Tag: nevin manimala

J Adv Nurs. 2022 Apr 22. doi: 10.1111/jan.15239. Online ahead of print.

ABSTRACT

AIMS: This review aims to examine updated evidence to evaluate the effectiveness of caregiver-mediated exercise interventions on basic and extended activities of daily living (ADL), anxiety and depression of post-stroke rehabilitation individuals.

DESIGN: A systematic review and meta-analysis.

DATA SOURCES: Six electronic databases, including CINAHL, CENTRAL, Embase, PubMed, PsycINFO and Scopus, grey literature and trial registry were searched from inception until February 2021.

METHODS: Only randomized controlled trials written in English were included. Meta-analyses were conducted for basic and extended ADL, anxiety and depression outcomes using RevMan software. Overall quality of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation framework.

RESULTS: A total of 11 randomized controlled trials comprising 2120 participants were identified, with 10 trials meta-analysed. Meta-analyses indicated statistically significant effects favouring caregiver-mediated exercise interventions for basic ADL. Subgroup analyses revealed significant effects for exercise-only interventions mediated by caregivers for basic ADL. No significant effects were found for extended ADL, anxiety and depression for stroke survivors.

CONCLUSION: Caregiver-mediated exercise interventions appear to have beneficial impacts on basic ADL for stroke survivors, suggesting caregiver-mediated exercise interventions as a potentially feasible way to improve functional independence.

IMPACT: Caregiver-mediated intervention with exercises as a major component could be a promising approach to augment stroke rehabilitation. Future research should include high-quality studies with focus on specific intervention components or to explore caregiver outcomes.

PMID:35451521 | DOI:10.1111/jan.15239

Acta Obstet Gynecol Scand. 2022 Apr 22. doi: 10.1111/aogs.14366. Online ahead of print.

ABSTRACT

Traditional null hypothesis significance testing (NHST) incorporating the critical level of significance of 0.05 has become the cornerstone of decision-making in health care, and nowhere less so than in obstetric and gynecological research. However, such practice is controversial. In particular, it was never intended for clinical significance to be inferred from statistical significance. The inference of clinical importance based on statistical significance (p < 0.05), and lack of clinical significance otherwise (p ≥ 0.05) represents misunderstanding of the original purpose of NHST. Furthermore, the limitations of NHST-sensitivity to sample size, plus type I and II errors-are frequently ignored. Therefore, decision-making based on NHST has the potential for recurrent false claims about the effectiveness of interventions or importance of exposure to risk factors, or dismissal of important ones. This commentary presents the history behind NHST along with the limitations that modern-day NHST presents, and suggests that a statistics reform regarding NHST be considered.

PMID:35451497 | DOI:10.1111/aogs.14366

J Nutr. 2022 Apr 22:nxac093. doi: 10.1093/jn/nxac093. Online ahead of print.

ABSTRACT

BACKGROUND: Diet therapy may bridge the therapeutic gap in ulcerative colitis (UC).

OBJECTIVES: The novel 4-SURE diet (4-strategies-to-SUlfide-REduction), designed to modulate colonic fermentation and influence production of excess hydrogen sulfide, was examined in a feasibility study for tolerability, clinical efficacy and effects on microbial end-points.

DESIGN: Adults ≥ 18 years old with mild to moderately active UC were advised to increase intake of fermentable fibers, restrict total and sulfur-containing proteins and avoid specific food additives for 8-weeks. The primary outcome was tolerability of diet (100-mm visual analogue scale (VAS) with 100-mm being intolerable). Secondary exploratory outcomes were self-reported adherence (always adherent ≥ 76-100%), clinical and endoscopic response (reduction in partial Mayo ≥ 2 and Mayo endoscopic sub-score ≥ 1), modulation of fecal characteristics including markers of protein and carbohydrate fermentation, and food-related quality of life (IBD-FRQoL-29). Primary analysis was by intention to treat, performed using paired t and Wilcoxon signed-rank statistical tests.

RESULTS: 28 adults with UC, mean age 42 (range 22-72) years, 15 female, 3 proctitis, 14 left-sided and 11 extensive, were studied. Prescribed dietary targets were achieved overall. The diet was well tolerated (VAS: 19 mm; 95% CI 7, 31 mm) with 95% frequently or always adherent. Clinical response occurred in 13/28 (46%) and endoscopic improvement in 10/28 (36%). Two (7%) worsened. Fecal excretion of short-chain fatty acids (SCFA) increased by 69% (p < 0.0001) while the proportion of branched-chain to SCFA were suppressed by 27% (-1.34%; 95% CI: -2.28, -0.40; p = 0.007). FRQoL improved by 10 points (95% CI: 4, 16; p < 0.001).

