Mean Intensity Score Research Articles

Technical and biological sources of unreliability of Infinium probes on Illumina methylation microarrays

The Illumina Methylation array platform has facilitated countless epigenetic studies on DNA methylation (DNAme) in health and disease, yet relatively few studies have so studied its reliability, i.e., the consistency of repeated measures. Here we investigate the reliability of both type I and type II Infinium probes. We propose a method for excluding unreliable probes based on dynamic thresholds for mean intensity (MI) and ‘unreliability’, estimated by probe-level simulation of the influence of technical noise on methylation β values using the background intensities of negative control probes. We validate our method in several datasets, including newly generated Illumina MethylationEPIC BeadChip v1.0 data from paired whole blood samples taken six weeks apart and technical replicates spanning multiple sample types. Our analysis revealed that specifically probes with low MI exhibit higher β value variability between repeated samples. MI was associated with the number of C-bases in the respective probe sequence and correlated negatively with unreliability scores. The unreliability scores were substantiated through validation in a new EPIC v1.0 (blood and cervix) and a publicly available 450k (blood) dataset, as they effectively captured the variability observed in β values between technical replicates. Finally, despite promising higher robustness, the newer version v2.0 of the MethylationEPIC BeadChip retained a substantial number of probes with poor unreliability scores. To enhance current pre-processing pipelines, we developed an R package to calculate MI and unreliability scores and provide guidance on establishing optimal dynamic score thresholds for a given dataset.

Loneliness and pain among community-dwelling middle-aged and older Black, Latino, and White adults in the United States.

Prior research has demonstrated a strong and independent association between loneliness and pain, but few studies to date have explored this relationship in racially and ethnically diverse groups of midlife and older adults. We drew on the diathesis stress model of chronic pain and cumulative inequality theory to examine the relationship of loneliness and the presence and intensity of pain in a nationally representative sample of Black, Latino, and White adults aged 50 or older in the United States. Data were from Wave 3 of the National Social Life, Health, and Aging Project (n = 2,706). We used weighted logistic and ordinary least squares regression analyses to explore main and interactive effects of loneliness and race and ethnicity while adjusting for well-documented risk and protective factors (e.g., educational attainment, perceived relative income, inadequate health insurance, perceived discrimination) and salient social and health factors. Almost half (46%) of the participants reported feeling lonely and 70% reported the presence of pain. Among those who reported pain (n = 1,910), the mean intensity score was 2.89 (range = 1-6) and 22% reported severe or stronger pain. Greater loneliness was associated with increased odds of pain presence (AOR = 1.154, 95% CI [1.072, 1.242]) and higher pain intensity (β = 0.039, p < 0.01). We found no significant interaction effects involving Black participants. However, Latino participants who reported greater loneliness had significantly higher levels of pain (β = 0.187, p < 0.001) than their White counterparts with similar levels of loneliness. Loneliness is an important correlate of pain presence and intensity and may have a stronger effect on pain intensity among Latino adults aged 50 or older. We discuss clinical and research implications of these findings, including the need for more fine-grained analyses of different types of loneliness (e.g., social, emotional, existential) and their impact on these and other pain-related outcomes (e.g., interference). Our findings suggest a need for interventions to prevent and manage pain by targeting loneliness among middle-aged and older adults, particularly Latino persons.

First evaluation of Eyberg Child Behavior Inventory for foster children in Japan.

Behavioral problems of foster children are an important issue for the maintenance of the foster care system, but they have not been adequately studied in Japan. We used the Eyberg Child Behavior Inventory (ECBI) to investigate behavioral problems among foster children and to examine associated factors. Twenty-nine foster children and their foster parents and 479 non-foster children and parents were recruited for the foster and control groups, respectively. Both groups underwent statistical comparative analyses using data from their ECBI assessments. The ECBI has two scales: the Intensity Scale quantifies the severity of child behavioral problems, and the Problem Scale captures the caregiver's perceived difficulties handling each behavior. We conducted a retrospective investigation of the background of the foster parent-child pairs to explore potential causal relationships with behavioral problems. The mean intensity score for the foster group was significantly higher than that for the control group (p = 0.001). The mean problem scores for the foster group and the control group were not significantly different (p = 0.79). In the foster group, the retrospective investigation revealed two children with neurological or neurodevelopmental disorders, 17 with histories of abuse, and 10 with other issues. Intensity scores showed severe behavioral problems among foster children, perhaps caused by neurological disorders, abuse, parental mental health, or economic hardship. Problem scores showed no significant differences between groups. It can therefore be posited that foster parents might exhibit a more lenient parenting style when dealing with children who have a history of abuse by their biological parents.

