Effect of device-guided paced breathing of biofeedback on blood pressure, stress and anxiety levels in hypertensives

The present study aimed to evaluate the influence of cardiac coherence through Biofeedback Therapy (BT) with paced breathing on blood pressure, stress and anxiety levels in individuals with essential arterial hypertension. The participants underwent 8 sessions of paced breathing guided by biofeedback visual therapy for 20 minutes, in which they were evaluated through clinical assessment, Hamilton Anxiety Rating Scale, Perceived Stress Scale and cardiovascular variables. Comparisons of means were performed using the paired and unpaired Student's t-test. Statistically significant correlations were considered when p ≤ 0.05 with a 95% confidence interval. The effect size (Cohen's d) and common language effect size were calculated to assess the effect of such therapy. Sixteen patients with mean age of 57.3 ± 14 years old participated in this study. Comparisons between mean initial and final systolic blood pressure levels (SBP) in women (p = 0.007; Cohen's d = 0.50), pre- and post-training heart rate (p = 0.02; Cohen's d = 0.60) and anxiety levels (p = 0.01; Cohen's d = 1.04) were significant. Comparisons between pre- and post-training SBP (p = 0.006; Cohen's d = 0.81) and pre- and post-training anxiety levels (p = 0.04; Cohen's d = 0.32) were significant among males. In conclusion, paced breathing training with biofeedback therapy can be promising to reduce anxiety levels in individuals with essential arterial hypertension.

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Single Pill Indapamide and Perindopril Arginine Combination: Optimal Coupling of Vascular Protection and Hemodynamic Risk Factors Reduction in Patients with Essential Arterial Hypertension

Kardiologiia ◽

10.18087/cardio.2019.3.10236 ◽

2019 ◽

Vol 59 (3) ◽

pp. 18-26 ◽

Cited By ~ 1

Author(s):

E. V. Borisova ◽

A. I. Kochetkov ◽

O. D. Ostroumova

Keyword(s):

Blood Pressure ◽

Arterial Stiffness ◽

Arterial Hypertension ◽

Arterial Compliance ◽

Stage Ii ◽

Stiffness Index ◽

Single Pill ◽

Essential Arterial Hypertension ◽

The Impact

Objective: to investigate the impact of indapamide / perindopril single-pill combination (I / P SPC) on arterial stiffness parameters, blood pressure (BP) level and BP variability (BPV) in middle-aged patients with stage II grade 1–2 essential arterial hypertension (EAH). Materials and methods. We retrospectively formed a group of patients with stage II grade 1–2 EAH who had not previously received regular antihypertensive therapy (AHT) (n=52, mean age 52.9±6.0 years). All patients were treated with I / P SPC and all of them achieved target office BP level (less than 140 / 90 mm Hg). After 12 weeks of follow-up (from the time of reaching the target BP) assessment of AHT effectiveness (general clinical data, ambulatory blood pressure monitoring [ABPM], volume sphygmography, echocardiography), and vascular stiffness evaluation were performed.Results. At the end of follow-up office systolic BP (SBP), diastolic BP (DBP), pulse BP, day-time, night-time and 24‑hour SBP and DBP significantly (p<0.001 for all) decreased. According to the ABPM data day-time, nighttime, and 24‑hour systolic BPV significantly decreased (p=0.029, p=0.006 and p<0.001, respectively); day-time and 24‑hour diastolic BPV also significantly decreased (p=0.001 and p<0.001, respectively). Day-night standard deviation (SDdn) significantly decreased too (p=0.002 and p<0.001, respectively). Volumetric sphygmography showed significant decrease of right cardio-ankle vascular index (CAVI) (from 8.20±1.29 to 7.58±1.44, p=0.001) and of left CAVI (from 8.13±1.40 to 7.46±1.43, p<0.001), as well as reduction of the number o f patients with a right- and / or left-CAVI >9.0 (from 32.7 to 11.5 %, p=0.018). According to assessment of arterial stiffness using the Vasotens24 software package, the arterial stiffness index (ASI) significantly (p<0.001) decreased from 153.5±29.9 to 138.3±20.0 (by –9.2±13.1 %). Transthoracic echocardiography data demonstrated significant decrease (p<0.001) in effective arterial elastance (from 1.82±0.43 to 1.58±0.36 mm Hg; by –11.85±16.29 %) and significant (p<0.001) increase in the arterial compliance – from 1.27±0.34 to 1.54±0.38 mm Hg / ml (+26.95±38.06 %).Conclusion. In AHT naive patients 40–65 years old with stage II grade 1–2 EAH therapy with I / P SPC provided effective 24‑hour BP control, reduced BPV and improved arterial stiffness parameters.

