56 research outputs found
Multinational development and validation of an early prediction model for delirium in ICU patients
Rationale
Delirium incidence in intensive care unit (ICU) patients is high and associated with poor outcome. Identification of high-risk patients may facilitate its prevention.
Purpose
To develop and validate a model based on data available at ICU admission to predict delirium development during a patientâs complete ICU stay and to determine the predictive value of this model in relation to the time of delirium development.
Methods
Prospective cohort study in 13 ICUs from seven countries. Multiple logistic regression analysis was used to develop the early prediction (E-PRE-DELIRIC) model on data of the first two-thirds and validated on data of the last one-third of the patients from every participating ICU.
Results
In total, 2914 patients were included. Delirium incidence was 23.6 %. The E-PRE-DELIRIC model consists of nine predictors assessed at ICU admission: age, history of cognitive impairment, history of alcohol abuse, blood urea nitrogen, admission category, urgent admission, mean arterial blood pressure, use of corticosteroids, and respiratory failure. The area under the receiver operating characteristic curve (AUROC) was 0.76 [95 % confidence interval (CI) 0.73â0.77] in the development dataset and 0.75 (95 % CI 0.71â0.79) in the validation dataset. The model was well calibrated. AUROC increased from 0.70 (95 % CI 0.67â0.74), for delirium that developed 6 days.
Conclusion
Patientsâ delirium risk for the complete ICU length of stay can be predicted at admission using the E-PRE-DELIRIC model, allowing early preventive interventions aimed to reduce incidence and severity of ICU delirium
Planetary population synthesis
In stellar astrophysics, the technique of population synthesis has been
successfully used for several decades. For planets, it is in contrast still a
young method which only became important in recent years because of the rapid
increase of the number of known extrasolar planets, and the associated growth
of statistical observational constraints. With planetary population synthesis,
the theory of planet formation and evolution can be put to the test against
these constraints. In this review of planetary population synthesis, we first
briefly list key observational constraints. Then, the work flow in the method
and its two main components are presented, namely global end-to-end models that
predict planetary system properties directly from protoplanetary disk
properties and probability distributions for these initial conditions. An
overview of various population synthesis models in the literature is given. The
sub-models for the physical processes considered in global models are
described: the evolution of the protoplanetary disk, the planets' accretion of
solids and gas, orbital migration, and N-body interactions among concurrently
growing protoplanets. Next, typical population synthesis results are
illustrated in the form of new syntheses obtained with the latest generation of
the Bern model. Planetary formation tracks, the distribution of planets in the
mass-distance and radius-distance plane, the planetary mass function, and the
distributions of planetary radii, semimajor axes, and luminosities are shown,
linked to underlying physical processes, and compared with their observational
counterparts. We finish by highlighting the most important predictions made by
population synthesis models and discuss the lessons learned from these
predictions - both those later observationally confirmed and those rejected.Comment: 47 pages, 12 figures. Invited review accepted for publication in the
'Handbook of Exoplanets', planet formation section, section editor: Ralph
Pudritz, Springer reference works, Juan Antonio Belmonte and Hans Deeg, Ed
Cumulative Low Back Load at Work as a Risk Factor of Low Back Pain: A Prospective Cohort Study
Purpose Much research has been performed on physical exposures during work (e.g. lifting, trunk flexion or body vibrations) as risk factors for low back pain (LBP), however results are inconsistent. Information on the effect of doses (e.g. spinal force or low back moments) on LBP may be more reliable but is lacking yet. The aim of the present study was to investigate the prospective relationship of cumulative low back loads (CLBL) with LBP and to compare the association of this mechanical load measure to exposure measures used previously. Methods The current study was part of the Study on Musculoskeletal disorders, Absenteeism and Health (SMASH) study in which 1,745 workers completed questionnaires. Physical load at the workplace was assessed by video-observations and force measurements. These measures were used to calculate CLBL. Furthermore, a 3-year follow-up was conducted to assess the occurrence of LBP. Logistic regressions were performed to assess associations of CLBL and physical risk factors established earlier (i.e. lifting and working in a flexed posture) with LBP. Furthermore, CLBL and the risk factors combined were assessed as predictors in logistic regression analyses to assess the association with LBP. Results Results showed that CLBL is a significant risk factor for LBP (OR: 2.06 (1.32-3.20)). Furthermore, CLBL had a more consistent association with LBP than two of the three risk factors reported earlier. Conclusions From these results it can be concluded that CLBL is a risk factor for the occurrence of LBP, having a more consistent association with LBP compared to most risk factors reported earlier. © 2012 The Author(s)
