Health-related quality of life one year after refractory cardiac arrest treated with conventional or extracorporeal CPR; a secondary analysis of the INCEPTION-trial

Background: Prospective, trial-based data comparing health-related quality of life (HRQoL) in patients surviving out-of-hospital cardiac arrest (OHCA) through extracorporeal cardiopulmonary resuscitation (ECPR) or conventional CPR (CCPR) are scarce. We aimed to determine HRQoL during 1-year after refractory OHCA in patients treated with ECPR and CCPR. Methods: We present a secondary analysis of the multicenter INCEPTION-trial, which studied the effectiveness of ECPR versus CCPR in patients with refractory OHCA. HRQoL was prospectively assessed using the EQ-5D-5L questionnaire. Poor HRQoL was pragmatically defined as an EQ-5D-5L health utility index (HUI) > 1 SD below the age-adjusted norm. We used mixed linear models to assess the difference in HRQoL over time and univariable analyses to assess factors potentially associated with poor HRQoL. Results: A total of 134 patients were enrolled, and hospital survival was 20% (27 patients). EQ-5D-5L data were available for 25 patients (5 ECPR and 20 CCPR). One year after OHCA, the estimated mean HUI was 0.73 (0.05) in all patients, 0.84 (0.12) in ECPR survivors, and 0.71 (0.05) in CCPR survivors (p-value 0.31). Eight (32%) survivors had a poor HRQoL. HRQoL was good in 17 (68%) patients, with 100% in ECPR survivors versus 60% in CCPR survivors (p-value 0.14). Conclusion: One year after refractory OHCA, 68% of the survivors had a good HRQoL. We found no statistically significant difference in HRQoL one year after OHCA in patients treated with ECPR compared to CCPR. However, numerical differences may be clinically relevant in favor of ECPR

Skill training project

The aim of this project was to investigate whether the short-term acquisition of a new force-matching skill is mediated by alterations in the shared synaptic input to spinal motor neurons. For this purpose, we decomposed high-density surface electromyograms from a hand (first dorsal interosseous; FDI) and a leg (tibialis anterior; TA) muscle using this algorithm. We also conducted simulations of entire motor neuron pools to elucidate the neural mechanisms that could explain our results. For further details, please refers to the READ ME file.</p

Muscle length project

The aim of this project was to investigate whether whether alterations in muscle length could alter the common synaptic oscillations to spinal motor neurons, particularly in the tremor band (5-15 Hz). To achieve this, we decomposed motor unit spike trains from high-density surface electromyograms recorded from a leg muscle (tibialis anterior; TA) at two different muscle lengths using this algorithm. To interpret the results derived from the motor unit spike trains, we conducted a second set of experiments, combined with computational simulations, to investigate how changes in muscle length affected the low-pass characteristics of the TA twitches.For further details, please refers to the READ ME file.</p

Embedded dialogue and dreams: the worlds and accessibility relations of Inception

In this article, Text World Theory (Gavins, 2007; Werth, 1999) and Ryan’s model of fictional worlds (1991a, 1991b) are both applied to Nolan’s blockbuster film, Inception (2010) to explore the multi-layered architecture of the narrative. The opening two scenes of Nolan’s screenplay are analysed using Text World Theory, with particular attention to the embedded nature of character dialogue, or, more generally, ‘represented discourse’ (Herman, 1993), otherwise known as Direct Speech (Leech and Short, 2007). Based on this analysis, I suggest a modification to the way in which Text World Theory deals with represented discourse, which improves the framework’s applicability to all text types. Moving from the micro-analysis of the screenplay text, to a macro-analysis of the film narrative as a whole, I outline the various different worlds that make up the reality, dream and ‘limbo’ layers in the film, explaining how most of the action takes place at a remove from the world at the centre of the textual system. I use Deictic Shift Theory’s terms PUSH and POP (Galbraith, 1995) to describe the movements between the ontological layers of the narrative and suggest that these terms are better suited to describe hierarchies of ontology rather than horizontal deictic shifts. Ryan’s taxonomy of accessibility relations is used to describe the ways in which the film differs from reality, as well as the ways in which the dreams differ from the internal reality of the film. The complex ontological structure and asymmetric accessibility relations between the worlds are ascribed as the reason for many viewers’ difficulty in processing the film’s narrative. With its attention to discourse-world factors, Text World Theory is then used to account for the myriad of reactions to Inception – as expressed on online discussion forums – which range from engagement and enjoyment to frustration and resistance

A review and proposal for a core set of factors for prospective cohorts in low back pain : a consensus statement

No abstrac

Determinants of health-related quality of life in a multinational systemic sclerosis inception cohort.