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A non-parametric effect size measure capturing changes in central tendency and shape of data distributions more flexibly than Cohen’s d

10.21203/rs.2.21070/v1 ◽

2020 ◽

Author(s):

Jörn Lötsch ◽

Alfred Ultsch

Keyword(s):

Effect Size ◽

Data Science ◽

Heterogeneous Data ◽

Machine Learning Algorithms ◽

Central Tendency ◽

Effect Size Measure ◽

Specific Data ◽

Cohen’S D ◽

Size Measure ◽

Cohen's D

Abstract Calculating the magnitude of treatment effects or of differences between two groups is a common task in quantitative science. Standard effect size measures based on differences, such as the commonly used Cohen's, fail to capture the treatment-related effects on the data if the effects were not reflected by the central tendency. "Impact” is a novel nonparametric measure of effect size obtained as the sum of two separate components and includes (i) the change in the central tendency of the group-specific data, normalized to the overall variability, and (ii) the difference in the probability density of the group-specific data. Results obtained on artificial data and empirical biomedical data showed that impact outperforms Cohen's d by this additional component. It is shown that in a multivariate setting, while standard statistical analyses and Cohen’s d are not able to identify effects that lead to changes in the form of data distribution, “Impact” correctly captures them. The proposed effect size measure shares the ability to observe such an effect with machine learning algorithms. It is numerically stable even for degenerate distributions consisting of singular values. Therefore, the proposed effect size measure is particularly well suited for data science and artificial intelligence-based knowledge discovery from (big) and heterogeneous data.

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Total Lifestyle Coaching: A Pilot Study Evaluating the Effectiveness of a Mind–Body and Nutrition Telephone Coaching Program for Obese Adults at a Community Health Center

Global Advances in Health and Medicine ◽

10.1177/2164956118784902 ◽

2018 ◽

Vol 7 ◽

pp. 216495611878490 ◽

Cited By ~ 2

Author(s):

Emma Chad-Friedman ◽

Melanie Pearsall ◽

Kathleen M Miller ◽

Amy E Wheeler ◽

John W Denninger ◽

...

Keyword(s):

Blood Pressure ◽

Weight Loss ◽

Community Health ◽

Health Center ◽

Perceived Stress ◽

Community Health Center ◽

Cohen’S D ◽

Coaching Intervention ◽

Cohen's D ◽

Telephone Coaching

Background Stress and obesity are interrelated and common among low-income adults. Mind–body interventions have been shown to reduce psychological distress and have been incorporated into many weight loss interventions. However, few of these programs have incorporated a telephone coaching component. Objective We designed and piloted a novel weight loss telephone coaching intervention for this population and examined its effectiveness on weight loss and improvements in health behaviors in obese community health center patients. Methods This was a 6-month, single-arm, prospective, pre–post pilot study. The study took place at a community health center near Boston, Massachusetts. Participants were 27 overweight and obese community health center patients. The intervention consisted of one in-person intake with the registered dietitian, trained in mind–body approaches, and approximately 1 phone coaching session every 2 weeks for 6 consecutive months. Anthropometric data consisted of weight, body mass index (BMI), and blood pressure. Questionnaires consisted of the Perceived Stress Scale-10 item, the CIGNA Healthy Eating Survey, Section H: Behavioral Eating, a physical activity questionnaire, and a nutritional habits questionnaire. We used paired samples t tests to assess pre–post changes in weight, BMI, blood pressure, perceived stress, behavioral eating, and physical activity. We also conducted semistructured exit interviews to learn about participants’ experiences in this program. Results There was a trend toward weight reduction ( P < .1, Cohen’s d = 0.33) and significant improvements in systolic blood pressure ( P = .001, Cohen’s d = 0.72), perceived stress ( P = .001, Cohen’s d = 0.75), and behavioral eating ( P = .009, Cohen’s d = 0.54). Improvements in weight were sustained 6 months after completion of the intervention. Conclusion Results suggest that a telephone nutrition health coaching intervention is feasible and may facilitate weight loss in obese community health center patients. Future randomized-controlled studies are warranted to better understand these improvements. Clinicaltrials.gov registration NCT03025217

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Wavelet decomposition analysis is a clinically relevant strategy to evaluate cerebrovascular buffering of blood pressure after spinal cord injury

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00152.2017 ◽

2018 ◽

Vol 314 (5) ◽

pp. H1108-H1114 ◽

Cited By ~ 10

Author(s):

Saqib Saleem ◽

Diana Vucina ◽

Zoe Sarafis ◽

Amanda H. X. Lee ◽

Jordan W. Squair ◽

...

