Tele-rehabilitation following Covid-19: a sub analysis dependant on level of respiratory intervention during hospitalisation

Introduction: Tele-rehabilitation has been shown to be effective in improving exercise capacity, quality of life, fatigue and mood in patients discharged from hospital following Covid-19 infection. It remains unknown however whether the level intervention received during hospitalisation is associated with the response to tele-rehabilitation. The aims of this research were therefore to identify the effect tele-rehabilitation in individuals that received high, low and no respiratory intervention during hospitalisation. Methods: Forty patients (Female; n=17, Male; n=23) discharged from two University Teaching Hospitals in the North of England following Covid-19 infection participated in a single centre, mixed methods, fast-track, randomised control trial of tele-rehabilitation. Participants completed a 6-week tele-rehabilitation programme, with exercise sessions occurring twice a week and weekly education events and peer support. Data analysis and outcome measures: Participants were split by the level of intervention they received during hospitalisation, which were high respiratory intervention (Ventilation, Continuous Positive Airway Pathway), low respiratory intervention (High Flow Nasal Oxygen, Oxygen) and no respiratory intervention. The primary outcome measures were exercise capacity (1 minute sit-to-stand), Quality of life, [EuroQol -Visual Analogue Scale (EQ-VAS)], Fatigue [Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F)] and mood [Hospital Anxiety and Depression Scale (HADS)]. Results: Improvements in exercise capacity, respiratory symptoms, and quality-of-life were seen. Sit-to-stand scores improved from 19 (14-24) at baseline to 26 (23-28) following telerehabilitation (p0.05), however improved in the low respiratory intervention group from 11 (4.75-13.75) at baseline to 7 (6-11) post-rehabilitation (p<0.05).Conclusion: Our results show that tele-rehabilitation is a successful method of providing rehabilitation in patients regardless of the level of intervention during hospitalisation. However, data indicates the need for more psychological support in individuals that received intensive hospital treatment, which should be considered during the development of long-covid treatment strategies

The role of glycosyltransferase 61 and BAHD genes in determining ferulate & para-coumarate content of the cell walls of the Poaceae

Lignocellulosic biomass, composed largely of plant cell walls, of economically important cereal crops is remarkably recalcitrant to digestion, both in second generation biofuel production and ruminant nutrition applications. Ferulic acid (FA) esterified to arabinoxylan (AX) forms oxidatively linked dimers and oligomers which cross-link polysaccharide chains. FA is also a nucleation site for lignin formation. These cross-links are major inhibitors of enzymatic digestion, and therefore FA is a key target for improving the digestibility of grass cell walls. Also, para coumaric acid (pCA) esterified to AX may be involved in the polymerisation of lignin. Despite the importance of cell wall bound hydroxycinnamic acids, many of the genes and enzymes responsible for the esterification of pCA and FA to AX remain to be elucidated. The BAHD and glycosyltransferase (GT)61 gene families have previously been identified as likely to be involved in the process (Mitchell et al., 2007). Here, the role of candidate genes within the BAHD and GT61 families in pCA and FA esterification to AX is investigated in the model organism Brachypodium distachyon (Brachypodium). Jasmonic acid induced large increases in cell wall-esterified pCA, and moderate increases in FA and FA dimer in Brachypodium callus, accompanied by up-regulation of genes within the BAHD and GT61 families. Furthermore, transformation of Brachypodium with RNAi constructs designed to knock-down expression of paralogues BdGT61.9p1 and BdGT61.9p2 resulted in decreased cell wall-esterified FA. Overexpression of BdGT61.9p1 in Brachypodium resulted in a small increase in the 8-8-coupled FA dimer. These findings complemented the existing body of evidence for the involvement of genes within the BAHD and GT61 families in hydroxycinnamic acid esterification to AX

Group-based pulmonary telerehabilitation is feasible, safe, beneficial and well-received in patients that have been hospitalised with Covid-19

