Non-expert Group Research Articles

The value of three narrow-band imaging model in the diagnosis of small colorectal polyps

This prospective study was aimed to evaluate the clinical value of narrow-band imaging (NBI), magnification endoscopy with narrow-band imaging (NBIME) and magnification endoscopy with acetic acid enhancement and narrow-band imaging (AA-NBIME) in the diagnosis of small colorectal polyps. We studied 261 small colorectal polyps from 122 patients with the use of above three techniques. Lesions were resected for histopathological analysis. The endoscopic images were independently reviewed by three experts and three non-experts and the diagnostic accuracy and image definition were compared among the modalities. The “experts-agreed” diagnostic accuracy was 87.7% for NBI versus 91.6% for NBIME versus 94.6% for AA-NBIME. The “non-experts-agreed” diagnostic accuracy was 80.1% for NBI versus 84.3% for NBIME versus 89.3% for AA-NBIME. All experts and non-experts diagnosed the small colorectal polyps statistically more accurately with AA-NBIME than NBI (P < 0.05). In all three modalities, the expert group’s diagnostic accuracies were statistically significantly higher compared with the non-expert group. For experts, the Kappa values for AA-NBIME, NBIME and NBI diagnosis were 0.962 (0.892–1.032), 0.577 (0.507–0.647) and 0.567 (0.497–0.637), respectively; while for nonexperts, 0.818 (0.748–0.888), 0.532 (0.462–0.602) and 0.530 (0.460–0.600). This demonstrated a good reproducibility of AA-NBIME diagnosis. The average scores (experts and non-experts) of images acquired using AA-NBIME were significantly higher than those acquired using NBIME and ME (P < 0.05). AA-NBIME is a promising tool to clearly visualize the mucosal pit pattern (PP) of colorectal polyps for better differentiating neoplastic polyps from non-neoplastic ones.

TacticUP Video Test for Soccer: Development and Validation.

This study aims to expand the process of tactical assessment of soccer players through the development and validation of a video-based test based on core tactical principles of play. The TacticUP video test for soccer is composed of offensive and defensive video sequences of 11vs11 soccer situations. Participants should choose the most appropriate solution for each video sequence. Content validity was established based on a panel of nine experts from four different countries. Construct validity was assessed through the comparison between players with distinct expertise levels. Comparisons between groups’ final scores showed statistical differences (p < 0.05) in 10 out of the 15 variables assessed, in which the expert group displayed higher values compared to the non-expert group. Face validity examined the acceptability and suitability of the test by players. Reliability was determined through the test–retest method for each video sequence, and Cohen’s Kappa values ranged from 0.622 to 1.0. Therefore, the TacticUP video test showed adequate content, construct, and face validity and was a reliable measure of perceptual-cognitive and decision-making skills in soccer. We overcame limitations from previous video-based tests in soccer by introducing situations concerning off-the-ball movements in both offensive and defensive phases. The practical applications of this test are: (i) it can be used to monitor players’ perceptual-cognitive and decision-making skills; (ii) the test is based on players’ response selection in a video-based test, which enables the measurement of their perceptual-cognitive and decision-making skills based on the core tactical principles of play; (iii) generate players’ tactical profile considering their perceptual-cognitive and decision-making skills based on core tactical principles of play; and (iv) measure the effectiveness of intervention/training programs on the development of perceptual-cognitive and decision-making skills.

