bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fluctuating Vestibulo-Ocular Reflex in Ménière's Disease
Authors: Yacovino Dario A. , Hain Timothy C. , Musazzi Maria 
Published: December 2016

Objectives:
To describe the fluctuating high velocity vestibular ocular-reflex (VOR) during the Ménière's attacks and correlate those features with pathophysiology.

Patients:
A patient with unilateral Ménière's disease (MD) was evaluated closely during and after acute vertigo episodes.

Main Outcome Measures:
The spontaneous nystagmus and the dynamic VOR changes were measured by the video head impulse test (VHIT) at different stages of the vertigo crisis and during the quiescent phase of the condition.

Results:
During the Ménière's attack, the VOR gain showed large changes on the affected side; however, on recovery a return to the normal value was evident. The VOR gain also showed fluctuation on follow up, paralleling symptoms. The greatest reduction of the VOR was during the paralytic nystagmus phase.

Conclusions:
The present case documents rapid vestibular fluctuation documented with VHIT testing in MD. The ionic-chemical perilymphatic intoxication and the endolymphatic space collapse due to membrane rupture could explain those features. VHIT fluctuation is a promising tool for diagnosis of patients with episodic vestibular symptoms.
Lactate - Arterial and Venous Agreement in Sepsis: a prospective observational study
Authors: Datta Deepankar , Grahamslaw Julia , Gray Alasdair J. , Graham Catriona , Walker Craig A. 
Published: December 2016

Background
Sepsis is a common condition in the emergency department (ED). Lactate measurement is an important part of management: arterial lactate (A-LACT) measurement is the gold standard. There is increasing use of peripheral venous lactate (PV-LACT); however, there is little research supporting the interchangeability of the two measures.
If PV-LACT has good agreement with A-LACT, it would significantly reduce patient discomfort and the risks of arterial sampling for a large group of acutely unwell patients, while allowing faster and wider screening, with potential reduced costs to the healthcare system.

Objective
The aim of this study is to determine the agreement between PV-LACT and A-LACT in septic patients attending the ED.

Methods
We carried out a prospective observational cohort study of 304 consented patients presenting with sepsis to a single UK NHS ED (110 000 adult attendances annually) taking paired PV-LACT and A-LACT. Bland–Altman analysis was carried out to determine agreement. Receiver operating characteristic curves and 2×2 tables were constructed to explore the predictive value of PV-LACT for A-LACT.

Results
The mean difference (PV-LACT−A-LACT) is 0.4 mmol/l [95% confidence interval (CI): 0.37–0.45], with 95% limits of agreement from −0.4 (95% CI: −0.45 to −0.32) to 1.2 (95% CI: 1.14–1.27). A PV-LACT of at least 2 mmol/l predicts an A-LACT of at least 2 with 100% sensitivity (95% CI: 89–100%) and 83% specificity (95% CI: 77–87%).

Conclusion
This study is the largest comparing the two measurements, and shows good clinical agreement. We recommend using PV-LACT in the routine screening of septic patients. A PV-LACT less than 2 mmol/l is predictive of an A-LACT less than 2 mmol/l.
Therapy-related myeloid neoplasms
Authors: Ganser Arnold , Heuser Michael 
Published: December 2016

Purpose of review
Advances in the genetic characterization of patients with therapy-related myeloid neoplasms (t-MNs) have changed our understanding of the pathogenesis of these diseases. In addition, extensive sequencing studies have identified recurrent mutations with diagnostic and prognostic impact. Thus, the revised version of the WHO classification combines therapy-related myelodysplastic syndromes (t-MDS) and therapy-related acute myeloid leukemia (t-AML) in the one entity of t-MNs because of their similar pathogenesis, rapid progression from t-MDS to t-AML, and their equally poor prognosis.

