Interparticle interaction-dependent jamming in colloids: insights into glass transition and morphology modulation during rapid evaporation-induced assembly.

Understanding the role of interparticle interactions in jamming phenomena is essential for gaining insights into the intriguing glass transition behavior observed in atomic and molecular systems. In this study, we investigate the jamming behavior of colloids with tunable interparticle interactions during evaporation-induced assembly (EIA). By manipulating the interaction among charged colloids using cationic polyethyleneimine (PEI) through electro-sorption and subsequent free polymer induced repulsion, we observe distinct jamming behavior in silica colloids during EIA, depending on the interparticle interactions. Silica colloids with strong repulsive interactions exhibit a repulsive colloidal glass state with a volume fraction of silica colloids in supraparticle ϕ ∼ 0.70. On the other hand, PEI-mediated attractive interactions among silica colloids lead to an attractive colloidal glass phase with a significantly lower ϕ ∼ 0.43. Free polymer induced repulsion of colloids at higher PEI concentration once again results in a repulsive glassy state with ϕ ∼ 0.61. Furthermore, we revealed that interparticle interactions not only influence the jamming behavior but also play a significant role in shaping the morphology of self-assembled structures during EIA, and the assembled structure undergoes a morphological reentrant transition from a doughnut-like shape to a spherical form and again back to a doughnut-like configuration. Jamming-dependent evolution of micropores and dynamics of the confined PEI have been probed using positron annihilation lifetime spectroscopy (PALS) and broadband dielectric spectroscopy (BDS). PALS reveals distinct variations in the micropores of the supraparticles with different PEI loadings, confirming the impact of jamming on the evolution of the micropores within the supraparticles. BDS measurements uncover non-monotonic dynamics of PEI molecules confined in the evolved pore network. It is revealed that the reentrant jamming behavior of colloids, modulated by PEI, holds profound significance for the long-term stability of supraparticles.

Spectrum of renal disease in scleroderma other than scleroderma renal crisis: A review of the literature.

BACKGROUND: Systemic sclerosis (SSc) is a multi-system rheumatic disease characterized by vascular and fibrotic manifestations that can affect practically every organ. Scleroderma renal crisis (SRC) is the most common renal manifestation of SSc. However, with the use of angiotensin-converting enzyme inhibitors (ACEi), the morbidity and mortality associated with SRC has significantly reduced. Renal manifestations in SSc other than SRC have been generally under-recognized and can be left untreated, which can lead to grave consequences in this patient population. In this article, we will describe the spectrum of renal disease in SSc besides SRC. MATERIALS AND METHODS: A literature search was conducted on PubMed and Cochrane from inception to December 2022 using medical subject headings (MeSH) terms for "scleroderma", "systemic sclerosis" combined with "renal injury", and "renal dysfunction". We included case reports, case series, observational studies, and literature reviews. RESULTS: The initial search revealed 393 articles. After the exclusion of duplicates and non-relevant articles, data was included from 30 articles and 45 patients. The mean age was 55.2 years, 9 males (20%) and 36 females (80%). The most reported renal manifestations included: ANCA-associated vasculitis (n = 22), penicillamine-induced renal injury (n = 8), oxalate nephropathy (n = 5), Goodpasture syndrome (n = 4), nephrotic range proteinuria (n = 2), renal artery stenosis (n = 2), membranous glomerulonephritis (n = 1), and Evans syndrome (n = 1). CONCLUSION: The spectrum of kidney involvement in SSc can range from asymptomatic reduction of the glomerular filtration rate to life-threatening scleroderma renal crisis. Therefore, it is essential that physicians closely monitor renal function in these patients for any emerging renal dysfunction.

Depression as a prognostic factor for lumbar spinal stenosis outcomes: a systematic review.