Operator experience impact on the evaluation of still images of a first trimester cardiac assessment protocol

Objective Congenital heart disease (CHD) is the most common birth defect and represents the leading cause for mortality and morbidity in infants and young adults. Early fetal echocardiography is usually considered a highly specialized scan. The goal of this study is to evaluate the impact of operator’s experience in assessing still images of the 4-chamber view and 3-vessels view and to evaluate the feasibility and the performance of a first trimester screening protocol for CHD. Methods An online questionnaire consisting of still images of the 4-camber view and 3-vessel view from 50 normal and abnormal cases was reviewed by an expert group made of seven obstetricians specialized in fetal medicine and a nonexpert group made of 13 obstetricians that are certified in ultrasound. After individually visualizing each image set made of the 4-chamber view and 3-vessel view, they had to conclude if the case was normal or abnormal and what images were abnormal. Results A total of 50 image sets of both normal and abnormal fetal hearts were examined by the 20 reviewers, resulting in 1000 evaluations. The expert group achieved a detection rate of 97.1% with a false positive rate of 5.7%. The nonexpert group achieved also a good detection rate of 91.3% but with a much higher false positive rate of 33.9%. The most frequently missed CHD involved the great arteries and had a normal 4-chamber view. In the majority of false positive cases the 3-vessel view was incorrectly interpreted as abnormal. Conclusions A screening protocol for CHD, based on the 4-chamber view and 3-vessel view alone can offer a good detection rate for CHD with a small false positive rate, but only if it is implemented by highly specialized sonographers.

Tu1060 COLORECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION BY NON-EXPERTS AS A RISK FACTOR FOR THE ONSET OF POST-ESD ELECTROCOAGULATION SYNDROME

Colorectal endoscopic submucosal dissection (ESD) is technically more difficult than gastric or esophageal ESD from the viewpoint of anatomy, and post-ESD complications, such as postoperative hemorrhage and perforation, have been reported. In particular, a post-ESD complication, post-ESD electrocoagulation syndrome (PECS), may lead to delayed perforation. Previous studies reported that risk factors for PECS included female sex, a long operative time, sample diameter, tumor diameter, and fractional excision. However, considering these risk factors, most patients require strict postoperative management, and it has been necessary to establish simpler risk factors. Our aim was to clarify risk factors for PECS after colorectal ESD and establish satisfactory postoperative management. We conducted a retrospective cohort study involving 164 patients with colorectal tumors (170 lesions) who had undergone colorectal ESD at our hospital between May 2013 and September 2018. Physicians who had experienced ≥1,000 sessions of colonoscopy were assigned to the expert group, and those who had experienced <1,000 sessions of colonoscopy were assigned to the non-expert group. We analyzed 156 patients. There were 107 males (68.5%). The mean age was 67 years (39-92 years). The expert group consisted of 102 patients and the non-expert group consisted of 54 patients. Based on univariate analysis, the operative time (expert and non-expert groups: 60 vs. 161 minutes, respectively), incidence of PECS (3.9 vs. 24.0%, respectively), and C-reactive protein level (0.480 vs. 1.615 mg/dL, respectively) were significantly higher in the non-expert group (p<0.001). According to multivariate analysis, the operative time (odds ratio: 1.01, 95%CI: 1.00-1.01, p=0.013) and incidence of PECS (odds ratio: 4.00, 95%CI: 1.01-15.9, p=0.049) were significantly higher in the non-expert group. Colorectal ESD is technically difficult, requiring high-level skills. This study demonstrated that treatment by non-experts required a long operative time, increasing the incidence of PECS. At most medical institutions, the admission period for colorectal ESD is established in a protocol, and it is important to predict risk factors for PECS before ESD. The operative time, sample diameter, tumor diameter, and fractional excision become known after ESD, but ESD treatment by non-experts is an index that can be predicted. Therefore, for colorectal ESD by non-experts, postoperative management in consideration of the onset of PECS is necessary.

