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In the frame of the interpersonal psychological theory of suicide (IPTS), Interpersonal Needs Questionnaire (INQ-15) assesses thwarted belongingness (TB) and perceived burdensomeness (PB), related to suicidal ideation (SI); Acquired Capability for Suicide Scale–Fearlessness About Death (ACSS-FAD) measures this component which contributes to lethal self-harm. The objective was to evaluate the psychometric properties of INQ-15 and ACSS-FAD in a population of Italian university students. Since the Italian INQ-15 was already validated, we translated ACSS-FAD through a multistage procedure and administered both to 1,665 Italian university students. Factor analysis confirmed a two-factor-related model of INQ-15, one factor of ACSS-FAD, and good reliability for both. We proved the association between INQ-15 and current SI and between ACSS-FAD and lifetime suicidal planning and/or suicide attempt. The convergent and discriminant validities were in line with those of previous studies. Both tools are valid and reliable to assess the constructs associated with suicide outcomes according to IPTS. [ABSTRACT FROM AUTHOR]

Irritable bowel syndrome (IBS) is a functional gastrointestinal condition. Probiotics and other nutraceutical compounds can have specific indications in the context of IBS. A retrospective analysis was conducted on 123 IBS patients in order to evaluate the effects of an oral probiotic-based dietary supplement (Colicron, one cps/day for 4 wk) on stool consistency and pain intensity. Different time points were defined as follows: baseline (T0), 2 wk of treatment (T2), and 4 wk of treatment (T4). Stool consistency was assessed by using the Bristol Stool Scale. Pain intensity was evaluated by the Visual Analogue Scale (VAS). Patients who were initially categorized as normal retained regular bowel movements throughout the study. Both patients with constipation and diarrhea showed an improvement in the Bristol Stool Scale. The score increased from 1.5 ± 0.5 to 3.3 ± 0.7 (p < 0.001) and decreased from 6.5 ± 0.7 to 4.3 ± 0.9 (p < 0.001) at T4, respectively, compared to T0. The VAS score for pain in the pooled IBS patients improved from 6.7 ± 2.2 to 2.8 ± 1.9 at T0 vs T4 (p < 0.001), with a similar trend also observed when patients were categorized based on stool consistency: normal (from 5.2 ± 1.9 to 2.9 ± 1.7), constipation (from 7.5 ± 1.3 to 3.2 ± 2.2), and diarrhea (6.7 ± 2.3 to 2.5 ± 1.9) (p < 0.001). Colicron could be useful in symptom relief, reducing abdominal pain and improving stool consistency of IBS patients. However, further controlled clinical trials are needed to confirm these preliminary findings. [ABSTRACT FROM AUTHOR]

Simple Summary: This study examines the viability of liver grafts from donors aged 85 years and older in liver transplantation (LT) compared to those from younger donors under 40 years old. The research, conducted on data from 2005 to 2023, evaluates post-LT outcomes using propensity score matching. Despite lower 5-year survival rates in the elderly group before matching, the proposed nomogram provides a more acceptable 10-year post-LT survival using grafts from older donors. Notably, the study emphasizes the importance of proper matching, particularly for recipients with hepatocellular carcinoma (HCC), in achieving satisfactory long-term results amid organ scarcity. Background: Despite the ongoing trend of increasing donor ages in liver transplantation (LT) setting, a notable gap persists in the availability of comprehensive guidelines for the utilization of organs from elderly donors. This study aimed to evaluate the viability of livers grafts from donors aged ≥85 years and report the post-LT outcomes compared with those from "ideal" donors under 40 years old. Methods: Conducted retrospectively at a single center from 2005 to 2023, this study compared outcomes of LTs from donors aged ≥85 y/o and ≤40 y/o, with the propensity score matching to the recipient's gender, age, BMI, MELD score, redo-LT, LT indication, and cause of donor death. Results: A total of 76 patients received grafts from donors ≥85 y/o and were compared to 349 liver grafts from donors ≤40 y/o. Prior to PSM, the 5-year overall survival was 63% for the elderly group and 77% for the young group (p = 0.002). After PSM, the 5-year overall survival was 63% and 73% (p = 0.1). A nomogram, developed at the time of graft acceptance and including HCC features, predicted 10-year survival after LT using a graft from a donor aged ≥85. Conclusions: In the context of organ scarcity, elderly donors emerge as a partial solution. Nonetheless, without proper selection, LT using very elderly donors yields inferior long-term outcomes compared to transplantation from very young donors ≤40 y/o. The resulting nomogram based on pre-transplant criteria allows for the optimization of elderly donor/recipient matching to achieve satisfactory long-term results, in addition to traditional matching methods. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the effect of bromelain and propolis extract on the bond strength (BS) of a universal adhesive system to eroded dentin. Materials and Method s : Sixty human molars with exposed dentin were halved, with one half protected by composite resin and the other subjected to erosive treatment followed by remineralization. After the erosive treatment, the composite resin was removed, and the teeth were randomly assigned to three groups (n = 20): Adhesive‐Control System; Br‐10%; Pr‐16%. Following the treatments, composite resin blocks were built on the dentin surfaces and sticks of 0.9 mm2 were obtained and stored in distilled water at 37°C for 24 h and 6 months. After these periods, the sticks underwent bond strength testing and the data were analyzed using 2‐way ANOVA, Bonferroni test, p < 0.05. Fracture patterns were observed using light microscope and scanning electron microscopy. Results: Irrespective of the substrate and aging duration, propolis demonstrated higher BS (p < 0.05) compared to the other treatments. Eroded dentin exhibited greater removal of the smear layer and dentinal tubules with a larger diameter than sound dentin, especially when treated with bromelain, resulting in the formation of resin tags. Conclusions: Propolis consistently promoted the highest bond strength, irrespective of aging or substrate. Eroded dentin treated with propolis, or bromelain exhibited a higher prevalence of non‐adhesive fractures and resin tag formation. Clinical Significance: Propolis shows promise for enhancing the longevity of adhesive restorations in eroded dentin due to its ability to promote high bond strength. [ABSTRACT FROM AUTHOR]

Simple Summary: The role of surgery in the combined treatment with hyperthermic intrathoracic chemotherapy of thymoma recurrences and pleural mesothelioma has assumed a controversial role in the context of the multimodal treatment of these diseases, especially when minimally invasive techniques are considered. The authors aim to propose future directions in the approach to these pathologies by placing robotic surgery at the center of reflection, starting, however, from a review of the literature available to date. (1) Background. Intracavitary hyperthermic chemotherapy (HITHOC) remains part of the complex mosaic that is the multimodal approach for advanced stage thymoma and pleural malignancies. However, robotic pleurectomy/removal of pleural lesions in combination with intrathoracic chemotherapy is not currently being investigated. The aim of this study is to evaluate the safety of robotic pleurectomy/removal of relapses and HITHOC in patients with pleural recurrence of thymoma or MPM. (2) Methods: The data of nine consecutive patients affected by thymoma relapses or MPM who underwent robotic surgery in combination with HITHOC from February 2017 to November 2022 were collected and analyzed. Surgery performed prior to intrathoracic infusion of high-temperature chemotherapy consisted of removal of recurrences (three patients) or pleurectomy (six patients). All surgeries were performed with a four-port, fully robotic technique. (3) Results: No intraoperative complications occurred. No renal complications related to infusion were recorded. One patient, who underwent pleurectomy for MPM, had a grade II Clavien–Dindo postoperative complication. Oncological follow-up showed results in line with the literature. (4) Conclusions: With the limitation of the small number of patients, robotic surgery in combination with HITHOC seems to be safe in patients with pleural relapses of thymoma and early-stage MPM. [ABSTRACT FROM AUTHOR]

Background: Controversy exists with the presence of alterations in descending pain inhibition mechanisms in patients with non‐specific neck pain (NSNP). The aim of the present study was to evaluate the status of conditioned pain modulation CPM, remote pressure pain thresholds (PPT), and psychological factors in a specific subgroup of patients with NSNP such as young adult students. In addition, possible associations between CPM, psychological factors, and pain characteristics were analyzed. Methods: Thirty students with recurrent or chronic NSNP and 30 pain‐free students were included in this cross‐sectional study. The following measures were assessed: CPM, remote PPT, psychological factors (depression, anxiety, pain catastrophizing, and kinesiophobia), pain characteristics (duration, intensity, severity of chronic pain, interference with daily life), and central sensitization inventory (CSI). Results: No significant differences were found in the efficacy of CPM between students with chronic or recurrent NSNP and pain‐free students (β coefficient = −0.67; 95% CI = −1.54, 0.20). However, students with pain showed a significantly higher remote PPT (mean difference = −1.94; 95% CI = −2.71, −1.18). and a greater presence of anxious (mean difference = 6; 95% CI = 2, 9) and depressive symptoms (mean difference = 8.57; 95% CI = 3.97, 13.16). In addition, significant moderate or strong correlations were found between CPM and pain intensity (partial r = 0.41), pain catastrophizing and mean pain intensity (r = 0.37), grade (r = 0.50), and interference of pain (r = 0.57), kinesiophobia and disability (r = 0.38), and depression and CSI (r = 0.39). Conclusions: Young adult students with chronic or recurrent NSNP present remote hyperalgesia and symptoms of depression and anxiety but not dysfunctional CPM. [ABSTRACT FROM AUTHOR]

