604 research outputs found
A pragmatic randomised controlled trial of hydrotherapy and land exercises on overall well being and quality of life in rheumatoid arthritis
Background \ud
Hydrotherapy is highly valued by people with rheumatoid arthritis yet few studies have compared the benefits of exercises in heated water against exercises on land. In particular, data on quality of life is rarely reported. This is especially important because patients treated with hydrotherapy often report an enhanced sense of well-being. We report a randomised controlled trial in which we compared the effects of hydrotherapy with exercises on land on overall response to treatment, physical function and quality of life in patients with rheumatoid arthritis. \ud
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Methods \ud
One hundred and fifteen patients with RA were randomised to receive a weekly 30-minute session of hydrotherapy or similar exercises on land for 6 weeks. Our primary outcome was a self-rated global impression of change – a measure of treatment effect on a 7-point scale ranging from 1(very much worse) to 7 (very much better) assessed immediately on completion of treatment. Secondary outcomes including EuroQol health related quality of life, EuroQol health status valuation, HAQ, 10 metre walk time and pain scores were collected at baseline, after treatment and 3 months later. Binary outcomes were analysed by Fisher's exact test and continuous variables by Wilcoxon or Mann-Whitney tests. \ud
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Results \ud
Baseline characteristics of the two groups were comparable. Significantly more patients treated with hydrotherapy (40/46, 87%) were much better or very much better than the patients treated with land exercise (19/40, 47.5%), p < 0.001 Fisher's exact test. Eleven patients allocated land exercise failed to complete treatment compared with 4 patients allocated hydrotherapy (p = 0.09). Sensitivity analyses confirmed an advantage for hydrotherapy if we assumed non-completers would all not have responded (response rates 70% versus 38%; p < 0.001) or if we assumed that non-completers would have had the same response as completers (response rates 82% versus 55% p = 0.002). Ten metre walk time improved after treatment in both cases (median pre-treatment time for both groups combined 10.9 seconds, post-treatment 9.1 s, and 3 months later 9.6 s). There was however no difference between treatment groups. Similarly there were no significant differences between groups in terms of changes to HAQ, EQ-5D utility score, EQ VAS and pain VAS. \ud
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Conclusion \ud
Patients with RA treated with hydrotherapy are more likely to report feeling much better or very much better than those treated with land exercises immediately on completion of the treatment programme. This perceived benefit was not reflected by differences between groups in 10-metre walk times, functional scores, quality of life measures and pain scores
Effect of extreme data loss on long-range correlated and anti-correlated signals quantified by detrended fluctuation analysis
We investigate how extreme loss of data affects the scaling behavior of
long-range power-law correlated and anti-correlated signals applying the DFA
method. We introduce a segmentation approach to generate surrogate signals by
randomly removing data segments from stationary signals with different types of
correlations. These surrogate signals are characterized by: (i) the DFA scaling
exponent of the original correlated signal, (ii) the percentage of
the data removed, (iii) the average length of the removed (or remaining)
data segments, and (iv) the functional form of the distribution of the length
of the removed (or remaining) data segments. We find that the {\it global}
scaling exponent of positively correlated signals remains practically unchanged
even for extreme data loss of up to 90%. In contrast, the global scaling of
anti-correlated signals changes to uncorrelated behavior even when a very small
fraction of the data is lost. These observations are confirmed on the examples
of human gait and commodity price fluctuations. We systematically study the
{\it local} scaling behavior of signals with missing data to reveal deviations
across scales. We find that for anti-correlated signals even 10% of data loss
leads to deviations in the local scaling at large scales from the original
anti-correlated towards uncorrelated behavior. In contrast, positively
correlated signals show no observable changes in the local scaling for up to
65% of data loss, while for larger percentage, the local scaling shows
overestimated regions (with higher local exponent) at small scales, followed by
underestimated regions (with lower local exponent) at large scales. Finally, we
investigate how the scaling is affected by the statistics of the remaining data
segments in comparison to the removed segments
Long-range correlation and multifractality in Bach's Inventions pitches
We show that it can be considered some of Bach pitches series as a stochastic
process with scaling behavior. Using multifractal deterend fluctuation analysis
