Anxiety after stroke: intervention design and a randomised controlled trial

INTRODUCTION: Anxiety is common and potentially debilitating after stroke. There is no reliable evidence to guide treatment. Barriers exist in accessing psychological care after stroke. Little is known about anxiety subtypes and what provokes anxiety in people after stroke. Treatment approaches effective in non-stroke populations may not be feasible or generalisable to stroke patients. AIMS: The first aim is to develop an intervention for treating anxiety after stroke and evaluate its feasibility in patients. The second aim is to test the feasibility of a randomised controlled trial (RCT) to evaluate the intervention’s effectiveness. METHODS: I used a range of clinical research methodologies: i) a systematic review to summarise the design of anxiety interventions in stroke and acquired brain injury and their efficacy; ii) a prospective cohort study to investigate the frequency of anxiety subtypes, anxiety-provoking stimuli, factors associated with anxiety, and clinical outcomes associated with anxiety after stroke; iii) a study of diagnostic validity and reliability of two anxiety measures, iv) complex intervention development using a systematic approach; v) a feasibility RCT—Treating Anxiety after StroKe (TASK RCT) RESULTS: My anxiety intervention was practical to deliver and acceptable to patients. The TASK RCT procedures were feasible at a small scale. This thesis will inform further refinements of the intervention and trial procedures in preparation for the large scale definitive TASK RCT

New Insights into Stroke from Continuous Passively Collected Temperature and Sleep Data Using Wrist-Worn Wearables

Actigraphy may provide new insights into clinical outcomes and symptom management of patients through passive, continuous data collection. We used the GENEActiv smartwatch to passively collect actigraphy, wrist temperature, and ambient light data from 27 participants after stroke or probable brain transient ischemic attack (TIA) over 42 periods of device wear. We computed 323 features using established algorithms and proposed 25 novel features to characterize sleep and temperature. We investigated statistical associations between the extracted features and clinical outcomes evaluated using clinically validated questionnaires to gain insight into post-stroke recovery. We subsequently fitted logistic regression models to replicate clinical diagnosis (stroke or TIA) and disability due to stroke. The model generalization performance was assessed using a leave-one-subject-out cross validation method with the selected feature subsets, reporting the area under the curve (AUC). We found that several novel features were strongly correlated (|r|>0.3) with stroke symptoms and mental health measures. Using selected novel features, we obtained an AUC of 0.766 to estimate diagnosis and an AUC of 0.749 to estimate whether disability due to stroke was present. Collectively, these findings suggest that features extracted from the temperature smartwatch sensor may reveal additional clinically useful information over and above existing actigraphy-based features

Factors Associated with Poststroke Anxiety:A Systematic Review and Meta-Analysis

Background and Purpose. Anxiety affects 25% of stroke survivors. There are no effective treatments. Poststroke depression, prestroke anxiety and depression, locus of control, coping, confidence, fatigue, and sleep are factors that may be associated with poststroke anxiety and can potentially be targeted by therapy. We systematically reviewed the literature and performed a meta-analysis to identify associations with these factors. Methods. We searched electronic databases from January 2014 to July 2015 to complement a literature search performed from inception to May 2014. Study quality was assessed using an internationally endorsed checklist. We used odds ratios (ORs) to estimate the strength of associations and random-effects modelling to calculate summary effect sizes. Results. There were 24 studies recruiting 15448 patients. Quality of reporting was satisfactory. 13 studies with 2408 patients reported associations between poststroke anxiety and poststroke depression (OR=4.66, 95% confidence interval: 2.23, 9.74). One study reported association with prestroke anxiety, three with prestroke depression, one with fatigue, and two with sleep. No studies reported on locus of control, coping, or confidence. Conclusion. Poststroke anxiety was associated with depression but there are limited data on other modifiable associations. Further research is needed to identify potential targets for treatment

OMMA enables population-scale analysis of complex genomic features and phylogenomic relationships from nanochannel-based optical maps.

BackgroundOptical mapping is an emerging technology that complements sequencing-based methods in genome analysis. It is widely used in improving genome assemblies and detecting structural variations by providing information over much longer (up to 1 Mb) reads. Current standards in optical mapping analysis involve assembling optical maps into contigs and aligning them to a reference, which is limited to pairwise comparison and becomes bias-prone when analyzing multiple samples.FindingsWe present a new method, OMMA, that extends optical mapping to the study of complex genomic features by simultaneously interrogating optical maps across many samples in a reference-independent manner. OMMA captures and characterizes complex genomic features, e.g., multiple haplotypes, copy number variations, and subtelomeric structures when applied to 154 human samples across the 26 populations sequenced in the 1000 Genomes Project. For small genomes such as pathogenic bacteria, OMMA accurately reconstructs the phylogenomic relationships and identifies functional elements across 21 Acinetobacter baumannii strains.ConclusionsWith the increasing data throughput of optical mapping system, the use of this technology in comparative genome analysis across many samples will become feasible. OMMA is a timely solution that can address such computational need. The OMMA software is available at https://github.com/TF-Chan-Lab/OMTools

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat