Practical Scale Research Articles

Omnichannel product selection and shelf space planning optimization

As the retail industry is evolving toward an omnichannel paradigm, we study a product selection and shelf space planning problem faced by omnichannel retailers. We aim to maximize aggregated profits across channels by determining the optimal product offerings for the offline and online channels while optimizing the allocation of limited shelf space to these products in brick-and-mortar stores. Furthermore, the showroom effect of physical stores on online sales is also taken into account. We propose a corresponding model that jointly optimizes these decisions. To solve the nonlinear nonconvex model of practical scale, we first reformulate it into a mixed integer quadratic programming by exploring the structural properties. Next, we use the reformulation linearization technique to further improve the computational speed. Our numerical studies validate the efficiency of the proposed solution approach. In addition, we derive some managerial insights, including that retailers should adopt joint optimization and consider how the involved effects and parameters may influence their profits and decisions.

Intercultural Sensitivity as a Factor in Perceived Culturally Responsive Teaching of Teachers in Northern Thailand

This study examined the relationship of teachers’ intercultural sensitivity to their in-class culturally responsive teaching. A total of 168 teachers with teaching experience in multicultural classrooms in northern Thailand answered a questionnaire with two psychological scales: the intercultural sensitivity scale and the culturally responsive teaching practice scale. To supplement quantitative findings, 19 teachers from the total number of participants were included in the semi-instructed interview. By conducting factor analysis, intercultural sensitivity perceived by teachers with multicultural facilitation experience in northern Thailand was extracted into three components: interaction engagement, interaction confidence, and respect for cultural differences. The results from structural equation modelling indicate that teachers’ intercultural sensitivity significantly affects teachers’ perceived culturally responsive teaching practices with the largest coefficient size. This study also discussed the associations between teachers’ culturally responsive teaching practices and other significant background factors based on the local context, including school size, non-local student enrolment frequency, overseas travel experience, and the existence of intercultural colleagues.

Perceived progress toward scale of 14 maternal, newborn, child health, and nutrition (MNCHN) assets at subnational level in Burkina Faso, Ethiopia, India, Kenya, and Nigeria.

Inequitable coverage of evidence-based MNCHN interventions is particularly pronounced in low and middle income countries where access and delivery of these interventions can vary dramatically at the subnational level. We conducted health system assessments in nine subnational geographies in five countries (Burkina Faso, Ethiopia, India, Kenya and Nigeria) to explore progress toward scale of 14 evidence-based MNCHN interventions (iron-folic acid, oxytocin, magnesium sulfate, misoprostol; 7.1% chlorhexidine for umbilical cord care, neonatal resuscitation, kangaroo mother care, community regimen for the treatment of possible severe bacterial infection; amoxicillin dispersible tablets, multiple micronutrient supplements, balanced energy protein supplementation, early and exclusive breastfeeding, feeding of small and sick newborns, and management of severe and moderate acute malnutrition in children less than five years old). Between March and October 2021, we conducted key informant interviews with a purposive sample of 275 healthcare providers and 94 district health management (DHMT) staff to better understand bottlenecks, facilitators and uptake of the interventions across varied subnational settings. Across all interventions and geographies, providers and DHMT staff perceived lack of robust HMIS data as the most significant barrier to scale followed by weak facility infrastructure. DHMT staff viewed limited budget allocation and training as a much larger barrier than healthcare providers, most likely given their purview as subnational managers. Healthcare providers were focused on supply chain and staffing, which affect workflows and service provision. Understanding provider and health facility management views of why interventions do or do not advance towards effective coverage can assist in creating enabling environments for the scale of best practices. These types of data are most helpful when collected at the subnational level, which allows for comparisons both within and between countries to show health disparities. Importantly, this strategic data collection can provide a starting point for improvement efforts to address existing health system gaps.

