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Sarcopenia estimation using psoas major enhances P-POSSUM mortality prediction in older patients undergoing emergency laparotomy: cross-sectional study.Emergency laparotomy is a considerable component of a colorectal surgeon's workload and conveys substantial morbidity and mortality, particularly in older patients. Frailty is associated with poorer surgical outcomes. Frailty and sarcopenia assessment using Computed Tomography (CT) calculation of psoas major area predicts outcomes in elective and emergency surgery. Current risk predictors do not incorporate frailty metrics. We investigated whether sarcopenia measurement enhanced mortality prediction in over-65 s who underwent emergency laparotomy and emergency colorectal resection. An analysis of data collected prospectively during the National Emergency Laparotomy Audit (NELA) was conducted. Psoas major (PM) cross-sectional area was measured at the L3 level and a ratio of PM to L3 vertebral body area (PML3) was calculated. Outcome measures included inpatient, 30-day and 90-day mortality. Statistical analysis was conducted using Mann-Whitney, Chi-squared and receiver operating characteristics (ROC). Logistic regression was conducted using P-POSSUM variables with and without the addition of PML3. Nine-hundred and forty-four over-65 s underwent emergency laparotomy from three United Kingdom hospitals were included. Median age was 76 years (IQR 70-82 years). Inpatient mortality was 21.9%, 30-day mortality was 16.3% and 90-day mortality was 20.7%. PML3 less than 0.39 for males and 0.31 for females indicated significantly worse outcomes (inpatient mortality 68% vs 5.6%, 30-day mortality 50.6% vs 4.0%,90-day mortality 64% vs 5.2%, p < 0.0001). PML3 was independently associated with mortality in multivariate analysis (p < 0.0001). Addition of PML3 to P-POSSUM variables improved area under the curve (AUC) on ROC analysis for inpatient mortality (P-POSSUM:0.78 vs P-POSSUM + PML3:0.917), 30-day mortality(P-POSSUM:0.802 vs P-POSSUM + PML3: 0.91) and 90-day mortality (P-POSSUM:0.79 vs P-POSSUM + PML3: 0.91). PML3 is an accurate predictor of mortality in over-65 s undergoing emergency laparotomy. Addition of PML3 to POSSUM appears to improve mortality risk prediction.
Patient‐relevant health outcomes for hemophilia care: Development of an international standard outcomes setAbstract: Background: Patient‐relevant health outcomes for persons with hemophilia should be identified and prioritized to optimize and individualize care for persons with hemophilia. Therefore, an international group of persons with hemophilia and multidisciplinary health care providers set out to identify a globally applicable standard set of health outcomes relevant to all individuals with hemophilia. Methods: A systematic literature search was performed to identify possible health outcomes and risk adjustment variables. Persons with hemophilia and multidisciplinary health care providers were involved in an iterative nominal consensus process to select the most important health outcomes and risk adjustment variables for persons with hemophilia. Recommendations were made for outcome measurement instruments. Results: Persons with hemophilia were defined as all men and women with an X‐linked inherited bleeding disorder caused by a deficiency of coagulation factor VIII or IX with plasma activity levels <40 IU/dL. We recommend collecting the following 10 health outcomes at least annually, if applicable: (i) cure, (ii) impact of disease on life expectancy, (iii) ability to engage in normal daily activities, (iv) severe bleeding episodes, (v) number of days lost from school or work, (vi) chronic pain, (vii) disease and treatment complications, (viii) sustainability of physical functioning, (ix) social functioning, and (x) mental health. Validated clinical as well as patient‐reported outcome measurement instruments were endorsed. Demographic factors, baseline clinical factors, and treatment factors were identified as risk‐adjustment variables. Conclusion: A consensus‐based international set of health outcomes relevant to all persons with hemophilia, and corresponding measurement instruments, was identified for use in clinical care to facilitate harmonized longitudinal monitoring and comparison of outcomes.
Social network analysis of small social groups: Application of a hurdle GLMM approach in the Alpine marmot ( Marmota marmota )Abstract: Social network analysis (SNA) has recently emerged as a fundamental tool to study animal behavior. While many studies have analyzed the relationship between environmental factors and behavior across large, complex animal populations, few have focused on species living in small groups due to limitations of the statistical methods currently employed. Some of the difficulties are often in comparing social structure across different sized groups and accounting for zero‐inflation generated by analyzing small social units. Here, we use a case study to highlight how Generalized Linear Mixed Models (GLMMs) and hurdle models can overcome the issues inherent to study of social network metrics of groups that are small and variable in size. We applied this approach to study aggressive behavior in the Alpine marmot (Marmota marmota) using an eight‐year long dataset of behavioral interactions across 17 small family groups (7.4 ± 3.3 individuals). We analyzed the effect of individual and group‐level factors on aggression, including predictors frequently inferred in species with larger groups, as the closely related yellow‐bellied marmot (Marmota flaviventris). Our approach included the use of hurdle GLMMs to analyze the zero‐inflated metrics that are typical of aggressive networks of small social groups. Additionally, our results confirmed previously reported effects of dominance and social status on aggression levels, thus supporting the efficacy of our approach. We found differences between males and females in terms of levels of aggression and on the roles occupied by each in agonistic networks that were not predicted in a socially monogamous species. Finally, we provide some perspectives on social network analysis as applied to small social groups to inform subsequent studies.
Acceptance and values clarification versus cognitive restructuring and relaxation: A randomized controlled trial of ultra-brief non-expert-delivered coaching interventions for social resilience.Low social resilience (e.g., susceptibility to social anxiety, and social avoidance) has been associated with poor mental and physical health outcomes, and can lead to ostracism. Support services such as university counselling centres, which deal with non-diagnosable psychological distress, linked to low social resilience, require effective yet brief interventions deliverable by non-experts to meet service demands. As it is not always possible to prevent subjectively negative experiences, acceptance-based interventions aim to change how we respond behaviourally to such experiences. The present study tests the efficacy of an ultra-brief (1hr) non-expert delivered acceptance and values-based (AV) coaching intervention to increase resilience to negative social interactions. This was compared to a comparable dose of a cognitive restructuring and relaxation-based (CRR) analogue, and a psycho-education and progressive muscle relaxation-based (PE-PMR) control. Participants ( N =60) were assessed on perceived burdensomeness, belonging, and 3 scenarios measuring anxiety and likelihood to engage in social situations. Participants then played Cyberball, an ostracising task, before recompleting the aforementioned measures. Physiological measures indicated Cyberball was an aversive experience. In the AV condition only, we observed an improved behavioral intention to engage with social scenarios ( dppc2 = .57). Ultra-brief AV-based coaching interventions delivered by non-expert coaches appear promising in increasing participant’s likelihood to continue engaging in social interactions after a stressful social experience. We tentatively conclude that gains in committed action may increase the propensity of at-risk individuals to seek social support.