Early lactate changes improve the outcome prediction for extracorporeal membrane oxygenation

Abstract OBJECTIVES Serial lactate (clearance) data are commonly used for risk stratification in patients receiving veno-arterial extracorporeal life support (ECLS). METHODS We retrospectively analysed 855 patients who had undergone ECLS due to cardiac (n = 578) and non-cardiac (n = 277) aetiologies between 2002 and 2013 at National Taiwan University Hospital. Serial lactate (clearance) data were collected before ECLS and at 8, 16, 24, 48 and 72 h after ECLS. To investigate the impact of lactate (clearance) levels on 180-day survival, we performed linear mixed model and joint model analyses using the Bayesian approach. RESULTS Among the 855 patients, 564 (65.9%) patients died within 180 days after ECLS cannulation. The joint model showed that the effect of lactate on survival was null in both the reduced model and the fully adjusted model. However, an effect of lactate clearance on survival was observed in the reduced model [estimate 0.004; 95% confidence interval (CI) 0.002–0.006] and the fully adjusted model (estimate 0.003; 95% CI 0.001–0.005). In a further secondary analysis, lactate clearance (hazard ratio 0.861; 95% CI 0.813–0.931) at 16 h after ECLS cannulation was determined to be a risk factor for mortality. According to a receiver operating characteristic curve analysis, the SAVE score combined with lactate clearance (area under curve = 0.881) showed good outcome discrimination. CONCLUSIONS Incorporating lactate clearance at 16 h after ECLS cannulation into the SAVE system improved the predictive value for mortality in patients receiving ECLS.

Download Full-text

Does Sample Attrition Affect the Assessment of Frailty Trajectories Among Older Adults? A Joint Model Approach

Gerontology ◽

10.1159/000489335 ◽

2018 ◽

Vol 64 (5) ◽

pp. 430-439 ◽

Cited By ~ 5

Author(s):

Erwin Stolz ◽

Hannes Mayerl ◽

Éva Rásky ◽

Wolfgang Freidl

Keyword(s):

Older Adults ◽

Mixed Models ◽

Mixed Model ◽

Linear Mixed Model ◽

Linear Mixed Models ◽

Joint Model ◽

Joint Models ◽

Sample Attrition ◽

Standard Linear ◽

The Impact

Background: Frailty constitutes an important risk factor for adverse outcomes among older adults. In longitudinal studies on frailty, selective sample attrition may threaten the validity of results. Objective: To assess the impact of sample attrition on frailty index trajectories and gaps related to socio-economic status (education) therein among older adults in Europe. Methods: A total of 64,143 observations from 21,044 respondents (50+) from the Survey of Health, Ageing and Retirement in Europe across 12 years of follow-up (2004–2015) and subject to substantial sample attrition (59%) were analysed. We compared results of a standard linear mixed model assuming missing at random (MAR) sample attrition with a joint model assuming missing not at random sample attrition. Results: Estimated frailty trajectories of both the mixed and joint models were identical up to an age of 80 years, above which modest underestimation occurred when a standard linear mixed model was used rather than a joint model. The latter effect was larger for men than women. Substantial education-based inequality in frailty continued throughout old age in both the mixed and joint models. Conclusion: Linear mixed models assuming MAR sample attrition provided good estimates of frailty trajectories up until high age. Thus, the validity of existing studies estimating frailty trajectories based on standard linear mixed models seems not threatened by substantial sample attrition.

Download Full-text

Clinical implementation of a 3D4K-exoscope (Orbeye) in microneurosurgery

Neurosurgical Review ◽

10.1007/s10143-021-01577-3 ◽

2021 ◽

Author(s):

Judith Rösler ◽

Stefan Georgiev ◽

Anna L. Roethe ◽

Denny Chakkalakal ◽

Güliz Acker ◽

...

Keyword(s):

