Preparing healthcare leaders of the digital age with an integrative artificial intelligence curriculum: a pilot study

Artificial intelligence (AI) is rapidly being introduced into the clinical workflow of many specialties. Despite the need to train physicians who understand the utility and implications of AI and mitigate a growing skills gap, no established consensus exists on how to best introduce AI concepts to medical students during preclinical training. This study examined the effectiveness of a pilot Digital Health Scholars (DHS) non-credit enrichment elective that paralleled the Dartmouth Geisel School of Medicine's first-year preclinical curriculum with a focus on introducing AI algorithms and their applications in the concurrently occurring systems-blocks. From September 2022 to March 2023, ten self-selected first-year students enrolled in the elective curriculum run in parallel with four existing curricular blocks (Immunology, Hematology, Cardiology, and Pulmonology). Each DHS block consisted of a journal club, a live-coding demonstration, and an integration session led by a researcher in that field. Students' confidence in explaining the content objectives (high-level knowledge, implications, and limitations of AI) was measured before and after each block and compared using Mann-Whitney U tests. Students reported significant increases in confidence in describing the content objectives after all four blocks (Immunology: U = 4.5, p = 0.030; Hematology: U = 1.0, p = 0.009; Cardiology: U = 4.0, p = 0.019; Pulmonology: U = 4.0, p = 0.030) as well as an average overall satisfaction level of 4.29/5 in rating the curriculum content. Our study demonstrates that a digital health enrichment elective that runs in parallel to an institution's preclinical curriculum and embeds AI concepts into relevant clinical topics can enhance students' confidence in describing the content objectives that pertain to high-level algorithmic understanding, implications, and limitations of the studied models. Building on this elective curricular design, further studies with a larger enrollment can help determine the most effective approach in preparing future physicians for the AI-enhanced clinical workflow.

Parents and teachers' perspectives on a school-located influenza vaccination program: A pilot study in the Region of Murcia, Spain

During the 2022-2023 season, the Region of Murcia (an autonomous community of Spain) introduced the influenza vaccination campaign in children aged 24-59 months with the live-attenuated influenza nasal spray vaccine. To expand coverage, a pilot study was conducted to include the 3- to 4-year population in 24 public schools. The aim of the study was to assess the experiences of parents and teachers involved in the project. This was a psychosocial qualitative study in which information was collected from a cohort of 23 parents and 17 teachers who attended three and two focus group sessions, respectively. A high degree of satisfaction with the school-located influenza vaccination program was consistently reported. The teachers reported creating a friendly environment and acting as companions to support children in the absence of their parents. They also considered the intranasal route, which avoids intramuscular puncture, as a facilitating element that turned the vaccination process into a kind of game. Parents emphasized the importance of vaccination to protect their children, and secondarily, to ensure protection of the family nucleus. Some parents who had their children already vaccinated in the health care center reported preference for the school setting, probably selecting this option in the future. The availability of school-based influenza vaccination promoted greater equity in accessing the vaccine and facilitated family reconciliation. To optimize coverage and minimize potential reluctance, providing the necessary information to parents both before and after vaccination was considered. School-located influenza vaccination was feasible and is a valuable strategy to be implemented in future campaigns.

UCOMB-real life data: treatment strategies for chronic urticaria patients with comorbidities

BACKGROUND

There is a lack of real-life safety data on treatment options for chronic urticaria in the presence of comedication and comorbidities.

METHODS

We present a single-center UCARE pilot study of 212 outpatients with chronic urticaria. Patients were divided into three groups according to different CU therapies according to international guidelines.

RESULTS

Of 212 patients, 108 (mean age 48.9 years, 71.3% female) had 59 comorbidities, including cardiovascular, autoimmune and malignant diseases. Patients were followed for a mean of 24.6 months (SD ± 21.3). Urticaria therapies were divided into three groups: A: 105 (97.2%) with omalizumab and 2nd generation antihistamines), B: 16 patients (14.8%): dual therapy with antihistamines and cyclosporine in 10 (9.3%), montelukast in five (4. 6%), dapsone in four (3.7%), hydroxychloroquine in one patient (0.9%), C: 12 (11.1%) patients received a third drug for 4.9 months (SD ± 3.2) and one quadruple therapy (2.1 months). 10 out of 12 (83.3%) patients received montelukast, two (16.7%) cyclosporine, two (16.7%) dapsone and one (8.3%) hydroxychloroquine as a third drug for chronic urticaria.

CONCLUSIONS

Combining treatment modalities for chronic urticaria and comorbidities are available and feasible with a good safety profile.

Efficacy and safety of a novel 785 nm picosecond neodymium-doped yttrium aluminum garnet laser for the treatment of facial benign pigmented lesions in Asian skin: a pilot study

BACKGROUND AND OBJECTIVES

Benign pigmented lesions and a general uneven tone in people with skin of color are growing issues that have been presented to dermatologists. To the best of our knowledge, this is the first controlled study to examine the efficacy and safety of using the newly introduced 785 nm neodymium-doped yttrium aluminum garnet (Nd:YAG) picosecond laser to treat facial benign pigmented lesions in Asian patients with diffractive lens array.

MATERIALS AND METHODS

A 785 nm Nd:YAG picosecond laser was used to treat 15 healthy female volunteers older than 18 years who had Fitzpatrick skin types II-IV and facial benign pigmented lesions. Each volunteer received five weekly treatments in dual modes. The clinical improvement was assessed by independent investigators and by objectively measuring the melanin index.

RESULTS

After the treatment, the melanin and erythema indices decreased, and the pigmented lesions showed clinical improvements. No serious adverse effects were observed during the study period.

CONCLUSIONS

A 785 nm Nd:YAG picosecond laser may be safe and effective in treating facial benign pigmented lesions in Asian skin.

Evaluation of the clinical usefulness of pancreatic alpha amylase as a novel biomarker in dogs with acute pancreatitis: a pilot study

Pancreatic alpha amylase (P-AMY) is used as a biomarker of acute pancreatitis (AP) in human medicine. To our knowledge, there are no studies evaluating the usefulness of P-AMY in dogs with AP. In this study, we evaluated the diagnostic value of P-AMY, currently not verified in veterinary medicine. The AP group (n = 40) consisted of dogs with AP diagnosed using clinical signs and laboratory examinations, including abnormal canine pancreatic lipase (cPL) concentration, and compatible abdominal ultrasound examination at first presentation. Evaluation of the canine AP severity (CAPS) score was performed. The control group (n = 38) was composed of normal dogs without any abnormalities in clinical findings, blood exams or diagnostic imaging. The correlation of P-AMY with cPL was confirmed by Pearson's correlation analysis (r = 0.564, p < .001). The sensitivity and specificity for the most appropriate cut-off values of P-AMY were recorded similar to the values of DGGR. The dogs with AP and CAPS ≥11 had significantly higher serum P-AMY (p = .016) contrary to DGGR lipase and cPL. Furthermore, there was a significant difference in the median P-AMY dependent on the presence of systemic inflammatory response syndrome (p = .001). P-AMY showed similar level of diagnostic accuracy along with sensitivity and specificity compared to DGGR lipase. In addition, P-AMY showed a significant association with CAPS score, contrary to cPL and DGGR lipase. Along with other biomarkers associated with AP, P-AMY has the potential of usefulness as a supportive diagnostic and prognostic biomarker of AP in dogs.

Evaluation of serum levels of soluble vascular endothelial (sVE)-Cadherin in early- and late-onset preeclampsia serum sVE-Cadherin levels in preeclampsia

OBJECTIVE

Endothelial dysfunction is a major feature of preeclampsia. sVE-cadherin plays a role in the preservation and regulation of the endothelial barrier. For that reason, to evaluation of sVE-cadherin may help elucidate the disease pathophysiology of preeclampsia.

METHODS

The sample size was calculated as a minimum of 46 pregnant women for each group based on serum sVE-Cadherin levels in a pilot study of 10 preeclamptic and 10 control groups. Hundred-twenty pregnancies complicated with early-onset (n = 60) and late-onset (n = 60) preeclampsia were compared with 120 gestational-age (GA)-matched (±1 week) uncomplicated pregnancies. The venous blood sampling was performed upon preeclampsia diagnosis prior to the onset of the labor in the preeclampsia group and the matching (±1 week) pregnancy week in the control group. Demographic and biochemical parameters were evaluated.

RESULTS

Mean serum sVE-Cadherin was significantly higher in women with EOPE compared to that of the GA-matched control group (5.86 ± 1.57 ng/mL vs. 2.28 ± 0.80 ng/mL, p < 0.001), in women with LOPE compared to that of the GA-matched control group (3.11 ± 0.97 ng/mL vs. 1.69 ± 0.87 ng/mL, p < 0.001), and in women with EOPE compared to that of LOPE group (5.86 ± 1.57 ng/mL vs. 3.11 ± 0.97 ng/mL, p < 0.001) after correction for GA. Serum sVE-Cadherin positively correlated with systolic and diastolic blood pressure and a negative correlation with gestational age at sampling.

CONCLUSION

The serum level of sVE-Cadherin was higher in women with preeclampsia than that of GA-matched healthy pregnant women, in women with EOPE compared to that of LOPE. sVE-Cadherin is an important marker in early-onset pre-eclampsia with severe clinical findings.

