The Impact and Statistical Analysis of a Multifaceted Anticoagulation Strategy in Children Supported on ECMO

2016 ◽  
Vol 32 (1) ◽  
pp. 59-67 ◽  
Author(s):  
Aaron D. Kessel ◽  
Myriam Kline ◽  
Marcia Zinger ◽  
Dawn McLaughlin ◽  
Peter Silver ◽  
...  
Keyword(s):  
Mixed Model ◽  
Linear Mixed Model ◽  
Tertiary Care ◽  
Disease Process ◽  
Factor Xa ◽  
Current Group ◽  
Heparin Infusion ◽  
Positive Correlation ◽  
Mixed Model Analysis ◽  
The Impact

Background: We sought to determine whether the introduction of a new anticoagulation protocol improved the frequency with which target anticoagulation parameters were met in children supported with extracorporeal membrane oxygenation (ECMO). Additionally, we sought to correlate the results of various tests of anticoagulation with the heparin infusion dose (HID) for patients on ECMO and to evaluate the utility of these anticoagulation monitoring tests for the titration of the HID. Methods: A retrospective chart review of 18 patients who received ECMO at an academic tertiary care children’s hospital. Nine patients who were managed using a new anticoagulation protocol were matched by age and diagnosis with 9 patients managed with the old protocol. We collected data relating to patient demographics, type of extracorporeal support, disease process, and incidence of bleeding or thrombosis. Anticoagulation parameters collected include the activated clotting time (ACT), activated partial thromboplastin time (aPTT), prothrombin time/international normalized ratio, anti-factor Xa level, and antithrombin 3 level along with the HID at each time point. Patient groups were compared using a Generalized Linear Mixed Model, a mixed model analysis of variance, and correlational studies. Main Results: The percentage of in-range ACT values was not different between the 2 protocols, whereas the percentage of in-range aPTT values was higher in the new anticoagulation protocol (ACT: 37.7% vs 39.5%; aPTT: 25.1% vs 39.8%). After accounting for repeated and variable measures within patients, the probability of obtaining an in-range ACT and aPTT did not differ significantly between the 2 protocols (ACT: P = .3488; aPTT: P = .16). The mean HID did not differ between the 2 groups (35.0 unit/kg/h vs 37.6 unit/kg/h, P = .56). Correlation coefficients demonstrated a significant inverse correlation between the ACT and the HID in both the groups (old: r = −.22, P < .0001; new: r = −.26, P < .0001). We observed a significant positive correlation between the aPTT and the HID in the historical group ( r = .25, P < .0001), but no correlation between the aPTT and the HID in the current group ( r = −.02, P = .71). The anti-factor Xa level showed a significantly positive correlation with the HID in the current group ( r = .62, P < .0001). Conclusions: A multipronged monitoring regimen slightly increased the amount of time that anticoagulation parameters were within range. Correlations between the HID and the aPTT differed based on anticoagulation protocol, with a positive correlation in the older protocol and no correlation in the new protocol. This may highlight a problem in study design and analysis that requires further examination. Further trials are needed to assess the most useful markers with which anticoagulation protocols for ECMO can be created, adjusted, and evaluated.

scholarly journals Does river channelization increase the abundance of invasive crayfish? Survey of Faxonius limosus in small Central European streams

2021 ◽  
Author(s):  
Maciej Bonk ◽  
Rafał Bobrek
Keyword(s):  
Invasive Species ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Regulated River ◽  
Mixed Model Analysis ◽  
South Central ◽  
Dam Reservoirs ◽  
Invasive Crayfish ◽  
Riverine Habitats ◽  
The Impact

AbstractThe aim of this study was to assess whether regulated river reaches show higher numbers of the spiny cheek crayfish Faxonius limosus, a common freshwater invader in Europe. Man-made alterations of riverine habitats may increase their susceptibility to biological invasions. This phenomenon is commonly studied in the context of dam reservoirs; however, the impact of river channelization and the resulting riverine habitat homogenization on the success of invasive species are mostly lacking. Surveys were conducted in natural and channelised river stretches in five rivers of south-central Poland. General linear mixed model analysis showed that crayfish abundance is usually higher at sites located within regulated reaches. The likely reason for the detected differences in abundance of crayfish may be related to decreased food-web complexity and lack of predators in a homogenised habitat. The results suggest that the channelization of small watercourses may increase the abundance of invasive species F. limosus and its pressure on native European crayfish. However, due to limited data obtained in field, our study should be considered as a pilot one.

scholarly journals Impact of Be EPIC on Person-Centered Communication

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 575-575
Author(s):  
Marie Savundranayagam ◽  
Kristine Williams ◽  
Shalane Basque ◽  
Joseph Orange ◽  
Marita Kloseck ◽  
...  
Keyword(s):  
Mixed Model ◽  
Linear Mixed Model ◽  
Control Group ◽  
Significant Group ◽  
Mixed Model Analysis ◽  
Personal Support ◽  
Time Interaction ◽  
The Impact