Latin American families' history and life experiences impact the priorities and values the families have for their children with disabilities. It may be beneficial for early intervention (EI) providers to explore and integrate Latin American families' backgrounds to improve EI services. We completed a qualitative interview study using a collective case study analysis to (a) learn about Latin American families' parenting values and (b) explore families' experiences with a statewide early intervention model. Three mothers with young children who had received EI services completed two interviews. We found that each family had unique histories, compositions, support networks, and priorities that impacted their experiences with a statewide coaching model. Families revealed how their funds of knowledge were, at times, integrated into the EI they received. Our study describes a valuable method of learning about Latin American families' cultural backgrounds so that EI providers may sustain families' cultures within the services they provide. [ABSTRACT FROM AUTHOR]

Simple Summary: Survivors of childhood brain tumors, because of the treatments they have undergone, have a greater risk of dying earlier from cardiovascular causes compared to the general population. The objective of this study was to evaluate differences between cardiovascular risk biomarkers and cardiopulmonary exercise test (CPET) results from childhood brain tumor survivors and healthy controls. We found worse CPET performance in survivors associated with higher endothelin-1 values compared to controls. Correlation analysis showed an inverse relationship between CPET results and leptin, emphasizing the role of radiotherapy as a possible cause in the genesis of a greater cardiovascular risk in survivors of childhood brain tumors. In recent decades, the improvement of treatments and the adoption of therapeutic protocols of international cooperation has led to an improvement in the survival of children affected by brain tumors. However, in parallel with the increase in survival, long-term side effects related to treatments have been observed over time, including the activation of chronic inflammatory processes and metabolic alterations, which can facilitate the onset of metabolic syndrome and increased cardiovascular risk. The aim of this study was to find possible statistically significant differences in the serum concentrations of early biomarkers of metabolic syndrome and in the results of cardiopulmonary exercise testing between survivors of childhood brain tumors and healthy controls. This is a prospective and observational study conducted on a group of 14 male patients who survived childhood brain tumors compared with the same number of healthy controls. The concentrations of early metabolic syndrome biomarkers [adiponectin, leptin, TNF-α, IL-1, IL-6, IL-10, endothelin-1, apolipoprotein B, and lipoprotein (a)] were measured and a cardiopulmonary exercise test (CPET) was performed. Results: Childhood brain tumor survivors performed worse on average than controls on the CPET. Furthermore, they showed higher endothelin-1 values than controls (p = 0.025). The CPET results showed an inverse correlation with leptin. The differences found highlight the greater cardiovascular risk of brain tumor survivors, and radiotherapy could be implicated in the genesis of this greater cardiovascular risk. [ABSTRACT FROM AUTHOR]

Introduction: Frailty is widely acknowledged as influencing health outcomes among critically ill old patients. Yet, the traditional understanding of its impact has predominantly been through frequentist statistics. We endeavored to explore this association using Bayesian statistics aiming to provide a more nuanced understanding of this multifaceted relationship. Methods: Our analysis incorporated a cohort of 10,363 older (median age 82 years) patients from three international prospective studies, with 30-day all-cause mortality as the primary outcome. We defined frailty as Clinical Frailty Scale ≥ 5. A hierarchical Bayesian logistic regression model was employed, adjusting for covariables, using a range of priors. An international steering committee of registry members reached a consensus on a minimal clinically important difference (MCID). Results: In our study, the 30-day mortality was 43%, with rates of 38% in non-frail and 51% in frail groups. Post-adjustment, the median odds ratio (OR) for frailty was 1.60 (95% CI 1.45–1.76). Frailty was invariably linked to adverse outcomes (OR > 1) with 100% probability and had a 90% chance of exceeding the minimal clinically important difference (MCID) (OR > 1.5). For the Clinical Frailty Scale (CFS) as a continuous variable, the median OR was 1.19 (1.16–1.22), with over 99% probability of the effect being more significant than 1.5 times the MCID. Frailty remained outside the region of practical equivalence (ROPE) in all analyses, underscoring its clinical importance regardless of how it is measured. Conclusions: This research demonstrates the significant impact of frailty on short-term mortality in critically ill elderly patients, particularly when the Clinical Frailty Scale (CFS) is used as a continuous measure. This approach, which views frailty as a spectrum, enables more effective, personalized care for this vulnerable group. Significantly, frailty was consistently outside the region of practical equivalence (ROPE) in our analysis, highlighting its clinical importance. [ABSTRACT FROM AUTHOR]

The HEXACO model divides the space of personality into six main dimensions: Honesty–Humility, Emotionality, eXtraversion, Agreeableness (vs. anger), Conscientiousness, and Openness to Experience. Despite the lexical foundation, no validated adjective-based instruments are available yet. This contribution describes the newly developed HEXACO Adjective Scales (HAS), a 60 adjectives instrument to measure the six main personality dimensions. Study 1 (N =368) proceeds to the first pruning of a large set of adjectives to identify potential markers. Study 2 (N =811) delineates the final list of 60 adjectives and provides benchmarks for the new scales' internal consistency, convergent/discriminant, and criterion validity. Study 3 (N =411) confirms the HAS factorial structure, internal consistency, and criterion validity. The study also provides evidence of temporal stability (test–retest reliability) and convergence between raters (peer/self-evaluation). The HAS shows excellent psychometric properties and constitutes a valuable tool for assessing the HEXACO personality dimensions using adjectives. [ABSTRACT FROM AUTHOR]

Subjective well-being (SWB) has been widely studied in general populations; however, few studies have evaluated aspects related to the internal structure of the instrument. Thus, the present research aimed to gather new psychometric evidence for operationalising the SWB in the context of physical exercise and test its invariance in different groups. The sample comprised 359 participants aged between 18 and 70 (M=36.6 SD=11.9; 67.7% female). The results obtained through confirmatory factor analysis indicated the adequacy of the three-factor model, with good accuracy rates. Furthermore, the invariance analysis suggested that the SWB is measured similarly among those who practice physical exercise in different ways (virtual and face-to-face) and individuals of different genders (female and male). The results contribute to the accumulation of validity evidence for the BES measure in the context of physical exercise. [ABSTRACT FROM AUTHOR]

Sexual dysfunction (SD) is a common symptom for many with multiple sclerosis (MS). However, most studies researching this topic have predominantly White samples. While this matches epidemiological estimates, research has shown that those of other ethnic groups, such as African Americans/Blacks and Hispanics/Latinos, tend to exhibit more symptomology. This study aimed to determine if this greater symptomology in other ethnic groups with MS holds for SD. Study participants were recruited from the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry. Participants completed the MSISQ-19 and the PDDS and provided demographic information. Study participants were 5445 respondents (Mage = 51 years, SD = 9.56, 75% female, 93% White). White, African American/Black, and Hispanic/Latino groups were compared on sexual dysfunction. Linear mixed effects modeling revealed that the MSISQ-19 subscale scores were significantly different for the African American/Black group (t = − 2.48, p < 0.013) and all female participants (t = − 2.58, p < 0.010). African American/Black participants had the least amount of primary SD (M = 10.56, 95% CI [9.09, 12.03]). African American/Black participants had the highest amount of secondary SD (M = 18.62, 95% CI [17.15, 20.09]), though the result was not statistically significant. Additionally, African American/Black females scored higher in all subscale scores when compared to African American/Black males, with a 3-point and 2-point difference in primary and tertiary symptoms. Our study has highlighted the importance of clinicians assessing for SD within their patients and to consider potential differences in symptom presentations of racial groups. [ABSTRACT FROM AUTHOR]

The correlation of female sexual dysfunction (FSD) with the degree of glycemic control, the duration and complications of diabetic disease and cardiovascular risk factors are not so clear. The aim of this study was to assess the prevalence of FSD in a sample of females with type 2 diabetes mellitus (T2DM), and to identify factors involved in its pathogenesis. We enrolled 81 females who have T2DM. We administered the female sexual function index (FSFI), self-rating anxiety scale (SAS) and self-rating depression scale (SDS) questionnaires. We also estimated anthropometric parameters, glyco-metabolic control, comorbidities, autonomic nervous system assessment, some adipocytokines and ongoing therapy. 87% of participants were affected by FSD. There was evidence of an inverse correlation between the total score of the FSFI questionnaire and the mean of the values ​​of HbA1c in the previous years. There was an inverse correlation with the duration of diabetes and homeostasis model assessment of insulin resistance index in participants not affected by FSD. Participants with FSD have a higher prevalence of anxiety (p = 0.043) and participants with depression and ischemic heart disease scored less on the FSFI questionnaire (p = 0.005 and p = 0.010, respectively). Homocysteine ​​and E-selectin values ​were higher in participants with FSFI (p = 0.002, and p = 0.017, respectively). Most of the enrolled females with T2DM had FSD. Glycemic control, ischemic heart disease, endothelial dysfunction, autonomic neuropathy, and psychological conditions, such as anxiety and depression, seem to have a close correlation with FSD. An early diagnosis of FSD can help to improve not only participants' quality of life, but also to early identify and treat risk factors related not only to FSD, but also to cardiovascular risk. Therefore, we highly recommend that clinicians have a high index of suspicion for FSD in females with T2DM. [ABSTRACT FROM AUTHOR]