Ethnic differences in CT derived abdominal body composition measures: a comparative retrospect pilot study between European and Inuit study population

Understanding ethnic variations in body composition is crucial for assessing health risks. Universal models may not suit all ethnicities, and there is limited data on the Inuit population. This study aimed to compare body composition between Inuit and European adults using computed tomography (CT) scans and to investigate the influence of demographics on these measurements. A retrospective analysis was conducted on 50 adults (29 Inuit and 21 European) who underwent standard trauma CT scans. Measurements focused on skeletal muscle index (SMI), various fat indices, and densities at the third lumbar vertebra level, analyzed using the Wilcoxon-Mann-Whitney test and multiple linear regression. Inuit women showed larger fat tissue indices and lower muscle and fat densities than European women. Differences in men were less pronouncehd, with only Intramuscular fat density being lower among Inuit men. Regression indicated that SMI was higher among men, and skeletal muscle density decreased with Inuit ethnicity and age, while visceral fat index was positively associated with age. This study suggests ethnic differences in body composition measures particularly among women, and indicates the need for Inuit-specific body composition models. It higlights the importance of further research into Inuit-specific body composition measurements for better health risk assessment.

Hemodiafiltration with endogenous reinfusion for uremic toxin removal in patients undergoing maintenance hemodialysis: a pilot study

OBJECTIVE

To delineate the efficacy and safety profile of hemodiafiltration with endogenous reinfusion (HFR) for uremic toxin removal in patients undergoing maintenance hemodialysis (MHD).

METHODS

Patients who have been on MHD for a period of at least 3 months were enrolled. Each subject underwent one HFR and one hemodiafiltration (HDF) treatment. Blood samples were collected before and after a single HFR or HDF treatment to test uremic toxin levels and to calculate clearance rate. The primary efficacy endpoint was to compare uremic toxin levels of indoxyl sulfate (IS), λ-free light chains (λFLC), and β2-microglobulin (β2-MG) before and after HFR treatment. Secondary efficacy endpoints was to compare the levels of urea, interleukin-6 (IL-6), P-cresol, chitinase-3-like protein 1 (YKL-40), leptin (LEP), hippuric acid (HPA), trimethylamine N-oxide (TMAO), asymmetric dimethylarginine (ADMA), tumor necrosis factor-α (TNF-α), fibroblast growth factor 23 (FGF23) before and after HFR treatment. The study also undertook a comparative analysis of uremic toxin clearance between a single HFR and HDF treatment. Meanwhile, the lever of serum albumin and branched-chain amino acids before and after a single HFR or HDF treatment were compared. In terms of safety, the study was meticulous in recording vital signs and the incidence of adverse events throughout its duration.

RESULTS

The study enrolled 20 patients. After a single HFR treatment, levels of IS, λFLC, β2-MG, IL-6, P-cresol, YKL-40, LEP, HPA, TMAO, ADMA, TNF-α, and FGF23 significantly decreased (p < 0.001 for all). The clearance rates of λFLC, β2-MG, IL-6, LEP, and TNF-α were significantly higher in HFR compared to HDF (p values: 0.036, 0.042, 0.041, 0.019, and 0.036, respectively). Compared with pre-HFR and post-HFR treatment, levels of serum albumin, valine, and isoleucine showed no significant difference (p > 0.05), while post-HDF, levels of serum albumin significantly decreased (p = 0.000).

CONCLUSION

HFR treatment effectively eliminates uremic toxins from the bloodstream of patients undergoing MHD, especially protein-bound toxins and large middle-molecule toxins. Additionally, it retains essential physiological compounds like albumin and branched-chain amino acids, underscoring its commendable safety profile.

Postmenopausal women with higher TSH values within the normal range present improved handgrip strength: a pilot study

OBJECTIVE

To evaluate the possible association between thyroid function within the euthyroid range and musculoskeletal parameters as well as body composition in a sample of postmenopausal women.

METHODS

This cross-sectional study included 96 postmenopausal women with serum thyroid-stimulating hormone (TSH) within the normal laboratory reference range. Fasting venous blood samples were obtained for biochemical/hormonal assessment. Bone status and body composition were measured using Dual Energy X-ray absorptiometry (DXA). Physical activity was quantified using the International Physical Activity Questionnaire (IPAQ) index.

RESULTS

Serum TSH correlated with handgrip strength (HGS, r-coefficient = 0.233, p = .025), and total body bone mineral density (BMD) T-score values (r-coefficient = 0.321, p = .003). HGS measures were associated with BMD (r-coefficient = 0.415, p < .001), with bone mineral content (BMC, r-coefficient = 0.427, p < .001), and lean mass (r-coefficient = 0.326, p = .003). Women with low muscle strength, defined as HGS < 16 kg, had lower TSH levels than women with normal muscle strength (low vs. normal muscle strength, ANCOVA 1.13 ± 0.49 mU/L vs. 1.60 ± 0.83 mU/L, p = 0.024) independently of age, BMD, percentage of body fat or absolute lean mass. Multivariable linear regression analysis showed that HGS values were associated with TSH measurements (β-coefficient = 0.246, p = .014) and BMD T-score values (β-coefficient = 0.306, p = .002). All models were adjusted for age, body mass index (BMI), vitamin D, low-density lipoprotein cholesterol, current smoking, physical activity, and homeostasis model assessment of insulin resistance.

CONCLUSIONS

In this sample of postmenopausal women, lower serum TSH values, within normal range, were associated with lower muscle strength compared to higher normal TSH values. Further research is needed to elucidate the significance of our preliminary findings.

Predicting intensive care need in women with preeclampsia using machine learning - a pilot study

BACKGROUND

Predicting severe preeclampsia with need for intensive care is challenging. To better predict high-risk pregnancies to prevent adverse outcomes such as eclampsia is still an unmet need worldwide. In this study we aimed to develop a prediction model for severe outcomes using routine biomarkers and clinical characteristics.

METHODS

We used machine learning models based on data from an intensive care cohort with severe preeclampsia (n=41) and a cohort of preeclampsia controls (n=40) with the objective to find patterns for severe disease not detectable with traditional logistic regression models.

RESULTS

The best model was generated by including the laboratory parameters aspartate aminotransferase (ASAT), uric acid and body mass index (BMI) with a cross-validation accuracy of 0.88 and an area under the curve (AUC) of 0.91. Our model was internally validated on a test-set where the accuracy was lower, 0.82, with an AUC of 0.85.

CONCLUSION

The clinical routine blood parameters ASAT and uric acid as well as BMI, were the parameters most indicative of severe disease. Aspartate aminotransferase reflects liver involvement, uric acid might be involved in several steps of the pathophysiologic process of preeclampsia, and obesity is a well-known risk factor for development of both severe and non-severe preeclampsia likely involving inflammatory pathways..[Figure: see text].

Exploratory Pilot Studies to Demonstrate Mechanisms of Preventing Antibiotic-Associated Diarrhea and the Role for Probiotics

Context: Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host. One of the most common indications for probiotic treatment is the prevention of antibiotic-associated diarrhea (AAD). Unfortunately, many probiotic products used for AAD are not supported by rigorous independent research, and often results in non-evidence-based usage. Additionally, it is not clear when is the most appropriate time to take a probiotic when on an antibiotic course. Objectives: The primary aim is to determine the ability of BB-12 to impact antibiotic-induced reduction in short chain fatty acid concentration (SCFA), as reflected by the levels of acetate on day 14. Secondarily to determine the ability of BB-12 to impact antibiotic-induced disruption of the gut microbiota with 16S rDNA profiling, with the addition of the time variable of probiotic consumption. Study Design and Interventions: A five group randomized controlled trial, finished in December 2022, we are currently analyzing all the data, but will be finished much prior to NAPCRG. All participants were given a 7-day prescription for amoxicillin-clavulanic acid 875mg taken twice daily. One group received no other interventions. While the other participants were broken into 4 groups. Two groups consumed the yogurt intervention (either yogurt+probiotic or control yogurt) four hours after the antibiotic and two groups consumed the yogurt intervention (either yogurt+probiotic or control yogurt) concomitantly with antibiotics. This timing question is important, as it is unknown if the optimal time for patients to administer probiotics is concurrently with, or after four hours following antibiotic consumption. Setting: Capital Areal Primary Care Practice Based Research Network. Population Studied: 118 participants, ages 18-65 years, generally healthy. Outcome Measures: Change in SCFA among the five groups, microbiome reduced disruption and clinically diagnosed diarrhea. Results: Study is complete and analysis is underway. Should have full results by end of July 2023, much before NAPCRG. .

Fospropofol disodium versus propofol for long-term sedation during invasive mechanical ventilation: A pilot randomized clinical trial

STUDY OBJECTIVE

Fospropofol disodium is a propofol prodrug that is water-soluble and has a reduced risk of bacterial contamination and hypertriglyceridemia compared with propofol. Prior to implementing a large randomized trial, we investigated the feasibility, initial efficacy, and safety of fospropofol disodium compared with propofol in long-term mild-to-moderate sedation in intensive care units (ICUs).

DESIGN

Single-centered, prospective, unblind, randomized, parallel-group clinical trial.

SETTING

The general ICU of university-affiliated teaching hospital.

PATIENTS

Adult patients (n = 60) expected to have mechanical ventilation for >24 h were enrolled and randomly assigned to the fospropofol or propofol group.

INTERVENTIONS

The fospropofol group received continuous fospropofol disodium infusions and the propofol group received continuous propofol infusions. The sedation goal was a score of -3 to 0 on the Richmond Agitation and Sedation Scale (RASS).

MEASUREMENTS

The primary outcome was the percentage of time spent in the target sedation range without rescue sedation. Safety outcomes were based on adverse events. Blood samples were collected to measure formate concentration in plasma.

