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

2021 ◽  
Author(s):  
Judith Rösler ◽  
Stefan Georgiev ◽  
Anna Lena 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

Abstract Background Exoscopic 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. Methods 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 analyze 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. Results 39 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. Conclusion 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 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 Whole Wheat and Bran Cereal Affects Microbiome Stability

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 1162-1162
Author(s):  
Abigail Johnson ◽  
Mo Houtti ◽  
Anna Saboe ◽  
Katie Koecher ◽  
Ravi Menon ◽  
...  
Keyword(s):  
Beta Diversity ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Alpha Diversity ◽  
Dosage Level ◽  
Rank Test ◽  
Microbiome Composition ◽  
Whole Wheat ◽  
The Impact ◽  
Fiber Cereal

Abstract Objectives Health outcomes in previous fiber intervention studies have been variable, potentially due to differences in gut microbiome composition. This study aimed to determine if the effect of fiber intervention on the microbiome differs by initial microbiome or the quantity of fiber provided. Methods This study was designed as a randomized, un-blinded, cross-over trial of fiber cereal dosage. The cross-over design tested the effect of two 2-week long interventions with a High (28g) and Low (14g) level of daily supplemental fiber from whole wheat and bran cereal. Analysis was also completed on the overall study as a single arm, non-randomized, intervention of fiber cereal. The study enrolled 31 healthy adults. The microbiome was assessed at baseline and after intervention for changes in diversity, composition, and stability. Results Across all individuals, fiber intervention increased microbiome alpha-diversity (paired t-test, P = 0.047), but the microbiome was otherwise resistant to the effects of the intervention. Increasing fiber dose (High v. Low) was not associated with consistent changes in beta-diversity (linear mixed models). Approximately 20% of subjects were identified as responders based on beta diversity effect size. At baseline, responders had higher Prevotella copri and lower Bacteroides abundance than non-responders (Wilcoxon rank sum, qval < 0.05). In responders, fiber intake caused increased abundance of Bacteroides and Alistipes and reduced Prevotella (paired Wilcoxon, q < 0.2). In all subjects, fiber intervention decreased microbiome stability (paired Wilcoxon signed rank test, P = 0.006). In responders, there was a significant effect of the fiber level on stability, with higher fiber further lowering stability (linear mixed model, P = 0.05). Conclusions Our data suggest a responder/non-responder microbiome signature for this whole wheat and bran fiber cereal. We find that many effects were not additive by dosage level. Overall, microbiome diversity was increased and stability was decreased during the fiber cereal intervention and in responders this was dose dependent; the clinical implications of the impact of changes in stability remain unknown, and it is possible that the microbiome would stabilize in a longer intervention study. ClinicalTrials.gov identifier: NCT03623308. Funding Sources General Mills, Inc.

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 (>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.

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.

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

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.

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

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.

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

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.

The Impact of Clinical Review Bias on Child Language Grammaticality

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.

scholarly journals Early lactate changes improve the outcome prediction for extracorporeal membrane oxygenation

2020 ◽  
Vol 58 (5) ◽  
pp. 915-922
Author(s):  
Ting-Tse Lin ◽  
Ming-Hsien Lin ◽  
Cho-Kai Wu ◽  
Lian-Yu Lin ◽  
Jou-Wei Lin ◽  
...  
Keyword(s):  
Mixed Model ◽  
Linear Mixed Model ◽  
Life Support ◽  
Lactate Clearance ◽  
Joint Model ◽  
University Hospital ◽  
Reduced Model ◽  
Model Estimate ◽  
Adjusted Model ◽  
The Impact

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.

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

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.

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