Clinical outcomes amongst elderly patients with inflammatory bowel disease.

BACKGROUNDS AND AIMS: Inflammatory bowel disease (IBD) affects a growing cohort of elderly patients. Our aim was to compare the quality of care received by elderly patients with IBD with a nonelderly adult IBD population using clinical markers including steroid-free clinical remission. METHOD: Retrospective audit of all consecutive patients attending a specialist IBD centre over a 1-year period aged >60 (elderly cohort [EC]) and 50 consecutive patients aged 30-45 years (control cohort [CC]). A follow-up survey was completed assessing current symptoms and perceptions of care. RESULTS: One hundred thirty-nine patients were evaluated (89 EC, 50 CC). Steroid-free clinical remission was observed less commonly in the EC (58, 64%) compared with the CC (40, 80%) (P < 0.05). Biologics such as infliximab (15% EC vs 36% CC; P < 0.01) and adalimumab (14% EC vs 30% CC; P = 0.02) were used less frequently in the EC, whilst vedolizumab (6% EC vs 6% CC; P = 1) and ustekinumab (3% EC vs 2% CC; P = 1) were used at a similar frequency. Patients in the EC were less likely to have specialist IBD nursing contact (P < 0.01), smoking screening (P < 0.011) or influenza vaccinations (P < 0.006). IBD nurse contact was associated with significantly greater provision of the preventative care measures. CONCLUSION: Elderly patients with IBD were less likely to experience steroid-free clinical remission or be prescribed biologics. Elderly patients were less likely to receive education with respect to preventative medicine. The models of care for the elderly need re-evaluation and greater incorporation with the multidisciplinary IBD team.

Long-Term Outcome of Multidisciplinary Versus Standard Gastroenterologist Care for Functional Gastrointestinal Disorders: A Randomized Trial.

BACKGROUND & AIMS: Functional gastrointestinal disorders are common and costly to the healthcare system. In the Multidisciplinary Treatment of Functional Gastrointestinal Disorders study, we demonstrated that multidisciplinary care resulted in superior clinical and cost outcomes, when compared with standard gastroenterologist-only care at end of treatment. In this study we evaluate the longer-term outcomes. METHODS: In a single-center, pragmatic trial patients with Rome IV criteria-defined functional gastrointestinal disorders were randomized 1:2 to a gastroenterologist-only standard care vs a multidisciplinary clinic comprising gastroenterologists, dietitians, gut hypnotherapists, psychiatrists, and biofeedback physiotherapists. Outcomes in this study were assessed 12 months after the end of treatment. Global symptom improvement was assessed by using a 5-point Likert scale. Symptoms, specific disorder status, psychological state, quality of life, and cost were additional outcomes. A modified intention-to-treat analysis was performed. RESULTS: Of 188 randomized patients, 143 (46 standard care, 97 multidisciplinary) formed the longer-term modified intention-to-treat analysis. Sixty-two percent of multidisciplinary clinic patients saw allied clinicians. Sixty-five percent (30/46) standard care versus 76% (74/97) multidisciplinary clinic patients achieved global symptom improvement 12 months after end of treatment (P = .17), whereas 20% (9/46) versus 37% (36/97) rated their symptoms as "5/5 much better" (P = .04). A ≥50-point reduction in Irritable Bowel Syndrome Severity Scoring System occurred in 38% versus 66% (P = .02), respectively, for irritable bowel syndrome patients. Anxiety and depression were greater in the standard care than multidisciplinary clinic (12 vs 10, P = .19), and quality of life was lower in standard care than the multidisciplinary clinic (0.75 vs 0.77, P =·.03). An incremental cost-effectivness ratio found that for every additional 3555AUD spent in the multidisciplinary clinic, a further quality-adjusted life year was gained. CONCLUSIONS: Twelve months after the completion of treatment, integrated multidisciplinary clinical care achieved a greater proportion of patients with improvement of symptoms, psychological state, quality of life, and cost, compared with gastroenterologist-only care. CLINICAL TRIALS: gov: number NCT03078634.

Pelvic floor behavioral treatment for fecal incontinence and constipation in quiescent inflammatory bowel disease.