MAIN RESULTS

The median dose was 4.33 (IQR, 3.08-4.94) mg/kg/h in the fospropofol group and 1.96 (IQR, 1.44-2.94) mg/kg/h in the propofol group. The median percentage of time spent in the target RASS range without rescue sedation was identical in both groups, with 83.33% (IQR, 74.43%-100.00%) in the fospropofol group and 83.33% (IQR, 77.45%-100.00%) in the propofol group (p = 0.887). At least one adverse event was identifed in 23 (76.7%) fospropofol patients and 27 (90.0%) propofol patients. The most common adverse events were tachycardia and hypotension. No paresthesia, catheter-related bloodstream infection or propofol infusion syndrome in both groups was reported. Three patients in the fospropofol group had mild hypertriglyceridemia, and nine patients in propofol group had hypertriglyceridemia (mild in eight patients and moderate in one patient) (10% versus 30%, p = 0.104). The formate concentration in plasma was very low, and no significant difference was identified at any time point between the two groups.

CONCLUSIONS

Fospropofol disodium appears to be a feasible, effective and safe sedative for patients receiving invasive mechanical ventilation with long-term sedation.

Menthol versus tobacco e-liquid flavor: Impact on acute subjective effects, puff patterns, and intentions for use among Black and White menthol smokers

BACKGROUND

The proposed FDA product standard to prohibit menthol as a characterizing flavor in combustible cigarettes has the potential to significantly reduce tobacco-related health disparities. Whether a menthol e-liquid product standard would improve or hinder public health is unknown. No known research has directly examined the impact of menthol vs. tobacco flavored e-liquid use on acute e-cigarette use patterns, subjective experience, behavioral intentions, and craving and withdrawal among menthol cigarette smokers.

METHODS

Black (n = 47) and White (n = 4) nicotine-deprived menthol smokers with limited e-cigarette experience completed two counterbalanced in-laboratory 30-minute ad libitum vaping sessions with menthol and tobacco nicotine salt-based e-liquid in a randomized crossover pilot trial design. Questionnaires assessed reductions in craving and withdrawal and post-session subjective experience and behavioral intentions. Puff topography was measured continuously throughout each vaping session.

RESULTS

Measures of puff topography did not differ significantly by e-liquid flavor (all p > .40). Similarly, menthol and tobacco flavored e-cigarettes were both rated positively in terms of subjective effects and behavioral intentions (all p > .10) and about 40 % of participants reported a preference for the tobacco-flavored e-liquid. Finally, participants showed comparable reductions in craving (p = .210) and withdrawal (p = .671) from pre- and post-session regardless of e-liquid flavor.

CONCLUSIONS

Among menthol smokers in a lab-based setting, findings suggest that menthol vs tobacco e-liquid flavor has little impact on acute changes in puff patterns, subjective experience, behavioral intentions, or craving and withdrawal.

Measuring Allyship: Development and Validation of Two Measures to Assess Collegiate Athlete Department Staff Engagement in LGBTQ Allyship and Ally Behaviors

This pilot quantitative study sought to explore lesbian, gay, bisexual, transgender, and queer (LGBTQ) ally engagement by collegiate coaches and athletic department staff. In particular, this study sought to investigate the psychometric properties for two adapted measures: the Ally Identity Scale-Athletic Staff Version and the Engagement in LGBTQ Ally Actions in Sports Scale-Athletic Staff Version. These measures could provide a means to assess the degree to which coaches and athletic department staff identify as allies and engage in actions that support a welcoming and inclusive climate for LGBTQ student-athletes and athletic department staff. The sample for this study was 87 coaches and athletic department staff who completed an online survey. The results of this study provide preliminary psychometric support for two adapted measures and provide insights into the next steps scholars can take in exploring the intersection of LGBTQ identities and collegiate athletics.

Equivalent weight: Application of the assessment method on real task conducted by railway workers wearing a back support exoskeleton

Commonly used risk indexes, such as the NIOSH Lifting Index, do not capture the effect of exoskeletons. This makes it difficult for Health and Safety professionals to rigorously assess the benefit of such devices. The community requires a simple method to assess the effectiveness of back-support exoskeleton's (BSE) in possibly reducing ergonomic risk. The method introduced in this work is termed "Equivalent Weight" (EqW) and it proposes an interpretation of the effect built on the benefit delivered through reduced activation of the erector spinae (ES). This manifests itself as an apparent reduction of the lifted load perceived by the wearer. This work presents a pilot study where a practical application of the EqW method is used to assess the ergonomic risk in manual material handling (MMH) when using a back support exoskeleton (StreamEXO). The results are assessed by combining observational measurements from on-site testing with five different workers and quantitative measures of the muscle activity reduction achieved during laboratory evaluation with ten workers. These results will show that when lifting, lowering, and carrying a 19 kg load the StreamEXO can reduce risk by up to two levels (from "high" to "low") in the target sub-tasks. The Lifting index (LI) was reduced up to 64% when examining specific sub-tasks and the worker's movement conduction.

BI-REAL: A 12-session DBT skills group intervention adapted for bipolar disorder - A feasibility randomised pilot trial

International guidelines endorse psychological treatment for Bipolar Disorder (BD); however, the absence of a recognised gold-standard intervention requires further research. A Dialectical Behaviour Therapy (DBT) skills group intervention with 12 sessions was developed. This pilot randomised controlled trial (RCT) aims to evaluate the feasibility, acceptability, and outcomes variance of Bi-REAL - Respond Effectively, Assertively, and Live mindfully, tailored for individuals with BD, in preparation for a future RCT.

METHODS

52 participants (female = 62.7 %; mean age = 43.2 ± 11.1) with BD were randomised by blocks to either the experimental group (EG; n = 26; Bi-REAL + Treatment as Usual, TAU) receiving 12 weekly 90-minutes sessions, or the control group (CG; n = 26, TAU). Feasibility and acceptability were assessed with a multimethod approach (qualitative interviews, semi-structured clinical interviews and a battery of self-report questionnaires - candidate main outcomes Bipolar Recovery Questionnaire (BRQ) and brief Quality of Life for Bipolar Disorder (QoL.BD)). All participants were evaluated at baseline (T0), post-intervention (T1) and 3-month follow-up (T2).

RESULTS

Acceptability was supported by participants' positive feedback and ratings of the sessions and programme overall, as well as the treatment attendance (86.25 % of sessions attended). The trial overall retention rate was 74.5 %, with CG having a higher dropout rate across the 3-timepoints (42.31 %). A significant Time × Group interaction effect was found for BRQ and QoL.BD favouring the intervention group (p < .05).

LIMITATIONS

The assessors were not blind at T1 (only at T2). Recruitment plan was impacted due to COVID-19 restrictions and replication is questionable. High attrition rates in the CG.

CONCLUSIONS

The acceptability of Bi-REAL was sustained, and subsequent feasibility testing will be necessary to establish whether the retention rates of the overall trial improve and if feasibility is confirmed, before progressing to a definitive trial.

Investigating the impact of greenery elements in office environments on cognitive performance, visual attention and distraction: An eye-tracking pilot-study in virtual reality

The human-nature connection is one of the main aspects determining supportive and comfortable office environments. In this context, the application of eye-tracking-equipped Virtual Reality (VR) devices to support an evaluation on the effect of greenery elements indoors on individuals' efficiency and engagement is limited. A new approach to investigate visual attention, distraction, cognitive load and performance in this field is carried out via a pilot-study comparing three virtual office layouts (Indoor Green, Outdoor Green and Non-Biophilic). 63 participants completed cognitive tasks and surveys while measuring gaze behaviour. Sense of presence, immersivity and cybersickness results supported the ecological validity of VR. Visual attention was positively influenced by the proximity of users to the greenery element, while visual distraction from tasks was negatively influenced by the dimension of the greenery. In the presence of greenery elements, lower cognitive loads and more efficient information searching, resulting in improved performance, were also highlighted.

Understanding heterogeneity, comorbidity, and variability in depression: Idiographic models and depression outcomes

This study uses time-intensive, item-level assessment to examine individual depressive and co-occurring symptom dynamics. Participants experiencing moderate-severe depression (N = 31) completed ecological momentary assessment (EMA) four times per day for 20 days (total observations = 2480). We estimated idiographic networks using MDD, anxiety, and ED items. ED items were most frequently included in individual networks relative to depression and anxiety items. We built ridge and logistic regression ensembles to explore how idiographic network centrality metrics performed at predicting between-subject depression outcomes (PHQ-9 change score and clinical deterioration, respectively) at 6-months follow-up. For predicting PHQ-9 change score, R2 ranged between 0.13 and 0.28. Models predicting clinical deterioration ranged from no better than chance to 80 % accuracy. This pilot study shows how co-occurring anxiety and ED symptoms may contribute to the maintenance of depressive symptoms. Future work should assess the predictive utility of psychological networks to develop understanding of how idiographic models may inform clinical decisions.

A text message intervention aimed at nurturing peer outreach to help meet drinking limit goals: A remote pilot randomized trial in non-collegiate young adults

OBJECTIVE

Scalable interventions attempting to nurture peer outreach to help young adults meet drinking limit goals remain under-developed. To address this gap, we developed ASPIRE, a text message intervention focused on coaching individuals to engage with close peers to assist them in meeting drinking limit goals.

METHOD

Non-collegiate young adults who had reported one or more heavy drinking days in the preceding month and were at least contemplating change were recruited through social media. Participants were randomly assigned to one of three 6-week text message interventions: Control, Goal Support, or ASPIRE. All groups completed baseline assessments and received weekly text message assessments on Thursdays and Sundays. Control and ASPIRE groups were prompted to complete web-based outcome assessments at 6- and 12-weeks.

RESULTS

We enrolled 92 young adults from 31 US states (65% female; 73% White). All groups had high text response rates but intervention usability was sub-optimal. Follow-up rates were 87% at 6-weeks and 79% at 12-weeks. Compared to Control, ASPIRE participants reported significantly more peer support and less peer pressure to drink. ASPIRE exhibited higher goal confidence compared to the Goal Support group. Using multiple imputation, there were no significant differences in drinking outcomes between groups.

