Disease characteristics, prognosis, and response to therapy in patients with large-cell transformed mycosis fungoides: A single-center retrospective study.

BACKGROUND: Mycosis fungoides with large-cell transformation (MF-LCT) is associated with an aggressive clinical course, yet data comparing treatment outcomes in MF-LCT are sparse. OBJECTIVE: To compare treatment outcomes and to determine disease prevalence and characteristics associated with survival in MF-LCT. METHODS: A retrospective review was conducted of mycosis fungoides patients from 2012 to 2020 treated at Thomas Jefferson University. Patients with histopathologic diagnosis of MF-LCT were included. Treatment outcomes were assessed by mean changes in the modified Severity Weighted Assessment Tool (mSWAT) and stage. RESULTS: Of 171 patients with mycosis fungoides, 23 (13.4%) had histologic diagnosis of MF-LCT. The overall 5-year survival rate for MF-LCT was 74% and was not significantly associated with sex, age, or initial stage at the time of MF-LCT diagnosis. Brentuximab vedotin showed the greatest mean decrease in mSWAT (-20.53) and stage progression (change in Δ stage: -0.4) in MF-LCT compared to oral bexarotene (ΔmSWAT: +4.51; Δstage: +0.27), skin-directed therapy (ΔmSWAT: -5.93; Δstage: -0.08), and chemotherapy (ΔmSWAT: +4.97; Δstage: +0.85). LIMITATIONS: Single-center retrospective design, and patients often on multiple treatment modalities. CONCLUSIONS: We report superior treatment outcomes for brentuximab vedotin compared to oral bexarotene, skin-directed therapy, and chemotherapy in MF-LCT in both early and advanced disease.

Response to topical corticosteroid monotherapy in mycosis fungoides.

BACKGROUND: Topical corticosteroids alone or in combination with other therapies are widely used to treat mycosis fungoides (MF), but data on response rates to their use as monotherapy in MF are limited. OBJECTIVE: To evaluate the efficacy of topical corticosteroid monotherapy in MF; compare sex, age, stage distributions, and histopathologic features between responders and nonresponders. METHODS: A retrospective cross-sectional review of patients with MF from 2013 to 2019 treated at Thomas Jefferson University was conducted. Patients with biopsy-proven MF, all stages, who received topical corticosteroid monotherapy were included. Response rates were determined by percent change in body surface area (BSA) involvement and modified Severity-Weighted Assessment Tool (mSWAT). RESULTS: Of the 163 patients with MF in our database, 23% (37/163) initially received topical steroid monotherapy. Of these, 73% (27/37) improved, with an average 65% decrease in BSA (67% in mSWAT); 27% (10/37) did not respond/progressed, with an average 51.6% increase in BSA (57% in mSWAT); and 33% (12/37) had a complete response (BSA, 0%) with prolonged topical steroid use. Early-stage MF and female sex were more represented in responders. LIMITATIONS: Single-center retrospective design. CONCLUSIONS: Topical steroid monotherapy in early-stage MF can produce measurable improvements in BSA and mSWAT scores and achieve complete remission in a limited subset of patients.

Linear basal cell nevus with a novel mosaic PTCH1 mutation.

The patched tumor suppressor gene (PTCH1) encodes a receptor, which is a key component of the hedgehog signalling pathway. Mutations in PTCH1 are implicated in the development of sporadic basal cell carcinomas (BCC), as well as those in Gorlin Syndrome. Rarely, BCCs may develop in a linear pattern along lines of Blaschko due to cutaneous mosaicism. In cases in which there are other features of Gorlin syndrome, genomic analysis has demonstrated lesional mutations in the Hedgehog signalling pathway. Causative mutations, however, have not been firmly demonstrated in the cases of linear and segmental BCCs in otherwise healthy individuals. Herein, we report a case of a 31 year-old Caucasian woman with linear development of multiple superficial BCCs in a Blaschkoid distribution without other characteristic findings of Gorlin syndrome. Genomic analysis of lesional skin by whole-exome sequencing identified a novel heterozygous mutation PTCH1: NM_000264.3, Exon 15, c.2336-2337insGGTAGGA, p.Asp779Glufs*13 in PTCH1, shared by two discrete samples within the lesion, while no mutations were found in the non-lesional skin or peripheral blood. Given the young age of our patient and linear distribution of BCCs on non-sun exposed skin, our findings suggest segmental mosaicism. The patient was treated with topical 5% imiquimod with histologically confirmed clearance of BCCs in 2 months.

Effects of a wearable exoskeleton stride management assist system (SMA®) on spatiotemporal gait characteristics in individuals after stroke: a randomized controlled trial.

