scholarly journals Education Research: Resident education through adult learning in neurology

Neurology ◽  
2018 ◽  
Vol 91 (5) ◽  
pp. 234-238
Author(s):  
Hazem Shoirah ◽  
Achilles Ntranos ◽  
Rachel Brandstadter ◽  
Yangbo Liu ◽  
Elisha Medina ◽  
...  
Keyword(s):  
Adult Learning ◽  
Residency Program ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Resident Education ◽  
Analysis Of Covariance ◽  
Medical Licensing ◽  
Service Training ◽  
Score Reports ◽  
Change In Mean

ObjectiveTo enhance residency education by implementing the 6 principles of adult learning theory (ALT) in a large academic neurology residency program.MethodsWe implemented a set of curricular interventions aimed at Resident Education through Adult Learning in Neurology (REAL Neurology), in a large, academic neurology residency program. Interventions included didactic reform, increasing resident-as-teacher activities, and enhancing residents' interaction. The primary outcome was the change in mean Residency In-service Training Examination (RITE) percentile between the preintervention and postintervention cohorts, adjusting for US Medical Licensing Examination step 1 and 2 score. Other analysis included evaluating the effect of the duration of intervention exposure on outcome and evaluating the intervention effect on the proportion of advanced performers.ResultsA total of 134 RITE score reports were evaluated (87 preintervention and 47 postintervention). The mean RITE score percentile postintervention was 11.7 points higher than preintervention (adjusted, longitudinal analysis: fit linear mixed model, p < 0.0001). Postgraduate year 3 learners who had 1 and 2 years of exposure scored 13.4 and 18.9 points higher than those with no exposure at all, respectively (analysis of covariance, p = 0.04). The adjusted odds of better performance with REAL Neurology was 5.77 (ordinal logistic regression, 95% confidence interval 2.37–14.07, p < 0.05).ConclusionThis study evaluated the efficacy and feasibility of an ALT-based curricular program in neurology education. The results show robust and sustainable benefit for residents in training without imposing a financial or logistical burden on programs. REAL Neurology could serve as a model for curricular reform in other programs across subspecialties.

scholarly journals Metformin in non-diabetic patients with metabolic syndrome and diastolic dysfunction: the MET-DIME randomized trial

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
R Ladeiras-Lopes ◽  
F Sampaio ◽  
S Leite ◽  
D Santos-Ferreira ◽  
E Vilela ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Diastolic Dysfunction ◽  
Randomized Trial ◽  
Functional Capacity ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Western World ◽  
Diabetic Patients ◽  
Lifestyle Counseling ◽  
Change In Mean

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Merck Background Metabolic syndrome (MetS) affects one out of 3 adults in the western world and is associated with preclinical diastolic dysfunction that impairs functional capacity and quality of life (QoL). Purpose This randomized trial was designed to evaluate if the addition of metformin to the standard treatment of non-diabetic patients with MetS improves diastolic dysfunction. Methods Prospective, randomized, open-label, blinded-endpoint trial. Fifty-four non-diabetic adults with MetS and diastolic dysfunction were randomized to lifestyle counseling or lifestyle counseling plus metformin (target dose 1000 mg bid). The primary endpoint was the change in mean e’ velocity (assessed at baseline, 6, 12 and 24 months). Secondary endpoints were improvements in insulin resistance, functional capacity and QoL. Linear mixed effects modelling was used for longitudinal data analysis using modified intention-to-treat (mITT) and per-protocol (PP) approaches. Results Forty-nine patients were included in the mITT analysis (mean age = 51.8 ± 6.4; 55% males). Metformin treatment was associated with a significant decrease in HOMA-IR. There was a significantly different mean change in e’ velocity during the study period between trial arms, both in the mITT (at 24 months, change of +0.67 ± 1.90cm/s in metformin arm vs. -0.33 ± 1.50cm/s in control arm) and PP populations (+0.80 ± 1.99cm/s in metformin arm vs. -0.37 ± 1.52cm/s in control arm), using a random intercept linear mixed model. There were no significant differences in peak oxygen uptake and SF-36 scores between trial arms. Conclusion Treatment with metformin of non-diabetic MetS patients with diastolic dysfunction, on top of lifestyle counseling, is associated with improved diastolic function. Abstract Figure.