Abstract This study assessed the impact of Be EPIC, a dementia-focused, person-centered communication intervention for personal support workers (PSWs). Video-recorded conversations between PSWs and simulated persons with dementia assessed whether Be EPIC participants (n=13) (versus a wait-list control group, n=8) reported a greater proportion of person-centered communication utterances (recognition, negotiation, facilitation, validation). We used linear mixed model analysis to investigate if Be EPIC influenced PSWs’ person-centered communication. Group (Be EPIC versus control group), time (pre-, post-, and 3-months) and their interaction were included in the model. There was a significant group by time interaction. Follow-up tests showed that participants who took Be EPIC showed significant increases in person-centered utterances from pre- to post-training and pre-training to 3 months later. Participants in the control group showed no changes in person-centered communication. These findings show that Be EPIC enhanced person-centered communication, which is essential for quality of care.

scholarly journals Reducing Aggression by Developing Emotional and Inhibitory Control

2021 ◽  
Vol 18 (10) ◽  
pp. 5263
Author(s):  
Miriam Romero-López ◽  
María Carmen Pichardo ◽  
Ana Justicia-Arráez ◽  
Judit Bembibre-Serrano
Keyword(s):  
Psychosocial Development ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Generalized Linear Mixed Model ◽  
Emotional Control ◽  
Control Group ◽  
Post Intervention ◽  
Mixed Model Analysis ◽  
Intervention Measures ◽  
Experimental Group

The objective of this study is to measure the effectiveness of a program on improving inhibitory and emotional control among children. In addition, it is assessed whether the improvement of these skills has an effect on the reduction of aggressive behavior in pre-school children. The participants were 100 children, 50 belonging to the control group and 50 to the experimental group, aged between 5 and 6 years. Pre-intervention and post-intervention measures of inhibitory and emotional control (BRIEF-P) and aggression (BASC) were taken. A Generalized Linear Mixed Model analysis (GLMM) was performed and found that children in the experimental group scored higher on inhibitory and emotional control compared to their peers in the control group. In addition, these improvements have an effect on the decrease in aggressiveness. In conclusion, preventive research should have among its priorities the design of such program given their implications for psychosocial development.

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

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.

scholarly journals Methods to Assess Fat Mass in Infants and Young Children: A Comparative Study Using Skinfold Thickness and Air-Displacement Plethysmography

Life ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 75
Author(s):  
Stefanie M. P. Kouwenhoven ◽  
Nadja Antl ◽  
Jos W. R. Twisk ◽  
Berthold V. Koletzko ◽  
Martijn J. J. Finken ◽  
...  
Keyword(s):  
Young Children ◽  
Fat Mass ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Correlation Coefficients ◽  
Skinfold Thickness ◽  
Limited Information ◽  
Air Displacement Plethysmography ◽  
Mixed Model Analysis ◽  
Infants And Young Children

Background: Traditionally, fat mass is estimated using anthropometric models. Air-displacement plethysmography (ADP) is a relatively new technique for determining fat mass. There is limited information on the agreement between these methods in infants and young children. Therefore we aimed to longitudinally compare fat mass percentage values predicted from skinfold thicknesses (SFTs) and ADP in healthy infants and young children. Methods: Anthropometry and body composition were determined at the ages of 1, 4, and 6 months and 2 years. We quantified the agreement between the two methods using the Bland–Altman procedure, linear mixed-model analysis, and intra-class correlation coefficients (ICC). Results: During the first 6 months of life, fat mass% predicted with SFT was significantly different from that measured with ADP in healthy, term-born infants (n = 245). ICCs ranged from 0.33 (at 2 years of age) and 0.47 (at 4 months of age). Although the mean difference (bias) between the methods was low, the Bland–Altman plots showed proportional differences at all ages with wide limits of agreement. Conclusions: There is poor agreement between ADP and SFTs for estimating fat mass in infancy or early childhood. The amount of body fat was found to influence the agreement between the methods.

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

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 (&gt;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&lt;0.01). Relative to HF, HF+XY improved the AID of GE, CP, and NDF (P&lt;0.05), and improved the ACED, ACOD, and ATTD of DM, GE, CP, NDF, ADF, and hemicellulose (P&lt;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&lt;0.01). Pigs fed xylanase had a greater proportion of acetate in cecal digesta and butyrate in colonic digesta among treatments (P&lt;0.05). Compared with LF, HF increased ileal, cecal, and colonic viscosity, but HF+XY decreased ileal viscosity compared with HF (P&lt;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.

scholarly journals The impact of a ‘milking the COW’ campaign in a regional hospital in Singapore

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Surinder Kaur M. S. Pada ◽  
Poh Lishi ◽  
Kim Sim Ng ◽  
Sarathamani Rethenam ◽  
Lilibeth Silagan Alenton ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Pathogenic Bacteria ◽  
Mixed Model ◽  
Mixed Model Analysis ◽  
Colony Forming Units ◽  
Skin Flora ◽  
Before And After ◽  
The Difference ◽  
And Control ◽  
The Impact

