Mean Estimates Research Articles

Headache in the adult population of Cameroon: prevalence estimates and demographic associations from a cross-sectional nationwide population-based study

BackgroundKnowledge of headache prevalence, and the burdens attributable to headache disorders, remains incomplete in sub-Saharan Africa (SSA): reliable studies have been conducted only in Zambia (southern SSA) and Ethiopia (eastern SSA). As part of the Global Campaign against Headache, we investigated the prevalence of headache in Cameroon, in Central SSA.MethodsWe used the same methodology as the studies in Zambia and Ethiopia, employing cluster-randomized sampling in four regions of Cameroon, selected to reflect the country’s geographic, ethnic and cultural diversities. We visited, unannounced, randomly selected households in each region, and randomly selected one adult member (aged 18–65 years) of each. Trained interviewers administered the Headache-Attributed Restriction, Disability and Impaired Participation (HARDSHIP) structured questionnaire, developed by an international expert consensus group and translated into Central African French. Demographic enquiry was followed by diagnostic questions based on ICHD-3 criteria.ResultsHeadache was a near-universal experience in Cameroon (lifetime prevalence: 94.8%). Observed 1-year prevalence of headache was 77.1%. Age- and gender-adjusted estimates were 76.4% (95% confidence interval: 74.9–77.9) for any headache, 17.9% (16.6–19.3) for migraine (definite + probable), 44.4% (42.6–46.2) for tension-type headache (TTH; also definite + probable), 6.5% (5.7–7.4) for probable medication-overuse headache (pMOH) and 6.6% (5.8–7.6) for other headache on ≥ 15 days/month (H15 +). One-day prevalence (“headache yesterday”) was 15.3%. Gender differentials were as expected (more migraine and pMOH among females, and rather more TTH among males). pMOH increased in prevalence until age 55 years, then declined somewhat. Migraine and TTH were both associated with urban dwelling, pMOH, in contrast, with rural dwelling.ConclusionsHeadache disorders are prevalent in Cameroon. As in Zambia and Ethiopia, estimates for both migraine and TTH exceed global mean estimates. Attributable burden is yet to be reported, but these findings must lead to further research, and measures to develop and implement headache services in Cameroon, with appropriate management and preventative strategies.

Cost‐effectiveness of Resonance® metallic ureteral stent compared with standard polyurethane ureteral stents in malignant ureteric obstruction: A cost‐utility analysis

AbstractBackgroundMalignant ureteral obstruction (MUO) is a frequent challenge for urologists. Patients have poor prognoses, treatment aims to improve quality‐of‐life while optimising renal function. Standard practice in the United Kingdom is to use polyurethane stents, which require frequent surgical replacements for blockages and encrustation. More durable metallic stents are available, although these incur an increased initial purchase price.AimsWe aim to assess whether the use of polyurethane double‐J (JJ) or metallic stent, Resonance® is more cost‐effective for managing MUO in the UK healthcare setting.MethodsA Markov model was parameterised to 5 years with costs and health‐related quality‐of‐life consequences for treating MUO with Resonance metallic stent (Cook Medical), versus standard JJ stents, from the UK care system perspective, with 3.5% discounting. Deterministic and probabilistic sensitivity analyses were undertaken to assess the effect of uncertainty.ResultsOver 5 years, approximately four fewer repeat surgical interventions were estimated in the metallic stent arm compared with the JJ stent, driving a 23.4% reduction in costs. The mean estimates of costs and benefits indicate that treatment of MUO with Resonance for 5 years is dominant over JJ stents. Over 5 years a cost‐saving of £2164.74 and a health gain of +0.046 quality‐adjusted life years (QALYs) per patient is estimated. With a maximum willingness to pay of £20 k per QALY, a net monetary benefit (NMB) of £3077.83 is estimated. Probabilistic sensitivity analysis at a willingness to pay threshold of £20 000 indicates an 89.3% probability of Resonance being cost‐effective over JJ stents. Within 1‐year savings of £726.53 are estimated driven by a reduction of two fewer repeat surgical interventions when using the metallic stent.ConclusionsResonance metallic stents for the treatment of MUO reduce the number of repeat procedures and could be a cost‐effective option for the treatment, potentially offering efficiencies to the healthcare system.