Identification of Sensitive Measures of Recovery After External Load From Football Match Play

2017 ◽  
Vol 12 (7) ◽  
pp. 969-976 ◽  
Author(s):  
Amber E. Rowell ◽  
Robert J. Aughey ◽  
Will G. Hopkins ◽  
Andrew M. Stewart ◽  
Stuart J. Cormack
Keyword(s):  
Mixed Model ◽  
Linear Mixed Model ◽  
Individual Variability ◽  
High Load ◽  
Football Players ◽  
Jump Height ◽  
Match Play ◽  
Salivary Testosterone ◽  
Football Match ◽  
Change In Mean

Objective measures of recovery from football match play could be useful for assessing athletes’ readiness to train, if sensitive to preceding match load.Purpose:To identify the sensitivity of countermovement-jump (CMJ) performance and concentration of salivary testosterone and cortisol relative to elite football match load.Methods:CMJ performance and salivary hormones were measured in 18 elite football players before (27, 1 h) and after (0.5, 18, 42, 66, 90 h) 3 consecutive matches. Match load was determined via accelerometer-derived PlayerLoad and divided into tertiles. Sensitivity of CMJ performance and hormone concentrations to match load was quantified with t statistics and magnitude-based inferences (change in mean as % ± 90% confidence interval) derived with a linear mixed model.Results:Jump height was reduced in medium and high load at 0.5 h (10% ± 7% and 16% ± 8%) and 18 h (7% ± 4% and 9% ± 5%) postmatch. There was a 12% ± 7% reduction in ratio of flight time to contraction time (FT:CT) in high load at 0.5 h post, with reductions in medium and high load at 18 h. Reductions in FT:CT persisted at later postmatch time points than changes in jump height. Increased cortisol (range 55–165%) and testosterone (range 17–20%) were observed in all match loads at 0.5 h post, with individual variability thereafter.Conclusions:Measures of CMJ performance and hormonal concentrations were sensitive to levels of A League football match load. Although jump height was reduced immediately postmatch, FT:CT provided a more sensitive measure of recovery. Football match play induces an acute hormonal response with substantial individual variability thereafter.

scholarly journals Solutions for Determining the Significance Region Using the Johnson-Neyman Type Procedure in Generalized Linear (Mixed) Models

2011 ◽  
Vol 36 (6) ◽  
pp. 699-719 ◽  
Author(s):  
Ann A. Lazar ◽  
Gary O. Zerbe
Keyword(s):  
Error Rate ◽  
Multiple Testing ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Type I Error ◽  
Hierarchical Linear Model ◽  
Wald Test ◽  
Analysis Of Covariance ◽  
Type I ◽  
Type I Error Rate

Researchers often compare the relationship between an outcome and covariate for two or more groups by evaluating whether the fitted regression curves differ significantly. When they do, researchers need to determine the “significance region,” or the values of the covariate where the curves significantly differ. In analysis of covariance (ANCOVA), the Johnson-Neyman procedure can be used to determine the significance region; for the hierarchical linear model (HLM), the Miyazaki and Maier (M-M) procedure has been suggested. However, neither procedure can assume nonnormally distributed data. Furthermore, the M-M procedure produces biased (downward) results because it uses the Wald test, does not control the inflated Type I error rate due to multiple testing, and requires implementing multiple software packages to determine the significance region. In this article, we address these limitations by proposing solutions for determining the significance region suitable for generalized linear (mixed) model (GLM or GLMM). These proposed solutions incorporate test statistics that resolve the biased results, control the Type I error rate using Scheffé’s method, and uses a single statistical software package to determine the significance region.

scholarly journals Reduced Cognitive and Psychomotor Impairment with Extended-Release Oxymorphone Versus Controlled-Release Oxycodone