Recent findings
Fifteen percent of t-AML patients present with favorable risk fusion genes, whereas 50% have adverse cytogenetics. The most frequent molecular aberration in t-AML and t-MDS affects TP53 (33%). Selection of a pre-existing treatment-resistant hematopoietic stem cell clone with TP53 mutation has been shown as an important mechanism in the development of t-MNs and explains the high frequency of TP53 mutations in these patients. Following previous cytotoxic therapy, patients develop specific vulnerabilities, which become especially evident as high nonrelapse mortality of t-MN patients after allogeneic hematopoietic cell transplantation.

Summary
Patients are treated according to their genetic risk profile. Assessment of minimal residual disease helps to guide allogeneic transplantation for patients with favorable risk and genetic markers.
The Effectiveness of Medical Simulation in Teaching Medical Students Critical Care Medicine
Authors: Beal Matthew David , Kinnear John , Anderson Caroline Rachael , Martin Thomas David , Wamboldt Rachel , Hooper Lee 
Published: December 2016

Summary Statement
We aimed to assess effectiveness of simulation for teaching medical students critical care medicine and to assess which simulation methods were most useful. We searched AMED, EMBASE, MEDLINE, Education Resources Information Centre, British Education Index, Australian Education Index, and bibliographies and citations, in July 2013. Randomized controlled trials comparing effectiveness of simulation with another educational intervention, or no teaching, for teaching medical students critical care medicine were included. Assessments for inclusion, quality, and data extraction were duplicated and results were synthesized using meta-analysis.
We included 22 randomized control trials (n = 1325). Fifteen studies comparing simulation with other teaching found simulation to be more effective [standardized mean difference (SMD) = 0.84; 95% confidence interval (CI) = 0.43 to 1.24; P < 0.001; I
2 = 89%]. High-fidelity simulation was more effective than low-fidelity simulation, and subgrouping supported high-fidelity simulation being more effective than other methods. Simulation improved skill acquisition (SMD = 1.01; 95% CI = 0.49 to 1.53) but was no better than other teaching in knowledge acquisition (SMD = 0.41; 95% CI = −0.09 to 0.91).
Eye Tracking
Authors: Henneman Elizabeth A. , Marquard Jenna L. , Fisher Donald L. , Gawlinski Anna 
Published: December 2016

Introduction
Eye tracking, used to evaluate a clinician’s eye movements, is an example of an existing technology being used in novel ways by patient safety researchers in the simulated setting. The use of eye-tracking technology has the potential to augment current teaching, evaluation, and research methods in simulated settings by using this quantitative, objective data to better understand why an individual performed as he or she did on a simulated or naturalistic task.

Methods
Selected literature was reviewed with the purpose of explicating how eye tracking can be used by researchers and educators to evaluate error-prone processes. The literature reviewed was obtained by querying the databases PubMed, CINHAL, and Google Scholar using the key words eye tracking, patient safety, and medical errors from 2005 through 2015.
An introduction to the use of eye tracking, including both theoretical underpinnings and technological considerations, is presented. In addition, examples of how eye tracking has been used in research studies conducted in both simulated and naturalistic settings are provided.

Conclusions
The use of eye-tracking technology to capture the eye movements of novice and expert clinicians has provided new insight into behaviors associated with the identification of medical errors. The study of novices’ and experts’ eye movements provides data about clinician performance not possible with existing evaluation methods such as direct observation, verbal reports, and thinking out loud. The use of eye tracking to capture the behaviors of experts can lead to the development of training protocols to guide the education of students and novice practitioners. Eye-tracking technology clearly has the potential to transform the way clinical simulation is used to improve patient safety practices.
Validation of a High-Fidelity Electrophysiology Simulator and Development of a Proficiency-Based Simulator Training Program
Authors: Ullah Waqas , Hunter Ross J. , Finlay Malcolm , Earley Mark J. , McLean Ailsa , Marazzi Raffaella , De Ponti Roberto , Schilling Richard J. 
Published: December 2016

Introduction
Simulator training can potentially provide high-intensity training in electrophysiology (EP) without compromising patient safety. We assessed the construct validity of a novel EP simulator (ANGIO Mentor; Simbionix) and developed proficiency-based scores for clinical EP simulator training.