Objectives The main aim was to determine the effects of percutaneous electrical nerve stimulation (PENS) and transcutaneous electrical nerve stimulation (TENS) on endogenous pain mechanisms in patients with musculoskeletal pain. Design A systematic review and meta-analysis. Methods The search was conducted on March 1, 2022, in the EMBASE, CINAHL, PubMed, PEDro, Cochrane Library, Web of Science, Medline, and SCOPUS databases. Randomized controlled trials comparing the use of transcutaneous or percutaneous electrostimulation with a placebo, control group, or standard treatment in patients with musculoskeletal pain were included. Outcome measurements were quantitative sensory testing somatosensory variables like pressure pain threshold (PPT), conditioned pain modulation, and temporal summation of pain. The pooled data were evaluated in Review Manager 5.4. Results Twenty-four randomized controlled trials (n = 24) were included in the qualitative analysis and 23 in the meta-analysis. The immediate effects of PENS and TENS on local PPTs were significant, with a moderate effect size (standardized mean difference [SMD] 0.53; 95% confidence interval [CI]: 0.34 to 0.72; P  < 0.00001). When only studies with a lower risk of bias were analyzed, the heterogeneity decreased from I 2 = 58% (P  < 0.00001) to I 2 = 15% (P  = 0.01), and a decrease in the overall effect was observed (SMD 0.33; 95% CI: 0.7 to 0.58). The short-term effects on local PPTs were not significant when compared with the control group (P  = 0.13). The mid-term effects on local PPTs were significant, showing a large effect size (SMD 0.55; 95% CI: 0.9 to 1.00; P  = 0.02). The immediate effects on conditioned pain modulation were significant, with a large effect size (SMD 0.94; 95% CI: 0.48 to 1.41; P  < 0.0001). Conclusion PENS and TENS have a mild–moderate immediate effect on local mechanical hyperalgesia in patients with musculoskeletal pain. It appears that these effects are not sustained over time. Analyses suggest an effect on central pain mechanisms producing a moderate increase in remote PPT, an increase in conditioned pain modulation, but further studies are needed to draw clearer conclusions. [ABSTRACT FROM AUTHOR]

Background. Shoulder pathologies are increasingly common in the worldwide population. Total shoulder replacement procedures grew significantly in the last ten years. Based on the diagnosis, shoulder conditions can be treated with different surgical implants, such as shoulder hemiarthroplasty (HA), total anatomic shoulder arthroplasty (TSA), and reverse shoulder arthroplasty (RSA). Materials and methods. Data from Italian Register of Arthroplasty (RIAP) from 2018 to 2020 of the Campania region were collected to perform this investigation. Results. Between 2018 and 2019 an increase of 18.3% in shoulder replacement surgeries was reported by a total of 35 different hospitals in Campania. However, in 2020 the number of shoulder arthroplasty decreased of 21.3%. Proximal humeral fractures and their sequelae were reported as an indication for shoulder arthroplasty with an increasing rate of +10.3%. While the indication most frequently reported was rotator cuff arthropathy with and increasing of +15.4% between 2018 and 2019. Conclusions. Shoulder interventions are becoming increasingly common. Reverse shoulder arthroplasty has been the most performed in Campania during the last three years in patients with rotator cuff arthropathy. [ABSTRACT FROM AUTHOR]

Objective: Early COVID‐19 eating disorders (EDs) research used regionally restricted samples with little sociodemographic diversity. The present study aimed to address these research gaps by examining whether pandemic‐related changes in ED symptoms and mental healthcare prevalence differed for historically marginalized groups within a national sample of US college students. Method: Participants included 242,906 US college students (Mage = 23.45, SD = 7.04; MBMI = 25.28, SD = 5.91) who completed the repeated cross‐sectional multi‐institute Healthy Minds Study between January 2019 and May 2021. Moderated logistic regressions examined whether pandemic‐related changes in individuals' likelihoods of exhibiting current probable ED, reporting lifetime ED diagnoses, and—among individuals with current probable ED—mental healthcare engagement differed for diverse gender, sexual, and racial/ethnic identity groups, and by body mass index (BMI) and financial stress. Results: There were increases of 5% and 12% in individuals' likelihoods of exhibiting current probable ED and symptomatic individuals' mental healthcare engagement, respectively, pre‐ to post‐COVID‐19 onset, but no pandemic‐related changes in lifetime ED diagnosis prevalence. There were also important variations in these time‐trends for different marginalized groups. For example, individuals identifying as genderqueer/gender nonconforming and lesbian exhibited increasing ED symptoms pre‐ to post‐COVID‐19 onset, and individuals with current probable ED and higher BMIs were increasingly likely to receive mental healthcare. Associations between financial stress, and the ED and mental healthcare outcomes did not change over time. Discussion: These findings provide insight into groups of US college students that experienced disproportionate ED burden during the pandemic at the population level, and directions for research and interventions that warrant consideration. [ABSTRACT FROM AUTHOR]

Simple Summary: Management of potentially malignant oral disorders pose a challenge to the clinician. These lesions, over time, can undergo cellular and morphologic alteration (dysplasia) until they evolve into squamous cell carcinoma. Diagnosis is made by biopsy and histologic analysis. Screening methods that noninvasively allow these lesions to be monitored both diagnostically and prognostically (biomarkers) have long been sought. A class of non-coding RNAs called miRNAs is readily found in biological fluids and in saliva: they fit into this area of research. From the data presented in this study, miR-181 appears to be a promising salivary biomarker for dysplasia. (1) Background: Oral potentially malignant disorders (OPMD) represent a fundamental challenge for clinicians, considering the possibility of progression into oral epithelial dysplasia (OED) and oral squamous cell carcinoma (OSCC). Several studies have examined the expression of miRNAs in humans as diagnostic and prognostic biomarkers. Among these, miR-21, miR-27b, and miR-181b proved to be promising. This cohort study evaluated the different expressions of those miRNAs in the saliva of patients with OPMD and OSCC. (2) Methods: Patients with a clinical diagnosis of OPMD and/or OSCC were enrolled; saliva samples were collected; miRNAs were extracted and quantified via qRT-PCR was performed. Data were analyzed by subgroups based on the histopathological diagnosis (OSCC and the grade of OED) using the ΔΔCt method. Saliva from 10 healthy donors was used as the control. One-way ANOVA and Kruskal–Wallis tests were performed to assess the differences between groups. (3) Results: 23 patients for the OPMD group (6 with no dysplasia, 7 with low-grade, and 10 with high-grade dysplasia) and 10 with OSCC were analyzed. MiR-21 did not show any variation among groups; miR-27b was under-expressed in dysplastic lesions (p = 0.046); miR-181b was upregulated in high-grade dysplasia (p = 0.006), increasing with the degree of dysplasia, and decreasing in OSCCs. (4) Conclusions: Salivary miR-27b and miR-181b could be promising biomarkers for oral dysplasia. Further studies are needed to clarify their feasibility. [ABSTRACT FROM AUTHOR]

Family routines provide young children with predictable, repeatable, and functional contexts for learning about the world. Participating in family routines is a critical pathway by which all children learn. While the use of family routines in caregiver-implemented interventions (CIIs) is supported by theories, research, and recommended practices, few investigations examine the degree to which interventions take place within routines across developmental domains in early childhood intervention research. We conducted a scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist to examine an interdisciplinary body of CIIs. We coded 42 articles for the presence and types of routines, child and family demographics, developmental targets, and how routines were identified within CIIs. Autism spectrum disorder was the highest represented disability; many studies included play routines or a combination of play with another routine. In this article, we discuss the importance of family routines in CIIs, how to jointly identify a range of routines with caregivers, and we describe the need for research on family routines in CIIs across disabilities and diverse family backgrounds. [ABSTRACT FROM AUTHOR]