PURPOSE: Lumbar spinal stenosis (LSS) is associated with increased levels of psychological distress, including depression; however, the prognostic value of depression remains unclear. The purpose of this systematic review was to synthesize the evidence on the prognostic value of depression for a range of outcomes in patients with LSS. METHODS: Inclusion criteria were prospective cohort studies that investigated depression in patients diagnosed with LSS. Searches were conducted in 7 databases. Critical appraisal, data extraction, and judgement of cumulative evidence were conducted independently by two reviewers. A meta-analysis was not conducted due to a lack of unique cohorts for each outcome, varying follow-up times, and differences in measurements for both prognostic factors and outcomes. RESULTS: Twenty-three articles were included. There was evidence for an association between preoperative depression and postoperative disability and symptom severity outcomes for patients with LSS. Odds ratios ranged from 1.15 to 2.94 for postoperative disability and 1.16-1.20 for symptom severity at various follow-up times. Using GRADE, evidence supporting depression as a prognostic factor for these LSS outcomes was deemed to be of moderate quality. Similarly strong evidence suggested depressive symptoms are of no prognostic value for postoperative walking capacity. CONCLUSION: Depression appears to have small to moderate prognostic value for LSS outcomes, with the strongest evidence for postoperative disability and symptom severity. The prognostic value of depression for LSS outcomes should be further explored using standardized measures in additional cohorts, including patients managing their condition conservatively, who have been neglected in related research.

A Look at Traumatic Brain Injury Community Programs in British Columbia: Barriers and facilitators of implementation.

RESEARCH OBJECTIVES: 1) Characterize the delivery of programs that support acceptance and resiliency for people with brain injury in the healthcare sector; 2) Understand the barriers and facilitators in implementation of programs to support self-acceptance and resiliency for people with brain injury. DESIGN: Participatory focus groups were used to explore experiences of conducting brain injury programs and knowledge of the barriers and facilitators to their implementation. Focus group data were analyzed with manifest content analysis to minimally deviate from broad and structural information provided by participants. SETTING: Four focus group sessions were conducted online through a video calling platform. PARTICIPANTS: 22 individuals from community associations conducting programs for people with brain injury. Participants were recruited from a public brain injury organization database. RESULTS: Systemic challenges such as access to and allocation of funding require navigation support. Resource consistency and availability, including stable program leaders and a welcoming atmosphere, are important for program implementation and sustainability. Shared experiences promote connection with the community and personal development. CONCLUSIONS: This study informs individual- and community-level approaches to promote meaningful life after brain injury. Findings highlight existing resources and support future programming for people with brain injury.

Cognitive behavioral therapy for managing depressive and anxiety symptoms after brain injury: a meta-analysis.

BACKGROUND: Individuals with traumatic brain injury (TBI) are at increased risk of depression and anxiety, leading to impaired recovery. While cognitive-behavioral therapy (CBT) addresses anxiety and depression maintenance factors, its efficacy among those with TBI has not been clearly demonstrated. This review aims to bridge this gap in the literature. METHODS: Several databases, including Medline, PsycInfo and EMBASE, were used to identify studies published between 1990 and 2021. Studies were included if: (1) trials were randomized controlled trials (RCT) involving CBT-based intervention targeting anxiety and/or depression; (2) participants experienced brain injury at least 3-months previous; (3) participants were ≥18 years old. An SMD ± SE, 95% CI and heterogeneity were calculated for each outcome. RESULTS: Thirteen RCTs were included in this meta-analysis. The pooled-sample analyses suggest that CBT interventions had small immediate post-treatment effects on reducing depression (SMD ± SE: 0.391 ± 0.126, p < 0.005) and anxiety (SMD ± SE: 0.247 ± 0.081, p < 0.005). Effects were sustained at a 3-months follow-up for depression. A larger effect for CBT was seen when compared with supportive therapy than control. Another sub-analysis found that individualized CBT resulted in a slightly higher effect compared to group-based CBT. CONCLUSION: This meta-analysis provides substantial evidence for CBT in managing anxiety and depression post-TBI.

Acute Kidney Injury in Systemic Sclerosis Beyond Scleroderma Renal Crisis: A Case-Control Study.