Self-reported symptoms experienced by intensive care unit patients: a prospective observational multicenter study

PurposeThe purpose of this study is to describe the prevalence, intensity and distress of five symptoms in intensive care unit (ICU) patients and to investigate possible predictive factors associated with symptom intensity.MethodsThis is a prospective cohort study of ICU patients. A symptom questionnaire (i.e., Patient Symptom Survey) was used to describe the prevalence, intensity and distress of pain, thirst, anxiousness, tiredness, and shortness of breath over seven ICU days. Associations between symptom intensity and possible predictive factors were assessed using the general estimating equation (GEE) model.ResultsOut of 603 eligible patients, 353 (Sample 2) were included in the present study. On the first ICU day, 195 patients (Sample 1) reported thirst as the most prevalent symptom (66%), with the highest mean intensity score (6.13, 95% confidence interval (CI) [5.7–6.56]). Thirst was the most prevalent (64%) and most intense (mean score 6.05, 95%CI [5.81–6.3]) symptom during seven days in the ICU. Anxiousness was the most distressful (mean score 5.24, 95%CI [4.32–6.15]) symptom on the first day and during seven days (mean score 5.46, 95%CI [4.95–5.98]). During seven days, analgesic administration and sepsis diagnosis were associated with increased thirst intensity. Older age and being mechanically ventilated were associated with decreased pain intensity, and analgesic administration was associated with increased pain intensity. Family visits and female gender were associated with increased intensity of anxiousness and shortness of breath, respectively.ConclusionsSelf-reporting ICU patients experienced a high and consistent symptom burden across seven days. Certain variables were associated with the degree of symptom intensity, but further research is required to better understand these associations.

Development and Profiling of Affordable and Nutritionally Optimal Pigeon Pea-Based Products for Improved Recipes Diversification in Rural Communities in Tanzania

Pigeon pea is an affordable source of protein, vitamins and minerals. Despite its nutritional importance, the legume has not been adequately utilized for human consumption in Tanzania due to limited recipes. Therefore, the study aimed to develop and profile quantitative attributes of value-added pigeon pea-based noodles (PPBN) and instant porridge (PPIP) flour for diversification of recipes in rural Tanzania communities. The computation on the amount of ingredients, the cost of the product mix and optimization was done using Linear programming, simplex method. PPBN and PPIP were developed and Quantitative Descriptive Analysis (QDA) was done by trained panelists. Data were analysed using R and XLSTAT software. Eight and four samples of PPBN and PPIP respectively were formulated and developed. Major ingredients for PPBN was pigeon pea, wheat and orange flesh sweet potatoes flour and for PPIP was pigeon pea, maize, orange flesh sweet potatoes flour (or pumpkin flour). The protein content for PPBN ranged from 41.0 to 58.2 g. The highest amount of iron content was observed in sample PPBN193 (26.4 mg), followed by PPBN1718 (21.0 mg), PPBN267 (19.3 mg) and PPBN136 (18.3mg). The highest value of zinc and pro-vitamin A was observed in sample PPBN136. For instant porridge the highest value of protein (17.1 g), iron (7.9 g), zinc (5.4 mg) and pro-vitamin A (308.5 µg) was observed in sample PPIPofspr. The highest mean intensity score for colour, aroma and mouthfeel was observed in samples PPBN718, PPBN193 and PPBN136. For sample PPIPofspr, colour (8.7) Aroma (7.7), mouthfeel (7.8), sweetness (7.1) and viscosity (7.9) had the highest mean intensity score. There was a significant increase in protein, iron, zinc and pro-vitamin A with an increase in the amount of pigeon pea and/or orange flesh sweet potato flour. Sample PPBN718, PPBN193, PPBN136 and PPIPofspr had better nutritional and sensory qualities that make

Moral Distress and Its Relating Factors Among Pediatric Emergency Department Nurses: A Cross-Sectional Study.

