Tag: nevin manimala

Biom J. 2021 Nov 25. doi: 10.1002/bimj.202000015. Online ahead of print.

ABSTRACT

In many biomedical studies or clinical trials, we have data with more than one response variable on the same subject repeatedly measured over time. In analyzing such data, we adopt a multivariate linear mixed-effects longitudinal model. On the other hand, in longitudinal data, we often find features that do not impact modeling the response variable and are eliminated from the study. In this paper, we consider the problem of simultaneous variable selection and estimation in a multivariate t linear mixed-effects model (MtLMM) for analyzing longitudinally measured multioutcome data. This work’s motivation comes from a cohort study of patients with primary biliary cirrhosis. The interest is eliminating insignificant variables using the smoothly clipped and absolute deviation penalty function in the MtLMM. The proposed penalized model offers robustness and flexibility to accommodate fat tails. An expectation conditional maximization algorithm is employed for the computation of maximum likelihood estimates of parameters. The calculation of standard errors is affected by an information-based method. The methodology is illustrated by analyzing Mayo Clinic Primary Biliary Cirrhosis sequential (PBCseq) data and a simulation study. We found drugs and sex can be eliminated from the PBCseq analysis, and over time the disease progresses.

PMID:34821410 | DOI:10.1002/bimj.202000015

J Med Virol. 2021 Nov 25. doi: 10.1002/jmv.27475. Online ahead of print.

ABSTRACT

BACKGROUND: Interferons are essential part of the innate immune system and have antiviral and immunomodulatory functions. We studied the effects of Interferon β-1a on outcomes of severe cases of COVID-19.

MATERIAL AND METHODS: This retrospective study was conducted on hospitalized COVID-19 patients in Loghman-Hakim hospital from 20 February 2020 to 20 April 2020, Tehran, Iran. Patients were selected from two groups, the first group received Interferon β-1a in addition to standard treatment regimen, and the second group received standard care. The clinical progression of two groups during their hospital admission has been compared.

RESULTS: We studied a total number of 395 hospitalized COVID-19 patients. Out of this number, 111 patients (33.5%) died (31.3% of the Interferon β-1a group and 34.1% of the control group). Mortality rate indicated no statistically significant difference between groups (p-value = 0.348), however for patients who were hospitalized for more than a week, the rate of mortality was lower in the Interferon β-1a group (p-value = 0.014). The median hospital stay was statistically longer for patients treated by Interferon β-1a (p-value <0.001).

CONCLUSION: The results of this study showed that Interferon β-1a can improve the outcomes of hospitalized patients with severe COVID-19, but more adequately-powered randomized controlled trials should be conducted. This article is protected by copyright. All rights reserved.

PMID:34821387 | DOI:10.1002/jmv.27475

Med Phys. 2021 Nov 25. doi: 10.1002/mp.15380. Online ahead of print.

ABSTRACT

PURPOSE: The common practice in acquiring the magnetic resonance (MR) images is to obtain two-dimensional (2D) slices at coarse locations while keeping the high in-plane resolution in order to ensure enough body coverage while shortening the MR scan time. The aim of this study is to propose a novel method to generate HR MR images from low resolution MR images along the longitudinal direction. In order to address the difficulty of collecting paired low- and high-resolution MR images in clinical settings and to gain the advantage of parallel cycle consistent generative adversarial networks (CycleGANs) in synthesizing realistic medical images, we developed a parallel CycleGANs based method using a self-supervised strategy.

METHODS AND MATERIALS: The proposed workflow consists of two parallelly trained CycleGANs to independently predict the HR MR images in the two planes along the directions that is orthogonal to the longitudinal MR scan direction. Then the final synthetic HR MR images are generated by fusing the two predicted images. MR images, including T1-weighted (T1), contrast enhanced T1-weighted (T1CE), T2-weighted (T2) and T2 Fluid Attenuated Inversion Recovery (FLAIR), of the multimodal brain tumor segmentation challenge 2020 (BraTS2020) dataset were processed to evaluate the proposed workflow along the cranial-caudal (CC), lateral and anterior-posterior directions. Institutional collected MR images were also processed for evaluation of the proposed method. The performance of the proposed method was investigated via both qualitative and quantitative evaluations. Metrics of normalized mean absolute error (NMAE), peak signal-to-noise ratio (PSNR), edge keeping index (EKI), structural similarity index measurement (SSIM), information fidelity criterion (IFC) and visual information fidelity in pixel domain (VIFP) were calculated.