Introduction Covid-19 has caused worldwide mass hospitalisation. The need for multi-disciplinary post-hospitalisation rehabilitation is becoming increasingly apparent and telerehabilitation has been endorsed. The aim of study was to investigate the feasibility and efficacy of pulmonary telerehabilitation for Covid-19 survivors.Methods A single centre, mixed-methods, fast-track (wait-list), randomised controlled trial of telerehabilitation for patients who have been hospitalised with Covid-19.Participants Forty patients discharged from two University Teaching Hospitals in the North of England. Interventions: Telerehabilitation consisted of twelve exercise classes, six education events and opportunity for peer support. Patients commenced telerehabilitation 14 days after randomisation in the fast-track group and 56 days after randomisation in the wait-list group.Outcome measures and results Descriptive and statistical improvements were noted is several clinical outcome measures. Exercise capacity increased from a median (Q1–Q3) 20 (14–24) sit-to-stand repetitions in one-minute at baseline to 25 (24–30) post-telerehabilitation. Breathlessness rated using the MRC changed from 3.5 (3–4) at baseline to 2 (1.5–3) post-telerehabilitation, with additional favourable outcomes noted in respiratory symptoms measured using numerical rating scales and visual analogue scales (VAS). Quality of life measured using the EQ-VAS improved from 55 (60–70) units at baseline to 70 (55–80) units following telerehabilitation. Improvements in fatigue (FACIT-F) and mood (HADS-D) were also observed. Natural recovery was observed in the wait-list group prior to receiving telerehabilitation, however, improvements were accelerated by early telerehabilitation in the fast-track group.Conclusions We have shown that group-based telerehabilitation is feasible, safe, beneficial and well-received in this population

Telerehabilitation for patients who have been hospitalised with covid-19: a qualitative study

PurposeThe aim of this qualitative study was to explore the views of participants of a group-based, supervised, telerehabilitation programme, following discharge from hospital with Covid-19. This study was part of a single-centre, fast-track (wait-list), randomised, mixed-methods, feasibility trial of telerehabilitation (Registration: Clinicaltrials.gov reference:285205).MethodsSemi-structured interviews were conducted over a virtual teleconference platform with 10 participants who took part in a telerehabilitation programme following Covid-19 after discharge from an acute hospital. Data were transcribed verbatim and analysed using thematic analysis.ResultsFive themes were important from the participant perspective: telerehabilitation programme as part of the Covid-19 journey; the telerehabilitation programme design and delivery; peer aspects; the role of the instructor; and the role of technology and online delivery.ConclusionsOverall, the telerehabilitation programme was a positive experience for participants. The instructors were central to this positive view as was the group nature of the programme. The group aspect was particularly important in supporting the broader perceived wellbeing gains, such as the sense of enjoyment and reduced social isolation. Several participants would have liked to have continued with the exercises beyond the six-week intervention indicating that the programme could be a way to help people sustain a physically active lifestyle.IMPLICATIONS FOR REHABILITATIONParticipants who were recovering from Covid-19 following hospital admission perceived the telerehabilitation to be a positive experience overall.The group aspect of the telerehabilitation programme was important in supporting the broader perceived wellbeing gains such as the sense of enjoyment and reduced social isolation.Telerehabilitation programmes for Covid-19 may need to include pathways for participants to continue to engage in exercise beyond the time-limited six-week intervention to support ongoing self-management

Real-world post-deployment performance of a novel machine learning-based digital health technology for skin lesion assessment and suggestions for post-market surveillance

IntroductionDeep Ensemble for Recognition of Malignancy (DERM) is an artificial intelligence as a medical device (AIaMD) tool for skin lesion assessment.MethodsWe report prospective real-world performance from its deployment within skin cancer pathways at two National Health Service hospitals (UK) between July 2021 and October 2022.ResultsA total of 14,500 cases were seen, including patients 18–100 years old with Fitzpatrick skin types I–VI represented. Based on 8,571 lesions assessed by DERM with confirmed outcomes, versions A and B demonstrated very high sensitivity for detecting melanoma (95.0–100.0%) or malignancy (96.0–100.0%). Benign lesion specificity was 40.7–49.4% (DERM-vA) and 70.1–73.4% (DERM-vB). DERM identified 15.0–31.0% of cases as eligible for discharge.DiscussionWe show DERM performance in-line with sensitivity targets and pre-marketing authorisation research, and it reduced the caseload for hospital specialists in two pathways. Based on our experience we offer suggestions on key elements of post-market surveillance for AIaMDs

