Tag: nevin manimala

J Psychol. 2024 Apr 2:1-23. doi: 10.1080/00223980.2024.2334289. Online ahead of print.

ABSTRACT

The functional outcomes associated with subjective well-being (SWB) and the detrimental aspects of psychological distress (PD) make it essential to explore contributing factors. The present study investigated a model about the existing gap in the determining role of trait anger (TA), state anger (SA), cognitive reappraisal (CR), rumination and cognitive failure (CF) as predictors of SWB and PD. The study contributes by exploring the interaction of dispositional, situation factors and emotional regulation strategies in shaping SWB and PD in the Indian Sample. A cross-sectional survey design was employed wherein 600 young adults aged 18-40 (M_age = 22.13, SD_age = 4.06) were recruited from Uttar Pradesh, India using a multi-level cluster sampling method. The data were collected using questionnaires in the field setting during August-December 2021. Regression and path analysis revealed that the proposed predictors explained significant variance in SWB and PD, i.e., R² = 0.24, F (5, 594) = 38.03, p < 0.01, Cohen f² =0.31 and R² = 0.35, F (5, 594) = 66.40, p < 0.01, Cohen f² = 0.53, respectively. The models also fit well with the statistical indices. Except CR, all predictors emerged as significant risk factors. The findings suggest that the interventions to reduce PD and enhance SWB may consider inculcating CR and reducing higher levels of TA, SA, rumination and CF to enhance an individual’s adaptive functioning. The findings pave the way for conducting a pre-planned experiment to study the outcomes of various levels of TA in regulating incidental anger (SA) employing CR and rumination.

PMID:38564674 | DOI:10.1080/00223980.2024.2334289

J Orthop Res. 2024 Apr 2. doi: 10.1002/jor.25844. Online ahead of print.

ABSTRACT

Although the Achilles tendon is the largest and strongest tendon in the body, healing of the Achilles tendon is the most common injury, and this process is difficult due to poor tendon circulation; moreover, the underlying mechanism has not been fully elucidated. In our study, we aimed to investigate the effects of pentoxifylline and alpha-tocopherol administered separately or in combination on rats with Achilles tendon injury. Forty-eight male Wistar rats weighing 230 ± 30 g were used in the study. The rats were randomly divided into eight groups of six animals each. Tendons were evaluated histopathologically and biomechanically. According to the statistical analysis, the vascularity density in the pentoxifylline group on day 14 was significantly greater than that in the other groups (p < 0.05). The collagen arrangement in the pentoxifylline and alpha-tocopherol groups on day 14 was found to be firmer and smoother than that in the control group (p < 0.05). The collagen arrangement in the pentoxifylline group on day 28 was greater than that in the other groups (p < 0.05). The biomechanical results were significantly greater in all groups (p < 0.05). Pentoxifylline contributed to tendon healing both through neovascularization in the early period and by improving collagen orientation in the late period, while alpha-tocopherol had a positive effect on collagen orientation in the early period. No beneficial effects were observed when pentoxifylline and alpha-tocopherol were used together. We believe that further research is needed to understand the effects of this combination therapy on tendon healing.

PMID:38564283 | DOI:10.1002/jor.25844

Cogn Sci. 2024 Apr;48(4):e13437. doi: 10.1111/cogs.13437.

ABSTRACT

Statistical learning enables humans to involuntarily process and utilize different kinds of patterns from the environment. However, the cognitive mechanisms underlying the simultaneous acquisition of multiple regularities from different perceptual modalities remain unclear. A novel multidimensional serial reaction time task was developed to test 40 participants’ ability to learn simple first-order and complex second-order relations between uni-modal visual and cross-modal audio-visual stimuli. Using the difference in reaction times between sequenced and random stimuli as the index of domain-general statistical learning, a significant difference and dissociation of learning occurred between the initial and final learning phases. Furthermore, we used a negative and positive occurrence-frequency-and-reaction-time correlation to indicate implicit and explicit learning, respectively, and found that learning simple uni-modal patterns involved an implicit-to-explicit segue, while acquiring complex cross-modal patterns required an explicit-to-implicit segue, resulting in a X-shape crossing of regularity learning. Thus, we propose an X-way hypothesis to elucidate the dynamic interplay between the implicit and explicit systems at two distinct stages when acquiring various regularities in a multidimensional probability space.

PMID:38564270 | DOI:10.1111/cogs.13437

JMIR Res Protoc. 2024 Apr 2;13:e52365. doi: 10.2196/52365.

ABSTRACT

BACKGROUND: Ankle-foot orthoses (AFOs) are vital in gait rehabilitation for patients with stroke. However, many conventional AFO designs may not offer the required precision for optimized patient outcomes. With the advent of 3D scanning and printing technology, there is potential for more individualized AFO solutions, aiming to enhance the rehabilitative process.