In this study, the effect of a remotely supervised, home-based, family-centered individualized rehabilitation program of motor activities for individuals with Rett syndrome (RTT) was evaluated. Thirteen participants with classic genetically confirmed RTT followed by a three-month program of motor activities at home. A total of 47 rehabilitative goals were set. Goals achievement, motor function, and parental satisfaction were evaluated. Each program was carried out by the participant's parents and remotely supervised via Skype calls, twice by a therapist experienced in RTT rehabilitation. Thirty-seven (78.7%) rehabilitative goals were achieved or overachieved. Ten participants (76.9%) significantly increased their gross motor functional level with a medium size effect (0.604). Parental reports of the involved families suggest, on average, a high level of usefulness of the program (4.4/5), adherence to the program (4.4/5), and general satisfaction (4.5/5). Our findings strongly support the implementation of such programs for this population. As these programs were remotely supervised, they can be implemented when the children are away from referenced facilities for long durations, such as during long holidays or a Covid-19 type lockdown. A remote supervised motor activity program carried out by the primary caregiver supports motor functioning in RTT. Therapists should consider family members' motivation to carry out the activities and integrate them into the family's daily routine. The program should be flexible to adapt to any sudden change in medical and environmental conditions, functional ability, and family members' motivational levels. [ABSTRACT FROM AUTHOR]

Although the role of epigenetic alterations in oncogenesis has been well studied, their prevalence in metastatic solid tumours is still poorly described. We therefore aimed at: (i) describing the presence of epigenetic gene alterations (EGA) - defined by an alteration in a gene encoding an epigenetic regulator; and (ii) evaluating their relationship with clinical characteristics and outcome in patients (pts) included in prospective molecular profiling trials. On-purpose tumour biopsies from pts with metastatic solid tumours enrolled in the Gustave Roussy-sponsored MOSCATO (NCT01566019) and MATCHR (NCT02517892) trials were molecularly profiled using whole exome sequencing (WES). Alterations in 176 epigenetic genes were assessed and classified as pathogenic variants (PV) or non-pathogenic variants by a molecular tumour board. Clinical characteristics and outcome were collected. Between Dec 2011 and Oct 2016, WES was successfully performed in 292 pts presenting various solid tumours. We found 496 epigenetic gene alterations in 134 patients (49%), including 237 pathogenic variants in 86 patients; 63 tumour samples (47%) presented ≥3 EGAs. The median number of previous treatment lines was 3 (1–10). The most frequently altered genes were KMT2D and KMT2C (16% each), ARID1A and SETD2 (10% each) and KMT2A (8%).; 31% of EGA co-occurred with a driver gene alteration (p < 0.001). Outcome was not correlated with the presence of EGA. Epigenetic alterations occur frequently in metastatic solid tumours. With the current development of epigenetic modifiers, they increasingly represent actionable targets. Such genes should now be systematically analysed in molecular profiling studies. • 49% of solid tumours present at least one epigenetic gene alteration. • The most frequently altered genes are subunits of the COMPASS or SWI/SNF complexes. • Epigenetic gene alterations tend to co-occur with driver alterations in our series of patients with advanced metastatic tumours. [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to: (1) identify recent temporal changes in the prevalence of different cognitive and behavioral eating disorder (ED) symptoms, current probable EDs, lifetime ED diagnoses, and mental healthcare use among college students across the United States; (2) determine whether established disparities in ED prevalence and receiving mental healthcare have widened or narrowed over time for marginalized groups within this population. Method: Participants included a large national sample of U.S. college students (N = 286,720) who completed the repeated cross‐sectional Healthy Minds Study from 2013 to 2020. Descriptive statistics and polynomial regressions quantified time‐trends in participants' ED symptoms and past 12‐month mental healthcare. Moderated regressions examined temporal changes in ED symptoms and mental healthcare based on sociodemographic characteristics. Results: Individuals' engagement in different cognitive and behavioral ED symptoms, and likelihoods of exhibiting current probable EDs, reporting lifetime ED diagnoses, and (for individuals with current probable EDs) receiving therapy or counseling in the past 12‐months exhibited nonlinear increases from 2013 to 2020. Further, the prevalence of current and lifetime ED symptoms and (for symptomatic individuals) past 12‐month mental healthcare differed over time for individuals with different BMIs and gender, sexual, and racial/ethnic identities (but not ages). In particular, individuals with higher BMIs and those who identified as male, bisexual, and gay, lesbian, or queer exhibited increasing ED pathology over time. Discussion: These findings provide important information on groups of U.S. college students that have experienced increasing burden of ED symptoms and may help guide ED prevention, treatment, and research priorities. Public Significance: Recent temporal changes in the prevalence of eating disorder (ED) symptoms and mental healthcare were examined in a national sample of U.S. young adults. Non‐linear increases in ED symptoms and mental healthcare were identified among U.S. young adults overall from 2013 to 2020. U.S. young adults with higher BMIs, males, bisexual, and gay, lesbian, or queer individuals exhibited increasing ED burden over time. [ABSTRACT FROM AUTHOR]

Familial caregiving research is yet to examine the factors that underpin the association between attachment insecurity and carer burden. Furthermore, previous research consists largely of data collected at a single point in time. This paper addresses these gaps by reporting on a study involving 57 parent–child dyads to determine whether adult children's caregiving self-efficacy mediates the association between carer attachment insecurity and carer burden. Furthermore, care-recipient care-seeking style was investigated as a moderator of the association between carer's attachment insecurity and their self-efficacy. Carers completed self-report measures of attachment orientations at baseline, caregiving self-efficacy at 3 months, and carer burden at 6 months. At 3 months, dyads also engaged in a video-recorded caregiving discussion task assessing care-recipient's observed care-seeking style. The mediation effects of carer attachment orientations on burden through caregiving self-efficacy were contingent on care-recipient indirect-constructive care-seeking. Findings highlight the complex interplay between carer attachment orientations, caregiving self-efficacy, and care-recipient care-seeking style in predicting the burden experienced by adult children. [ABSTRACT FROM AUTHOR]

Background The provision of appropriate nutritional care in care homes is a priority for health services in England. There is limited evidence demonstrating the role of dietitians within older people care homes. This study explores the experiences of dietitians working with care homes for older people in England. Methods A qualitative study using semi-structured face-to-face or telephone interviews was conducted. Criterion and snowball purposive sampling recruited six dietitian participants. Interviews were audio recorded and transcribed verbatim. A reflexive diary was completed, and data analyses followed interpretative phenomenological analyses. Constant comparison, code–recode audits, independent coding by a supervisor, supervisory support and peer review were used to promote rigour. Results Two key themes and three subthemes were identified: Theme 1 is collaboration with multidisciplinary team (MDT) professionals and its two subthemes are as follows: using support strategies (pathway/standards implementation, training/education and resident dietetic assessment) and delivering value (by benefitting more residents, demonstrating unique dietetic skills, nutritional prescription savings and meeting other professional's knowledge gap). Theme 2 is communication with MDT professionals and its subtheme is the understanding of the dietitian's role and of nutritional care. Conclusion Dietitians believe that they play a key role in supporting care homes with nutritional care, identifying themselves as experts and leaders, working with MDT professionals. The findings highlight the importance of a consistent approach to managing nutrition and the need for dietitians to share outcome data to improve the limited evidence-base. There is a need to agree a defined dietetic service provision to care homes in England. [ABSTRACT FROM AUTHOR]

The present study aimed to determine how young adults' use of disordered eating behaviors (DEBs) and alcohol uniquely cluster with one another, how these clusters differ by sex and race, and map onto health-related correlates. As a part of a cross-sectional study assessing college student health and experiences, female (n = 1,026), male (n = 336), White (n = 640), and Black (n = 561) young adult college students at three universities (Mage = 20.54, SD = 1.80) completed measures assessing DEBs and alcohol use, and physical and mental health. Multigroup mixture modeling was used to identify subgroups of female, male, White, and Black young adults that are characterized by different levels of DEBs (fasting, food avoidance, loss of control eating, overeating) and alcohol use (binge drinking, drinking quantity). Whether group membership relates to theoretically and clinically relevant health correlates (stress, depressive symptoms, sleep health) was examined via auxiliary analyses. Qualitative and quantitative differences were identified in the best-fitting mixture models for female (four groups), male (four groups), White (five groups), and Black (three groups) participants that suggest sex and racial variations exist in patterns of DEBs and alcohol use severity. Generally, classification in groups characterized by moderate to high probabilities of DEBs only, or the combination of moderate to high DEBs and alcohol use, was associated with worse affective concerns across sexes and races. Targeting young adults' DEBs and alcohol use via diversity-informed treatments focused on coping skill development may help promote health and well-being. [ABSTRACT FROM AUTHOR]

