scholarly journals Ground truth labels challenge the validity of sepsis consensus definitions in critical illness

2022 ◽  
Vol 20 (1) ◽  
Holger A. Lindner ◽  
Shigehiko Schamoni ◽  
Thomas Kirschning ◽  
Corinna Worm ◽  
Bianka Hahn ◽  

Abstract Background Sepsis is the leading cause of death in the intensive care unit (ICU). Expediting its diagnosis, largely determined by clinical assessment, improves survival. Predictive and explanatory modelling of sepsis in the critically ill commonly bases both outcome definition and predictions on clinical criteria for consensus definitions of sepsis, leading to circularity. As a remedy, we collected ground truth labels for sepsis. Methods In the Ground Truth for Sepsis Questionnaire (GTSQ), senior attending physicians in the ICU documented daily their opinion on each patient’s condition regarding sepsis as a five-category working diagnosis and nine related items. Working diagnosis groups were described and compared and their SOFA-scores analyzed with a generalized linear mixed model. Agreement and discriminatory performance measures for clinical criteria of sepsis and GTSQ labels as reference class were derived. Results We analyzed 7291 questionnaires and 761 complete encounters from the first survey year. Editing rates for all items were > 90%, and responses were consistent with current understanding of critical illness pathophysiology, including sepsis pathogenesis. Interrater agreement for presence and absence of sepsis was almost perfect but only slight for suspected infection. ICU mortality was 19.5% in encounters with SIRS as the “worst” working diagnosis compared to 5.9% with sepsis and 5.9% with severe sepsis without differences in admission and maximum SOFA. Compared to sepsis, proportions of GTSQs with SIRS plus acute organ dysfunction were equal and macrocirculatory abnormalities higher (p < 0.0001). SIRS proportionally ranked above sepsis in daily assessment of illness severity (p < 0.0001). Separate analyses of neurosurgical referrals revealed similar differences. Discriminatory performance of Sepsis-1/2 and Sepsis-3 compared to GTSQ labels was similar with sensitivities around 70% and specificities 92%. Essentially no difference between the prevalence of SIRS and SOFA ≥ 2 yielded sensitivities and specificities for detecting sepsis onset close to 55% and 83%, respectively. Conclusions GTSQ labels are a valid measure of sepsis in the ICU. They reveal suspicion of infection as an unclear clinical concept and refute an illness severity hierarchy in the SIRS-sepsis-severe sepsis spectrum. Ground truth challenges the accuracy of Sepsis-1/2 and Sepsis-3 in detecting sepsis onset. It is an indispensable intermediate step towards advancing diagnosis and therapy in the ICU and, potentially, other health care settings.

2020 ◽  
James L. Peugh ◽  
Sarah J. Beal ◽  
Meghan E. McGrady ◽  
Michael D. Toland ◽  
Constance Mara

2020 ◽  
Vol 641 ◽  
pp. 159-175
J Runnebaum ◽  
KR Tanaka ◽  
L Guan ◽  
J Cao ◽  
L O’Brien ◽  

Bycatch remains a global problem in managing sustainable fisheries. A critical aspect of management is understanding the timing and spatial extent of bycatch. Fisheries management often relies on observed bycatch data, which are not always available due to a lack of reporting or observer coverage. Alternatively, analyzing the overlap in suitable habitat for the target and non-target species can provide a spatial management tool to understand where bycatch interactions are likely to occur. Potential bycatch hotspots based on suitable habitat were predicted for cusk Brosme brosme incidentally caught in the Gulf of Maine American lobster Homarus americanus fishery. Data from multiple fisheries-independent surveys were combined in a delta-generalized linear mixed model to generate spatially explicit density estimates for use in an independent habitat suitability index. The habitat suitability indices for American lobster and cusk were then compared to predict potential bycatch hotspot locations. Suitable habitat for American lobster has increased between 1980 and 2013 while suitable habitat for cusk decreased throughout most of the Gulf of Maine, except for Georges Basin and the Great South Channel. The proportion of overlap in suitable habitat varied interannually but decreased slightly in the spring and remained relatively stable in the fall over the time series. As Gulf of Maine temperatures continue to increase, the interactions between American lobster and cusk are predicted to decline as cusk habitat continues to constrict. This framework can contribute to fisheries managers’ understanding of changes in habitat overlap as climate conditions continue to change and alter where bycatch interactions could occur.