Emergency services are patient circulation units that require chaos, trauma, and high tension. It was aimed to determine the moral distress levels of pediatric nurses in pediatric emergency and emergency departments and relevant factors. This study is a descriptive and cross-sectional study. It consists of 255 nurses with their data. The Participant Information Form and the Moral Distress Scale-Revised for Pediatric Nurses (MDS-R) were used to collect data. In the study, the mean score of MDS-R frequency was found to be 27.36 ± 13.16, the mean score of MDS-R intensity to be 37.65 ± 17.53, and the mean total score of MDS-R to be 58.96 ± 39.40. It was determined that 93.7% of the nurses received training on moral distress, and education level was effective on moral distress levels of the nurses. The nurses working in the pediatric emergency service had higher moral distress levels than the nurses serving pediatric patients in the emergency department ( P(total MDS-R) = 0.02, P(frequency of MDS-R) = 0.008). Job satisfaction ( P(total MDS-R) = 0.003, P(frequency of MDS-R) < 0.001, P(intensity of MDS-R) < 0.001) and frequency of thinking about changing working unit ( P(frequency of MDS-R) = 0.02, P(intensity of MDS-R) = 0.01) were found to be effective on the level of moral distress. It was determined that the type of emergency service, the working time in the emergency service, and the level of job satisfaction significantly affected the total moral distress scores of the nurses ( P < 0.001, R2 = 0.09). It was found in the study that nurses had low levels of moral distress; however, many factors relevant to working conditions were associated with moral distress. The pediatric emergency service nurses were determined to experience a higher moral distress compared with the emergency department nurses serving pediatric patients.

A multicenter, randomized, placebo-controlled study to select the minimum effective dose of estetrol in postmenopausal participants (E4Relief): part 2-vaginal cytology, genitourinary syndrome of menopause, and health-related quality of life.

A phase 2 study showed that 15 mg estetrol (E4) alleviates vasomotor symptoms (VMS). Here, we present the effects of E4 15 mg on vaginal cytology, genitourinary syndrome of menopause, and health-related quality of life. In a double-blind, placebo-controlled study, postmenopausal participants (n = 257, 40-65 y) were randomized to receive E4 2.5, 5, 10, or 15 mg or placebo once daily for 12 weeks. Outcomes were the vaginal maturation index and maturation value, genitourinary syndrome of menopause score, and the Menopause Rating Scale to assess health-related quality of life. We focused on E4 15 mg, the dose studied in ongoing phase 3 trials, and tested its effect versus placebo at 12 weeks using analysis of covariance. Least square (LS) mean percentages of parabasal and intermediate cells decreased, whereas superficial cells increased across E4 doses; for E4 15 mg, the respective changes were -10.81% (P = 0.0017), -20.96% (P = 0.0037), and +34.17% (P < 0.0001). E4 15 mg decreased LS mean intensity score for vaginal dryness and dyspareunia (-0.40, P = 0.03, and -0.47, P = 0.0006, respectively); symptom reporting decreased by 41% and 50%, respectively, and shifted to milder intensity categories. The overall Menopause Rating Scale score decreased with E4 15 mg (LS mean, -3.1; P = 0.069) and across doses was associated with a decreasing frequency and severity of VMS (r = 0.34 and r = 0.31, P < 0.001). E4 demonstrated estrogenic effects in the vagina and decreased signs of atrophy. E4 15 mg is a promising treatment option also for important menopausal symptoms other than VMS.

Sensory properties, preference mapping and shelf life stability of linear programmed quelea meat based instant complementary food for children aged 6–23 months in Tanzania

