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Nonlinear heart model predicts range of heart rates for 2:1 swinging in pericardial effusion.

We analyze two mathematical models of Rigney and Goldberger (14) of heart swinging in large pericardial effusions. Both models represent the torques due to the outflow of blood from the heart. The first assumes that the duration of systole does not vary with heart rate (in beats/min), whereas the second assumes that it varies linearly with heart rate. We examine the motion of the heart for heart rates between 50 and 200 and for a range of initial positions and velocities. Both models predict that the heart swings once every other beat (2:1 swinging, giving rise to electrical alternans) in a discrete range of heart rates and swings once per beat otherwise; both models explain the appearance and disappearance of 2:1 swinging mathematically. The first model predicts a rate range from 105 to 116 for the occurrence of 2:1 swinging. The second model predicts the same qualitative behavior but with 2:1 swinging occurring at heart rates between 88 and 119, which agrees well with published clinical data showing 2:1 swinging at heart rates between 90 and 144. We describe an analysis program for ordinary differential equations that analyzed the models quickly and automatically.

Animals↗

A discounted least squares quadratic growth prediction model for use in 2 year toxicity studies.

Weekly weighings of the laboratory rats are required to determine the correct dosage for mixing in the food. This creates problems in that the food mixing must be done immediately after the weighings and staff are often heavily taxed to perform the task. A discounted least squares growth prediction model allows for prediction of weights a week ahead of time, obviating the necessity for instantaneously processing the weight data. When dosages were prepared based on these predictions, for 10 treatment combinations 100% of the doses proved to be within 8-0% of the required dosage; 98-4% were within 5% of the required dosage; 78-7% were within 2% of the required dosage; and 51-6% were within 1% of the required dosage. The quadratic weight prediction model can also be incorporated into a model for predicting food consumption.

Animal Feed↗

Changes in the light sensitivity of buried Polygonum aviculare seeds in relation to cold-induced dormancy loss: development of a predictive model.

The effect of cold (stratification) temperature on changes in the sensitivity of Polygonum aviculare seeds to light was investigated. Seeds buried in pots were stored under stratification temperatures (1.6, 7 and 12 degrees C) for 137 d. Seeds exhumed at regular intervals during storage were exposed to different light treatments. Germination responses obtained for seeds exposed to different light treatments and stratification temperatures were used to develop a model to predict the sensitivity of buried seeds to light. Seed sensitivity to light increased as dormancy loss progressed, showing the successive acquisition of low-fluence responses (LFR), very low-fluence responses (VLFR), and the loss of the light requirement for germination for a fraction of the seed population. These changes were inversely correlated to stratification temperature, allowing the use of a thermal time index to relate observed changes in seed light sensitivity to stratification temperature. The rate of increase in sensitivity of P. aviculare seeds to light during stratification is inversely correlated to soil temperature, and these changes in light sensitivity could be predicted in relation to temperature using thermal-time models.

Cold Temperature↗

A crash-prediction model for multilane roads.