CONCLUSIONS

Preliminary findings from this pilot study suggest that a text message intervention focused on nurturing peer outreach to help meet drinking limit goals holds promise in altering peer support and pressure as well as boosting drinking limit goal confidence. Design improvements are needed to reduce alcohol consumption.

Biostimulation of sulfate reduction for in-situ metal(loid) precipitation at an industrial site in Flanders, Belgium

A 30-month pilot study was conducted to evaluate the potential of in-situ metal(loid) removal through biostimulation of sulfate-reducing processes. The study took place at an industrial site in Flanders, Belgium, known for metal(loid) contamination in soil and groundwater. Biostimulation involved two incorporations of an organic substrate (emulsified vegetable oil) as electron donor and potassium bicarbonate to raise the pH of the groundwater by 1-1.5 units. The study focused on the most impacted permeable fine sand aquifer (8-9 m below groundwater level) confined by layers of non-permeable clay. The fine sands exhibited initially oxic conditions (50-200 mV), an acidic pH of 4.5 and sulfate concentrations ranging from 600 to 800 mg/L. At the central monitoring well, anoxic conditions (-200 to -400 mV) and a pH of 5.9 established shortly after the second substrate and reagent injection. Over the course of 12 months, there was a significant decrease in the concentration of arsenic (from 2500 to 12 μg/L), nickel (from 360 to <2 μg/L), zinc (from 78,000 to <2 μg/L), and sulfate (from 930 to 450 mg/L). Low levels of metal(loid)s were still present after 34 months (end of study). Mineralogical analysis indicated that the precipitates formed were amorphous in nature. Evidence for biologically driven metal(loid) precipitation was provided by compound specific stable isotope analysis of sulfate. In addition, changes in microbial populations were assessed using next-generation sequencing, revealing stimulation of native sulfate-reducing bacteria. These results highlight the potential of biostimulation for long-term in situ metal(loid) plume treatment/containment.

Development and validation of high-performance liquid chromatography-Orbitrap mass spectrometric method for quantification of NDMA in ranitidine drug products and evaluation of antioxidants as inhibitors of classical nitrosation reaction

RATIONALE

N-Nitroso dimethylamine (NDMA) is a mutagenic impurity detected in several ranitidine products. The amino functional group of ranitidine is a risk factor for classical nitrosation-induced NDMA formation in ranitidine drug products during storage conditions. The United States Food and Drug Administration (US FDA) recommended the use of antioxidants to control NDMA in drug products. Considering the need for sensitive analytics, a liquid chromatography/high-resolution mass spectrometry (LC-HRMS) method was developed and validated to detect NDMA in this pilot study to demonstrate the antioxidants as inhibitors of nitrosation reactions.

METHODS

The method, utilizing an EC-C18 column and tuned to atmospheric pressure chemical ionization/selected ion monitoring (APCI/SIM) mode, separated NDMA (m/z: 75.0553; tR: 3.71 min) and ranitidine (m/z: 315.1485; tR: 8.61 min). APCI mode exhibited four times higher sensitivity to NDMA than electrospray ionization (ESI) mode. Classical nitrosation of the dimethyl amino group of ranitidine was studied with sodium nitrite in solid pellets. Antioxidants (alpha-tocopherol, ascorbic acid, and trolox) were evaluated as NDMA attenuators in ranitidine pellets under vulnerable storage conditions. The developed method quantified NDMA levels in samples, extracted with methanol through vortex shaking for 45 min.

RESULTS

The method achieved a limit of detection (LOD) and limit of quantitation (LOQ) of 0.01 and 0.05 ng/mL, respectively, with linearity within 1-5000 ng/mL (R1: 0.9995). It demonstrated good intra-day and inter-day precision (% RSD [relative standard deviation]: <2) and accuracy (96.83%-101.72%). Nitrosation of ranitidine induced by nitrite was significant (p < 0.001; R2 = 0.9579) at various sodium nitrite levels. All antioxidants efficiently attenuated NDMA formation during ranitidine nitrosation. Ascorbic acid exhibited the highest NDMA attenuation (96.98%), followed by trolox (90.58%). This study recommends 1% ascorbic acid and trolox as potent NDMA attenuators in ranitidine drug products.

CONCLUSIONS

This study compared the effectiveness of antioxidants as NDMA attenuators in ranitidine under storage conditions susceptible to NDMA generation. The study concluded that ascorbic acid and trolox are potent inhibitors of NDMA formation and nitrosation attenuators in ranitidine drug products.

From grass to gas and beyond: Anaerobic digestion as a key enabling technology for a residual grass biorefinery

Roadside grass clippings hold potential as a sustainable source of bioenergy as they do not compete with crops for land use, and are only partially utilized for low-value applications. In this study, we proposed using roadside grass as a sole feedstock for anaerobic digestion (AD) in three different settings, and assessed the potential of producing biomaterials and fertilizers from grass-based digestate. Wet continuous digestion at pilot scale and dry batch digestion at pilot and large scales resulted in biogas yields up to 700 Nm3.t-1 DOM with a methane content of 49-55 %. Despite promising results, wet AD had operational problems such as clogging and poor mixing; once upscaled, the dry digestion initially also presented an operational problem with acidification, which was overcome by the second trial. Digested grass fibers from the pilot dry AD were processed into biomaterials and performed similarly or better than the undigested fibers, while around 20 % performance reduction was observed when compared to reference wood fibers. A mass balance indicated reduced fiber recovery when higher biogas production was obtained. The liquid fraction from the pilot dry AD was characterized for its nutrient content and used as a biofertilizer in another study. In contrast, the leachate collected from the large-scale dry AD had a low nitrogen content and high chloride content that could hinder its further use. Finally, a regional market analysis was conducted showing that the biocomposites produced with the available grass fibers could substitute at least half of the current European market based on our results.

Mitochondrial DNA mutations in extremely preterm infants with bronchopulmonary dysplasia

Bronchopulmonary dysplasia (BPD) is a serious chronic lung disease affecting extremely preterm infants. While mitochondrial dysfunction has been investigated in various medical conditions, limited research has explored mitochondrial DNA (mtDNA) gene mutations, specifically in BPD. This study aimed to evaluate mitochondrial mtDNA gene mutations in extremely preterm infants with BPD. In this prospective observational study, we enrolled a cohort of extremely preterm infants diagnosed with BPD. Clinical data were collected to provide comprehensive patient profiles. Peripheral blood mononuclear cells were isolated from whole-blood samples obtained within a defined timeframe. Subsequently, mtDNA extraction and sequencing using next-generation sequencing technology were performed to identify mtDNA gene mutations. Among the cohort of ten extremely preterm infants with BPD, mtDNA sequencing revealed the presence of mutations in seven patients, resulting in a total of twenty-one point mutations. Notably, many of these mutations were identified in loci associated with critical components of the respiratory chain complexes, vital for proper mitochondrial function and cellular energy production. This pilot study provides evidence of mtDNA point mutations in a subset of extremely preterm infants with BPD. These findings suggest a potential association between mitochondrial dysfunction and the pathogenesis of BPD. Further extensive investigations are warranted to unravel the mechanisms underlying mtDNA mutations in BPD.

Quantifying lower limb muscle stiffness in typically developing children and adolescents using acoustic radiation force impulse shear wave elastography (ARFI/SWE)-a pilot study

OBJECTIVE

To investigate and quantify age-related changes in lower limb muscle stiffness in typically developing children and adolescents using acoustic radiation force impulse shear wave elastography.

MATERIALS AND METHODS

Shear wave velocities of bilateral rectus femoris, tibialis anterior, and medial gastrocnemius muscles at rest were obtained in typically developing children and adolescents aged 3 to 18 years. The participants were classified into three age groups: Group 1 (children), 3 to 7 years old; Group 2, 8 to 12 (pre-adolescent); and Group 3 (adolescent), 13 to 18. The shear wave velocities of muscle were compared across the three age groups, as well as compared between right- and left-side limbs. The correlation between shear wave velocities and body weight or body mass index was assessed.

RESULTS

Of the 47 participants, 21 were in Group 1, 17 in Group 2, and 9 in Group 3. There were no significant differences among the three age groups' shear wave velocities of bilateral lower limb muscles, and no significant differences between right and left sides. There was no correlation between muscle stiffness and body weight or body mass index.

CONCLUSION

The present pilot study applied acoustic radiation force impulse shear wave elastography to quantify lower limb muscle stiffness in typically developing children and adolescents aged 3 to 18 years, suggesting no marked change in muscle stiffness occurs as they develop.

Veteran's Attitudes and Knowledge of End-of-Life Care: A Pilot Study Using a Mixed Methods Approach

Veterans make up a quarter of the deaths in the United States (US). However, little is known about their knowledge and preferences about end-of-life care and pain management. Given this, we were interested in how veterans' military experiences impact their end-of-life experiences and attitudes. Our exploratory study addressed the knowledge and perceptions of hospice and pain management at the end of life. The quantitative aspect was a survey using descriptive statistics that used a small (n = 14) subgroup from a randomly selected sample in the continental US. A small population-based sample (N = 123) used a blended sampling frame of randomly selected validated cell phone and landline numbers. The qualitative aspect examined eight targeted interviews of urban dwelling older veterans over age 60 residing in Northeast Ohio to get a deeper understanding of their knowledge and attitudes toward end-of-life care. Our findings suggest that veterans did not understand the difference between hospice and palliative care and expressed concerns regarding pain medication use at the end of life. Future research examining the concept of stoicism at the end of life among veterans and educational interventions are needed.

Compassion in health professionals: Development and validation of the Capacity for Compassion Scale

BACKGROUND

Health professionals witness pain and suffering when they care for sick people and their families. Compassion is a necessary quality in their work as it combines the will to help, alleviate suffering and promote the well-being of both the people they are attending and the professionals themselves. The aim of the study was to design and evaluate the psychometric properties of the Capacity for Compassion Scale (CCS).