The Relationship Between Principals’ Leadership Practices and Students’ Learning Outcomes From a Distributed Perspective

There is little empirical evidence that convinces the effectiveness of distributed leadership in contemporary educational research. Thus, many distinguished scholars suggest its’ statistical examination. Considering this need, the primary purpose of this study was to investigate the effects of principals’ distributed leadership practices on students’ learning outcomes at Technical and Vocational Education Training schools in Eritrea. The study was conducted based on quantitative design and applied structural equation modelling. A sample of six hundred and three students was employed. The researcher developed the structural equation model to test a model that hypothesized the relationship between the major variables using path analysis. The study results demonstrate that the principals’ distributed leadership practice has a direct and significant (.883, p<.001) effect on students’ learning outcomes keeping other things constant. The strongest predictor of students’ learning outcomes was capacity building, given it has the largest path coefficient (β=.346). Moreover, findings show gender disparity among the respondents and in terms of turnout rate; nevertheless, it was not statistically significant (p<.001). One of the study’s contributions is that it developed and assessed the validity of the principals’ distributed leadership practice scale for Eritrea’s TVET schools through CFA model. The study offered basic evidence that distributed type of leadership is a significant predictor of learning outcomes by exploring six factors of leadership practices, which shows a promising area for practice and future studies.

Development and implementation of a high-fidelity simulation training course for medical and nursing collaboration based on the Fink integrated course design model.

The purpose of this study is to examine the design and implementation of a high-fidelity simulation training course for medical and nursing collaboration, based on the Fink integrated course design model. Additionally, the study aims to validate the teaching effectiveness of the course. Previous empirical studies have highlighted the effectiveness of collaborative healthcare education in institutional teaching and hospital training. However, the development of healthcare collaborative education in China has been slow to develop in China. In recent years, Chinese nursing educators and researchers have shown interest in utilizing high-fidelity simulators for healthcare collaborative education. These simulators help address the limitations of traditional nursing teaching and healthcare separation simulation. Nevertheless, a standardized simulation interprofessional education curriculum is still lacking. Therefore, nursing educators need to develop a standardized high-fidelity simulation training curriculum for healthcare collaboration, guided by established science curriculum development theories. A high-fidelity simulation training course on healthcare collaboration was designed based on the Fink integrated curriculum design model. The course was taught to 14 nursing students and 8 clinical medicine students from March to July 2022. To comprehensively evaluate the effectiveness of the healthcare collaboration high-fidelity simulation training course, several assessment tools were used. These included course grades, satisfaction and self-confidence scales, simulation teaching practice scales, healthcare collaboration attitude scales, critical thinking skills scales, and semi-structured interviews. After the course was implemented, students demonstrated high overall scores (79.19 ± 5.12) and reported high satisfaction ratings (4.44 ± 0.37). They also exhibited increased self-confidence (4.16 ± 0.33). Additionally, students evaluated all four dimensions of the course teaching practice scale positively. Furthermore, the study demonstrated significant improvements in various aspects, such as attitudes toward medical and nursing collaboration (t = -7.135, P < 0.01), shared education and teamwork (t = -3.247, P = 0.002), job autonomy for nurses (t = -1.782, P = 0.000), and reduced physician dominance (t = -6.768, P = 0.000). The critical thinking skills of the students showed significant improvement, with higher scores in truth-seeking (t = -3.052, P = 0.004), analytical ability (t = -2.561, P = 0.014), systematic ability (t = -3.491, P = 0.001), self-confidence in critical thinking (t = -4.024, P = 0.000), and curiosity (t = -5.318, P = 0.000) compared to their scores before the course (all P < 0.05). The interviews showed that the course's student-centered approach enabled active learning. Students suggested enhancing teaching cases and allocating more time for reflection and summarization. The study successfully designed a high-fidelity simulation training course for healthcare collaboration by utilizing the Fink integrated curriculum design model. The findings provide valuable insights for the development of standardized curricula and healthcare collaboration education in China. Moreover, the course adheres to best practice principles, fostering improved attitudes toward healthcare collaboration and enhancing students' healthcare collaboration and clinical thinking skills.

