scholarly journals P089: The effect of patient positioning on ultrasound landmarking for cricothyrotomy

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S88-S88
Author(s):  
J. Lee ◽  
H. Chen ◽  
M. Zhang ◽  
D. Kim
Keyword(s):  
Patient Positioning ◽  
Mixed Effects ◽  
Cricothyroid Membrane ◽  
Convenience Sample ◽  
Linear Mixed Effects ◽  
Bed Elevation ◽  
Mallampati Score ◽  
Significant Difference ◽  
Head Of Bed Elevation ◽  
Airway Access

Introduction: The cricothyroid membrane is used as a landmark for emergent surgical airway access. Ultrasound identification of the cricothyroid membrane is more accurate than landmarking by palpation. The objective of this study was to determine whether head of bed elevation affects the position of the cricothyroid membrane as identified by ultrasound. Methods: This was a prospective, observational study on a convenience sample of adult patients presenting to the emergency department. Participants underwent ultrasound scans by trained physicians at 0, 30 and 90 degrees head of bed elevation to identify the cricothyroid membrane. The cricothyroid membrane position identified at 0 degrees was used as a reference, and the change in position of the external landmark of the cricothyroid membrane with the patient at 30 and 90 degrees was measured. Additionally, the patients gender, age, body mass index (BMI) and Mallampati score were recorded for comparison. Linear mixed effects models with 95% confidence intervals were used to determine the effect of head of bed elevation, age, BMI and Mallampati score on the differences between measured distances. Results: One hundred and two patients were enrolled in the study. The average change in position from reference was statistically significant for both 30 degrees [2.72±0.77mm (p<0.01)] and 90 degrees [4.23±0.77mm (p<0.01)] head of bed elevation. The adjusted linear mixed effects model showed age greater than 70, BMI over 30 and higher Mallampati score were associated with greater change in distance between cricothyroid membrane landmarks. Conclusion: There was a statistically significant difference in the position of the cricothyroid membrane comparing 0 degrees to 30 and 90 degrees head of bed elevation. However, the relatively small differences suggest that this finding is not clinically relevant. Further study is required to evaluate if these differences impact the actual successful performance of cricothyrotomy.

scholarly journals The effects of different degrees of head-of-bed elevation on the respiratory pattern and drainage following thyroidectomy: a randomized controlled trial

2020 ◽  
Vol 20 (1) ◽  
pp. 488-497
Author(s):  
Serpil Yüksel ◽  
Seher Deniz Öztekin ◽  
Zeynep Temiz ◽  
Gülay Altun Uğraş ◽  
Emel Şengül ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
University Hospital ◽  
Patient Comfort ◽  
Respiratory Pattern ◽  
Hematoma Formation ◽  
Randomized Controlled ◽  
Bed Elevation ◽  
Significant Difference ◽  
Head Of Bed Elevation

Background: The patient’s position is important for ensuring patient comfort and preventing complications after thyroidectomy. Objectives: This study was carried out to determine the effects of different degrees of head-of-bed elevation (HOBE) on the respiratory pattern and drainage following thyroidectomy and to provide suggestions for evidence-based clinical practice. Methods: The sample of this prospective, parallel arm, randomized controlled trial included 114 patients undergoing thyroidec- tomy in a university hospital in Turkey. The patients were randomly assigned (1:1:1) to supine 0° (baseline), 30° and 45° HOBE groups. Respiratory pattern including respiratory rate (RR), peripheral oxygen saturation (SpO2) and dyspnea, and drainage including amount of drainage and hematoma formation were evaluated at the 1st, 2nd, 3rd and 4th hours following thy- roidectomy. Results: The majority of the patients (83.3%) were female and 84.2% had undergone total thyroidectomy. The mean RR (18.47, 95% CI=17.85-19.09) of the patients in the supine 30° HOBE group at the 1st hour was significantly higher than that of the patients in the supine 0° group (17.32, 95% CI=16.88-17.76; p<0.05). There was no significant difference between the SpO2 values of the patients in the groups (p>0.05). The amount of drainage was significantly higher in the supine 0° group at the 2nd hour than that of the patients in the supine 45° HOBE group (5.92±5.18; 3.34±5.56 respectively; p<0.05). None of the patients in the groups had hematoma formation. While no patient in the supine 30° HOBE group had dyspnea, dyspnea occurred in 9 patients in the supine 0° group and in 3 patients in the supine 45° HOBE group. Conclusion: This study showed that different HOBE positions resulted in clinically insignificant changes on the RR and amount of drainage during the first 4 hours following thyroidectomy but did not affect SpO2 value. Keywords: Head-of-bed elevation; thyroidectomy; controlled trial.

