-integrate people into their communities.
A systematic breakdown of the levels of evidence supporting the European Society of Cardiology guidelines
Authors: van Dijk Wouter B , Grobbee Diederick E , de Vries Martine C , Groenwold Rolf H H , van der Graaf Rieke , Schuit Ewoud 
Published: August 2019

AbstractAimsReviews of clinical practice guidelines have repeatedly concluded that only a minority of guideline recommendations are supported by high-quality evidence from randomised controlled trials. The aim of this study is to evaluate whether these findings apply to the whole cardiovascular evidence base or specific recommendation types and actions.MethodsAll recommendations from current European Society of Cardiology guidelines were extracted with their class (I, treatment is beneficial; II, treatment is possibly beneficial; III, treatment is harmful) and level of evidence (A, multiple randomised controlled trials/meta-analyses; B, single randomised controlled trials/large observational studies; C, expert opinion/small studies). Recommendations were categorised by type (therapeutic, diagnostic, other) and actions (e.g. pharmaceutical intervention/non-invasive imaging/test).ResultsIn total, 3531 recommendations (median 128, interquartile range 108–150) were extracted from 27 guidelines. Therapeutic recommendations comprised 2545 (72.1%) recommendations, 411 (16.1%) were supported by level of evidence A, 833 (32.7%) by B and 1301 (51.1%) by C. Class I/III (should/should not) recommendations on minimally invasive interventions were most supported by level of evidence A (55/183, 30.1%) (B [70/183, 38.3%], C [58/183, 31.7%]), while class I/III recommendations on open surgical interventions were least supported by level of evidence A (15/164, 9.1%) (B [34/164, 20.7%], C [115/164, 70.1%]). Of all (831, 23.5%) diagnostic recommendations, just 44/503 (8.7%) class I/III recommendations were supported by level of evidence A (B (125/503, 24.9%), C (334/503, 66.4%)).ConclusionEvidence levels supporting European Society of Cardiology guideline recommendations differ widely between recommendation types and actions. Attributing to this variability are different evidence requirements, therapeutic/diagnostic recommendations, different feasibility levels for trials (e.g. open surgical/pharmacological) and many off-topic/policy recommendations based on expert opinion.
Effectiveness of oral antibiotics for definitive therapy of non-Staphylococcal Gram-positive bacterial bloodstream infections
Authors: Quinn Nicholas J. , Sebaaly Jamielynn C. , Patel Bianka A. , Weinrib David A. , Anderson William E. , Roshdy Danya G. 
Published: August 2019

Background: Data on the effectiveness of definitive oral (PO) antibiotics for BSIs in preparation for discharge from hospital are lacking, particularly for Gram-positive bacterial BSIs (GP-BSI). The objective of this study was to determine rates of treatment failure based on bioavailability of PO antimicrobial agents used for GP-BSI. Methods: This was a single-center, retrospective cohort study of adult inpatients admitted to an academic medical center over a three-year period. Patients with a non-staphylococcal GP-BSI who received intravenous antibiotics and were then switched to PO antibiotics for at least a third of their treatment course were included. The cohort was stratified into high (⩾90%) and low (<90%) bioavailability groups. The primary endpoint was the proportion of patients experiencing clinical failure in each group. Secondary endpoints included clinical failure stratified by antibiotic group, bactericidal versus bacteriostatic PO agents, and organism. Results: A total of 103 patients met criteria for inclusion, which failed to reach the a priori power calculation. Of the patients included, 26 received high bioavailability agents and 77 received low bioavailability agents. Infections originated largely from a pulmonary source (30%) and were caused primarily by streptococcal species (75%). Treatment failure rates were 19.2% in the high bioavailability group and 23.4% in the low bioavailability group ( p = 0.66). Clinical failure stratified by subgroups also did not yield statistically significant differences. Conclusions: Clinical failure rates were similar among patients definitively treated with high or low bioavailability agents for GP-BSI, though the study was underpowered to detect such a difference.
Automated Measurement of Lumbar Lordosis on Radiographs Using Machine Learning and Computer Vision
Authors: Cho Brian H. , Kaji Deepak , Cheung Zoe B. , Ye Ivan B. , Tang Ray , Ahn Amy , Carrillo Oscar , Schwartz John T. , Valliani Aly A. , Oermann Eric K. , Arvind Varun , Ranti Daniel , Sun Li , Kim Jun S. , Cho Samuel K. 
Published: August 2019