Longitudinal comparison of the self-administered ALSFRS-RSE and ALSFRS-R as functional outcome measures in ALS

Objective Test the feasibility, adherence rates and optimal frequency of digital, remote assessments using the ALSFRS-RSE via a customized smartphone-based app. Methods This fully remote, longitudinal study was conducted over a 24-week period, with virtual visits every 3 months and weekly digital assessments. 19 ALS participants completed digital assessments via smartphone, including a digital version of the ALSFRS-RSE and mood survey. Interclass correlation coefficients (ICC) and Bland-Altman plots were used to assess agreement between staff-administered and self-reported ALSFRS-R pairs. Longitudinal change was evaluated using ANCOVA models and linear mixed models, including impact of mood and time of day. Impact of frequency of administration of the ALSFRS-RSE on precision of the estimate slope was tested using a mixed effects model. Results In our ALS cohort, digital assessments were well-accepted and adherence was robust, with completion rates of 86%. There was excellent agreement between the digital self-entry and staff-administered scores computing multiple ICCs (ICC range = 0.925–0.961), with scores on the ALSFRS-RSE slightly higher (1.304 points). Digital assessments were associated with increased precision of the slope, resulting in higher standardized response mean estimates for higher frequencies, though benefit appeared to diminish at biweekly and weekly frequency. Effects of participant mood and time of day on total ALSFRS-RSE score were evaluated but were minimal and not statistically significant. Conclusion Remote collection of digital patient-reported outcomes of functional status such as the ALSFRS-RSE yield more accurate estimates of change over time and provide a broader understanding of the lived experience of people with ALS.

Determination of differences in ultrasound parameters for patellar tendons in males with unilateral patellar tendinopathy-An ancillary analysis of data from two randomized controlled trials.

To investigate power Doppler (PD) activity and tendon structure (between the injured and contralateral limb) in patients with unilateral patellar tendinopathy (PT) using ultrasonography (US). Secondly, the aim was to determine the intra-rater reliability of the PD activity and tendon structure. This study analyzed US baseline data from 57 male participants with symptomatic unilateral PT who had been enrolled in one of two randomized clinical trials. Data were analyzed to examine if systematic differences existed between injured and contralateral limbs using Fiji ImageJ. The PD activity of the symptomatic tendon was larger 25.6 (Q1 = 14.9; Q3 = 41.6) mm2 than the asymptomatic 0 (Q1 = 0.0; Q3 = 0.0) mm2 (p < 0.001). There was a significantly greater tendon thickness at the proximal (2.5 mm 95% CI [2.0; 3.0]), mid (0.8 mm 95% CI [0.5; 1.1]), and distal (0.2 mm 95% CI [0.1; 0.4]) part of the tendon for the symptomatic compared to the asymptomatic tendon. Intra-rater reliability for PD activity and tendon structure ranged from moderate-to-excellent (0.74; 0.99). These results provide mean estimates for tendon thickness of symptomatic and asymptomatic tendons, that can be used for clinicians to reliably estimate pathological tendon thickness.

Azov sea fishes stock assessment by swept area method through bootstrap

Recently driven changes in habitat conditions in the Azov Sea make classic applications of swept area method inconsistent. Swept area stock assessment method modification for stock estimation of aquatic biological resources through nonparametric bootstrap is presented. New approach is tested against classic calculated results of swept area method for next fish species: Azov anchovy, tulka, turbot and Black-Azov sea shad according to data collected during 2022. Results comparison of classic and modified through bootstrap stock assessment methods leads no significant deviations in mean value estimation. Maximum difference between mean estimates of stock size was 3,75%. Confidential intervals width difference between reviewed methods, in general, was not significant. Most valuable difference in confidential intervals was detected in BCa approach against classic method with quantile approach (due to methodological features of BCa in bias correction procedure). The new stock assessment approach for swept area method though bootstrap permit to calculate statistically valid estimates, their confidential intervals and perform input data validation. The absence of significant differences in the results by the classical and proposed methods indicates the further applicable possibility of classic method even in normality violation in source samples. The normality requirements in methodology of classic approach, probably, is redundant.

