DataSheet_1_A latent scale model to minimize subjectivity in the analysis of visual rating data for the National Turfgrass Evaluation Program.csv

IntroductionTraditional evaluation procedure in National Turfgrass Evaluation Program (NTEP) relies on visually assessing replicated turf plots at multiple testing locations. This process yields ordinal data; however, statistical models that falsely assume these to be interval or ratio data have almost exclusively been applied in the subsequent analysis. This practice raises concerns about procedural subjectivity, preventing objective comparisons of cultivars across different test locations. It may also lead to serious errors, such as increased false alarms, failures to detect effects, and even inversions of differences among groups.MethodsWe reviewed this problem, identified sources of subjectivity, and presented a model-based approach to minimize subjectivity, allowing objective comparisons of cultivars across different locations and better monitoring of the evaluation procedure. We demonstrate how to fit the described model in a Bayesian framework with Stan, using datasets on overall turf quality ratings from the 2017 NTEP Kentucky bluegrass trials at seven testing locations.ResultsCompared with the existing method, ours allows the estimation of additional parameters, i.e., category thresholds, rating severity, and within-field spatial variations, and provides better separation of cultivar means and more realistic standard deviations.DiscussionTo implement the proposed model, additional information on rater identification, trial layout, rating date is needed. Given the model assumptions, we recommend small trials to reduce rater fatigue. For large trials, ratings can be conducted for each replication on multiple occasions instead of all at once. To minimize subjectivity, multiple raters are required. We also proposed new ideas on temporal analysis, incorporating existing knowledge of turfgrass.</p

Image_1_A latent scale model to minimize subjectivity in the analysis of visual rating data for the National Turfgrass Evaluation Program.png

IntroductionTraditional evaluation procedure in National Turfgrass Evaluation Program (NTEP) relies on visually assessing replicated turf plots at multiple testing locations. This process yields ordinal data; however, statistical models that falsely assume these to be interval or ratio data have almost exclusively been applied in the subsequent analysis. This practice raises concerns about procedural subjectivity, preventing objective comparisons of cultivars across different test locations. It may also lead to serious errors, such as increased false alarms, failures to detect effects, and even inversions of differences among groups.MethodsWe reviewed this problem, identified sources of subjectivity, and presented a model-based approach to minimize subjectivity, allowing objective comparisons of cultivars across different locations and better monitoring of the evaluation procedure. We demonstrate how to fit the described model in a Bayesian framework with Stan, using datasets on overall turf quality ratings from the 2017 NTEP Kentucky bluegrass trials at seven testing locations.ResultsCompared with the existing method, ours allows the estimation of additional parameters, i.e., category thresholds, rating severity, and within-field spatial variations, and provides better separation of cultivar means and more realistic standard deviations.DiscussionTo implement the proposed model, additional information on rater identification, trial layout, rating date is needed. Given the model assumptions, we recommend small trials to reduce rater fatigue. For large trials, ratings can be conducted for each replication on multiple occasions instead of all at once. To minimize subjectivity, multiple raters are required. We also proposed new ideas on temporal analysis, incorporating existing knowledge of turfgrass.</p

Process of theme development (following Braun & Clarke, 2006).

Process of theme development (following Braun & Clarke, 2006).</p

The proportion (%) of intervention adherence in each paediatric intensive care unit.

The proportion (%) of intervention adherence in each paediatric intensive care unit.</p

SANDWICH implementation.

BackgroundProlonged mechanical ventilation increases the risk of mortality and morbidity. Optimising sedation and early testing for possible liberation from invasive mechanical ventilation (IMV) has been shown to reduce time on the ventilator. Alongside a multicentre trial of sedation and ventilation weaning, we conducted a mixed method process evaluation to understand how the intervention content and delivery was linked to trial outcomes.Methods10,495 children admitted to 18 paediatric intensive care units (ICUs) in the United Kingdom participated in a stepped-wedge, cluster randomised controlled trial, with 1955 clinical staff trained to deliver the intervention. The intervention comprised assessment and optimisation of sedation levels, and bedside screening of respiratory parameters to indicate readiness for a spontaneous breathing trial prior to liberation from ventilation. 193 clinical staff were interviewed towards the end of the trial. Interview data were thematically analysed, and quantitative adherence data were analysed using descriptive statistics.ResultsThe intervention led to a reduced duration of IMV (adjusted median difference– 7.1 hours, 95% CI -9.6 to -5.3, p = 0.01). Overall intervention adherence was 75% (range 59–85%). Ease and flexibility of the intervention promoted it use; designated responsibilities, explicit pathways of decision-making and a shared language for communication fostered proactivity and consistency towards extubation. Delivery of the intervention was hindered by established hospital and unit organisational and patient care routines, clinician preference and absence of clinical leadership.ConclusionsThe SANDWICH trial showed a significant, although small, reduction in duration of IMV. Findings suggest that greater direction in decision-making pathways, robust embedment of new practice in unit routine, and capitalising on the skills of Advanced Nurse Practitioners and physiotherapists would have contributed to greater intervention effect.Trial registrationisrctn.org Identifier: ISRCTN16998143.</div

