The effects of gender congruency, risk propensity and purchasing frequency on perceived risk of online shopping websites

Online shopping is becoming increasingly prevalent and identifying factors that influence a user’s trust could be the difference between a successful purchase or the loss of a customer. As such, identifying potential influencing factors of trust is necessary to avoid loss of valued custom. The present study examined the effects of Website Gender Congruency, Propensity for Risk and Frequency of Online Shopping on the Perceived Risk of online shopping websites. The current study employed an experimental, between-groups design (three-way ANOVA) by means of an online survey. In Phase 1, 22 participants rated websites on their perceived target gender. In Phase 2, a further 60 participants rated the Perceived Risk of each website. Participants utilised an adapted 7 point Likert scale to rate Perceived Risk of the individual websites. Results indicated no significant relationship between Website Gender Congruency and Perceived Risk. However, there was a significant inverse relationship between Propensity for Risk and Perceived Risk. Frequency of Online Purchasing was not found to significantly affect Perceived Risk. These findings suggest that individuals with a high Propensity for Risk perceive less Risk than individuals with a low Propensity for Risk. The strengths and limitations of the present study are discussed, as are suggestions for future research.</p

Cost of pre-surgical evaluation for epilepsy surgery: A single-center experience

OBJECTIVE: To estimate the cost and time taken to evaluate adults with drug-resistant focal epilepsy for potentially curative surgery. METHODS: We reviewed data on 100 consecutive individuals at a tertiary referral center evaluated for epilepsy surgery in 2017. The time elapsed between referral and either surgery or a definitive decision not to progress was measured. National Health Service tariffs applicable to our setting were used to estimate the total cost of evaluation for individuals following different routes through the pre-surgical pathway. After surgery, self-reported seizure freedom rates were obtained from each individual to assess the approximate cost of pre-surgical evaluation per additional person seizure-free. RESULTS: Of 100 individuals evaluated, 27 had surgery, 63 had a definitive decision not to have surgery, and ten were awaiting further investigations. The median duration of the pre-surgical evaluation was 29.7 months (IQR 18.6-44.1 months), with a median cost per person of £9138 (IQR £6984-£14,868). Those who proceeded to Stage Two investigations (including fluorodeoxyglucose positron emission tomography, ictal single-photon emission computerized tomography and intracranial electroencephalography) had a higher cost and extended evaluation length. After a median of 3.1 (IQR 2.3-3.7) years, 15/27 people who had surgery were seizure-free. This equated to an approximate cost of £123,500 spent per additional person seizure-free. CONCLUSION: Pre-surgical evaluation is long and costly, particularly for those who require icEEG. For those with drug-resistant focal epilepsy, surgery is, however, associated with a greater chance of seizure freedom. The suitability and risk-benefit ratio of surgery should be considered at each step of the pre-surgical pathway

Seizure outcomes in people with drug-resistant focal epilepsy evaluated for surgery but do not proceed

ObjectiveTo ascertain seizure outcomes in people with drug-resistant focal epilepsy considered for epilepsy surgery but who did not proceed.MethodsWe identified people discussed at a weekly presurgical epilepsy multi-disciplinary (MDT) meeting from January 2015 to December 2019 and in whom a decision not to proceed to surgery was made. Seizure outcomes were obtained from individuals, primary care physicians and attending neurologists at a minimum of 12 months following the not to proceed decision.ResultsWe considered 315 people who did not proceed to surgery after evaluation. Nine died, and 25 were lost to follow-up. We included 281 people with a median follow-up of 2.4 (IQR 1.5–4) years. In total, 83 (30%) people reported that seizures had improved or resolved since the MDT meeting. Thirteen (5%) were seizure-free over the last 12 months of follow-up, 70 (25%) had experienced more than 50% reduction in seizure frequency, 180 (64%) had no meaningful change, and 18 (6%) reported a doubling of seizure frequency. Of the 53 (16%) who had vagal nerve stimulation, 19/53 (37%) reported more than 50% reduction in frequency, including one seizure-free.SignificanceThe chances of seizure freedom with further medications and neurostimulation are low for people with drug-resistant focal epilepsy who have been evaluated for surgery and do not proceed, but improvement may still occur. Up to a quarter have a > 50% reduction in seizures, and one in twenty become seizure-free eventually. Trying additional anti-seizure medication and neurostimulation is worthwhile in this population

