Can inpatient multidisciplinary rehabilitation improve health-related quality of life in MS patients on the long term - The Danish MS Hospitals Rehabilitation Study.

BACKGROUND: Inpatient multidisciplinary rehabilitation (MDR) can improve health-related quality of life (HRQoL) in multiple sclerosis (MS) patients. However, the evidence of a long-term benefit is limited. OBJECTIVES: To investigate the long-term effectiveness of inpatient MDR on HRQoL in MS patients. METHODS: We conducted a randomized controlled partial crossover trial with 427 MS patients. RESULTS: Statistical significant long-term improvements in HRQoL were found in three of the six outcome measures at 12-month follow-up. Three in four suggested minimal clinically important differences (MCIDs) were unmet. CONCLUSION: These results indicate that the administration of inpatient MDR may lead to long-lasting improvements in HRQoL in MS patients.

Technical note: Random forests prediction of daily eating time of dairy cows from 3-dimensional accelerometer and radiofrequency identification.

Feed intake and time spent eating at the feed bunk are important predictors of dairy cows' productivity and animal welfare, and deviations from normal eating behavior may indicate subclinical or clinical disease. In the current study, we developed a random forests algorithm to predict dairy cows' daily eating time (of a total mixed ration from a common feed bunk) using data from a 3-dimensional accelerometer and a radiofrequency identification (RFID) prototype device (logger) mounted on a neck collar. Models were trained on continuous focal animal observations from a total of 24 video recordings of 18 dairy cows at the Danish Cattle Research Centre (Foulum, Tjele, Denmark). Each session lasted from 21 to 48 h. The models included both the present time signal and observations several seconds back in time (lag window). These time-lagged signals were included with the purpose of capturing changes over time. Because of the high costs of installing an RFID antenna in the feed bunk, we also investigated a model based solely on 3-dimensional accelerometer data. Furthermore, to address the trade-off between prediction accuracy and reduced model complexity and its implications for battery longevity, we investigated the importance of including observations back in time using lag window sizes between 8 and 128 s. Performance was evaluated by internal leave-one-cow-out cross-validation. The results indicated that we obtained accurate predictions of daily eating time. For the most complex model (a lag window size of 128 s), the median of the balanced accuracy was 0.95 (interquartile interval: 0.93 to 0.96), and the median daily eating time deviation was 7 min 37 s (interquartile interval: -6 to 15 min). The median of the average daily eating time during sessions was 3 h 41 min with an interquartile interval of 2 h 56 min to 4 h 16 min. Exclusion of RFID data resulted in a considerable decrease in prediction accuracy, mainly due to a decreased sensitivity of locating the cow at the feed bunk (median balanced accuracy of 0.87 at a lag window size of 128 s). In contrast, prediction accuracy only slightly decreased with decreasing lag window size (median balanced accuracy of 0.94 at a lag window size of 8 s). We suggest a lag window size of 64 s for further development of the prototype logger. The methodology presented in this paper may be relevant for future automatic recordings of eating behavior in commercial dairy herds.

Longer term effectiveness of inpatient multidisciplinary rehabilitation on health-related quality of life in MS patients: a pragmatic randomized controlled trial - The Danish MS Hospitals Rehabilitation Study.

BACKGROUND: There is insufficient evidence to support the effectiveness of multidisciplinary rehabilitation on the health-related quality of life (HRQoL) of MS patients. OBJECTIVES: To evaluate the longer term effectiveness of inpatient multidisciplinary rehabilitation on the HRQoL of MS patients. METHODS: The study was a two-hospital, pragmatic, randomized controlled trial with a 6-month follow-up. Patients aged 18-65 years with MS and Expanded Disability Status Scale scores ≤7.5 were randomly assigned (1:1) to 4 weeks of inpatient multidisciplinary rehabilitation (20 days of scheduled rehabilitation) or 6 months on a wait list. The outcome measures were Functional Assessment in Multiple Sclerosis (FAMS), Multiple Sclerosis Impact Scale-29 (MSIS-29), EQ-5D-5L and 15D. RESULTS: We randomized 213 patients to the wait-list control group and 214 patients to the treatment group. Trends in favour of the treatment group were observed across all measures. However, the difference was significant in only two of the six measures. The treatment effect was -2.7 (95% CI: -5.6 to (-0.1)), p = 0.046) for the MSIS-29 Psychological and 0.017 (95% CI: 0.005-0.030, p = 0.008) for the 15D. FAMS, which we used to calculate the sample size, was not significant. CONCLUSION: The results indicated that inpatient multidisciplinary rehabilitation is effective in improving the HRQoL of MS patients after 6 months.

Dietary Patterns and Their Associations with Symptom Levels Among People with Multiple Sclerosis: A Real-World Digital Study.

INTRODUCTION: The objective of the study was to investigate long-term food intake patterns and establish possible associations between the inferred dietary habits and levels of reported symptoms among people with multiple sclerosis (MS) in Denmark. METHODS: The present study was designed as a prospective cohort study. Participants were invited to register daily food intake and MS symptoms and were observed during a period of 100 days. Dropout and inclusion probabilities were addressed using generalized linear models. Dietary clusters were identified among 163 participants using hierarchical clustering on principal component scores. Associations between the dietary clusters and the levels of self-assessed MS symptoms were estimated using inverse probability weighting. Furthermore, the effect of a person's position on the first and second principal dietary component axis on symptom burden was investigated. RESULTS: Three dietary clusters were identified: a Western dietary cluster, a plant-rich dietary cluster and a varied dietary cluster. Analyses further indicated a vegetables-fish-fruit-whole grain axis and a red-meat-processed-meat axis. The plant-rich dietary cluster showed reduction in symptom burden in nine pre-defined MS symptoms compared to the Western dietary cluster (between 19 and 90% reduction). This reduction was significant for pain and bladder dysfunction as well as across all nine symptoms (pooled p value = 0.012). Related to the two dietary axes, high intake of vegetables resulted in 32-74% reduction in symptom burden compared to low levels of vegetable intake. Across symptoms, this was significant (pooled p value = 0.015), also regarding walking difficulty and fatigue. CONCLUSIONS: Three dietary clusters were identified. Compared to levels of self-assessed MS-related symptoms, and adjusted for potential confounders, the results suggested less symptom burden with increased intake of vegetables. Although the research design limits the possibilities of establishing causal inference, the results indicate that general guidelines for healthy diet may be relevant as a tool in coping with MS symptoms.