A comparison between expert and beginner learning for motor skill development in a virtual reality serious game

In order to be used for skill development and skill maintenance, virtual environments require accurate simulation of the physical phenomena involved in the process of the task being trained. The accuracy needs to be conveyed in a multimodal fashion with varying parameterisations still being quantified, and these are a function of task, prior knowledge, sensory efficacy and human perception. Virtual reality (VR) has been integrated from a didactic perspective in many serious games and shown to be effective in the pedological process. This paper interrogates whether didactic processes introduced into a VR serious game, by taking advantage of augmented virtuality to modify game attributes, can be effective for both beginners and experts to a task. The task in question is subjective performance in a clay pigeon shooting simulation. The investigation covers whether modified game attributes influence skill and learning in a complex motor task and also investigates whether this process is applicable to experts as well as beginners to the task. VR offers designers and developers of serious games the ability to provide information in the virtual world in a fashion that is impossible in the real world. This introduces the question of whether this is effective and transfers skill adoption into the real world and also if a-priori knowledge influences the practical nature of this information in the pedagogic process. Analysis is conducted via a between-subjects repeated measure ANOVA using a 2 times 2 factorial design to address these questions. The results show that the different training provided affects the performance in this task (N=57). The skill improvement is still evidenced in repeated measures when information and guidance is removed. This effect does not exist under a control condition. Additionally, we separate by an expert and non-expert group to deduce if a-priori knowledge influences the effect of the presented information, it is shown that it does not.

Skill level and forearm muscle fatigue effects on ball speed in tennis serve

ABSTRACT This study determined the effect of skill level (ITN 3 vs. ITN 8) on the tennis serve biomechanics and analysed the impact of forearm fatigue on dominant arm mechanisms between the two groups (expert vs. non-expert tennis players). The motion capture system with 17 reflective markers attached on anatomic landmarks of the participant was used for data collection. A total of 12 expert and 11 non-expert tennis players performed the required serving tasks. The ball speed of the expert group was significantly faster than that of the non-expert group during non-fatigued and fatigued states (p < 0.001). The wrist radial/ulnar deviation angle at impact was significantly different between non-fatigued and fatigued states for top-spin (p = 0.030) and flat serves (p = 0.018). A significant increase in extensor carpi ulnaris (ECU) and extensor carpi radialis (ECR) muscle activity during extension (p < 0.010) was observed, with that of the ECU being an ulnar deviation. Both the ECU and ECR might contribute to wrist joint and racket handle stability for the coming acceleration and impact while fatigue occurs. Fatigue might substantially influence non-experts’ dominant forearms because of the significantly different elbow joint angles and dominant arm syndromes they displayed as compared with the experts.

Validation of a Virtual Reality–Based Hip Arthroscopy Simulator

To assess construct and face validity of a novel virtual reality-based hip arthroscopy simulator using the previously validated Arthroscopic Surgery Skills Evaluation Tool (ASSET), metric parameters, and a questionnaire. Metric parameters including task completion time, camera path, and grasper path were recorded, and the ASSET score was used to assess construct validity. Face validity was evaluated using a questionnaire. Nine hip arthroscopy experts, of whom the majority performed more than 200 procedures (age, 48 ± 7.3; range, 38-61years; 8 men, 1 woman), and 33 nonexperts (age, 33 ± 7.9; range, 26-62years; 25 men, 8 women) performed 3 individual tasks on a virtual reality-based arthroscopy simulator of a left hip. The ASSET global rating scale showed a statistically significant difference between the hip arthroscopy expert and the nonexpert group, indicating strong construct validity (25.0 in the expert group, range, 17-34, versus 15.30 in the nonexpert group, range, 8-30 [P < .001], respectively). This also applied to most metric parameters recorded by the simulator. The simulator also demonstrated high face validity. The overall impression in terms of realism was graded "completely realistic" by 17% and "close to realistic" by 62% of participants. The tested simulator demonstrated high construct and face validity. This study demonstrates the construct and face validity of a novel hip arthroscopy simulator. The device proved to be an adequate model for the simulation of some arthroscopic procedures of the hip.