Mental Health Challenges Among Children and Adolescents Associated With HIV Status Disclosure: A Systematic Review and Meta-Analysis Protocol

BACKGROUND: Prenatally acquired HIV is highly prevalent among children and adolescents globally. HIV status disclosure to children is recommended to start from 8 years and older and has shown several benefits. However, HIV status disclosure is also associated with high risks of mental health challenges. This review and meta-analysis aim at describing the prevalence of mental health challenges and associated factors among children and adolescents living with HIV. METHODS: The study will involve conducting a systematic review and meta-analysis of the existing literature on the burden of mental health challenges including stigma, depression, anxiety and suicidality after HIV status disclosure among children and adolescents aged 8-17 years. Searches for both observational and interventional studies will be performed in PubMed, Medline, Embase, CINAHL and APA Psych Info from 2000 to the date of the review. Statistical heterogeneity will be assessed using I2 test and visual inspection of the forest plot. Data will be extracted using an investigator designed data extraction form by two independent people and any disagreements will be solved by involving a third person. Using the RevMan software, a random effects model will be applied to calculate a standardised mean estimate of the prevalence of mental health challenges. A narrative will be presented for the factors associated with the mental health challenges. Risk of bias will be assessed using the appropriate study design tool and results will be reported following the PRISMA 2015 guidelines. CONCLUSION: The review will provide valuable results that will shed light on the burden of mental health challenges associated with HIV status disclosure and the influencing factors among children and adolescents. This will inform clinical practice about the importance of assessing and managing the challenges according as well as designing health policies regarding the same.

Marginal clustered multistate models for longitudinal progressive processes with informative cluster size

AbstractInformative cluster size (ICS) is a phenomenon where cluster size is related to the outcome. While multistate models can be applied to characterize the unit‐level transition process for clustered interval‐censored data, there is a research gap addressing ICS within this framework. We propose two extensions of multistate model that account for ICS to make marginal inference: one by incorporating within‐cluster resampling and another by constructing cluster‐weighted score functions. We evaluate the performances of the proposed methods through simulation studies and apply them to the Veterans Affairs Dental Longitudinal Study (VADLS) to understand the effect of risk factors on periodontal disease progression. ICS occurs frequently in dental data, particularly in the study of periodontal disease, as people with fewer teeth due to the disease are more susceptible to disease progression. According to the simulation results, the mean estimates of the parameters obtained from the proposed methods are close to the true values, but methods that ignore ICS can lead to substantial bias. Our proposed methods for clustered multistate model are able to appropriately take ICS into account when making marginal inference of a typical unit from a randomly sampled cluster.

52 Evaluation of linseed meal on ovarian follicular development after synchronization in preovulatory small ruminants during seasonal anestrus