BACKGROUND AND AIM: Refractory bowel symptoms in quiescent inflammatory bowel disease (IBD) are common but evidence for effective management is limited. We aimed to determine whether behavioral treatment, including pelvic floor muscle training, decreases the severity of functional bowel symptoms in patients with quiescent IBD. Secondary aims were to evaluate the treatment effect on quality of life, psychological well-being and pelvic floor muscle function. METHODS: This prospective study included IBD patients in remission with persistent symptoms of fecal incontinence or constipation who received up to six sessions of behavioral treatment at monthly intervals. The primary outcome was patient-rated symptom improvement on a 7-point Likert scale (1 = substantially worse, 7 = substantially better). Secondary outcomes included validated symptom scores, quality-of-life, psychological measures, and transperineal ultrasound assessment of pelvic floor muscle activity. RESULTS: Thirty-four patients (median age 38 years; 24 females; 18 ulcerative colitis, 13 Crohn's disease, 3 ileo-anal pouch) were included. Twenty-one of the 29 (72%) patients who completed treatment, or 21 of all 34 (62%) patients, reported moderate or substantial improvement (patient rating of 6 or 7). Symptom scores (p < .001), IBD-specific quality of life (p = .008) and illness perception scores (p = .003) significantly improved. General quality of life, and anxiety and depression scores, did not change significantly. Transperineal ultrasound pelvic floor measures did not correlate with patient-rating of symptom improvement. CONCLUSION: Significant symptomatic improvement occurred in a majority of patients with quiescent IBD. Behavioral treatment should be considered for patients with quiescent IBD and ongoing functional bowel symptoms of fecal incontinence, fecal urgency, or constipation.

Diet and gut microbiome in gastrointestinal disease.

The composition and function of the dynamic microbial community that constitutes the gut microbiome is continuously shaped by the host genome, mode of birth delivery, geography, life stage, antibiotic consumption, and diet. Diet is one of the most potent factors in determining microbiome integrity. Dietary factors in early life appear to substantially determine the risk of later health or disease; for example, exposure to ultra-processed foods in childhood or adolescence may increase the risk of the later development of inflammatory bowel disease or colorectal cancer, thought to be mediated by modulation of the gut microbiota. Dietary factors when gut diseases are established influence symptoms and disease activity, can form a risk factor for ongoing disease, or can be used as therapy to decrease disease activity. The characterization of dietary content is currently complex and imperfect, but tools are emerging to define precisely the nature of dietary composition. Similarly, the revolution in microbial analysis allows greater understanding of how diet influences microbial composition and function. Defining the interaction between diet, the gut microbiome, and gastrointestinal disease is leading to radical changes in our clinical approach to these disorders.

Investigating the impact of a chronic disease self-management programme on depression and quality of life scores in an Irish sample.

Depression is more common among people with chronic conditions than in the general population and can negatively influence both health behaviours and outcomes. The Chronic Disease Self-Management Programme (CDSMP) is a six-week psycho-educational programme designed to promote self-efficacy and to teach patients skills for managing their chronic conditions. A longitudinal design evaluated the effect of the CDSMP on depression in an Irish cohort. Self-report data on psychological wellbeing were collected at baseline (n = 263), immediately post-program (n = 102), and six months (n = 81) after enrolment. CDSMP participation was associated with a significant decrease in the mean depression score of the whole sample, across the three time points. Significant improvements in quality of life and health interference in social activities were also observed among those who met criteria for depression on the PHQ-8 at baseline, but not their peers with sub-threshold depression scores. Quality of life continued to improve between the end of the programme and 6-month follow-up. These findings support the efficacy of the CDSMP in the treatment of chronic conditions, as well as its role in promoting sustainable changes to quality of life.

Pharmacist-led intervention in treatment non-adherence and associated direct costs of management among ambulatory patients with type 2 diabetes in southwestern Nigeria.