2010 ◽  
Vol 6;13 (6;12) ◽  
pp. 561-573
Author(s):  
Kerri A. Schoedel
Keyword(s):  
Reaction Time ◽  
Controlled Release ◽  
Extended Release ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Analysis Of Covariance ◽  
Tracking Accuracy ◽  
Double Blind ◽  
Psychomotor Effects ◽  
Psychomotor Impairment

Background: Opioids provide effective pain control, yet have risks including adverse events (AEs) (e.g., constipation, nausea/vomiting, sedation) and cognitive/psychomotor effects. Objective: To compare cognitive and psychomotor effects of oxymorphone extended release (OM-ER) versus oxycodone controlled release (OC-CR). Study design: Randomized, double-blind, 5-way crossover Setting: Single inpatient research unit Methods: Nondependent recreational opioid users were administered single intact oral tablets of placebo, OM-ER (15 and 30 mg), and OC-CR (30 and 60 mg), separated by a 7- to 21-day washout. The divided attention (DA) test measured psychomotor impairment (e.g., manual tracking [e.g., percentage over road], target accuracy [e.g., target hits], reaction time [hit latency]). Visual analog scales measured alertness/drowsiness, agitation/relaxation, and dizziness. Sedative, stimulant, and dysphoric effects were measured using the Addiction Research Center Inventory PentobarbitalChlorpromazine-Alcohol (PCAG), Benzedrine Group (BG), and Lysergic Acid Diethylamide (LSD) scales, respectively. Comparisons were made between equianalgesic doses (OM-ER 15 mg vs OCCR 30 mg; OM-ER 30 mg vs OC-CR 60 mg), within active drug doses, and between active drugs and placebo using least squares (LS) mean difference of the peak maximum (Emax) or minimum (Emin) effect using linear mixed model analysis of covariance. Results: Thirty-five participants received all 5 treatments. Peak cognitive and psychomotor impairment (LS mean [SE]) was less with OM-ER than equianalgesic doses of OC-CR for reaction time (Emax hit latency, longer if impaired; 571.2 [13.4] vs 588.1 ms [13.4], P=0.03 for OM-ER 15 mg vs OC-CR 30 mg, respectively; 572.4 [13.4] vs 604.3 ms [13.4], P<0.001 for OM-ER 30 mg vs OC-CR 60 mg, respectively); tracking accuracy (Emin percentage over road, lower if impaired; 71.4 [2.4] vs 65.3 [2.4], P=0.007; 69.9 [2.4] vs 59.4 [2.4], P<0.001), and target accuracy (Emin target hits percentage, lower if impaired; 81.0 [3.1] vs 74.5 [3.1], P=0.02; 79.4 [3.1] vs 66.1 [3.1], P<0.001). Several other DA measures showed that OC-CR, especially 60 mg, produced more psychomotor impairment than equianalgesic OM-ER. Compared to OM-ER, OC-CR produced more dizziness (Emax, P<0.001 for OM-ER 15 mg vs OC-CR 30 mg and for OM-ER 30 mg vs OC-CR 60 mg), drowsiness (Emax, P<0.001 for both equianalgesic dose groups), relaxation (Emin, P=0.003 for OM-ER 15 mg vs OC-CR 30 mg; P=0.001 for OM-ER 30 mg vs OC-CR 60 mg), dysphoria (Emax LSD, P<0.001 for both equianalgesic dose groups), and sedation (Emax, PCAG; P<0.001 for both equianalgesic dose groups) and less stimulation (BG, Emin; P=0.01 for OM-ER 15 mg vs OC-CR mg; P<0.001 for OM-ER 30 mg vs OC-CR 60 mg). Several AEs occurred more commonly with OC-CR than OM-ER (e.g., euphoria, nausea, somnolence, vomiting, dizziness). Limitations: Participants were young, healthy volunteer nondependent recreational drug users, and only single doses were evaluated. The effects of tampering or higher doses were not assessed. Conclusions: Single oral intact low and high doses of OM-ER produced less cognitive and psychomotor impairment plus less sedation than equianalgesic OC-CR in this exploratory study. ClinicalTrials.gov registration NCT00955110 Key words: opioid, cognitive effects, psychomotor effects, sedation, dysphoria, oxymorphone, oxycodone, long-acting opioids

scholarly journals Skin Carotenoid Accumulation in Response to a Two-Week Sweet Potato Snack Added to the Usual Diet