Keyword(s):

Blood Pressure ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Transfer Function ◽

Wavelet Decomposition ◽

Statistical Power ◽

Decomposition Analysis ◽

Cohen’S D ◽

Cord Injury ◽

Cohen's D

The capacity of the cerebrovasculature to buffer changes in blood pressure (BP) is crucial to prevent stroke, the incidence of which is three- to fourfold elevated after spinal cord injury (SCI). Disruption of descending sympathetic pathways within the spinal cord due to cervical SCI may result in impaired cerebrovascular buffering. Only linear analyses of cerebrovascular buffering of BP, such as transfer function, have been used in SCI research. This approach does not account for inherent nonlinearity and nonstationarity components of cerebrovascular regulation, often depends on perturbations of BP to increase the statistical power, and does not account for the influence of arterial CO2 tension. Here, we used a nonlinear and nonstationary analysis approach termed wavelet decomposition analysis (WDA), which recently identified novel sympathetic influences on cerebrovascular buffering of BP occurring in the ultra-low-frequency range (ULF; 0.02–0.03Hz). WDA does not require BP perturbations and can account for influences of CO2 tension. Supine resting beat-by-beat BP (Finometer), middle cerebral artery blood velocity (transcranial Doppler), and end-tidal CO2 tension were recorded in cervical SCI ( n = 14) and uninjured ( n = 16) individuals. WDA revealed that cerebral blood flow more closely follows changes in BP in the ULF range ( P = 0.0021, Cohen’s d = 0.89), which may be interpreted as an impairment in cerebrovascular buffering of BP. This persisted after accounting for CO2. Transfer function metrics were not different in the ULF range, but phase was reduced at 0.07–0.2 Hz ( P = 0.03, Cohen’s d = 0.31). Sympathetically mediated cerebrovascular buffering of BP is impaired after SCI, and WDA is a powerful strategy for evaluating cerebrovascular buffering in clinical populations.

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0636 Using AI To Predict Future CPAP Adherence and the Impact of Behavioral and Technical Interventions

SLEEP ◽

10.1093/sleep/zsaa056.632 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A243-A243

Author(s):

W Hevener ◽

B Beine ◽

J Woodruff ◽

D Munafo ◽

C Fernandez ◽

...

Keyword(s):

Effect Size ◽

Statistical Significance ◽

Post Intervention ◽

Cpap Adherence ◽

Cohen’S D ◽

Usage Patterns ◽

Patient Outreach ◽

Cohen's D ◽

The Impact ◽

Usage Data

Abstract Introduction Clinical management of CPAP adherence remains an ongoing challenge. Behavioral and technical interventions such as patient outreach, coaching, troubleshooting, and resupply may be deployed to positively impact adherence. Previous authors have described adherence phenotypes that retrospectively categorize patients by discrete usage patterns. We design an AI model that predictively categorizes patients into previously studied adherence phenotypes and analyzes the statistical significance and effect size of several types of interventions on subsequent CPAP adherence. Methods We collected a cross-sectional cohort of subjects (N = 13,917) with 455 days of daily CPAP usage data acquired. Patient outreach notes and resupply data were temporally synchronized with daily CPAP usage. Each 30-days of usage was categorized into one of four adherence phenotypes as defined by Aloia et al. (2008) including Good Users, Variable Users, Occasional Attempters, and Non-Users. Cross-validation was used to train and evaluate a Recurrent Neural Network model for predicting future adherence phenotypes based on the dynamics of prior usage patterns. Two-sided 95% bootstrap confidence intervals and Cohen’s d statistic were used to analyze the significance and effect size of changes in usage behavior 30-days before and after administration of several resupply interventions. Results The AI model predicted the next 30-day adherence phenotype with an average of 90% sensitivity, 96% specificity, 95% accuracy, and 0.83 Cohen’s Kappa. The AI model predicted the number of days of CPAP non-use, use under 4-hours, and use over 4-hours for the next 30-days with OLS Regression R-squared values of 0.94, 0.88, and 0.95 compared to ground truth. Ten resupply interventions were associated with statistically significant increases in adherence, and ranked by adherence effect size using Cohen’s d. The most impactful were new cushions or masks, with a mean post-intervention CPAP adherence increase of 7-14% observed in Variable User, Occasional Attempter, and Non-User groups. Conclusion The AI model applied past CPAP usage data to predict future adherence phenotypes and usage with high sensitivity and specificity. We identified resupply interventions that were associated with significant increases in adherence for struggling patients. This work demonstrates a novel application for AI to aid clinicians in maintaining CPAP adherence. Support

