Effect of a Machine Learning-Derived Early Warning Tool With Treatment Protocol on Hypotension During Cardiac Surgery and ICU Stay: The Hypotension Prediction 2 (HYPE-2) Randomized Clinical Trial.

Objectives: Cardiac surgery is associated with perioperative complications, some of which might be attributable to hypotension. The Hypotension Prediction Index (HPI), a machine-learning-derived early warning tool for hypotension, has only been evaluated in noncardiac surgery. We investigated whether using HPI with diagnostic guidance reduced hypotension during cardiac surgery and in the ICU.

An evolutionarily conserved metabolite inhibits biofilm formation in Escherichia coli K-12.

Methylerythritol cyclodiphosphate (MEcPP) is an intermediate in the biosynthesis of isoprenoids in plant plastids and in bacteria, and acts as a stress signal in plants. Here, we show that MEcPP regulates biofilm formation in Escherichia coli K-12 MG1655. Increased MEcPP levels, triggered by genetic manipulation or oxidative stress, inhibit biofilm development and production of fimbriae.

The influence of anesthetic drug strategy on the incidence of post-induction hypotension in elective, non-cardiac surgery - A prospective observational cohort study.

Study Objectives: To identify the influence of modifiable factors in anesthesia induction strategy on post-induction hypotension (PIH), specifically the type, dosage and speed of administration of induction agents. A secondary aim was to identify patient related non-modifiable factors associated with PIH.

Design: Single-center, prospective observational cohort study.

Defining Postinduction Hemodynamic Instability With an Automated Classification Model.

Background: Postinduction hypotension (PIH) may be associated with increased morbidity and mortality. In earlier studies, the definition of PIH is solely based on different absolute or relative thresholds. However, the time-course (eg, how fast blood pressure drops during induction) is rarely incorporated, whereas it might represent the hemodynamic instability of a patient.

Integrated Dual-Channel Retrograde Signaling Directs Stress Responses by Degrading the HAT1/TPL/IMPα-9 Suppressor Complex and Activating CAMTA3.

Unlabelled: The intricate communication between plastids and the nucleus, shaping stress-responsive gene expression, has long intrigued researchers. This study combines genetics, biochemical analysis, cellular biology, and protein modeling to uncover how the plastidial metabolite MEcPP activates the stress-response regulatory hub known as the Rapid Stress Response Element (RSRE). Specifically, we identify the HAT1/TPL/IMPα- 9 suppressor complex, where HAT1 directly binds to RSRE and its activator, CAMTA3, masking RSRE and sequestering the activator.

A critical review of the use of R in risk equalization research.

Nearly all empirical studies that estimate the coefficients of a risk equalization formula present the value of the statistical measure R. The R-value is often (implicitly) interpreted as a measure of the extent to which the risk equalization payments remove the regulation-induced predictable profits and losses on the insured, with a higher R-value indicating a better performance. In many cases, however, we do not know whether a model with R = 0.

A framework for ex-ante evaluation of the potential effects of risk equalization and risk sharing in health insurance markets with regulated competition.

Many health insurance markets are organized by principles of regulated competition. Regulators of these markets typically apply risk equalization (aka risk adjustment) and risk sharing to mitigate risk selection. Risk equalization and risk sharing can have various positive and negative effects on efficiency and fairness.

Exploratory study of the lateral body sway predictability as frame of reference for gait rehabilitation following a total knee arthroplasty.

Aims: The aim of the present study was to investigate whether the predictability of fronto-parallel trunk rotations (lateral body sway) could serve as a frame of reference to monitor recovery after total knee arthroplasty (TKA).

Methods: Before surgery, 11 TKA patients were asked to perform a treadmill walking task at three different speeds. In addition, their gait abilities were scored on three standard clinical walking tests.

Preconditions for efficiency and affordability in competitive healthcare markets: Are they fulfilled in Belgium, Germany, Israel, the Netherlands and Switzerland? Ten years later.

From the mid-1990s several countries have introduced elements of the model of regulated competition in healthcare. In 2012 we assessed the extent to which in five countries ten important preconditions for achieving efficiency and affordability in competitive healthcare markets were fulfilled. In this paper we assess to what extent the fulfilment of these preconditions has changed ten years later.

The roads to managed competition for mixed public-private health systems: a conceptual framework.

Health systems' insurance/funding can be organised in several ways. Some countries have adopted systems with a mixture of public-private involvement (e.g.

Hypotension during intensive care stay and mortality and morbidity: a systematic review and meta-analysis.

Purpose: The aim of this study is to provide a summary of the existing literature on the association between hypotension during intensive care unit (ICU) stay and mortality and morbidity, and to assess whether there is an exposure-severity relationship between hypotension exposure and patient outcomes.

Methods: CENTRAL, Embase, and PubMed were searched up to October 2022 for articles that reported an association between hypotension during ICU stay and at least one of the 11 predefined outcomes. Two independent reviewers extracted the data and assessed the risk of bias.

Inertial-Sensor-Based Monitoring of Sample Entropy and Peak Frequency Changes in Treadmill Walking during Recovery after Total Knee Arthroplasty.

This study aimed to investigate whether sample entropy (SEn) and peak frequency values observed in treadmill walking could provide physical therapists valuable insights into gait rehabilitation following total knee arthroplasty (TKA). It was recognized that identifying movement strategies that during rehabilitation are initially adaptive but later start to hamper full recovery is critical to meet the clinical goals and minimize the risk of contralateral TKA. Eleven TKA patients were asked to perform clinical walking tests and a treadmill walking task at four different points in time (pre-TKA, 3, 6, and 12 months post-TKA).