Abstract Seasonal estrous of small ruminants can hinder overall reproductive efficiency of holistic management strategies involving sheep and goats. The objective of this study was to quantify the effect of increased melatonin containing feed ingredients on ovarian function during seasonal anestrus. Ovarian follicle number and follicle sizes were evaluated on Spanish × Boer cross does and Rambouillet ewes amounts of lineseed meal in the treatment diet (P30DIET) or an isocoloric and isonitrogenous control diet (CON). The P30DIET contained 2.5% linseed meal which contained increased melatonin (Manchester et al. 2000). At d -18 ewes and does were stratified by age into treatment groups and the P30DIET and CON diets were supplemented (0.91 kg and 0.68 kg per animal per day for sheep and goats, respectively). Synchronization protocols were administered at d 0 for both groups and ovarian ultrasound measures were collected 48 h after the removal of the controlled internal drug release device (CIDR). Mixed model procedures of SAS were used to analyze the number of dominant follicles that were present following the synchronization protocols. The number of dominant follicles observed in the P30DIET goats was significantly greater than the CON consuming goats (P &amp;lt; 0.05). Least Squares Means estimates (LSMEANS) in the P30DIET were 1.5 ± 0.20 as compared with CON goats (0.91 ± .21). These data suggest that flushing small ruminants with greater linseed meal during the seasonal anestrus period can increase the number of dominant follicles therefore implying an improvement in reproductive efficiency in holistic management strategies of small ruminants.

Nonresponse Bias of Japanese Wage Statistics

This article analyzes unit nonresponse bias of establishment surveys, drawing on two major government wage surveys in Japan. We find that unit nonresponse is prevalent among establishments with fewer employees, in urban prefectures, and operating in the service industry. Further, while low-wage establishments are less likely to respond, the resulting bias is quantitatively negligible. Regarding establishment sampling of employees, we find that the sampled establishments randomly choose workers in an appropriate manner. Overall, with proper weighting, nonresponse bias is negligible in Japanese wage statistics to the extent that the mean estimate is concerned. In addition to nonresponse bias, we also assess potential bias due to limited coverage of the sampling population and find substantial bias at the tails of the wage distribution. In particular, excluding corporate executives and establishments with few employees results in an underestimation of wage inequality.

Whole value at risk for flood damage estimates through spatial data analysis

Effective disaster risk reduction (DRR) for flooding requires a comprehensive estimate of the whole value at risk (WVAR) to inform appropriate and proportionate mitigation expenditure. Conventional flood risk estimation methods focus on the direct effects of inundation on community value and generally ignore collateral effects on assets and populations outside the flooded area. Consequently, conventional methods tend to underestimate the cost of flooding, leading to an underestimate of the return on DRR investment. Using spatial data analysis in an urban case study for Toronto, Canada, we identify and capture the collateral value at risk (ColVaR) to estimate the WVAR more comprehensively. In our case study, ColVaR (mean estimate) amounts to 70% of direct losses (ColVar = $344 M; direct losses = $475 M CAD), ranging from 20%–150% (ColVar $100–$740 M) when spanning the 90% confidence intervals of our Monte Carlo simulations. Thus, we demonstrate that if the collateral value at risk is ignored, WVAR can be significantly underestimated, potentially leading to reduced disaster risk reduction resource allocations and thereby adding risk exposure for communities. We present an accessible, seven-step process using existing spatial analysis tools and techniques that infrastructure stakeholders and planners can use to estimate ColVaR and better formulate DRR measures for their communities.

An adaptation of dual‐frame sampling for estimating bat population trends in multi‐hibernacula systems

AbstractReliable estimates of population trends are important for prioritizing and implementing wildlife management actions. Abundance estimates are the most informative metric of population status but are difficult and costly to achieve for rare or elusive species. For bat species that are highly mobile and nocturnal, abundance estimates are usually only possible at their roosts. Although they are relatively easy to census in individual roosts, it is often unclear whether observed trends are representative of broader populations trends. Dual‐frame sampling is useful for monitoring wildlife populations that exhibit site fidelity and are highly visible but where the proportion of the population in known sites is unknown. We adapted a dual‐frame sampling approach to estimate abundance of Townsend's big‐eared bats (Corynorhinus townsendii) hibernating in a system of &gt;800 caves at Lava Beds National Monument (LBNM) in northern California, USA, in 2013–2022. Beginning with a list of opportunistically discovered hibernacula, we expanded inference to the entire system by randomly selecting sites and stratifying survey effort according to number of bats observed during previous counts. Following 4 years of surveys, we began substituting survey‐informed estimates for some site types to improve efficiency of the monitoring effort. We estimated that a mean of 2,216 ± 112 (SE) bats hibernated at the study site annually and observed fluctuations of up to 22% around the mean population estimate and as much as 21% from the previous year. Despite annual fluctuations, we did not detect a trend in the number of hibernating bats at LBNM over the study period, underlining the challenges of detecting population trends in long‐lived species not exposed to pronounced stressors. Because our analytical approach generates reliable estimates of trend while accommodating annual variability in survey effort among years, it should be attractive to wildlife managers faced with shifting priorities and resources.