OBJECTIVE: This nonrandomized trial seeks to introduce and validate a novel system for AFO design tailored to patients with stroke. By leveraging the capabilities of 3D scanning and bespoke software solutions, the aim is to produce orthoses that might surpass conventional designs in terms of biomechanical effectiveness and patient satisfaction.

METHODS: A distinctive 3D scanner, complemented by specialized software, will be developed to accurately capture the biomechanical data of leg movements during gait in patients with stroke. The acquired data will subsequently guide the creation of patient-specific AFO designs. These personalized orthoses will be provided to participants, and their efficacy will be compared with traditional AFO models. The qualitative dimensions of this experience will be evaluated using the Quebec User Evaluation of Satisfaction With Assistive Technology (QUEST) assessment tool. Feedback from health care professionals and the participants will be considered throughout the trial to ensure a rounded understanding of the system’s implications.

RESULTS: Spatial-temporal parameters will be statistically compared using paired t tests to determine significant differences between walking with the personalized orthosis, the existing orthosis, and barefoot conditions. Significant differences will be identified based on P values, with P<.05 indicating statistical significance. The Statistical Parametric Mapping method will be applied to graphically compare kinematic and kinetic data across the entire gait cycle. QUEST responses will undergo statistical analysis to evaluate patient satisfaction, with scores ranging from 1 (not satisfied) to 5 (very satisfied). Satisfaction scores will be presented as mean and SD values. Significant variations in satisfaction levels between the personalized and existing orthosis will be assessed using a Wilcoxon signed rank test. The anticipation is that the AFOs crafted through this innovative system will either match or outperform existing orthoses in use, with higher patient satisfaction rates.

CONCLUSIONS: Embracing the synergy of technology and biomechanics may hold the key to revolutionizing orthotic design, with the potential to set new standards in patient-centered orthotic solutions. However, as with all innovations, a balanced approach, considering both the technological possibilities and individual patient needs, will be paramount to achieving optimal outcomes.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/52365.

PMID:38564249 | DOI:10.2196/52365

Stat Med. 2024 Apr 2. doi: 10.1002/sim.10061. Online ahead of print.

ABSTRACT

Common statistical theory applicable to confirmatory phase III trial designs usually assumes that patients are enrolled simultaneously and there is no time gap between enrollment and outcome observation. However, in practice, patients are enrolled successively and there is a lag between the enrollment of a patient and the measurement of the primary outcome. For single-stage designs, the difference between theory and practice only impacts on the trial duration but not on the statistical analysis and its interpretation. For designs with interim analyses, however, the number of patients already enrolled into the trial and the number of patients with available outcome measurements differ, which can cause issues regarding the statistical analyses of the data. The main issue is that current methodologies either imply that at the time of the interim analysis there are so-called pipeline patients whose data are not used to make a statistical decision (like stopping early for efficacy) or the enrollment into the trial needs to be at least paused for interim analysis to avoid pipeline patients. There are methods for delayed responses available that introduced error-spending stopping boundaries for the enrollment of patients followed by critical values to reject the null hypothesis in case the stopping boundaries have been crossed beforehand. Here, we will discuss other solutions, considering different boundary determination algorithms using conditional power and introducing a design allowing for recruitment restart while keeping the type I error rate controlled.

PMID:38564226 | DOI:10.1002/sim.10061

J Palliat Med. 2024 Apr 1. doi: 10.1089/jpm.2023.0670. Online ahead of print.

ABSTRACT

Background: The use of continuous intravenous inotropic support (CIIS) as palliative therapy in patients with advanced heart failure (HF) has increased over the past decade. CIIS improves New York Heart Association (NYHA) functional class but does not impact survival. Objective: The objective of this study was to examine patients’ understanding of the therapeutic intent of CIIS, prognostic awareness, and quality of life with CIIS. Design: We conducted a prospective, cross-sectional, multicenter study of patients with advanced HF receiving CIIS as palliative therapy between 2020 and 2022. Settings/Subjects: An investigator-developed survey instrument was administered to outpatients on CIIS in the United States via telephone. Measurements: Survey data were analyzed using descriptive and inferential statistics. Results: Forty-eight patients, 63% male, 81% African American/Black, with a mean age of 68.9 (standard deviation 12.3) years, participated in this study. The majority of patients responded that they expected CIIS to make them feel better (79%) and increase longevity (75%), but few expected that CIIS would cure their HF (19%). Patients described their overall quality of life on CIIS as not better/worse (19%), somewhat better (46%), and significantly better (35%) and reported high treatment satisfaction (87% were at least somewhat satisfied). Conclusions: In this study, patients report improved quality of life with CIIS as palliative therapy. Patients on CIIS as palliative therapy expected increased survival on CIIS, which is incongruent with current evidence. Further studies on how we can improve care processes so that patients have accurate prognostic and disease-state awareness, and receive goal concordant care, are warranted.