Usability of non-standard lower anchor configurations for child restraint system (CRS) installation

Objectives: The objective of this study was to determine whether the amount of tension required for proper child restraint system (CRS) installation varies with lower anchor spacing and to determine whether nonexperts can produce adequate tension on wider-than-standard lower anchor configurations.Methods: CRSs were installed by certified child passenger safety technicians (CPSTs; n = 6 subjects, n = 72 installations) and nonexperts (n = 30 subjects, n = 120 installations) on a mock-up vehicle seat fixture with lower anchors set at 11 (standard), 15, 19, and 23 in. apart from one another. Each CPST installed a rear-facing (RF) infant base, RF convertible, and forward-facing (FF) convertible into each of the 4 spacing configurations in random order. The CPSTs were instructed to tighten the lower connector strap until the tension was exactly at the threshold between passing and failing the 1-in. test. Each nonexpert installed one CRS model into all 4 spacing conditions in random order. Nonexperts were instructed to install the CRS to the best of their ability. The tension produced on the lower connector strap was recorded via load cell in the lower anchor assembly of the vehicle seat. Resultant tension magnitudes were compared across spacing conditions using matched pair t-tests. The CPSTs’ mean 1-in. test threshold values were compared to tensions produced by nonexperts. Installations were visually evaluated for errors and qualitative usability feedback was collected via survey.Results: CPSTs installed the infant base with higher tensions in the 15-, 19-, and 23-in. configurations compared to the standard 11-in. configuration (P = .034, .032, and .003, respectively). The nonexperts installed the infant base with higher tension in the 15- and 23-in. configurations compared to the 11-in. configuration (P = .004 and .026, respectively). The RF convertible and FF convertible installations showed no significant differences in tension among any of the spacing configurations for either group. Only 19% of the nonexperts’ installations were tight enough to pass CPST thresholds, and the pass rate did not vary with respect to lower anchor spacing. In feedback surveys, the nonexpert group did not show a consistent preference for either standard or wider-than-standard lower anchor configurations.Conclusions: The amount of tension required to pass the 1-in. rule did not vary with lower anchor spacing configurations for the RF and FF convertible CRS, but the infant base required more tension in wider anchor configurations. Nonexperts tended to produce less than ideal tension in all configurations, although their tension magnitudes increased for the infant base in wider configurations.

Task Switching in Rock Climbing: Validation of a Computational Model for Different Skill Levels

Thirty-two rock climbers, all self-identifying as capable of lead climbing (place protective gear in the rock, to mitigate the risks of falling), climbed an outdoor route while placing what they believed was the necessary amount of protection. Cameras recorded the percentage of time they spent climbing upward (productivity) relative to placing protection (safety). We then applied STOM (strategic task overload model) to predict percent time-on-task, using the differences in their ratings of task interest, task priority, and task difficulty as predictors. The model significantly predicted time on task for the participants categorized as experts, but not for those categorized as non-experts. Time on the climbing (versus protection) task for the expert group, but not the non-expert group, was also predicted by a derived measure inferred to assess risk tolerance in climbing.

Interobserver variability in the classification of congenital coronary abnormalities: A substudy of the ANOCOR registry

Objectives We studied the observer variability in the description and classification of anomalous connections of the coronary arteries (ANOCOR) between a non-expert group of physicians (ANOCOR investigators) and a group of expert physicians, using the ANOCOR cohort. Background The diagnosis of ANOCOR requires an appropriate identification for the management of the patients involved. A misdiagnosis may have serious repercussions for the management to come. For example a subpulmonic course is sometimes interpreted as an interarterial course ( Fig. 1 ). Methods Consecutive patients identified by 71 referring cardiologists (ANOCOR investigators) were included in the ANOCOR cohort. ANOCOR was diagnosed by invasive and/or computed tomography (CT) coronary angiography. Angiographic images were reviewed by an angiographic committee with experience in the ANOCOR field. Both ANOCOR investigators and angiographic committee filled out a questionnaire to classify each ANOCOR with the type of coronary artery involved, the site of anomalous connection, and the initial course. Observer variability between ANOCOR investigators and angiographic committee was assessed by κ statistics. ANOCOR with an interarterial course were defined as at-risk. Results In total, 496 ANOCOR were identified among 472 patients of the ANOCOR cohort and an interarterial course was present in 31% of the abnormalities. The agreement for the type of artery was excellent (κ = 0.92, 95% CI: 0.86–0.98, P Table 1 ). Conclusions Observer variability in the assessment of ANOCOR between non-experienced and experienced physicians can be significant. We found that expert physicians provide a more robust classification of ANOCOR in comparison with non-expert physicians. Therefore, referral to physicians with a relevant experience should be considered, especially if an ANOCOR at-risk is suspected.