(MF-DFA) method, frequency series of Bach pitches have been analyzed. In this
view we find same second moment exponents (after double profiling) in ranges
(1.7-1.8) in his works. Comparing MF-DFA results of original series to those
for shuffled and surrogate series we can distinguish multifractality due to
long-range correlations and a broad probability density function. Finally we
determine the scaling exponents and singularity spectrum. We conclude fat tail
has more effect in its multifractality nature than long-range correlations.Comment: 18 page, 6 figures, to appear in JSTA
Automatically extracting functionally equivalent proteins from SwissProt
In summary, FOSTA provides an automated analysis of annotations in UniProtKB/Swiss-Prot to enable groups of proteins already annotated as functionally equivalent, to be extracted. Our results demonstrate that the vast majority of UniProtKB/Swiss-Prot functional annotations are of high quality, and that FOSTA can interpret annotations successfully. Where FOSTA is not successful, we are able to highlight inconsistencies in UniProtKB/Swiss-Prot annotation. Most of these would have presented equal difficulties for manual interpretation of annotations. We discuss limitations and possible future extensions to FOSTA, and recommend changes to the UniProtKB/Swiss-Prot format, which would facilitate text-mining of UniProtKB/Swiss-Prot
Effects of coarse-graining on the scaling behavior of long-range correlated and anti-correlated signals
We investigate how various coarse-graining methods affect the scaling
properties of long-range power-law correlated and anti-correlated signals,
quantified by the detrended fluctuation analysis. Specifically, for
coarse-graining in the magnitude of a signal, we consider (i) the Floor, (ii)
the Symmetry and (iii) the Centro-Symmetry coarse-graining methods. We find,
that for anti-correlated signals coarse-graining in the magnitude leads to a
crossover to random behavior at large scales, and that with increasing the
width of the coarse-graining partition interval this crossover moves
to intermediate and small scales. In contrast, the scaling of positively
correlated signals is less affected by the coarse-graining, with no observable
changes when a crossover appears at small
scales and moves to intermediate and large scales with increasing . For
very rough coarse-graining () based on the Floor and Symmetry
methods, the position of the crossover stabilizes, in contrast to the
Centro-Symmetry method where the crossover continuously moves across scales and
leads to a random behavior at all scales, thus indicating a much stronger
effect of the Centro-Symmetry compared to the Floor and the Symmetry methods.
For coarse-graining in time, where data points are averaged in non-overlapping
time windows, we find that the scaling for both anti-correlated and positively
correlated signals is practically preserved. The results of our simulations are
useful for the correct interpretation of the correlation and scaling properties
of symbolic sequences.Comment: 19 pages, 13 figure
Effect of Trends on Detrended Fluctuation Analysis
Detrended fluctuation analysis (DFA) is a scaling analysis method used to
estimate long-range power-law correlation exponents in noisy signals. Many
noisy signals in real systems display trends, so that the scaling results
obtained from the DFA method become difficult to analyze. We systematically
study the effects of three types of trends -- linear, periodic, and power-law
trends, and offer examples where these trends are likely to occur in real data.
We compare the difference between the scaling results for artificially
generated correlated noise and correlated noise with a trend, and study how
trends lead to the appearance of crossovers in the scaling behavior. We find
that crossovers result from the competition between the scaling of the noise
and the ``apparent'' scaling of the trend. We study how the characteristics of
these crossovers depend on (i) the slope of the linear trend; (ii) the
amplitude and period of the periodic trend; (iii) the amplitude and power of
the power-law trend and (iv) the length as well as the correlation properties
of the noise. Surprisingly, we find that the crossovers in the scaling of noisy
signals with trends also follow scaling laws -- i.e. long-range power-law
dependence of the position of the crossover on the parameters of the trends. We
show that the DFA result of noise with a trend can be exactly determined by the
superposition of the separate results of the DFA on the noise and on the trend,
assuming that the noise and the trend are not correlated. If this superposition
rule is not followed, this is an indication that the noise and the superimposed
trend are not independent, so that removing the trend could lead to changes in
the correlation properties of the noise.Comment: 20 pages, 16 figure
Prevalence and risk factors of restrictive spirometry in a cohort of Peruvian adults
INTRODUCTION: Few studies have described the prevalence of and lung function decline among those with a restrictive spirometric pattern (RSP) in low- and middle-income countries.