CONCLUSIONS: The 4-SURE dietary strategy is considered tolerable and an acceptable diet by adults with mild to moderately active UC. The dietary teachings achieved the prescribed dietary and fecal targets. Given signals of therapeutic efficacy, further evaluation of this diet is warranted in a placebo-controlled trial. Trial registration number: Australian New Zealand Clinical Trials Registry ACTRN12619000063112.

PMID:35451489 | DOI:10.1093/jn/nxac093

Metallomics. 2022 Apr 22:mfac028. doi: 10.1093/mtomcs/mfac028. Online ahead of print.

ABSTRACT

Hemodialysis (HD) represents a life-sustaining treatment for patients with end stage renal disease. However, it is associated with several complications, including anemia. Erythropoiesis stimulating agents (ESA) are often administered to HD patients with renal anemia, but a relevant proportion of them fail to respond to the therapy. Since trace metals are involved in several biological processes and their blood levels can be altered by hemodialysis, we study the possible association between serum trace metal concentrations and ratios with the administration and response to ESA. For this study, data and sample information of 110 HD patients were downloaded from the UC San-Diego Metabolomics Workbench public repository (PR000565). The blood serum levels (and ratios) of antimony, cadmium, copper, manganese, molybdenum, nickel, selenium, tin and zinc were studied applying an omics statistical approach. The Random Forest model was able to discriminate HD dependent patients treated and not treated with ESA, with an accuracy of 71.7% (95% CI 71.5-71.9%). Logistic regression analysis identifies alterations of Mn, Mo, Cd, Sn, and several of their ratios as characteristic of patients treated with ESA. Moreover, patients with scarce response to ESA showed to be characterized by reduced Mn to Ni and Mn to Sb ratios. In conclusion, our results show that trace metals, in particular manganese, play a role in the mechanisms underlying human response to ESA, and if further confirmed, the re-equilibration of their physiological levels could contribute to a better management of HD patients hopefully reducing their morbidity and mortality.

PMID:35451491 | DOI:10.1093/mtomcs/mfac028

Nephrol Dial Transplant. 2022 Apr 22:gfac157. doi: 10.1093/ndt/gfac157. Online ahead of print.

ABSTRACT

BACKGROUND: In FIGARO-DKD, finerenone reduced the risk of cardiovascular events in patients with type 2 diabetes (T2D) and stage 1-4 chronic kidney disease (CKD). In FIDELIO-DKD, finerenone improved kidney and cardiovascular outcomes in patients with advanced CKD. This analysis further explores kidney outcomes in FIGARO-DKD.

METHODS: FIGARO-DKD (NCT02545049) included patients with urine albumin-to-creatinine ratio (UACR) 30-<300 mg/g and estimated glomerular filtration rate (eGFR) 25-90 mL/min/1.73 m2 or UACR 300-5000 mg/g and eGFR ≥ 60 mL/min/1.73 m2. Outcomes included two composite kidney endpoints of kidney failure, renal death and with either a sustained decrease from baseline of ≥ 40% or ≥ 57% in eGFR for ≥ 4 weeks. Change in of albuminuria and eGFR slope were also analysed. Kidney and CV outcomes were evaluated by baseline UACR.

RESULTS: A lower incidence rate for the eGFR ≥ 40% kidney composite endpoint was observed with finerenone compared with placebo, but the between-group difference was not significant (HR = 0.87; 95%CI 0.76-1.01; P = 0.069). A greater treatment effect was observed on the eGFR ≥ 57% kidney composite endpoint (HR = 0.77; 95%CI 0.60-0.99; P = 0.041) with a 36% relative risk reduction for end-stage kidney disease. A larger magnitude of effect on kidney outcomes was observed with finerenone versus placebo for patients with severely increased albuminuria than with moderately increased albuminuria. Improvements in UACR, eGFR slope and cardiovascular risk were evident in both subgroups with finerenone.

CONCLUSIONS: The present analyses suggest that finerenone protects against kidney disease progression and cardiovascular events in patients with T2D and early- or late-stage CKD.