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Metabolism of quantity elements and essential trace elements in patients with essential arterial hypertension in different ecological settings

Kazan medical journal ◽

10.17816/kmj1793 ◽

2013 ◽

Vol 94 (6) ◽

pp. 798-803 ◽

Cited By ~ 1

Author(s):

Z R Khabibrakhmanova ◽

T P Makarova ◽

D I Sadykova

Keyword(s):

Blood Pressure ◽

Arterial Hypertension ◽

Children And Adolescents ◽

Blood Pressure Monitoring ◽

Essential Elements ◽

Healthy Children ◽

Residential Areas ◽

Pressure Monitoring ◽

Industrial Areas ◽

Essential Arterial Hypertension

Aim. To study the specifics of lead, zinc, copper, magnesium and calcium metabolism in children and adolescents with essential arterial hypertension living in different ecological settings. Methods. 100 children and adolescents aged 13-17 years with arterial hypertension, living in «industrial» (52 patients) and «residential» (48 patients) areas were examined in cardiology ward. 33 healthy children and adolescents comparable by age and gender were included as healthy controls. According to 24-hour blood pressure monitoring, groups with stable, labile arterial hypertension and «white coat hypertension» were formed. The levels of elements in 24-hour urine and in serum were measured by atomic absorption spectrophotometry. Results. In children and adolescents with stable arterial hypertension living in industrial areas, parameters of 24-hour blood pressure monitoring (mean 24-hour and mean daytime systolic blood pressure values, time of systolic hypertension, mean 24-hour and mean daytime blood pressure values) were higher compared to the same parameters in children from residential areas, the difference was statistically significant. The study of elements metabolism revealed increased lead exposure in children with essential arterial hypertension living in industrial areas, and misbalance of essential elements in those patients compared to the same parameters in children from residential areas. Conclusion. Results suggest increased exposure to arterial hypertension and marked misbalance of essential elements in children and adolescents with essential arterial hypertension living in industrial areas.

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The Unforgettables: a chorus for people with dementia with their family members and friends

International Psychogeriatrics ◽

10.1017/s1041610217001867 ◽

2018 ◽

Vol 30 (6) ◽

pp. 779-789 ◽

Cited By ~ 8

Author(s):

Mary Sherman Mittelman ◽

Panayiota Maria Papayannopoulou

Keyword(s):

Quality Of Life ◽

Social Support ◽

Pilot Study ◽

Effect Size ◽

Family Members ◽

Positive Effects ◽

Cohen’S D ◽

People With Dementia ◽

Cohen's D

Summary/AbstractOur experience evaluating a museum program for people with dementia together with their family members demonstrated benefits for all participants. We hypothesized that participation in a chorus would also have positive effects, giving them an opportunity to share a stimulating and social activity that could improve their quality of life. We inaugurated a chorus for people with dementia and their family caregivers in 2011, which rehearses and performs regularly. Each person with dementia must be accompanied by a friend or family member and must commit to attending all rehearsals and the concert that ensues. A pilot study included a structured assessment, take home questionnaires and focus groups. Analyses of pre-post scores were conducted; effect size was quantified using Cohen's d. Results showed that quality of life and communication with the other member of the dyad improved (Effect size: Cohen's d between 0.32 and 0.72) for people with dementia; quality of life, social support, communication and self-esteem improved (d between 0.29 and 0.68) for caregivers. Most participants stated that benefits included belonging to a group, having a normal activity together and learning new skills. Participants attended rehearsals in spite of harsh weather conditions. The chorus has been rehearsing and performing together for more than 6 years and contributing to its costs. Results of this pilot study suggest that people in the early to middle stage of dementia and their family members and friends can enjoy and learn from rehearsing and performing in concerts that also engage the wider community. It is essential to conduct additional larger studies of the benefits of participating in a chorus, which may include improved quality of life and social support for all, and reduced cognitive decline among people with dementia.