The Glasgow Coma Scale: 50-year anniversary.

In 1974, Sir Graham Teasdale and Bryan Jennett wrote the "Assessment of coma and impaired consciousness, A practical scale," which has become one of the most influential papers in the history of traumatic brain injury, with more than 10,000 citations as of January 2024. Today, it is one of the most widely used tools in emergency departments, providing a reliable general overview of the patient's consciousness status.

Predictors of Knowledge, Attitudes and Practice Regarding Heat Waves: An Exploratory Cross-Sectional Study in Greece

Predictors of Knowledge, Attitudes and Practice Regarding Heat Waves: An Exploratory Cross-Sectional Study in Greece

Development and validation of the Trans- and Nonbinary-Affirming Parental Practices (TAPP) measure.

Parental support is instrumental in protecting the mental health of trans and nonbinary youth (TNB). Yet minimal measures exist that measure parental support, and current measures typically measure parental attitudes or general perceptions of supportiveness rather than measuring specific TNB-affirming behaviors. This study aimed to fill this gap by developing and validating the Trans- and Nonbinary-Affirming Parental Practices scale. The scale items were developed based on existing psychological literature on TNB-affirming parenting behaviors as well as adapting existing measures. The sample consisted of 570 parents or caregivers of TNB youth ages 5-27 (M = 15). The vast majority of participants were White (90%) and cisgender women (92%). The sample was randomly split to conduct both exploratory factor analysis and confirmatory factor analysis. Factor analysis found good fit for a four-factor structure with 14 items. Each subscale represented a type of TNB-affirming parental behavior: communicating support, affirming language, advocating for their TNB child, and seeking affirming resources. The measure demonstrated invariance with both heterosexual participants and participants with minoritized sexual identities and demonstrated convergent and discriminant validity. The Trans- and Nonbinary-Affirming Parental Practices measure can be useful in intervention research aimed at increasing TNB-affirming behaviors among parents and caregivers of TNB youth. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Neonatal Intensive Care Nurses' Knowledge of Neonatal Pain Assessment in Private and Public Hospitals in Jeddah, Saudi Arabia: A Cross-Sectional Study.

Neonatal Intensive Care Unit (NICU) nurses with adequate neonatal pain assessment knowledge are crucial in effective neonatal pain management. There is limited research that assessed the knowledge of NICU nurses in Saudi Arabia regarding neonatal pain assessment. To assess the knowledge of NICU nurses in Saudi Arabia regarding neonatal pain assessment. A cross-sectional design using an online survey was conducted to capture information regarding neonatal pain assessment knowledge from 125 NICU nurses in Saudi Arabia. Knowledge of pain assessment was assessed using a modified version of the knowledge, attitudes, and practice scale. Knowledge scores were classified as high, average, and low. Participants' knowledge regarding neonatal pain assessment was inadequate (Mean = 63/100). The majority of the participants had a low to average level of knowledge (n= 97, 78%). A significant proportion of NICU nurses had inadequate knowledge regarding neonatal pain assessment, which can be improved. Educational interventions are needed to boost these nurses' knowledge regarding neonatal pain assessment.

Association Between Betrayal Trauma and the PAI Traumatic Stress Scale

ABSTRACT The Personality Assessment Inventory (PAI) is among the most commonly used broadband inventories of psychological functioning. For the purposes of assessing trauma specifically, the most relevant aspect of the PAI is the Traumatic Stress subscale of the Anxiety-Related Disorders scale (ARD-T), which measures the degree to which a person feels wounded by something in their past. Research suggests that ARD-T is associated with exposure to a variety of different traumatic stressors. However, there is little research on the degree to which traumatic stressors that entail a component of interpersonal betrayal (i.e. betrayal trauma) are associated with higher scores on ARD-T relative to other stressors. In this study, we evaluated the relative associations between traumas with varying degrees of betrayal and scores on ARD-T in a secondary analysis of two non-clinical samples (college sample N = 494; crowdsourced sample N = 364) using a Bayesian approach to multiple regression. In both samples, traumas with both high and medium (but not low) degrees of betrayal were associated with elevated ARD-T scores. Findings suggest that ARD-T scores are associated with interpersonal trauma regardless of betrayal, which has implications for interpretation of the ARD-T scale in practice.