Considerable research has been carried out in recent years to establish relationships between crashes and traffic flow, geometric infrastructure characteristics and environmental factors for two-lane rural roads. Crash-prediction models focused on multilane rural roads, however, have rarely been investigated. In addition, most research has paid but little attention to the safety effects of variables such as stopping sight distance and pavement surface characteristics. Moreover, the statistical approaches have generally included Poisson and Negative Binomial regression models, whilst Negative Multinomial regression model has been used to a lesser extent. Finally, as far as the authors are aware, prediction models involving all the above-mentioned factors have still not been developed in Italy for multilane roads, such as motorways. Thus, in this paper crash-prediction models for a four-lane median-divided Italian motorway were set up on the basis of accident data observed during a 5-year monitoring period extending between 1999 and 2003. The Poisson, Negative Binomial and Negative Multinomial regression models, applied separately to tangents and curves, were used to model the frequency of accident occurrence. Model parameters were estimated by the Maximum Likelihood Method, and the Generalized Likelihood Ratio Test was applied to detect the significant variables to be included in the model equation. Goodness-of-fit was measured by means of both the explained fraction of total variation and the explained fraction of systematic variation. The Cumulative Residuals Method was also used to test the adequacy of a regression model throughout the range of each variable. The candidate set of explanatory variables was: length (L), curvature (1/R), annual average daily traffic (AADT), sight distance (SD), side friction coefficient (SFC), longitudinal slope (LS) and the presence of a junction (J). Separate prediction models for total crashes and for fatal and injury crashes only were considered. For curves it is shown that significant variables are L, 1/R and AADT, whereas for tangents they are L, AADT and junctions. The effect of rain precipitation was analysed on the basis of hourly rainfall data and assumptions about drying time. It is shown that a wet pavement significantly increases the number of crashes. The models developed in this paper for Italian motorways appear to be useful for many applications such as the detection of critical factors, the estimation of accident reduction due to infrastructure and pavement improvement, and the predictions of accidents counts when comparing different design options. Thus this research may represent a point of reference for engineers in adjusting or designing multilane roads.

Accidents, Traffic↗

Penalized maximum likelihood estimation to directly adjust diagnostic and prognostic prediction models for overoptimism: a clinical example.

BACKGROUND AND OBJECTIVE: There is growing interest in developing prediction models. The accuracy of such models when applied in new patient samples is commonly lower than estimated from the development sample. This may be because of differences between the samples and/or because the developed model was overfitted (too optimistic). Various methods, including bootstrapping techniques exist for afterwards shrinking the regression coefficients and the model's discrimination and calibration for overoptimism. Penalized maximum likelihood estimation (PMLE) is a more rigorous method because adjustment for overfitting is directly built into the model development, instead of relying on shrinkage afterwards. PMLE has been described mainly in the statistical literature and is rarely applied to empirical data. Using empirical data, we illustrate the use of PMLE to develop a prediction model. METHODS: The accuracy of the final PMLE model will be contrasted with the final models derived by ordinary stepwise logistic regression without and with shrinkage afterwards. The potential advantages and disadvantages of PMLE over the other two strategies are discussed. RESULTS: PMLE leads to smaller prediction errors, provides for model reduction to a user-defined degree, and may differently shrink each predictor for overoptimism without sacrificing much discriminative accuracy of the model. CONCLUSION: PMLE is an easily applicable and promising method to directly adjust clinical prediction models for overoptimism.

Bias↗

Development of a predictive model for postoperative pulmonary complications after cholecystectomy.

The purpose of this study was to develop a model to predict the occurrence of a postoperative pulmonary complication (PPC) following cholecystectomy. Seventeen potential risk factors were extracted from the literature by identifying and ranking those most frequently referenced. The study included only those risk factors available to the nurse in the preoperative, intraoperative, and immediate postoperative setting. Three institutions were used for data collection, and data were collected by a retrospective chart review of 300 randomly chosen subjects from a population of 720. Of the 300 subjects, 37 were omitted due to exclusion criteria. A PPC was present in 54 of the remaining 263 subjects (20.5%). Of the original 17 risk factors, 10 were included in model development. The 54 subjects with a PPC and 54 subjects without a PPC (randomly chosen from the remaining 209) were used to determine which combination of risk factors best predicted subject classification (PPC or no PPC). The direct entry discriminant function that provided the highest percentage of correct classification (PPC, no PPC) consisted of five variables: sex, age, smoking history, duration of anesthesia, and nasogastric tube. The resulting equation correctly classified 75% of the cases.

Adult↗

Predictive model of muscle fatigue after spinal cord injury in humans.

