Development and validation of a new prognostic model for patients with acute-on-chronic liver failure in intensive care unit.

BACKGROUND: Cirrhotic patients with acute-on-chronic liver failure (ACLF) in the intensive care unit (ICU) have a poor but variable prognoses. Accurate prognosis evaluation can guide the rational management of patients with ACLF. However, existing prognostic scores for ACLF in the ICU environment lack sufficient accuracy. AIM: To develop a new prognostic model for patients with ACLF in ICU. METHODS: Data from 938 ACLF patients in the Medical Information Mart for Intensive Care (MIMIC) database were used to develop a new prognostic model (MIMIC ACLF) for ACLF. Discrimination, calibration and clinical utility of MIMIC ACLF were assessed by area under receiver operating characteristic curve (AUROC), calibration curve and decision curve analysis (DCA), respectively. MIMIC ACLF was then externally validated in a multiple-center cohort, the Electronic Intensive Care Collaborative Research Database and a single-center cohort from the Second Hospital of Hebei Medical University in China. RESULTS: The MIMIC ACLF score was determined using nine variables: ln (age) × 2.2 + ln (white blood cell count) × 0.22 - ln (mean arterial pressure) × 2.7 + respiratory failure × 0.6 + renal failure × 0.51 + cerebral failure × 0.31 + ln (total bilirubin) × 0.44 + ln (internationalized normal ratio) × 0.59 + ln (serum potassium) × 0.59. In MIMIC cohort, the AUROC (0.81/0.79) for MIMIC ACLF for 28/90-day ACLF mortality were significantly greater than those of Chronic Liver Failure Consortium ACLF (0.76/0.74), Model for End-stage Liver Disease (MELD; 0.73/0.71) and MELD-Na (0.72/0.70) (all P < 0.001). The consistency between actual and predicted 28/90-day survival rates of patients according to MIMIC ACLF score was excellent and superior to that of existing scores. The net benefit of MIMIC ACLF was greater than that achieved using existing scores within the 50% threshold probability. The superior predictive accuracy and clinical utility of MIMIC ACLF were validated in the external cohorts. CONCLUSION: We developed and validated a new prognostic model with satisfactory accuracy for cirrhotic patients with ACLF hospitalized in the ICU. The model-based risk stratification and online calculator might facilitate the rational management of patients with ACLF.

Improving Social Inclusion for People with Physical Disabilities: The Roles of Mobile Social Networking Applications (MSNA) by Disability Support Organizations in China.

Having friendships and interpersonal social connections is a normal and expected necessity of life that enhances an individual's well-being. Digital platforms, such as mobile social network applications (MSNA), present a means for people with disabilities to integrate in society. This study combines intrinsic benefits (such as enjoyment experience and information) and extrinsic benefits (such as social networking) to explore the impact of these benefits on online friendships, and the influence of these online friendships on the perceived social connectedness and well-being of people with physical disabilities. The partial least squares methodology was used to conduct statistical analysis on survey data; the outputs were obtained through convergent analysis, discriminant analysis, and bootstrapping. The results showed that enjoyment experience and social network benefits significantly influence online friendships, which influence perceived social connectedness and well-being. In addition, the perceived social exclusion has a significant moderation effect. Our findings are expected to help local disability service organizations develop effective digital disability inclusion strategies to combat widespread social exclusion among people with disabilities.

What Makes Hotel Chefs in Korea Interact with SNS Community at Work? Modeling the Interplay between Social Capital and Job Satisfaction by the Level of Customer Orientation.

This study aimed to investigate the effect of social network services (SNS) on hotel chef job satisfaction, and to provide an effective strategy to reduce chef turnover and maintain sustainable economic development in hospitality. The intention was to empirically test and analyze the effect of SNS on hotel chef job satisfaction by applying the social capital theory. The social capital theory was explored and the effect of chefs' social capital on their social presence and job satisfaction was demonstrated. Furthermore, this study aimed to determine the moderation effect of customer orientation. A total of 130 surveys were collected from chefs working at Michelin-starred restaurants in Seoul, Korea. SPSS and AMOS were used to conduct statistical analyses. The outputs included exploratory factor analysis, confirmatory factor analysis, convergent analysis, discriminant analysis, path analysis, mediation effect analysis, and moderation effect analysis. The results illustrated that bridging social capital significantly impacts chef social presence, while bonding social capital does not significantly influence their presence. In addition, both bonding and bridging social capital positively relate to chef job satisfaction. Significant mediation and moderation effects were demonstrated on the path taken by chefs. The results of this study offer theoretical and managerial implications for hotel human resources managers to enhance chef job satisfaction.