Sampling Protocol for Measuring Mean Diameter at Breast Height of Forked Urban Trees

The sustainable management of urban green areas requires clear and efficient protocols for measuring the biometric properties of tree vegetation. Specifically, operational in situ sampling solutions are essential to inventory forked (multi-stemmed) trees. This study aimed to assess the efficiency of two different sampling protocols for mean tree diameter at breast height (DBH) measurement of forked urban trees. The protocols were tested on a dataset of 76 forked trees, each having more than three stems and sampled in urban areas of Kyiv, Ukraine. First, we tested the efficiency of mean tree DBH estimations using measurements of randomly selected one, two, or three stems (random sampling, or RSM). Second, we examined different combinations of the thinnest, thickest, and average stems (identified visually) for each tree to estimate mean tree DBH (targeted sampling, or TSM). The distributions of mean tree DBH and root mean square errors (RMSE) were utilized to compare the utility of the two approaches. The TSM of three stems (the thinnest, thickest, and average) provided the highest accuracy of mean tree DBH estimation (RMSE% = 6.3% of the mean), compared to the RSM (RMSE% = 12.1%). The TSM of the four thickest stems demonstrated the overestimation of mean tree DBH for forked trees with five or more stems. Accurate mean tree DBH estimates can be derived with negligible systematic errors applying the RSM over a large number of measured trees. However, these estimates will not likely match the measurements from previous inventories due to random stem selection. We recommend using the TSM with measuring three specific stems as a balanced solution in terms of estimation accuracy, bias, and time costs.

Two-Stage Limited-Information Estimation for Structural Equation Models of Round-Robin Variables

We propose and demonstrate a new two-stage maximum likelihood estimator for parameters of a social relations structural equation model (SR-SEM) using estimated summary statistics (Σ^) as data, as well as uncertainty about Σ^ to obtain robust inferential statistics. The SR-SEM is a generalization of a traditional SEM for round-robin data, which have a dyadic network structure (i.e., each group member responds to or interacts with each other member). Our two-stage estimator is developed using similar logic as previous two-stage estimators for SEM, developed for application to multilevel data and multiple imputations of missing data. We demonstrate out estimator on a publicly available data set from a 2018 publication about social mimicry. We employ Markov chain Monte Carlo estimation of Σ^ in Stage 1, implemented using the R package rstan. In Stage 2, the posterior mean estimates of Σ^ are used as input data to estimate SEM parameters with the R package lavaan. The posterior covariance matrix of estimated Σ^ is also calculated so that lavaan can use it to calculate robust standard errors and test statistics. Results are compared to full-information maximum likelihood (FIML) estimation of SR-SEM parameters using the R package srm. We discuss how differences between estimators highlight the need for future research to establish best practices under realistic conditions (e.g., how to specify empirical Bayes priors in Stage 1), as well as extensions that would make 2-stage estimation particularly advantageous over single-stage FIML.