Interobserver variability in the classification of congenital coronary abnormalities: A substudy of the anomalous connections of the coronary arteries registry.

The diagnosis of anomalous connections of the coronary arteries (ANOCOR) requires an appropriate identification for the management of the patients involved. We studied the observer variability in the description and classification of ANOCOR between a nonexpert group of physicians and a group of expert physicians, using the ANOCOR cohort. Consecutive patients identified by 71 referring cardiologists were included in the ANOCOR cohort. Anomalous connection was diagnosed by invasive and/or computed tomography coronary angiography. Angiographic images were reviewed by an angiographic committee with experience in this field. Both investigators and angiographic committee filled out a questionnaire to classify each anomaly with the type of coronary artery involved, the site of anomalous connection, and the initial course. Observer variability between investigators and angiographic committee was assessed by κ statistics. Anomalous connection with a preaortic course was defined as at-risk. Among 472 patients of the ANOCOR cohort, 496 abnormalities were identified with a preaortic course present in 31%. The agreement for the type of artery was excellent (κ = 0.92, 95% CI = 0.86-0.98, P < .05), while the agreement for the site of anomalous connection was moderate (κ = 0.50, 95% CI = 0.42-0.58, P < .05), and the agreement for the initial course was only fair (κ = 0.32, 95% CI = 0.28-0.37, P < .05). Observer agreement for the identification of at-risk forms was moderate (κ = 0.497, 95% CI = 0.40-0.59, P < .05). Observer variability in the assessment of anomalous connection of the coronary arteries between nonexperienced and experienced physicians can be significant. We found that expert physicians provide a more robust classification in comparison with nonexpert physicians. Therefore, referral to physicians with a relevant experience should be considered, especially if an anomaly at-risk is suspected.

Sleep spindle detection based on non-experts: A validation study.

Accurate and efficient detection of sleep spindles is a methodological challenge. The present study describes a method of using non-experts for manual detection of sleep spindles. We recruited five experts and 168 non-experts to manually identify spindles in stage N2 and stage N3 sleep data using a MATLAB interface. Scorers classified each spindle into definite and indefinite spindle (with weights of 1 and 0.5, respectively). First, a method of optimizing the thresholds of the expert/non-expert group consensus according to the results of experts and non-experts themselves is described. Using this method, we established expert and non-expert group standards from expert and non-expert scorers, respectively, and evaluated the performance of the non-expert group standards by compared with the expert group standard (termed EGS). The results indicated that the highest performance was the non-expert group standard when definite spindles were only considered (termed nEGS-1; F1 score = 0.78 for N2; 0.68 for N3). Second, four automatic spindle detection methods were compared with the EGS. We found that the performance of nEGS-1 versus EGS was higher than that of the four automated methods. Our results also showed positive correlation between the mean F1 score of individual expert in EGS and the F1 score of nEGS-1 versus EGS across 30 segments of stage N2 data (r = 0.61, P < 0.001). Further, we found that six and nine non-experts were needed to manually identify spindles in stages N2 and N3, respectively, while maintaining acceptable performance of nEGS-1 versus EGS (F1 score = 0.79 for N2; 0.64 for N3). In conclusion, this study establishes a detailed process for detection of sleep spindles by non-experts in a crowdsourcing scheme.