BACKGROUND AND OBJECTIVES: Renal involvement in systemic sclerosis remains a significant concern with the focus often centered on scleroderma renal crisis (SRC). However, the broader spectrum of renal manifestations, beyond SRC, remains underrecognized. In our case-control analysis, we describe other causes, risk factors, and renal outcomes of acute kidney injury (AKI) in systemic sclerosis other than SRC. METHODS: Patients diagnosed with SSC, with and without AKI, between 2017 and 2023 at Albany Medical Center, were included in the case-control study using International Classification of Diseases, 10th Revision codes and electronic medical records. Patients with SRC were carefully excluded. Data were collected and compared between AKI and non-AKI groups for patients' demographics, clinical characteristics, and baseline treatment. Additionally, data were collected for baseline, peak, and follow-up creatinine, etiology of AKI, treatment, and outcomes. Statistical analysis was performed using R (version 4.3.0) and Minitab (V19). Categorical variables were presented as frequencies/percentages, and continuous variables as means/standard deviations. Associations between categorical variables were assessed by χ2 test and Fisher exact test. Odds ratios and 95% confidence intervals were calculated using binary logistic regression to separately assess the effect of each independent variable on the odds of AKI. Statistical significance was set at p < 0.05. RESULTS: A total of 74 cases were identified. Out of these 74 cases, 27 had AKI and 47 did not have AKI. Out of the 27 AKI cases, 4 with SRC were excluded. Advanced age, chronic kidney disease, and heart failure were identified as risk factors for AKI development. The predominant cause of AKI was prerenal etiology, accounting for 47.8% (n = 11) of cases. This was followed by cardiorenal syndrome and acute tubular necrosis, accounting for 21.7% and 17.3% of the cases, respectively. Most of the cases with AKI had complete renal recovery 78% (n = 18), whereas 17% (n = 4) had progression of the underlying chronic kidney disease. One patient progressed to end-stage renal disease requiring hemodialysis. CONCLUSIONS: This analysis highlights the risk factors and variable clinicopathological courses of renal involvement in patients with scleroderma. This may range from mild AKI with good prognosis to life-threatening SRC.

Insights into the CO2 Capture Characteristics within the Hierarchical Pores of Carbon Nanospheres Using Small-Angle Neutron Scattering.

Understanding adsorption processes at the molecular level has transformed the discovery of engineered materials for maximizing gas storage capacity and kinetics in adsorption-based carbon capture applications. In this work, we studied the molecular mechanism of gas (CO2, H2, methane, and ethane) adsorption inside an interconnected porous network of carbon. This was achieved by synthesizing novel macro-meso-microporous carbon (M3C) nanospheres with interconnected pore structures. The M3Cs showed a CO2 capture capacity of 5.3 mmol/g at atmospheric CO2 pressure, with excellent kinetics. This was due to fast CO2 adsorption within the interconnected hierarchical macro-meso-microporous M3C. In situ small-angle neutron scattering (SANS) under various CO2 pressures indicated that the macro- and mesopores of M3C enable fast diffusion of CO2 molecules inside the micropores, where adsorbed CO2 molecules densify into a liquid-like state. This strong densification of CO2 molecules causes fast CO2 diffusion in the macro- and mesopores of M3C, restarting the adsorption cycle for fresh CO2 molecules until all pores are completely filled. Notably, M3C also showed good capture capacities for hydrogen and various hydrocarbons, with excellent selectivity toward ethane over methane.

Renal sarcoidosis.

Renal sarcoidosis (RS) is a rare form of sarcoidosis that results in granulomatous inflammation of renal parenchyma. We describe the epidemiology, pathogenesis, clinical features, diagnostic approach, treatment strategies and outcomes of this condition. RS occurs most commonly at the time of initial presentation of sarcoidosis but can at any time along the course of the disease. The most common presenting clinical manifestations of RS are renal insufficiency or signs of general systemic inflammation. End-stage renal disease (ESRD) requiring dialysis is a rare initial presentation of RS. The diagnosis of RS should be considered in patients who present with renal failure and have either a known diagnosis of sarcoidosis or have extra-renal features consistent with sarcoidosis. A renal biopsy helps to establish the diagnosis of RS, with interstitial non-caseating granulomas confined primarily to the renal cortex being the hallmark pathological finding. However, these histologic findings are not specific for sarcoidosis, and alternative causes for granulomatous inflammation of the renal parenchyma should be excluded. Corticosteroids are the drug of choice for RS. Although RS usually responds well to corticosteroids, the disease may have a chronic course and require long-term immunosuppressive therapy. The risk of progression to ESRD is rare.