Linear programming has been reported to be a good technique that can be used to develop and optimize complementary foods to curb children's malnutrition. Despite some studies using it to develop and assess the nutritional quality of linear programmed instant complementary foods based on high proteinous red-billed quelea bird meat, information on the sensory and shelf life stability of these foods is limited in the country. The objective of this study was to develop and assess the sensory properties, preference mapping and shelf life of the developed and optimized quale birds meat-based complementary flour and porridge. Four formulations; control containing birds meat only, banana mixed with meat (Banana_meat), potatoes mixed with meat (potatoes_meat) and rice mixed with meat (rice_meat) were developed by mixing with other ingredients and extruded separately using a barrel extrude to get flour. The extruded flours were assessed for shelf life and also used to develop porridge samples for sensory properties, consumer acceptance and preference mapping analyses using standard methods. There were significant (p < 0.05) differences in mean intensity scores between the formulation with potatoes mixed with meat samples having higher colour (7.5 ± 1.5), aroma (7.3 ± 1.6), viscosity (5.3 ± 3.0) and smoothness (7.65.3 ± 2.5) values than other samples with respective lower values of 4.4 ± 2.1–6.5 ± 1.5.2.6 ± 0.6–6.4 ± 2.4), 4.8 ± 0.2–5.2 ± 1.8 and 2.7 ± 0.6–6.3 ± 2.3. Rice mixed with meat sample had significantly highest whiteness (4.5 ± 1.5) and sweetness (7.5 ± 1.9) intensities scores while the control meat only samples had significantly highest oiliness intensity scores (5.0 ± 1.4) compared to other samples. Moreover, the potatoes mixed with meat sample was the most acceptable formulation (7.7 ± 0.3) compared to other samples with aroma, smoothness sweetness, colour and viscosity attributes being the main drivers for consumer liking of complementary porridge samples. The shelf life study revealed that the overall acceptability scores of complementary flour samples decreased progressively with storage days with the longest predicted shelf life of 140 days observed in rice mixed with meat sample followed by potatoes mixed with meat with 48 days and the shortest shelf life of 23.7 days in control samples. This suggests that quelea bird meat could be combined with cereal, tubers, and other minor ingredients like vegetables, optimized using the linear programming technique and extruded into complementary instant flour and porridge for children between the ages of 6 and 23 months with long shelf lives, appealing sensory properties, and consumer acceptance, respectively. Hence, it is advised to use the method and consume the developed formulations. • Linear programming resulted in complementary foods with appealing sensory properties and consumer acceptability. • The mean intensity score of sensory attributes differed significantly (p < 0.05) between the linear programmed complementary porridge samples. • Control (meat only) and potatoes_meat samples were the least and most acceptable formulations respectively. • Aroma, sweetness, smoothness, and colour were the main attributes driving consumers' acceptance of the porridge samples. • Rice_ meat and control samples had the longest and shortest shelf lives of 140 and 23.7 days respectively.

A Model for Work Intensity in a Pediatric Training Program.

The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to monitor scheduling, work intensity, and work compression. We aimed to create a model for assessing intern work intensity by examining patient and clinical factors in our electronic health systems using multiple linear regression. We identified measurable factors that may contribute to resident work intensity within our electronic health systems. In the spring of 2021, we surveyed interns on pediatric hospital medicine rotations each weekday over 5 blocks to rank their daily work intensity on a scale from -100 (bored) to +100 (exasperated). We queried our electronic systems to identify patient care activities completed by study participants on days they were surveyed. We used multiple linear regression to identify factors that correlate with subjective scores of work intensity. Nineteen unique interns provided 102 survey responses (28.3% response rate) during the study period. The mean work intensity score was 9.82 (SD=44.27). We identified 19 candidate variables for the regression model. The most significantly associated variables from our univariate regression model were text messages (β=0.432, P<.0009, R2=0.105), orders entered (β=0.207, P<.0002, R2=0.128), and consults ordered (β=0.268, P=.022, R2=0.053). Stepwise regression produced a reduced model (R2=0.247) including text messages (β=0.379, P=.002), patient transfers (β=-1.405, P=.15), orders entered (β=0.186, P<.001), and national patients (β=-0.873, P=.035). Our study demonstrates that data extracted from electronic systems can be used to estimate resident work intensity.

Real-life experience of a lidocaine/tetracaine self-occluding topical anesthetic for dermatological procedures.

Pliaglis® is a self-occluding topical anesthetic containing a eutectic mixture of 7% lidocaine and 7% tetracaine, with proven efficacy and safety in several trials. To evaluate the effectiveness and safety of Pliaglis® for different dermatological procedures in real-life clinical practice. This retrospective, multicenter study included 35 patients treated with Pliaglis® prior to five dermatological procedures (pulsed dyed laser, picosecond laser, non-ablative fractional laser, radiofrequency microneedling, and photodynamic therapy). The primary endpoint was to assess the pain during the procedure with a visual analogue score (VAS) from 0 (no pain) to 10 (most severe pain). Secondary endpoints were the global effectiveness and tolerability (from 0=very low to 10=excellent), and the adverse events (AEs) after Pliaglis® removal, classified according to intensity (1-3). The median and mean pain VAS reported by patients was 2 (range 0-9) and 2.9 (±2.3), respectively. More than 65% of the patients had a VAS score ≤3. The effectiveness reported by investigators was "very good" (median 8 [range 2-10], mean 7.5 [±1.9]), which was strongly correlated with the pain VAS reported by patients (Spearman coefficient=- 0.9; p<0.001). Forty-five percent of patients reported AEs and they were transient and mostly mild, with a mean intensity score of 1.5 (range 1-3). Tolerability of Pliaglis® was reported by investigators as "excellent" (median 10 [range 1-10], mean 9 [±1.8]). Pliaglis® is an effective topical anesthetic for several dermatological procedures, with an excellent safety and tolerability profile.