The fatigability of paralyzed muscle limits its ability to deliver physiological loads to paralyzed extremities during repetitive electrical stimulation. The purposes of this study were to determine the reliability of measuring paralyzed muscle fatigue and to develop a model to predict the temporal changes in muscle fatigue that occur after spinal cord injury (SCI). Thirty-four subjects underwent soleus fatigue testing with a modified Burke electrical stimulation fatigue protocol. The between-day reliability of this protocol was high (intraclass correlation, 0.96). We fit the fatigue index (FI) data to a quadratic-linear segmental polynomial model. FI declined rapidly (0.3854 per year) for the first 1.7 years, and more slowly (0.01 per year) thereafter. The rapid decline of FI immediately after SCI implies that a "window of opportunity" exists for the clinician if the goal is to prevent these changes. Understanding the timing of change in muscle endurance properties (and, therefore, load-generating capacity) after SCI may assist clinicians when developing therapeutic interventions to maintain musculoskeletal integrity.

Adolescent↗

Text composition by the physically disabled: a rate prediction model for scanning input.

Keyboard 'bypass' techniques allow physically disabled people, otherwise unable to use conventional means of text composition, to do so. Ability to compose text is extremely important to the disabled, offering potential for non-speech communication, computer access, creative writing, etc. Consequently, these techniques have received a good deal of attention and many diverse systems have evolved. They all suffer, however, from the drawback of inherently slow input, quite apart from any disability on the part of the user. For this reason, text composition rate (or communication rate) is the major figure of merit. Since many diverse systems and approaches exist, quantitative methods of comparison are required to guide prescription and development of such aids. Only recently have attempts to produce models which predict communication rate been made. This paper extends the earlier model of Rosen and Gooenough-Trepagnier to encompass scanning-input systems. Scanning input is of considerable interest since it can be used by very severely disabled people. The model developed is applied to the comparison of two very different systems: row-column scanning and the 'scanning Microwriter'. According to the model, row-scanning is very much faster than the scanning Microwriter when a letter-frequency arrangement of the character selections is used. The relation of the model to classical information theory, treating the disabled user as an information source, is also explored.

Journal Article↗

Preoperative risk-of-death prediction model in heart surgery with deep hypothermic circulatory arrest in the neonate.

OBJECTIVE: Our goal was to generate a preoperative risk-of-death prediction model in selected neonates with congenital heart disease undergoing surgery with deep hypothermic circulatory arrest. METHODS: We completed a single-center, prospective, randomized, double-blind, placebo- controlled neuroprotection trial in selected neonates with congenital heart disease requiring operations for which deep hypothermic circulatory arrest was used. An extensive database was generated that included preoperative, intraoperative, and postoperative variables. Variables (delivery, maternal, and infant related) were evaluated to produce a preoperative risk-of-death prediction model by means of logistic regression. An operative risk-of-death prediction model including duration of deep hypothermic circulatory arrest was also generated. RESULTS: Between July 1992 and September 1997, 350 (74%) of 473 eligible infants were enrolled with 318 undergoing deep hypothermic circulatory arrest. The mortality was 52 of 318 (16.4%), unaffected by investigational drug. The resulting preoperative risk model contained 4 variables: (1) cardiac anatomy (two-ventricle vs single ventricle surgery, with/without arch obstruction), (2) 1-minute Apgar score (</=5 vs >5), (3) presence of genetic syndrome, and (4) age at hospital admission for surgery (</=5 or >5 days). Mortality for two-ventricle repair was 3.2% (4/130). Mortality for single ventricle palliation was 25.5% (48/188) and was significantly influenced by Apgar score, genetic diagnosis, and admission age. The preoperative model had a prediction accuracy of 80%. The operative risk model included duration of deep hypothermic circulatory arrest, which significantly (P =.03) increased risk of death, with a prediction accuracy of 82%. CONCLUSIONS: In this selected population, postoperative mortality risk is significantly affected by preoperative conditions. Identification of infants with varying mortality risks may affect family counseling, therapeutic intervention, and risk stratification for future study designs.

