A comparison of existing risk prediction models in patients undergoing venoarterial extracorporeal membrane oxygenation

© 2020 The Author(s) Background: Patients undergoing consideration for venoarterial extracorporeal membrane oxygenation (VA-ECMO) require an immediate risk profile assessment in the setting of incomplete information. A number of survival prediction models for critically ill patients and patients undergoing elective cardiac surgery or institution of VA-ECMO support have been designed. We assess the ability of these models to predict outcomes in a cohort of patients undergoing institution of VA-ECMO for cardiogenic shock or cardiac arrest. Methods: Fifty-one patients undergoing institution of VA-ECMO support were retrospectively analyzed. APACHE II, SOFA, SAPS II, Encourage, SAVE, and ACEF scores were calculated. Their ability to predict outcomes were assessed. Results: Indications for ECMO support included postcardiotomy shock (25%), ischemic etiologies (39%), and other etiologies (36%). Pre-ECMO arrest occurred in 73% and 41% of patients underwent cannulation during arrest. Survival to discharge was 39%. Three survival prediction model scores were significantly higher in nonsurvivors to discharge than surivors; the Encourage score (25.4 vs 20; p =.04), the APACHE II score (23.6 vs 19.2; p =.05), and the ACEF score (3.1 vs 1.8; p =.03). In ROC analysis, the ACEF score demonstrated the greatest predictive ability with an AUC of 0.7. Conclusions: A variety of survival prediction model scores designed for critically ill ICU and VA-ECMO patients demonstrated modest discriminatory ability in the current cohort of patients. The ACEF score, while not designed to predict survival in critically ill patients, demonstrated the best discriminatory ability. Furthermore, it is the simplest to calculate, an advantage in the emergent setting

Embedding environmental sustainability within oral health professional curricula—Recommendations for teaching and assessment of learning outcomes

The FDI World Dental Federation suggests that “dentistry, as a profession, should integrate Sustainable Development Goals into daily practice and support a shift to a green economy in the pursuit of healthy lives and wellbeing for all, through all stages of life.” This article reports on the recent activity of the Association for Dental Education in Europe Special Interest Group for Sustainability in Dentistry. Following on from the group's previous activities, which explored current educational practice, this work aimed to reach a pan-European consensus on a number of learning outcomes for environmental sustainability, in order to (i) support institutions in designing and delivering their curriculum, and (ii) to further harmonise the delivery of oral health professional education across Europe. This article presents specific learning outcomes relating to environmental sustainability and recommendations relating to curriculum development, including methods of teaching and assessment

Software quality management improvement through mentoring: an exploratory study from GSD projects

Proceeding of: OTM 2011 Workshops: Confederated InternationalWorkshops and Posters: EI2N+NSF ICE, ICSP+INBAST, ISDE, ORM, OTMA, SWWS+MONET+SeDeS, and VADER 2011, Hersonissos, Crete, Greece, October 17-21, 2011Software Quality Management (SQM) is a set of processes and procedures designed to assure the quality of software artifacts along with their development process. In an environment in which software development is evolving to a globalization, SQM is seen as one of its challenges. Global Software Development is a way to develop software across nations, continents, cultures and time zones. The aim of this paper is to detect if mentoring, one of the lead personnel development tools, can improve SQM of projects developed under GSD. The results obtained in the study reveal that the influence of mentoring on SQM is just temperate

Mental disorders as risk factors: assessing the evidence for the Global Burden of Disease Study

Background: Mental disorders are associated with a considerable burden of disease as well as being risk factors for other health outcomes. The new Global Burden of Disease (GBD) Study will make estimates for both the disability and mortality directly associated with mental disorders, as well as the burden attributable to other health outcomes. Herein we discuss the process by which health outcomes in which mental disorders are risk factors are selected for inclusion in the GBD Study. We make suggestions for future research to strengthen the body of evidence for mental disorders as risk factors

Tuning σ-Holes: Charge Redistribution in the Heavy (Group 14) Analogues of Simple and Mixed Halomethanes Can Impose Strong Propensities for Halogen Bonding

Halogen bonding between halide sites (in substituted organic molecules or inorganic halides) and Lewis bases is a rapidly progressing area of exploration. Investigations of this phenomenon have improved our understanding of weak intermolecular interactions and suggested new possibilities in supramolecular chemistry and crystal engineering. The capacity for halogen bonding is investigated at the MP2(full) level of theory for 100 compounds, including all 80 MH4-nXn systems (M = C, Si, Ge, Sn, and Pb; X = F, Cl, Br, and I). The charge redistribution in these molecules and the (in)stability of the σ-hole at X as a function of M and n are catalogued and examined. For the mixed MH3-mFmI compounds, we identify a complicated dependence of the relative halogen bond strengths on M and m. For m = 0, for example, the H3C-I----NH3 halogen bond is 6.6 times stronger than the H3Pb-I----NH3 bond. When m = 3, however, the F3Pb-I----NH3 bond is shorter and ∼1.6 times stronger than the F3C-I----NH3 bond. This substituent-induced reversal in the relative strengths of halogen bond energies is explained

Molecular Dynamics of Mesophilic-Like Mutants of a Cold-Adapted Enzyme: Insights into Distal Effects Induced by the Mutations

Networks and clusters of intramolecular interactions, as well as their “communication” across the three-dimensional architecture have a prominent role in determining protein stability and function. Special attention has been dedicated to their role in thermal adaptation. In the present contribution, seven previously experimentally characterized mutants of a cold-adapted α-amylase, featuring mesophilic-like behavior, have been investigated by multiple molecular dynamics simulations, essential dynamics and analyses of correlated motions and electrostatic interactions. Our data elucidate the molecular mechanisms underlying the ability of single and multiple mutations to globally modulate dynamic properties of the cold-adapted α-amylase, including both local and complex unpredictable distal effects. Our investigation also shows, in agreement with the experimental data, that the conversion of the cold-adapted enzyme in a warm-adapted variant cannot be completely achieved by the introduction of few mutations, also providing the rationale behind these effects. Moreover, pivotal residues, which are likely to mediate the effects induced by the mutations, have been identified from our analyses, as well as a group of suitable candidates for protein engineering. In fact, a subset of residues here identified (as an isoleucine, or networks of mesophilic-like salt bridges in the proximity of the catalytic site) should be considered, in experimental studies, to get a more efficient modification of the features of the cold-adapted enzyme