METHODS: We analyzed prospective data from 3055 adults recruited across four diverse settings in Peru over a 3-year period. Multivariable logistic regression was used to study the association between the presence of restriction and associated risk factors. Multivariable linear mixed models were used to determine lung function decline.
RESULTS: Among 3055 participants, the average age was 55.4 years (SD 12.4); 49% were male. Overall prevalence of RSP was 4.7%, ranging from 2.8% (Lima) to 6.9% (Tumbes). The odds of having RSP were higher among those who lived in a rural environment (OR 2.19, 95%CI 1.43–3.37), had a diagnosis of diabetes (OR 1.94, 95%CI 1.10–3.40) and among women (OR 2.09, 95%CI 1.41–3.09). When adjusting for baseline lung function, adults with RSP had accelerated decline in forced expiratory volume in 1 s (FEV1) compared with non-obstructed, non-restricted individuals.
DISCUSSION: RSP is prevalent particularly among women and in individuals living in rural settings of Peru. When adjusted for baseline lung function, participants with RSP had accelerated rates of FEV1 decline. Our findings are consistent with the notion that RSP is an insidious inflammatory condition with deleterious effects of lung function decline
Management and prevention of chronic obstructive pulmonary disease exacerbations: a state of the art review
Exacerbations of chronic obstructive pulmonary disease (COPD) are important events in the natural history of this prevalent and devastating condition. This review provides a concise, state of the art summary on prevention and management of exacerbations. Considerable new data underpins evidence in support of many preventative interventions, pharmacological and non-pharmacological, that are now available. Challenges remain in developing new approaches, and delivering those that already exist to the right patient at the right time. Management of an exacerbation remains stepwise according to clinical severity, but there is now additional focus on addressing comorbidities and taking the opportunity at acute events to optimise preventative strategies for the future. Ultimately, exacerbations are heterogeneous events in a heterogeneous disease, and an individualised approach is paramount
Communication style and exercise compliance in physiotherapy (CONNECT). A cluster randomized controlled trial to test a theory-based intervention to increase chronic low back pain patients’ adherence to physiotherapists’ recommendations: study rationale, design, and methods
Physical activity and exercise therapy are among the accepted clinical rehabilitation guidelines and are recommended self-management strategies for chronic low back pain. However, many back pain sufferers do not adhere to their physiotherapist’s recommendations. Poor patient adherence may decrease the effectiveness of advice and home-based rehabilitation exercises. According to self-determination theory, support from health care practitioners can promote patients’ autonomous motivation and greater long-term behavioral persistence (e.g., adherence to physiotherapists’ recommendations). The aim of this trial is to assess the effect of an intervention designed to increase physiotherapists’ autonomy-supportive communication on low back pain patients’ adherence to physical activity and exercise therapy recommendations. \ud
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This study will be a single-blinded cluster randomized controlled trial. Outpatient physiotherapy centers (N =12) in Dublin, Ireland (population = 1.25 million) will be randomly assigned using a computer-generated algorithm to either the experimental or control arm. Physiotherapists in the experimental arm (two hospitals and four primary care clinics) will attend eight hours of communication skills training. Training will include handouts, workbooks, video examples, role-play, and discussion designed to teach physiotherapists how to communicate in a manner that promotes autonomous patient motivation. Physiotherapists in the waitlist control arm (two hospitals and four primary care clinics) will not receive this training. Participants (N = 292) with chronic low back pain will complete assessments at baseline, as well as 1 week, 4 weeks, 12 weeks, and 24 weeks after their first physiotherapy appointment. Primary outcomes will include adherence to physiotherapy recommendations, as well as low back pain, function, and well-being. Participants will be blinded to treatment allocation, as they will not be told if their physiotherapist has received the communication skills training. Outcome assessors will also be blinded. \ud
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We will use linear mixed modeling to test between arm differences both in the mean levels and the rates of change of the outcome variables. We will employ structural equation modeling to examine the process of change, including hypothesized mediation effects. \ud
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This trial will be the first to test the effect of a self-determination theory-based communication skills training program for physiotherapists on their low back pain patients’ adherence to rehabilitation recommendations. Current Controlled Trials ISRCTN63723433\u
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