Computer-Assisted Planning for Stereoelectroencephalography (SEEG)

Stereoelectroencephalography (SEEG) is a diagnostic procedure in which multiple electrodes are stereotactically implanted within predefined areas of the brain to identify the seizure onset zone, which needs to be removed to achieve remission of focal epilepsy. Computer-assisted planning (CAP) has been shown to improve trajectory safety metrics and generate clinically feasible trajectories in a fraction of the time needed for manual planning. We report a prospective validation study of the use of EpiNav (UCL, London, UK) as a clinical decision support software for SEEG. Thirteen consecutive patients (125 electrodes) undergoing SEEG were prospectively recruited. EpiNav was used to generate 3D models of critical structures (including vasculature) and other important regions of interest. Manual planning utilizing the same 3D models was performed in advance of CAP. CAP was subsequently employed to automatically generate a plan for each patient. The treating neurosurgeon was able to modify CAP generated plans based on their preference. The plan with the lowest risk score metric was stereotactically implanted. In all cases (13/13), the final CAP generated plan returned a lower mean risk score and was stereotactically implanted. No complication or adverse event occurred. CAP trajectories were generated in 30% of the time with significantly lower risk scores compared to manually generated. EpiNav has successfully been integrated as a clinical decision support software (CDSS) into the clinical pathway for SEEG implantations at our institution. To our knowledge, this is the first prospective study of a complex CDSS in stereotactic neurosurgery and provides the highest level of evidence to date

Comparison of robotic and manual implantation of intracerebral electrodes:a single-centre, single-blinded, randomised controlled trial

Abstract There has been a significant rise in robotic trajectory guidance devices that have been utilised for stereotactic neurosurgical procedures. These devices have significant costs and associated learning curves. Previous studies reporting devices usage have not undertaken prospective parallel-group comparisons before their introduction, so the comparative differences are unknown. We study the difference in stereoelectroencephalography electrode implantation time between a robotic trajectory guidance device (iSYS1) and manual frameless implantation (PAD) in patients with drug-refractory focal epilepsy through a single-blinded randomised control parallel-group investigation of SEEG electrode implantation, concordant with CONSORT statement. Thirty-two patients (18 male) completed the trial. The iSYS1 returned significantly shorter median operative time for intracranial bolt insertion, 6.36 min (95% CI 5.72–7.07) versus 9.06 min (95% CI 8.16–10.06), p = 0.0001. The PAD group had a better median target point accuracy 1.58 mm (95% CI 1.38–1.82) versus 1.16 mm (95% CI 1.01–1.33), p = 0.004. The mean electrode implantation angle error was 2.13° for the iSYS1 group and 1.71° for the PAD groups (p = 0.023). There was no statistically significant difference for any other outcome. Health policy and hospital commissioners should consider these differences in the context of the opportunity cost of introducing robotic devices. Trial registration: ISRCTN17209025 ( https://doi.org/10.1186/ISRCTN17209025 )

Hippocampal resection in Temporal Lobe epilepsy: do we need to resect the tail?

Introduction: Anteromesial temporal lobe resection is the most common surgical technique used to treat drug-resistant mesial temporal lobe epilepsy, particularly when secondary to hippocampal sclerosis. Structural and functional imaging data suggest the importance of sparing the posterior hippocampus for minimising language and memory deficits. Recent work has challenged the view that maximal posterior hippocampal resection improves seizure outcome. This study was designed to assess whether resection of posterior hippocampal atrophy was associated with improved seizure outcome. Methods: Retrospective analysis of a prospective database of all anteromesial temporal lobe resections performed in individuals with hippocampal sclerosis at our epilepsy surgery centre, 2013-2021. Pre- and post-operative MRI were reviewed by 2 neurosurgical fellows to assess whether the atrophic segment, displayed by automated hippocampal morphometry, was resected, and ILAE seizure outcomes were collected at 1 year and last clinical follow-up. Data analysis used univariate and binary logistic regression. Results: Sixty consecutive eligible patients were identified of whom 70% were seizure free (ILAE Class 1 & 2) at one year. There was no statistically significant difference in seizure freedom outcomes in patients who had complete resection of atrophic posterior hippocampus or not (Fisher’s Exact test statistic 0.69, not significant at p<.05) both at one year, and at last clinical follow-up. In the multivariate analysis only a history of status epilepticus (OR=0.2, 95%CI:0.042-0.955, p=.04) at one year, and pre-operative psychiatric disorder (OR=0.145, 95%CI:0.036-0.588, p=.007) at last clinical follow-up, were associated with a reduced chance of seizure freedom. Significance: Our data suggest that seizure freedom is not associated with whether or not posterior hippocampal atrophy is resected. This challenges the traditional surgical dogma of maximal posterior hippocampal resection in anteromesial temporal lobe resections and is a step further optimising this surgical procedure to maximise seizure freedom and minimise associated language and memory deficits