Preschool Teachers' Emotional Acting and School-Based Interactions.

How preschool teachers manage and express their feelings across school-based interactions (e.g., teacher-child, teacher-family, and teacher-colleague) has implications for their professional success and the developmental and academic outcomes of their relational counterparts. This study explores how preschool teachers make sense of their emotional labor, or the deliberate expression or suppression of emotions to achieve organizational goals, in the context of three professional interactions. Qualitative findings show preschool teachers' decisions to engage in particular types of emotional acting are both informed by and a facilitator of the strength and intimacy of their relationships. Implications for research, practice and policy are reviewed. Supplementary Information: The online version contains supplementary material available at 10.1007/s10643-022-01326-1.

Polyethylenimine assisted non-monotonic jamming of colloids during evaporation induced assembly and its implication on CO2 sorption characteristics.

We report a detailed study of hierarchically organized silica-polyethylenimine (PEI) microspheres achieved through evaporation-induced assembly. Due to complex interactions between oppositely-charged silica nanoparticles and PEI, non-monotonic jamming of the colloidal particles is manifested. With an increase in the polymer concentration, the local volume fraction of the silica particles decreases from 0.68 to 0.43 and then increases to 0.55 with further increase. The unusual jamming behaviour of the silica colloids in the presence of PEI provides an avenue for immobilizing PEI without reducing the porosity and specific area in contrast to the conventional impregnation approach. The resultant composite microspheres show good thermal stability and CO2 sorption characteristics. For a 33 wt% PEI loading, the microspheres exhibit a significant CO2 capture capacity of 65 mg g-1 even at room temperature and it is increased to 90 mg g-1 at 75 °C. The variation in the CO2 capture capacity at 0 °C as a function of PEI loading also demonstrated the signature of non-monotonicity owing to the structural modification in the silica-PEI microspheres. The composite microspheres demonstrated fast adsorption kinetics reaching 70% of the total capture capacity in one minute during the CO2 capture. The CO2 cycling adsorption-desorption studies showed good regeneration capability up to 20 cycles.

Unravelling the polyethylenimine mediated non-monotonic stability behaviour of silica colloids: the role of competing electrostatic and entropic interactions.

Polymer-mediated interactions play an important role in the stability of colloids and are therefore paramount for both fundamental as well as scientific interests. The stability of colloids in the presence of neutral polymers depends on several parameters such as the adsorbing/non-adsorbing nature, molecular weight, concentration and temperature, and such systems are well studied. However, the stability behaviour of charged colloids in the presence of charged polyelectrolyte involves complex interaction mechanisms and hence needs attention. The present work reports the study of the stability behaviour of negatively charged silica colloids in the presence of cationic polyethylenimine (PEI) polyelectrolyte using small-angle neutron and X-ray scattering. The intriguing non-monotonic stability behaviour of silica colloids is observed with varying concentrations of PEI. In the low and intermediate PEI concentration regimes, electrosorption of PEI on the silica colloids causes partial screening of charges, leading to aggregation of colloids. The DLVO interaction potential at low and intermediate concentrations of PEI exhibit a reduced repulsion barrier which is responsible for aggregation. In the high concentration regime, the entropic interaction between the free PEI molecules and PEI decorated silica colloids leads to depletion re-stabilization. The combination of DLVO potential and adsorbed PEI mediated enhanced depletion repulsion in the presence of free PEI gives rise to an increased repulsion barrier responsible for the re-stabilization at high PEI concentrations.

The CanPain SCI clinical practice guidelines for rehabilitation management of neuropathic pain after spinal cord injury: 2021 update.