BACKGROUND: Non-adherence to recommended therapy remains a challenge to achieving optimal clinical outcome with resultant economic implications. OBJECTIVE: To evaluate the effect of a pharmacist-led intervention on treatment non-adherence and direct costs of management among patients with type 2 diabetes (T2D). METHOD: A quasi-experimental study among 201-patients with T2D recruited from two-tertiary healthcare facilities in southwestern Nigeria using semi-structured interview. Patients were assigned into control (HbA1c < 7%, n = 95) and intervention (HbA1c ≥ 7%, n = 106) groups. Baseline questionnaire comprised modified 4-item Medication Adherence Questions (MAQ), Perceived Dietary Adherence Questionnaire (PDAQ) and International Physical Activity Questionnaire, to assess participants' adherence to medications, diet and physical activity, respectively. Post-baseline, participants were followed-up for 6-month with patient-specific educational intervention provided to resolve adherence discrepancies in the intervention group only, while control group continued to receive usual care. Subsequently, direct costs of management for 6-month pre-baseline and 6-month post-baseline were estimated for both groups. Data were summarized using descriptive statistics. Chi-square, McNemar and paired t-test were used to evaluate categorical and continuous variables at p < 0.05. RESULTS: Mean age was 62.9 ± 11.6 years, and 160(79.6%) were females. Glycated haemoglobin (HbA1c) was 6.1 ± 0.6% (baseline) and 6.1 ± 0.8% at 6-month post-baseline (p = 0.094) for control group, and 8.7 ± 1.5% (baseline) versus 7.8 ± 2.0% (6-month), p < 0.001, for the intervention. Post-baseline, response to MAQ items 1 (p = 0.017) and 2 (p < 0.001) improved significantly for the intervention. PDAQ score increased significantly from 51.8 ± 8.8 at baseline to 56.5 ± 3.9 at 6-month (p < 0.001) for intervention, and from 56.3 ± 4.0 to 56.5 ± 3.9 (p = 0.094) for the control group. Physical activity increased from 775.2 ± 700.5 Metabolic Equivalent Task (MET) to 829.3 ± 695.5MET(p < 0.001) and from 901.4 ± 743.5MET to 911.7 ± 752.6MET (p = 0.327) for intervention and control groups, respectively. Direct costs of management per patient increased from USD 327.3 ± 114.4 to USD 333.0 ± 118.4 (p = 0.449) for the intervention, while it decreased from USD 290.1 ± 116.97 to USD289.1 ± 120.0 (p = 0.89) for control group, at baseline and 6-month post-baseline, respectively. CONCLUSION: Pharmacist-led intervention enhanced adherence to recommended medications, diet and physical activity among the intervention patients, with a corresponding significant improvement in glycaemic outcome and an insignificant increase in direct costs of management. There is a need for active engagement of pharmacists in management of patients with diabetes in clinical practice. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04712916 . Retrospectively-registered.

Delivery of care for functional gastrointestinal disorders: A systematic review.

BACKGROUND: A diverse range of treatments are available for the treatment of functional gastrointestinal disorders (FGIDs). Individual treatments, including drug therapies, behavioral therapy ("biofeedback"), psychological therapies, and dietary therapies, have been well validated in controlled, randomized trials and real-life case series. However, few studies have evaluated models of delivery of care for the whole population of referred patients with an FGID. This review evaluates models of specialist outpatient care for the management of FGIDs. METHODS: A systematic review was performed of full-text articles published until October 2018 in Pubmed/Medline and Embase. Studies were included if they evaluated a model of outpatient care in a specialist setting for the treatment of adult patients with an FGID and included patient-reported outcomes comprising symptoms, quality of life, or psychological well-being. RESULTS: Few studies have evaluated the delivery of care for the whole population of referred patients with an FGID, and there was one randomized comparison of different models of care. Two studies that evaluated the outcome of gastroenterologist-only clinics suggested poor long-term results. Two non-comparative case series reported the outcome of multidisciplinary care, including gastroenterologists and psychological therapists, suggesting improved patient quality of life and psychological well-being. CONCLUSIONS: Despite the high prevalence and cost of treating FGIDs, and the availability of effective treatments, there are few data and limited randomized comparisons reporting the outcome of different types of specialist care. The few data available suggest that multidisciplinary care is superior to gastroenterologist-only care, but this needs to be validated in prospective comparative studies.

Outcome of hospital outpatient treatment of functional gastrointestinal disorders.