PMID:35451488 | DOI:10.1093/ndt/gfac157

Pain Med. 2022 Apr 22:pnac064. doi: 10.1093/pm/pnac064. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the current cutoff score and a recalibrated adaptation of the Veterans Health Administration (VHA) Risk Index for Serious Prescription Opioid-Induced Respiratory Depression or Overdose (RIOSORD) in active duty service members.

DESIGN: Retrospective case-control.

SETTING: Military Health System.

SUBJECTS: Active duty service members dispensed ≥ 1 opioid prescription between January 1, 2018 and December 31, 2019.

METHODS: Service members with a documented opioid overdose were matched 1:10 to controls. An active duty-specific (AD) RIOSORD was constructed using the VHA RIOSORD components. Analyses examined the risk stratification and predictive characteristics of two RIOSORD versions (VHA and AD).

RESULTS: Cases (n = 95) were matched with 950 controls. Only 6 of the original 17 elements were retained in the AD RIOSORD. Long-acting or extended-release opioid prescriptions, antidepressant prescriptions, hospitalization, and emergency department visits were associated with overdose events. The VHA RIOSORD had fair performance (C-statistic 0.77, 95% CI 0.75, 0.79), while the AD RIOSORD did not demonstrate statistically significant performance improvement (C-statistic 0.78, 95% CI, 0.77, 0.80). The DoD selected cut point (VHA RIOSORD > 32) only identified 22 of 95 ORD outcomes (Sensitivity 0.23) while an AD-specific cut point (AD RIOSORD > 16) correctly identified 53 of 95 adverse events (Sensitivity 0.56).

CONCLUSION: Results highlight the need to continually recalibrate predictive models and to consider multiple measures of performance. Although both models had similar overall performance with respect to the C-statistic, an AD-specific index threshold improves sensitivity. The calibrated AD RIOSORD does not represent an end-state, but a bridge to a future model developed on a wider range of patient variables, taking into consideration features that capture both care received, and care that was not received.

PMID:35451483 | DOI:10.1093/pm/pnac064

Mil Med. 2022 Apr 22:usac106. doi: 10.1093/milmed/usac106. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate facility postoperative opioid prescribing patterns in comparison to published guidelines and adherence to opioid safety mandates.

METHODS: This quality analysis was performed between November 2019 and March 2020. Patients were identified to have been opioid naïve prior to receiving a new opioid prescription postoperatively during the study period. Patient charts were reviewed, and patients were contacted to collect desired data. Statistical analysis was performed to evaluate distributions of morphine equivalent daily dose and opioid day supply prescribed across study subpopulations.

RESULTS: Ninety-four of 100 prescriptions evaluated were determined to be within quantity or duration recommendations of the selected guideline. Statistical analysis found no significantly different distributions between the duration and quantity of opioid prescribed at discharge and patient-specific risk factors. Forty-eight patients did not use the entire quantity of the initial opioid prescription dispensed. Of those patients, 26 still had opioids within the home. Opioid risk review documentation was completed in 19 of 65 patients indicated for documentation.

CONCLUSION: Most opioid prescriptions provided within the study period aligned with recommendations from author-selected guidelines. However, a review of risk prior to opioid prescribing frequently was not performed. The number of patients utilizing less than 50% of prescribed opioids, and few refills indicate that reductions in opioids prescribed would improve safety for both patients and the surrounding community without increasing the risk for the under-treatment of postoperative pain. Improved prescribing habits and patient safety will be targeted through provider education regarding risk review documentation in opioid naïve patients.

PMID:35451478 | DOI:10.1093/milmed/usac106

Integr Comp Biol. 2022 Apr 22:icac015. doi: 10.1093/icb/icac015. Online ahead of print.