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THE FREQUENCY OF USE OF COMBINATIONS OF ANTIHYPERTENSIVE DRUGS IN PATIENTS WITH DIFFICULT-TO-CONTROL HYPERTENSION ON THE BACKGROUND OF BIOFEEDBACK AND PACED BREATHING AND HEART RATE VARIABILITY

The Journal of V. N. Karazin Kharkiv National University, Series "Medicine" ◽

10.26565/2313-6693-2018-35-09 ◽

2018 ◽

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Heart Rate Variability ◽

Drug Therapy ◽

Arterial Hypertension ◽

Antihypertensive Effect ◽

Antihypertensive Drugs ◽

Basic Subgroup ◽

Paced Breathing ◽

Frequency Of Use

The frequency of administration of combinations of antihypertensive drugs and its changes at different stages of observation was studied in 60 patients with difficult-to-control arterial hypertension (DTCAH) (32 men and 28 women) aged 59.0 ± 9.4. All patients were randomly divided into two subgroups: biofeedback (BFB) in the loop of paced breathing (PB) and heart rate variability (HRV) (33 patients) – basic subgroup, subgroup of comparisons (27 patients). Determined that patients with DTCAH in the subgroup of patients with the BFB in the loop of PB there has been a reduction of four-component antihypertensive therapy to three-component and in the subgroup of comparisons the frequency of the appointment of a four-component therapy was increased. At the same time, it was found that the addition of drug therapy with regular BFB sessions in the loop of PB contributed to the potentiation of the antihypertensive effect in patients with DTCAH. It is concluded that the BFB in the loop of PB and HRV can be used as a technology to improve the efficiency of control of blood pressure in patients with DTCAH.

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Effect Size Guidelines, Sample Size Calculations, and Statistical Power in Gerontology

Innovation in Aging ◽

10.1093/geroni/igz036 ◽

2019 ◽

Vol 3 (4) ◽

Cited By ~ 15

Author(s):

Christopher R Brydges

Keyword(s):

Individual Differences ◽

Sample Size ◽

Effect Size ◽

Effect Sizes ◽

Group Differences ◽

Cohen’S D ◽

Pearson's R ◽

Sample Size Calculations ◽

Cohen's D ◽

Pearson’S R

Abstract Background and Objectives Researchers typically use Cohen’s guidelines of Pearson’s r = .10, .30, and .50, and Cohen’s d = 0.20, 0.50, and 0.80 to interpret observed effect sizes as small, medium, or large, respectively. However, these guidelines were not based on quantitative estimates and are only recommended if field-specific estimates are unknown. This study investigated the distribution of effect sizes in both individual differences research and group differences research in gerontology to provide estimates of effect sizes in the field. Research Design and Methods Effect sizes (Pearson’s r, Cohen’s d, and Hedges’ g) were extracted from meta-analyses published in 10 top-ranked gerontology journals. The 25th, 50th, and 75th percentile ranks were calculated for Pearson’s r (individual differences) and Cohen’s d or Hedges’ g (group differences) values as indicators of small, medium, and large effects. A priori power analyses were conducted for sample size calculations given the observed effect size estimates. Results Effect sizes of Pearson’s r = .12, .20, and .32 for individual differences research and Hedges’ g = 0.16, 0.38, and 0.76 for group differences research were interpreted as small, medium, and large effects in gerontology. Discussion and Implications Cohen’s guidelines appear to overestimate effect sizes in gerontology. Researchers are encouraged to use Pearson’s r = .10, .20, and .30, and Cohen’s d or Hedges’ g = 0.15, 0.40, and 0.75 to interpret small, medium, and large effects in gerontology, and recruit larger samples.

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Comparing Normalized Gain g and Effect Size Cohen’s d to Measure the Improvement of Student’s Scientific Literacy

10.31237/osf.io/n98kp ◽

2019 ◽

Author(s):

Adib Rifqi Setiawan

Keyword(s):

Education Research ◽

Student Learning ◽

Effect Size ◽

Physics Education ◽

Scientific Literacy ◽

Biology Education ◽

Physics Education Research ◽

Cohen’S D ◽

Cohen's D ◽

Normalized Gain

In this work I investigate about my curiousity. My investigation focused on the implications on claims about student learning that result from choosing between one of two metrics. The metrics are normalized gain g, which is the most common method used in Physics Education Research (PER), and effect size Cohen’s d, which is broadly used in Discipline-Based Education Research (DBER) including Biology Education Research (BER). Data for the analyses came from the research about scientific literacy on Physics and Biology Education from courses at institutions across Indonesia. This work reveals that the bias in normalized gaing can harm efforts to improve student’s scientific literacy by misrepresenting the efficacy of teaching practices across populations of students and across institutions. This work, also, recommends use effect size Cohen’s d for measuring student learning, based on reliability statistical method for calculating student learning.

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