BACKGROUND: Functional gastrointestinal disorders (FGID) are the commonest conditions observed in gastrointestinal (GI) practice, yet the outcomes of their outpatient care are not known. AIM: To evaluate the outcome for patients with FGID attending a specialist GI clinic. METHODS: Consecutive, newly referred patients with a FGID attending a specialist GI clinic in a tertiary hospital, over a 1-year period were reviewed and then completed a phone survey to assess current symptoms. RESULTS: Of 102 patients, 57% had irritable bowel syndrome, 28% functional dyspepsia and 15% other functional disorders. At interview, a median of 402 days after the last consultation 38% expressed symptom improvement, but 64% remained concerned about their condition despite 62% having been reassured. After treatment, 50% of employed patients took time off work because of gut symptoms. Functional dyspepsia patients were less likely to be symptomatically improved than other FGID (21% vs 45%, P = 0.02). Patients given a diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols were more likely than others to achieve symptom improvement (53% vs 31%, P = 0.03); PPI-treated patients were less likely to experience improvement (22% vs 44%, P = 0.05); other treatments did not predict outcome. Number of visits, seniority of clinician, duration of care and comorbidities did not predict outcome. CONCLUSION: One year after attending a specialist GI clinic a minority of patients with FGID were symptomatically improved. Failure to benefit by many patients may relate to the nature of patients and conditions being treated or the limited nature and range of treatments offered. Different models of care, including more diverse multidisciplinary models, should be explored.

Concurrence of Gemination and Fusion in Maxillary Central Incisors: A Case Report.

This case reports the concurrence of gemination and fusion affecting the maxillary central incisors of a twelve-year-old patient and the collaboration of the pediatric dentist, endodontist, orthodontist and oral and maxillofacial surgeon. Developmental dental anomalies can occur in both primary and permanent dentitions as a result of conjoining defects. Double teeth, or cases of gemination or fusion, are not exceedingly rare, but the presence of both anomalies in a single patient is a rarity. Gemination is the division of a single tooth bud, resulting in a large single tooth with a bifid crown and common root and root canal. Fusion is the union of two separate tooth buds, resulting in a joined tooth with confluence of dentin and separate root canals. Labial apexogenesis with MTA, composite resin placement, re-contouring and orthodontic care allowed proper alignment with long-term monitoring of growth and development for possible incisor replacement.

Management of traumatic tooth injuries in the dental office.

Dental trauma is sudden, unscheduled, and the dentist and staff must be adequately equipped to expeditiously and properly treat the patient to assure the best possible outcome. This paper reviews current dental trauma guidelines to provide the correct treatment protocol to ensure the best prognosis. The case report illustrates the technique of avulsion care, RCT care, and functional splinting in a successful manner.

Evaluation of Tyro3 expression, Gas6-mediated Akt phosphorylation, and the impact of anti-Tyro3 antibodies in melanoma cell lines.

Tyro3, a member of the Tyro3/Axl/Mer (TAM) family of receptor tyrosine kinases, has emerged as a potential oncogene in melanoma. Here, we confirm that Tyro3 is specifically overexpressed in primary melanoma samples and show that Tyro3 is expressed at varying levels in numerous melanoma cell lines. Short hairpin RNA-mediated knockdown of Tyro3 led to significant cell death via apoptotic mechanisms in nearly all melanoma cell lines tested, regardless of the BRAF or NRAS mutation status or co-expression of Axl and/or Mer. We generated soluble and monomeric versions of the human Tyro3 extracellular domain and human Gas6 for affinity measurements and correlated these values with the level of Gas6 required to induce Tyro3 signaling in cellular assays. Calcium was critical for the correct folding of Gas6 and its binding to Tyro3. In melanoma cell lines, Gas6 induced Tyro3 phosphorylation and downstream Akt phosphorylation without apparent effects on Erk. We generated monoclonal antibodies (mAbs) against Tyro3 to examine their effect on survival signaling in melanoma cell lines. The mAbs generated against Tyro3 included nonligand blockers, partial blockers, and competitive ligand blockers. A number of weak and partial ligand blockers (all recognizing the Tyro3 Ig domains) were the most effective at blocking ligand-mediated downstream signaling of Tyro3. Overall, these data indicate that Tyro3 may confer increased survival signals in melanoma cells and can be stymied using inhibitory mAbs. These mAbs may be useful for further investigations of the role of Tyro3 in melanoma.