Introduction: Patients with diabetes have up to five times higher incidence of cataract, mainly at a younger age, and cataract in these patients progresses more rapidly than senile cataract, especially in eyes affected with sight-threatening diabetic retinopathy (DR). Aim: This study aimed to investigate the risk factors associated with cataract development in patients with type 2 diabetes (T2DM). Methods: This case-control cross-sectional study included 90 T2DM (56M/34F). Metabolic risk factors glycated hemoglobin (HbA1c), total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides were determined using routine laboratory methods. Blood pressure was measured with a mercury sphygmomanometer after a 10-min resting period. Lens opacity was graded according to the Lens Opacity Classification System version III (LOCS III). Results: According to the LOCS III, patients were divided into two groups: group 1—patients with clear crystalline lens, and group 2—patients with initial cataract. Compared to patients with a clear crystalline lens, those with initial cataract had longer diabetes duration (p = 0.002), higher HbA1c (p = 0.037), higher total cholesterol (p = 0.029), higher diastolic blood pressure (DBP) (p = 0.014), and lower creatinine clearance (p = 0.017). Cataract was positively associated with diabetes duration (p = 0.001), HbA1c (p = 0.035), LDL cholesterol (p = 0.042), and DBP (p = 0.009), while negatively with creatinine clearance (p = 0.005). Logistic regression analysis showed that the influence of DBP (AOR = 1.06, p = 0.014) and creatinine clearance (AOR = 2.93, p = 0.045) on cataract development remained significant even after adjustment for diabetes duration and HbA1c. Conclusions: Diabetes duration and various metabolic risk factors, particularly poor glycemic control, hypercholesterolemia, DBP, and diabetic nephropathy's coexistence, are associated with cataract development in T2DM. [ABSTRACT FROM AUTHOR]

This retrospective cohort study investigates risks of hospitalised fall or hip fractures in working age adults receiving mental health care in South London. Patients aged 18 to 64, who received a first mental illness diagnosis between 2008 and 2016 were included. Primary outcome was hospitalised falls, secondary outcome was hip fractures. Age- and gender-standardised incidence rates and incidence rate ratios (IRRs) compared to local general population were calculated. Multivariate Cox proportionate hazard models were used to investigate which mental health diagnoses were most at risk. In 50,885 patients incidence rates were 8.3 and 0.8 per 1,000 person-years for falls and hip fractures respectively. Comparing mental health patients to the general population, age-and-gender-adjusted IRR for falls was 3.6 (95% CI: 3.3–4.0) and for hip fractures 7.5 (95% CI: 5.2–10.4). The falls IRR was highest for borderline personality and bipolar disorder and lowest for schizophreniform and anxiety disorder. After adjusting for multiple confounders in the sample of mental health service users, borderline personality disorder yielded a higher and anxiety disorder a lower falls risk. Working age adults using mental health services have almost four times the incidence of hospitalised falls compared to general population. Targeted interventions are warranted. • Falls/hip fractures were more frequent in mental health patients than controls. • Borderline personality disorder had the highest incidence of hospitalised falls. • Anxiety disorder had the lowest incidence of falls, similar to controls. • Borderline personality disorder had a higher falls risk than other conditions. [ABSTRACT FROM AUTHOR]

Background: Before the COVID‐19 pandemic, very little was known about the impact of social isolation on individuals' alcohol use and misuse. This study examines how socially isolated individuals with a history of heavy drinking used alcohol during the pandemic. Methods: Data for this study came from an add‐on to the Managing Heavy Drinking (MHD) longitudinal study of drivers convicted of DWI that was conducted in Erie County, New York. Pre‐COVID information (October 2019–March 2020) was augmented with a COVID‐19 questionnaire collected between July and August 2020. A total of 92 participants completed the COVID‐19 survey. Results: The sample of problem drinkers showed a significant increase after the pandemic outbreak in the average number of drinking days from 1.99 to 2.49 per week (p = 0.047), but a significant decrease in the average number of drinks per drinking day, from 3.74 to 2.74 (p = 0.003). The proportion of individuals who drank more frequently was greater among those who, before the outbreak had an Alcohol Use Disorders Identification Test (AUDIT) score <8 (26% increase) compared with those with an AUDIT score of >8 (13%). Alcohol treatment was also associated with the frequency of drinking, with individuals who were not in alcohol treatment showing a 16% increase in frequency compared with a 10% increase among those in treatment. Further, individuals who, after the outbreak worried about their health (30%) or finances (37%) reported greater increases in the frequency of drinking than those who did not worry about their health (17%) or finances (10%). Conclusions: Overall, the individuals in our sample showed small changes in the frequency andheaviness of drinking after the outbreak of COVID‐19, effects that opposite in direction from one another and thus resulted in no overall change in drinks consumed. Nonetheless, we identified factors that influenced the effects of the pandemic on drinking behavior among individuals convicted of DWI, which emphasizes the need to individualize these individuals' treatment, particularly in the context of dramatic environmental change. [ABSTRACT FROM AUTHOR]

Purpose: Interactions with caregivers during the ordinary activities that occur as families go about their everyday lives are critical to supporting children’s acquisition of social communication and language skills. The purpose of this study was to examine child communication and parent verbal responsiveness across interaction contexts in 211 children (Mage = 20 months) on the autism spectrum (n = 121), with developmental delay (n = 46), or with typical development (n = 44). Method: Families participated in up to eight activities during an hour-long, video-recorded home observation. We tested differences in the strength of associations between diagnostic group and interaction context using linear mixed-effects models, with child rate per minute of communication and proportions of parent follow-in comments and directives as outcome variables. Child communicative functions expressed across contexts were also examined. Results: Children across groups communicated at significantly higher rates per minute during book sharing and play with people compared to other interaction contexts. Most child communication was for the function of joint attention during book sharing, for social interaction during play with people, and for behavior regulation during necessary activities such as family chores and meals. On average, parents of children responded using proportionally more follow-in comments during book sharing and play compared to necessary activities, during which parents used more follow-in directives. Conclusion: Results provide a glimpse into the dyadic communication that may occur within everyday activities at home, which supports the need for future intervention research and may aid clinicians seeking to identify activities that serve as important contexts for intervention. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to examine the impact of an intervention in which childcare providers (CCPs) are coached to support toddlers' gesture use during every day classroom routines. Method: This study uses a multiple-baseline across strategies single-case experimental design to examine the impact of a coaching intervention on three CCPs' use of communication strategies with toddlers experiencing early childhood poverty. The CCPs were coached with a systematic framework called Setting the Stage, Observation and Opportunities to Embed, Problemsolving and Planning, Reflection and Review as they learned to implement three strategies to support toddlers' gesture use--modeling gestures with a short phrase, opportunities to gesture, and responding/expanding child gestures. CCPs were coached during book sharing and another classroom routine of their choice. Social validity data on the coaching approach and on the intervention strategies were gathered from postintervention interviews. Results: The visual analysis and nonoverlap of all pairs' effect size indicates that the coaching intervention had a functional relation with CCPs' use of modeling gestures and responding/expanding gestures during book sharing, play, and circle time. Social validity data indicate that CCPs found the coaching framework supportive of their learning and feelings of self-efficacy, and that the intervention strategies supported their toddlers' communication. Conclusions: The coaching framework was used to increase CCP strategy use during everyday classroom routines with toddlers. CCPs endorsed the coaching approach and the intervention strategies. This study adds to the literature supporting efforts to enhance children's earliest language learning environments. [ABSTRACT FROM AUTHOR]

Immune checkpoint inhibitors (ICIs) alone or in combination with chemotherapy (CT) are the current standard of therapy in several cancer types. Patients (pts) with lung cancer display higher response rates to CT when given after ICIs. Although ICIs have failed to demonstrate antitumour activity in microsatellite stable (MSS) metastatic colorectal cancer (mCRC), little is known about CT effect after ICIs. We aimed to assess whether sequential ICIs followed by CT may be an alternative therapeutic approach in a population of pts with mCRC. We retrospectively assessed CT after ICI (CAICI) failure in pts with mCRC. The ICI regimen consisted of anti-PD(L)1 alone or in combination. The primary end-point was objective response rate. Progression-free survival (PFS) and overall survival (OS) were secondary end-points. Between 2014 and 2018, 29 pts with mCRC received CAICI (MSS tumours, 27 pts [86%]). The median number of previous lines was 4 (range, 2–7). Regimens included TAS-102 (n = 14), FOLFIRI (irinotecan, leucovorin, and fluorouracil; n = 6) or FOLFOX (oxaliplatin, leucovorin, and fluorouracil; n = 4), regorafenib (n = 3) and carboplatin (1 pt with BRCA mutation). Partial response and stable disease were observed in 4 (19%) and 9 (43%) pts, respectively (disease control rate, 62%). The median PFS and OS were 3.8 months (95% confidence interval [CI] = 1.5–5.4) and 8.0 months (95% CI = 4.2–14.0), respectively. ICIs administered before CT might enhance cytotoxic effects even in pts with immunorefractory MSS mCRC. The results of this small cohort need to be validated in independent prospective cohorts. The role of ICIs as modifiers of both tumour cells and microenvironment in mCRC deserves further research. • Chemotherapy (CT) beyond immunotherapy was assessed in patients with metastatic colorectal cancer (mCRC). • Immunotherapy followed by CT provides tumour control in mCRC. • Immunorefractory mCRC could benefit from sequential immunotherapy and CT. • Immunotherapy-induced delayed effects might enhance chemotherapy in mCRC. [ABSTRACT FROM AUTHOR]