scholarly journals Phonetic realisations of Madurese vowels and their implications for the Madurese vowel system

2020 ◽  
Vol 10 (1) ◽  
pp. 173-183
Author(s):  
M. Misnadin
Keyword(s):  
Mixed Effects ◽  
Mixed Effects Model ◽  
Dispersion Theory ◽  
Linear Mixed Effects Model ◽  
Linear Mixed Effects ◽  
Formant Frequencies ◽  
Significant Difference ◽  
Second Formant

It has been suggested that Madurese has eight surface vowels [a, ɛ, ə, ɔ, ɤ, i, ɨ, u], but there have been disagreements with regard to the number of its vowel phonemes. The disagreements arise partly because some scholars base their analyses of Madurese vowels on phonetic grounds while others base them on certain phonological analyses. Besides, some researchers do not consider native versus non-native Madurese words in their analyses. The paper addresses these problems by incorporating both phonetic and phonological analyses in order to provide a better description of Madurese vowels. To achieve this, we investigated the acoustic realisations of the eight surface vowels by looking at the first and second formant frequencies (F1 and F2) of the high and non-high vowel pairs (i ~ ɛ, ɨ ~ ə, ɤ ~ a, u ~ ɔ). Fifteen speakers of Madurese were recorded reading Madurese words put in a carrier phrase. All segmentations were done employing Praat, and F1 and F2 values were extracted using a Praat script. The data were assessed with a linear mixed-effects model accounting for variation due to both random and fixed factors. The results showed that all high and non-high vowel pairs significantly differed in their F1 values. However, the results for F2 values showed variations; only the pair [ɨ ~ ə] showed a significant difference at vowel onset and at vowel midpoint the pairs [i ~ ɛ] and [ɨ ~ ə] were significantly different. Furthermore, we also looked at the vowels [ɤ] and [ɨ] as well as [ɤ] and [ə] to see if they differed in their F1 and F2 values. Our results confirmed that at both vowel onset and midpoint, they were significantly different. The results were discussed employing phonological analysis and vowel dispersion theory. The result of the analyses suggests that Madurese should be best described as a language with a four-vowel system and further offers a solution to the disagreements on the number of vowel phonemes in Madurese

The Use of Theory of Linear Mixed-Effects Models to Detect Fraudulent Erasures at an Aggregate Level

2021 ◽  
pp. 001316442199489
Author(s):  
Luyao Peng ◽  
Sandip Sinharay
Keyword(s):  
Type I Error ◽  
Real Data ◽  
Mixed Effects ◽  
Error Rates ◽  
Mixed Effects Models ◽  
Type I ◽  
Aggregate Level ◽  
Linear Mixed Effects Models ◽  
Linear Mixed Effects ◽  
Best Linear Unbiased

Wollack et al. (2015) suggested the erasure detection index (EDI) for detecting fraudulent erasures for individual examinees. Wollack and Eckerly (2017) and Sinharay (2018) extended the index of Wollack et al. (2015) to suggest three EDIs for detecting fraudulent erasures at the aggregate or group level. This article follows up on the research of Wollack and Eckerly (2017) and Sinharay (2018) and suggests a new aggregate-level EDI by incorporating the empirical best linear unbiased predictor from the literature of linear mixed-effects models (e.g., McCulloch et al., 2008). A simulation study shows that the new EDI has larger power than the indices of Wollack and Eckerly (2017) and Sinharay (2018). In addition, the new index has satisfactory Type I error rates. A real data example is also included.

scholarly journals Socioeconomic inequalities in children’s weight, height and BMI trajectories in Norway

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Teferi Mekonnen ◽  
Eleni Papadopoulou ◽  
Onyebuchi A. Arah ◽  
Anne Lise Brantsæter ◽  
Nanna Lien ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Social Inequalities ◽  
Mixed Effects ◽  
Linear Mixed Effects ◽  
Parental Income ◽  
Educational Differences ◽  
Bmi Trajectories ◽  
Study Population ◽  
Weight Velocity

AbstractStudies exploring when social inequalities in body mass index (BMI) and its composites emerge and how these evolve with age are limited. Thus, this study explored parental income and education related inequalities in children’s weight, height, weight velocity and body mass index among Norwegian children from 1 month to 8 years. The study population included 59,927 family/children pairs participating in the Norwegian Mother, Father, and Child Cohort Study. Growth was modelled using the Jenss–Bayley model and linear mixed effects analyses were conducted. Maternal and paternal educational differences in children’s weight and BMI trajectories emerged during infancy, continuing to age 8 years. Parental income-related inequalities in children’s weight were observed from the age of 1 month to 4 years for maternal and up to 1 year for paternal income-related differences but then disappeared. Parental income-related inequalities in child’s BMI were observed from 18 months to 8 years for maternal income, and from 9 months to 8 years for paternal income-related differences. These results suggest that social inequalities in children’s BMI present early in infancy and continue to 8 years of age. The inequalities sometimes differed by indicator of socioeconomic position used. Interventions to combat these inequalities early in life are, thus needed.