Cardiac Surgical Procedures↗

Thymus size in infants from birth until 24 months of age evaluated by ultrasound. A longitudinal prediction model for the thymic index.

PURPOSE: To do a follow-up sonography assessment of the thymic size in infants at an age of 24 months, and to create a longitudinal prediction model for the thymic index covering all ages from birth to 24 months. MATERIAL AND METHODS: Of 37 infants examined in an earlier investigation, 34 attended a 24-month follow-up examination. The thymic index, a volume estimate, was assessed by sonography and compared to clinical variables, breast-feeding status and illness. The longitudinal prediction model was based on data throughout 2 years. RESULTS: There was no significant relation between the thymic index and the clinical variables, breast-feeding status or illness at 24 months. An overall test for the effect of breast-feeding status at 4 months for infants from 0-24 months was significant, as was the actual body length of the infants from 0-8 months. Prediction models were estimated. CONCLUSION: Based on a 24-month longitudinal sonography study, prediction models are presented whereby the thymic size, as an index, can be predicted at all times from birth to 24 months of age.

Child Development↗

[Application of a predictive model for morbidity among middle socioeconomic class infants].

A predictive model which identifies infants who suffer 4 to 5 times more morbidity than their unselected peers was calculated in previous studies, in population of the low socio-economic stratum (SES) (Rev Med Chile 1992; 120: 342-8): Some families of the middle SES also seek care at the Primary Health Care System. Therefore, since our aim is to propose an instrument to be used at this level, the predictive model was applied in families of this stratum. Children identified by means of the model suffered as many episodes of diarrhea but not of other illnesses, as their peers of the low SES (4.8 vs 4.3 respectively). Families in whom the instrument was positive were fewer in the middle SES (6.8 vs 15.7%). Because during the study a campaign to prevent cholera was carried out in Santiago, and this may modify the predictor's performance, at the end of the follow up the model was validated again in families of the low-SES; results confirmed that children with a positive predictor suffered more diarrhea than those of the non-selected population (6.5 vs 3.4 episodes/children/year).

Chile↗

Predictive model for serious bacterial infections among infants younger than 3 months of age.

OBJECTIVE: To develop a data-derived model for predicting serious bacterial infection (SBI) among febrile infants <3 months old. METHODS: All infants </=90 days old with a temperature >/=38.0 degrees C seen in an urban emergency department (ED) were retrospectively identified. SBI was defined as a positive culture of urine, blood, or cerebrospinal fluid. Tree-structured analysis via recursive partitioning was used to develop the model. SBI or No-SBI was the dichotomous outcome variable, and age, temperature, urinalysis (UA), white blood cell (WBC) count, absolute neutrophil count, and cerebrospinal fluid WBC were entered as potential predictors. The model was tested by V-fold cross-validation. RESULTS: Of 5279 febrile infants studied, SBI was diagnosed in 373 patients (7%): 316 urinary tract infections (UTIs), 17 meningitis, and 59 bacteremia (8 with meningitis, 11 with UTIs). The model sequentially used 4 clinical parameters to define high-risk patients: positive UA, WBC count >/=20 000/mm(3) or </=4100/mm(3), temperature >/=39.6 degrees C, and age <13 days. The sensitivity of the model for SBI is 82% (95% confidence interval [CI]: 78%-86%) and the negative predictive value is 98.3% (95% CI: 97.8%-98.7%). The negative predictive value for bacteremia or meningitis is 99.6% (95% CI: 99.4%-99.8%). The relative risk between high- and low-risk groups is 12.1 (95% CI: 9.3-15.6). Sixty-six SBI patients (18%) were misclassified into the lower risk group: 51 UTIs, 14 with bacteremia, and 1 with meningitis. CONCLUSIONS: Decision-tree analysis using common clinical variables can reasonably predict febrile infants at high-risk for SBI. Sequential use of UA, WBC count, temperature, and age can identify infants who are at high risk of SBI with a relative risk of 12.1 compared with lower-risk infants.