Automatic segmentation of stereoelectroencephalography (SEEG) electrodes post-implantation considering bending

The accurate and automatic localisation of SEEG electrodes is crucial for determining the location of epileptic seizure onset. We propose an algorithm for the automatic segmentation of electrode bolts and contacts that accounts for electrode bending in relation to regional brain anatomy. Co-registered post-implantation CT, pre-implantation MRI, and brain parcellation images are used to create regions of interest to automatically segment bolts and contacts. Contact search strategy is based on the direction of the bolt with distance and angle constraints, in addition to post-processing steps that assign remaining contacts and predict contact position. We measured the accuracy of contact position, bolt angle, and anatomical region at the tip of the electrode in 23 post-SEEG cases comprising two different surgical approaches when placing a guiding stylet close to and far from target point. Local and global bending are computed when modelling electrodes as elastic rods. Our approach executed on average in 36.17 s with a sensitivity of 98.81% and a positive predictive value (PPV) of 95.01%. Compared to manual segmentation, the position of contacts had a mean absolute error of 0.38 mm and the mean bolt angle difference of 0.59◦ resulted in a mean displacement error of 0.68 mm at the tip of the electrode. Anatomical regions at the tip of the electrode were in strong concordance with those selected manually by neurosurgeons, ICC(3, k) = 0.76, with average distance between regions of 0.82 mm when in disagreement. Our approach performed equally in two surgical approaches regardless of the amount of electrode bending. We present a method robust to electrode bending that can accurately segment contact positions and bolt orientation. The techniques presented in this paper will allow further characterisation of bending within different brain regions

Community occupational therapy for people with dementia and family carers (cotid-uk) versus treatment as usual (valuing active life in dementia [valid] programme): study protocol for a randomised controlled trial

Background: A community-based occupational therapy intervention for people with mild to moderate dementia and their family carers (Community Occupational Therapy in Dementia (COTiD)) was found clinically and cost effective in the Netherlands but not in Germany. This highlights the need to adapt and implement complex interventions to specific national contexts. The current trial aims to evaluate the United Kingdom-adapted occupational therapy intervention for people with mild to moderate dementia and their family carers living in the community (COTiD-UK) compared with treatment as usual. Methods/Design: This study is a multi-centre, parallel-group, pragmatic randomised trial with internal pilot. We aim to allocate 480 pairs, with each pair comprising a person with mild to moderate dementia and a family carer, who provides at least 4 hours of practical support per week, at random between COTiD-UK and treatment as usual. We shall assess participants at baseline, 12 and 26 weeks, and by telephone at 52 and 78 weeks (first 40 % of recruits only) after randomisation. The primary outcome measure is the Bristol Activities of Daily Living Scale (BADLS) at 26 weeks. Secondary outcome measures will include quality of life, mood, and resource use. To assess intervention delivery, and client experience, we shall collect qualitative data via audio recordings of COTiD-UK sessions and conduct semi-structured interviews with pairs and occupational therapists. Discussion: COTiD-UK is an evidence-based person-centred intervention that reflects the current priority to enable people with dementia to remain in their own homes by improving their capabilities whilst reducing carer burden. If COTiD-UK is clinically and cost effective, this has major implications for the future delivery of dementia services across the UK