-
Trials Sep 2021Some parallel-group cluster-randomized trials use covariate-constrained rather than simple randomization. This is done to increase the chance of balancing the groups on...
Simple compared to covariate-constrained randomization methods in balancing baseline characteristics: a case study of randomly allocating 72 hemodialysis centers in a cluster trial.
BACKGROUND AND AIM
Some parallel-group cluster-randomized trials use covariate-constrained rather than simple randomization. This is done to increase the chance of balancing the groups on cluster- and patient-level baseline characteristics. This study assessed how well two covariate-constrained randomization methods balanced baseline characteristics compared with simple randomization.
METHODS
We conducted a mock 3-year cluster-randomized trial, with no active intervention, that started April 1, 2014, and ended March 31, 2017. We included a total of 11,832 patients from 72 hemodialysis centers (clusters) in Ontario, Canada. We randomly allocated the 72 clusters into two groups in a 1:1 ratio on a single date using individual- and cluster-level data available until April 1, 2013. Initially, we generated 1000 allocation schemes using simple randomization. Then, as an alternative, we performed covariate-constrained randomization based on historical data from these centers. In one analysis, we restricted on a set of 11 individual-level prognostic variables; in the other, we restricted on principal components generated using 29 baseline historical variables. We created 300,000 different allocations for the covariate-constrained randomizations, and we restricted our analysis to the 30,000 best allocations based on the smallest sum of the penalized standardized differences. We then randomly sampled 1000 schemes from the 30,000 best allocations. We summarized our results with each randomization approach as the median (25th and 75th percentile) number of balanced baseline characteristics. There were 156 baseline characteristics, and a variable was balanced when the between-group standardized difference was ≤ 10%.
RESULTS
The three randomization techniques had at least 125 of 156 balanced baseline characteristics in 90% of sampled allocations. The median number of balanced baseline characteristics using simple randomization was 147 (142, 150). The corresponding value for covariate-constrained randomization using 11 prognostic characteristics was 149 (146, 151), while for principal components, the value was 150 (147, 151).
CONCLUSION
In this setting with 72 clusters, constraining the randomization using historical information achieved better balance on baseline characteristics compared with simple randomization; however, the magnitude of benefit was modest.
Topics: Humans; Ontario; Probability; Random Allocation; Renal Dialysis; Research Design
PubMed: 34526092
DOI: 10.1186/s13063-021-05590-1 -
Arthroplasty Today Mar 2019Balanced gaps and proper rotation are felt to be essential for optimum range of motion, stability, and patellar tracking in total knee arthroplasty. The purpose of this...
Balanced gaps and proper rotation are felt to be essential for optimum range of motion, stability, and patellar tracking in total knee arthroplasty. The purpose of this study is to assess, using computed tomography, the rotation of femoral and tibial components in fresh-frozen human cadaver knees that have been balanced using nanosensor trials while also observing how this rotation affects measured compartment loads and requirement for ligament balancing adjustment. We found that minor degrees of rotational malalignment of the femur and tibia were common using standard instrumentation and measured resection technique. Quantitative balance and rotational congruence are aided by nanosensor guidance, and femoral malrotation of up to 8° does not appear to affect compartment loads significantly as long as rotational congruity is present.
PubMed: 31020025
DOI: 10.1016/j.artd.2018.07.008 -
Aging and Disease Oct 2021From year to year, we know more about neurodegeneration and Parkinson's disease (PD). A positive influence of various types of physical activity is more often described... (Review)
Review
From year to year, we know more about neurodegeneration and Parkinson's disease (PD). A positive influence of various types of physical activity is more often described in the context of neuroprotection and prevention as well as the form of rehabilitation in Parkinson's patients. Moreover, when we look at supplementation, clinical nutrition and dietetics, we will see that balancing consumed products and supplementing the vitamins or minerals is necessary. Considering the biochemical pathways in skeletal muscle, we may see that many researchers desire to identify molecular mediators that have an impact through exercise and balanced diet on human health or development of the neurodegenerative disease. Therefore, it is mandatory to study the potential mechanism(s) related to diet and factors resulted from physical activity as molecular mediators, which play a therapeutic role in PD. This review summarizes the available literature on mechanisms and specific pathways involved in diet-exercise relationship and discusses how therapy, including appropriate exercises and diet that influence molecular mediators, may significantly slow down the progress of neurodegenerative processes. We suggest that a proper diet combined with physical activity will be a good solution for psycho-muscle BALANCE not only in PD but also in other neurodegenerative diseases.
PubMed: 34631210
DOI: 10.14336/AD.2021.0123 -
The Journal of Arthroplasty Jul 2018Knee instability is emerging as a major complication after total knee arthroplasty (TKA), with ligament laxity and component alignment listed as important contributory...
BACKGROUND
Knee instability is emerging as a major complication after total knee arthroplasty (TKA), with ligament laxity and component alignment listed as important contributory factors. Knee balancing remains an art and is largely dependent on the surgeon's subjective "feel." The objectives were to measure the accuracy of an electronic balancing device to document the magnitude of correction in knee balance after soft-tissue releases and measure change in knee laxity after medial release.