DESIGN

A quantitative, descriptive and cross-sectional study was carried out to evaluate the psychometric properties of the scale (reliability, temporal stability, content validity, criterion validity and construct validity).

METHODS

The study was carried out in two phases: pilot study and final validation. The data were collected between April and May 2022. The sample was selected by convenience sampling and was made up of a total of 264 participants, 59 in the pilot phase and 205 in the final validation.

RESULTS

The Capacity for Compassion Scale has been shown to have good psychometric properties in relation to reliability, temporal stability, and content, criterion, and construct validity. Factor analysis showed that there were four subdimensions of the scale: motivation/commitment, presence, shared humanity and self-compassion. The results also indicate that compassionate ability is significantly correlated with age and work experience.

CONCLUSIONS

The Capacity for Compassion Scale shows adequate psychometric properties. This instrument measures the compassion capacity of health professionals, which is a valuable discovery for new lines of research in this field.

IMPACT

Through this scale, low levels of capacity for compassion can be detected that negatively influence the quality of care provided by health professionals. The Capacity for Compassion Scale can therefore contribute to the identification of needs and promote training around compassion for health professionals.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution. WHAT PROBLEM DID THE STUDY ADDRESS?: Compassion in health professionals has positive effects on improving the quality of care, the satisfaction of professionals and the work environment. There are compassion cultivation programmes whose validity has been proven for the development of the dimensions of compassion. There is no specific instrument that measures capacity for compassion in healthcare professionals. WHAT WERE THE MAIN FINDINGS?: A scale is designed to measure capacity for compassion in health professionals. This is the only such scale available up until now. The scale measures four dimensions of compassion: motivation/commitment, presence, shared humanity and self-compassion. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: The development of specific programmes that can increase the compassion of health professionals with all the benefits that this can bring to health care is encouraged. It will be possible to analyse the effects of training programmes on the cultivation of compassion.

Feasibility and efficacy of an early sensory-motor rehabilitation program on hand function in patients with stroke: a pilot, single-subject experimental design

OBJECTIVE

Hand and upper limb functional impairments following stroke lead to limitations in performing activities of daily living. We aimed to investigate feasibility and efficacy of an early sensory-motor rehabilitation program on hand and upper limb function in patients with acute stroke.

DESIGN

A pilot, single-subject experimental, A-B-A study.

SETTING

Stroke unit of an educational hospital and an outpatient occupational therapy clinic.

PARTICIPANTS

A convenience sample including five people with acute stroke.

PROCEDURES

Participants received 3 h of an intensive hand and upper limb sensory and motor rehabilitation program, 5 days per week for 3 months (15-min mental imagery, 15-min action observation, 30-min mirror therapy, 1.5-h constraint-induced movement therapy, and 30-min bilateral arm training). Activities were chosen based on the task-oriented occupational therapy approach.

OUTCOME MEASURES

An assessor blinded to intervention program measured sensory and motor functions using action research arm test, box and block test, Semmes-Weinstein monofilaments, and upper extremity section of Fugl-Meyer assessment.

RESULTS

Assessment data points in intervention and follow-up phases compared to baseline were in higher levels, sloped upwardly, and increased significantly for all participants in all outcome measures.

CONCLUSIONS

The present pilot study showed that a package of nowadays evidence-based rehabilitation methods including mental imagery, action observation, mirror therapy, modified constraint-induced movement therapy, bilateral arm training, and task-oriented occupational therapy approach is able to improve sensory and motor functions of the hand and upper limb in patients with acute stroke.

Pilot composite tubular bioreactor for outdoor photo-fermentation hydrogen production: From batch to continuous operation

A novel 70 L composite tubular photo-bioreactor was constructed, and its photo-fermentation hydrogen production characteristics of batch and continuous modes were investigated with glucose as the substrate in an outdoor environment. In the batch fermentation stage, the hydrogen production rate peaked at 37.6 mL H2/(L·h) accompanied by a high hydrogen yield of 7 mol H2/mol glucose. The daytime light conversion efficiency is 4 %, with 37 % of light energy from the sun. An optimal hydraulic retention time of 5 d was identified during continuous photo-fermentation. Under this condition, the stability of the cell concentration is maintained and more electrons can be driven to the hydrogen generation pathway while attaining a hydrogen production rate of 20.7 ± 0.9 mL H2/(L·h). The changes of biomass, volatile fatty acids concentration and ion concentration during fermentation were analyzed. Continuous hydrogen production by composite tubular photo-bioreactor offers new ideas for the large-scale deployment of photobiological hydrogen production.

A pilot study of diabetes effects on radiation attenuation characteristics of tibia and femur of rats

This study aimed to investigate the effect of diabetes on radiation attenuation parameters of the femur and tibia of rats using Monte Carlo Simulations. First, control and diabetic rats were identified and tibias and femurs were removed. Then, the elemental ratios of the bones obtained were calculated using EDS (Energy Dissipative X-ray Spectroscopy). Therefore, radiation permeability properties of control and diabetic bones were simulated by using the content ratios in the bones in MCNP6 (Monte Carlo N-Particle) and PHITS (Particle and Heavy Ion Transport code System) 3.22 and Stopping and Range of Ions in Matter (SRIM) simulation codes. Attenuation coefficient results were compared with the NIST database via XCOM. Although differences in absorption coefficients are observed at low energies, these differences disappear as the energy increases.

Urine proteome profile of firefighters with exposure to emergency fire-induced smoke: A pilot study to identify potential carcinogenic effects

Firefighters are frequently exposed to a variety of chemicals formed from smoke, which pose a risk for numerous diseases, including cancer. Comparative urine proteome profiling could significantly improve our understanding of the early detection of potential cancer biomarkers. In this study, for the first time, we conducted a comparative protein profile analysis of 20 urine samples collected from ten real-life firefighters prior to and following emergency fire-induced smoke. Using a label-free quantitative proteomics platform, we identified and quantified 1325 unique protein groups, of which 45 proteins showed differential expressions in abundance in response to fire-smoke exposure (post) compared to the control (pre). Pathway analysis showed proteins associated with epithelium development (e.g., RHCG, HEG1, ADAMTSL2) and Alzheimer's disease (SORL1) were significantly increased in response to smoke exposure samples. A protein-protein-network study showed a possible link between these differentially abundant proteins and the known cancer gene (TP53). Moreover, a cross-comparison analysis revealed that seven proteins-ALDH1A1, APCS, POMC, COL2A1, RDX, DDAH2, and SDC4 overlapped with the previously published urine cancer proteome datasets, suggesting a potential cancer risk. Our findings demonstrated that the discovery proteomic platform is a promising analytical technique for identifying potential non-invasive biomarkers associated with fire-smoke exposure in firefighters that may be related to cancer.

Pilot-scale production of Bacillus subtilis MSCL 897 spore biomass and antifungal secondary metabolites in a low-cost medium

OBJECTIVES

Bacillus subtilis is a plant growth promoting bacterium (PGPB) that acts as a microbial fertilizer and biocontrol agent, providing benefits such as boosting crop productivity and improving nutrient content. It is able to produce secondary metabolites and endospores simultaneously, enhancing its ability to survive in unfavorable conditions and eliminate competing microorganisms. Optimizing cultivation methods to produce B. subtilis MSCL 897 spores on an industrial scale, requires a suitable medium, typically made from food industry by-products, and optimal temperature and pH levels to achieve high vegetative cell and spore densities with maximum productivity.

RESULTS

This research demonstrates successful pilot-scale (100 L bioreactor) production of a biocontrol agent B. subtilis with good spore yields (1.5 × 109 spores mL-1) and a high degree of sporulation (>80%) using a low-cost cultivation medium. Culture samples showed excellent antifungal activity (1.6-2.3 cm) against several phytopathogenic fungi. An improved methodology for inoculum preparation was investigated to ensure an optimal seed culture state prior to inoculation, promoting process batch-to-batch repeatability. Increasing the molasses concentration in the medium and operating the process in fed-batch mode with additional molasses feed, did not improve the overall spore yield, hence, process operation in batch mode with 10 g molasses L-1 is preferred. Results also showed that the product quality was not significantly impacted for up to 12 months of storage at room temperature.

CONCLUSION

An economically-feasible process for B. subtilis-based biocontrol agent production was successfully developed at the pilot scale.

A phase II randomised controlled trial of intranasal oxytocin in anorexia nervosa

BACKGROUND

Anorexia nervosa (AN) is an eating disorder (ED) with high mortality rates and limited response to existing treatments, prompting the need to identify effective agents and adjuncts. There is evidence for an emerging role for the neuropeptide oxytocin (OT) in the pathophysiology of AN, with studies showing a perturbed oxytocinergic system in patients with AN. Preliminary evidence has demonstrated that intranasal OT (IN-OT) can produce anxiolytic effects in AN, as well as reducing concern about eating, and dysfunctional attentional biases related to the disorder. IN-OT is a non-invasive treatment option for AN that requires investigation as an adjunct to nutritional rehabilitation.

METHODS

This multi-site study (Trial Registration:ACTRN1261000897460) sought to replicate and extend a previous randomised placebo-controlled pilot trial of repeated dose IN-OT in patients with AN hospitalised for nutritional rehabilitation. Patients with AN (N=61) received daily IN-OT (18 IU twice per day) or placebo for four weeks, whilst undergoing inpatient hospital treatment. Outcome measures included ED psychopathology (primary) as measured by the Eating Disorder Examination (EDE) and Body Mass Index (BMI; secondary). Participants were assessed pre- and post-treatment, and at six months following the intervention. The effects of the first and last doses of IN-OT on responses (anxiety ratings and salivary cortisol) to a high-energy snack were also examined.