Do nursing students' attitudes to clinical practice training affect the levels of vocational motivation?

It is extremely important for nursing students to be professionally motivated to train qualified future professional nurses. Students' vocational motivation is affected by their experiences in clinical and academic learning environments. The aim of this study was to investigate the correlation between the vocational motivation levels of nursing students and their attitudes toward clinical practice. 292 nursing students participated in the cross-sectional, descriptive study. The Student Information Form, Nursing Students' Attitudes Towards Clinical Practices Scale, Motivation Sources and Problems Scale (MSPS) were used to gather the data. The average score for students' attitudes toward clinical practice was 107.08±18.13, while the total score for MSPS stood at 3.80±0.63. A positive correlation was identified between the attitude toward clinical practice and vocational motivation levels (r = 0.367; p < 0.001). There were positive correlations between the intrinsic motivation (r = 0.572; p < 0.001) and extrinsic motivation (r = 0.58; p < 0.001), and negative correlations were observed between the negative motivation (r=-0.324; p < 0.001) and the attitude toward clinical practice scale. There were positive correlations between belief and expectation (r = 0.492; p < 0.001) and positive approach (r = 0.532; p < 0.001) with the MSPS. In the multiple regression analysis, intrinsic motivation, extrinsic motivation, satisfaction with studying nursing, and participation in vocational courses were determined as effective predictors of attitudes towards clinical practice and explained 60.4% of the variance. The study concluded that nursing students' attitudes toward clinical practices affect vocational motivation. Clinical learning environments should be arranged in a way to increase the motivation level of students towards professional learning.

Quality of life and influencing factors in older adults with benign prostatic hyperplasia

AbstractThe aim of this study was to investigate the relationship between the quality of life (QoL) and self‐efficacy in older adults with benign prostatic hyperplasia (BPH), as well as the factors affecting their QoL. Previous research has shown that self‐efficacy is one of the factors affecting the QoL of individuals. Diminished self‐efficacy can impair cognitive and behavioural function, while heightened self‐efficacy can drive changes in treatment acceptance behaviour and, subsequently, physical and mental health. Although past research has investigated QoL among patients with BPH, no known studies have investigated the impact of self‐efficacy on QoL, specifically among the Chinese aged population who may have a different disease status. The study followed a cross‐sectional design and included 372 older adults with BPH. The Chinese version of the Benign Prostatic Hyperplasia QoL Scale (BPH‐QLS), the Chinese version of the Self‐rated Abilities for Health Practices Scale (SRAHP) and General Survey Questionnaire were used. One‐way ANOVA and multiple regression analysis were employed to identify factors influencing QoL and evaluate the relationship between self‐efficacy and QoL. The results indicated a positive correlation between QoL and self‐efficacy. Educational level, sexual intercourse, disease duration, marital status, monthly family income and self‐efficacy were identified as factors influencing QoL in older adults with BPH. Multiple linear regression analysis revealed that self‐efficacy for health responsibility had the most significant impact on QoL scores. To enhance QoL in older adults with BPH, active measures are needed. Future studies should focus on intervention programmes that target self‐efficacy, which is a modifiable factor with significant potential for improvement.