Impoverishing effects of catastrophic health out-of-pocket payments in Nigeria

Out-of-Pocket (OOP) expenditure on healthcare is a major share of total healthcare expenditure in many developing countries, including Nigeria. Households in different income groups in Nigeria spent a larger share of income mainly on consumption and basic needs, hence, OOP expenditure for health constituted a burden with attendant effects on household well-being. Catastrophic headcount and Overshoot mean positive gap and concentration indexes were used to capture the incidence and severity of catastrophic health expenditure. The poverty headcount, poverty gap, normalized poverty gap, and its mean estimate were used to empirically identify the effect of catastrophic health expenditure using the national poverty line of ₦137,430 per year. Data on 22,110 households with non-zero expenditure were obtained from the 2018/2019 Nigeria Living Standard Survey. The incidence and severity of catastrophic health expenditure were higher for poorest and poor income quintiles using total consumption expenditure and total non-food expenditure at various catastrophic thresholds. The results indicated that about one million Nigerians were pushed into poverty due to OOP expenditure. Widening the coverage of the available social health insurance and implementation of alternative means of healthcare financing would minimize the financial burden on many poorest and poor households.

Ketamine versus etomidate as an induction agent for tracheal intubation in critically ill adults: a Bayesian meta-analysis

BackgroundTracheal intubation is a high-risk intervention commonly performed in critically ill patients. Due to its favorable cardiovascular profile, ketamine is considered less likely to compromise clinical outcomes. This meta-analysis aimed to assess whether ketamine, compared with other agents, reduces mortality in critically ill patients undergoing intubation.MethodsWe searched MEDLINE, Embase, and the Cochrane Library from inception until April 27, 2023, for randomized controlled trials and matched observational studies comparing ketamine with any control in critically ill patients as an induction agent. The primary outcome was mortality at the longest follow-up available, and the secondary outcomes included Sequential Organ Failure Assessment score, ventilator-free days at day 28, vasopressor-free days at day 28, post-induction mean arterial pressure, and successful intubation on the first attempt. For the primary outcome, we used a Bayesian random-effects meta-analysis on the risk ratio (RR) scale with a weakly informative neutral prior corresponding to a mean estimate of no difference with 95% probability; the estimated effect size will fall between a relative risk of 0.25 and 4. The RR and 95% credible interval (CrI) were used to estimate the probability of mortality reduction (RR < 1). The secondary outcomes were assessed with a frequentist random-effects model. We registered this study in Open Science Framework (https://osf.io/2vf79/).ResultsWe included seven randomized trials and one propensity-matched study totaling 2978 patients. Etomidate was the comparator in all the identified studies. The probability that ketamine reduced mortality was 83.2% (376/1475 [25%] vs. 411/1503 [27%]; RR, 0.93; 95% CrI, 0.79–1.08), which was confirmed by a subgroup analysis excluding studies with a high risk of bias. No significant difference was observed in any secondary outcomes.ConclusionsAll of the included studies evaluated ketamine versus etomidate among critically ill adults requiring tracheal intubation. This meta-analysis showed a moderate probability that induction with ketamine is associated with a reduced risk of mortality.Graphical abstract

A Reliability Generalization Meta-Analysis of Scores on the Professional Quality of Life (ProQOL) Scale Across Sample Characteristics

The Professional Quality of Life Scale (ProQOL) has an extensive history of use that often relies on inductions of reliability from precedent literature. We completed a systematic of the literature and extracted sample-specific reliability estimates for ProQOL subscale scores. Random effects meta-analytic modeling was implemented to identify mean estimates of reliability. Secondary analyses were completed to depict generalization across samples and possible scores in future studies. Our analyses detected mean internal consistency estimates for the Compassion Satisfaction (.875), Secondary Traumatic Stress (.808), and Burnout (.754) similar to those reported in the ProQOL manual. However, secondary analyses revealed statistical variations associated with the professional identity and proportions of ethnicity represented within samples. ProQOL score reliability has remained fairly stable over time with scores for Compassion Satisfaction and Secondary Traumatic Stress supporting use in basic research, but not clinical decision making, the Burnout scale was associated with more questionable precision.

Current perspectives and challenges in the estimation of fruit juice consumption across the lifecycle in Europe.