A Search for the Most Massive Galaxies. III. Global and Central Structure

We used the Advanced Camera for Surveys on board the Hubble Space Telescope to obtain high resolution i-band images of the centers of 23 single galaxies, which were selected because they have SDSS velocity dispersions larger than 350 km/s. The surface brightness profiles of the most luminous of these objects (M_i<-24) have well-resolved `cores' on scales of 150-1000 pc, and share similar properties to BCGs. The total luminosity of the galaxy is a better predictor of the core size than is the velocity dispersion. The correlations of luminosity and velocity dispersion with core size agree with those seen in previous studies of galaxy cores. Because of high velocity dispersions, our sample of galaxies can be expected to harbor the most massive black holes, and thus have large cores with large amounts of mass ejection. The mass-deficits inferred from core-Sersic fits to the surface-brightness profiles are approximately double the black-hole masses inferred from the M_bh-sigma relation and the same as those inferred from the M_bh-L relation. The less luminous galaxies (M_i>-23) tend to have steeper `power-law' inner profiles, higher-ellipticity, diskier isophotes, and bulge-to-total ratios of order 0.5 -- all of which suggest that they are `fast-rotators' and rotational motions could have contaminated the velocity dispersion estimate. There are obvious dust features within about 300 pc of the center in about 35% of the sample, predominantly in power-law rather than core galaxies.Comment: 27 Pages, 22 Figures, 2 Tables, Accepted for Publication in MNRA

Reconstructing galaxy fundamental distributions and scaling relations from photometric redshift surveys. Applications to the SDSS early-type sample

Noisy distance estimates associated with photometric rather than spectroscopic redshifts lead to a mis-estimate of the luminosities, and produce a correlated mis-estimate of the sizes. We consider a sample of early-type galaxies from the SDSS DR6 for which both spectroscopic and photometric information is available, and apply the generalization of the V_max method to correct for these biases. We show that our technique recovers the true redshift, magnitude and size distributions, as well as the true size-luminosity relation. We find that using only 10% of the spectroscopic information randomly spaced in our catalog is sufficient for the reconstructions to be accurate within about 3%, when the photometric redshift error is dz = 0.038. We then address the problem of extending our method to deep redshift catalogs, where only photometric information is available. In addition to the specific applications outlined here, our technique impacts a broader range of studies, when at least one distance-dependent quantity is involved. It is particularly relevant for the next generation of surveys, some of which will only have photometric information.Comment: 14 pages, 12 figures, 1 table, new section 3.1 and appendix added, MNRAS in pres

Accuracy of an artificial intelligence as a medical device as part of a UK-based skin cancer teledermatology service

IntroductionAn artificial intelligence as a medical device (AIaMD), built on convolutional neural networks, has demonstrated high sensitivity for melanoma. To be of clinical value, it needs to safely reduce referral rates. The primary objective of this study was to demonstrate that the AIaMD had a higher rate of correctly classifying lesions that did not need to be referred for biopsy or urgent face-to-face dermatologist review, compared to teledermatology standard of care (SoC), while achieving the same sensitivity to detect malignancy. Secondary endpoints included the sensitivity, specificity, positive and negative predictive values, and number needed to biopsy to identify one case of melanoma or squamous cell carcinoma (SCC) by both the AIaMD and SoC.MethodsThis prospective, single-centre, single-arm, masked, non-inferiority, adaptive, group sequential design trial recruited patients referred to a teledermatology cancer pathway (clinicaltrials.gov NCT04123678). Additional dermoscopic images of each suspicious lesion were taken using a smartphone with a dermoscopic lens attachment. The images were assessed independently by a consultant dermatologist and the AIaMD. The outputs were compared with the final histological or clinical diagnosis.ResultsA total of 700 patients with 867 lesions were recruited, of which 622 participants with 789 lesions were included in the per-protocol (PP) population. In total, 63.3% of PP participants were female; 89.0% identified as white, and the median age was 51 (range 18–95); and all Fitzpatrick skin types were represented including 25/622 (4.0%) type IV-VI skin. A total of 67 malignant lesions were identified, including 8 diagnosed as melanoma. The AIaMD sensitivity was set at 91 and 92.5%, to match the literature-defined clinician sensitivity (91.46%) as closely as possible. In both settings, the AIaMD identified had a significantly higher rate of identifying lesions that did not need a biopsy or urgent referral compared to SoC (p-value = 0.001) with comparable sensitivity for skin cancer.DiscussionThe AIaMD identified significantly more lesions that did not need to be referred for biopsy or urgent face-to-face dermatologist review, compared to teledermatologists. This has the potential to reduce the burden of unnecessary referrals when used as part of a teledermatology service