Abstract Background Computerisation of various processes in hospitals and reliance on electronic devices raises the concern of contamination of these devices from the patient environment. We undertook this study to determine if an attached hand hygiene device that unlocks the screen of a computer on wheels (COW) on usage can be effective in decreasing the microbiological burden on computer keyboards. Methods An electronic hand sanitizer was integrated onto the COW. A prospective cohort study with a crossover design involving 2 control and 2 intervention wards was used. The study end point was the number of colony forming units found on the keyboards. Bacteria were classified into 4 main groups; pathogenic, skin flora, from the environment or those thought to be commensals in healthy individuals. We then used a mixed effects model for the statistical analysis to determine if there were any differences before and after the intervention. Results Thirty-nine keyboards were swabbed at baseline, day 7 and 14, with 234 keyboards cultured, colony forming units (CFUs) counted and organisms isolated. By mixed model analysis, the difference of mean bacteria count between intervention and control for week 1 was 32.74 (− 32.74, CI − 94.29 to 28.75, p = 0.29), for week 2 by 155.86 (− 155.86, CI − 227.45 to − 83.53, p < 0.0001), and after the 2-week period by 157.04 (− 157.04, CI − 231.53 to − 82.67, p < 0.0001). In the sub-analysis, there were significant differences of pathogenic bacteria counts for the Intervention as compared to the Control in contrast with commensal counts. Conclusion A hand hygiene device attached to a COW may be effective in decreasing the microbiological burden on computer keyboards.

Factors influencing the occurrence of high ultimate pH in three muscles of lamb carcasses in Australia

2014 ◽  
Vol 54 (10) ◽  
pp. 1853 ◽  
Author(s):  
N. G. McPhail ◽  
J. L. Stark ◽  
A. J. Ball ◽  
R. D. Warner
Keyword(s):  
Mixed Model ◽  
Linear Mixed Model ◽  
Rectus Femoris ◽  
Carcass Weight ◽  
Mixed Model Analysis ◽  
Factors Influencing ◽  
South Wales ◽  
Generalised Linear Mixed Model ◽  
Processing Plants ◽  
Few Data

Chilled lamb meat exported from Australia has, on occasions, been rejected by importing countries due to greening, after only 6 weeks of storage time. Greening is known to be more prevalent in high ultimate pH (pHu) beef meat (>5.9). There are few data available for lamb carcasses in Australia on the occurrence of high pHu meat, which may have an impact on the understanding and control of quality and greening during storage. The aim of this project was to determine the prevalence of, and influencing factors for, high pHu meat in a range of muscle types in lamb carcasses in Australia. Muscle pHu data were collected from a total of 1614 carcasses from 78 lots at four lamb processing plants in Victoria and New South Wales in autumn and spring of 2013. The pHu of the knuckle (rectus femoris), rack (longissimus) and blade (infraspinatus) was measured and data on carcass and lot characteristics were recorded. Data were subjected to restricted maximum likelihood and generalised linear mixed model analysis. The mean pHu of the knuckle, rack and shoulder were 6.06, 5.79 and 6.12 respectively, and the main factors influencing muscle pHu and occurrence of dark-cutting were breed, season, electrical stimulation and carcass weight. Merino lambs had a higher pHu in the blade and knuckle than did other breeds (P < 0.05, P < 0.01 respectively). Lambs processed in autumn had a higher predicted pHu in the blade and knuckle and a higher percentage dark-cutting (DC; pHu >6.0) for those muscles, than did those processed in spring (P < 0.05). Carcasses that had been electrically stimulated had a higher %DC and a higher pHu in all three muscles (P < 0.05). Carcass weight had a significant effect on the pHu of all three muscles (P < 0.001), with heavier carcasses having a lower pHu and lower %DC. The pHu of the rack was not a reliable predictor for the pHu in other muscles of the lamb carcass. In conclusion, the high occurrence of DC in the muscles, particularly the blade and knuckle, suggests that these muscles may be at risk for producing greening in the vacuum bag during storage.

Size-related boldness is not altered by stomach flushing in a terrestrial salamander

2021 ◽  
pp. 1-6
Author(s):  
Sebastiano Salvidio ◽  
Andrea Costa ◽  
Fabrizio Oneto
Keyword(s):  
Body Condition ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Animal Personality ◽  
Model Analysis ◽  
Mixed Model Analysis ◽  
Linear Mixed Model Analysis ◽  
Before And After ◽  
Trophic Strategy ◽  
The Relationship

Abstract Animal personality is a relatively neglected field in amphibian research. In this study we assessed the influence of stomach flushing, a non-lethal technique used in amphibian dietary studies, on the boldness behaviour of the cave salamander Speleomantes strinatii. The time of emergence from a shelter located in an unfamiliar environment (a proxy for individual boldness) was measured in 26 cave salamanders before and after stomach flushing, while 14 non-flushed salamanders were tested as controls. Boldness was a repeatable behaviour for salamanders and larger individuals emerged from their shelter more rapidly than smaller ones. Linear mixed model analysis showed that flushing, sex and body condition had no effect on this behaviour. These findings are promising in the framework of the study of salamander personality. In particular, our results will be useful when exploring the relationship between individual trophic strategy and boldness, aggression or exploration behaviours in terrestrial salamanders.

scholarly journals 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

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
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.

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