Respiratory rate­oxygenation (ROX) index for predicting high-flow nasal cannula failure in patients with and without COVID-19.

BACKGROUND: The predictive value of the respiratory rate­oxygenation (ROX) index for a high-flow nasal cannula (HFNC) in patients with COVID-19 with acute hypoxemic respiratory failure (AHRF) may differ from patients without COVID-19 with AHRF, but these patients have not yet been compared. We compared the diagnostic accuracy of the ROX index for HFNC failure in patients with AHRF with and without COVID-19 during acute emergency department (ED) visits. METHODS: We performed a retrospective analysis of patients with AHRF treated with an HFNC in an ED between October 2020 and April 2022. The ROX index was calculated at 1, 2, 4, 6, 12, and 24 h after HFNC placement. The primary outcome was the failure of the HFNC, which was defined as the need for subsequent intubation or death within 72 h. A receiver operating characteristic (ROC) curve was used to evaluate discriminative power of the ROX index for HFNC failure. RESULTS: Among 448 patients with AHRF treated with an HFNC in an ED, 78 (17.4%) patients were confirmed to have COVID-19. There was no significant difference in the HFNC failure rates between the non-COVID-19 and COVID-19 groups (29.5% vs. 33.3%, p = 0.498). The median ROX index was higher in the non-COVID-19 group than in the COVID-19 group at all time points. The prognostic power of the ROX index for HFNC failure as evaluated by the area under the ROC curve was generally higher in the COVID-19 group (0.73-0.83) than the non-COVID-19 group (0.62-0.75). The timing of the highest prognostic value of the ROX index for HFNC failure was at 4 h for the non-COVID-19 group, whereas in the COVID-19 group, its performance remained consistent from 1 h to 6 h. The optimal cutoff values were 6.48 and 5.79 for the non-COVID-19 and COVID-19 groups, respectively. CONCLUSIONS: The ROX index had an acceptable discriminative power for predicting HFNC failure in patients with AHRF with and without COVID-19 in the ED. However, the higher ROX index thresholds than those in previous publications involving intensive care unit (ICU) patients suggest the need for careful monitoring and establishment of a new threshold for patients admitted outside the ICU.

How the EQ-5D utilities are derived matters in Chinese diabetes patients: a comparison based on different EQ-5D scoring functions for China.

OBJECTIVES: In China, multiple approaches to calculating EQ-5D utilities are available, including the two EQ-5D-3L (3L2014 and 3L2018) scoring functions, the EQ-5D-5L (5L) scoring function, and the crosswalk function linking the 3L utilities and 5L health states. The study compared utilities derived from them in terms of agreement and discriminative power; and assessed whether the use of different approaches may affect QALY estimation in Chinese type 2 diabetes (T2D) patients. METHODS: Cross-sectional data of 289 T2D patients who self-completed both the 5L and 3L questions were used. Agreement were examined using intraclass correlation coefficient (ICC) and Bland-Altman plots. The ability of the EQ-5D utilities in differentiating the patients with and without clinical conditions was evaluated using F-statistics. Their influence on QALY estimation was assessed adopting mean absolute difference (MAD) in utility values between the patients. RESULTS: The ICC values were 0.881 (3L2014-3L2018), 0.958 (5L-c5L2014), and 0.806 (5L-c5L2018). The two 3L utilities and the three 5L utilities had poor agreement at the lower end of utility scale according to Bland-Altman plots. The 3L2018 utilities had lower F-statistics compared to the 3L2014 utilities; the two c5L utilities had larger or similar F-statistics compared to the 5L utilities. The mean MADs were 0.138 (5L), 0.116 (3L2014), 0.115 (c5L2014), 0.055 (c5L2018), and 0.055 (3L2018). CONCLUSION: The 3L2014 utilities is more discriminative than the 3L2018 utilities; and the two c5L utilities have no worse discriminative power compared with the 5L utilities. The choice of the approach to calculating the EQ-5D utilities is likely to affect QALY estimates.

External validation of the European System for Cardiac Operative Risk Evaluation II in a Tunisian population.

OBJECTIVE: The main objective of this study is to evaluate the performance of the predictive model (EuroSCORE II) on a Tunisian population to validate its use in our country. METHODS: This is a retrospective study of data from 418 adult patients undergoing cardiac surgery with cardiopulmonary bypass between 1 January 2015 and 31 December 2016 in the department of cardiovascular and thoracic surgery of the Sahloul University Hospital of Sousse. The EuroSCORE ΙΙ is calculated using the application validated on the site www.euroscore.org. The performance of the score is evaluated by analyzing its discriminative power by constructing the receiver operating characteristic (ROC) curve and analyzing its calibration using the Hosmer-Lemeshow statistics. RESULTS: The EuroSCORE II shows good discriminative power in our population with an area under the ROC curve more than 0.7 in all study groups (0.864 ± 0.032 for general cardiac surgery, 0.822 ± 0.061 for coronary surgery, 0.864 ± 0.052 for valvular surgery, and 0.900 ± 0.041 for urgent cardiac surgery). The model appears to be calibrated as well by obtaining P values above the statistical significance level of 0.05 (0.638 for general cardiac surgery, 0.543 for coronary surgery, 0.179 for valvular surgery, and 0.082 for urgent cardiac surgery). CONCLUSION: The EuroSCORE II presents acceptable performance in our population, attested by a good discriminative power and an adequate calibration.