Plasma and cerebrospinal fluid ABeta42 for the differential diagnosis of Alzheimer's disease dementia in participants diagnosed with any dementia subtype in a specialist care setting

BackgroundDementia is a syndrome that comprises many differing pathologies, including Alzheimer's disease dementia (ADD), vascular dementia (VaD) and frontotemporal dementia (FTD). People may benefit from knowing the type of dementia they live with, as this could inform prognosis and may allow for tailored treatment. Beta-amyloid (1-42) (ABeta42) is a protein which decreases in both the plasma and cerebrospinal fluid (CSF) of people living with ADD, when compared to people with no dementia. However, it is not clear if changes in ABeta42 are specific to ADD or if they are also seen in other types of dementia. It is possible that ABeta42 could help differentiate ADD from other dementia subtypes.ObjectivesTo determine the accuracy of plasma and CSF ABeta42 for distinguishing ADD from other dementia subtypes in people who meet the criteria for a dementia syndrome.Search methodsWe searched MEDLINE, and nine other databases up to 18 February 2020. We checked reference lists of any relevant systematic reviews to identify additional studies.Selection criteriaWe considered cross-sectional studies that differentiated people with ADD from other dementia subtypes. Eligible studies required measurement of participant plasma or CSF ABeta42 levels and clinical assessment for dementia subtype.Data collection and analysisSeven review authors working independently screened the titles and abstracts generated by the searches. We collected data on study characteristics and test accuracy. We used the second version of the 'Quality Assessment of Diagnostic Accuracy Studies' (QUADAS-2) tool to assess internal and external validity of results. We extracted data into 2 x 2 tables, cross-tabulating index test results (ABeta42) with the reference standard (diagnostic criteria for each dementia subtype). We performed meta-analyses using bivariate, random-effects models. We calculated pooled estimates of sensitivity, specificity, positive predictive values, positive and negative likelihood ratios, and corresponding 95% confidence intervals (CIs). In the primary analysis, we assessed accuracy of plasma or CSF ABeta42 for distinguishing ADD from other mixed dementia types (non-ADD). We then assessed accuracy of ABeta42 for differentiating ADD from specific dementia types: VaD, FTD, dementia with Lewy bodies (DLB), alcohol-related cognitive disorder (ARCD), Creutzfeldt-Jakob disease (CJD) and normal pressure hydrocephalus (NPH). To determine test-positive cases, we used the ABeta42 thresholds employed in the respective primary studies. We then performed sensitivity analyses restricted to those studies that used common thresholds for ABeta42.Main resultsWe identified 39 studies (5000 participants) that used CSF ABeta42 levels to differentiate ADD from other subtypes of dementia. No studies of plasma ABeta42 met the inclusion criteria. No studies were rated as low risk of bias across all QUADAS-2 domains. High risk of bias was found predominantly in the domains of patient selection (28 studies) and index test (25 studies). The pooled estimates for differentiating ADD from other dementia subtypes were as follows: ADD from non-ADD: sensitivity 79% (95% CI 0.73 to 0.85), specificity 60% (95% CI 0.52 to 0.67), 13 studies, 1704 participants, 880 participants with ADD; ADD from VaD: sensitivity 79% (95% CI 0.75 to 0.83), specificity 69% (95% CI 0.55 to 0.81), 11 studies, 1151 participants, 941 participants with ADD; ADD from FTD: sensitivity 85% (95% CI 0.79 to 0.89), specificity 72% (95% CI 0.55 to 0.84), 17 studies, 1948 participants, 1371 participants with ADD; ADD from DLB: sensitivity 76% (95% CI 0.69 to 0.82), specificity 67% (95% CI 0.52 to 0.79), nine studies, 1929 participants, 1521 participants with ADD. Across all dementia subtypes, sensitivity was greater than specificity, and the balance of sensitivity and specificity was dependent on the threshold used to define test positivity.Authors' conclusionsOur review indicates that measuring ABeta42 levels in CSF may help differentiate ADD from other dementia subtypes, but the test is imperfect and tends to misdiagnose those with non-ADD as having ADD. We would caution against the use of CSF ABeta42 alone for dementia classification. However, ABeta42 may have value as an adjunct to a full clinical assessment, to aid dementia diagnosis