Effect of the machine learning-derived Hypotension Prediction Index (HPI) combined with diagnostic guidance versus standard care on depth and duration of intraoperative and postoperative hypotension in elective cardiac surgery patients: HYPE-2 - study protocol of a randomised clinical trial.

Introduction: Hypotension is common during cardiac surgery and often persists postoperatively in the intensive care unit (ICU). Still, treatment is mainly reactive, causing a delay in its management. The Hypotension Prediction Index (HPI) can predict hypotension with high accuracy.

More Predictable and Less Automatized Movements during Walking -not during Repetitive Punching- in Knee Osteoarthritis.

Using the non-affected leg as stable frame of reference for the affected leg in gait assessment in knee osteoarthritis (KO) fails due to compensatory mechanisms. Assessing the cyclical movements of the upper extremities in a frequency-controlled repetitive punching task may provide an alternative frame of reference in gait assessment in patients with KO. Eleven participants with unilateral KO and eleven healthy controls were asked to perform treadmill walking and repetitive punching.

Clinical agreement of a novel algorithm to estimate radial artery blood pressure from the non-invasive finger blood pressure.

Study Objective: A new algorithm was developed that transforms the non-invasive finger blood pressure (BP) into a radial artery BP (B̂P), whereas the original algorithm estimated brachial BP (B̂P). In this study we determined whether this new algorithm shows better agreement with invasive radial BP than the original one and whether in the operating room this algorithm can be used safely.

Design, Setting And Patients: This observational study was conducted on thirty-three non-cardiac surgery patients.

Reciprocity between a retrograde signal and a putative metalloprotease reconfigures plastidial metabolic and structural states.

Reconfiguration of the plastidial proteome in response to environmental cues is central to tailoring adaptive responses. To define the underlying mechanisms and consequences of these reconfigurations, we performed a suppressor screen, using a mutant () accumulating high levels of a plastidial retrograde signaling metabolite, MEcPP. We isolated a revertant partially suppressing the dwarf stature and high salicylic acid of and identified the mutation in a putative plastidial metalloprotease (VIR3).

The goal of risk equalization in regulated competitive health insurance markets.

Different opinions exist about the goal of risk equalization in regulated competitive health insurance markets. There seems to be consensus that an element of the goal of risk equalization is 'to remove the predictable over- and undercompensations of subgroups of insured' or, equivalently, 'to achieve a level playing field for each risk composition of an insurer's portfolio' or, equivalently, 'to remove the incentives for risk selection'. However, the role of efficiency appears to be a major issue: should efficiency also be an element of the goal of risk equalization, or should it be a restriction to the goal, or should efficiency not be an element of the goal or a restriction to the goal? If efficiency plays a role, a comprehensive analysis of the total effect of risk equalization on efficiency needs to be done.

Should administrative costs in health insurance be included in the risk-equalization? An analysis of five countries.

Most countries that apply risk-equalization in their health insurance market(s) perform risk-equalization on medical claims but do not include other components of the insurance premium, such as administrative costs. Using fixed effects panel regressions from individual insurers in Australia, Germany, the Netherlands, Switzerland, and the US, we find evidence that health insurers with a high morbidity population on average have higher administrative costs. We argue that administrative costs should also be included in risk-equalization and we show that such equalization results in additional equalization payments nontrivial in size.

Machine learning methods for perioperative anesthetic management in cardiac surgery patients: a scoping review.

Background: Machine learning (ML) is developing fast with promising prospects within medicine and already has several applications in perioperative care. We conducted a scoping review to examine the extent and potential limitations of ML implementation in perioperative anesthetic care, specifically in cardiac surgery patients.

Methods: We mapped the current literature by searching three databases: MEDLINE (Ovid), EMBASE (Ovid), and Cochrane Library.

Performance of a machine-learning algorithm to predict hypotension in mechanically ventilated patients with COVID-19 admitted to the intensive care unit: a cohort study.

The Hypotension Prediction Index (HPI) is a commercially available machine-learning algorithm that provides warnings for impending hypotension, based on real-time arterial waveform analysis. The HPI was developed with arterial waveform data of surgical and intensive care unit (ICU) patients, but has never been externally validated in the latter group. In this study, we evaluated diagnostic ability of the HPI with invasively collected arterial blood pressure data in 41 patients with COVID-19 admitted to the ICU for mechanical ventilation.

Increased Speed Elicited More Automatized but Less Predictable Control in Cyclical Arm and Leg Movements.

The present study explores variations in the degree of automaticity and predictability of cyclical arm and leg movements. Twenty healthy adults were asked to walk on a treadmill at a lower-than-preferred speed, their preferred speed, and at a higher-than-preferred speed. In a separate, repetitive punching task, the three walking frequencies were used to cue the target pace of the cyclical arm movements.

Monitoring, management, and outcome of hypotension in Intensive Care Unit patients, an international survey of the European Society of Intensive Care Medicine.

Introduction: Hypotension in the ICU is common, yet management is challenging and variable. Insight in management by ICU physicians and nurses may improve patient care and guide future hypotension treatment trials and guidelines.

Methods: We conducted an international survey among ICU personnel to provide insight in monitoring, management, and perceived consequences of hypotension.