RESULTS

Sixty-one female inpatients (Mage=24.36,SD=7.87) with an average BMI of 16.24 (range: 11.43-18.55), were recruited into the study. No significant differences were found between placebo and OT groups at any of the time points on the outcomes of interest, but significant improvements in almost all psychological parameters in both groups were evident over time. IN-OT did not significantly reduce anxiety nor salivary cortisol in response to a high-calorie snack.

CONCLUSION

This is the largest randomised placebo-controlled trial of repeated dose intranasal OT in people with AN, during refeeding. The therapeutically promising findings of the pilot study were not replicated. Limitations and reasons for the non-replication included relatively large variance, baseline psychopathology scores being higher in this patient group, potential ceiling effects in BMI and ED psychopathology as well as differing comorbidities.

Intraparenchymal near-infrared spectroscopy for detection of delayed cerebral ischemia in poor-grade aneurysmal subarachnoid hemorrhage

OBJECTIVE

Detection of delayed cerebral ischemia (DCI) is challenging in comatose patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH). Brain tissue oxygen pressure (PbtO2) monitoring may allow early detection of its occurrence. Recently, a probe for combined measurement of intracranial pressure (ICP) and intraparenchymal near-infrared spectroscopy (NIRS) has become available. In this pilot study, the parameters PbtO2, Hboxy, Hbdeoxy, Hbtotal and rSO2 were measured in parallel and evaluated for their potential to detect perfusion deficits or cerebral infarction.

METHODS

In patients undergoing multimodal neuromonitoring due to poor neurological condition after aSAH, Clark oxygen probes, microdialysis and NIRS-ICP probes were applied. DCI was suspected when the measured parameters in neuromonitoring deteriorated. Thus, perfusion CT scan was performed as follow up, and DCI was confirmed as perfusion deficit. Median values for PbtO2, Hboxy, Hbdeoxy, Hbtotal and rSO2 in patients with perfusion deficit (Tmax > 6 s in at least 1 vascular territory) and/or already demarked infarcts were compared in 24- and 48-hour time frames before imaging.

RESULTS

Data from 19 patients (14 University Hospital Zurich, 5 Charité Universitätsmedizin Berlin) were prospectively collected and analyzed. In patients with perfusion deficits, the median values for Hbtotal and Hboxy in both time frames were significantly lower. With perfusion deficits, the median values for Hboxy and Hbtotal in the 24 h time frame were 46,3 [39.6, 51.8] µmol/l (no perfusion deficits 53 [45.9, 55.4] µmol/l, p = 0.019) and 69,3 [61.9, 73.6] µmol/l (no perfusion deficits 74,6 [70.1, 79.6] µmol/l, p = 0.010), in the 48 h time frame 45,9 [39.4, 51.5] µmol/l (no perfusion deficits 52,9 [48.1, 55.1] µmol/l, p = 0.011) and 69,5 [62.4, 74.3] µmol/l (no perfusion deficits 75 [70,80] µmol/l, p = 0.008), respectively. In patients with perfusion deficits, PbtO2 showed no differences in both time frames. PbtO2 was significantly lower in patients with infarctions in both time frames. The median PbtO2 was 17,3 [8,25] mmHg (with no infarctions 29 [22.5, 36] mmHg, p = 0.006) in the 24 h time frame and 21,6 [11.1, 26.4] mmHg (with no infarctions 31 [22,35] mmHg, p = 0.042) in the 48 h time frame. In patients with infarctions, the median values of parameters measured by NIRS showed no significant differences.

CONCLUSIONS

The combined NIRS-ICP probe may be useful for early detection of cerebral perfusion deficits and impending DCI. Validation in larger patient collectives is needed.

Whole genome sequencing as a first-tier diagnostic test for infants in neonatal intensive care units: A pilot study in Brazil

In this pilot study, we aimed to evaluate the feasibility of whole genome sequencing (WGS) as a first-tier diagnostic test for infants hospitalized in neonatal intensive care units in the Brazilian healthcare system. The cohort presented here results from a joint collaboration between private and public hospitals in Brazil considering the initiative of a clinical laboratory to provide timely diagnosis for critically ill infants. We performed trio (proband and parents) WGS in 21 infants suspected of a genetic disease with an urgent need for diagnosis to guide medical care. Overall, the primary indication for genetic testing was dysmorphic syndromes (n = 14, 67%) followed by inborn errors of metabolism (n = 6, 29%) and skeletal dysplasias (n = 1, 5%). The diagnostic yield in our cohort was 57% (12/21) based on cases that received a definitive or likely definitive diagnostic result from WGS analysis. A total of 16 pathogenic/likely pathogenic variants and 10 variants of unknown significance were detected, and in most cases inherited from an unaffected parent. In addition, the reported variants were of different types, but mainly missense (58%) and associated with autosomal diseases (19/26); only three were associated with X-linked diseases, detected in hemizygosity in the proband an inherited from an unaffected mother. Notably, we identified 10 novel variants, absent from public genomic databases, in our cohort. Considering the entire diagnostic process, the average turnaround time from enrollment to medical report in our study was 53 days. Our findings demonstrate the remarkable utility of WGS as a diagnostic tool, elevating the potential of transformative impact since it outperforms conventional genetic tests. Here, we address the main challenges associated with implementing WGS in the medical care system in Brazil, as well as discuss the potential benefits and limitations of WGS as a diagnostic tool in the neonatal care setting.

Improving anthropometric measurements in hospitalized children: A quality-improvement project

BACKGROUND

The objective of this quality-improvement project was to increase documentation rates of anthropometrics (measured weight, length/height, and body mass index [BMI], which are critical to identify patients at malnutrition (undernutrition) risk) from <50% to 80% within 24 hours of hospital admission for pediatric patients.

METHODS

Multidisciplinary champion teams on surgical, cardiac, and intensive care (ICU) pilot units were established to identify and iteratively test interventions addressing barriers to documentation from May 2016 to June 2018. Percentage of patients with documented anthropometrics <24 h of admission was assessed monthly by statistical process control methodology. Percentage of patients at malnutrition (undernutrition) risk by anthropometrics was compared by χ2 for 4 months before and after intervention.

RESULTS

Anthropometric documentation rates significantly increased (P < 0.001 for all): BMI, from 11% to 89% (surgical), 33% to 57% (cardiac), and 16% to 51% (ICU); measured weight, from 24% to 88% (surgical), 69% to 83% (cardiac), and 51% to 67% (ICU); and length/height, from 12% to 89% (surgical), 38% to 57% (cardiac), and 26% to 63% (ICU). Improvement hospital-wide was observed (BMI, 42% to 70%, P < 0.001) with formal dissemination tactics. For pilot units, moderate/severe malnutrition (undernutrition) rates tripled (1.2% [24 of 2081] to 3.4% [81 of 2374], P < 0.001).

CONCLUSION

Documentation of anthropometrics on admission substantially improved after establishing multidisciplinary champion teams. Goal rate (80%) was achieved within 26 months for all anthropometrics in the surgical unit and for weight in the cardiac unit. Improved documentation rates led to significant increase in identification of patients at malnutrition (undernutrition) risk.

A Pilot Study on Novel Use of Color Doppler Imaging for Navigation of Wiring in Coronary Interventions

OBJECTIVE

To test the Doppler guide wire (DGW) for navigation of the wire positioning by color Doppler ultrasound in the setting of percutaneous coronary intervention (PCI).

METHODS

An acoustically active DGW was tested in a water tank before its in vivo use. A waveform generator was connected to the DGW, and a transducer scanned the DGW to visualize a Doppler shift signal between the vibrating piezoelectric crystal located at the DGW tip and Doppler signal from the transducer as a distinct, instantaneous color marker. An intracoronary injection was tested in four male domestic pigs using an open-chest setting. A Judkins left coronary guiding catheter was inserted into the ascending aorta via the right carotid artery under B-mode ultrasound guidance. The DGW with an infusion catheter or over-the-wire (OTW) balloon catheter was inserted into the guiding catheter. The color marker instantaneously defined the DGW tip and navigated the catheter into the left anterior descending artery (LAD).

RESULTS

The tip of the DGW was visualized within the guiding catheter by a distinct color marker and helped to engage the guiding catheter to the left main orifice. The DGW with an infusion or OTW balloon catheter was inserted into the LAD. We confirmed that the catheter was positioned in the proximal LAD by the colored territory perfused by an injected indigo carmine solution.

CONCLUSION

Ultrasound navigation using acoustically active DGW was feasible. Our pilot study introduces a new concept of color Doppler-navigated wire positioning in the coronary artery in the setting of PCI.

The effects of UPGRADE your performance on employment soft skills of students with intellectual and developmental disabilities: A pilot study of generalization

Previous research has identified UPGRADE Your Performance as a method for teaching employment soft skills to students with disabilities. UPGRADE Your Performance instruction is a multicomponent intervention including self-evaluation, self-graphing, goal setting, and technology-aided instruction. This pilot study investigated the generalized effects of UPGRADE Your Performance on soft skills of secondary students with intellectual and other developmental disabilities participating in an 18-21 transition program located on a university campus. Results indicated that when students improved in two targeted soft skill areas, generalization occurred to three non-targeted soft skill areas. Implications for practice and suggestions for future research are included.

Elevated subgingival temperature infers high bacterial pathogen counts in severe periodontitis

OBJECTIVES

Periodontal inflammation may be assessed by bleeding on probing and subgingival temperature. This pilot study evaluated the intrapatient relationship between subgingival temperature and selected bacterial groups/species in deep periodontal pockets with bleeding on probing.

MATERIALS AND METHODS

In each of eight adults, an electronic temperature probe identified three "hot" pockets with elevated subgingival temperature and three "cool" pockets with normal subgingival temperature among premolars/molars with 6‒10 mm probing depths and bleeding on probing. Microbial samples collected separately from the hot and cool periodontal pockets were cultured for selected periodontal pathogens.