METHODS
The accuracy of a second-generation electronic ligament-balancing device was compared with that of 2 mechanical balancing instruments. TKA was performed in 12 cadaver knees. Soft-tissue balance was measured sequentially before TKA, after mounting a trial femoral component, after medial release, and after resecting the posterior cruciate ligament. Coronal laxity of the knee under a 10 Nm valgus moment was measured before and after medial release.
RESULTS
The electronic balancing instrument was more accurate than mechanical instruments in measuring distracted gap and distraction force. On average, before TKA, the flexion gap was wider than the extension gap, and the medial gap was tighter than the lateral gap. Medial release increased the medial gap in flexion and increased passive knee valgus laxity. Posterior cruciate ligament release increased the tibiofemoral gap in both flexion and extension with a greater increase in the lateral gap.
CONCLUSION
The second-generation electronic balancing device was significantly more accurate than mechanical instruments and could record knee balance over the entire range of flexion. More accurate soft-tissue balance may enhance outcomes after TKA.
Topics: Arthroplasty, Replacement, Knee; Cadaver; Humans; Joint Instability; Knee; Knee Joint; Knee Prosthesis; Ligaments; Posterior Cruciate Ligament; Range of Motion, Articular
PubMed: 29555494
DOI: 10.1016/j.arth.2018.02.057 -
Clinical EEG and Neuroscience Jan 2024The past decade has witnessed tremendous growth in analyzing the cortical representation of human locomotion and balance using Electroencephalography (EEG). With the... (Review)
Review
The past decade has witnessed tremendous growth in analyzing the cortical representation of human locomotion and balance using Electroencephalography (EEG). With the advanced developments in miniaturized electronics, wireless brain recording systems have been developed for mobile recordings, such as in locomotion. In this review, the cortical dynamics during locomotion are presented with extensive focus on motor imagery, and employing the treadmill as a tool for performing different locomotion tasks. Further, the studies that examine the cortical dynamics during balancing, focusing on two types of balancing tasks, ie, static and dynamic, with the challenges in sensory inputs and cognition (dual-task), are presented. Moreover, the current literature demonstrates the advancements in signal processing methods to detect and remove the artifacts from EEG signals. Prior studies show the electrocortical sources in the anterior cingulate, posterior parietal, and sensorimotor cortex was found to be activated during locomotion. The event-related potential has been observed to increase in the fronto-central region for a wide range of balance tasks. The advanced knowledge of cortical dynamics during mobility can benefit various application areas such as neuroprosthetics and gait/balance rehabilitation. This review will be beneficial for the development of neuroprostheses, and rehabilitation devices for patients suffering from movement or neurological disorders.
Topics: Humans; Electroencephalography; Locomotion; Gait; Evoked Potentials; Sensorimotor Cortex
PubMed: 36052404
DOI: 10.1177/15500594221123690 -
Optics Express May 2020During the past few years, a lot of efforts have been devoted in studying optical analog computing with artificial structures. Up to now, much of them are primarily...
During the past few years, a lot of efforts have been devoted in studying optical analog computing with artificial structures. Up to now, much of them are primarily focused on classical mathematical operations. How to use artificial structures to simulate quantum algorithm is still to be explored. In this work, an all-dielectric metamaterial-based model is proposed and realized to demonstrate the quantum Deutsch-Jozsa algorithm. The model is comprised of two cascaded functional metamaterial subblocks. The oracle subblock encodes the detecting functions (constant or balanced), onto the phase distribution of the incident wave. Then, the original Hadamard transformation is performed with a graded-index subblock. Both the numerical and experimental results indicate that the proposed metamaterials are able to simulate the Deutsch-Jozsa problem with one round operation and a single measurement of the output eletric field, where the zero (maximum) intensity at the central position results from the destructive (constructive) interference accompanying with the balance (constant) function marked by the oracle subblock. The proposed computational metamaterial is miniaturized and easy-integration for potential applications in communication, wave-based analog computing, and signal processing systems.
PubMed: 32549449
DOI: 10.1364/OE.393444 -
The Bone & Joint Journal Nov 2014Total knee replacement (TKR) smart tibial trials have load-bearing sensors which will show quantitative compartment pressure values and femoral-tibial tracking patterns.... (Review)
Review
Total knee replacement (TKR) smart tibial trials have load-bearing sensors which will show quantitative compartment pressure values and femoral-tibial tracking patterns. Without smart trials, surgeons rely on feel and visual estimation of imbalance to determine if the knee is optimally balanced. Corrective soft-tissue releases are performed with minimal feedback as to what and how much should be released. The smart tibial trials demonstrate graphically where and how much imbalance is present, so that incremental releases can be performed. The smart tibial trials now also incorporate accelerometers which demonstrate the axial alignment. This now allows the surgeon the option to perform a slight recut of the tibia or femur to provide soft-tissue balance without performing soft-tissue releases. Using a smart tibial trial to assist with soft-tissue releases or bone re-cuts, improved patient outcomes have been demonstrated at one year in a multicentre study of 135 patients (135 knees).