Splinting or surgery for carpal tunnel syndrome? Design of a randomized controlled trial [ISRCTN18853827]
BACKGROUND: Carpal tunnel syndrome is a common disorder, which can be treated with surgery or conservative options. However, there is insufficient evidence and no consensus among physicians with regard to the preferred treatment for carpal tunnel syndrome. Therefore, a randomized controlled trial is conducted to compare the short- and long-term efficacy of surgery and splinting in patients with carpal tunnel syndrome. An attempt is also made to avoid the (methodological) limitations encountered in earlier trials on the efficacy of various treatment options for carpal tunnel syndrome. METHODS: Patients of 18 years and older, with clinically and electrophysiologically confirmed idiopathic carpal tunnel syndrome, are recruited by neurologists in 13 hospitals. Patients included in the study are randomly allocated to either open carpal tunnel release or wrist splinting during the night for at least 6 weeks. The primary outcomes are general improvement, waking up at night and severity of symptoms (main complaint, night and daytime pain, paraesthesia and hypoesthesia). Outcomes are assessed up to 18 months after randomization
Rare Copy Number Variants Observed in Hereditary Breast Cancer Cases Disrupt Genes in Estrogen Signaling and TP53 Tumor Suppression Network
Breast cancer is the most common cancer in women in developed countries, and the contribution of genetic susceptibility to breast cancer development has been well-recognized. However, a great proportion of these hereditary predisposing factors still remain unidentified. To examine the contribution of rare copy number variants (CNVs) in breast cancer predisposition, high-resolution genome-wide scans were performed on genomic DNA of 103 BRCA1, BRCA2, and PALB2 mutation negative familial breast cancer cases and 128 geographically matched healthy female controls; for replication an independent cohort of 75 similarly mutation negative young breast cancer patients was used. All observed rare variants were confirmed by independent methods. The studied breast cancer cases showed a consistent increase in the frequency of rare CNVs when compared to controls. Furthermore, the biological networks of the disrupted genes differed between the two groups. In familial cases the observed mutations disrupted genes, which were significantly overrepresented in cellular functions related to maintenance of genomic integrity, including DNA double-strand break repair (Pâ=â0.0211). Biological network analysis in the two independent breast cancer cohorts showed that the disrupted genes were closely related to estrogen signaling and TP53 centered tumor suppressor network. These results suggest that rare CNVs represent an alternative source of genetic variation influencing hereditary risk for breast cancer
Mammalian NADH:ubiquinone oxidoreductase (Complex I) and nicotinamide nucleotide transhydrogenase (Nnt) together regulate the mitochondrial production of H2O2âImplications for their role in disease, especially cancer
International Consensus Statement on Rhinology and Allergy: Rhinosinusitis
Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICARâRS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICARâRSâ2021 as well as updates to the original 140 topics. This executive summary consolidates the evidenceâbased findings of the document. Methods: ICARâRS presents over 180 topics in the forms of evidenceâbased reviews with recommendations (EBRRs), evidenceâbased reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICARâRSâ2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidenceâbased management algorithm is provided. Conclusion: This ICARâRSâ2021 executive summary provides a compilation of the evidenceâbased recommendations for medical and surgical treatment of the most common forms of RS
Perspectives on Salutogenesis of Scholars Writing in Dutch
It is quite uncommon in The Netherlands to publish in Dutch so most publications about salutogenesis are in English. However, we identified 19 publications written in Dutch. These are publications in the field of development psychology, workplace health, mental health, medicine, care for people with disabilities, and musical and art therapy. In the Dutch language literature, salutogenesis is mainly conceptualized in terms of the sense of coherence, and one of its elements: meaningfulness. Generalized resistance resources are hardly mentioned. Most often salutogenesis was applied in a conceptual way (12 studies), but we also found seven studies with empirical research
Aan lage rugpijn gerelateerde beroepsziekten in Nederland: (1) Een instrument voor de beoordeling van de werkgerelateerdheid van aspecifieke lage rugklachten
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