Study Design: Cross sectional database study. Objective: To develop a fully automated artificial intelligence and computer vision pipeline for assisted evaluation of lumbar lordosis. Methods: Lateral lumbar radiographs were used to develop a segmentation neural network (n = 629). After synthetic augmentation, 70% of these radiographs were used for network training, while the remaining 30% were used for hyperparameter optimization. A computer vision algorithm was deployed on the segmented radiographs to calculate lumbar lordosis angles. A test set of radiographs was used to evaluate the validity of the entire pipeline (n = 151). Results: The U-Net segmentation achieved a test dataset dice score of 0.821, an area under the receiver operating curve of 0.914, and an accuracy of 0.862. The computer vision algorithm identified the L1 and S1 vertebrae on 84.1% of the test set with an average speed of 0.14 seconds/radiograph. From the 151 test set radiographs, 50 were randomly chosen for surgeon measurement. When compared with those measurements, our algorithm achieved a mean absolute error of 8.055° and a median absolute error of 6.965° (not statistically significant, P > .05). Conclusion: This study is the first to use artificial intelligence and computer vision in a combined pipeline to rapidly measure a sagittal spinopelvic parameter without prior manual surgeon input. The pipeline measures angles with no statistically significant differences from manual measurements by surgeons. This pipeline offers clinical utility in an assistive capacity, and future work should focus on improving segmentation network performance.
Dislocation of a Scleral-Fixated, Hydrophobic, Single-Piece Acrylic Intraocular Lens Secondary to Eyelet Fracture From Gore-Tex Suture
Authors: Gupta R. Rishi , Seamone Mark E. , Pollmann André S. , O’Brien Daniel M. , Lewis Darrell R. 
Published: August 2019

Purpose: This article reports a case of the dislocation of a scleral-fixated enVista MX60 (Bausch + Lomb) intraocular lens (IOL) secondary to eyelet fracture at the point of contact with a Gore-Tex (W.L. Gore & Associates) suture. Methods: A case report is discussed. Results: An 81-year-old woman presented with decreased vision secondary to a dislocated Gore-Tex scleral-sutured enVista MX60 IOL in the left eye 14 months after surgery. The patient returned to the operating room for IOL exchange, and intraoperatively it was confirmed that the eyelet of the lens had fractured secondary to tension from the Gore-Tex suture. Conclusions: To the best of the authors’ knowledge, this is the first report of eyelet fracture in an enVista MX60 scleral-sutured IOL secondary to tension from a Gore-Tex suture.
Identifying quality improvement opportunities using patient complaints: Feasibility of using a complaints taxonomy in a metropolitan maternity service
Authors: Nowotny Benjamin M , Loh Erwin , Davies-Tuck Miranda , Hodges Ryan , Wallace Euan M 
Published: August 2019

Background The Healthcare Complaints Analysis Tool (HCAT) is a coding taxonomy developed to interrogate patient complaints for quality and safety improvement lessons. The reliability of the tool has been tested in whole-of-system and whole-of-service settings. We sought to assess whether the taxonomy is functional at the level of a single hospital department. Objectives To demonstrate the feasibility of applying HCAT in the setting of a large maternity department with a view to using it to inform quality and safety improvement opportunities. Methods All 200 de-identified complaints made between 1 April 2011 and 30 April 2016 to a multi-site maternity service were collated. Each complaint entry included a summary of complaint content, complaint report date, complaint closure date and an incident severity rating (ISR). HCAT was applied to the analysis of complaints using a previously validated content analysis framework. A coding flowchart was developed to aid classification. Results The 200 complaints involved 567 issues, an average of 2.8 issues per complaint. The most common issues were rude behaviour (n = 46), poor communication (n = 38), complaints relating to the quality of medical care (n = 36), nursing care (n = 35), surgical/medical complications (n = 28) and complaints relating to the attitude of staff members (n = 23). Complaints in the clinical domain made up the greatest proportion of both severe (ISR 1 – 66.7%) and moderate (ISR 2 – 64.5%) incidents. Conclusions Using a reliable taxonomy, we were able to successfully interrogate patient complaints, identifying quality improvement targets within a single maternity service. The taxonomy appears suitable for adoption and application across health jurisdictions.