BACKGROUND: Robots offer an alternative, potentially advantageous method of providing repetitive, high-dosage, and high-intensity training to address the gait impairments caused by stroke. In this study, we compared the effects of the Stride Management Assist (SMA®) System, a new wearable robotic device developed by Honda R&D Corporation, Japan, with functional task specific training (FTST) on spatiotemporal gait parameters in stroke survivors. METHODS: A single blinded randomized control trial was performed to assess the effect of FTST and task-specific walking training with the SMA® device on spatiotemporal gait parameters. Participants (n=50) were randomly assigned to FTST or SMA. Subjects in both groups received training 3 times per week for 6-8 weeks for a maximum of 18 training sessions. The GAITRite® system was used to collect data on subjects' spatiotemporal gait characteristics before training (baseline), at mid-training, post-training, and at a 3-month follow-up. RESULTS: After training, significant improvements in gait parameters were observed in both training groups compared to baseline, including an increase in velocity and cadence, a decrease in swing time on the impaired side, a decrease in double support time, an increase in stride length on impaired and non-impaired sides, and an increase in step length on impaired and non-impaired sides. No significant differences were observed between training groups; except for SMA group, step length on the impaired side increased significantly during self-selected walking speed trials and spatial asymmetry decreased significantly during fast-velocity walking trials. CONCLUSIONS: SMA and FTST interventions provided similar, significant improvements in spatiotemporal gait parameters; however, the SMA group showed additional improvements across more parameters at various time points. These results indicate that the SMA® device could be a useful therapeutic tool to improve spatiotemporal parameters and contribute to improved functional mobility in stroke survivors. Further research is needed to determine the feasibility of using this device in a home setting vs a clinic setting, and whether such home use provides continued benefits. TRIAL REGISTRATION: This study is registered under the title "Development of walk assist device to improve community ambulation" and can be located in clinicaltrials.gov with the study identifier: NCT01994395 .

Mexican-origin Early Adolescents' Ethnic Socialization, Ethnic Identity, and Psychosocial Functioning.

The current study examined how parental ethnic socialization informed adolescents' ethnic identity development and, in turn, youths' psychosocial functioning (i.e., mental health, social competence, academic efficacy, externalizing behaviors) among 749 Mexican-origin families. In addition, school ethnic composition was examined as a moderator of these associations. Findings indicated that mothers' and fathers' ethnic socialization were significant longitudinal predictors of adolescents' ethnic identity, although fathers' ethnic socialization interacted significantly with youths' school ethnic composition in 5th grade to influence ethnic identity in 7th grade. Furthermore, adolescents' ethnic identity was significantly associated with increased academic self-efficacy and social competence, and decreased depressive symptoms and externalizing behaviors. Findings support theoretical predictions regarding the central role parents play in Mexican-origin adolescents' normative developmental processes and adjustment and, importantly, underscore the need to consider variability that is introduced into these processes by features of the social context such as school ethnic composition.

Associations between adolescents' perceived discrimination and prosocial tendencies: the mediating role of Mexican American values.

Experiences with perceived discrimination (e.g., perceptions of being treated unfairly due to race or ethnicity) are expected to impact negatively youths' prosocial development. However, resilience often occurs in light of such experiences through cultural factors. The current longitudinal study examined the influence of perceived discrimination on the emergence of Mexican American adolescents' later prosocial tendencies, and examined the mediating role of Mexican American values (e.g., familism, respect, and religiosity). Participants included 749 adolescents (49 % female) interviewed at 5th, 7th, and 10th grade. Results of the current study suggested that, although perceived discrimination was associated negatively with some types of prosocial tendencies (e.g., compliant, emotional, and dire) and related positively to public prosocial helping, the associations were mediated by youths' Mexican American values. Directions for future research are presented and practical implications for promoting adolescents' resilience are discussed.

Topical Moringa Formulations: An Emerging Skincare Ingredient.

Recently, the addition of moringa to skincare products has become a popular trend, especially in the natural beauty industry. It is being marketed for its intended moisturizing, antioxidant, and anti-aging properties; however, data are scarce demonstrating its clinical effects as well as standardized concentration, formula, source, and extraction methods. Skin specialists must be aware of this trendy ingredient, including its recent claims in marketing material and current evidence in the literature.

A prospective study of Mexican American adolescents' academic success: considering family and individual factors.

Mexican American youth are at greater risk of school failure than their peers. To identify factors that may contribute to academic success in this population, this study examined the prospective relationships from 5th grade to 7th grade of family (i.e., human capital [a parent with at least a high school education], residential stability, academically and occupationally positive family role models, and family structure) and individual characteristics (i.e., externalizing symptoms, bilingualism, gender, and immigrant status) to the academic performance of 749 Mexican American early adolescents (average age = 10.4 years and 48.7% were girls in 5th grade) from economically and culturally diverse families as these youth made the transition to junior high school. Results indicated that while controlling for prior academic performance, human capital and positive family role models assessed when adolescents were in 5th grade positively related to academic performance in 7th grade. Further, being a girl also was related to greater 7th grade academic success, whereas externalizing symptoms were negatively related to 7th grade academic performance. No other variables in the model were significantly and prospectively related to 7th grade academic performance. Implications for future research and interventions are discussed.

