Tag: pubmed

J Appl Clin Med Phys. 2023 Nov 3:e14193. doi: 10.1002/acm2.14193. Online ahead of print.

ABSTRACT

BACKGROUND: Positron Emission Tomography-Magnetic Resonance (PET-MR) scanners could improve ano-rectal radiotherapy planning through improved Gross Tumour Volume (GTV) delineation and enabling dose painting strategies using metabolic measurements. This requires accurate quantitative PET images acquired in the radiotherapy treatment position.

PURPOSE: This study aimed to evaluate the impact on GTV delineation and metabolic parameter measurement of using novel Attenuation Correction (AC) maps that included the radiotherapy flat couch, coil bridge and anterior coil to see if they were necessary.

METHODS: Seventeen ano-rectal radiotherapy patients received a ¹⁸ F-FluoroDeoxyGlucose PET-MR scan in the radiotherapy position. PET images were reconstructed without (CTAC_std ) and with (CTAC_cba ) the radiotherapy hardware included. Both AC maps used the same Computed Tomography image for patient AC. Semi-manual and threshold GTVs were delineated on both PET images, the volumes compared and the Dice coefficient calculated. Metabolic parameters: Standardized Uptake Values SUV_max , SUV_mean and Total Lesion Glycolysis (TLG) were compared using paired t-tests with a Bonferroni corrected significance level of $p=0.05/8=0.006$ .

RESULTS: Differences in semi-manual GTV volumes between CTAC_cba and CTAC_std were approaching statistical significance (difference $–15.9\%\pm 1.6\%$ , $p=0.007$ ), with larger differences in low FDG-avid tumours ( ${\mathrm{SUV}}_{\mathrm{mean}}<8.5g{\mathrm{mL}}^{–1}$ ). The CTAC_cba and CTAC_std GTVs were concordant with Dice coefficients 0.89 ± 0.01 (manual) and 0.98 ± 0.00 (threshold). Metabolic parameters were significantly different, with SUV_max , SUV_mean and TLG differences of $–11.5\%\pm 0.3\%$ ( $p<0.001$ ), $–11.6\%\pm 0.3\%$ ( $p<0.001$ ) and $–13.7\%\pm 0.6\%$ ( $p=0.003$ ) respectively. The TLG difference resulted in 1/8 rectal cancer patients changing prognosis group, based on literature TLG cut-offs, when using CTAC_cba rather than CTAC_std .

CONCLUSIONS: This study suggests that using AC maps with the radiotherapy hardware included is feasible for patient imaging. The impact on tumour delineation was mixed and needs to be evaluated in larger cohorts. However using AC of the radiotherapy hardware is important for situations where accurate metabolic measurements are required, such as dose painting and treatment prognostication.

PMID:37922377 | DOI:10.1002/acm2.14193

Int J Health Plann Manage. 2023 Nov 3. doi: 10.1002/hpm.3730. Online ahead of print.

ABSTRACT

BACKGROUND: Pregnancy complications and adverse birth outcomes are among the major contributors to poor maternal and child health. Mothers in remote communities are at higher risk of adverse birth outcomes due to constraints in access to healthcare services. In Ghana, a community-based primary healthcare programme called the Ghana Essential Health Interventions Programme (GEHIP) was implemented in a rural region to help strengthen primary healthcare delivery and improve maternal and child healthcare services delivery. This study assessed the effect of this programme on adverse pregnancy outcomes.

METHODS: Baseline and end-line survey data from reproductive-aged women from the GEHIP project were used in this analysis. Difference-in-differences and logistic regressions were used to examine the impact and equity effect of GEHIP on adverse pregnancy outcomes using household wealth index and maternal educational attainment as equity measures. The analysis involves the comparison of project baseline and end-line outcomes in intervention and non-intervention districts.

RESULTS: The intervention had a significant effect in the reduction of adverse pregnancy outcomes (OR = 0.96, 95% CI:0.93-0.99). Although disadvantaged groups experience larger reductions in adverse pregnancy outcomes, controlling for covariates, there was no statistically significant equity effect of GEHIP on adverse pregnancy outcomes using either the household wealth index (OR = 0.99, 95% CI:0.85-1.16) or maternal educational attainment (OR = 0.68, 95% CI: 0.44-1.07) as equity measures.

CONCLUSION: GEHIP’s community-based healthcare programme reduced adverse pregnancy outcomes but no effect on relative equity was established. Factoring in approaches for targeting disadvantaged populations in the implementation of community-based health programs is crucial to ensuring equity in health outcomes.

PMID:37922332 | DOI:10.1002/hpm.3730

PLoS One. 2023 Nov 3;18(11):e0287287. doi: 10.1371/journal.pone.0287287. eCollection 2023.