Bitter and sweet taste perception: relationships to self-reported oral hygiene habits and oral health status in a survey of Australian adults

BackgroundOral health, an essential part of general health and well-being, is influenced by multiple factors, including oral hygiene habits and dietary factors. Dietary preferences are influenced by variation in taste perceptions and threshold tasting. Polymorphisms in specific genes for sweet and bitter taste receptors and bitter taste perception have been associated with dental caries. However, taste is complex with multiple receptors, each with multiple potential polymorphisms contributing to taste perception as well as social, cultural, and environmental influences. Additionally, these association studies have been conducted in restricted cohorts (e.g., children only). Furthermore, outcomes have been limited to dental caries and studies between taste perception and oral hygiene habits have not been completed.MethodsA cross-sectional online survey was conducted to investigate the relationships between bitter and sweet taste perception (liking and intensity of index food items), self-reported oral hygiene habits and oral health (n = 518).ResultsHigher mean intensity scores for bitter (16–21%) and sweet (< 5%-60%) were seen with higher frequencies of oral hygiene habits (brushing, use of mouthwash, chewing gum and tongue cleaning). Lower mean bitter liking scores (18–21%) were seen with higher frequencies of oral hygiene habits (brushing, mouthwash use, floss use and chewing gum). Sweet liking scores varied by reported frequency of mouthwash use and flossing only, with mixed patterns of variance. Mean bitter and sweet intensity perception scores varied with the number of dental caries ((13–20% higher in those with 3 or more caries, compared to none).ConclusionsWhile there were numerous relationships identified between liking and perception of sweet and bitter and oral health outcomes, the magnitude and direction of associations varied by outcome. The direction of the associations cannot be inferred due to the cross-sectional nature of the study. The demonstrated relationships justify further future investigations, which could help better understand if taste liking and perception is impacted by oral hygiene and health, or vice versa. This could be important in understanding the causation and progression of oral health diseases or the development of novel therapeutics for oral health.

Reduction of extrinsic tooth stain by a toothpaste containing 10% high cleaning silica, 0.5% sodium phytate and 0.5% sodium pyrophosphate: an 8-week randomised clinical trial

ObjectiveTo assess the effects for controlling extrinsic tooth stain of a whitening toothpaste containing 10% high cleaning silica, 0.5% sodium phytate and 0.5% sodium pyrophosphate, in comparison with a negative control toothpaste.MethodsA total of 86 adults who met with the inclusion and exclusion criteria were invited to take part in the study. They were distributed into test and control groups randomly. At baseline, 4 weeks and 8 weeks, the same examiner provided the clinical examinations, including evaluations of oral soft and hard tissues and measurements of tooth stain of the anterior teeth using the Lobene Stain Index. Adverse events and any changes in general health conditions of the patients were monitored.ResultsWhen the study was completed, comparisons between patients in test and control groups yielded statistically significant differences in Lobene stain adjusted mean area score [0.83 (0.05) vs. 1.13 (0.05)], Lobene stain adjusted mean intensity score [0.99 (0.06) vs. 1.32 (0.06)] and Lobene stain adjusted mean composite score [1.45 (0.13) vs. 2.50 (0.13)] (All, P < 0.001). Patients in the test group exhibited reductions of 26.55%, 25% and 42%, respectively in Lobene stain area, intensity and composite scores, relative to patients in the control group. Comparisons within groups showed that all three Lobene scores at 8 weeks in both groups were lower than those at baseline (All, P < 0.001).ConclusionThis study demonstrates that 8-week use of a toothpaste containing 10% high cleaning silica, 0.5% sodium phytate and 0.5% sodium pyrophosphate can effectively reduce extrinsic tooth stain.Trial registration NCT04238429 (before enrollment of the first participant). Data register: March 4, 2018.

Frequency and Severity of Phantom Limb Pain in Veterans with Major Upper Limb Amputation: Results of a National Survey.