This study evaluated the effect of extending the duration of exposure to curing light on the depth of cure of two conventional (RBC1‐conventional and RBC2‐conventional) and two bulk‐fill (RBC1‐bulk and RBC2‐bulk) resin composites. Polywave and single‐peak photocuring units were used. Cylinder‐shaped specimens were exposed to curing light either for the time period recommended by the manufacturer or twice the length of that time, and depth of cure was estimated using manual scraping (similar to the ISO‐4049 standard) and solvent immersion techniques. Depth of cure was analyzed, using two‐way ANOVA, for the factors measurement method and exposure time. For RBC1‐conventional and RBC1‐bulk, the solvent immersion technique estimated a greater depth of cure than did manual scraping; for RBC1‐conventional, both techniques and both light‐exposure time periods resulted in a depth of cure of >2 mm; and for RBC1‐bulk, only the solvent method after photocuring for twice the manufacturer's recommended time resulted in a depth of cure of 5 mm. For RBC2‐conventional and RBC2‐bulk, neither technique nor exposure time resulted in estimated depths of cure that matched those indicated by the manufacturer. The results suggest that extending the duration of photopolymerization increases depth of cure. Also, calculation of depth of cure can vary according to the measurement technique used. [ABSTRACT FROM AUTHOR]

Background: Pulmonary vein isolation is the cornerstone of catheter ablation in patients with atrial fibrillation (AF). However, with advanced left atrial (LA) structural changes, additional targeted catheter ablation of low‐voltage zones (LVZs) has produced favorable results. Therefore, with the advent of single‐shot techniques, it would be helpful to predict the presence of LVZs before an ablation procedure. Objective: We hypothesized that computed tomography (CT)‐derived left atrial volume index (LAVI), in combination with other objective parameters, could be used to develop a score able to predict the presence of LVZs. Methods: In a large cohort of patients undergoing their first AF ablations, comprehensive echocardiographic evaluations and cardiac CT were performed. During the electrophysiological studies, LA geometry and electroanatomic voltage maps were created. LVZs were defined as areas ≥1 cm2 with bipolar peak‐to‐peak voltage amplitudes ≤0.5 mV. Results: In a derivation cohort of 374 patients, predictors of LVZs were identified by regression analysis and used to build the Zentralklinik Bad Berka and University of L'Aquila (ZAQ) score (age ≥65 years; female sex; and CT‐LAVI ≥57 mL/m2). The ZAQ score of 2 points accurately identified the presence and the extent of LVZs (area under the curve [AUC], 0.809; 95% confidence interval [CI], 0.758‐0.861; P <.001 and 3 [interquartile range, IQR, 1.5‐4.5] vs 7 cm2 [IQR 4‐9]; P =.001). In a validation cohort of 103 patients, the predictive value of the score was confirmed (AUC, 0.793; 95% CI, 0.709‐0.878; P <.001 and 4 [IQR, 2‐7] vs 11.5 cm2 [IQR, 8‐16.5]; P =.001). Conclusions: The ZAQ score identifies LVZs and may be useful for planning the ablation strategy ahead of time. [ABSTRACT FROM AUTHOR]

Background: Translation of findings from randomised controlled trials (RCT), the foundation of evidence‐based medicine, into clinical practice requires an understanding of relationships between patient characteristics, treatment practices and outcomes. We propose a novel technique, External Validity Analysis (EVA), to evaluate applicability of findings from a large RCT, comparing baseline characteristics, interventions and outcomes between the RCT and a large clinical database. Aim: To perform EVA of the findings of a randomised controlled trial (ESTHER‐1) to a population in an Australian clinic setting. To demonstrate this method, we evaluated the discordance in first cycle follicle‐stimulating hormone (FSH) exposure and outcomes between the two populations, to inform clinical practice. Materials and Methods: In this retrospective, descriptive analysis, we compared practices and outcomes between the follitropin alfa 'conventional' dosing arm of the ESTHER‐1 trial and a selected comparable clinic subpopulation of patients who underwent controlled ovarian stimulation using FSH. Results: Mean FSH exposure was 34% higher in the clinic subpopulation than in the trial subpopulation, resulting in higher average ovarian response without improving the likelihood of clinical pregnancy or live birth. Conclusions: EVA allowed for the comparison of a trial population with a selected clinic population with similar characteristics. With respect to FSH consumption, this analysis revealed higher exposure to FSH in the clinic setting without a corresponding benefit. The comparison reveals population differences as well as the potential to improve clinical outcomes through a reappraisal of current practices and objectives in gonadotropin dose selection. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to provide descriptive data on rates of expressive communication skill use in young children with Down syndrome (DS) across early childhood. Children with DS are known to have delays in expressive communication, but there are little current data on rates of communication in early skills, such as gestures, vocalizations, words, and word combinations. In addition, few studies use measures that offer a composite or "across-skills" view of early development across time. Method: This article used a longitudinal descriptive design to generate growth curves for expected rates of communication in young children with DS in 4 major skill elements as measured by the Individual Growth and Development Indicator-Early Communication Index. Using data from 19 children aged 11-42 months with DS, we used hierarchical linear modeling to generate growth curves for children with DS while comparing them to the benchmarked data available for children who are typically developing. Results: Results indicate relative strengths in gesture use, a longer period of vocalizations, and lower rates of growth in single and multiple word combinations across time. Children differed significantly from one another on all parameters. Conclusion: These data indicate a need to develop and research interventions to support the transition from gestures to words and that support early word combinations in young children with DS. [ABSTRACT FROM AUTHOR]

Background: According to the perception of nurses in the intensive care unit (ICU), surgical patients need more nursing care, thus requiring higher nursing workloads for these patients than those admitted as clinical patients. However, some study results on the relationship between the type of admission and the nursing workload are considered contradictory. Aims and objectives: To identify if the type of admission (clinical, emergency surgery or elective surgery) is a predictive factor of the nursing workload required by patients on the first day or throughout their stay in the ICU. Design: This was a quantitative cross‐sectional study comprised of a retrospective analysis of clinical records of critical patients. Methods: Data were collected from 1 May 2015 to 30 September 2015 in a hospital located in São Paulo, Brazil. Nursing workload was measured using the Nursing Activities Score. The type of admission and the demographic and clinical variables of the patients were investigated. Multiple linear regression was used to identify nursing workload predictive factors, with 5% significance level. Results: In the analysed sample (n = 211; mean age of 60·3 ± 18·7 years), there was a prevalence of male gender (56·9%). A statistically significant difference (p = 0·025) was found between the type of admission and the nursing workload required for patients on the first ICU day. The Simplified Acute Physiologic Score (p = 0·009) was a predictor of nursing workload on the first day in the ICU, and the Logistic Organ Dysfunction System (p = 0·026) and mortality (p < 0·001) were predictors throughout the ICU stay. Conclusions: The type of admission was not a predictive factor of the nursing workload required by critical patients. Relevance to clinical practice: Identifying the predictive factors of nursing workload favours the appropriate staffing of the critical unit by nurses. However, nurses should not consider the type of admission in predicting the nursing workload required by patients in the ICU. [ABSTRACT FROM AUTHOR]

Objective: Early initiation of renal replacement therapy (RRT) effect on survival and renal recovery of critically ill patients is still uncertain. We aimed to systematically review current evidence comparing outcomes of early versus late initiation of RRT in critically ill patients. Methods: We searched the Medline (via Pubmed), LILACS, Science Direct, and CENTRAL databases from inception until November 2016 for randomized clinical trials (RCTs) or observational studies comparing early versus late initiation of RRT in critically ill patients. The primary outcome was mortality. Duration of mechanical ventilation, intensive care unit (ICU) length of stay (LOS), hospital LOS, and renal function recovery were secondary outcomes. Meta-analysis and trial sequential analysis (TSA) were used for the primary outcome. Results: Sixty-two studies were retrieved and analyzed, including 11 RCTs. There was no difference in mortality between early and late initiation of RRT among RCTs (odds ratio [OR] = 0.78; 95% confidence interval [CI]: 0.52-1.19; I 2 = 63.1%). Trial sequential analysis of mortality across all RCTs achieved futility boundaries at both 1% and 5% type I error rates, although a subgroup analysis of studies including only acute kidney injury patients was not conclusive. There was also no difference in time on mechanical ventilation, ICU and hospital LOS, or renal recovery among studies. Early initiation of RRT was associated with reduced mortality among prospective (OR = 0.69; 95% CI: 0.49-0.96; I 2 = 85.9%) and retrospective (OR = 0.61; 95% CI: 0.41-0.92; I 2 = 90.9%) observational studies, both with substantial heterogeneity. However, subgroup analysis excluding low-quality observational studies did not achieve statistical significance. Conclusion: Pooled analysis of randomized trials indicates early initiation of RRT is not associated with lower mortality rates. The potential benefit of reduced mortality associated with early initiation of RRT was limited to low-quality observational studies. [ABSTRACT FROM AUTHOR]