ABSTRACT

INTRODUCTION: Chronic fatigue syndrome (CFS) is a physical and mental disorder in which long-term fatigue is the main symptom. CFS patients are often accompanied by functional gastrointestinal diseases (FGIDs), which lead to decreased quality of life and increased fatigue. Prolong-life-with-nine-turn-method (PLWNT) is a kind of physical and mental exercise. Its operation includes adjusting the mind, breathing and cooperating with eight self-rubbing methods and one upper body rocking method. PLWNT was used to improve the digestive function in ancient China and to treat FGIDs such as functional dyspepsia and irritable bowel syndrome in modern times. Previous studies have shown that PLWNT can reduce fatigue in patients with CFS. But it is unclear whether the effect of PLWNT on CFS fatigue is related to gastrointestinal function. The aim of this study was to explore the relationship between PLWNT and fatigue and gastrointestinal function in patients with CFS.

METHODS: This study is a non-inferiority randomized controlled trial (RCT). The whole study period is 38 weeks, including 2 weeks of baseline evaluation, 12 weeks of intervention and 6 months of follow-up. Ninety-six CFS patients will be stratified random assigned to the intervention group (PLWNT) and the control group (cognitive behavior treatment) in the ratio of 1:1 through the random number table generated by SPSS. In the evaluation of results, Multidimensional Fatigue Inventory-20 (MFI-20), Gastrointestinal Symptom Rating Scale (GSRS), Bristol Stool Form Scale (BSFS), and Short Form 36 item health survey (SF-36) will be evaluated at week 0 (baseline), week 6 (midterm), week 12 (endpoint) and month 9 (follow up). The intestinal flora will be evaluated at week 0 (baseline) and week 12 (endpoint). The data results will be processed by statistical experts. The data analysis will be based on the intention to treat principle and per-protocol analysis. In the efficacy evaluation, repeated measurement analysis of variance will be used for data conforming to normal distribution or approximate normal distribution. The data which do not conform to the analysis of repeated measurement variance will be analyzed by the generalized estimation equation Linear discriminant analysis will be used to clarify the difference species of intestinal flora. The significance level sets as 5%. The safety of interventions will be evaluated after each treatment session.

DISCUSSION: This trial will provide evidence to PLWNT exerting positive effects on fatigue and gastrointestinal function of CFS. It will further explore whether the improvement of PLWNT on CFS fatigue is related to gastrointestinal function.

TRIAL REGISTRATION: The trial was registered at Chinese Clinical Trial Registry http://www.chictr.org.cn/showproj.aspx?proj=151456 (Registration No.: ChiCTR2200056530). Date: 2022-02-07.

PMID:37922308 | DOI:10.1371/journal.pone.0287287

PLoS One. 2023 Nov 3;18(11):e0292486. doi: 10.1371/journal.pone.0292486. eCollection 2023.

ABSTRACT

A physical model, based on energy balances, is proposed to describe the fractures in solid structures such as stelae, tiles, glass, and others. We applied the model to investigate the transition of the Rosetta Stone from the original state to the final state with three major fractures. We consider a statistical corner-breaking model with cutting rules. We obtain a probability distribution as a function of the area and the number of vertices. Our generic results are consistent with the current state of the Rosetta Stone and, additionally, predictions related to a fourth fracture are declared. The loss of information on such heritage pieces is considered through entropy production. The explicit quantification of this concept in information theory stays examined.

PMID:37922292 | DOI:10.1371/journal.pone.0292486

PLoS One. 2023 Nov 3;18(11):e0292169. doi: 10.1371/journal.pone.0292169. eCollection 2023.

ABSTRACT

INTRODUCTION: Breast cancer (BC) is the leading cause of female cancer deaths in Africa, and in Zimbabwe, >80% present with advanced disease. A Needs Project (NP) was carried out to determine the key factors responsible for delayed diagnosis and poor BC outcomes and to investigate possible solutions in 6 rural and urban districts of Matabeleland South and Bulawayo Metropolitan Provinces.

METHODS: A mixed method approach was used to collect data in 2 phases. Phase 1: an exploration of key factors leading to poor BC outcomes with >50 professional stakeholders and patient representatives. Phase 2: (i) Quantitative arm; validated questionnaires recording breast cancer knowledge, demographic information and perceived barriers to care administered to women and their relatives (Group 1) and health professionals (HPs) (Group 2). (ii) Qualitative arm; 10 focus group discussions with medical specialists and interested lay representatives (Group 3). The Cochran sample size formulae technique was used to determine the quantitative sample size and data was aggregated and analysed using SPSS Version 23™. Purposive sampling for the qualitative study selected participants with an understanding of BC and the NP. Focus group discussions were recorded and a thematic analysis of the transcriptions was conducted using NVivo9™.