Age Factors↗

The influence of personality on nicotine craving: a hierarchical multivariate statistical prediction model.

The present study proposes a hierarchical multivariate statistical prediction model which enables to determine the most prominent variables (physiological, biochemical and personality factors) related to nicotine craving and dopaminergic activation. Based on animal studies reporting a reduction of the rewarding effects of psychotropic drugs after blockade or destruction of the mesolimbic dopamine (DA) system, changes in nicotine craving after pharmacological manipulation by means of a DA agonist (lisuride 0.2 mg) and a DA antagonist (fluphenazine 2 mg) were assessed in 36 healthy male heavy smokers. The major aim was the development of a multivariate prediction model which is applicable in samples lacking variance homogeneity or the prerequisite of a multivariate normal distribution. The model proposed is a combination of multivariate parametric and nonparametric methods taking advantage of their individual merits. Especially personality variables, such as sensation seeking, impulsivity, and neuroticism showed to be important predictors of craving in this responder approach.

Adult↗

How to diagnose rheumatoid arthritis early: a prediction model for persistent (erosive) arthritis.

OBJECTIVE: To develop a clinical model for the prediction, at the first visit, of 3 forms of arthritis outcome: self-limiting, persistent nonerosive, and persistent erosive arthritis. METHODS: A standardized diagnostic evaluation was performed on 524 consecutive, newly referred patients with early arthritis. Potentially diagnostic determinants obtained at the first visit from the patient's history, physical examination, and blood and imaging testing were entered in a logistic regression analysis. Arthritis outcome was recorded at 2 years' followup. The discriminative ability of the model was expressed as a receiver operating characteristic (ROC) area under the curve (AUC). RESULTS: The developed prediction model consisted of 7 variables: symptom duration at first visit, morning stiffness for > or =1 hour, arthritis in > or =3 joints, bilateral compression pain in the metatarsophalangeal joints, rheumatoid factor positivity, anti-cyclic citrullinated peptide antibody positivity, and the presence of erosions (hands/feet). Application of the model to an individual patient resulted in 3 clinically relevant predictive values: one for self-limiting arthritis, one for persistent nonerosive arthritis, and one for persistent erosive arthritis. The ROC AUC of the model was 0.84 (SE 0.02) for discrimination between self-limiting and persistent arthritis, and 0.91 (SE 0.02) for discrimination between persistent nonerosive and persistent erosive arthritis, whereas the discriminative ability of the American College of Rheumatology 1987 classification criteria for rheumatoid arthritis was significantly lower, with ROC AUC values of 0.78 (SE 0.02) and 0.79 (SE 0.03), respectively. CONCLUSION: A clinical prediction model was developed with an excellent ability to discriminate, at the first visit, between 3 forms of arthritis outcome. Validation in other early arthritis clinics is necessary.

Adolescent↗

Development of nonexercise prediction models of maximal oxygen uptake in healthy Japanese young men.

The present study developed nonexercise models for predicting maximal oxygen uptake (VO2max) using skeletal muscle (SM) mass and cardiac dimensions and to investigate the validity of these equations in healthy Japanese young men. Sixty healthy Japanese men were randomly separated into two groups: 40 in the development group and 20 in the validation group. VO2max during treadmill running was measured using an automated breath-by-breath mass spectrometry system. Left ventricular internal dimensions at end-diastole (LVIDD) and at end-systole (LVIDS) were measured using M-mode ultrasound with a 2.5 MHz transducer. Stroke volume (SV) was calculated based on the Pombo rule. SM mass was predicted by B-mode ultrasound muscle thickness. Correlations were observed between VO2max and predicted thigh (r = 0.74, P < 0.001) and lower leg SM mass (r = 0.55, P < 0.001). Furthermore, there were correlations between VO2max and LVIDD (r = 0.74, P < 0.001) and SV (r = 0.72, P < 0.001). Stepwise regression analysis was applied to thigh SM mass and SV for prediction of VO2max in the development group, and these parameters were closely correlated with absolute measured VO2max (R2 = 0.72, P < 0.001) by multiple regression analysis. When the VO2max prediction equations were applied to the validation group, significant correlations were also observed between the measured and predicted VO2max (R2 = 0.83, P < 0.001). These results suggested that nonexercise prediction of VO2max using thigh SM mass and cardiac dimension is a valid method to predict VO2max in young Japanese adults.