2019 ◽  
Vol 24 (2) ◽  
pp. 200-208
Ravindra Arya ◽  
Francesco T. Mangano ◽  
Paul S. Horn ◽  
Sabrina K. Kaul ◽  
Serena K. Kaul ◽  

OBJECTIVEThere is emerging data that adults with temporal lobe epilepsy (TLE) without a discrete lesion on brain MRI have surgical outcomes comparable to those with hippocampal sclerosis (HS). However, pediatric TLE is different from its adult counterpart. In this study, the authors investigated if the presence of a potentially epileptogenic lesion on presurgical brain MRI influences the long-term seizure outcomes after pediatric temporal lobectomy.METHODSChildren who underwent temporal lobectomy between 2007 and 2015 and had at least 1 year of seizure outcomes data were identified. These were classified into lesional and MRI-negative groups based on whether an epilepsy-protocol brain MRI showed a lesion sufficiently specific to guide surgical decisions. These patients were also categorized into pure TLE and temporal plus epilepsies based on the neurophysiological localization of the seizure-onset zone. Seizure outcomes at each follow-up visit were incorporated into a repeated-measures generalized linear mixed model (GLMM) with MRI status as a grouping variable. Clinical variables were incorporated into GLMM as covariates.RESULTSOne hundred nine patients (44 females) were included, aged 5 to 21 years, and were classified as lesional (73%), MRI negative (27%), pure TLE (56%), and temporal plus (44%). After a mean follow-up of 3.2 years (range 1.2–8.8 years), 66% of the patients were seizure free for ≥ 1 year at last follow-up. GLMM analysis revealed that lesional patients were more likely to be seizure free over the long term compared to MRI-negative patients for the overall cohort (OR 2.58, p < 0.0001) and for temporal plus epilepsies (OR 1.85, p = 0.0052). The effect of MRI lesion was not significant for pure TLE (OR 2.64, p = 0.0635). Concordance of ictal electroencephalography (OR 3.46, p < 0.0001), magnetoencephalography (OR 4.26, p < 0.0001), and later age of seizure onset (OR 1.05, p = 0.0091) were associated with a higher likelihood of seizure freedom. The most common histological findings included cortical dysplasia types 1B and 2A, HS (40% with dual pathology), and tuberous sclerosis.CONCLUSIONSA lesion on presurgical brain MRI is an important determinant of long-term seizure freedom after pediatric temporal lobectomy. Pediatric TLE is heterogeneous regarding etiologies and organization of seizure-onset zones with many patients qualifying for temporal plus nosology. The presence of an MRI lesion determined seizure outcomes in patients with temporal plus epilepsies. However, pure TLE had comparable surgical seizure outcomes for lesional and MRI-negative groups.

Miriam Romero-López ◽  
María Carmen Pichardo ◽  
Ana Justicia-Arráez ◽  
Judit Bembibre-Serrano

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.

Forests ◽  
2021 ◽  
Vol 12 (2) ◽  
pp. 118
Lunel Joseph ◽  
Raúl Marino Yaranga Cano ◽  
Marco Arizapana-Almonacid ◽  
Marcela Venelli Pyles ◽  
Flávia Freire de Siqueira ◽  

Research Highlights: Families more dependent on crops as the main source of income of properties have a greater intention of restoring Polylepis forest areas. However, this intention reduces with the increase of family dependence on subsistence products supplied by Polylepis forests. Properties where the chances of restoration of Polylepis forests are greater are those where the educational and technical level is better. Objectives: We aimed to comprehend which socioeconomic factors of rural properties and families’ perception were determinant for the intention to restore Polylepis forests in the Central Andes region of Peru. Material and Methods: We collected data through visits and the application of questionnaires. We selected 13 rural communities in the Tulumayo River Basin. We randomly sampled 10 to 20 families in each community, depending on its size, totaling 200 families. We used generalized linear mixed model (GLMM) to test which variables affect the intention to restore the forest. Results: When crops are the main source of income in the property, the families have more intention to restore Polylepis areas, on the other hand, when Polylepis forests are an important source of products for the family subsistence, the intention to restore forests reduces, indicating that higher technological status has a positive impact on restoration. The perception that Polylepis forests are important for the existence of water sources had a positive impact on the families’ intention to restore the areas. However, the perception that Polylepis forests are important for native flora persistence had a negative impact on the intention to restore their areas. Conclusions: Our results showed that investment in improving the productivity of the properties and in the education of their landowners should increase the success of eventual programs for restoration of Polylepis forests.