To describe the frequency and severity of phantom limb pain (PLP) in veterans with major upper limb amputation and determine the association between PLP and person, amputation, and prosthesis characteristics. Cross-sectional design. National survey of veterans living in the community. U.S. military veterans (N = 776) with major upper limb amputations. Frequency and intensity of PLP, person characteristics such as age and gender, amputation characteristics such as level and etiology, and prosthesis characteristics such as type and intensity of prosthesis use. Respondents were 97% male with a mean age of 63 years and a mean time since amputation of 31 years. The most common amputation level was transradial (36%) and 62% reported accident as the amputation etiology. 73% of amputees reported PLP with a mean intensity score of 4.2 (standard deviation 3.4). PLP frequency in the daily to always category was reported in 42% of amputees. Weekly and more frequent residual limb pain was associated with having any PLP. Amputation at the shoulder (odds ratio [OR] 3.78 [1.93, 7.39]), amputation at the transhumeral level (OR 1.76 [1.10,2.81]), and amputation due to cancer (OR 5.33 [1.15, 24.81]) were also associated with any PLP. Moderate (β = 1.34, P = < .001) and severe (β = 3.31, P < .001) residual limb pain intensity was associated with higher PLP intensity among those with pain. Amputation at the shoulder level was associated with a 1.5 points higher average pain intensity score (P < .001) compared to the transradial level. Multivariable models failed to show an association between PLP prevalence and amputation of the dominant limb (P = .08) and PLP was not associated with intensity of daily prosthesis use in bivariate analyses. This study of a large cohort of veterans with major upper limb amputation highlights the long-term persistence of moderate frequency and intensity PLP.

Multicentre, non-interventional study of the efficacy and tolerability of linaclotide in the treatment of irritable bowel syndrome with constipation in primary, secondary and tertiary centres: the Alpine study

ObjectivesWe evaluated the effectiveness and tolerability of linaclotide, a minimally absorbed guanylate cyclase-C agonist, in patients with irritable bowel syndrome with constipation (IBS-C) in routine clinical practice.SettingA multicentre, non-interventional study...

Increased Expression and Activation of FAK in Small-Cell Lung Cancer Compared to Non-Small-Cell Lung Cancer.

Introduction: Focal adhesion kinase (FAK) plays a crucial role in cancer development and progression. FAK is overexpressed and/or activated and associated with poor prognosis in various malignancies. However, in lung cancer, activated FAK expression and its prognostic value are unknown. Methods: FAK and activated FAK (phospho-FAK Y397) expressions were analyzed by multiplex immunofluorescence staining in formalin-fixed paraffin-embedded tissues from 95 non-small-cell lung cancer (NSCLC) and 105 small-cell lung cancer (SCLC) patients, and 37 healthy donors. The FAK staining score was defined as the percentage (%) of FAK-stained tumor area multiplied by (×) FAK mean intensity and phospho-FAK staining score as the (% of phospho-FAK-stained area of low intensity × 1) + (% of phospho-FAK-stained area of medium intensity × 2) + (% of the phospho-FAK-stained area of high intensity × 3). FAK and phospho-FAK staining scores were compared between normal, NSCLC, and SCLC tissues. They were also tested for correlations with patient characteristics and clinical outcomes. Results: The median follow-up time after the first treatment was 42.5 months and 6.4 months for NSCLC and SCLC patients, respectively. FAK and phospho-FAK staining scores were significantly higher in lung cancer than in normal lung and significantly higher in SCLC compared to NSCLC tissues (p < 0.01). Moreover, the ratio between phospho-FAK and FAK staining scores was significantly higher in SCLC than in NSCLC tissues (p < 0.01). However, FAK and activated FAK expression in lung cancer did not correlate with recurrence-free and overall survival in NSCLC and SCLC patients. Conclusions: Total FAK and activated FAK expressions are significantly higher in lung cancer than in normal lung, and significantly higher in SCLC compared to NSCLC, but are not prognostic biomarkers in this study.

Healthcare Utilization is High in Adult Patients Relapsing after Allogeneic Hematopoietic Cell Transplantation.