Scales for assessing neurological disorders and degenerative changes in the cervical spine. Literature review

More than sixty scales have been developed for the diagnosis and treatment of degenerative pathology of the cervical spine from the perspective of neurological syndromes. The use of most of these in clinical practice is limited. The purpose of this study is to highlight the most popular scales for assessing degenerative changes of the cervical spine from the perspective of neurological syndromes in the diagnosis and determination of treatment tactics for single-segment stenosis of the spinal canal at the cervical level. The current clinical guidelines “Degenerative Spine Diseases” 2021 use the Neck Disability Index, the Visual Analog Scale, and the Frankel Grade among all scales. MEDLINE (PubMed) and Google Scholar were searched from 1972 to 2023 using the key words “cervical spine degeneration”. The initial search identified more than 13,000 articles. This review included 52 studies in which the analysis of clinical and neurological data was carried out using scoring scales for assessing neurological syndromes and functional status in degenerative spinal stenoses at the cervical level. The validity, reliability, and applicability of the scales in clinical practice were analyzed and compared. Based on the analysis of literature data, the most rational scales to use from the standpoint of validity, reliability, and time consumption are the Visual Analog Scale for pain assessment, the Neck Disability Index for assessing cervical radiculopathy, the European Myelopathy Score to assess cervical myelopathy, the Neck Pain and Disability Scale to assess functional outcomes, and the Hospital Anxiet y and Depression Scale for mental status assessment.

Inflammatory index score in children: its relationship with neophobia, dietary quality and anthropometric measurements

The aim of this study was to examine the correlation between the Diet Inflammatory Index (DII) scores and dietary quality in children, which was measured by the Mediterranean Diet Quality Index (KIDMED), also neophobia scores and anthropometric measurements. This study was conducted in primary schools in Famagusta, Cyprus. A total of 300 children (150 girls, 150 boys) in the 3rd, 4th and 5th grade were included in the study. The frequency of food consumption was measured to calculate the DII scores. Moreover, neophobia and KIDMED scores were obtained. The KIDMED score is a popular tool that is mostly used as a practical scale to assess adherence to the Mediterranean diet among children. Additionally, anthropometric measurements (body weight, height, waist circumference, neck circumference) were collected. Finally, DII scores were compared with KIDMED scores, neophobia scores, and anthropometric measurements. Anthropometric measurements and body mass index (BMI) values were found to be significantly different (p < 0.05) based on the DII scores. Children with DII scores in the 1st quartile had significantly different anthropometric measurements compared to those who had scores in the 2nd, 3rd, and 4th quartiles (p < 0.05). The DII scores of normal-weight children were higher than those of obese children. A significant negative correlation was observed between KIDMED scores and DII scores of the children (p < 0.05). Furthermore, a significant positive correlation was observed between neophobia scores and DII scores (p < 0.05). Additionally, DII scores were correlated with dietary quality and anthropometric measurements (p < 0.05). The MD enhances the anti-inflammatory properties of the diet; it has clearly demonstrated positive effects on diet quality and anthropometric measurements. Furthermore, the MD is suggested to reduce the risk of chronic diseases as a result of improving DII scores at an early age.

A Psychometric Study of the Student Evidence-Based Practice Scale S-EBPQ-Arabic Version for Use among Undergraduate Nursing Students.