User Satisfaction ◽

Mixed Model ◽

Linear Mixed Model ◽

Intraoperative Complications ◽

Rank Test ◽

User Group ◽

Clinical Implementation ◽

Physical Strain ◽

Conventional Microscope ◽

The Impact

AbstractExoscopic surgery promises alleviation of physical strain, improved intraoperative visualization and facilitation of the clinical workflow. In this prospective observational study, we investigate the clinical usability of a novel 3D4K-exoscope in routine neurosurgical interventions. Questionnaires on the use of the exoscope were carried out. Exemplary cases were additionally video-documented. All participating neurosurgeons (n = 10) received initial device training. Changing to a conventional microscope was possible at all times. A linear mixed model was used to analyse the impact of time on the switchover rate. For further analysis, we dichotomized the surgeons in a frequent (n = 1) and an infrequent (n = 9) user group. A one-sample Wilcoxon signed rank test was used to evaluate, if the number of surgeries differed between the two groups. Thirty-nine operations were included. No intraoperative complications occurred. In 69.2% of the procedures, the surgeon switched to the conventional microscope. While during the first half of the study the conversion rate was 90%, it decreased to 52.6% in the second half (p = 0.003). The number of interventions between the frequent and the infrequent user group differed significantly (p = 0.007). Main reasons for switching to ocular-based surgery were impaired hand–eye coordination and poor depth perception. The exoscope investigated in this study can be easily integrated in established neurosurgical workflows. Surgical ergonomics improved compared to standard microsurgical setups. Excellent image quality and precise control of the camera added to overall user satisfaction. For experienced surgeons, the incentive to switch from ocular-based to exoscopic surgery greatly varies.

Download Full-text

The influence of xylanase on the fermentability, digestibility, and physiochemical properties of insoluble corn-based fiber along the gastrointestinal tract of growing pigs

Journal of Animal Science ◽

10.1093/jas/skab159 ◽

2021 ◽

Author(s):

Amy L Petry ◽

Nichole F Huntley ◽

Michael R Bedford ◽

John F Patience

Keyword(s):

Mixed Model ◽

Linear Mixed Model ◽

Nutrient Digestibility ◽

Growing Pigs ◽

Neutral Detergent Fiber ◽

Adaptation Period ◽

High Fiber ◽

Gross Energy ◽

Digesta Viscosity ◽

The Impact

Abstract In theory, supplementing xylanase in corn-based swine diets should improve nutrient and energy digestibility and fiber fermentability, but its efficacy is inconsistent. The experimental objective was to investigate the impact of xylanase on energy and nutrient digestibility, digesta viscosity, and fermentation when pigs are fed a diet high in insoluble fiber (>20% neutral detergent fiber; NDF) and given a 46-d dietary adaptation period. Three replicates of 20 growing gilts were blocked by initial body weight, individually housed, and assigned to 1 of 4 dietary treatments: a low-fiber control (LF) with 7.5% NDF, a 30% corn bran high-fiber control (HF; 21.9% NDF), HF+100 mg xylanase/kg [HF+XY, (Econase XT 25P; AB Vista, Marlborough, UK)] providing 16,000 birch xylan units/kg; and HF+50 mg arabinoxylan-oligosaccharide (AXOS) product/kg [HF+AX, (XOS 35A; Shandong Longlive Biotechnology, Shandong, China)] providing AXOS with 3-7 degrees of polymerization. Gilts were allowed ad libitum access to fed for 36-d. On d 36, pigs were housed in metabolism crates for a 10-d period, limit fed, and feces were collected. On d 46, pigs were euthanized and ileal, cecal, and colonic digesta were collected. Data were analyzed as a linear mixed model with block and replication as random effects, and treatment as a fixed effect. Compared with LF, HF reduced the apparent ileal digestibility (AID), apparent cecal digestibility (ACED), apparent colonic digestibility (ACOD), and apparent total tract digestibility (ATTD) of dry matter (DM), gross energy (GE), crude protein (CP), acid detergent fiber (ADF), NDF, and hemicellulose (P<0.01). Relative to HF, HF+XY improved the AID of GE, CP, and NDF (P<0.05), and improved the ACED, ACOD, and ATTD of DM, GE, CP, NDF, ADF, and hemicellulose (P<0.05). Among treatments, pigs fed HF had increased hindgut DM disappearance (P=0.031). Relative to HF, HF+XY improved cecal disappearance of DM (162 vs. 98g; P=0.008) and NDF (44 vs. 13g; P<0.01). Pigs fed xylanase had a greater proportion of acetate in cecal digesta and butyrate in colonic digesta among treatments (P<0.05). Compared with LF, HF increased ileal, cecal, and colonic viscosity, but HF+XY decreased ileal viscosity compared with HF (P<0.001). In conclusion, increased insoluble corn-based fiber decreases digestibility, reduces cecal fermentation, and increases digesta viscosity, but supplementing xylanase partially mitigated that effect.

Download Full-text

The Use of Telehealth Technology in Assessing the Accuracy of Self-Reported Weight and the Impact of a Daily Immediate-Feedback Intervention among Obese Employees

International Journal of Telemedicine and Applications ◽

10.1155/2011/909248 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Nicolaas P. Pronk ◽

A. Lauren Crain ◽

Jeffrey J. VanWormer ◽

Brian C. Martinson ◽

Jackie L. Boucher ◽

...