Fruit juice (FJ) is typically low in energy, contains natural sugars, important amounts of micronutrients and is not permitted to have added sugars/sweeteners. However, its role in a healthy diet is under scrutiny partly due to the wider adoption of the definition for free sugars in nutrition policy. This review aimed to identify data on FJ consumption from national food consumption surveys across Europe, to examine current intakes, percent consumers and its contribution to intakes of energy, total sugars, free sugars, vitamin C, folate and potassium. Data were extracted on the population mean intake of FJ and its contribution to nutrient intakes across the lifecycle and crude estimates of population mean intakes across countries were reported for the total population and for consumers only. This review highlighted significant gaps/challenges regarding the availability of country-specific national food consumption surveys across Europe and specifically data on FJ consumption (including complexities surrounding categorisations). Nonetheless, using a comparable/homogenous definition, the mean intake of FJ among consumers was approximately 1 × 150 ml glass/day for adults/older adults, with lower intakes among infants (86 g/d), children (108 g/d) and teenagers (112 g/d). FJ made important contributions to intakes of vitamin C while making little contribution to energy intakes but also contributed 2-14 % of free sugars intake (which may be considered modest compared to other sources). The complexity of collating and interpreting data on FJ intake as elucidated in this review raises questions surrounding the categorisation of FJ in research and presents significant challenges for policymakers with respect to dietary guidance for FJ.

Cardiorespiratory abnormalities in ICU survivors of COVID-19 with postacute sequelae of SARS-CoV-2 infection are unrelated to invasive mechanical ventilation.

Postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC) often leads to exertional intolerance and reduced exercise capacity, particularly in individuals previously admitted to an intensive care unit (ICU). However, the impact of invasive mechanical ventilation (IMV) on PASC-associated cardiorespiratory abnormalities during exercise remains poorly understood. This single-center, cross-sectional study aimed to gather knowledge on this topic. Fifty-two patients with PASC recruited ∼6 mo after ICU discharge were clustered based on their need for IMV (PASC + IMV, n = 27) or noninvasive support therapy (PASC + NIS, n = 25). Patients underwent pulmonary function and cardiopulmonary exercise testing (CPX) and were compared with a reference group (CONTROL, n = 19) comprising individuals of both sexes with similar age, comorbidities, and physical activity levels but without a history of COVID-19 illness. Individuals with PASC, irrespective of support therapy, presented with higher rates of cardiorespiratory abnormalities than CONTROL, especially dysfunctional breathing patterns, dynamic hyperinflation, reduced oxygen uptake and oxygen pulse, and blunted heart rate recovery (all P < 0.05). Only the rate of abnormal oxygen pulse was greater among PASC + IMV group than PASC + NIS group (P = 0.05). Mean estimates for all CPX variables were comparable between PASC + IMV and PASC + NIS groups (all P > 0.05). These findings indicate significant involvement of both central and peripheral factors, leading to exertional intolerance in individuals with PASC previously admitted to the ICU, regardless of their need for IMV.NEW & NOTEWORTHY We found cardiorespiratory abnormalities in ICU survivors of severe-to-critical COVID-19 with PASC to be independent of IMV need. Overall, both group of patients experienced dysfunctional breathing patterns, dynamic hyperinflation, lower oxygen uptake and oxygen pulse, and blunted heart rate responses to CPX. PASC seems to impact exertional tolerance and exercise capacity due to ventilatory inefficiency, impaired aerobic metabolism, and potential systolic and autonomic dysfunction, all of these irrespective of support therapy during ICU stay.

Likelihood-free posterior estimation and uncertainty quantification for diffusion MRI models