Background and objectives: Guidelines for the management of neonatal hyperbilirubinemia have helped to reduce rates of significant hyperbilirubinemia. However, recent evidence suggesting overtreatment and potential harms of phototherapy have informed the American Academy of Pediatrics clinical practice guideline revision and the accompanying increase in phototherapy thresholds. These changes are predicted to safely reduce overuse; however, to date, the exact effect of these guidelines has not been established. Methods: We conducted a retrospective study of newborns born at ≥35 weeks' gestation across a network of 8 hospitals between January 2022 and June 2023. Outcomes included rates of phototherapy and total serum bilirubin (TSB) measurements before and after guideline publication, as well as clinical outcomes, including length of stay, readmissions, and duration of phototherapy. Results: In our cohort of >22 000 newborns, we observed a 47% decrease in phototherapy utilization, from 3.9% to 2.1% (P < .001). TSB measurements were reduced by 23%, from 712 to 551 measurements per 1000 newborns (P < .001), without an increase in outpatient TSB measurements. We did not observe an increase in readmissions receiving phototherapy, and length of stay increased by only 1 hour (P < .001). Conclusions: Our study reveals that the publication of the updated American Academy of Pediatrics 2022 hyperbilirubinemia guidelines has likely yielded a significant reduction in phototherapy use and serum bilirubin measurement. Dedicated quality improvement initiatives may help determine which implementation strategies are most effective. Further population-level studies are needed to confirm safety with ongoing guideline uptake. [ABSTRACT FROM AUTHOR]

Simple Summary: Extended thymectomy is the gold standard in the treatment of patients with thymic neoplasm and affected by myasthenia gravis. For a long time, the traditional approach has been sternotomy, though the application of minimally invasive techniques has spread in recent decades. Several authors have demonstrated the safety and feasibility of minimally invasive thymectomy. This multicenter study aims to compare the outcomes of robotic and open thymectomy in myasthenic patients affected by thymic tumors. Short-term and long-term results were presented, showing how the robotic approach can be considered comparable to open surgery in terms of oncological radicality and the improvement of myasthenic symptomatology, with associated faster recovery. Thymectomy is the gold standard in the treatment of thymic neoplasm and plays a key role in the therapeutic path of myasthenia gravis. For years, sternotomy has been the traditional approach for removing anterior mediastinal lesions, although the robotic thymectomy is now widely performed. The literature is still lacking in papers comparing the two approaches and evaluating long-term oncological and neurological outcomes. This study aims to analyze the postoperative results of open and robotic thymectomy for thymic neoplasms in myasthenic patients. Surgical, oncological and neurological data of myasthenic patients affected by thymic neoplasms and surgically treated with extended thymectomy, both with the open and the robotic approach, in six Italian Thoracic Centers between 2011 and 2021 were evaluated. A total of 213 patients were enrolled in the study: 110 (51.6%) were treated with the open approach, and 103 (48.4%) were treated with robotic surgery. The open surgery, compared with the robotic, presented a shorter operating time (p < 0.001), a higher number of postoperative complications (p = 0.038) and longer postoperative hospitalization (p = 0.006). No other differences were observed in terms of surgical, oncological or neurological outcomes. The robotic approach can be considered safe and feasible, comparable to the open technique, in terms of surgical, oncological and neurological outcomes. [ABSTRACT FROM AUTHOR]

The mental health needs of children and adolescents living with HIV (ALHIV) in Namibia are poorly understood, despite the dramatic improvement in their survival. ALHIV in resource poor contexts face particular risk factors, such as poverty, orphanhood, and poor social support. This study examines the mental health of ALHIV in Namibia, and the factors that contribute to mental health problems. A case-control design assessed emotional and behavioural symptoms of distress, risk and protective factors among adolescents aged 12-18 years. Case participants were 99 HIV-positive adolescents. Case controls were 159 adolescents from the same community who were not known to be HIV seropositive at the time of the study. Control group participants were selected from schools using a stratified random sampling. A larger proportion of HIV-positive adolescents were orphaned (62.6% vs. 20.8%, p < .001); the groups showed no differences in poverty factors. HIV-positive adolescents scored lower than the control group on total perceived social support (p < .05) and caregiver support (p < .05), but no differences in perceived friend support and support from a self-selected person were present. HIV-positive adolescents reported significantly more total emotional and behavioural difficulties (p = .027) and conduct problems (p = .025), even after controlling for socio-demographic factors. However, after controlling for the effects of orphanhood, group differences in mental health outcomes were no longer significant. Furthermore, mediation analysis suggested that social support completely mediated the relationship between HIV status and mental health (standardised pathway coefficients = .05, p = .021). Policies and programmes that aim to strengthen social support and take orphanhood status into consideration may improve the mental health of adolescents living with HIV. [ABSTRACT FROM AUTHOR]

This study used a single-case, multiple baseline design to examine the effectiveness of collaborative coaching on three Early Head Start (EHS) teachers' use of responsive communication strategies with toddlers with communication delays. Child communication targets and teacher communication strategies were measured as secondary outcomes. The coaching approach included a joint planning session in which the interventionist and teachers chose child targets and how to embed strategies within classroom routines. The teachers increased their use of the responsiveness strategies in play and caregiving routines during intervention and maintenance. Child participants also increased their rates of communication during intervention and maintenance. Implications for professional development and the social validity of the approach are discussed. [ABSTRACT FROM AUTHOR]

Abstract: This qualitative study examined caregivers' experiences with SafeCare®, an evidence‐based programme that focuses on child neglect through modules on health, safety, and parenting. Shortly after completing SafeCare, 30 caregivers participated in a semi‐structured interview about their experiences with the programme. Overall, caregivers indicated that the programme helped with improvements in their parenting skills. Among the factors that contributed to a positive experience were the simplicity of language, the skills‐based approach, and the quality of the relationship with the SafeCare provider. Caregivers also noted several factors that made it difficult to fully benefit from the programme, including financial constraints, removal of their child from the home, and general distrust towards the child welfare system. Findings provide relevant information for SafeCare providers in terms of identifying areas that work well for caregivers completing the programme, as well as areas that might serve as impediments. Implications for contemporary child welfare practice are also considered. [ABSTRACT FROM AUTHOR]

Background: Use of echocardiography (echo) has exponentially increased in recent decades. Concerned about this scientific society developed appropriate use criteria (AUC). Clinical management still suffers geographical variations, and no objective data are available about echo AUC in developing countries. We aimed to evaluate (1) the appropriateness of referrals and (2) their relation to changes in clinical decision management. Methods: Prospective analysis of referrals from January to December 2014. Appropriateness and endpoints analyzed in different time points from medical archives. Endpoints: (1) change in the diagnosis, (2) indication for another method to complete the diagnosis, (3) change in clinical treatment, (4) indication for a treatment intervention, or (5) no change in management. Descriptive statistical analysis, Fisher's or chi‐square tests, and Cox regression used as appropriate (significance if P < .05). Results: One thousand one hundred referrals were analyzed (55.5 ± 16.1 years, 44.6% male). 80.5% of referrals were appropriate (A), 11.2% “Rarely Appropriate” (RA), and 8.3% “May Be Appropriate” (MBA). Proportion of (A) did not differ between modalities (TTE‐80.5% vs TEE‐87.7% vs STR‐81.2%, P = .67). (A) referrals were more related to clinical decision than (RA)+(MBA) (38.9% [A] vs 15% [RA]+[MBA], P < .001). The most frequent clinical indications of (RA) and (MBA) TTE were reevaluation of ventricular function without clinical change (AUC 10 and 11) and search of infectious endocarditis when low clinical probability (53). Conclusions: In a developing country, appropriateness of echo was similar to the United States and Europe. However, a significant proportion of referrals were still (RA) or (MBA), with no effect in clinical management. Controlling referrals 10, 11, and 53 can optimize echo use in developing countries. [ABSTRACT FROM AUTHOR]

Background Little research in sub-Saharan Africa has looked at factors that predict mental health problems in adolescents living with HIV ( ALHIV). This study examines the psychological impact of HIV in adolescents in Namibia, including risk and protective factors associated with mental health. Methods Ninety-nine fully disclosed ALHIV between the ages of 12 and 18 were interviewed at a State Hospital in Windhoek. A structured questionnaire assessed mental health, using the SDQ (Goodman, 1997), sociodemographic factors, poverty, social support, adherence and stigma. Results Mean age was 14.3 years, 52.5% were female and most were healthy. Twelve percent scored in the clinical range for total mental health difficulties and 22% for emotional symptoms. Poverty was associated with more total mental health difficulties, t(96) = −2.63, p = .010, and more emotional symptoms, t(96) = −3.45, p = .001, whereas better social support was a protective factor, particularly caregiver support ( r = −.337, p = .001). Adherence problems, HIV-related stigma and disclosing one's own HIV status to others were also associated with more total mental health difficulties. Poverty ( β = −.231, p = .023) and stigma ( β = .268, p = .009) were the best predictors for total mental health difficulties, whereas stigma ( β = .314, p = .002) predicted emotional symptoms. Social support had a protective effect on peer problems ( p = .001, β = −.349). Conclusions Several contextual factors associated with poorer mental health in ALHIV are identified. [ABSTRACT FROM AUTHOR]