Adult↗

Determining the main risk factors and high-risk groups of breast cancer using a predictive model for breast cancer risk assessment in South Korea.

This study was aimed at developing a predictive model for assessing the breast cancer risk of Korean women under the assumption of differences in the risk factors between Westerners and Koreans. The cohort comprised 384 breast cancer patients and 2 control groups: one comprising 166 hospitalized patients and the other comprising 104 nurses and teachers. Two initial models were produced by comparing cases and the 2 control groups, and the final equations were established by selecting highly significant variables of the initial models to test the accuracy of the models in terms of disease probability and predictability. Both the initial models and the final disease-probability models were confirmed to exhibit high degrees of accuracy and predictability. Major risk factors determined by comparing the patients with hospitalized controls were a family history, menstrual regularity, total menstrual duration, age at first full-term pregnancy, and duration of breastfeeding. Major risk factors determined by comparing patients with nurse/teacher controls were age, education level, menstrual regularity, drinking status, and smoking status. The predictive model developed here shows that risk factors for breast cancer differ between Korean and Western subjects in the aspect of breastfeeding behavior. However, identifying the relationship between genetic susceptibility and breast cancer will require further studies with larger samples. In a model with nurse/teacher controls, drinking and higher education were found to be protective variables, whereas smoking was a risk factor. Hence the predictive model in this group could not be generalized to the Korean population; instead, breast cancer incidence needs to be compared among nurses and teachers in a nurse-and-teacher cohort.

Adult↗

Using predictive modeling to evaluate the financial effect of disease management.

The objective of this study was to use predictive modeling to evaluate a disease management (DM) program's effect on a chronically ill population. Specifically, diagnostic cost grouping (DCG) predictive modeling was utilized to measure the financial effect of DM in populations of individuals with congestive heart failure and coronary artery disease. The literature of current practices regarding DM's financial effect measurement was reviewed and critiqued--especially with reference to the population-based pre-post method. The time period for the present study is three years, and the variables of interest are financial metrics. Claims data and DM program-specific data covering the 24-month period of 2001 to 2002 and the 24-month period of 2002 to 2003 were analyzed. The mean differences between DCG predicted and actual total claims costs in 2002 and in 2003 were computed. Inflation factors, based on actual health plan population experience for the populations in question, were developed and applied to accurately evaluate financial effect. The preliminary findings suggest that a study design utilizing DCG predictive modeling in evaluating DM program financial impact provides more accurate results compared with the population-based pre-post method currently favored by DM companies.

Adolescent↗

A predictive model of mercury fish tissue concentrations for the southeastern United States.

We developed a statistical model for predicting mercury concentrations in fish tissue in four southeastern states in the United States with an emphasis on identifying important predictor variables. A number of variables that could influence mercury fish tissue concentration, including proximity to sources of mercury, environmental factors affecting mercury movement and transformation, and factors affecting mercury accumulation, were considered. The model consists of three components using classification and regression three modeling, generalized additive modeling, and universal kriging, respectively. Each modeling component accounts for a different level of variation in fish tissue mercury concentration. Important factors for predicting mercury fish tissue concentrations are: (1) location, (2) species, (3) water body pH, and (4) fish weight. South central Arkansas and southeast Mississippi are the two "hot spots" with high fish tissue mercury concentrations. In addition, relatively high mercury levels were found near the Arkansas-Louisiana border and the mid-section of Mississippi.

Animals↗