Previous studies have demonstrated the significance of evidence-based practice in improving patient care and outcomes. Therefore, integrating evidence-based practice into the health professions' education curriculum has become a pedagogical priority. However, there is a lack of reliable and valid scales to measure students' evidence-based practice usage, attitudes, knowledge, and skills in Arab countries. This study aims to examine the adapted Student Evidence-Based Practice Scale Questionnaire (S-EBPQ) validity at logical statistical level and reliability for use among students in Arabic context. This cross-sectional study included 233 undergraduate nursing students from a university in Saudi Arabia, who were recruited after translating and pilot testing the S-EBPQ. Three distinctive types of validity including conceptual, content, and face validity were assessed to determine the quality of the questionnaire items logically. Exploratory factor analyses were performed to examine the tool's structural validity. Additionally, internal consistency was assessed to evaluate reliability. Findings. All items were considered relevant to Arab culture, and no changes were made to any items. The content validity indices for all items were above 0.80 as this was considered an acceptable value. The exploratory factor analysis identified the same four factors (practice, attitude, retrieving and reviewing evidence, and sharing and applying evidence-based practice). All KMO values for the individual items ≥0.876 were also well above the acceptable 0.6 limit. The four-factor structure explained a total variance of 64%, with factor load score λ ≥ 0.455. The total and subscale S-EBPQ scores showed evidence of reliability, with Cronbach's alpha ≥0.8. This study demonstrated the reliability and validity of the Arabic S-EBPQ version. The study has the potential to advance Arab countries' understanding of evidence-based practice. S-EBPQ is a validated tool that can be used to assess nursing students' knowledge of EBP practices. Since educators need to continually evaluate instructional and curricular design in order to meet contemporary nursing needs, this scale can enhance the educational process and enhance students' competencies.

HRM practices in the public service: a measurement model

Purpose Considering the significant increase in researchers’ interest in human resource management (HRM) in the public sector domain, this study aims to focus on producing a scale of HRM practices customized for the context of public organizations. Design/methodology/approach Experts and semantic analysis were performed for the scale development (qualitative stage), and exploratory and confirmatory factor analysis through structural equation modeling was conducted for the scale validation (quantitative stage). Findings The public HRM practices scale (public HRMPS) is composed of 19 items, distributed along four factors/dimensions, named training, development and education; relationship; work conditions; and competency and performance appraisal. The scale showed evidence of internal and construct validity (convergent, divergent, criterion-related and discriminant), as well as reliability and content validity. Research limitations/implications The public HRMPS can be applied in relational studies to test structural models of prediction, mediation and moderation to evaluate relationships with organizational behavior variables, such as leader-members exchange, engagement at work, life quality at work and well-being at work, among others. Practical implications The public HRMPS may also serve as a useful diagnostic tool for the decision-making process made by public managers so they can promote a strategic, evidence-based HRM. Furthermore, the transforming role of strategic HRM can be operationalized by adopting practices gathered in the public HRMPS, advancing toward new HRM strategies to promote healthier and more productive work environments. Social implications Healthier and more productive environments translate into real impacts for society, the first beneficiary of public services with more quality, efficiency and accountability. Originality/value The public HRMPS is the first attempt to produce an operationally valid and reliable measure to evaluate strategic HRM practices, responding to calls in the literature concerning the need for an integrated, comprehensive and customized HRM practices scale for the public service context.

Validation of the scale of reflective practice in clinical settings among nursing students in Morocco

Background and SettingThe Clinical Practice Reflection Questionnaire (CPRQ) for Nursing Students is a reliable assessment tool used to evaluate students’ reflective practice in clinical settings. However, its validation in the French and Moroccan context and its utilization in nursing education require further investigation. ObjectiveThis study aims to verify the validity of the French version of the CPRQ, specifically translated and adapted for nursing students. ParticipantsThe study included two purposive samples of nursing students from the Higher Institute of Nursing Professions and Health Techniques (HINPHT) in Fez, along with its affiliated campuses in Meknes and Taza. The first sample consisted of 400 nursing students from various academic backgrounds in their second or third year of study. The second sample comprised 800 nursing students. Design and MethodsAn exploratory factor analysis (EFA) was performed on the sample of 400 participants to identify the underlying factor structure. The EFA revealed six factors, which were further validated using confirmatory factor analysis (CFA) on the larger sample of 800 participants. ResultsThe principal factor analysis showed that the CPRQ consists of six factors, explaining 80.78% of the total variance. These factors are essential dimensions of the CPRQ, capturing a significant amount of variability in the scores. The reliability analysis indicated a Cronbach's alpha coefficient of 0.720, indicating good internal consistency. The model's fit indices in the CFA demonstrated high levels of agreement, confirming the strong performance and favorable fit of the measurement model. The CFA also confirmed the original structure proposed by Bijani et al. in 2021, encompassing factors such as professional competence, internal sources of motivation, stimulating clinical context, dynamic organizational atmosphere, reflection-based self-management, and dynamic professional growth. ConclusionsThe findings of this study provide empirical evidence supporting the validity and reliability of the French version of the CPRQ scale as an effective tool for evaluating nursing students’ reflection skills in clinical practice. The validated scale can be confidently employed by nursing educators to assess students’ reflective abilities in a rigorous and consistent manner.