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 121-121
Author(s):  
Taylor Erickson ◽  
Rui Li ◽  
Elizabeth Woods ◽  
Stephanie Dickinson ◽  
Alyce Fly
Keyword(s):  
Sweet Potato ◽  
Repeated Measures ◽  
Fixed Effects ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Least Square ◽  
Post Intervention ◽  
Change In Mean ◽  
Usual Diet ◽  
Over Time

Abstract Objectives To evaluate changes in skin carotenoid score (SCS) from baseline, during and following a two-week sweet potato snack added to a participant's usual diet. Methods Forty participants were recruited by convenience for a 7-week longitudinal cohort study with a 1-week period to establish baseline SCS, an intervention consisting of a sweet potato snack fed 3 times/week for 2 weeks in the lab while consuming a usual diet outside of the lab, followed by a 4-week monitoring period. SCS were measured 17 times over the study with pressure-mediated reflectance spectroscopy (Veggie Meter). SCS were analyzed using a linear mixed model (LMM) with repeated measures (fixed effects) to determine whether SCS increased from baseline to the follow up points of the intervention and post-intervention periods (α = 0.05). Data were plotted with a Loess line to visualize change over time. Secondary analyses were conducted to determine if baseline SCS affected time to detect differences post-intervention. Baseline SCS tertiles were analyzed using LMM with repeated measures (fixed effects, α = 0.05). Simple differences in least square means were calculated for each tertile at each time point. Results Participants included 28 (72%) females and 11 (28%) males from 20–62 years who identified themselves as “White” (69.2%), “Asian” (23.1%), “Black/African American” (5.1%), and “Other-Latina” (2.6%). Five participants (12.8%) reported a Hispanic ethnicity. Analyses included 39 of 40 original participants, as one withdrew the first week of the study. Change in mean SCS from baseline over time was significant (P &lt; 0.001). While SCS during the intervention period were not significantly higher than baseline (P = 0.271), those at post-intervention were higher (P &lt; 0.001). The Loess line for mean change in SCS from baseline depicted a period of consistent increase from day 26 to day 36, approximately 3 weeks after the start of the intervention. Change in SCS across periods for all tertiles was significant (P &lt; 0.001). Conclusions These data suggest that 3 weeks after the beginning of a two-week intervention may be a period of interest when measuring the efficacy of such an intervention. Additionally, the difference in mean SCS between periods may depend on baseline SCS. Funding Sources This project was funded in part by Indiana University.

Analyzing discontinuities in longitudinal count data: A multilevel generalized linear mixed model.

2020 ◽  
Author(s):  
James L. Peugh ◽  
Sarah J. Beal ◽  
Meghan E. McGrady ◽  
Michael D. Toland ◽  
Constance Mara
Keyword(s):  
Count Data ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Generalized Linear Mixed Model ◽  
Longitudinal Count Data

Predicting bycatch hotspots based on suitable habitat derived from fishery-independent data

2020 ◽  
Vol 641 ◽  
pp. 159-175
Author(s):  
J Runnebaum ◽  
KR Tanaka ◽  
L Guan ◽  
J Cao ◽  
L O’Brien ◽  
...  
Keyword(s):  
Habitat Suitability ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Gulf Of Maine ◽  
Homarus Americanus ◽  
Management Tool ◽  
American Lobster ◽  
Suitable Habitat ◽  
Climate Conditions ◽  
Suitability Index

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.

Long-term seizure outcomes after pediatric temporal lobectomy: does brain MRI lesion matter?

2019 ◽  
Vol 24 (2) ◽  
pp. 200-208
Author(s):  
Ravindra Arya ◽  
Francesco T. Mangano ◽  
Paul S. Horn ◽  
Sabrina K. Kaul ◽  
Serena K. Kaul ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Hippocampal Sclerosis ◽  
Brain Mri ◽  
Temporal Lobectomy ◽  
Seizure Freedom ◽  
Seizure Onset

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.

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