Disease relapse is the leading cause of death for patients with acute leukemia (AL) and myelodysplastic syndrome (MDS) who undergo allogeneic hematopoietic cell transplantation (HCT). Relapse post-HCT is associated with poor prognosis; however, inpatient healthcare utilization of this population is unknown. Here we describe survival, intensity of healthcare utilization, and characteristics associated with high resource use at the end of life (EOL). Adult patients with AL/MDS who underwent HCT at a large regional referral center with subsequent relapse between 2005 and 2015 were included in this retrospective study. We compared the distribution of demographic and clinical characteristics of patients as well as healthcare utilization over 2 years postrelapse and at EOL by postrelapse disease-directed therapeutic interventions. We created a composite score for EOL healthcare utilization intensity by summing the presence of any of the following criteria: death in the hospital, use of chemotherapy, emergency department, hospitalization, intensive care unit, intubation, cardiopulmonary resuscitation, or hemodialysis in the last month of life. Higher scores indicate more intense healthcare use at EOL. Multivariable linear regression analysis was used to determine variables (demographic characteristics, postrelapse treatment group, advance directives documentation, palliative care referral, time to relapse) associated with EOL healthcare utilization intensity. One hundred fifty-four patients were included; median age at relapse was 56 years (interquartile range [IQR], 39 to 63), 55% were men, 79% had AL, and median time from HCT to relapse was 6 months (IQR, 3 to 10). After relapse, 28% received supportive care only, 50% received chemotherapy only, and 22% received chemotherapy plus cell therapy (either donor lymphocyte infusion, second HCT, or donor lymphocyte infusion plus second HCT). With the exception of time until relapse and Karnofsky Performance Status, baseline characteristics (gender, age, race, graft-versus-host disease, year of treatment) did not significantly differ by postrelapse treatment group. One hundred thirty-six patients (88%) died within 2 years of relapse; survival differed significantly by postrelapse treatment group, with those receiving disease-directed treatment showing lower risk of death. Healthcare use in AL/MDS patients after post-HCT relapse was high overall, with 44% visiting the emergency department at least once (22% at least 2 times), 93% hospitalized (55% at least 2 times, 16% at least 5 times), and 38% using the intensive care unit (median length of stay 5, days; IQR, 3 to 10). Use was high even among those receiving only supportive care. For those patients who died, the mean intensity score for EOL healthcare use was 1.8 (standard deviation, 1.8). Most patients (70%) had a marker of high-intensity healthcare utilization at the EOL or died in hospital. In multivariable analysis, an increase in age (estimate -.03 (95% CI, -.06 to -.003) and having AL versus MDS were significantly associated with a decreased EOL healthcare intensity score; no other variables were associated with intensity of EOL healthcare use. Healthcare utilization after post-HCT relapse is associated with receipt of disease-directed therapy but remains high across all groups despite known poor prognosis. Interventions are needed to minimize nonbeneficial treatments and promote goal-concordant EOL care in this seriously ill patient population.

Psoriasis and skin pain: real-life effectiveness of calcipotriol plus betamethasone dipropionate in aerosol foam formulation.

Although 40% of psoriasis patients reported skin pain, this symptom is often underestimated. A new formula of calcipotriol plus betamethasone dipropionate (Cal/BD) has been recently approved for psoriasis treatment. Therefore, we aimed to evaluate the efficacy of Cal/BD aerosol foam on skin pain of patients with plaque psoriasis. A real-life 4-week prospective, open study on Cal/BD aerosol foam (not compared to vehicle or emollient cream) was performed in adult psoriasis patients attending three Dermatology units located in Campania region, Italy, between March and October 2018. Inclusion criteria were a history of skin pain over the last week and psoriatic involvement of the palmar area. Before (t0) and after a course of once daily application of Cal/BD aerosol foam for 4 weeks (t1), the following items were evaluated: Psoriasis Area and Severity Index (PASI), Physician Global Assessment (PGA) index of target plaque on palmar region, subjective skin pain features through Pain Qualities Assessment Scale questionnaire and skin pain threshold measured by pressure digital algometer at palmar psoriatic plaques. Seventy-five patients (43 male, mean age of 43.2 years) were enrolled. After 4 weeks of therapy with Cal/BD aerosol foam, a significant improvement in both PASI (mean: 6.5 ± 2.1 at t0 vs. 2.3 ± 1.6 at t1) and palmar plaques PGA (mean: 3.6 at t0 vs. 1.7 at t1) was observed (P < 0.001). The mean intensity score of skin pain decreased from 7.6 to 1.3 (P < 0.001); among skin pain qualities, intense, sensible, aching and unpleasant showed the highest rate of reduction (t0-t1: 6.3, 6.3, 6.1 and 5.8, respectively). Pain threshold of palmar skin lesions increased at t1. Our real-life study suggested that Cal/BD aerosol foam may represent a valid topical anti-psoriatic treatment, not only improving skin lesions, but also relieving cutaneous pain, thus contributing to ameliorate patients' quality of life.