A diagonal and social protection plus approach to meet the challenges of the COVID-19 syndemic: cash transfers and intimate partner violence interventions in Latin America.

Latin America has been particularly hard hit by the COVID-19 syndemic, including the associated economic fallout that has threatened the livelihoods of most families. Social protection platforms and policies should have a crucial role in safeguarding individual and family wellbeing; however, the response has been insufficient to address the scale of the crisis. In this Viewpoint, we focus on two policy challenges of the COVID-19 syndemic: rapidly and effectively providing financial support to the many families that lost livelihoods, and responding to and mitigating the increased risk of intimate partner violence (IPV). We argue that building programmatic linkages between social protection platforms, particularly cash transfers, and IPV prevention, mitigation, and response services, creates synergies that can promote freedom from both poverty and violence.

Effectiveness of staffing models in residential, subacute, extended aged care settings on patient and staff outcomes.

BACKGROUND: A key concern for managers and nurse administrators of healthcare settings is staffing. Determining and maintaining an appropriate level and mix of staff is especially problematic for those working in the long-term aged-care sector, where resident needs are complex and recruitment and retention of staff is challenging. OBJECTIVES: To identify which staffing models are associated with the best patient and staff outcomes. SEARCH STRATEGY: We searched the Effective Practice and Organisation of Care (EPOC) Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) and the Database of Abstracts of Reviews of Effectiveness (DARE) in The Cochrane Library and the databases MEDLINE, EMBASE, Ageline, CINAHL, and Dissertation abstracts. We also handsearched the reference lists and bibliographies of all retrieved articles. SELECTION CRITERIA: This review considered interrupted time series studies and studies with concurrent control designs of care staff or residents of residential or subacute or extended aged-care settings that evaluated the effectiveness of staffing models and skill mixes on resident and care staff outcomes. DATA COLLECTION AND ANALYSIS: Two review authors critically appraised all studies that were retrieved based on the screening of titles and abstracts according to the EPOC Group's data collection checklist.The same two review authors independently extracted and summarised details of eligible studies using the data abstraction form developed by EPOC. MAIN RESULTS: We included two studies (one interrupted time series and one controlled before-and-after study); both evaluated a primary-care model compared with a either a team-nursing model or a usual-care model. The primary-care model was found to provide slightly better results than the comparator for some outcomes such as resident well-being or behaviour. While nursing staff favoured the primary-care model in one study, neither study found significant improvements in staff outcomes using the primary model compared with the comparator. One study evaluated the uptake of the primary-care model within their facilities and found incorporation of this model into their practice was limited. AUTHORS' CONCLUSIONS: Apart from two small studies evaluating primary care, no evidence in the form of concurrently controlled trials could be identified. While these two studies generally favour the use of primary care, the research designs of both ITS and CBA studies are considered prone to bias, specifically selection and blinding of participants and assessors. Therefore, these studies should be regarded with caution and there is little clear evidence for the effective use of any specific model of care in residential aged care to benefit either residents or care staff. Research in this area is clearly needed.

What's eating you? human flea (Pulex irritans).

The human flea, Pulex irritans, is an important vector in the transmission of human diseases. This flea has been identified as a vector for the bubonic plague as far back as the 14th century, causing millions of deaths. Pulex irritans also has been identified as a vector for Bartonella bacteria species, which can cause trench fever. Rickettsia species, which can cause Rocky Mountain spotted fever and Mediterranean spotted fever, also have been identified in P irritans. Flea bites present as intensely pruritic papules and can be treated with topical antipruritics and corticosteroids. The most effective form of flea control and prevention includes a combination of insecticidal products and insect growth regulators.

Skindex-29 scores indicate poor quality of life in early stage mycosis fungoides.

BACKGROUND: Questionnaire tools are increasingly being used to assess health related quality of life (HRQOL) in mycosis fungoides (MF) patients. However, a thorough understanding of the factors that lead to poor HRQoL in early stage disease and their distribution across patient subgroups is lacking. OBJECTIVES: To characterize factors affecting HRQoL as assessed by Skindex-29 in subgroups of patients with early stage MF seen at a multidisciplinary cutaneous lymphoma clinic. METHODS: Skindex-29, a multidimensional survey that evaluates HRQoL (emotions, symptoms, function), was distributed to early stage MF patients. Overall and component scores were analyzed in three groups: no evidence of disease (NED), active disease with limited early stage (AD-T1), and active disease with more extensive early stage (AD-T2). Scores were also compared among patients receiving different treatment modalities. RESULTS: 56 patients (9 NED, 36 AD-T1, and 11 AD-T2) were enrolled in the study. Overall Skindex-29 scores and scores for individual dimensions were comparable among the three sub-groups. Similarly, these scores did not significantly differ among treatment groups or after removal of patients with previous staging higher than IB. Analysis of individual questions revealed that NED patients reported higher scores for questions pertaining to anger and fatigue. CONCLUSIONS: Early stage MF patients enrolled in this study had high overall Skindex-29 scores. Surprisingly, Skindex-29 scores of NED patients were comparable to those of patients with active disease, T1 and T2, mostly due to anger and fatigue. Even when skin involvement is minimal or absent, MF patients continue to report impaired HRQoL.