OBJECTIVES: To evaluate health-related quality of life (HRQoL) and its determinants in a systemic sclerosis (SSc) multinational inception cohort. We performed a meta-analysis of data from individual countries, and compared the meta-analysis to individual country results by pooling data from each of the countries. METHODS: SSc patients within 2 years of disease onset were recruited from 5 countries participating in the International Systemic Sclerosis Inception Cohort (INSYNC). Data from each country's database were exported for analysis using a harmonised platform. HRQoL was assessed using the Medical Outcomes Short Form-36 (SF-36). Multivariate linear regression assessed associations between HRQoL and predictors in cohorts separately and meta-analyzed to generate pooled estimates. The analyses were repeated using individual patient data. RESULTS: Of the 637 SSc patients recruited, the majority was female (80.2%-83.3%), aged between 52.4-56.7 years with limited cutaneous disease subtype (48.6%-66.7%). HRQoL scores were lower for SSc patients than the general population (SF-36 physical component summary (PCS) score (36.4-39.6), mental component summary (MCS) score (41.0-46.4)). Determinants of SF-36 PCS by meta-analysis included increasing age (β=-0.1, 95%CI -0.2, -0.01), diffuse cutaneous disease subtype (β=-8.4, 95%CI -10.6, -6.3), and pulmonary arterial hypertension (β=-10.9, 95%CI -16.6, -5.3). Increasing age (β=0.09, 95%CI 0.0, 0.18) was the only variable associated with SF-36 MCS. Analyses using individual patient data revealed similar results to those of the meta-analysis of cohort data. CONCLUSIONS: Our study provides estimates of HRQoL in a large inception SSc cohort and provides evidence that individual patient data analysis is valid in the INSYNC dataset

Determinants of health-related quality of life in a multinational systemic sclerosis inception cohort

OBJECTIVES: To evaluate health-related quality of life (HRQoL) and its determinants in a systemic sclerosis (SSc) multinational inception cohort. We performed a meta-analysis of data from individual countries, and compared the meta-analysis to individual country results by pooling data from each of the countries. METHODS: SSc patients within 2 years of disease onset were recruited from 5 countries participating in the International Systemic Sclerosis Inception Cohort (INSYNC). Data from each country's database were exported for analysis using a harmonised platform. HRQoL was assessed using the Medical Outcomes Short Form-36 (SF-36). Multivariate linear regression assessed associations between HRQoL and predictors in cohorts separately and meta-analyzed to generate pooled estimates. The analyses were repeated using individual patient data. RESULTS: Of the 637 SSc patients recruited, the majority was female (80.2%-83.3%), aged between 52.4-56.7 years with limited cutaneous disease subtype (48.6%-66.7%). HRQoL scores were lower for SSc patients than the general population (SF-36 physical component summary (PCS) score (36.4-39.6), mental component summary (MCS) score (41.0-46.4)). Determinants of SF-36 PCS by meta-analysis included increasing age (β=-0.1, 95%CI -0.2, -0.01), diffuse cutaneous disease subtype (β=-8.4, 95%CI -10.6, -6.3), and pulmonary arterial hypertension (β=-10.9, 95%CI -16.6, -5.3). Increasing age (β=0.09, 95%CI 0.0, 0.18) was the only variable associated with SF-36 MCS. Analyses using individual patient data revealed similar results to those of the meta-analysis of cohort data. CONCLUSIONS: Our study provides estimates of HRQoL in a large inception SSc cohort and provides evidence that individual patient data analysis is valid in the INSYNC dataset.K. Morrisroe, M. Hudson, M. Baron, J. de Vries-Bouwstra, P. Carreira, D. Wuttge, M. Wang, T. Frech, W. Stevens, S. Proudman, M. Nikpour (International Systemic Sclerosis Inception Cohort (INSYNC) collaboration