Methods
Two European training centers participated. Participants were grouped on the basis of years of EP experience and (for a subset) subjectively scored clinical catheter manipulation skills. Each participant attempted the simulator's 5 modules 3 times. These modules focus on catheter manipulation in 3-dimensional models, ranging from geometric shapes to fluoroscopic contracting cardiac models, with performance scored by the system on the basis of attainment of preset targets. Using these scores, targets were formulated for basic EP training.

Results
Twenty-eight participants were included (13 with subjectively scored catheter manipulation). Scores for participants with less than 1-year EP experience (group 1) were significantly lower for each of the attempts at the modules (P < 0.002). For group 1 only, scores improved with subsequent attempts (P < 0.005). In 4 of the 5 modules, scores of group 1 were significantly lower than the more experienced groups (P < 0.0005). Participants with subjectively scored above-average catheter manipulation skills also had higher scores in 4 of the 5 modules (P < 0.05). Target scores for a proficiency-based training program were generated from the median scores for each module for those with 1-year experience or more.

Conclusions
Scores attained in the simulator can distinguish those with less than 1-year EP experience and those with above-average catheter manipulation skills. Consequently, target scores have been generated for a proficiency-based training program.
Evaluation of a Vibrotactile Simulator for Dental Caries Detection
Authors: Kuchenbecker Katherine J. , Parajon Robert C. , Maggio Margrit P. 
Published: December 2016

Introduction
Developed to educate dental students in caries detection, the VerroTeach simulator allows dental faculty to share, record, and replay the tactile vibrations felt through a dental hand instrument. We assessed this simulation approach by asking experienced dental educators to evaluate the system’s real-time and video playback modes.

Methods
VerroTeach uses an accelerometer to sense instrument vibrations and a voice coil actuator to reproduce these vibrations on another tool. Seventeen dental faculty participated in the study, first experiencing real-time mode by feeling vibrations while the experimenter touched extracted teeth. The subject then experienced vibrotactile playback of 5 prerecorded caries detection tasks and 1 prerecorded caries extraction procedure, making 10 total caries judgments and repeatedly rating the system’s perceptual accuracy.

Results
Dental educators rated caries detection as significantly more difficult for students than experienced dentists (P < 0.0001), and they rated tactile feedback as a highly important source of information for this judgment. Subjects highly rated the realism of both real-time mode and playback mode. Experienced dentists performed well on the simulator, answering most questions correctly. Interestingly, nonpracticing dentists performed significantly worse than practicing dentists on the caries judgment questions (P = 0.003). Finally, subjects strongly recommended the system for training dental students.

Conclusions
These positive results indicate that sharing, recording, and replaying instrument vibrations may be beneficial for teaching caries detection to dental students. Further research is planned to improve tactile feedback quality, integrate VerroTeach into the preclinical curriculum, and explore other possible applications for this approach to clinical simulation.
Using Simulation as an Investigational Methodology to Explore the Impact of Technology on Team Communication and Patient Management
Authors: Gittinger Matthew , Brolliar Sarah M. , Grand James A. , Nichol Graham , Fernandez Rosemarie 
Published: December 2016

Introduction
This pilot study used a simulation-based platform to evaluate the effect of an automated mechanical chest compression device on team communication and patient management.

Methods
Four-member emergency department interprofessional teams were randomly assigned to perform manual chest compressions (control, n = 6) or automated chest compressions (intervention, n = 6) during a simulated cardiac arrest with 2 phases: phase 1 baseline (ventricular tachycardia), followed by phase 2 (ventricular fibrillation). Patient management was coded using an Advanced Cardiovascular Life Support–based checklist. Team communication was categorized in the following 4 areas: (1) teamwork focus; (2) huddle events, defined as statements focused on re-establishing situation awareness, reinforcing existing plans, and assessing the need to adjust the plan; (3) clinical focus; and (4) profession of team member. Statements were aggregated for each team.