Pain assessment in older people with dementia: literature review.

AIM: This paper is a report of a literature review conducted to identify barriers to successful pain assessment in older adults with dementia and possible strategies to overcome such barriers. BACKGROUND: Pain is frequently undetected, misinterpreted, or inaccurately assessed in older adults with cognitive impairment. These people are often unable to articulate or convey how they feel and are often perceived as incapable of experiencing or recalling pain. DATA SOURCES: Searches were conducted of CINAHL, Medline and other databases for the period 1993-2007 using the search terms pain, dementia, assess*, barrier* and obstacle*. METHODS: Studies were critically appraised by two independent reviewers. Data were extracted using instruments specifically developed for the review. Studies were categorized according to levels of evidence defined by the Australian National Health and Medical Research Council and Joanna Briggs Institute. RESULTS: Perceived barriers to successful pain assessment in people with dementia included lack of recognition of pain, lack of sufficient education and/or training, misdiagnosis or late diagnosis, and non-use of assessment tools. Barriers related to people with dementia included insufficient evidence, the possibility of a 'no pain' subset of people with dementia, type of pain, and stoical attitudes. Strategies proposed as means of overcoming these barriers included knowing the person, knowing by diversity/intuitive perception, education and training, and use of adequate tools. CONCLUSION: More extensive education and training about the relationship between pain and dementia are urgently needed, as is the development and implementation of an effective pain assessment tool specifically designed to detect and measure pain in older adults with all stages of dementia.

Goal and personality trait development in emerging adulthood.

The present research examined continuity and change in the importance of major life goals and the relation between change in goals and change in personality traits over the course of college (N = 298). Participants rated the importance of their life goals 6 times over a 4-year period and completed a measure of the Big Five personality traits at the beginning and end of college. Like personality traits, life goals demonstrated high levels of rank-order stability. Unlike personality traits assessed during the same period and in the same sample, the mean importance of most life goals decreased over time. Moreover, each goal domain was marked by significant individual differences in change, and these individual differences were related to changes in personality traits. These findings provide insights into the relatively unstudied question of how life goals change during emerging adulthood.

The Mexican American biculturalism scale: bicultural comfort, facility, and advantages for adolescents and adults.

Empirical research on biculturalism is limited, in part because of the lack of quality measures of biculturalism. The currently available measures have limitations due to scoring procedures and sampling of only a narrow range of behaviors and attitudes. We present a measure of biculturalism that captures a broader range of the bicultural experience and uses a scoring system that better represents the wide ranging levels of biculturalism that exist in the diverse population of Mexican American adolescents, mothers, and fathers born in either Mexico or the United States. The Mexican American Biculturalism Scale (27 items) includes 3 subscales: bicultural comfort (9 items), bicultural facility (9 items), and bicultural advantages (9 items). We report on the reliability and construct validity of test scores and present confirmatory factor analyses findings for a diverse sample of 316 Mexican American families from a large southwestern metropolitan city. The Mexican American Biculturalism Scale is available in English and in Spanish. The use of the scale has implications for future research studying how biculturalism is related to psychological outcomes for Mexicans/Mexican Americans.

Family and cultural processes linking family instability to Mexican American adolescent adjustment.

Despite the rapidly growing Mexican American population, no studies to date have attempted to explain the underlying relations between family instability and Mexican American children's development. Using a diverse sample of 740 Mexican American adolescents (49% female; 5th grade, M age = 10.4 years; 7th grade, M age = 12.8 years) and their mothers, we prospectively examined the relations between family instability and adolescent academic outcomes and mental health in the 7th grade. The model fit the data well and results indicated that family instability between 5th and 7th grade was related to increased 7th-grade mother-adolescent conflict, and, in turn, mother-adolescent conflict was related to decreased school attachment and to increased externalizing and internalizing symptoms in the 7th grade. Results also indicated that 7th-grade mother-adolescent conflict mediated the relations between family instability and 7th-grade academic outcomes and mental health. Further, we explored adolescent familism values as a moderator and found that adolescent familism values served as a protective factor in the relation between mother-adolescent conflict and grades. Implications for future research and intervention strategies are discussed.