Explicit and Implicit Responses to Tasting Drinks Associated with Different Tasting Experiences.

Probing food experience or liking through verbal ratings has its shortcomings. We compare explicit ratings to a range of (neuro)physiological and behavioral measures with respect to their performance in distinguishing drinks associated with different emotional experience. Seventy participants tasted and rated the valence and arousal of eight regular drinks and a "ground truth" high-arousal, low-valence vinegar solution. The discriminative power for distinguishing between the vinegar solution and the regular drinks was highest for sip size, followed by valence ratings, arousal ratings, heart rate, skin conductance level, facial expression of "disgust," pupil diameter, and Electroencephalogram (EEG) frontal alpha asymmetry. Within the regular drinks, a positive correlation was found between rated arousal and heart rate, and a negative correlation between rated arousal and Heart Rate Variability (HRV). Most physiological measures showed consistent temporal patterns over time following the announcement of the drink and taking a sip. This was consistent over all nine drinks, but the peaks were substantially higher for the vinegar solution than for the regular drinks, likely caused by emotion. Our results indicate that implicit variables have the potential to differentiate between drinks associated with different emotional experiences. In addition, this study gives us insight into the physiological temporal response patterns associated with taking a sip.

ACES: a machine learning toolbox for clustering analysis and visualization.

BACKGROUND: Studies that aim at explaining phenotypes or disease susceptibility by genetic or epigenetic variants often rely on clustering methods to stratify individuals or samples. While statistical associations may point at increased risk for certain parts of the population, the ultimate goal is to make precise predictions for each individual. This necessitates tools that allow for the rapid inspection of each data point, in particular to find explanations for outliers. RESULTS: ACES is an integrative cluster- and phenotype-browser, which implements standard clustering methods, as well as multiple visualization methods in which all sample information can be displayed quickly. In addition, ACES can automatically mine a list of phenotypes for cluster enrichment, whereby the number of clusters and their boundaries are estimated by a novel method. For visual data browsing, ACES provides a 2D or 3D PCA or Heat Map view. ACES is implemented in Java, with a focus on a user-friendly, interactive, graphical interface. CONCLUSIONS: ACES has been proven an invaluable tool for analyzing large, pre-filtered DNA methylation data sets and RNA-Sequencing data, due to its ease to link molecular markers to complex phenotypes. The source code is available from https://github.com/GrabherrGroup/ACES .

Do you hear the noise? The German matrix sentence test with a fixed noise level in subjects with normal hearing and hearing impairment.

OBJECTIVE: The aim of this study was to determine the relationship between hearing loss and speech reception threshold (SRT) in a fixed noise condition using the German Oldenburg sentence test (OLSA). DESIGN: After training with two easily-audible lists of the OLSA, SRTs were determined monaurally with headphones at a fixed noise level of 65 dB SPL using a standard adaptive procedure, converging to 50% speech intelligibility. STUDY SAMPLE: Data was obtained from 315 ears of 177 subjects with hearing losses ranging from -5 to 90 dB HL pure-tone average (PTA, 0.5, 1, 2, 3 kHz). RESULTS: Two domains were identified with a linear dependence of SRT on PTA. The SRT increased with a slope of 0.094 ± 0.006 dB SNR/dB HL (standard deviation (SD) of residuals = 1.17 dB) for PTAs < 47 dB HL and with a slope of 0.811 ± 0.049 dB SNR/dB HL (SD of residuals = 5.54 dB) for higher PTAs. CONCLUSION: The OLSA can be applied to subjects with a wide range of hearing losses. With 65 dB SPL fixed noise presentation level the SRT is determined by listening in noise for PTAs < ∼47 dB HL, and above it is determined by listening in quiet.

Characterization and clinical use of inflammatory cerebrospinal fluid protein markers in Alzheimer's disease.