Abstract Diffusion magnetic resonance imaging (dMRI) allows to estimate brain tissue microstructure as well as the connectivity of the white matter (known as tractography). Accurate estimation of the model parameters (by solving the inverse problem) is thus very important to infer the underlying biophysical tissue properties and fiber orientations. Although there has been extensive research on this topic with a myriad of dMRI models, most models use standard nonlinear optimization techniques and only provide an estimate of the model parameters without any information (quantification) about uncertainty in their estimation. Further, the effect of this uncertainty on the estimation of the derived dMRI microstructural measures downstream (e.g., fractional anisotropy) is often unknown and is rarely estimated. To address this issue, we first design a new deep-learning algorithm to identify the number of crossing fibers in each voxel. Then, at each voxel, we propose a robust likelihood-free deep learning method to estimate not only the mean estimate of the parameters of a multi-fiber dMRI model (e.g., the biexponential model), but also its full posterior distribution. The posterior distribution is then used to estimate the uncertainty in the model parameters as well as the derived measures. We perform several synthetic and in-vivo quantitative experiments to demonstrate the robustness of our approach for different noise levels and out-of-distribution test samples. Besides, our approach is computationally fast and requires an order of magnitude less time than standard nonlinear fitting techniques. The proposed method demonstrates much lower error (compared to existing methods) in estimating several metrics, including number of fibers in a voxel, fiber orientation, and tensor eigenvalues. The proposed methodology is quite general and can be used for the estimation of the parameters from any other dMRI model.

Additional Effect of Extracorporeal Shockwave Therapy with Lidocaine Injection on Clinical and MRI Findings in Frozen Shoulder: A Prospective, Randomized, Double-Blinded, Placebo-Controlled Trial.

Frozen shoulder is a very common musculoskeletal condition and the evidence related to the additional effects of extracorporeal shockwave therapy (ESWT) with intra-articular (IA) lidocaine injection in individuals with frozen shoulder is rare. Therefore, this study aims to compare and investigate the additional effects of extracorporeal shockwave therapy (ESWT) with intra-articular (IA) lidocaine injection in a frozen shoulder. Sixty eligible participants with frozen shoulder were included and the active group (n = 30, age 52.12 ± 5.2years) received a lidocaine injection (1% lidocaine (Xylocaine) and 2cc (80 mg) methylprednisolone acetate) with active ESWT (3.5 bar air pressure and 2000 pulses with an energy flux density (EFD) ¼ 0.16 mJ/mm2) three sessions a week for 4 weeks. The placebo group (n = 30, age 53.56 ± 5.5years) received lidocaine injection with placebo treatment (a special head that blocked the shock waves) three sessions a week for 4 weeks. Both groups received progressive resistance exercises (PRE) to the shoulder muscles. The primary outcome was pain intensity, measured with the visual analogue scale. The other outcome measures were the thickness of the coracohumeral ligament (CHL) measured by magnetic resonance imaging (MRI), abduction, and lateral rotation range of motion (ROM), functional disability, kinesiophobia, depression status, and quality of life. Participants were assessed at baseline, after 4 weeks, 8 weeks, and at 6-month follow-up. The post-intervention at 4 weeks showed an improvement of 2.0 (CI 95% 1.71-2.28) in the active group compared to the placebo group. Similar effects were noted after 8 weeks (2.2) (CI 95% 1.91-2.48) and at the 6-month (1.9) (CI 95% 1.61-2.18) follow-up. Similar improvements were also found in the thickness of the CHL ligament (0.6) (CI 95% 0.46-0.73), abduction and lateral rotation (ROM) (-23.6) (CI 95% -27.47 to -19.72), (-18.10) (CI 95% -19.72 to -16.47), functional disability (16.2) (CI 95% 14.85-17.54), kinesiophobia (11.0 (CI 95% 10.21-11.98), depression status (4.4) (CI 95% 4.03-4.76) and quality of life (0.9) (CI 95% 0.79-1.00) (p = 0.001) at the 6-month follow-up period, where mean estimates and their confidence intervals all included worthwhile effects. There were no adverse reactions or side effects noted in either the active or placebo groups during and after the treatment. The study concluded that the addition of extracorporeal shockwave therapy after intra-articular lidocaine injection improves pain, functional disability, range of motion, kinesiophobia, depression status, and quality of life in people with frozen shoulder. https://ctri.nic.in , identifier; CTRI/2020/04/024834 prospectively registered on 24/04/2020.