Results
At baseline, groups were similar with respect to total communication statements and patient management. During cardiac arrest, the total number of communication statements was greater in teams performing manual compressions (median, 152.3; interquartile range [IQR], 127.6–181.0) as compared with teams using an automated compression device (median, 105; IQR, 99.5–123.9). Huddle events were more frequent in teams performing automated chest compressions (median, 4.0; IQR, 3.1–4.3 vs. 2.0; IQR, 1.4–2.6). Teams randomized to the automated compression intervention had a delay to initial defibrillation (median, 208.3 seconds; IQR, 153.3–222.1 seconds) as compared with control teams (median, 63.2 seconds; IQR, 30.1–397.2 seconds).

Conclusions
Use of an automated compression device may impact both team communication and patient management. Simulation-based assessments offer important insights into the effect of technology on healthcare teams.
Training Effectiveness of a Wide Area Virtual Environment in Medical Simulation
Authors: Wier Grady S. , Tree Rebekah , Nusr Rasha 
Published: December 2016

Introduction
The success of war fighters and medical personnel handling traumatic injuries largely depends on the quality of training they receive before deployment. The purpose of this study was to gauge the utility of a Wide Area Virtual Environment (WAVE) as a training adjunct by comparing and evaluating student performance, measuring sense of realism, and assessing the impact on student satisfaction with their training exposure in an immersive versus a field environment.

Methods
This comparative prospective cohort study examined the utility of a three-screen WAVE where subjects were immersed in the training environment with medical simulators. Standard field training commenced for the control group subjects. Medical skills, time to completion, and Team Strategies and Tools to Enhance Performance and Patient Safety objective metrics were assessed for each team (n = 94). In addition, self-efficacy questionnaires were collected for each subject (N = 470).

Results
Medical teams received poorer overall team scores (F
1,186 = 0.756, P = 0.001), took longer to complete the scenario (F
1,186 = 25.15, P = 0.001), and scored lower on The National Registry of Emergency Medical Technicians trauma assessment checklist (F
1,186 = 1.13, P = 0.000) in the WAVE versus the field environment. Critical thinking and realism factors within the self-efficacy questionnaires scored higher in the WAVE versus the field [(F
1,466 = 8.04, P = 0.005), (F
1,465 = 18.57, P = 0.000), and (F
1,466 = 53.24, P = 0.000), respectively].

Conclusions
Environmental and emotional stressors may negatively affect critical thinking and clinical skill performance of medical teams. However, by introducing more advanced simulation trainings with added stressors, students may be able to adapt and overcome barriers to performance found in high-stress environments.
Hepatic Epithelioid Hemangioendothelioma and Adult Liver Transplantation: Proposal for a Prognostic Score Based on the Analysis of the ELTR-ELITA Registry
Authors: Lai Quirino , Feys Estelle , Karam Vincent , Adam Rene , Klempnauer Jurgen , Oliverius Martin , Mazzaferro Vincenzo , Pascher Andreas , Remiszewski Piotr , Isoniemi Helena , Pirenne Jacques , Foss Aksel , Ericzon Bo G. , Markovic Sasa , Lerut Jan P. 
Published: December 2016

Background
Hepatic epithelioid hemangioendothelioma (HEHE) is a rare vascular tumor which has an intermediate aggressive behavior. Although the value of liver transplantation (LT) is well established, its place in the management of HEHE is still unclear. The aim of this study is to confirm, based on a very large patient cohort, the value of LT in the management of HEHE and to identify risk factors for post-LT recurrence.

Methods
The outcome of 149 transplant recipients with HEHE recorded in the European Liver Transplant Registry during the period November 1984 to May 2014 was analyzed. Median post-LT follow-up was 7.6 years (interquartile range, 2.8-14.4).