Keyword(s):

Body Weight ◽

Mixed Model ◽

Linear Mixed Model ◽

Controlled Trial ◽

Intervention Group ◽

Study Groups ◽

Outcome Variable ◽

Control Group ◽

Immediate Feedback ◽

The Impact

Objective.To determine the accuracy of self-reported body weight prior to and following a weight loss intervention including daily self-weighing among obese employees.Methods.As part of a 6-month randomized controlled trial including a no-treatment control group, an intervention group received a series of coaching calls, daily self-weighing, and interactive telemonitoring. The primary outcome variable was the absolute discrepancy between self-reported and measured body weight at baseline and at 6 months. We used general linear mixed model regression to estimate changes and differences between study groups over time.Results.At baseline, study participants underreported their weight by an average of 2.06 (se=0.33) lbs. The intervention group self-reported a smaller absolute body weight discrepancy at followup than the control group.Conclusions.The discrepancy between self-reported and measured body weight appears to be relatively small, may be improved through daily self-monitoring using immediate-feedback telehealth technology, and negligibly impacts change in body weight.

Download Full-text

O003 The impact of wind farm noise in a laboratory setting on objective and subjective sleep efficiency

SLEEP Advances ◽

10.1093/sleepadvances/zpab014.002 ◽

2021 ◽

Vol 2 (Supplement_1) ◽

pp. A1-A2

Author(s):

T Liebich ◽

L Lack ◽

G Micic ◽

K Hansen ◽

B Zajamsek ◽

...

Keyword(s):

Sleep Disturbance ◽

Wind Farm ◽

Mixed Model ◽

Linear Mixed Model ◽

Sleep Efficiency ◽

Self Report ◽

Sleep Diary ◽

Noise Condition ◽

Subjective Sleep ◽

The Impact

Abstract Introduction Well-controlled studies of wind farm noise (WFN) on sleep are lacking despite complaints and known effects of other noise types on sleep. This laboratory-based study investigated the impact of continuous full-night WFN exposure replicated from field recordings on polysomnography-measured (objective) and sleep diary-determined (subjective) sleep efficiency compared to a quiet control night. Methods Based on residential location and self-report data, 50 participants were categorised into three groups (14 living <10km from a wind farm and self-reporting sleep disturbance; 19 living <10km from a wind farm and self-reporting no sleep disturbance and 18 controls living in a quiet rural area). Participants underwent full in-laboratory polysomnography during exposure to continuous WFN (25 dB(A)) throughout the night and a quiet control night (background noise 19 dB(A)) in random order. Group and noise condition effects were examined via linear mixed model analysis. Results Participants (30 females) were aged (mean±SD) 54.9±17.6 range: 18–80 years. Sleep efficiency in the control condition was (median [interquartile range]) objective: 85.5 [77.4 to 91.2]%; subjective: 85.7 [69.2 to 92.7]%) versus the WFN condition (objective: 86.1 [78.6 to 91.7]% subjective: 85.8 [66.2 to 93.8]%) with no significant main or interaction effects of group or noise condition (all p’s >0.05). Conclusion These results do not support that WFN at 25 dB(A) significantly impacts objective or subjective sleep efficiency in participants with or without prior WFN exposure or self-reported WFN-related sleep disturbance. Further analyses to investigate potential sleep micro-structural changes remain warranted.

Download Full-text

THE IMPACT OF HOSPITAL BASED INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS TRAINING ON PEDIATRIC NURSE COMPETENCY

Belitung Nursing Journal ◽

10.33546/bnj.362 ◽

2018 ◽

Vol 4 (1) ◽

pp. 16-23

Author(s):

Fitri Haryanti ◽

Mohammad Hakimi ◽

Yati Sunarto ◽

Yayi S Prabandari

Keyword(s):

