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    Two-Arm Crossover Randomized Controlled Trial Versus Meta-Analysis of N-of-1 Studies: Comparison of Statistical Efficiency in Determining an Intervention Effect

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    : N-of-1 trials are currently receiving broader attention in healthcare research when assessing the effectiveness of interventions. In contrast to the most commonly applied two-arm randomized controlled trial (RCT), in an N-of-1 design, the individual acts as their own control condition in the sense of a multiple crossover trial. N-of-1 trials can lead to a higher quality of patient by examining the effectiveness of an intervention at an individual level. Moreover, when a series of N-of-1 trials are properly aggregated, it becomes possible to detect an intervention effect at a population level. This work investigates whether a meta-analysis of summary data of a series of N-of-1 trials allows us to detect a statistically significant intervention effect with fewer participants than in a traditional, prospectively powered two-arm RCT and crossover design when evaluating a digital health intervention in cardiovascular care. After introducing these different analysis approaches, we compared the empirical properties in a simulation study both under the null hypothesis and with respect to power with different between-subject heterogeneity settings and in the presence of a carry-over effect. We further investigate the performance of a sequential aggregation procedure. In terms of simulated power, the threshold of 80% was achieved earlier for the aggregating procedure, requiring fewer participants

    Myocardial Crypt in an Asymptomatic Young Athlete: How to Interpret?

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    Myocardial crypts are extensions of blood signal penetrating the compact myocardium and are considered in literature as either a distinctive cardiac magnetic resonance (CMR) imaging marker for hypertrophic cardiomyopathy or as benign congenital malformations. What if CMR reveals a myocardial crypt in the presence of an altered ECG in an asymptomatic, enlarged young athlete's heart? The illustrated case demonstrates that new insights in CMR can also require further diagnostic interventions, which might have deleterious consequences for the individual athlete due to the uncertain interpretation of some findings in the demanding new world of a rapidly developing diagnostic imaging technique

    Going Beyond Counting First Authors in Author Co-citation Analysis

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    The present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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