Golgi fragmentation is Rab and SNARE dependent in cellular models of Parkinson's disease.

Fragmentation of the Golgi ribbon is a common feature of many neurodegenerative diseases but little is known about the causes of this alteration. In Parkinson's disease, it is believed to be the consequence of an ER-Golgi transport imbalance and/or of cytoskeleton alterations. In the present study, we analyze the mechanisms involved in Golgi fragmentation in differentiated PC12 cells treated with 6-hydroxydopamine or methamphetamine as cellular models of Parkinson's disease. Our data demonstrate that Golgi fragmentation precedes and might trigger the aggregation of α-synuclein and the formation of inclusions, alterations in anterograde and retrograde transport between the endoplasmic reticulum and Golgi complex, and cytoskeleton damage. In contrast, fragmentation is directly related with alterations in the levels of Rab1, 2 and 8 and the SNARE protein syntaxin 5. Thus, overexpression of Rab1 and 8 and depletion of Rab2 and syntaxin 5 rescue the Golgi morphology. In conclusion, the homeostasis of a limited number of Rab and SNARE proteins is important for understanding the cytopathology of Parkinson's disease.

Fatal gunshot injuries in Benin City, Nigeria.

An upsurge in gun violence in recent times in our environment necessitated this study, which aims to document the patterns of fatal gunshot injuries with the hope of finding a solution to this problem. The study was a retrospective analysis of cases of fatal gunshot injuries on which autopsies were carried out over the 5-year period from January 1998 to December 2002 at Police Medical Services, Benin City - a Nigerian ancient town located in the South-South zone of the country. Most cases of medico-legal death in Benin City and environs are referred to the Police Pathologist at the center for autopsy. A total of 210 cases representing 27.2% of all medico-legal deaths during the study period were reviewed. Males were far more affected than females (M:F = 10.7:1). The intent for the fatal gunshots was murder (88.5%), excusable homicide (4.8%), accident (4.3%) and suicide (0.5%). In 1.9% of the deaths, the circumstances were not clear. Armed robbers, thugs and assassins accounted for 88.1% of the fatal shots, while the Police accounted for 9.0%. The trunk was affected much more than the head, neck and limbs. There is a need to improve security in the country and reduce poverty. Illegal firearms should also be removed from circulation. An improvement in emergency health services will reduce deaths from gunshots.

Skin Sensitivity Assessment Using Smartphone Haptic Feedback.

Goal: This work presents a smartphone application to assess cutaneous sensory perception by establishing Vibrational Perception Thresholds (VPTs). Cutaneous sensory perception diagnostics allow for the early detection and symptom tracking of tactile dysfunction. However, lack of access to healthcare and the limited frequency of current screening tools can leave skin sensation impairments undiscovered or unmonitored. Methods: A 23-participant cross-sectional study in subjects with a range of finger sensation tests Smartphone Established VPTs (SE-VPTs) by varying device vibrational intensity. These are compared against monofilament test scores, a clinical measure of skin sensitivity. Results: We find a strong positive correlation between SE-VPTs and monofilament scores ([Formula: see text] = 0.86, p = 1.65e-07). Conclusions: These results demonstrate the feasibility of using a smartphone as a skin sensation screening tool.

"Self-care selfies": Patient-uploaded videos capture meaningful changes in dexterity over 6 months.