Mixed Model ◽

Linear Mixed Model ◽

Integrated Management ◽

Well Being ◽

Childhood Illness ◽

Internal Conflict ◽

Child Health Services ◽

Management Support ◽

The Impact

Background: Although the WHO strategy integrated management of childhood illness (IMCI) for primary care has been implemented in over 100 countries, there is less global experience with hospital-based IMCI training. Until recently, no training had been done in Indonesia, and globally there has been limited experience of the role of IMCI in rebuilding health systems after complex emergencies.Objective: We aimed to examine the effect of hospital-based IMCI training on pedicatric nurse competency and explore the perception of Indonesian doctors, nurse managers and paediatricians about IMCI training and its development in West Aceh, a region that was severely affected by the South-Asian tsunami in December 2004.Methods: This study used stepped wedge design. Training was conducted for 39 nurses staff, 13 midwifes, 6 Head nurses, 5 manager of nurses, 5 doctors, 1 paediatricians, and 3 support facilities (nutritionist, pharmacist, laboratory) in Cut Nyak Dien (CND) Hospital in Meulaboh, West Aceh, Indonesia. The IMCI training was developed based on the WHO Pocketbook of Hospital Care for Children. A nurses competency questionnaire was used based on the guideline of assessment of the quality of child health services at the first level reference hospitals in districts / municipalities issued by the Ministry of Health in 2007. A linear mixed model was used for data analysis.Results: The hospital based IMCI training improved the competences of nurses paediatric in assessing emergency signs of the sick children, management of cough and difficulty breathing, diarrhoea, fever, nutritional problems, supportive care, monitoring, discharge planning and follow up. The assessment highlighted several problems in adaptation process of material training, training process and implementation in an environment soon after a major disaster.Conclusion: Hospital based IMCI training can be implemented in a setting after major disasters or internal conflict as part of a rebuilding process. The program requires strong management support and the emergency phase to be subsided. Other pre-requisites include the existence of standard operating procedures, adequate physical facilities and support for staff morale and well-being. Improving the quality of paediatric care requires more than just training and clinical guidelines; internal motivation and health worker support are essential.

Download Full-text

The SARS-CoV-2 Alpha variant is associated with increased clinical severity of disease

10.1101/2021.08.17.21260128 ◽

2021 ◽

Author(s):

David J Pascall ◽

Guy Mollett ◽

Rachel Blacow ◽

Naomi Bulteel ◽

Robyn Campbell ◽

...

Keyword(s):

Growth Rate ◽

Cohort Study ◽

Mixed Model ◽

Linear Mixed Model ◽

Transmission Rate ◽

Severe Disease ◽

Positive Association ◽

Clinical Severity ◽

Generalised Linear Mixed Model ◽

The Impact

Background The Alpha (B.1.1.7) SARS-CoV-2 variant of concern has been associated with increased transmission and increased 28-day mortality. We aimed to investigate the impact of infection on clinical severity of illness, including the need for oxygen or ventilation in a national cohort study. Methods In this prospective clinical cohort study, 1475 SARS-CoV-2 sequences were obtained from patients infected in Scotland, UK between the 1st November 2020 and 30th January 2021 and matched to clinical outcomes as the lineage became dominant in Scotland. We modelled the association between B.1.1.7 infection and severe disease using a cumulative generalised linear mixed model employing a 4-point scale of maximum severity based on requirement of respiratory support at 28 days. We also estimated the growth rate of B.1.1.7-associated infections as it emerged in Scotland using a phylogenetic exponential growth rate population model. Results The B.1.1.7 lineage was responsible for a third wave of SARS-CoV-2 infection in Scotland in association with a transmission rate 5-fold higher than the preceding second wave B.1.177 lineage. Of 1475 patients, 364 were infected with B.1.1.7, 1030 with B.1.177 and 81 with other lineages. Our analysis found a positive association between increased clinical severity and lineage (B.1.1.7 versus non-B.1.1.7; cumulative odds ratio: 1.40, 95% CI: 1.02, 1.93). Viral load was higher in B.1.1.7 samples than in non-B.1.1.7 samples, as measured by cycle threshold (Ct) value (mean Ct change: -2.46, 95% CI: -4.22, -0.70). Conclusions The B.1.1.7 lineage was associated with more severe clinical disease in Scottish patients than co-circulating lineages.

Download Full-text

The Impact of Clinical Review Bias on Child Language Grammaticality

Communication Disorders Quarterly ◽

10.1177/1525740119853243 ◽

2019 ◽

Vol 41 (4) ◽

pp. 214-221

Author(s):

Anny P. Castilla-Earls ◽

Brittany Harvey ◽

Katrina Fulcher-Rood ◽

Christopher D. Barr

Keyword(s):