SANDWICH and usual care.

BackgroundProlonged mechanical ventilation increases the risk of mortality and morbidity. Optimising sedation and early testing for possible liberation from invasive mechanical ventilation (IMV) has been shown to reduce time on the ventilator. Alongside a multicentre trial of sedation and ventilation weaning, we conducted a mixed method process evaluation to understand how the intervention content and delivery was linked to trial outcomes.Methods10,495 children admitted to 18 paediatric intensive care units (ICUs) in the United Kingdom participated in a stepped-wedge, cluster randomised controlled trial, with 1955 clinical staff trained to deliver the intervention. The intervention comprised assessment and optimisation of sedation levels, and bedside screening of respiratory parameters to indicate readiness for a spontaneous breathing trial prior to liberation from ventilation. 193 clinical staff were interviewed towards the end of the trial. Interview data were thematically analysed, and quantitative adherence data were analysed using descriptive statistics.ResultsThe intervention led to a reduced duration of IMV (adjusted median difference– 7.1 hours, 95% CI -9.6 to -5.3, p = 0.01). Overall intervention adherence was 75% (range 59–85%). Ease and flexibility of the intervention promoted it use; designated responsibilities, explicit pathways of decision-making and a shared language for communication fostered proactivity and consistency towards extubation. Delivery of the intervention was hindered by established hospital and unit organisational and patient care routines, clinician preference and absence of clinical leadership.ConclusionsThe SANDWICH trial showed a significant, although small, reduction in duration of IMV. Findings suggest that greater direction in decision-making pathways, robust embedment of new practice in unit routine, and capitalising on the skills of Advanced Nurse Practitioners and physiotherapists would have contributed to greater intervention effect.Trial registrationisrctn.org Identifier: ISRCTN16998143.</div

<i>PLOS ONE</i> clinical studies checklist.

BackgroundProlonged mechanical ventilation increases the risk of mortality and morbidity. Optimising sedation and early testing for possible liberation from invasive mechanical ventilation (IMV) has been shown to reduce time on the ventilator. Alongside a multicentre trial of sedation and ventilation weaning, we conducted a mixed method process evaluation to understand how the intervention content and delivery was linked to trial outcomes.Methods10,495 children admitted to 18 paediatric intensive care units (ICUs) in the United Kingdom participated in a stepped-wedge, cluster randomised controlled trial, with 1955 clinical staff trained to deliver the intervention. The intervention comprised assessment and optimisation of sedation levels, and bedside screening of respiratory parameters to indicate readiness for a spontaneous breathing trial prior to liberation from ventilation. 193 clinical staff were interviewed towards the end of the trial. Interview data were thematically analysed, and quantitative adherence data were analysed using descriptive statistics.ResultsThe intervention led to a reduced duration of IMV (adjusted median difference– 7.1 hours, 95% CI -9.6 to -5.3, p = 0.01). Overall intervention adherence was 75% (range 59–85%). Ease and flexibility of the intervention promoted it use; designated responsibilities, explicit pathways of decision-making and a shared language for communication fostered proactivity and consistency towards extubation. Delivery of the intervention was hindered by established hospital and unit organisational and patient care routines, clinician preference and absence of clinical leadership.ConclusionsThe SANDWICH trial showed a significant, although small, reduction in duration of IMV. Findings suggest that greater direction in decision-making pathways, robust embedment of new practice in unit routine, and capitalising on the skills of Advanced Nurse Practitioners and physiotherapists would have contributed to greater intervention effect.Trial registrationisrctn.org Identifier: ISRCTN16998143.</div

Standards for Reporting Qualitative Research (SRQR) checklist.

Standards for Reporting Qualitative Research (SRQR) checklist.</p