STUDY DESIGN: Clinical practice guidelines. OBJECTIVES: The objective was to update the 2016 version of the Canadian clinical practice guidelines for the management of neuropathic pain in people with spinal cord injury (SCI). SETTING: The guidelines are relevant for inpatient, outpatient and community SCI rehabilitation settings in Canada. METHODS: The guidelines were updated in accordance with the Appraisal of Guidelines for Research and Evaluation II tool. A Steering Committee and Working Group reviewed the relevant evidence on neuropathic pain management (encompassing screening and diagnosis, treatment and models of care) after SCI. The quality of evidence was scored using Grading of Recommendations Assessment, Development and Evaluation (GRADE). A consensus process was followed to achieve agreement on recommendations and clinical considerations. RESULTS: The working group identified and reviewed 46 additional relevant articles published since the last version of the guidelines. The panel agreed on 3 new screening and diagnosis recommendations and 8 new treatment recommendations. Two key changes to these treatment recommendations included the introduction of general treatment principles and a new treatment recommendation classification system. No new recommendations to model of care were made. CONCLUSIONS: The CanPainSCI recommendations for the management of neuropathic pain after SCI should be used to inform practice.

'Staying Afloat': A Mixed Methods Study of the Financial and Psychological Well-being of Early Childhood Educators.

Early childhood educators play a critical role in the lives of young children, especially through their sensitive interactions. Educators' capacities to engage in high-quality interactions are shaped by their mental health. Studies examining early childhood educators' mental health often focus on psychopathology or negative aspects of mental health, despite the importance of understanding mental health through a well-being lens. This study explores the connection between two important areas of well-being: psychological and financial well-being. Using mixed methods, we examined 123 early childhood educators' financial well-being and psychological well-being. Financial well-being predicted psychological well-being, but the relationship was curvilinear; those with the highest and lowest financial well-being had the highest psychological well-being. Qualitative findings suggest possible buffers for psychological well-being among educators with low-financial well-being and highlight struggles of those with low psychological well-being. Implications for how early childhood educators' well-being might be supported with policy and practice initiatives are discussed. Supplementary Information: The online version contains supplementary material available at 10.1007/s10643-022-01429-9.

Creation and validation of the 4-item BriefPCS-chronic through methodological triangulation.

BACKGROUND: The Pain Catastrophizing Scale (PCS) is a widely used self-report tool to evaluate pain related catastrophizing. The PCS was developed using classical test theory and has been shown to be psychometrically sound among various populations. However, it's current three subscales are rarely used in clinical practice, offering potential for an abbreviated version that reduces administrative burden and can be used to estimate full scale scores, yet is not bound by the inclusion of items from each subscale. Hence, the aim of the current study was to develop a unidimensional abbreviated version of the PCS through findings from qualitative, classical test theory, and newer Rasch analysis. METHODS: The current cross-sectional study used data from the Quebec Pain Registry (n = 5646) to obtain PCS scores of people seeking care at tertiary chronic pain centres. To develop an abbreviated unidimensional tool, items were removed based on triangulation of qualitative review of each item and response, corrected item-total correlations, and Rasch analysis. Confirmatory factor analysis was conducted on the final remaining items to confirm the tool was assessing a single latent construct (catastrophizing). Fit was assessed using the cumulative fit index (CFI), Tucker Lewis Index (TLI), and root-mean-squared error of approximation (RMSEA). RESULTS: After triangulation, a final abbreviated 4-item scale showed adequate model fit with a strong correlation (r > 0.95) with the original scale and properties that were stable across age, sex, cause, and medicolegal status. Additionally, the brief version addressed some problematic wording on some items on the original scale. Both the original and new abbreviated tool were associated with the Beck Depression Inventory and the Brief Pain Inventory at the same magnitude. CONCLUSION: The abbreviated scale may allow for a decrease in administrator burden and greater clinical uptake when a quick screen for exaggerated negative orientation towards pain is needed.

The frequent and the unusual red cell phenotypes in Indian blood donors: A quest for rare donors.