Clinical Review ◽

Language Impairment ◽

Binary Data ◽

Mixed Model ◽

Linear Mixed Model ◽

Child Language ◽

Communication Disorders ◽

The Impact ◽

English Students ◽

Language Sample

The purpose of this study was to examine the impact of clinical review bias on the coding of grammaticality in child language. Seventy-four native-English students studying communication disorders and sciences made judgments about the grammaticality of 250 utterances presented in five language samples. Each language sample included grammatical, ungrammatical, and ambiguous utterances. Participants were randomly assigned to a blind or nonblind group. The nonblind group was presented with diagnostic information, whereas the blind group was not. We employed a generalized linear mixed model to examine the binary data. Our results suggest that both blind and nonblind participants were accurate in judging grammatical and ungrammatical utterances. However, nonblind participants were slightly more likely to judge ambiguous utterances as ungrammatical when the language sample identified the child as having a language impairment, suggesting that there was an effect of clinical review bias in this study. This effect, although statistically significant, was small.

Download Full-text

Evaluating the impact of a coach development intervention for improving coaching practices and player outcomes in netball: The MASTER coaching randomized control trial

International Journal of Sports Science & Coaching ◽

10.1177/1747954120976966 ◽

2020 ◽

pp. 174795412097696

Author(s):

Narelle Eather ◽

Andrew Miller ◽

Brad Jones ◽

Philip J Morgan

Keyword(s):

Mixed Model ◽

Linear Mixed Model ◽

Assessment Tool ◽

Controlled Trial ◽

Assessment Instrument ◽

Master Program ◽

Development Intervention ◽

Self Perceptions ◽

Coach Development ◽

The Impact

The aim of this randomized controlled trial was to evaluate the impact of a novel 8-week coach development intervention (MASTER) on game-based coaching practices of netball coaches from one netball club (n = 16; 8 intervention, 8 active-control; NSW Australia), and player outcomes for the junior athletes being coached. The multi-component MASTER intervention aimed to educate coaches on how to design and implement high quality game-based coaching sessions. The core pillar of MASTER is ‘positive coaching,’ delivered through games-based coaching practices. At baseline and 10-weeks, two coaching sessions per coach were filmed and assessed using the MASTER assessment tool. Players (8-16yrs; n = 85) were videoed during structured gameplay, with three aspects of game play assessed using Game Performance Assessment Instrument. Coaches and players (n = 75; 12-16yrs) completed a perceptions questionnaire. Using linear mixed model ITT analysis, significant interventions effects were observed for the primary outcome: percentage of time spent performing playing-form activities [25.7% (95% CI (7.79-43.65), P = 0.008, d = 1.52]. Significant interventions effects were also observed for coach perceptions, player game skills, and player self-perceptions (P < 0.05). No significant changes were observed for player enjoyment, motivation, or wellbeing. The MASTER program was effective in improving coach and player self-perceptions, and coaching practices of netball coaches during training sessions.

Download Full-text

Lung function over the life course of paediatric and adult patients with cystic fibrosis from a large multi-centre registry

Scientific Reports ◽

10.1038/s41598-020-74502-1 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Arul Earnest ◽

Farhad Salimi ◽

Claire E. Wainwright ◽

Scott C. Bell ◽

Rasa Ruseckaite ◽

...

Keyword(s):

Cystic Fibrosis ◽

Lung Function ◽

Mixed Model ◽

Linear Mixed Model ◽

Pancreatic Insufficiency ◽

Forced Expiratory Volume ◽

Rate Of Change ◽

Data Registry ◽

Mortality Outcome ◽

The Impact

Abstract A key measure of lung function in people with Cystic Fibrosis (CF) is Forced Expiratory Volume in the first second FEV1 percent predicted (FEV1pp). This study aimed to address challenges in identifying predictors of FEV1pp, specifically dealing with non-linearity and the censoring effect of death. Data was obtained from a large multi-centre Australian Cystic Fibrosis Data Registry (ACFDR). A linear mixed model was used to study FEV1pp as the endpoint. There were 3655 patients (52.4% male) included in our study. Restricted cubic splines were used to fit the non-linear relationship between age of visit and FEV1pp. The following predictors were found to be significant in the multivariate model: age of patient at visit, BMI z-score, age interaction with lung transplantation, insulin dependent diabetes, cirrhosis/portal hypertension, pancreatic insufficiency, Pseudomonas aeruginosa infection and baseline variability in FEV1pp. Those with P. aeruginosa infection had a lower mean difference in FEV1pp of 4.7 units, p < 0.001 compared to those who did not have the infection. Joint modelling with mortality outcome did not materially affect our findings. These models will prove useful for to study the impact of CFTR modulator therapies on rate of change of lung function among patients with CF.

Download Full-text