RESULTS: Quantitative analysis of Group 1 data (n = 1107) confirmed that younger women (<30years) had the least knowledge of breast cancer (p<0.001). Just under half of all those surveyed regarded breast cancer as incurable. In Group 2 (n = 298) the largest group of health workers represented were general nurses and midwives (74.2%) in keeping with the structure of health provision in Zimbabwe. Analysis confirmed a strong association between age and awareness of BC incidence (p = 0.002) with respondents aged 30-39 years being both the largest group represented and the least knowledgeable, independent of speciality. Nearly all respondents (90%) supported decentralisation of appropriate breast surgical services to provincial and district hospitals backed up by specialist training. Thematic analysis of focus group discussions (Group 3) identified the following as important contributors to late BC diagnosis and poor outcomes: (i) presentation is delayed by poorly educated women and their families who fear BC and high treatment costs (ii) referral is delayed by health professionals with no access to training, skills or diagnostic equipment (iii), treatment is delayed by a disorganised, over-centralized patient pathway, and a lack of specialist care and inter-disciplinary communication.

CONCLUSION: This study confirms that the reasons for poor BC outcomes in Zimbabwe are complex and multi-factorial. All stakeholders support better user and provider education, diagnostic service reconfiguration, targeted funding, and specialist training.

PMID:37922284 | DOI:10.1371/journal.pone.0292169

PLoS One. 2023 Nov 3;18(11):e0293060. doi: 10.1371/journal.pone.0293060. eCollection 2023.

ABSTRACT

Beneficial effects of music intervention and progressive muscle relaxation alone on psychological issues were reported, however, studies evaluating their combined effects are limited. This study aimed to investigate the feasibility, acceptability and preliminary effects of music intervention combined with progressive muscle relaxation on anxiety, depression, stress, and quality of life among breast and gynaecological cancer patients receiving chemotherapy.

METHODS: The study was carried out from March to May 2022 in an oncology hospital in Vietnam. A single-blinded randomized controlled trial was conducted among 24 women with breast and gynaecological cancer undergoing chemotherapy. The intervention group (n = 12) received a face-to-face training program about music listening and progressive muscle relaxation skills. They then performed the self-practice daily at home for three weeks. The control group (n = 12) received standard care, including health assessment, regular health advice and nutrition consultation. Ten participants in the intervention group were interviewed with open-ended questions to explore the acceptability of the intervention. Anxiety, depression and stress were measured using the Depression Anxiety Stress Scale, while The Functional Assessment of Cancer Therapy-General was used to evaluate the quality of life. The outcome measurements were collected at baseline (T0), post-intervention (3rd week, T1) and follow-up (6th week, T2). Appropriate descriptive statistics were used to depict the outcome measures across study time points.

RESULTS: A total of 24 patients were eligible to join, and 20 of them completed the study. Greater reductions in anxiety, depression and stress were observed in the intervention group than in the control group at T1 and T2. Greater improvements on quality of life were found in the intervention group than control group at T1 and T2 with respect to T0. The content analysis supported the acceptable intervention of participants through two themes, perceived beneficial effects on psychological and physical health and willingness to keep practising in the future.

CONCLUSIONS: Implementing music intervention combined with progressive muscle relaxation is feasible and had a trend in reducing anxiety, depression and stress levels. A larger scale randomized controlled trial is needed to confirm the effect of the intervention on outcomes.

TRIAL REGISTRATION: This trial was registered on ClinicalTrials.gov with ID: NCT05262621.

PMID:37922279 | DOI:10.1371/journal.pone.0293060

PLoS One. 2023 Nov 3;18(11):e0293941. doi: 10.1371/journal.pone.0293941. eCollection 2023.

ABSTRACT

Adolescence phase has high intrinsic and instrumental relevance. The Transformative Action for Rural Adolescents intervention delivered PACE++ curriculum with innovations to introduce a) health and nutrition sessions and b) delivery of the content in community settings of rural Bihar. This paper examines impact of the intervention showcasing establishment of intergenerational community connect for empowering and invigorating adolescent girls on gender attitude, empowerment and adolescent health and nutrition. The impact evaluation is based on a two-arm (intervention and comparison groups) cluster randomized controlled design with two rounds of representative cross-sectional surveys. The baseline and endline sample comprised of 2327 and 2033 adolescent girls (15-19 years), respectively. Descriptive statistical, difference-in-differences and propensity score matching methods are used to confirm the program impact. The DID and PSM analyses confirm high significance of impact on gender equity norms, diets and nutritional knowledge and understanding of employee related rights and responsibilities. School-going adolescent girls performed better than those who have discontinued formal education. The intervention showcases the importance of delivering the modified PACE curriculum in rural settings through leveraging community platforms. The findings call for greater policy attention on scaling up of similar initiatives for empowerment and social capital development of adolescent girls.