2021 ◽  
pp. 1-26
Traci A. Bekelman ◽  
Corby K. Martin ◽  
Susan L. Johnson ◽  
Deborah H. Glueck ◽  
Katherine A. Sauder ◽  

Abstract The limitations of self-report measures of dietary intake are well known. Novel, technology-based measures of dietary intake may provide a more accurate, less burdensome alternative to existing tools. The first objective of this study was to compare participant burden for two technology-based measures of dietary intake among school-age children: the Automated-Self Administered 24-hour Dietary Assessment Tool-2018 (ASA24-2018) and the Remote Food Photography Method (RFPM). The second objective was to compare reported energy intake for each method to the Estimated Energy Requirement for each child, as a benchmark for actual intake. Forty parent-child dyads participated in 2, 3-day dietary assessments: a parent proxy-reported version of the ASA24 and the RFPM. A parent survey was subsequently administered to compare satisfaction, ease of use and burden with each method. A linear mixed model examined differences in total daily energy intake (TDEI) between assessments, and between each assessment method and the EER. Reported energy intake was 379 kcal higher with the ASA24 than the RFPM (p=0.0002). Reported energy intake with the ASA24 was 231 kcal higher than the EER (p = 0.008). Reported energy intake with the RFPM did not differ significantly from the EER (difference in predicted means = −148 kcal, p = 0.09). Median satisfaction and ease of use scores were 5 out of 6 for both methods. A higher proportion of parents reported that the ASA24 was more time consuming than the RFPM (74.4% vs. 25.6%, p = 0.002). Utilization of both methods is warranted given their high satisfaction among parents.

2021 ◽  
Vol 9 (2) ◽  
pp. 333
Shohei Ogata ◽  
Wessam Mohamed Ahmed Mohamed ◽  
Kodai Kusakisako ◽  
May June Thu ◽  
Yongjin Qiu ◽  

Members of the genus Spiroplasma are Gram-positive bacteria without cell walls. Some Spiroplasma species can cause disease in arthropods such as bees, whereas others provide their host with resistance to pathogens. Ticks also harbour Spiroplasma, but their role has not been elucidated yet. Here, the infection status and genetic diversity of Spiroplasma in ticks were investigated using samples collected from different geographic regions in Japan. A total of 712 ticks were tested for Spiroplasma infection by PCR targeting 16S rDNA, and Spiroplasma species were genetically characterized based on 16S rDNA, ITS, dnaA, and rpoB gene sequences. A total of 109 samples originating from eight tick species were positive for Spiroplasma infection, with infection rates ranging from 0% to 84% depending on the species. A linear mixed model indicated that tick species was the primary factor associated with Spiroplasma infection. Moreover, certain Spiroplasma alleles that are highly adapted to specific tick species may explain the high infection rates in Ixodes ovatus and Haemaphysalis kitaokai. A comparison of the alleles obtained suggests that horizontal transmission between tick species may not be a frequent event. These findings provide clues to understand the transmission cycle of Spiroplasma species in wild tick populations and their roles in host ticks.

Alice Iannaccone ◽  
Daniele Conte ◽  
Cristina Cortis ◽  
Andrea Fusco

Internal load can be objectively measured by heart rate-based models, such as Edwards’ summated heart rate zones, or subjectively by session rating of perceived exertion. The relationship between internal loads assessed via heart rate-based models and session rating of perceived exertion is usually studied through simple correlations, although the Linear Mixed Model could represent a more appropriate statistical procedure to deal with intrasubject variability. This study aimed to compare conventional correlations and the Linear Mixed Model to assess the relationships between objective and subjective measures of internal load in team sports. Thirteen male youth beach handball players (15.9 ± 0.3 years) were monitored (14 training sessions; 7 official matches). Correlation coefficients were used to correlate the objective and subjective internal load. The Linear Mixed Model was used to model the relationship between objective and subjective measures of internal load data by considering each player individual response as random effect. Random intercepts were used and then random slopes were added. The likelihood-ratio test was used to compare statistical models. The correlation coefficient for the overall relationship between the objective and subjective internal data was very large (r = 0.74; ρ = 0.78). The Linear Mixed Model using both random slopes and random intercepts better explained (p < 0.001) the relationship between internal load measures. Researchers are encouraged to apply the Linear Mixed Models rather than correlation to analyze internal load relationships in team sports since it allows for the consideration of the individuality of players.

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