Kinematic Characteristics Based on Proficiency In Geoduepyeopchagi in Taekwondo Poomsae Koryo

Objective: The purpose of this study was to help improve game performance and provide preliminary data to enhance the efficiency of the kick and stability of the support foot by comparing the kinematic characteristics of the repeated side kick (geodeupyeopchagi) in poomsaeKoryo between expert and non-expert groups. Method: The subjects were divided into 2 groups according to proficiency in Taekwondo, an expert group and a non-expert group (n = 7 in each group), to observe the repeated side-kick technique. Four video cameras were set at a speed of 60 frames/sec and exposure time of 1/500 sec to measure the kinematic factors of the 2 groups. The Kwon3D XPprogramas used to collect and analyze three-dimensional spatial coordinates. Ground reaction force data were obtained through a force plate with a 1.200-Hz frequency. An independent samplesttest was performed, and statistical significance was defined as .05. The SPSS 18.0 software was used to calculate the mean and standard deviation of the kinematic factors and to identify the difference between the experts and non-experts. Results: The angular displacement of the hip joint in both the expert and non-expert groups showed statistical significance on E1 and E4 of the left support foot and E5 of the right foot (p<.05). The angle displacement of the knee joint in both groups showed statistical significance on E4 of the left support foot, and E1 and E2 of the right foot (p<.05). The angular velocity of the lower leg in both groups showed no statistical significance on the left support foot but showed statistical significance on E2 and E6 of the right foot (p<.05). The angular velocity of the foot in both groups showed no statistical significance on the left support foot but showed statistical significance on E2 of the right foot (p<.05). The vertical ground reaction force in both groups showed statistical significance on E2 (p<.05). The center of pressure in all directions in both groups showed statistical significance (p<.5). Conclusion: While performing the repeated side kick (geodeupyeopchagi), the experts maintainedconsistency and stability of the angle of the support leg while the kick foot moved high and fast. On the other hand, the angle of the support foot of non-experts appeared inconsistent, and the kick foot was raised, relying on the support leg, resulting in unstable and inaccurate movement.

Esthetic Outcome of Implants Placed in Fresh Extraction Sockets by Clinicians with or without Experience: A Medium-Term Retrospective Evaluation.

This study discussed a 3-year retrospective survey of clinical and esthetic outcomes of immediate implants placed by experienced senior surgeons and residents in implant dentistry. The retrospective chart review included patients who received single-tooth extraction and immediate implant placement at the Tuscan Stomatology Institute between 2009 and 2011. Treated independent postextraction areas were divided into two groups according to the operator's experience: expert versus nonexpert group. Patient satisfaction with the esthetic aspect, chewing, speaking, comfort, self-esteem, and ease of cleaning were assessed by visual analog scales. Changes in the marginal bone level and parameters describing the changes of the facial soft tissue and in papilla index were assessed. Proper pairwise comparison tests were applied with a significant level α = .05. Of the 60 selected patients, 31 were in the expert group and 29 in the nonexpert group. At the 3-year follow-up, findings attested to a significantly higher bone loss in the nonexpert group (1.74 ± 0.59 mm) than those registered in the expert group (1.34 ± 0.45 mm), with a P value of .0044. The papilla index (PI) appeared very stable in the group of experts, whereas it showed a significant loss throughout the study in patients in the nonexpert group (PI = 2 at 1 year and PI = 1.5 at 3 years). Moreover, significant recessions at the buccal soft tissue were registered for all groups at both check-ups; however, in the expert group, slight soft tissue recession was evident 3 years later (0.58 ± 0.72 mm), whereas the nonexpert group showed greater recession (1.52 ± 0.74 mm). Patients reported higher overall satisfaction when treated by the group of experts (85.2%) than when treated by the nonexperts (81.1%) with P < .0001. The findings from this study suggested that immediate implant procedures could be considered a successful and satisfying treatment strategy when strict selection criteria together with a high level of surgical expertise are applied.

Using Nonexperts for Annotating Pharmacokinetic Drug-Drug Interaction Mentions in Product Labeling: A Feasibility Study.