Results
Cox regression analysis showed that macrovascular invasion (hazard ratio [HR], 4.8; P < 0.001), pre-LT waiting time of 120 days or less (HR, 2.6; P = 0.01) and hilar lymph node invasion (HR = 2.2; P = 0.03), but not pre-LT extrahepatic disease, were significant risk factors for recurrence. These findings, which were also confirmed in a propensity score analysis, allowed the development of a HEHE-LT score enabling stratification of patients in relation to their risk of tumor recurrence. Patients with a score of 2 or less had a much better 5-year disease-free survival compared to those having a score of 6 or higher (93.9% vs 38.5%; P < 0.001).

Conclusions
The analysis of this (largest in the world) HEHE adult liver recipient cohort clearly confirms the value of LT in the treatment of this rare disorder and also permits identification of patients at risk of posttransplant recurrence. Posttransplant follow-up should take the HEHE-LT score into account. Extrahepatic disease localization is reconfirmed not to be a contraindication for LT.
Strategic marketing patterns and performance implications
Authors: Agic Emir , Cinjarevic Merima , Kurtovic Emir , Cicic Muris 
Published: December 2016

PurposeThe purpose of this study is to create the taxonomy of firms based on the nature of the relationship between market-based resources and marketing capabilities. Anchored in the configuration theory, the present study aims to explore simultaneous roles of market-based resources, i.e. customer orientation and competitor orientation, and marketing capabilities, i.e. the execution of marketing practices and activities within a firm, on firm performance.Design/methodology/approachA self-administrated questionnaire was used to collect data from chief executive officers or top managers of 220 firms in Bosnia and Herzegovina, a transitional economy in South Eastern Europe.FindingsDrawing on a configuration approach via the latent class analysis, the authors empirically derive four distinct strategic marketing patterns, namely, marketing super achievers, marketing-focused virtuosi, marketing drifters and marketing mass pushers. The findings also highlight how business performance outcomes differ as a function of a class membership.Research limitations/implicationsCross-sectional research design and focus on a single country are main limitations of the present study. Thus, longitudinal studies in the context of developed and fast-reforming transition economies are advisable for future work.Practical implicationsThis study enhances the knowledge on how a firm can configure or bundle its market-based resources and marketing capabilities to produce desired outcomes. Findings suggest that joint attention to building market-oriented culture and developing marketing capabilities seems to pay off. However, the authors found that a lack of market knowledge can be substituted by the firms’ ability to build effective promotional and branding capabilities. Thus, the present study adds to the emerging dialog on the relative importance of alternative strategic orientations in achieving superior business performance.Originality/valueThis study contributes to the strategic marketing literature by examining the synergistic effect of market-based resources and marketing capabilities on firm performance using a configurational approach. It also provides support for the equifinality proposition, suggesting that different “bundles” of market-based resources and marketing capabilities can lead to similar level of performance outcomes.
Semantic Web service and pervasive information system conceptual adaptation
Authors: Fatma Achour , Jedidi Anis , Gargouri Faiez 
Published: December 2016

PurposeOne of the open questions is how to ensure the conceptual adaptation in the pervasive system. To answer this question, the authors needed to propose a generic model and a mechanism to describe this system and also need generic and semantic rules to ensure the adaptation. This paper aims to propose a model to describe the pervasive information system. Second, the authors suggest an approach to divide this model so as to describe each category of contextual information separately and ensure the adaptation in the pervasive system. Finally, the authors present examples of semantic rules executed in the pervasive system.Design/methodology/approachThis paper proposes an approach to ensure the conceptual adaptation in the pervasive system. To do it, the authors proposed a model to design the pervasive system and used semantic Web services. They proposed to divide the model to six descriptions related to the pervasive system categories information.FindingsPervasive information system, conceptual adaptation, semantic Web services and OWL-S are presented in this paper.Originality/valueThe originality of this paper is presented in the purpose of the pervasive information system conceptual adaption in the pervasive system. In this, later, semantic Web services were used to ensure the adaptation by the adding of contextual information in the semantic Web service description.