PMID:38564223 | DOI:10.1089/jpm.2023.0670

JAMA Netw Open. 2024 Apr 1;7(4):e244525. doi: 10.1001/jamanetworkopen.2024.4525.

ABSTRACT

IMPORTANCE: Biomarkers of lipid, apolipoprotein, and carbohydrate metabolism have been previously suggested to be associated with the risk for depression, anxiety, and stress-related disorders, but results are inconsistent.

OBJECTIVE: To examine whether the biomarkers of carbohydrate, lipid, and apolipoprotein metabolism are associated with the risk of depression, anxiety, and stress-related disorders.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study with longitudinal data collection assessed 211 200 participants from the Apolipoprotein-Related Mortality Risk (AMORIS) cohort who underwent occupational health screening between January 1, 1985, and December 31, 1996, mainly in the Stockholm region in Sweden. Statistical analysis was performed during 2022 to 2023.

EXPOSURES: Lipid, apolipoprotein, and carbohydrate biomarkers measured in blood.

MAIN OUTCOMES AND MEASURES: The associations between biomarker levels and the risk of developing depression, anxiety, and stress-related disorders through the end of 2020 were examined using Cox proportional hazards regression models. In addition, nested case-control analyses were conducted within the cohort, including all incident cases of depression, anxiety, and stress-related disorders, and up to 10 control individuals per case who were individually matched to the case by year of birth, sex, and year of enrollment to the AMORIS cohort, using incidence density sampling. Population trajectories were used to illustrate the temporal trends in biomarker levels for cases and controls.

RESULTS: A total of 211 200 individuals (mean [SD] age at first biomarker measurement, 42.1 [12.6] years; 122 535 [58.0%] male; 188 895 [89.4%] born in Sweden) participated in the study. During a mean (SD) follow-up of 21.0 (6.7) years, a total of 16 256 individuals were diagnosed with depression, anxiety, or stress-related disorders. High levels of glucose (hazard ratio [HR], 1.30; 95% CI, 1.20-1.41) and triglycerides (HR, 1.15; 95% CI, 1.10-1.20) were associated with an increased subsequent risk of all tested psychiatric disorders, whereas high levels of high-density lipoprotein (HR, 0.88; 95% CI, 0.80-0.97) were associated with a reduced risk. These results were similar for male and female participants as well as for all tested disorders. The nested case-control analyses demonstrated that patients with depression, anxiety, or stress-related disorders had higher levels of glucose, triglycerides, and total cholesterol during the 20 years preceding diagnosis, as well as higher levels of apolipoprotein A-I and apolipoprotein B during the 10 years preceding diagnosis, compared with control participants.

CONCLUSIONS AND RELEVANCE: In this cohort study of more than 200 000 participants, high levels of glucose and triglycerides and low levels of high-density lipoprotein were associated with future risk of depression, anxiety, and stress-related disorders. These findings may support closer follow-up of individuals with metabolic dysregulations for the prevention and diagnosis of psychiatric disorders.

PMID:38564219 | DOI:10.1001/jamanetworkopen.2024.4525

JAMA Netw Open. 2024 Apr 1;7(4):e244630. doi: 10.1001/jamanetworkopen.2024.4630.

ABSTRACT

IMPORTANCE: Artificial intelligence (AI) large language models (LLMs) demonstrate potential in simulating human-like dialogue. Their efficacy in accurate patient-clinician communication within radiation oncology has yet to be explored.

OBJECTIVE: To determine an LLM’s quality of responses to radiation oncology patient care questions using both domain-specific expertise and domain-agnostic metrics.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study retrieved questions and answers from websites (accessed February 1 to March 20, 2023) affiliated with the National Cancer Institute and the Radiological Society of North America. These questions were used as queries for an AI LLM, ChatGPT version 3.5 (accessed February 20 to April 20, 2023), to prompt LLM-generated responses. Three radiation oncologists and 3 radiation physicists ranked the LLM-generated responses for relative factual correctness, relative completeness, and relative conciseness compared with online expert answers. Statistical analysis was performed from July to October 2023.

MAIN OUTCOMES AND MEASURES: The LLM’s responses were ranked by experts using domain-specific metrics such as relative correctness, conciseness, completeness, and potential harm compared with online expert answers on a 5-point Likert scale. Domain-agnostic metrics encompassing cosine similarity scores, readability scores, word count, lexicon, and syllable counts were computed as independent quality checks for LLM-generated responses.