scholarly journals Cerebral and Somatic Oxygen Saturation in Neonates with Congenital Heart Disease before Surgery

2021 ◽  
Vol 10 (11) ◽  
pp. 2455
Author(s):  
Mi Jin Kim ◽  
Jae Suk Baek ◽  
Jung A Kim ◽  
Seul Gi Cha ◽  
Jeong Jin Yu
Keyword(s):  
Time Trends ◽  
Biochemical Parameters ◽  
Near Infrared ◽  
Mixed Effects ◽  
Contributing Factors ◽  
Linear Mixed Effects Model ◽  
Linear Mixed Effects ◽  
Hypoxic Brain Injury ◽  
Hypoxic Brain ◽  
Cardiac Diagnosis

BACKGROUND: We investigated preoperative cerebral (ScO2) and abdominal (StO2) regional oxygen saturations according to cardiac diagnosis in neonates with critical CHD, their time trends, and the clinical and biochemical parameters associated with them. METHODS: Thirty-seven neonates with a prenatal diagnosis of CHD were included. ScO2 and StO2 values were continuously evaluated using near-infrared spectroscopy. Measurements were obtained hourly before surgery. A linear mixed effects model was used to assess the effects of time and cardiac diagnosis on regional oxygenation and to explore the contributing factors. RESULTS: Regional oxygenation differed according to cardiac diagnosis (p < 0.001). ScO2 was lowest in the patients with severe atrioventricular valvar regurgitation (AVVR) (48.1 ± 8.0%). StO2 tended to be lower than ScO2, and both worsened gradually during the period between birth and surgery. There was also a significant interaction between cardiac diagnosis and time. The factors related to ScO2 were hemoglobin and arterial saturation, whereas no factor was associated with StO2. CONCLUSIONS: Preoperative ScO2 and StO2 in critical CHD differed according to cardiac diagnosis. ScO2 in the patients with severe AVVR was very low, which may imply cerebral hypoxia. ScO2 gradually decreased, suggesting that the longer the time to surgery, the higher the risk of hypoxic brain injury.

Cognate similarity and intervocalic /d/ production in Riverense Spanish

2021 ◽  
pp. 136700692199680
Author(s):  
Michael Gradoville ◽  
Mark Waltermire ◽  
Avizia Long
Keyword(s):  
Language Contact ◽  
Mixed Effects ◽  
Frequency Effect ◽  
Acoustic Measurements ◽  
Linear Mixed Effects Model ◽  
Phonetic Variation ◽  
Linear Mixed Effects ◽  
Contact Language ◽  
The Relationship ◽  
Phonetic Realization

Aims and objectives: While previous research has shown that phonetic variation in language contact situations is affected by whether a word has a cognate in the contact language, this paper aims to show that such an effect is not monotonic. According to the usage-based model, items in memory are organized according to similarity, thus we anticipated that formally more similar cognates would show a stronger cognate effect. Methodology: This variationist sociophonetic study investigates the relationship between cognate similarity and phonetic realization. We examined this relationship in the bilingual community of Rivera, Uruguay, in which both Portuguese and Spanish are spoken with regularity. Specifically, we focused on intervocalic /d/, which in monolingual Spanish is realized as an approximant [ð̞] or phonetic zero, but in monolingual Brazilian Portuguese is produced as a stop [d] or, in most varieties, an affricate [ʤ] before [i]. Data and analysis: We analyzed a corpus of sociolinguistic interviews of the Spanish spoken in Rivera. Acoustic measurements were taken from approximately 60 tokens each from 40 different speakers. Using a linear mixed-effects model, we examined the relationship between several predictors and the degree of constriction of intervocalic /d/. Findings/conclusions: While there is an overall frequency effect whereby more frequent words exhibit less constriction of intervocalic /d/, as both frequency and cognate similarity increase, less constriction of intervocalic /d/ obtains. Therefore, frequent cognates in Portuguese that have very similar forms affect the production of intervocalic /d/ more so than other cognates. Originality: No previous study has demonstrated that the cognate effect on phonetic variation in a situation of language contact is regulated by form similarity between cognate pairs. Significance/implications: The data support the usage-based model in that similar cognates have more lexical connections and can therefore show greater influence on phonetic realization than can cognates that share less phonetic material.

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