PMID:37922252 | DOI:10.1371/journal.pone.0293941

Clin Transplant. 2023 Nov 3:e15176. doi: 10.1111/ctr.15176. Online ahead of print.

ABSTRACT

Gastroparesis is a common complaint among patients with diabetes. Symptoms tend to improve following successful pancreas transplantation (PTx), but persist despite euglycemia in a subset of patients. We aimed to assess the benefit of gastric peroral endoscopic myotomy (G-POEM) in persistent gastroparesis following PTx. This was a single center retrospective review of all patients who underwent G-POEM for persistent gastroparesis following PTx. Patient demographics, pre and post procedure perception of symptom severity according to the patient assessment of upper gastrointestinal symptoms severity index (PAGI-SYM), gastroparesis cardinal symptom index (GCSI) score, and 36-item short form survey (SF36) score along with gastric emptying scintigraphy (GES) were analyzed. Seven PTx recipients underwent G-POEM for persistent gastroparesis symptoms. The majority were female. All reported nausea/vomiting, abdominal pain, bloating, and post prandial fullness prior to G-POEM. The post procedure survey scores improved in all patients although this was not significant. The improvement in gastric emptying on GES was statistically significant. G-POEM is a relatively new treatment option for gastroparesis. While it requires specialized proceduralist and training, we have documented improvement in the management of symptoms. With increasing experience, we anticipate more significant benefit in post PTx patients with persistent symptoms of gastroparesis undergoing G-POEM.

PMID:37922244 | DOI:10.1111/ctr.15176

Clin Transplant. 2023 Nov 3:e15177. doi: 10.1111/ctr.15177. Online ahead of print.

ABSTRACT

INTRODUCTION: Inpatient hyperglycemia is an established independent risk factor among several patient cohorts for hospital readmission. This has not been studied after kidney transplantation. Nearly one-third of patients who have undergone a kidney transplant reportedly experience 30-day readmission.

METHODS: Data on first-time solitary kidney transplantations were retrieved between September 2015 and December 2018. Information was linked to the electronic health records to determine diagnosis of diabetes mellitus and extract glucometric and insulin therapy data. Univariate logistic regression analysis and the XGBoost algorithm were used to predict 30-day readmission. We report the average performance of the models on the testing set on bootstrapped partitions of the data to ensure statistical significance.

RESULTS: The cohort included 1036 patients who received kidney transplantation; 224 (22%) experienced 30-day readmission. The machine learning algorithm was able to predict 30-day readmission with an average area under the receiver operator curve (AUC) of 78% with (76.1%, 79.9%) 95% confidence interval (CI). We observed statistically significant differences in the presence of pretransplant diabetes, inpatient-hyperglycemia, inpatient-hypoglycemia, minimum and maximum glucose values among those with higher 30-day readmission rates. The XGBoost model identified the index admission length of stay, presence of hyper- and hypoglycemia, the recipient and donor body mass index (BMI) values, presence of delayed graft function, and African American race as the most predictive risk factors of 30-day readmission. Additionally, significant variations in the therapeutic management of blood glucose by providers were observed.

CONCLUSIONS: Suboptimal glucose metrics during hospitalization after kidney transplantation are associated with an increased risk for 30-day hospital readmission. Optimizing hospital blood glucose management, a modifiable factor, after kidney transplantation may reduce the risk of 30-day readmission.

PMID:37922214 | DOI:10.1111/ctr.15177

IEEE Trans Vis Comput Graph. 2023 Nov 3;PP. doi: 10.1109/TVCG.2023.3327203. Online ahead of print.

ABSTRACT

Modern science and industry rely on computational models for simulation, prediction, and data analysis. Spatial blind source separation (SBSS) is a model used to analyze spatial data. Designed explicitly for spatial data analysis, it is superior to popular non-spatial methods, like PCA. However, a challenge to its practical use is setting two complex tuning parameters, which requires parameter space analysis. In this paper, we focus on sensitivity analysis (SA). SBSS parameters and outputs are spatial data, which makes SA difficult as few SA approaches in the literature assume such complex data on both sides of the model. Based on the requirements in our design study with statistics experts, we developed a visual analytics prototype for data type agnostic visual sensitivity analysis that fits SBSS and other contexts. The main advantage of our approach is that it requires only dissimilarity measures for parameter settings and outputs (Fig. 1). We evaluated the prototype heuristically with visualization experts and through interviews with two SBSS experts. In addition, we show the transferability of our approach by applying it to microclimate simulations. Study participants could confirm suspected and known parameter-output relations, find surprising associations, and identify parameter subspaces to examine in the future. During our design study and evaluation, we identified challenging future research opportunities.

PMID:37922175 | DOI:10.1109/TVCG.2023.3327203