RESULTS: It is shown that the proposed method can generate HR MR images visually indistinguishable from the ground truth in the investigations on the BraTS2020 dataset. In addition, the intensity profiles, difference images and SSIM maps can also confirm the feasibility of the proposed method for synthesizing HR MR images. Quantitative evaluations on the BraTS2020 dataset shows that the calculated metrics of synthetic HR MR images can all be enhanced for the T1, T1CE, T2 and FLAIR images. The enhancements in the numerical metrics over the low-resolution and bi-cubic interpolated MR images are statistically significant. Qualitative evaluation of the synthetic HR MR images of the clinical collected dataset could also confirm the feasibility of the proposed method.

CONCLUSIONS: The proposed method is feasible to synthesize HR MR images using self-supervised parallel CycleGANs, which can be expected to shorten MR acquisition time in clinical practices. This article is protected by copyright. All rights reserved.

PMID:34821395 | DOI:10.1002/mp.15380

J Med Virol. 2021 Nov 25. doi: 10.1002/jmv.27477. Online ahead of print.

ABSTRACT

As the present coronavirus disease 2019 (COVID-19) spreads and existing data suggested susceptibility factors for developing a severe course of the disease. This case-control experiment aimed to study the associations of genetic polymorphisms in tumor necrosis factors (TNFs) with COVID-19 and its mortality rate. A total of 550 participants (275 subjects and 275 controls) were enrolled. The tetra-ARMS-PCR technique was recruited to detect -308G>A TNFα and +252A>G TNFβ polymorphisms among the Iranian population. We demonstrated that participants carrying the G allele of TNFβ-252A/G, rs909253 A>G was more frequent in COVID-19 subjects compared to the healthy group and statistically increased the disease risk (OR=1.55, 95% CI=1.23-1.96, P<0.0001). At the same time, the A allele of TNFα-311A/G, rs1800629 G>A moderately decreased the risk of COVID-19 (OR=0.68, 95% CI=0.53-0.86, P<0.002). Also, we analyzed the various genotypes regarding the para-clinical and disorder severity; we found that the AA genotype of TNFβ-252A/G, rs909253 A>G, the CT scan pattern was different in comparison to cases in the AG genotype with P ₁ <0.001. In addition, in the severe cases of COVID-19, leucocyte and neutrophil count and duration of ICU hospitalization in the death group have been significantly increased (P<0.001). Moreover, the TNFα-311A/G, rs1800629 G>A variant is likely to change the pattern of splicing factor sites. Our findings provided deep insights into the relationship between TNFα/TNFβ polymorphisms and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Replicated studies may give scientific evidence for exploring molecular mechanisms of COVID-19 in other ethnicities. This article is protected by copyright. All rights reserved.

PMID:34821383 | DOI:10.1002/jmv.27477

Rev Esp Salud Publica. 2021 Nov 25;95:e202111195.

ABSTRACT

OBJECTIVE: National hip fracture registries have been established in several countries and recent publications show that the care process has been audited inspecting the representativeness according to quality standards. The aim of this study was to analyse if the Spanish National Hip Fracture Registry (RNFC) represents the Spanish population aged 75 and older admitted for hip fractures, and to compare its results regarding the care process with the national average, according to the National Inpatient register (Minimum Basic Dataset, CMBD).

METHODS: The 2017-2018 National Minimum Basic Dataset (Conjunto Mínimo Básico de Datos, CMBD) was used as reference. For analysis, we included 83,110 cases from the CMBD and 21,130 from the RNFC. Eight common variables of both registries were selected for comparison.

RESULTS: No significant differences were observed in the patient-related common variables (age, sex, type of fracture and fracture side), but statistically significant differences were found in the variables describing the care process (proportion of patients operated, deceased, surgical procedures and postoperative length of stay).

