Clinimetric Properties of the Working Alliance Inventory and Credibility Expectancy Questionnaire: Screening Options for Musculoskeletal Pain.

OBJECTIVE: To investigate clinimetric properties of 2 surveys used to evaluate common factors in the patient-provider relation and present screener options for the assessment of common factors and report their correlation with pain and functional outcomes. DESIGN: Observational cohort. SETTING: Outpatient physical therapy. PARTICIPANTS: 100 individuals (58% women, mean age=34, SD=15; N=100) presenting to physical therapy with musculoskeletal pain in the following regions: 44% lower extremity, 36% spine, 19% upper extremity, 1% undetermined. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Participants completed the Working Alliance Inventory (WAI) and the Credibility and Expectancy Questionnaire (CEQ). Exploratory factor analysis (EFA) explored factor structure of the WAI and CEQ. Internal consistency was evaluated for scales derived from items retained based on factor loadings. Finally, options for screener tools were proposed and assessed based on their correlation to original surveys as well as pain and functional outcomes. RESULTS: The data supported a 4-factor structure for the surveys. Some WAI items were excluded due to cross-loading. The derived four-factor scales demonstrated strong correlations with the original surveys (r=.89-.99) and exhibited good internal consistency (α=.824-.875). Two screening options were suggested: 1 retaining 11 of the original 18 items and the other comprising just 3 items. Both screening tools correlated with the original surveys and showed associations with improvements in pain and functional outcomes (r=-.21-.34). CONCLUSION: The proposed screeners provide concise measurement options to facilitate use in clinical practice. These tools can aid in facilitating patient communication specifically addressing patient expectation and understanding the tasks required to enact behavior change.

Applying Social Determinants of Health to Nursing Education Using a Concept-Based Approach.

BACKGROUND: The assessment of a patient's social determinants of health (SDOH) may uncover potentially modifiable factors that each contribute to or detract from the health and wellness of individuals, families, and groups. A concept-based curriculum may offer advantages for introducing SDOH assessment to nursing students. METHOD: The concept of SDOH was threaded throughout a baccalaureate concept-based curriculum using innovative and team-based learning strategies. RESULTS: A concept-based curriculum provides an effective platform for introducing SDOH topics in nursing education, but many of the learning activities also could be incorporated into traditional curricula. CONCLUSION: Nursing education should incorporate teaching about SDOH to prepare students for high-quality nursing practice and better patient advocacy. Assessment of SDOH also allows treatment plans to be tailored to the needs of that patient or population, which in turn may improve health outcomes. [J Nurs Educ. 2020;59(5):293-296.].

Effect of composite type and placement technique on cuspal strain.

OBJECTIVE: To compare the cuspal strain in Class II restorations made with bulk-fill and conventional composite resins. MATERIALS AND METHODS: Fifty extracted maxillary premolars were mounted into phenolic rings and divided into five groups (n = 10). Specimens received standardized MOD preparations. A two-step self-etch adhesive was applied and the preparations were restored using a custom matrix as follows: Filtek Supreme Ultra in eight 2-mm increments (FSUI); Filtek Supreme Ultra in bulk (FSUB); SonicFill in bulk (SF); SureFil SDR flow in bulk, covered with a 2-mm occlusal layer of Filtek Supreme Ultra (SDR/FSU); Tetric EvoCeram Bulk Fill in bulk (TEBF). Strain gages bonded to the buccal and lingual cusps recorded cuspal strain during restorations. End strain values were determined and data were subjected to Kruskal-Wallis testing, followed by one-way ANOVA and Tukey´s post hoc test. RESULTS: Combined strain values and standard deviations (in µÉ›) were: FSUI: 723 ± 102.8, FSUB: 929.2 ± 571.9, SF: 519.1 ± 80.2, SDR-FSU: 497.4 ± 67.6 and TEBF: 604.5 ± 127.1. A significant difference was found between group FSUI and groups SF, SDR-FSU, and TEBF. Group FSUB showed significantly higher mean strain and greater standard deviation than all other groups due to cuspal fractures, and was thus excluded from the statistical analysis. CONCLUSIONS: The tested bulk-fill composite resins exerted less strain onto tooth structure than the incrementally placed conventional composite resin, although the magnitude of generated strain was product-dependent. Bulk-filling with conventional composite resins is contraindicated. CLINICAL SIGNIFICANCE: Bulk-fill composite resins exerted less strain onto adjacent tooth structure than a traditional composite, even when that composite is was placed incrementally. Bulk-filling with traditional composite resins is unpredictable and contraindicated.

Basal metabolic rate and maternal energetic investment durations in mammals.

BACKGROUND: The Metabolic Theory of Ecology (MTE) predicts that gestation duration, lactation duration, and their sum, total development time, are constrained by mass-specific basal metabolic rate such that they should scale with body mass with an exponent of 0.25. However, tests of the MTE's predictions have yielded mixed results. In an effort to resolve this uncertainty, we used phylogenetically-controlled regression to investigate the allometries of gestation duration, lactation duration, and total development time in four well-studied mammalian orders, Artiodactyla, Carnivora, Primates, and Rodentia. RESULTS: The results we obtained are not consistent with the predictions of the MTE. Gestation duration scaling exponents are below 0.25 in all four orders. The scaling exponent for lactation duration is below 0.25 in Carnivora and Rodentia, indistinguishable from 0.25 in Artiodactyls, and steeper than 0.25 in Primates. Total development time scales with body mass as predicted by the MTE in Primates, but not in artiodactyls, carnivores, and rodents. In the latter three orders, the exponent is 0.15. CONCLUSIONS: Together, these results indicate that the influence of basal metabolic rate on mammalian maternal investment durations must be more complicated than the MTE envisages, and that other factors must play an important role. Future research needs to allow for the possibility that different factors drive gestation duration and lactation duration, and that the drivers of the two durations may differ among orders.