Multimethodological validation of the modified fatigue impact scale in a Danish population of people with Multiple Sclerosis.

OBJECTIVE: To provide a multimethodological validation of MFIS in compliance with the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) guidelines using a Danish population of patients with Multiple Sclerosis (pwMS). METHODS: Factor analytic and multidimensional Rasch analytic methods were applied to investigate the structural validity of MFIS. We employed measurement and bi-factor models to address divergence and convergence. McDonalds ω was used to assess reliability. Cross-cultural and nomological validity was assessed in relation to relevant external populations and constructs, respectively. Responsiveness was evaluated following one month of multi-disciplinary rehabilitation (MDR). RESULTS: Based on data from 424 Danish MS patients, the MFIS showed an acceptable fit to both factor analytic and multidimensional Rasch models. MFIS was found to be dominated by a general factor but with considerable substructure present. Sufficient divergence was found between cognitive and physical subdomains, but not the psychosocial subscale. Mc Donald's ωt of 0.96 indicated good reliability of the scale, however, with low specific reliability of the psychosocial subscale. Homogeneity across Danish and European populations of pwMS supported cross-cultural validity. Explorative factor analysis of the nomological network of MFIS revealed expected convergence with cognitive and physical aspects. MFIS showed good responsiveness as indicated by moderate to large effect sizes following MDR. CONCLUSION: The Danish version of the MFIS showed good reliability, a good structural, cross-cultural, and nomological validity an acceptable fit to a multidimensional Rasch analysis, and a good responsiveness. The psychosocial subscale of the MFIS however should be interpreted with caution.

Landscape genetics, historical isolation and cross-Andean gene flow in the wax palm, Ceroxylon echinulatum (Arecaceae).

Knowledge of the role of landscapes in shaping genetic connectivity and divergence is essential for understanding patterns of biogeography and diversity. This is particularly relevant for the Andes region, a major biodiversity hotspot of relatively recent origin. We examined the phylogeography and landscape genetics of the Andean wax palm Ceroxylon echinulatum (Arecaceae) that occurs in two narrow bands of montane forests on each side of the Andes in Ecuador and northeastern Peru. First, we tested the hypothesis of C. echinulatum being a geographic cline species crossing the Andes in the Amotape-Huancabamba zone (AHZ) of southern Ecuador/northern Peru, as indicated by observations on fruit morphology. Second, we assessed the timeframe of cross-Andean divergence, and third, we investigated the impact of contemporary and historical landscape features on observed spatio-genetic patterns. Individual-based Bayesian clustering (BC) identified a northeastern, southeastern, southwestern, and northwestern cluster, with areas of genetic discontinuity coinciding with the Andes and the Giron-Paute deflection. F-statistics derived from BC suggested an east-to-west dispersal history. Population-based analyses revealed strong genetic structuring at both small and large geographic scales. Interpopulation relationships and Mantel tests strongly supported the cline model with cross-Andean dispersal in the AHZ. Along the cline, gene flow measured as F(ST) was mainly limited by distance, with less but significant impact of climatic friction. Coalescent analysis revealed that cross-Andean divergence took place during the Quaternary. Significant historical isolation (R(ST) > F(ST)) was found in the southwestern population. The current study illustrates a joint effect of founder dynamics, divergence by distance and historical isolation on patterns of Andean diversity and distribution.

Mid-Tertiary dispersal, not Gondwanan vicariance explains distribution patterns in the wax palm subfamily (Ceroxyloideae: Arecaceae).

The Ceroxyloideae is a small but heterogeneous subfamily of palms (Arecaceae, Palmae). It includes a Caribbean lineage (tribe Cyclospathae), a southern hemisphere disjunction (tribe Ceroxyleae), and an amphi-Andean element (tribe Phytelepheae), until recently considered a distinct subfamily (Phytelephantoideae) due to its highly derived morphology. A variety of hypotheses have been proposed to account for the biogeography of the subfamily, involving Gondwanan vicariance, austral interplate dispersal from South America to Australia via Antarctica, Andean orogeny, and Pleistocene refuges. We assessed the systematic classification and biogeography of the group based on a densely sampled phylogeny using >5.5kb of DNA sequences from three plastid and two nuclear genomic regions. The subfamily and each of its three tribes were resolved as monophyletic with high support. Divergence time estimates based on penalized likelihood and Bayesian dating methods indicate that Gondwanan vicariance is highly unlikely as an explanation for basic disjunctions in tribe Ceroxyleae. Alternative explanations include a mid-Tertiary trans-Atlantic/trans-African dispersal track and the "lemurian stepping stones" hypothesis. Austral interplate dispersal of Oraniopsis to Australia could have occurred, but apparently only in the mid-Eocene/early Oligocene interval after global cooling had begun. Our data do not support Pleistocene climatic changes as drivers for speciation in the Andean-centered Phytelepheae as previously proposed. Radiation in this tribe coincides largely with the major uplift of the Andes, favoring Andean orogeny over Pleistocene climatic changes as a possible speciation-promoting factor in this tribe.