RESULTS: Of the 115 radiation oncology questions retrieved from 4 professional society websites, the LLM performed the same or better in 108 responses (94%) for relative correctness, 89 responses (77%) for completeness, and 105 responses (91%) for conciseness compared with expert answers. Only 2 LLM responses were ranked as having potential harm. The mean (SD) readability consensus score for expert answers was 10.63 (3.17) vs 13.64 (2.22) for LLM answers (P < .001), indicating 10th grade and college reading levels, respectively. The mean (SD) number of syllables was 327.35 (277.15) for expert vs 376.21 (107.89) for LLM answers (P = .07), the mean (SD) word count was 226.33 (191.92) for expert vs 246.26 (69.36) for LLM answers (P = .27), and the mean (SD) lexicon score was 200.15 (171.28) for expert vs 219.10 (61.59) for LLM answers (P = .24).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, the LLM generated accurate, comprehensive, and concise responses with minimal risk of harm, using language similar to human experts but at a higher reading level. These findings suggest the LLM’s potential, with some retraining, as a valuable resource for patient queries in radiation oncology and other medical fields.

PMID:38564215 | DOI:10.1001/jamanetworkopen.2024.4630

Transl Vis Sci Technol. 2024 Apr 2;13(4):4. doi: 10.1167/tvst.13.4.4.

ABSTRACT

PURPOSE: Establishing a development environment for machine learning is difficult for medical researchers because learning to code is a major barrier. This study aimed to improve the accuracy of a postoperative vault value prediction model for implantable collamer lens (ICL) sizing using machine learning without coding experience.

METHODS: We used Orange data mining, a recently developed open-source, code-free machine learning tool. This study included eye-pair data from 294 patients from the B&VIIT Eye Center and 26 patients from Kim’s Eye Hospital. The model was developed using OCULUS Pentacam data from the B&VIIT Eye Center and was internally evaluated through 10-fold cross-validation. External validation was performed using data from Kim’s Eye Hospital.

RESULTS: The machine learning model was successfully trained using the data collected without coding. The random forest showed mean absolute errors of 124.8 µm and 152.4 µm for the internal 10-fold cross-validation and the external validation, respectively. For high vault prediction (>750 µm), the random forest showed areas under the curve of 0.725 and 0.760 for the internal and external validation datasets, respectively. The developed model performed better than the classic statistical regression models and the Google no-code platform.

CONCLUSIONS: Applying a no-code machine learning tool to our ICL implantation datasets showed a more accurate prediction of the postoperative vault than the classic regression and Google no-code models.

TRANSLATIONAL RELEVANCE: Because of significant bias in measurements and surgery between clinics, the no-code development of a customized machine learning nomogram will improve the accuracy of ICL implantation.

PMID:38564200 | DOI:10.1167/tvst.13.4.4

Cell Oncol (Dordr). 2024 Apr 2. doi: 10.1007/s13402-024-00940-y. Online ahead of print.

ABSTRACT

INTRODUCTION: Chimeric antigen receptor (CAR)-T cells obtained long-term durability in about 30% to 40% of relapsed/refractory (r/r) B-cell non-Hodgkin lymphoma (B-NHL). Maintenance therapy after CAR-T is necessary, and PD1 inhibitor is one of the important maintenance therapy options.

METHODS: A total of 173 r/r B-NHL patients treated with PD1 inhibitor maintenance following CD19/22 CAR-T therapy alone or combined with autologous hematopoietic stem cell transplantation (ASCT) from March 2019 to July 2022 were assessed for eligibility for two trials. There were 81 patients on PD1 inhibitor maintenance therapy.

RESULTS: In the CD19/22 CAR-T therapy trial, the PD1 inhibitor maintenance group indicated superior objective response rate (ORR) (82.9% vs 60%; P = 0.04) and 2-year progression-free survival (PFS) (59.8% vs 21.3%; P = 0.001) than the non-maintenance group. The estimated 2-year overall survival (OS) was comparable in the two groups (60.1% vs 45.1%; P = 0.112). No difference was observed in the peak expansion levels of CD19 CAR-T and CD22 CAR-T between the two groups. The persistence time of CD19 and CD22 CAR-T in the PD1 inhibitor maintenance group was longer than that in the non-maintenance group. In the CD19/22 CAR-T therapy combined with ASCT trial, no significant differences in ORR (81.4% vs 84.8%; P = 0.67), 2-year PFS (72.3% vs 74.9%; P = 0.73), and 2-year OS (84.1% vs 80.7%; P = 0.79) were observed between non-maintenance and PD1 inhibitor maintenance therapy groups. The peak expansion levels and duration of CD19 and CD22 CAR-T were not statistically different between the two groups. During maintenance treatment with PD1 inhibitor, all adverse events were manageable. In the multivariable analyses, type and R3m were independent predictive factors influencing the OS of r/r B-NHL with PD1 inhibitor maintenance after CAR-T therapy.

CONCLUSION: PD1 inhibitor maintenance following CD19/22 CAR-T therapy obtained superior response and survival in r/r B-NHL, but not in the trial of CD19/22 CAR-T cell therapy combined with ASCT.

PMID:38564164 | DOI:10.1007/s13402-024-00940-y