Effect of Structured Nursing Education Programs in Prevention of Admitted Patients’ Phlebitis

BackgroundIn the hospitalization wards where phlebitis has an incidence and accounts for the most serious complications of environmental fluid therapy.ObjectivesThis study aimed to determine the effect of structured nursing education programs in prevention of admitted patients’ phlebitis.MethodsIn this quasi-experimental study in which the post-test design with control and intervention group was used, 400 patients were randomly divided into two groups of 200. Data were collected by questionnaire including demographic questions and Jackson’s Visual Infusion Phlebitis (VIP) scale was used to evaluate the complications of peripheral vascular catheter (phlebitis). The findings were analyzed by SPSS 25 software.ResultsThe mean score of phlebitis incidence in the hospital wards, whose nurses that had undergone such trainings, was significantly decreased (p<0.001) compared to the mean score of phlebitis occurrence in the wards, whose nurses represented the control group and had taken part in no such training programs. Moreover, the mean score of intensity of Phlebitis complications in the wards, whose nurses that were members of the experimental group, significantly decreased (p<0.001) compared to the mean score of phlebitis intensity among patients of the wards whose nurses represented the control group.ConclusionThe findings of this study testify that holding a structured nursing education programs will be effective in checking the incidence of phlebitis and its complexity among the patients hospitalized in Imam Khomeini Hospital in Mahabad.

Disruptive Behaviors across Different Disorders: Evaluation of a Clinical Sample Using the Eyberg Child Behavior Inventory.

The study reports the prevalence of disruptive behaviors in a help-seeking sample of young children across a diverse range of clinical diagnoses (based on ICD-10). The Eyberg Child Behavior Inventory (ECBI), a parent rating scale of disruptive behaviors, was completed on 310 children (2-11 years) at three child and adolescent psychiatry clinics in three German states (Bavaria, Hesse, Lower Saxony); the majority of children were outpatients. Mean intensity scores of disruptive behaviors differed significantly by diagnostic group, with the lowest ratings within a community sample, and increasingly higher scores in children with a diagnosis from the internalizing spectrum, those with pervasive developmental disorders, and finally, those with externalizing disorders (e. g. hyperkinetic disorder, conduct disorders). Seventy percent of the clinical sample, compared to only 17 % of the community sample, exceeded the normative cut-off score of 111, indicating that disruptive behaviors are common in young German children seeking help for different mental health problems. These findings support the Research Domain Criteria approach by showing that disruptive behaviors cross our current diagnostic labels and may need to be assessed and conceptualized in treatment planning, even in children without a primary diagnosis from the externalizing spectrum.

A randomized clinical trial to evaluate the stain removal efficacy of a sodium phytate dentifrice formulation.

ObjectivesPhytate is an organic, cyclic polyphosphate analogous to linear condensed polyphosphates used as stain removal agents. This study investigated stain removal efficacy of an experimental sodium phytate‐containing dentifrice compared to a reference dentifrice.MethodsAn experimental, moderate abrasivity (relative dentine abrasivity [RDA] ∼130) antisensitivity fluoride dentifrice containing sodium phytate (0.85% w/w as the hexasodium salt) (n = 111) was compared to a reference, marketed, low‐abrasivity (RDA ∼ 43), anti‐sensitivity fluoride dentifrice (n = 113), both containing 1150 ppm fluoride as sodium fluoride. Primary efficacy variables were between‐treatment differences in extrinsic dental stain of anterior teeth after 6 and 12 weeks' twice‐daily use, using Lobene stain index (MacPherson modification, MLSI) mean area (A) and intensity (I) scores. Comparisons included whole‐tooth and hard‐to‐reach areas (gingival, interproximal, body of lingual).ResultsAt both 6‐ and 12‐week timepoints, MLSI (A × I) scores for total area and hard‐to‐reach areas for the experimental dentifrice were statistically significantly lower than baseline (P < .0001 for all). This was demonstrated for the reference dentifrice at 6 weeks only, for total, interproximal (P < .0001 for both), and body of lingual (P = .0395) scores. Compared with the reference, the experimental dentifrice had statistically significantly lower MLSI scores at both 6 and 12 weeks for all outcome variables including both total MLSI (A × I) and hard‐to reach areas (P < .0001 in all cases). Products were generally well‐tolerated.ConclusionsDifferences between treatments were considered clinically differentiable. Sodium phytate may therefore be a suitable additive ingredient to improve tooth stain control performance within an otherwise conventional dentifrice formulation.Clinical SignificanceFollowing 6 and 12 weeks brushing, clinically differentiable differences were shown in stain index scores with an experimental dentifrice containing sodium phytate compared to a reference dentifrice without sodium phytate. Sodium phytate may therefore be a suitable additive ingredient to improve tooth stain control performance within an otherwise conventional dentifrice formulation.