BackgroundBecause vital details of potential pharmacokinetic drug-drug interactions are often described in free-text structured product labels, manual curation is a necessary but expensive step in the development of electronic drug-drug interaction information resources. The use of nonexperts to annotate potential drug-drug interaction (PDDI) mentions in drug product label annotation may be a means of lessening the burden of manual curation.ObjectiveOur goal was to explore the practicality of using nonexpert participants to annotate drug-drug interaction descriptions from structured product labels. By presenting annotation tasks to both pharmacy experts and relatively naïve participants, we hoped to demonstrate the feasibility of using nonexpert annotators for drug-drug information annotation. We were also interested in exploring whether and to what extent natural language processing (NLP) preannotation helped improve task completion time, accuracy, and subjective satisfaction.MethodsTwo experts and 4 nonexperts were asked to annotate 208 structured product label sections under 4 conditions completed sequentially: (1) no NLP assistance, (2) preannotation of drug mentions, (3) preannotation of drug mentions and PDDIs, and (4) a repeat of the no-annotation condition. Results were evaluated within the 2 groups and relative to an existing gold standard. Participants were asked to provide reports on the time required to complete tasks and their perceptions of task difficulty.ResultsOne of the experts and 3 of the nonexperts completed all tasks. Annotation results from the nonexpert group were relatively strong in every scenario and better than the performance of the NLP pipeline. The expert and 2 of the nonexperts were able to complete most tasks in less than 3 hours. Usability perceptions were generally positive (3.67 for expert, mean of 3.33 for nonexperts).ConclusionsThe results suggest that nonexpert annotation might be a feasible option for comprehensive labeling of annotated PDDIs across a broader range of drug product labels. Preannotation of drug mentions may ease the annotation task. However, preannotation of PDDIs, as operationalized in this study, presented the participants with difficulties. Future work should test if these issues can be addressed by the use of better performing NLP and a different approach to presenting the PDDI preannotations to users during the annotation workflow.

The role of surgical expertise with regard to chronic postoperative inguinal pain (CPIP) after Lichtenstein correction of inguinal hernia: a systematic review.

ObjectiveThe aim of this study was to evaluate whether a relation exists between surgical expertise and incidence of chronic postoperative inguinal pain (CPIP) after inguinal hernia repair using the Lichtenstein procedure .BackgroundCPIP after inguinal hernia repair remains a major clinical problem despite many efforts to address this problem. Recently, case volume and specialisation have been found correlated to significant improvement of outcomes in other fields of surgery; to date these important factors have not been reviewed extensively enough in the context of inguinal hernia surgery.MethodsA systematic literature review was performed to identify randomised controlled trials reporting on the incidence of CPIP after the Lichtenstein procedure and including the expertise of the surgeon. Surgical expertise was subdivided into expert and non-expert.ResultsIn a total of 16 studies 3086 Lichtenstein procedures were included. In the expert group the incidence of CPIP varied between 6.9 and 11.7 % versus an incidence of 18.1 and 39.4 % in the non-expert group. Due to the heterogeneity between groups no statistical significance could be demonstrated.ConclusionThe results of this evaluation suggest that an association between surgical expertise and CPIP is highly likely warranting further analysis in a prospectively designed study.

Good Thinking or Gut Feeling? Cognitive Reflection and Intuition in Traders, Bankers and Financial Non-Experts

The current study investigated differences in decision-making style and risk-taking between financial traders, non-trading bank employees, and people not working in finance. Traders scored significantly higher than participants in the other two groups on the cognitive reflection test (CRT) which measures the tendency to inhibit automatic but frequently false responses in reasoning tasks. Scores for traders compared to people outside the banking sector were also higher on a self-rated scale for reflective thinking in decision-making, but there were no differences in self-rated intuitive thinking between groups. Financial risk-taking correlated with cognitive reflection scores and was significantly lower in the non-expert group compared to the other groups working in financial services. Traders in the current study showed no elevated preference to use ‘intuition’ in their decision-making compared to other groups. Overall, these results indicate that compared to non-expert participants financial traders have a higher self-rated tendency for reflective thinking and a greater propensity to inhibit the use of mental shortcuts (heuristics) in decision-making.