OBJECTIVE: Upper extremity function reflects disease progression in multiple sclerosis (MS). This study evaluated the feasibility, validity, and sensitivity to change of remote dexterity assessments applying human pose estimation to patient-uploaded videos. METHODS: A discovery cohort of 50 adults with MS recorded "selfie" videos of self-care tasks at home: buttoning, brushing teeth, and eating. Kinematic data were extracted using MediaPipe Hand pose estimation software. Clinical comparison tests were grip and pinch strength, 9 hole peg test (9HPT), and vibration, and patient-reported dexterity assessments (ABILHAND). Feasibility and acceptability were evaluated (Health-ITUES framework). A validation cohort (N = 35) completed 9HPT and videos. RESULTS: The modality was feasible: 88% of the 50 enrolled participants uploaded ≥3 videos, and 74% completed the study. It was also usable: assessments easy to access (95%), platform easy to use (97%), and tasks representative of daily activities (86%). The buttoning task revealed four metrics with strong correlations with 9HPT (nondominant: r = 0.60-0.69, dominant: r = 0.51-0.57, P < 0.05) and ABILHAND (r = -0.48, P = 0.05). Retest validity at 1 week was stable (r > 0.8). Cross-sectional correlations between video metrics and 9HPT were similar at 6 months, and in the validation cohort (nondominant: r = 0.46, dominant: r = 0.45, P < 0.05). Over 6 months, pinch strength (5.8-5.0 kg/cm2 , P = 0.05) and self-reported pinch (ABILHAND) decreased marginally. While only 15% of participants worsened by 20% on 9HPT, 70% worsened in key buttoning video metrics. INTERPRETATION: Patient-uploaded videos represent a novel, patient-centered modality for capturing dexterity that appears valid and sensitive to change, enhancing its potential to be disseminated for neurological disease monitoring and treatment.

Effect of food additives on key bacterial taxa and the mucosa-associated microbiota in Crohn's disease. The ENIGMA study.

Food additives have been linked to the pro-inflammatory microbial dysbiosis associated with Crohn's disease (CD) but the underlying ecological dynamics are unknown. Here, we examine how selection of food additives affects the growth of multiple strains of a key beneficial bacterium (Faecalibacterium prausnitzii), axenic clinical isolates of proinflammatory bacteria from CD patients (Proteus, Morganella, and Klebsiella spp.), and the consortia of mucosa-associated microbiota recovered from multiple Crohn's disease patients. Bacterial growth of the axenic isolates was evaluated using a habitat-simulating medium supplemented with either sodium sulfite, aluminum silicate, carrageenan, carboxymethylcellulose, polysorbate 80, saccharin, sucralose, or aspartame, intended to approximate concentrations found in food. The microbial consortia recovered from post-operative CD patient mucosal biopsy samples were challenged with either carboxymethylcellulose and/or polysorbate 80, and the bacterial communities compared to unchallenged consortia by 16S rRNA gene amplicon profiling. Growth of all F. prausnitzii strains was arrested when either sodium sulfite or polysorbate 80 was added to cultures at baseline or mid-exponential phase of growth, and the inhibitory effects on the Gram-negative bacteria by sodium sulfite were conditional on oxygen availability. The effects from polysorbate 80, saccharin, carrageenan, and/or carboxymethylcellulose on these bacteria were strain-specific. In addition to their direct effects on bacterial growth, polysorbate 80 and/or carboxymethylcellulose can drive profound changes in the CD mucosa-associated microbiota via niche expansion of Proteus and/or Veillonellaceae - both implicated in early Crohn's disease recurrence. These studies on the interaction of food additives with the enteric microbiota provide a basis for dietary management in Crohn's disease.

Implications of failure on students who have repeated a class in a faculty of pharmacy.

INTRODUCTION: Academic failure is a major contributor to attrition in pharmacy education, and this attrition is also associated with other effects that are secondary fallouts of academic failure. This study sought to assess the emotional implications and overall psychological impact of academic failure among students who repeated at least one class in the pharmacy program at Obafemi Awolowo University (OAU), Ile-Ife, Nigeria. METHODS: The study involved 177 students from the 200 level to 500 level at the School of Pharmacy, OAU who had repeated at least one class. A pretested questionnaire was administered using a random sampling method. The questionnaire was divided into four sections assessing demographics, the academic emotions caused by academic failure, the psychological effects of failure, and the possible effects of academic failure on subsequent performance. RESULTS: Results indicated that the most common emotions among students who had repeated a class included shame (80%), anger (77.4%), anxiety (61%), and boredom (61%), which are all negative academic emotions. The repurposed Impact of Event Scale gave a median score of 41 out of a possible 42. Respondents also agreed that feelings of boredom, anger, anxiety, and shame subsequently impacted class attendance, learning, and test preparation. CONCLUSIONS: The study showed that students who had repeated at least one class experienced negative academic emotions and may have suffered symptoms typical of post-traumatic stress disorder. These emotional effects of academic failure were also noted to impact subsequent academic performance.

