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Many individually randomized group treatment (IRGT) trials randomly assign individuals to study arms but deliver treatments via shared agents, such as therapists, surgeons, or trainers. Post-randomization interactions induce correlations in outcome measures between participants sharing the same agent. Agents can be nested in or crossed with trial arm, and participants may interact with a single agent or with multiple agents. These complications have led to ambiguity in choice of models but there have been no systematic efforts to identify appropriate analytic models for these study designs. To address this gap, we undertook a simulation study to examine the performance of candidate analytic models in the presence of complex clustering arising from multiple membership, single membership, and single agent settings, in both nested and crossed designs and for a continuous outcome. With nested designs, substantial type I error rate inflation was observed when analytic models did not account for multiple membership and when analytic model weights characterizing the association with multiple agents did not match the data generating mechanism. Conversely, analytic models for crossed designs generally maintained nominal type I error rates unless there was notable imbalance in the number of participants that interact with each agent., (© 2024 The Author(s). Statistics in Medicine published by John Wiley & Sons Ltd. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.)

Background: Silicon nanopore membrane-based implantable bioartificial organs are dependent on arteriovenous implantation of a mechanically robust and biocompatible hemofilter. The hemofilter acts as a low-resistance, high-flow network, with blood flow physiology similar to arteriovenous shunts commonly created for hemodialysis access. A mock circulatory loop (MCL) that mimics shunt physiology is an essential tool for refinement and durability testing of arteriovenous implantable bioartificial organs and silicon blood-interfacing membranes. We sought to develop a compact and cost-effective MCL to replicate flow conditions through an arteriovenous shunt and used data from the MCL and swine to inform a bond graph mathematical model of the physical setup., Methods: Flow physiology through bioartificial organ prototypes was obtained in the MCL and during extracorporeal attachment to swine for biologic comparison. The MCL was tested for stability overtime by measuring pressurewave variability over a 48-h period. Data obtained in vitro and extracorporeally informed creation of a bond graph model of the MCL., Results: The arteriovenous MCL was a cost-effective, portable system that reproduced flow rates and pressures consistent with a pulsatile arteriovenous shunt as measured in swine. MCL performance was stable over prolonged use, providing a cost-effective simulator for enhanced testing of peripherally implanted bioartificial organ prototypes. The corresponding bond graph model recapitulates MCL and animal physiology, offering a tool for further refinement of the MCL system., (© 2023 The Authors. Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)

Background: Multiple-period parallel group randomized trials (GRTs) analyzed with linear mixed models can represent time in mean models as continuous or categorical. If time is continuous, random effects are traditionally group- and member-level deviations from condition-specific slopes and intercepts and are referred to as random coefficients (RC) analytic models. If time is categorical, random effects are traditionally group- and member-level deviations from time-specific condition means and are referred to as repeated measures ANOVA (RM-ANOVA) analytic models. Longstanding guidance recommends the use of RC over RM-ANOVA for parallel GRTs with more than two periods because RC exhibited nominal type I error rates for both time parameterizations while RM-ANOVA exhibited inflated type I error rates when applied to data generated using the RC model. However, this recommendation was developed assuming a variance components covariance matrix for the RM-ANOVA, using only cross-sectional data, and explicitly modeling time × group variation. Left unanswered were how well RM-ANOVA with an unstructured covariance would perform on data generated according to the RC mechanism, if similar patterns would be observed in cohort data, and the impact of not modeling time × group variation if such variation was present in the data-generating model., Methods: Continuous outcomes for cohort and cross-sectional parallel GRT data were simulated according to RM-ANOVA and RC mechanisms at five total time periods. All simulations assumed time × group variation. We varied the number of groups, group size, and intra-cluster correlation. Analytic models using RC, RM-ANOVA, RM-ANOVA with unstructured covariance, and a Saturated random effects structure were applied to the data. All analytic models specified time × group random effects. The analytic models were then reapplied without specifying random effects for time × group., Results: Results indicated the RC and saturated analytic models maintained the nominal type I error rate in all data sets, RM-ANOVA with an unstructured covariance did not avoid type I error rate inflation when applied to cohort RC data, and analytic models omitting time-varying group random effects when such variation exists in the data were prone to substantial type I error inflation unless the residual error variance is high relative to the time × group variance., Conclusion: The time × group RC and saturated analytic models are recommended as the default for multiple period parallel GRTs., (© 2022. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Background: Considerable debate exists regarding the definition, skill set, and training requirements for the new specialty of acute care surgery (ACS). We hypothesized that a patient subset could be identified that requires a level of care beyond general surgical training and justifies creation of this new specialty., Materials and Methods: Reviewed patient admissions over 1-y to the only general surgical service at a level I trauma center-staffed by trauma and/or critical care trained physicians. Patients classified as follows: trauma, ACS, emergency general (EGS), or elective surgery. ACS patients are nonelective, nontrauma patients with significantly altered physiology requiring intensive care unit admission and/or specific complex operative interventions. Differences in demographics, hospital course, and outcomes were analyzed., Results: In-patient service evaluated approximately 5500 patients, including 3300 trauma patients. A total of 2152 admissions include 37% trauma, 30% elective, 28% EGS, and 4% ACS. ACS and trauma patients were more likely to require multiple operations (ACS relative risk [RR] = 11.5; trauma RR = 5.7, P < 0.0001), have longer hospital and intensive care unit length of stay, and higher mortality (P < 0.0001). They were less likely to be discharged home (ACS RR = 0.75; trauma RR = 0.67, P < 0.0001) compared with that of the EGS group. EGS and elective patients were most similar to each other in multiple areas., Conclusions: ACS and EGS patients represent distinct patient cohorts, as reflected by significant differences in critical care needs, likelihood of multiple operations, and need for postdischarge rehabilitation. The skills required to care for ACS patients, including ability to rescue from complications and provide critical care, differ from those required for EGS patients and supports development of ACS training and regionalization of care., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Thirty-one samples from 8 geographic growing regions of the United States and 15 varieties common to these areas were converted to apple juice and analyzed for their attributes over the 3 year period 1979, 1980, and 1981. The total of 93 samples were analyzed for ash, brix, pH, proline, specific gravity, total acid, sorbitol, sucrose, fructose, and glucose. The elements cadmium, calcium, iron, lead, phosphorus, potassium, sodium, and zinc were also determined. These data are presented to serve as a data base for the detection of fraudulent or adulterated apple juice.

The operation of the single puncture maturometer is described. A linear regression relationship was established between single puncture maturometer readings (SPMR) and commercial maturometer readings. Various parameters of the force distance curve obtained during puncturing of individual peas were found to be related to gross chemical composition and maturity. Maximum force showed the highest and a positive correlation with alcohol insoluble solids (AIS). The force required to puncture peas was independent of the hole size used but increased with increasing pin diameter; it was related to AIS and to total solids by linear regressions. SPMR of peas in a single peapod showed that all were of similar maturity.

Flor sherry-like wines were produced continuously from New York State wines from Delaware or cold-pressed Concord grapes whose pigment contents were reduced with activated carbon. The course of flor fermentation was followed by total aldehyde analysis. Optimal flor production was observed at 18 to 20 C. Two continuous methods of fermentation were used. A glass column packed with ceramic saddles densely covered with yeasts gave good results, but required more careful management than the second method of submerged fermentation in a laboratory fermentor, which gave a higher sherry output and higher aldehyde production. With the laboratory fermentor, it was possible to obtain a sherry output of 22 liters per 24 hr with an aldehyde content of 300 to 500 mg per liter. The flor sherry produced by these methods required subsequent aging and fortification to the desired alcohol content.