BACKGROUND: Neuroinflammation has gained increasing attention as a potential contributing factor in Alzheimer's disease (AD) pathology. A clinical cerebrospinal fluid biomarker capable of monitoring this process during the course of the disease has yet to emerge, chiefly owing to contradictory research findings. In this study, we sought to clarify the utility of inflammatory biomarkers in diagnostic procedures of AD in three steps: (1) to screen for proteins that are robustly detectable in cerebrospinal fluid; (2) based on this analysis, to explore any associations between the analytically robust markers and salient pathological features of AD; and (3) to determine the discriminative power of these markers in the clinical diagnosis of AD. METHODS: From a total of 46 proteins, 15 that were robustly detectable in cerebrospinal fluid were identified. A subsequent analysis of these markers in a cohort of 399 patients (nondemented subjects, patients with mild cognitive impairment [MCI], and patients with AD, supplemented by smaller cohorts of other diseases) was conducted. Fluid biomarker data were related to AD pathology and neuropsychological markers and adjusted for confounders such as age, sex, apolipoprotein E genotype, and biobank storage time. RESULTS: Cerebrospinal fluid levels of C-reactive protein and soluble TREM2 differed between nondemented subjects, patients with MCI, or patients with AD and were associated with amyloid and tau pathology. Several markers were associated with tau pathology only or with other neurodegenerative diseases. Correlations between neuropsychological performance and inflammatory markers were weak, but they were most prominent in AD and for the most challenging cognitive tests. All investigated covariates had significant influence, with varying effects across the markers. Still, none of the markers achieved discriminative power of more than 70% to distinguish between patient groups defined by clinical or neuropathological categories. CONCLUSIONS: Basic analytical considerations proved indispensable for this type of study because only one-third of the tested markers were robustly detectable in cerebrospinal fluid. Detectable inflammatory protein markers were associated in multiple ways with AD pathology. Yet, even significantly associated markers were not powerful enough in terms of effect strength, sensitivity, and specificity, and hence they were not suited for direct use in clinical diagnostic practice. Targets other than those most commonly considered in this field of research might provide results with better clinical applicability.

Assessing the suitability of sets-based approaches: estimating the discriminative power of risk models for ordinal outcome treatments.

BACKGROUND: In order to evaluate the discrimination performance of an ordinal model for improved disease screening, a new test was proposed where information was obtained across all samples simultaneously. METHODS: The ordinal c-index builds upon the volume under the surface methodology without focusing on the accompanying receiver operating characteristic surfaces. However, it can be simplified to an average of pairwise c-indexes. In this paper, a set-based estimate (information was obtained across all samples simultaneously) was proposed by summing all correctly ordered groups. The asymptotic distribution of this proposed estimate was derived using U-statistics. RESULTS: A predictive model was applied using the blood urea nitrogen/creatinine ratio to discriminate stroke in evolution in acute ischemic stroke patients, which could potentially be life-saving in emergency departments. CONCLUSIONS: By conducting Monte Carlo simulations, it was concluded that the measure proposed herein is a better choice for clinical use because of the asymmetry of the predicted probabilities of groups.

The EQ-5D-5L is More Discriminative Than the EQ-5D-3L in Patients with Diabetes in Singapore.

OBJECTIVES: To compare the discriminative power of the five-level version of the EuroQol five-dimensional questionnaire (EQ-5D-5L [5L]) and its three-level version (EQ-5D-3L [3L]) in patients with diabetes in Singapore. METHODS: A consecutive sample of patients with type 2 diabetes mellitus (T2DM) self-completed the two versions of the EQ-5D in the clinic. The 3L index score was calculated from the Singapore 3L value set, whereas the 5L index score was mapped from the 5L index score using an interim scoring. The discriminative power of the two EQ-5D indices was assessed in terms of their relative efficiency (RE) in differentiating patients with T2DM with and without one of eight clinical conditions. The efficiency of the two EQ-5D classification systems was evaluated using the Shannon's index (H׳) and in terms of ceiling effects. RESULTS: A total of 121 patients with T2DM provided data for this study. The 3L score was systematically higher than the 5L score for patients with T2DM with a condition and systematically lower for the patients without a condition, with the mean differences being 0.005 and -0.011, respectively. The 5L index score showed higher RE in seven of eight clinical conditions (mean RE 1.87). The 5L classification system had higher H׳ in all dimensions: mobility (1.17 vs. 0.70), self-care (0.57 vs. 0.41), usual activities (1.01 vs. 0.72), pain/discomfort (1.47 vs. 1.02), and anxiety/depression (1.36 vs. 1.10). The overall ceiling effects decreased from 47.9% (3L) to 38.8% (5L). CONCLUSIONS: The EQ-5D-5L is more discriminative than the EQ-5D-3L in patients with T2DM in Singapore, supporting the use of EQ-5D-5L in the population.

Development and Verification of Indicators for a Foodservice & Nutrition Management Evaluation at a Hospital Nutrition Department

The purposes of this study were to develop the standard indicators to evaluate the food and nutrition systems in hospitals and to test the validity of those items scientifically. The results were as follows: First, the conceptual validity was examined with recognition degrees of importance from the hospital nutrition department managers. All of the hospital nutrition department's operation evaluation standards and the indicators' conceptual validity tested were in the range of 3.71~4.93 out of 5.0, and the mean score was 4.36. Therefore, the conceptual validity was verified. Second, to verify the factor validity of the items of the standards and indicators for the hospital nutrition department's operation evaluation, the standards and indicators were analyzed as key-factors. Key-factor analysis after vertical rotation showed that four factors appeared and were composed of (a) facilities management, (b) sanitation management, (c) operation & foodservice management, and (d) nutrition management. Third, the reliability of the standards and indicators for the hospital nutrition department's operation evaluation was analyzed and resulted in a score of 0.98, which showed good internal consistency. Fourth, the discriminative power of each item of the standards for the hospital nutrition department's operation evaluation was tested by checking the differences between groups with first quartile and forth quartile of total evaluation scores. The indicators having low distinction power were modified into obligatory items or eliminated for better differentiation.