Validity and Reliability of the Turkish Version of the Sleep Condition Indicator: A Clinical Screening Instrument Based on the DSM-5 Criteria for Insomnia.

We aimed to adapt the Turkish Sleep Condition Indicator (SCI) version and examine its psychometric properties among the general population. This study was a cross-sectional study. The item-total correlation, standard error of measurement, Cronbach's α, and McDonald's ω were used for internal consistency. We ran confirmatory factor analysis (CFA) and network analysis to confirm the factor structure. Multigroup CFA was run to assess the measurement invariance across gender, whether clinical insomnia or not, and poor sleep quality. We correlated SCI scores with Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) scores to evaluate construct validity. A receiver operating characteristic (ROC) curve analysis was conducted to calculate the cut-off score of the SCI. The temporal stability was examined with the intraclass correlation coefficient. Eight hundred thirty-four participants attended. Over half of the participants were women (63.2% n = 527); the mean age was 36.15 ± 9.64. Confirmatory factor and network analysis results show that the two-factor correlated model had a good model fit for the SCI. The SCI had scalar level invariance across gender, having clinical insomnia and poor sleep quality in the Multigroup CFA. ROC curve analysis shows that the SCI has good sensitivity (90.3%) and specificity (91.8%) for cut-off ≤ 15. The intraclass correlation coefficient computed between the first and second SCI total scores was significant (r=0.80 with a 95% confidence interval from 0.78 to 0.87; p < 0.001). The Turkish SCI is a practical self-reported insomnia scale with good psychometric properties that can be used to screen for insomnia disorder.

Ocular surface lesions in clinical grades of Bell's phenomenon.

Bell's phenomenon, also known as the palpebral oculogyric reflex, is a critical reflex that protects the cornea. We developed an innovative, simple, and practical grading scale for Bell's phenomenon that includes the inverse Bell's phenomenon. Using this scale, we investigated the characteristics of Bell's phenomenon among asymptomatic individuals in different age groups and examined the frequency of ocular surface lesions in asymptomatic and symptomatic participants with different grades. In this cross-sectional study, we randomly included 330 eyes of 165 asymptomatic, healthy, White Turkish individuals who attended the outpatient eye clinic, with a male-to-female ratio of 1:1.4, in the control group. These were categorized into four age groups: 4 - 20 years, 21 - 40 years, 41 - 60 years, and > 60 years. Eighty eyes from 40 patients with ocular surface lesions and absence of grade + 2 Bell's phenomenon were included in the symptomatic group. Bell's phenomenon was classified into five grades: grade + 2 (strong positive), grade + 1 (weak positive), grade 0 (no Bell's phenomenon, no eye movement), grade -1 (weak inverse), and grade -2 (strong inverse). We detected higher frequencies of grade + 2, + 1, and 0 in individuals aged 4 - 40, 41 - 60, and > 60 years, respectively. There was a significant difference between age groups in the frequencies of different grades (P < 0.001). Pairwise analysis revealed a significantly lower frequency of grade + 2 in the age group > 60 years compared with the 4 - 20 and 21 - 40 year groups (both P < 0.05). Grade + 2 was the most frequent in both sexes. We detected grade 0 in 27.1% of men and 22.1% of women in the control group, with no significant difference in the frequencies of different grades between sexes (P > 0.05). We observed significant differences between grades with respect to the frequency of ocular surface lesions (P < 0.001). Pairwise analysis revealed a significantly higher frequency of ocular surface lesions in asymptomatic individuals with grade 0 and all four other grades (all P < 0.001). However, the frequency of ocular surface lesions was comparable between sexes (P > 0.05). Of the 40 symptomatic individuals, 28 (70%), 5 (12.5%), 4 (10%), and 3 (7.5%) had grade 0, + 1, -1, and -2, respectively. The number of symptomatic patients was higher in grade 0 (n = 28) than in other grades (grade + 1, -1, and -2: n = 12 patients), and these individuals had a higher frequency of ocular surface lesions (n = 38 lesions) than others (grade + 1, -1, and -2: 7 lesions). Using a simple, practical grading scale for Bell's phenomenon that includes inverse Bell's phenomenon, we observed that inverse Bell's phenomenon is a reflex that may be present in healthy individuals and could have a protective effect on the eye, although not to such a degree as a strong Bell's phenomenon. Our observations imply that bilateral conjunctival calcifications/Vogt's limbal girdle may be associated with grades 0 and + 1 Bell's phenomenon. Further large-scale studies are needed to determine the frequency of Bell's phenomenon in the general population using this innovative, simple, practical grading scale, and to identify the protective or injurious effect of each grade on the ocular surface.