A clinically significant red cell alloantibody is capable of accelerated destruction of red cells bearing the corresponding antigen. Knowledge of prevalence of these antigens is necessary for performing day to day work and for research in immunohematology. The primary aim of this study was to find the prevalence of 18 clinically significant blood group antigens in blood donors. Secondary objectives were to motivate and create a database of accessible, volunteer O blood group donors and to register rare donors with existing registries. A cross-sectional observational study was conducted in the department of Transfusion Medicine at a large tertiary care hospital in India from October 2016 to May 2018 with a planned sample size of 4800. Study population included healthy blood donors of either gender coming for blood donation to the blood centre. A total of 6678 samples were included in the study. First time donors were 21.41 % while 78.59 % were repeat donors. Voluntary donors constituted 15.81 % while replacement donors were 84.19 %. Male donors were 89.82 % while female donors were 10.18 %. The antigen, phenotype and gene frequencies were calculated. An extended phenotyped voluntary donor database was created and four rare donors were identified. One of these rare donors was registered with the International Rare Donor Panel (IRDP) and rest were registered in a local registry. This study might help enhance the confidence of blood banks in finding appropriate units for patients with unexpected antibodies or with rare phenotypes. It also paves a way for registering rare donors locally and internationally.

Guided internet-delivered cognitive-behaviour therapy for persons with spinal cord injury: a feasibility trial.

STUDY DESIGN: Observational pre-post study. OBJECTIVE: Guided internet-delivered CBT (ICBT) offers an alternative approach for mental health service delivery in the community for those with spinal cord injury (SCI). The feasibility and acceptability of guided ICBT programme is available for various chronic health conditions; however, the evidence related to SCI is limited. The primary aim of the current study was to examine feasibility and acceptability of a guided transdiagnostic ICBT programme for persons with SCI. SETTING: Community. METHODS: In this single-group pre-post study, persons with SCI (n = 20) living in the community were provided with a guided 8-week transdiagnostic ICBT programme for overall well-being. Study feasibility was examined by the following outcomes: patient recruitment, engagement, and attrition. Acceptability of the programme was evaluated post-treatment. Reductions in symptoms of depression and anxiety were assessed at baseline, post-intervention, and at 3-month follow-up. RESULTS: Approximately 60% of eligible participants were recruited. The study found high rates of programme completion (90%) and outcome data were obtained from 90% of participants. Improvement in symptoms of depression (and anxiety) were seen after treatment. Gains were maintained at 3-month follow-up. CONCLUSIONS: Guided transdiagnostic ICBT programme is a feasible and acceptable treatment option for those with psychological needs following SCI.

A systematic review of internet-delivered cognitive behavior therapy for alcohol misuse: study characteristics, program content and outcomes.

Alcohol misuse is a common, disabling and costly issue worldwide. Internet-delivered cognitive behavior therapy (ICBT) has the potential to reduce the harms of alcohol misuse, particularly for individuals who are unable or unwilling to access face-to-face therapy. A systematic review was conducted using Medline, CINAHL, EMBASE and PsycINFO databases for all relevant articles published from 1980 to January 2019. Randomized controlled trials (RCTs) were included if (i) an ICBT intervention targeting alcohol misuse was delivered; (ii) participants were aged 18 years or older; and (iii) primary outcomes were quantity of drinking. A qualitative analysis was conducted on the content of the ICBT programs. Fourteen studies met inclusion criteria. Most studies included participants from the general population, while studies conducted within clinic settings with diagnosed individuals were rare. The programs were similar in terms of included modules. Small effects were seen in studies on self-guided ICBT, while therapist-guided ICBT rendered small to large effects. The current review indicates that ICBT has a significant effect in reducing alcohol consumption. Larger studies evaluating ICBT compared to active control groups especially within clinic settings are warranted.

Implementing Telerehabilitation After Stroke: Lessons Learned from Canadian Trials.

Introduction: Telerehabilitation has been promoted as a more efficient means of delivering rehabilitation services to stroke patients while also providing care options to those unable to attend conventional therapy. However, the application of telerehabilitation interventions in stroke populations has proven to be more challenging than anticipated, with many studies showing mixed results in terms of its efficacy. Six different clinical trials examining stroke telerehabilitation were initiated across Canada as part of the Heart and Stroke Foundation's 2013 Tele-Rehabilitation for Stroke Initiative, with interventions ranging from lifestyle coaching to delivering memory, speech, or physical training. The purpose of this article was to summarize the over-arching findings from this initiative, particularly the facilitators and barriers to the implementation of telerehabilitation services within a research context. Methods: Details of the projects were obtained directly from the study investigators and from materials published by each group. Qualitative open-ended questions were posed to each group for the discussion of lessons learned. Results: Important lessons learned from this initiative included: (1) the efficacy and cost of telerehabilitation is similar to that of traditional face-to-face management; (2) patients are satisfied with telerehabilitation services when trained appropriately and some social interaction occurs; (3) clinicians prefer face-to-face interactions but will use telerehabilitation when face-to-face is not feasible; and (4) technology should be selected based on ease of use and targeted to the skills and abilities of the users. Conclusions: Overall, results from these studies suggest that telerehabilitation services work best to augment face-to-face rehabilitation or when no other options are available.