RESULTS

Hot compared to cool periodontal pockets revealed significantly higher absolute and normalized subgingival temperatures and yielded higher mean proportions of Porphyromonas gingivalis (10.2% for hot vs. 2.5% for cool, p = 0.030) and total red/orange complex periodontal pathogens (48.0% for hot vs. 24.6% for cool, p = 0.012).

CONCLUSIONS

Hot versus cool deep periodontal pockets harbored significantly higher levels of major periodontal pathogens. Subgingival temperature measurements may potentially be useful to assess risk of periodontitis progression and the efficacy of periodontal therapy.

Doxofylline as a steroid-sparing treatment in Mexican children with asthma

OBJECTIVE

The aim of this pilot study was to assess the efficacy of doxofylline as an ICS-sparing agent in the treatment of Mexican children with asthma.

METHODS

10-week, open-label, crossover, pilot study, we examined the steroid-sparing effect of doxofylline in Mexican children with asthma. Patients aged 6-16 years treated with inhaled corticosteroids (ICS) for at least 8 wk before enrollment were divided randomly into two groups at the baseline visit. Group A (n = 31) received doxofylline (18 mg/kg/day) plus standard-dose budesonide (D + SDB) for the first 4-week period followed by doxofylline plus reduced-dose budesonide (D + RDB) for the second 4-week period. Group B (n = 30) received D + RDB followed by D + SDB. Clinical outcomes assessed included lung function (forced expiratory volume; in 1 s, FEV1), fractional exhaled nitric oxide (FeNO), asthma control, number of exacerbations and use of rescue medication (salbutamol).

RESULTS

It was shown that combined use of doxofylline and ICS may allow children with asthma to reduce their daily dose of ICS while maintaining lung function and improving asthma control (p = 0.008). There were few asthma exacerbations and only one patient required treatment with systemic corticosteroids. Rescue medication use decreased significantly in patients receiving D + SDB during the first 4-week period.

CONCLUSIONS

Our results suggest that doxofylline may be a steroid-sparing treatment in asthma, but longer-term, controlled studies are needed to confirm these observations.

Self-guided Online Medical Hypnosis Program Improves Dry Nights in Children With Nocturnal Enuresis in a Prospective Single-Center Pilot Study

Bedwetting is a common condition in children. We evaluated the effectiveness of medical hypnosis as a first-line therapy in children with primary monosymptomatic nocturnal enuresis (PMNE). The study enrolled children in a prospective single-center pilot clinical trial consisting of 1 month diary of dry nights prior to using the commercially available hypnosis intervention (www.keepingthebeddry.com), followed by 3 consecutive months diary following intervention. Seventeen children aged 8 to 15 years old were enrolled and 12 recorded at least 1 month data after the hypnosis intervention. The median dry nights prior to intervention was 8 (0-17) days and improved to 15.5 (7-28) days by the third month post-intervention (P = .0033). All patients who completed the study showed an improvement. Self-guided medical hypnosis therapy showed significant improvement in dry nights without any side effects and any identifiable risk to patients. It should be considered for use in children as first-line therapy for PMNE.

Comparison of antimicrobial efficacy of different disinfectants on the biofilm formation in dental unit water systems using dip slide and conventional methods: A pilot study

OBJECTIVE

Biofilm formation in dental waterlines brings opportunistic infections, especially for immunosuppressive patients. This study aimed to determine biofilm-forming microorganisms by various methods and investigate disinfectants' effects on biofilm.

MATERIALS & METHODS

In the study, samples were obtained from the waterlines of 10-15 aged six dental units, before (0 min.) and after chlorine dioxide (ClO2) and hypochlorous acid (HOCl) treatment (1, 5, 10, 20, and 30 min.), and total colony counts were performed using conventional surface smear method (SSM) and dip slide method (DSM). The Congo red agar and Christensen methods were used to examine the biofilm-forming properties of the isolates. Monitoring of biofilm presence was also visualized by SEM scanning.

RESULTS

When DSM and SSM are compared in all units where ClO2 and HOCl are applied, DSM can detect bacterial growth even during periods of greater exposure to disinfectant application. Although DSM can achieve a value approaching 3% even at the 10th minute in units treated with HOCl; SSM does not show reproduction at the same disinfectant exposure and duration; It was observed that in the units where ClO2 was applied, the growth was no longer observed at the 10th minute with DSM, and SSM, 50% growth in the first minute of the units treated with ClO2 could not be detected in the 5th minute.

CONCLUSIONS

It is concluded that it can be advisable to routinely disinfect the dental unit water systems with non-toxic doses of ClO2 application before patient treatments in clinics and also to perform contamination controls at regular intervals with DSM, which is a sensitive and very practical method.

RESEARCH HIGHLIGHTS

It has been observed that the dip slide method can count bacteria more sensitively than conventional methods in dental water systems without the need for experienced personnel and equipment. The difference between biofilm formation in water systems before and after disinfectant exposure in SEM examinations is remarkable. The effects of ClO2 and HOCl on biofilm were investigated and bacterial growth was inhibited in dental units between 5 and 10 minutes with both disinfectants.

Perspectives on self-directed learning in bioscience in nurse education - An integrative review

OBJECTIVES

There is a lack of synthesized knowledge on nursing students self-directed learning in bioscience and how to best support students' learning in this subject. The purpose of this integrative review is to synthesize current literature on perspectives on self-directed learning among nursing students studying bioscience to guide further research aiming to support students' learning more effectively.

METHODS

An integrative review in line with Whittemore & Knafl's modified framework containing five stages: problem identification, literature search, data evaluation, data analysis and presentation. A structured literature search was undertaken in the Web of Science, ERIC, Medline and CINAHL databases from November 2022 to January 2023. The inclusion criteria were nursing students enrolled in a bachelor programme, research addressing activities intended for learning bioscience, in addition to formal taught lectures and perspectives on self-directed learning in natural science subjects within nurse education such as views, actions, activities, habits and attitudes. Exclusion criteria were students in other education programs, research in formal learning contexts, and self-directed learning in other subjects than natural science subjects. Rigour of each included source was assessed using Whittemore & Knafl's suggested 2-point scale (high or low). A constant comparison method was used to synthesize results.

RESULTS

Of the initial 1143 sources, 12 articles were included after abstract and full-text screening: one pilot study for randomized controlled trial, one qualitative study, two mixed methods studies and eight quantitative studies. The sample size was from 23 to 563 participants.

DISCUSSION

This review identifies self-directed learning in bioscience understood as a continuum of teacher-directedness and self-directedness rather than as distinguished orientations. There seem to be no consistent definition of self-directed learning in bioscience, yet descriptions commonly imply metacognitive learning approaches. Nursing students value digital learning resources, yet technology might be secondary to the skill of self-directed learning.

End-of-day assessment of asymptomatic versus highly symptomatic soft contact lens wearers

PURPOSE

To investigate differences in key clinical parameters between asymptomatic and highly symptomatic soft contact lens (CL) wearers after 14 h of wear.

METHODS

In this pilot investigation, Phase 1 identified asymptomatic (CLDEQ-8 score ≤ 7) and highly symptomatic (CLDEQ-8 score ≥ 20) subjects after fitting with nelfilcon A CLs. Phase 2 investigated the following over a single nelfilcon A CL-wearing day (14 ± 2 h): blinking characteristics, tear meniscus height (TMH), non-invasive tear break-up time (NIBUT), tear film osmolarity and eyelid margin staining. Parameters for the two groups were compared using linear mixed models and post-hoc testing. The relationship between comfort scores and the clinical parameters was also investigated.

RESULTS

Overall, 161 and 42 subjects were enrolled into Phase 1 and 2, respectively. Twenty-five asymptomatic and 17 symptomatic subjects completed Phase 2. Lower eyelid TMH was decreased after 14 h in symptomatic compared with asymptomatic subjects (least square mean [LSM] difference -0.04 mm, 95% CI: -0.07, -0.01). Osmolarity was lower in symptomatic than in asymptomatic subjects at fitting (LSM difference -9.89, 95% CI: -18.91, -0.86). Upper eyelid margin staining was greater after 14 h in symptomatic than in asymptomatic subjects (LSM difference 0.53, 95% CI: 0.01, 1.05) and greater after 14 h than baseline in the symptomatic group (LSM difference 0.61, 95% CI: 0.16, 1.07). There was a significant relationship between comfort and upper eyelid margin staining (r = -0.40, 95% CI: -0.63, -0.11) and blink rate (r = -0.31, 95% CI: -0.57, -0.003).

CONCLUSION

The potential parameters most effective in differentiating asymptomatic from symptomatic wearers were upper eyelid margin staining and lower TMH. The parameter with the strongest relationship to comfort was upper eyelid margin staining, where higher comfort scores were associated with lower levels of staining.

A pilot study of antimicrobial effects and ototoxicity of a Norway spruce (Picea abies) resin-based canine otic rinse product

BACKGROUND

Norway spruce (Picea abies) resin-based products are used in human medicine. A resin-based otic rinse also could be useful in supportive care of canine otitis externa (COE), yet information on its antimicrobial effect against canine pathogens or ototoxicity is lacking.

OBJECTIVES

To investigate the antimicrobial properties and ototoxicity of a commercial resin-based otic product.