Barriers to Patients' Acceptance of Social Care Interventions in Clinic Settings.

INTRODUCTION: Despite efforts to identify and address the social needs of patients in U.S. healthcare settings, researchers consistently find high rates of patients who decline social interventions after reporting that they have unmet social needs. It is an open question as to why people who screen positive for social risks decline assistance. This question was qualitatively explored in a community health center in Rhode Island. METHODS: From 2020 to 2021, a total of 26 patients with a positive screen for social risks were telephonically interviewed. Zoom focus groups with clinic staff and Community Advisory Board members were also conducted. Interviews were audio recorded and transcribed. Transcripts were read and analyzed by 4 investigators using an open-coding framework to identify themes emerging from the data and across interviews. RESULTS: A total of 6 dominant themes related to why patients decline social assistance emerged from the data and were identified across interviews and study populations. Participants explained that the wording of screening questions, along with voluminous paperwork and time constraints of the clinic sometimes resulted in inaccurate reporting. Patients' knowledge of limited resources from previous experiences of requesting social support but not receiving help was a theme. Shame/pride, stigma/discrimination, beliefs and lack of understanding, and fear/mistrust were also described. CONCLUSIONS: Barriers to patients' acceptance of services to support social needs were influenced by multiple factors, both internal and external to the health center. These findings can inform best practices related to and the reliability of social risk screening processes in clinic settings to promote social justice and ensure health equity.

Effect of variable transmission on body-powered prosthetic grasping.

Body-powered upper-limb prostheses remain a popular option for those with limb absence due to their passive nature. These devices typically feature a constant transmission ratio between the forces input by the user and the grasp forces output by the prosthetic gripper. Work incorporating continuously variable transmissions into robotic hands has demonstrated a number of benefits in terms of their motion and forces. In this work, we use a custom prosthesis emulator to evaluate the viability of applying variable transmissions to a body-powered prosthetic context. With this haptics test bed, we measured user performance during a grasping and lift task under a variety of transmission ratio conditions and with three different test objects. Results indicate that use of a variable transmission leads to the successful manipulation of a wider variety of objects than the constant transmission ratio systems, while requiring less shoulder motion. Analysis also shows a potential tendency for users to apply higher grasp forces than necessary, when compared to constant transmission conditions. These findings suggest a multifaceted effect on grasp performance with both benefits and drawbacks when considering a variable approach that supports the continued study of variable transmissions in assisted grasping.

Interventions to Improve Adherence to Preventive Care in Inflammatory Bowel Disease: A Systematic Review.

BACKGROUND: Preventive health measures reduce treatment and disease-related complications including infections, osteoporosis, and malignancies in patients with inflammatory bowel disease (IBD). Although guidelines and quality measures for IBD care highlight the importance of preventive care, their uptake remains variable. This systematic review evaluates interventions aimed at improving the rates of provision and uptake of preventive health measures, including vaccinations, bone density assessment, skin cancer screening, cervical cancer screening, and smoking cessation counseling. METHODS: We searched PubMed, MEDLINE, EMBASE, and CENTRAL for full text articles published until March 2021. Studies were included if they evaluated interventions to improve the provision or uptake of 1 or more preventive health measures in adult IBD patients and if they reported pre- and postintervention outcomes. RESULTS: In all, 4655 studies were screened, and a total of 17 studies were included, including 1 randomized controlled trial, 1 cluster-controlled trial, and 15 prospective interventional studies. A variety of interventions were effective in improving the rates of adherence to preventive health measures. The most common interventions targeted gastroenterologists, including education, electronic medical records tools, and audit feedback. Other interventions targeted patients, such as education, questionnaires, and offering vaccine administration at clinic visits. Few interventions involved IBD nurses or primary care physicians. CONCLUSIONS: A range of interventions-targeted at gastroenterologists, patients, or both-were effective in improving the provision and uptake of preventive care. Future studies should involve randomized controlled trials evaluating multifaceted interventions that target barriers to adherence and involve IBD nurses and primary care physicians.