CONCLUSIONS: The RNFC, designed as a convenience sample, is also representative of the population of patients aged 75 and older treated for hip fractures in Spain. However, there is a participation bias related to the professionals and the hospitals interested in voluntarily participating in a quality improvement program, which would explain the better results observed in the care process, compared to the national average as collected by the CMBD.

PMID:34821224

Clin Ter. 2021 Nov 22;172(6):542-546. doi: 10.7417/CT.2021.2375.

ABSTRACT

BACKGROUND: Tibial plateau fractures pose multiple challenges to the surgeon given their frequent intra-articular involvement and the tendency to displace under axial load. The aim of this study is to de-scribe the clinical outcomes of a retrospective case series in which tibial plateau fractures were not treated with PL fragment osteosynthesis.

METHODS: In the present retrospective study, we included patients treated for tibial plateau fracture with PL fragment in our department from January 2016 to January 2020. All patients were seen at the outpa-tient clinic 2 and 5 weeks after surgery, and at 3, 6 and 12 months, and thereafter at regular intervals, depending on the overall clinical status. Every patient included in this study was then contacted by phone to assess self-reported clinical outcomes. The Oxford Knee Score (OKS) questionnaire was used to assess functional outcomes. Patients were divided in six groups depending on the three-column classification by Lou (groups A1-A6). Patients were also divided in four groups based on the whole area of the PL column and on the depression of the PL fragment (group B1-B4). One-way ANOVA was used to compare groups of patients.

RESULTS: OKS scores, extension and step-off of the PL fragment were analyzed in groups A1 – A6. No significant differences between OKS scores and step-off were found, while statistical difference was found between surfaces of PL fragment. No significant difference was found between OKS scores in groups B1-B4.

CONCLUSION: Our findings suggest that the treatment outcome is influenced not only by the superficial involvement or collapse of PL fragments, but also by other variables, including BMI, pre-injury physi-cal health, and age.

PMID:34821349 | DOI:10.7417/CT.2021.2375

Expert Rev Neurother. 2021 Nov 25. doi: 10.1080/14737175.2022.2011215. Online ahead of print.

ABSTRACT

INTRODUCTION: . Children with Autism Spectrum Disorder (ASD) experience difficulties in Executive Functions (EF) performances. However, efficacy of EF intervention needs to be further investigated.

OBJECTIVE: to evaluate the efficacy of different EF interventions in children and adolescents with ASD.

METHODS: A systematic review and meta-analysis were carried out according to PRISMA guidelines. Relevant databases including Pubmed, Psychinfo, Scopus and Web of Science were searched up to November 2019. Papers included in the study have the following characteristics: randomized controlled trial or quasi-experimental design and be published in English or Spanish.

RESULTS: After the elimination of duplicates, 949 were screened. Among these six were included in the systematic review. The main approaches for EF in ASD were computer-based interventions, cognitive-behavioral therapy and assisted-animal therapy. Statistically significant results (p=0.003) were found in using exergames.

CONCLUSION: Different approaches can be used for improving EF intervention, with positive effects on working memory, behavior, and flexibility.

PMID:34821185 | DOI:10.1080/14737175.2022.2011215

Clin Rehabil. 2021 Nov 25:2692155211057656. doi: 10.1177/02692155211057656. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the effectiveness of proprioceptive training on balance performance, trunk control, and gait speed in people with stroke.

METHODS: We searched PubMed, Science Direct, Cochrane, Embase, and Medline for randomized controlled trials that evaluated the effects of proprioceptive training for patients with stroke from the date of each database’s inception to July 26, 2021. Two reviewers independently screened the titles and abstracts of potentially eligible articles that were identified on the basis of the search criteria. Methodological quality was determined using version 2 of the Cochrane risk of bias tool for randomized trials. Data were analyzed using Comprehensive Meta-Analysis software. The treatment effect was estimated by calculating Hedges’ g and 95% confidence intervals (CIs) using a random-effects model. Statistical heterogeneity was assessed according to the I² value. The primary outcome was balance performance and secondary outcomes were trunk control, gait speed, and basic functional mobility.