THE PRACTICE AND PERCEPTION OF LOW RESIDUE DIETS IN ADULT PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Abstract BACKGROUND Low residue diets have been traditionally recommended during disease flares or post-operatively in patients with inflammatory bowel disease (IBD) for the purported benefits of reduced pain or lower risk of bowel obstruction. However, these diets may not be healthy if consumed long-term and can adversely impact quality of life. It remains controversial whether such diets are truly beneficial, and the scale of such dietary practice remains unknown. METHODS A survey was conducted to better understand the practice and the perception related to low residue diet recommendations among patients with IBD at a large academic medical system in the United States. Adult patients (age ≥18) with an established diagnosis of IBD were identified using ICD-10 codes in the electronic medical record system. The survey contained 23 questions and was disseminated electronically from August 2023 to October 2023. RESULTS 132 patients (Crohn’s disease: 59, ulcerative colitis: 68, IBD-unclassified: 5) completed the online survey. The median age was 54 years (IQR 41, 67), with a median disease duration of 15 years (IQR 8, 30). Sixty percent of respondents were female. The majority of respondents (57%) reported currently receiving a biologic therapy. 14 (11%) patients reported currently following a low residue diet, and 34 (25%) reported following the diet in the past. Subjects followed the diet for a median duration of 18 months (IQR 6, 72). Among the 48 patients who followed a low residue diet, 33 (69%) reported using the diet to help with disease flare, while 23 (48%) did so to improve IBD symptoms and an additional 9 patients (19%) reported using a low residue diet post-operatively. 32 (67%) were instructed by their healthcare providers to follow this diet; however, only 4 of them were told not to continue this diet indefinitely. Low residue diets were reported to be “very helpful” (n=14, 29%) or “helpful” (n=18, 38%) in improving IBD symptoms. This benefit consisted of reducing pain (65%), bloating (60%), bowel movement frequency (44%), or urgency (38%). However, respondents noted significant adverse impact on quality of life from a low residue diet: 96% reported that the diet at least moderately limited them from eating foods they enjoyed, and 90% reported that it prevented them from eating what they perceived to be a healthy diet. CONCLUSION Within this cohort of individuals with IBD, 36% of survey respondents either followed or had followed a low residue diet. While up to 65% of individuals felt that this may improve abdominal pain, bloating, or other symptoms, almost all individuals felt such a diet limited their intake of foods they enjoy and from eating a healthy diet. Further education is required for providers regarding screening for low residue diet use and its appropriate indications to reduce its negative impact on quality of life.