MATERIALS AND METHODS

Antimicrobial effect was evaluated using a standardised challenge test on Staphylococcus pseudintermedius, Corynebacterium auriscanis, Pseudomonas aeruginosa, Escherichia coli, Malassezia pachydermatis, and Streptococcus halichoeri strains to measure reduction in growth after 24 h exposure to the product. Effect on cell morphology was investigated by exposing S. pseudintermedius, C. auriscanis, P. aeruginosa and M. pachydermatis to the product in 20% and 100% (v/v) concentrations for 6, 24 and 48 h, and evaluating cells by transmission (TEM) and scanning (SEM) electron microscopy. An in vitro microbial kill-rate assay also was performed. Auditory brain stem response test, clinical evaluation and postmortem histological evaluation of ear canals were undertaken on experimental guinea pigs treated with the test product or saline controls.

RESULTS

The product showed >log 5 growth reduction for all strains in the challenge test. TEM and SEM images showed clear changes in the cells' inner structures and deterioration of cells, and 100% (v/v) test product exposure induced microbial killing in 1-2 h. Ototoxicity was not detected in guinea pigs.

CONCLUSIONS AND CLINICAL RELEVANCE

The product may be an option in supportive care of COE because of antimicrobial effects and lack of ototoxic properties in a guinea pig model.

Efficacy and safety of apomorphine pump infusion in Filipino patients insufficiently controlled on oral anti-Parkinson medications: an open-label, pilot study

BACKGROUND

Apomorphine hydrochloride is used in the management of advanced Parkinson disease (PD), either as a rescue medication for off periods during levodopa therapy or as a maintenance pump medication. This is the first study to describe the effects of apomorphine in Filipino patients with PD.

OBJECTIVE

To evaluate the safety and efficacy of apomorphine ampules (APO-go®) pump infusion in the treatment of motor fluctuations in patients inadequately controlled on oral anti-Parkinson medications.

METHODS

Patients diagnosed with PD who developed motor fluctuations with levodopa were evaluated at baseline and at the end of the study using the Modified Hoehn and Yahr (H&Y) Scale, the Unified Parkinson's Disease Rating Scale (UPDRS) and the Abnormal Involuntary Movement Scale (AIMS). After initial assessment, patients were administered 20 ampules of apomorphine hydrochloride 10 mg/mL by infusion pump over 20 days. Intention-to-treat (ITT) analysis included all patients who completed at least one posttreatment assessment. Motor disability based on modified H&Y scores, motor function and complications of therapy pre- and posttreatment were compared using Wilcoxon Signed Rank test. Chi-squared test was used to compare outcomes by age and sex. Frequencies of adverse reactions were recorded to evaluate the tolerability of the medication.

RESULTS

Ten patients (mean age 63 ± 9.7 years), 3 male and 7 female, were enrolled in the study. Patients were given apomorphine for at most 16 days. The doses used were 2.5 mg/0.50 mL (n = 2), 3 mg/0.60 mL (n = 6), 4 mg/0.80 mL (n = 1) and 7 mg/1.40 mL (n = 1). After obtaining the threshold dose, two patients discontinued treatment. Eight of nine patients showed significant improvement in H&Y scores after treatment (p < 0.017). There was marked improvement after 10 days of treatment in at least five of 10 patients in terms of motor function using UPDRS, which included tremor (p < 0.034), rigidity (p < 0.002), facial expression (p < 0.014), finger taps (p < 0.008), foot taps (p < 0.014) and gait (p < 0.006). Significant changes from pre- to posttreatment scores in the frequency of dyskinesias (p < 0.010) and dystonia (p < 0.025) were observed. Nine focus areas of AIMS showed significant improvements in the muscles of facial expression (p < 0.020), upper (p < 0.016) and lower extremities (p < 0.010), incapacitation by abnormal movement (p < 0.010) and patients' awareness of abnormal movements (p < 0.039). Six patients experienced adverse events, none of which were related to the study drug.

CONCLUSION

Apomorphine hydrochloride pump infusion therapy is potentially effective and safe in the treatment of motor fluctuations in Filipino patients with PD. This pilot study springboards safe engagements of Filipino PD patients in multicenter, large-scale trials.

Tear metabolomics for the diagnosis of primary open-angle glaucoma

Primary Open-Angle Glaucoma (POAG) is the most prevalent glaucoma type, and the leading cause of irreversible visual impairment and blindness worldwide. Identification of early POAG biomarkers is of enormous value, as there is not an effective treatment for the glaucomatous optic nerve degeneration (OND). In this pilot study, a metabolomic analysis, by using proton (1H) nuclear magnetic resonance (NMR) spectroscopy was conducted in tears, in order to determine the changes of specific metabolites in the initial glaucoma eyes and to discover potential diagnostic biomarkers. A classification model, based on the metabolomic fingerprint in tears was generated as a non-invasive tool to support the preclinical and clinical POAG diagnosis. 1H NMR spectra were acquired from 30 tear samples corresponding to the POAG group (n = 11) and the control group (n = 19). Data were analysed by multivariate statistics (partial least squares-discriminant analysis: PLS-DA) to determine a model capable of differentiating between groups. The whole data set was split into calibration (65%)/validation (35%), to test the performance and the ability for glaucoma discrimination. The calculated PLS-DA model showed an area under the curve (AUC) of 1, as well as a sensitivity of 100% and a specificity of 83.3% to distinguish POAG group versus control group tear data. This model included 11 metabolites, potential biomarkers of the disease. When comparing the study groups, a decrease in the tear concentration of phenylalanine, phenylacetate, leucine, n-acetylated compounds, formic acid, and uridine, was found in the POAG group. Moreover, an increase in the tear concentration of taurine, glycine, urea, glucose, and unsaturated fatty acids was observed in the POAG group. These results highlight the potential of tear metabolomics by 1H NMR spectroscopy as a non-invasive approach to support early POAG diagnosis and in order to prevent visual loss.

The effect of dance workshops participation on reaction time in persons with moderate intellectual disabilities - pilot study

Background: Persons with intellectual disabilities who are physically active have faster reaction time compared to the physically inactive persons with intellectual disabilities (Yildirim et al. 2010). Aim: To recognize how participation in a series of hip-hop dance workshops can improve reaction time in persons with intellectual disabilities. Methods: 13 persons with moderate intellectual disabilities aged 14-22 (M = 17,30; SD = 2,52). A quasi-experiment was prepared using a single-group plan (nine dance workshops). Study design applied: pre-test - post-test. Measurement Tool - Optogait - acoustic response test. Results: Reaction time measured prior to dance workshops was M = 1,58; SD = 0,48 and after workshops was M = 1,34; SD = 0,69. The analysis using Wilcoxon signed-ranks test showed that this difference is statistically significant, Z = 2,06; p < .05. Conclusions: Hip-hop dance classes improve response times in persons with moderate intellectual disabilities.

Maxillary basal arch forms in operated adult patients with cleft lip and palate using root apices: A pilot study

OBJECTIVES

The purpose was to identify the maxillary basal arch forms utilizing the root apices and compare the maxillary basal arch form of groups with cleft lip and palate (CLP) and normal group.

MATERIALS AND METHODS

This study included 30 patients (21.8 ± 3.5 years old) with unilateral CLP (ULCP group) and 30 patients (20.9 ± 2.2 years old) with bilateral CLP (BCLP group). The normal group consisted of 30 non-cleft patients (21.2 ± 2.3 years old) with normal occlusion. Three-dimensional (3D) Cartesian coordinates of the root apices of each tooth were determined using cone-beam computed tomography. The 3D coordinates were projected onto the palatal plane to create the 2D coordinates. Thereafter, the basal arch forms were constructed by the Procrustes superimposition. Finally, For the basal arch form comparisons among groups, the inter-root widths were measured.

RESULTS

Both CLP groups had a narrower inter-root width than the normal group. The BCLP group had significantly narrower premolar and molar widths than the UCLP group (P < .05). Especially, the inter-first molar width of the UCLP and BCLP groups was 3.7 ± 0.7 (P < .001) and 6.6 ± 0.8 (P < .001) mm smaller than that of the normal group, respectively.

CONCLUSIONS

We used the root apices to identify the basal arch forms. The basal arch form of patients with CLP was narrower than that of the normal group. The basal arch form of patients with BCLP was narrower than that of patients with UCLP. Our findings may help clinicians better comprehend basal arch forms in patients with CLP and transverse discrepancies.

Hispanic/Latinos and non-Hispanic whites' childhood cancer survivors and parents: a dyadic analysis of coping resources and mental health

PURPOSE

While limited, dyadic research demonstrates the interdependent relationship between the health and adjustment after treatment between cancer survivors and caregivers. We examined interrelationships between coping resources and mental health among childhood cancer survivors (CCS)-parent dyads.

METHODS

One hundred sixty CCS-parent dyads from the Project Forward pilot study completed validated questions assessing social support, religiosity, spirituality, depressive symptoms, and perceived stress. Bidirectional associations were identified with path analysis utilizing the actor-partner interdependence model (APIM). We used a multigroup approach to test for the moderating effects by Hispanic ethnicity on these relationships.

RESULTS

Mean age of CCS was 20 years old, 51% female, 30% diagnosed with leukemia, and mean of 7 years from diagnosis. The mean age of parents was 49 years old and 89% were mothers. For both CCS and parents, perceived social support was inversely associated with their depressive symptoms and perceived stress (e.g., actor effects). Parents' social support was not significantly associated with CCS's depressive symptoms and stress. However, higher perceived social support by the CCS was inversely associated with parents' depressive symptoms (β =  - 0.202, p < 0.01) and perceived stress (β =  - 0.164, p < 0.05) (e.g., partner effects). Additional actor effects were observed between spirituality, religiosity, and depressive systems when we explored the moderating effects of Hispanic ethnicity.

CONCLUSION

Partner effects of social support among CCS-parent dyads may influence psychological distress.

IMPLICATION FOR CANCER SURVIVORS

Our findings on parent-child associations between social support and psychosocial well-being imply that survivorship care can be enhanced when the social support needs of both survivors and their parents are addressed together.