RESULTS: In total, 17 trials involving 447 people with stroke were included. Proprioceptive training had a significant effect on balance performance (Hedges’ g = 0.69, 95% CI = 0.36-1.01), gait speed (Hedges’ g = 0.57, 95% CI = 0.19-0.94), trunk control (Hedges’ g = 0.75, 95% CI = 0.33-1.17), and basic functional mobility (Hedges’ g = 0.63, 95% CI = 0.31-0.94) among people with stroke.

CONCLUSION: Proprioceptive training may be effective in improving balance performance, gait speed, trunk control, and basic functional mobility among people with stroke.

PMID:34821158 | DOI:10.1177/02692155211057656

Clin Rehabil. 2021 Nov 25:2692155211062110. doi: 10.1177/02692155211062110. Online ahead of print.

ABSTRACT

OBJECTIVE: To test with the Rasch analysis the psychometric properties of the Falls Efficacy Scale International, a questionnaire for measuring concern about falling.

DESIGN: Longitudinal observational study, before-after rehabilitation.

SETTING: Inpatient rehabilitation.

SUBJECTS: A total of 251 neurological patients with balance impairment.

INTERVENTIONS: Physiotherapy and occupational therapy aimed at reducing the risk of falling.

MAIN MEASURES: Participants (median age, first-third quartile: 74.0, 65.5-80.5 years; stroke and polyneuropathy: 43% and 21% of the sample, respectively) received a balance assessment (Falls Efficacy Scale International included) pre- and post-rehabilitation. Rasch analysis was used to evaluate the Falls Efficacy Scale International. Differential item functioning, which assesses the measures’ stability in different conditions (e.g. before vs. after treatment) and in different groups of individuals, was tested for several variables.

RESULTS: Patients suffered a moderate balance impairment (Mini-BESTest median score; first-third quartile: 15; 11-19), mild-moderate concern about falling (Falls Efficacy Scale International: 28; 21-37) and motor disability (Functional Independence Measure, motor domain: 70.0; 57.0-76.5). Falls Efficacy Scale International items fitted the Rasch model (range of infit and outfit mean square statistics: 0.8-1.32 and 0.71-1.45, respectively) and the questionnaire’s reliability was satisfactory (0.87). No differential item functioning was found for treatment, gender, age and balance impairment. Differential item functioning was found for diagnosis and disability severity, but it is shown that it is not such as to bias measures.

CONCLUSIONS: Falls Efficacy Scale International ordinal scores can be turned into interval measures, i.e. measures of the type of temperature. Being differential item functioning-free for treatment, these measures can be safely used to compare concern about falling before and after rehabilitation, such as when interested in assessing the rehabilitation effectiveness.

PMID:34821159 | DOI:10.1177/02692155211062110

Health Informatics J. 2021 Oct-Dec;27(4):14604582211052259. doi: 10.1177/14604582211052259.

ABSTRACT

Online symptom checkers (SCs) are eHealth solutions that offer healthcare organizations the possibility to empower their patients to independently assess their symptoms. The successful implementation of eHealth solutions, such as SCs, requires a supportive organizational culture and leadership. However, there is limited knowledge about the factors associated with leaders’ support for the use of SCs. The aim of the study was to identify the factors associated to primary care leaders’ support for SCs in triage and their experiences of the benefits and challenges related to the use of SCs. An online survey was used to collect data from 84 Finnish primary care leaders. The data were analyzed using statistical analysis methods and content analysis. Vision clarity, perceiving efficiency improvements, and considering the service to be beneficial for patients were associated with leaders’ support for the service (β ranging from 0.41 to 0.44, p < 0.001). Leaders’ support for the service was also associated with how well the leaders provided information about the service to their subordinates (β =0.22, p < 0.048). SCs present slightly more challenges than benefits regarding health professionals’ work. The developers of SCs should focus more on features that decrease health professionals’ workload as well as how the solution can benefit patients.

PMID:34821152 | DOI:10.1177/14604582211052259