Incentive-Based Game for Allaying Preoperative Anxiety in Children: A Prospective, Randomized Trial.

BACKGROUND: Induction of anesthesia can be distressing both for children and their parents. Nonpharmacological behavioral interventions can reduce the anxiety of children without significant adverse effects as seen with sedative medications. We hypothesized that the use of incentive-based game therapy in conjunction with parental involvement would be a simple and cost-effective intervention in reducing the preoperative anxiety in children. METHODS: Eighty children between the age group of 4 and 8 years scheduled to undergo surgery were randomly assigned to a control group (n = 40) and intervention group (n = 40). Children in the intervention group participated in an incentive-based game in the preoperative room. Anesthesia was induced with parental presence in both the groups. The modified Yale Preoperative Anxiety Scale (mYPAS) score to measure the anxiety of the children during induction was taken as the primary outcome. Induction Compliance Checklist score and parental satisfaction were assessed as secondary outcomes. RESULTS: The mYPAS score of children in the intervention group was significantly less than the control group during anesthesia induction. The mean difference (95% confidence interval [CI]) of the mYPAS at induction between the 2 groups was 20 (95% CI, 16-24; P < .001). Fourteen (35%) children in the intervention group and 2 (5%) children in control group displayed no anxiety (mYPAS score <30) (difference of -30%; 95% CI, -11% to -49%; P < .001). Children in the intervention group were more compliant with mask induction and had a significantly less Induction Compliance Checklist score compared to the control (P < .001). Thirty (75%) parents in the intervention group were satisfied at the end of surgery compared to 6 (15%) in the control group (difference of -60%; 95% CI, -39% to -73%; P < .001). CONCLUSIONS: The use of incentive-based game therapy reduces the anxiety scores during induction of anesthesia and improves the compliance to facemask induction in children undergoing surgery. It can form a simple, cost-effective, and easy-to-administer technique that can be easily applied in low-income settings.

Internet-delivered cognitive behaviour therapy for chronic health conditions: a systematic review and meta-analysis.

This systematic review and meta-analysis aims to evaluate the effectiveness of internet-delivered cognitive behavioural therapy (ICBT) on anxiety and depression among persons with chronic health conditions. A systematic database search was conducted of MEDLINE, CINAHL, PsycInfo, EMBASE, and Cochrane for relevant studies published from 1990 to September 2018. A study was included if the following criteria were met: (1) randomized controlled trial involving an ICBT intervention; (2) participants experienced a chronic health condition; (3) participants ≥ 18 years of age; and (4) effects of ICBT on anxiety and/or depression were reported. The Cochrane Risk of Bias tool was used to assess the risk of bias on the included studies. Pooled analysis was conducted on the primary and condition specific secondary outcomes. Twenty-five studies met inclusion criteria and investigated the following chronic health conditions: tinnitus (n = 6), fibromyalgia (n = 3), pain (n = 7), rheumatoid arthritis (n = 3), cardiovascular disease (n = 2), diabetes (n = 1), cancer (n = 1), heterogeneous chronic disease population (n = 1), and spinal cord injury (n = 1). Pooled analysis demonstrated small effects of ICBT in improving anxiety and depression. Moderate effects of therapist-guided approach were seen for depression and anxiety outcomes; while, self-guided approaches resulted in small effects for depression and moderate effects in anxiety outcomes. ICBT shows promise as an alternative to traditional face-to-face interventions among persons with chronic health conditions. Future research on long-term effects of ICBT for individuals with chronic health conditions is needed.Trial Registration PROSPERO registration number: CRD42018087292.