In a previous effort we showed that compared with immigrants who are permanent residents, undocumented immigrants are more likely to binge drink, but less likely to drink while impaired (DWI) partly due to their limited amount of driving. This report examines a related risk: riding with an impaired driver (RWI). Data came from an ongoing longitudinal sample of Latino immigrants to Miami-Dade County, FL. Descriptive analyses and regression techniques were applied. While DWI rates among Latino immigrants is heavily limited by their access to a car, RWI rates were not restricted by driving limitations, nor related to participants' legal immigration status (LIS). RWI rates were linked only to heavy drinking. Because it is not affected by driving limitations, RWI for these Latino immigrants is perhaps a more immediate risk than DWI. Addressing RWI among Latino immigrants should be a priority for traffic safety to Miami/Dade country. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of exposure to pesticides on the central auditory functions (CAF) of Brazilian tobacco growers.Design: This was a cross-sectional study carried out between 2010 and 2012. Participants were evaluated with two behavioural procedures to investigate CAF, the random gap detection test (RGDT) and the dichotic digit test in Portuguese (DDT).Study sample: A total of 22 growers exposed to pesticides (study group) and 21 subjects who were not exposed to pesticides (control group) were selected.Results: No significant differences between groups were observed for pure-tone thresholds. A significant association between pesticide exposure and the results for RGDT and DDT was found. Significant differences between pesticide-exposed and nonexposed subjects were found for RGDT frequency average and DDT binaural average, when including age and hearing level as covariates. Age was significantly associated with RGDT frequency average, DDT left ear score, DDT binaural average and DDT right ear advantage. Hearing levels were not significantly associated with any of the test scores. The relative risk of failing the DDT and RGDT for the study group was 1.88 (95% CI: 1.10–3.20) and 1.74 (95% CI: 1.06–2.86), respectively, as compared with the control group.Conclusions: The results showed that tobacco growers exposed to pesticides exhibited signs of central auditory dysfunction characterised by decrements in temporal processing and binaural integration processes/abilities. [ABSTRACT FROM PUBLISHER]

Purpose. To report the early outcomes of iontophoresis-assisted corneal collagen cross-linking procedure with epithelial debridement (I-SCXL). Methods. Twenty eyes of twenty patients with progressive keratoconus were included in this prospective clinical study. Best spectacle corrected visual acuity (BSCVA), sphere and cylinder refraction, corneal topography, Scheimpflug tomography, aberrometry, anterior segment optical coherence tomography (AS-OCT), and endothelial cell count were assessed at baseline and at 1, 3, and 6 months of follow-up. The parameters considered to establish keratoconus progression were always proven with differential maps as change in curvature in the cone area of at least 1 diopter obtained with an instantaneous map. Results. Functional parameters showed a significant improvement (p<0.05) of BSCVA after 3 and 6 months of follow-up. Morphological parameters indicated stabilization of the corneal ectasia during the follow-up; however, a positive trend was noted with a mean flattening of 1.73 D. Minimum pachymetry values showed thinning that remained constant after the treatment. The demarcation line was clearly visible in all patients, reaching a depth of 308.2±37.74 μm. None of the patients had continuous progression of keratoconus or had to repeat cross-linking procedures. Endothelial cell counts did not change significantly (p>0.05). Conclusion. The early results indicate that the I-SCXL may be able to reduce the treatment time and improve the riboflavin diffusion. [ABSTRACT FROM AUTHOR]

Background: Little is known about community pharmacist–patient interaction within a consultation room, particularly in terms of patient activation and engagement. Objective: To explore pharmacists' communication and attitudes while providing advanced medication‐related services. Methods: A cross‐sectional descriptive study, using the Roter Interaction Analysis System (RIAS) framework, to analyse a sample of audio‐recorded pharmaceutical care consultations with elderly patients. Results: Around 15.0 per cent of pharmacists' utterances and 3.6 per cent of patients' were related to engagement with the latter during the exchange. To improve health outcomes, such as adherence to a therapeutic regime, pharmacists should augment patients' participation in the dialogue, facilitating concerns and disclosure of doubts, thus improving correct medication use behaviour. [ABSTRACT FROM AUTHOR]

BACKGROUND: Environmental cadmium (Cd) exposure is associated with type 2 diabetes. However, the association of Cd and gestational diabetes mellitus (GDM) is unknown. OBJECTIVES: We examined the association between body burden of Cd and GDM risk. METHODS: We used 140 GDM cases and 481 randomly selected noncase subcohort members from the Omega Study to conduct a case-cohort study. Creatinine (Cr)--corrected Cd in early pregnancy urine (U-Cd) was measured by inductively coupled plasma mass spectrometry. Tertiles (< 0.29; 0.29--0.42; > 0.43 μg/g Cr) were defined using the subcohort's U-Cd distribution. GDM was diagnosed using the 2004 American Diabetes Association guidelines. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression. RESULTS: GDM cases had higher geometric mean U-Cd (0.39 μg/g Cr; 95% CI: 0.37, 0.41) than noncases (0.31 μg/g Cr; 95% CI: 0.29, 0.33). Odds ratios for GDM increased with increasing U-Cd tertile (OR = 1.64; 95% CI: 0.88, 3.05 for middle vs. low tertile; OR = 2.07; 95% CI: 1.15, 3.73 for high vs. low tertile; p-trend = 0.015). Overweight/obesity (body mass index ≥ 25 kg/m²) did not modify the association between U-Cd and GDM (p = 0.26). CONCLUSIONS: Our findings suggest that body burden of Cd increases risk of GDM in a dose-dependent manner. Improved understanding of environmental factors influencing GDM may facilitate early identification of women at high risk of GDM. [ABSTRACT FROM AUTHOR]

Simple Summary: Early prediction of response to cancer therapies is critical for treatment personalisation. In patients with locally advanced rectal cancer (LARC) undergoing neoadjuvant chemoradiation therapy (nCRT), delta radiomics applied to mesorectal features could potentially lead to the development of predictive models of treatment response. Pre- and post-treatment MRIs of patients treated at a single institution were analysed. Radiomic features of the mesorectum and GTV were extracted and predictive models of pathological complete response (pCR) and two-year disease-free survival (2yDFS) were developed. In 203 patients with LARC, a total of 565 variables were evaluated; the best performing 2yDFS prediction model was based on one GTV and two mesorectal features with an AUC of 0.79 in the training set and 0.70 in the validation set. The mesorectum may contain important radiomics information for predicting response to nCRT treatment in LARC patients. Background: The aim of this study is to evaluate the delta radiomics approach based on mesorectal radiomic features to develop a model for predicting pathological complete response (pCR) and 2-year disease-free survival (2yDFS) in locally advanced rectal cancer (LARC) patients undergoing neoadjuvant chemoradiotherapy (nCRT). Methods: Pre- and post-nCRT MRIs of LARC patients treated at a single institution from May 2008 to November 2016 were retrospectively collected. Radiomic features were extracted from the GTV and mesorectum. The Wilcoxon–Mann–Whitney test and area under the receiver operating characteristic curve (AUC) were used to evaluate the performance of the features in predicting pCR and 2yDFS. Results: Out of 203 LARC patients, a total of 565 variables were evaluated. The best performing pCR prediction model was based on two GTV features with an AUC of 0.80 in the training set and 0.69 in the validation set. The best performing 2yDFS prediction model was based on one GTV and two mesorectal features with an AUC of 0.79 in the training set and 0.70 in the validation set. Conclusions: The results of this study suggest a possible role for delta radiomics based on mesorectal features in the prediction of 2yDFS in patients with LARC. [ABSTRACT FROM AUTHOR]

Longitudinal designs are common in the field of athletic training. For example, in the Journal of Athletic Training from 2005 through 2010, authors of 52 of the 218 original research articles used longitudinal designs. In 50 of the 52 studies, a repeatedmeasures analysis of variance was used to analyze the data. A possible alternative to this approach is the hierarchical linear model, which has been readily accepted in other medical fields. In this short report, we demonstrate the use of the hierarchical linear model for analyzing data from a longitudinal study in athletic training. We discuss the relevant hypotheses, model assumptions, analysis procedures, and output from the HLM 7.0 software. We also examine the advantages and disadvantages of using the hierarchical linear model with repeated measures and repeated-measures analysis of variance for longitudinal data. [ABSTRACT FROM AUTHOR]