ABSTRACT

Arboreal animals must learn to modulate their movements to overcome the challenges posed by the complexity of their heterogeneous environment, reduce performance failure, and survive. Anolis lizards are remarkable in the apparent ease with which they conquer this heterogeneity, demonstrating an impressive ability to modulate their locomotor behavior to maintain stable locomotion on widely disparate surfaces. Significant progress has been made towards understanding the impact of substrate structure on the behavioral plasticity of arboreal species, but it is unclear whether the same strategies employed to shift between substrates in one context can be employed to shift between those same substrates in a new context. Is the kinematic shift between broad and narrow perches achieved in a similar way on different inclines? Do all species within an ecomorph make similar adjustments? Here, we analyze the limb movements of two trunk-crown Anolis ecomorphs, A. carolinensis and A. evermanni, running on 6 different surfaces (3 inclinations × 2 perch diameters), from the perspective of Transfer Learning. Transfer learning is that field of machine learning which aims at exploiting the knowledge gained from one task to improve generalization about another, related task. In our setting, we use transfer learning to show that the strategies employed to improve locomotor stability on narrow perches are transferred across environments with different inclines. Further, behaviors used on vertical inclines are shared, and thus transfer well, across perch diameters whereas the relationship between horizontal and intermediate inclines change on different perch diameters, leading to lower transfer learning of shallow inclines across perch diameters. Interestingly, the best incline for transfer of behavior differs between limbs: forelimb models learn best from the vertical incline and hind limb models learn best from horizontal and intermediate inclines. Finally, our results suggest both that subtle differences exist in how A. carolinensis and A. evermanni adjust their behaviors in typical trunk-crown environments and that they may have converged on similar strategies for modulating forelimb behavior on vertical surfaces and hind limb behavior on shallow surfaces. The transfer of behavior is analogous to phenotypic plasticity, which likely plays a key role in the rapid adaptive evolution characteristic of Anolis lizards. This work is an example of how modern statistical methodology can provide an interesting perspective on new biological questions, such as on the role and nuances of behavioral plasticity and the key behaviors that help shape the versatility and rapid evolution of Anolis lizards.

PMID:35451476 | DOI:10.1093/icb/icac015

G3 (Bethesda). 2022 Apr 22:jkac094. doi: 10.1093/g3journal/jkac094. Online ahead of print.

ABSTRACT

By modeling the homoeologous gene losses that occurred in fifty genomes deriving from ten distinct polyploidy events, we show that the evolutionary forces acting on polyploids are remarkably similar, regardless of whether they occur in flowering plants, ciliates, fishes or yeasts. We show that many of the events show a relative rate of duplicate gene loss prior to the first post-polyploidy speciation that is significantly higher than in later phases of their evolution. The relatively weak selective constraint experienced by the single-copy genes these losses produced leads us to suggest that most of the purely selectively neutral duplicate gene losses occur in the immediate post-polyploid period. Nearly all of the events show strong evidence of biases in the duplicate losses, consistent with them being allopolyploidies, with two distinct progenitors contributing to the modern species. We also find ongoing and extensive reciprocal gene losses (RGL; alternative losses of duplicated ancestral genes) between these genomes. With the exception of a handful of closely related taxa, all of these polyploid organisms are separated from each other by tens to thousands of reciprocal gene losses. As a result, it is very unlikely that viable diploid hybrid species could form between these taxa, since matings between such hybrids would tend to produce offspring lacking essential genes. It is therefore possible that the relatively high frequency of recurrent polyploidies in some lineages may be due to the ability of new polyploidies to bypass RGL barriers.

PMID:35451464 | DOI:10.1093/g3journal/jkac094

Bioinformatics. 2022 Apr 22:btac288. doi: 10.1093/bioinformatics/btac288. Online ahead of print.

ABSTRACT

MOTIVATION: Elucidating the topology of gene regulatory networks (GRNs) from large single-cell RNA sequencing (scRNAseq) datasets, while effectively capturing its inherent cell-cycle heterogeneity and dropouts, is currently one of the most pressing problems in computational systems biology. Recently, graph learning (GL) approaches based on graph signal processing (GSP) have been developed to infer graph topology from signals defined on graphs. However, existing GL methods are not suitable for learning signed graphs, a characteristic feature of GRNs, which are capable of accounting for both activating and inhibitory relationships in the gene network. They are also incapable of handling high proportion of zero values present in the single cell datasets.

RESULTS: To this end, we propose a novel signed GL approach, scSGL, that learns GRNs based on the assumption of smoothness and non-smoothness of gene expressions over activating and inhibitory edges, respectively. scSGL is then extended with kernels to account for non-linearity of co-expression and for effective handling of highly occurring zero values. The proposed approach is formulated as a non-convex optimization problem and solved using an efficient ADMM framework. Performance assessment using simulated datasets demonstrates the superior performance of kernelized scSGL over existing state of the art methods in GRN recovery. The performance of scSGL is further investigated using human and mouse embryonic datasets.

AVAILABILITY AND IMPLEMENTATION: The scSGL code and analysis scripts are available on https://github.com/Single-Cell-Graph-Learning/scSGL.

SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

PMID:35451460 | DOI:10.1093/bioinformatics/btac288