Topics: Arthroplasty, Replacement, Knee; Biomechanical Phenomena; Computer Simulation; Humans; Knee Joint; Knee Prosthesis; Range of Motion, Articular
PubMed: 25381414
DOI: 10.1302/0301-620X.96B11.34339 -
Archives of Orthopaedic and Trauma... Oct 2021Surgically balanced total knee arthroplasties have shown improved functional and clinical outcomes. Two different alignment methods have been proposed, the measured...
INTRODUCTION
Surgically balanced total knee arthroplasties have shown improved functional and clinical outcomes. Two different alignment methods have been proposed, the measured resection technique which uses femoral landmarks on the one hand and the ligament balanced technique which uses spreaders on the other. As anatomical landmarks also vary widely, with regards to the tibial cut irrespective of the collateral ligaments, we hypothesized that anatomical landmarks are not suitable for ideal femoral component rotational alignment.
MATERIALS AND METHODS
Ten cadaveric bilateral knees underwent TKA using a navigational device and a double tensiometer. By means of the navigational device, flexion gaps were balanced by femoral component size, rotation and flexion until a symmetric flexion and extension gap was obtained. Acquired femoral component rotation was compared to femoral landmarks (Whiteside Line, posterior condylar line and trans-epicondylar line).
RESULTS
Using the Whiteside line, the posterior condylar line and the surgical trans-epicondylar line to identify femoral component rotation did not balance the flexion gap as well as navigation. Depending on the parameter, deviations in femoral rotation of up to 6° were observed compared to the gap balancing technique. Furthermore, large deviations between these landmarks were observed.
CONCLUSION
Based on this study flexion gap balancing can be better optimized using ligament balancing technique. As this technique is highly dependent on the proximal tibial cut, we do recommend the use of navigational devices, which additionally assure a neutral leg alignment.
Topics: Arthroplasty, Replacement, Knee; Femur; Humans; Knee Joint; Knee Prosthesis; Osteoarthritis, Knee; Range of Motion, Articular
PubMed: 32757034
DOI: 10.1007/s00402-020-03557-6 -
Giornale Italiano Di Nefrologia :... Dec 2023Although Randomized clinical trials (RCT) represent the gold standard to compare two or more treatments, the impact of observational studies cannot be ignored.... (Review)
Review
Although Randomized clinical trials (RCT) represent the gold standard to compare two or more treatments, the impact of observational studies cannot be ignored. Obviously, these latter are performed on unbalanced sample, and differences among the compared groups could be detected. These differences could have an impact on the estimated association between our allocation and our outcome. To avoid it, some methods should be applied in the analysis of observational cohort. Propensity score (PS) can be considered as a value which sums up and balances the known variables. It aims to adjust or balance the probability of receiving a specific allocation group, and could be used to match, stratify, weight, and perform a covariate adjustment. PS is calculated with a logistic regression, using allocation groups as the outcome. Thanks to PS, we compute the probability of being allocated to one group and we can match patients obtaining two balanced groups. It avoids computing analysis in unbalanced groups. We compared low protein diet (LPD) and the Mediterranean diet in CKD patients and analysed them using the PS methods. Nutritional therapy is fundamental for the prevention, progression and treatment of Chronic Kidney Disease (CKD) and its complications. An individualized, stepwise approach is essential to guarantee high adherence to nutritional patterns and to reach therapeutic goals. The best dietary regimen is still a matter of discussion. In our example, unbalanced analysis showed a significant renal function preservation in LPD, but this correlation was denied after the PS analysis. In conclusion, although unmatched analysis showed differences between the two diets, after propensity analysis no differences were detected. If RCT cannot be performed, balancing the PS score allows to balance the sample and avoids biased results.
Topics: Humans; Diet, Protein-Restricted; Propensity Score; Diet, Mediterranean; Renal Insufficiency, Chronic
PubMed: 38156537
DOI: No ID Found -
MSystems 2017Advances in sequencing technologies have enabled novel insights into microbial niche differentiation, from analyzing environmental samples to understanding human...
Advances in sequencing technologies have enabled novel insights into microbial niche differentiation, from analyzing environmental samples to understanding human diseases and informing dietary studies. However, identifying the microbial taxa that differentiate these samples can be challenging. These issues stem from the compositional nature of 16S rRNA gene data (or, more generally, taxon or functional gene data); the changes in the relative abundance of one taxon influence the apparent abundances of the others. Here we acknowledge that inferring properties of individual bacteria is a difficult problem and instead introduce the concept of balances to infer meaningful properties of subcommunities, rather than properties of individual species. We show that balances can yield insights about niche differentiation across multiple microbial environments, including soil environments and lung sputum. These techniques have the potential to reshape how we carry out future ecological analyses aimed at revealing differences in relative taxonomic abundances across different samples. By explicitly accounting for the compositional nature of 16S rRNA gene data through the concept of balances, balance trees yield novel biological insights into niche differentiation. The software to perform this analysis is available under an open-source license and can be obtained at https://github.com/biocore/gneiss. : An author video summary of this article is available.
PubMed: 28144630
DOI: 10.1128/mSystems.00162-16