A Proposed Framework for Group-Based Multi-Criteria Recommendations

The Multi Criteria Group Recommender System is gaining attention. In the proposed framework, the authors intend to find solutions to two problems. First, group members assign arbitrary ratings to multiple criteria of items; these do not reflect their honest opinions. The proposed framework selects a promising group for the target user on the basis of demographic attributes. In case more than one group claims to be the promising group, the proposed framework implicitly derives multi-criteria ratings of each group member on multiple item attributes. Second, as the group size increases, difficulty in aggregating the preferences of all the group members increases, resulting in errors in group recommendations. The framework generates group recommendations from the nearest neighbor set of group members (GNNSet), instead of generating group recommendations from all the members of the target group. Cascade TOPSIS is proposed, which selects the GNNSet from the identified group thereby retaining only those group members who are likely to provide good quality group recommendations. TOPSIS on expert group members and nonexpert group members are used to handle group decision making. The preferences of members of the GNNSet are used to generate recommendations for the target user. Using the Movie Lens dataset, significant improvement in recommendation quality is observed.

Sleep-spindle detection: crowdsourcing and evaluating performance of experts, non-experts and automated methods

Sleep spindles are discrete, intermittent patterns of brain activity that arise as a result of interactions of several circuits in the brain. Increasingly, these oscillations are of biological and clinical interest because of their role in development, learning, and neurological disorders. We used an internet interface to ‘crowdsource’ spindle identification from human experts and non-experts, and compared performance with 6 automated detection algorithms in middle-to-older aged subjects from the general population. We also developed a method for forming group consensus, and refined methods of evaluating the performance of event detectors in physiological data such as polysomnography. Compared to the gold standard, the highest performance was by individual experts and the non-expert group consensus, followed by automated spindle detectors. Crowdsourcing the scoring of sleep data is an efficient method to collect large datasets, even for difficult tasks such as spindle identification. Further refinements to automated sleep spindle algorithms are needed for middle-to-older aged subjects.

Facial profile preferences, self-awareness and perception among groups of people in the United Arab Emirates.

Objectives:The objective of this study is to assess the differences in facial profile preference among different layers of people in the United Arab Emirates. Facial profile self-awareness among the different groups was also evaluated.Materials and Methods:A total sample of 222 participants (mean [standard deviation] age = 25.71 [8.3] years, almost 80% of the participants were of Arab origin and 55% were males); consisting of 60 laypersons, 60 dental students, 60 general practitioners, 16 oral surgeons, and 26 orthodontists. Facial profile photographs of a male and female adult with straight profiles and a Class I skeletal relationship were used as a baseline template. Computerized photographic image modification was carried out on the templates to obtain seven different facial profile silhouettes for each gender. To assess differences in facial profile perception, participants were asked to rank the profiles of each gender on a scale from most to least attractive (1 [highest score] and 7 [least score]). Awareness and satisfaction with the facial appearance on a profile view was assessed using questionnaires completed by the non-expert groups.Results:The straight facial profile was perceived to be highly attractive by all five groups. The least attractive profiles were the bimaxillary protrusion and the mandibular retrusion for the male and the female profiles, respectively. Lip protrusion was more esthetically acceptable in females. Significant differences in perception existed among groups. The female profile esthetic perception was highly correlated between the expert groups (P > 0.05). Overall agreement between the non-expert group's perceptions of their own profiles and evaluation by the expert orthodontist was 51% (κ = 0.089). Candidates who perceived themselves as having a Class III facial profile were the least satisfied with their profile.Conclusions:Dental professionals, dental students, and laypersons had a similar perception trends in female and male aesthetic preference. Laypersons were more tolerant to profiles with bi-maxillary retrusion. The expert group's esthetic perception was highly correlated only for the female profiles. Most of the non-experts were unable to correctly identify their facial profile.