Establishing an empirical conceptual model of oral health in dependent adults: Systematic review.

AIM: This qualitative evidence synthesis was performed to establish a conceptual model of oral health in dependent adults that defines the construct of oral health and describes its interrelationships based on dependent adults' and their caregivers' experiences and views. METHODS: Six bibliographic databases were searched: MEDLINE, Embase, PsycINFO, CINAHL, OATD, and OpenGrey. Citations and reference lists were manually searched. A quality assessment of included studies was conducted independently by two reviewers using the Critical Appraisal Skills Programme (CASP) checklist. The 'best fit' framework synthesis method was applied. Data were coded against an a priori framework and data not captured by this framework were thematically analyzed. To assess the confidence of the findings from this review, the Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) approach was used. RESULTS: Twenty-seven eligible studies were included from 6126 retrieved studies. Four themes were generated to further understand oral health in dependent adults: oral health status, oral health impact, oral care, and oral health value. CONCLUSION: This synthesis and conceptual model offer a better understanding of oral health in dependent adults and subsequently provide a starting point to guide establishment of person-centred oral care interventions.

The 2023 Impact of Inflammatory Bowel Disease in Canada: Special Populations-IBD in Seniors.

Approximately one out of every 88 seniors has inflammatory bowel disease (IBD), and this is expected to increase in the future. They are more likely to have left-sided disease in ulcerative colitis, and isolated colonic disease in Crohn's disease; perianal disease is less common. Other common diagnoses in the elderly must also be considered when they initially present to a healthcare provider. Treatment of the elderly is similar to younger persons with IBD, though considerations of the increased risk of infections and malignancy must be considered when using immune modulating drugs. Whether anti-TNF therapies increase the risk of infections is not definitive, though newer biologics, including vedolizumab and ustekinumab, are thought to be safer with lower risk of adverse events. Polypharmacy and frailty are other considerations in the elderly when choosing a treatment, as frailty is associated with worse outcomes. Costs for IBD-related hospitalizations are higher in the elderly compared with younger persons. When elderly persons with IBD are cared for by a gastroenterologist, their outcomes tend to be better. However, as elderly persons with IBD continue to age, they may not have access to the same care as younger people with IBD due to deficiencies in their ability to use or access technology.

Evaluation of a Digital Handheld Hydrogen Breath Monitor to Diagnose Lactose Malabsorption: Interventional Crossover Study.

BACKGROUND: Lactose malabsorption is a common condition that affects a broad segment of the population. Clinical diagnosis based on symptom recall can be unreliable and conventional testing can be inconvenient, requiring expensive laboratory-based equipment and conduction of the testing in a clinical setting. OBJECTIVE: The aim of this study is to assess the performance of a digital handheld hydrogen breath monitor (GIMate) in diagnosing lactose malabsorption compared to a US Food and Drug Administration (FDA)-cleared device (H2 Check) for the same indication. METHODS: An interventional crossover study was performed in adult participants with a prior confirmed diagnosis of lactose malabsorption or a suspected history of lactose intolerance. RESULTS: A total of 31 participants (mean age 33.9 years) were enrolled in the study. There was 100% positive percent agreement and 100% negative percent agreement between the GIMate monitor and the H2 Check. Correlation between gastrointestinal symptoms and hydrogen values was positive at 0.82 (P<.001). CONCLUSIONS: The digital handheld GIMate breath monitor achieved equivalent diagnostic performance to that of an FDA-cleared device in the diagnosis of lactose malabsorption. TRIAL REGISTRATION: ClinicalTrials.gov NCT04754724; https://clinicaltrials.gov/ct2/show/NCT04754724.

Complications Associated With the Anesthesia Transport of Pediatric Patients: An Analysis of the Wake Up Safe Database.

BACKGROUND: Transporting patients under anesthesia care incurs numerous potential risks, especially for those with critical illness. The purpose of this study is to identify and report all pediatric anesthesia transport-associated adverse events from a preexisting database of perioperative adverse events. METHODS: An extract of the Wake Up Safe database was obtained on December 14, 2017, and screened for anesthesia transport-associated complications. This was defined as events occurring during or immediately after transport or movement of a pediatric patient during or in proximity to their care by anesthesiologists, including repositioning and transfer to recovery or an inpatient unit, if the cause was noted to be associated with anesthesia or handover. Events were excluded if the narrative clearly states that an event was ongoing and not impacted by anesthesia transport, such as a patient who develops cardiac arrest that then requires emergent transfer to the operating room. The search methodology included specific existing data elements that indicate transport of the patient, handover or intensive care status preoperatively as well as a free-text search of the narrative for fragments of words indicating movement. Screened events were reviewed by 3 anesthesiologists for inclusion, and all data elements were extracted for analysis. RESULTS: Of 2971 events in the database extract, 63.8% met screening criteria and 5.0% (148 events) were related to transport. Events were primarily respiratory in nature. Nearly 40% of all reported events occurred in infants age ≤6 months. A total of 59.7% of events were at least somewhat preventable and 36.4% were associated with patient harm, usually temporary. Of the 86 reported cardiac arrests, 50 (58.1%) had respiratory causes, of which 74% related to anesthesia or perioperative team factors. Respiratory events occurred at all stages of care, with 21.4% during preoperative transport and 75.5% postoperatively. Ninety-three percent of unplanned extubations occurred in patients 6 months and younger. Ten medication events were noted, 2 of which resulted in cardiac arrest. Root causes in all events related primarily to provider and patient factors, with occasional references to verbal miscommunication. CONCLUSIONS: Five percent of reported pediatric anesthesia adverse events are associated with transport. Learning points highlight the risk of emergence from anesthesia during transport to recovery or intensive care unit (ICU). ICU patients undergoing anesthesia transport face risks relating to transitions in providers, equipment, sedation, and physical positioning. Sedation and neuromuscular blockade may be necessary for transport in some patients but has been associated with adverse events in others.

Orofacial pain assessment and management for patients with dementia: A meta-ethnography.

Delivering dental treatment for patients with dementia can be challenging, and the complexity of treatment provision can increase as dementia progresses. Treatment at the later stages of dementia can be associated with ethical challenges and procedural risk meaning that a comprehensive patient assessment is crucial; the presence of orofacial pain is a key indication for active intervention from dental teams. To explore the process of oro-facial pain assessment and management, a comprehensive review of qualitative literature was undertaken by searching six electronic databases. No literature specific to orofacial pain assessment was identified. The inclusion criteria were widened to explore assessment and management of pain in general for patients with dementia. Meta-ethnography with reciprocal translation was used to identify key concepts and themes and synthesise information applicable to the dental setting. Three major themes arose as follows: challenges with pain assessment, challenges with pain management and logistics and education. Healthcare teams struggle with pain identification in patients with dementia though many signs were identified which may suggest a patient is experiencing pain. The long-term knowledge of individual patients held by family members and care teams can allow identification of deviation from patients' normal states; this knowledge can assist healthcare professionals in determining whether to provide specific treatments or interventions. Pain assessment tools were found to be problematic and are unlikely to be a practical solution to use for complex patients in dental settings. Education for dental and wider care teams on orofacial pain would be highly valuable; yet, this needs to be based on suitable evidence.

Resources to Reduce Underage Drinking Risks and Associated Harms: Social Ecological Perspectives.

Underage college student alcohol consumption results in adverse consequences for students, colleges, and communities. Unfortunately, college health practitioners have invested time and effort implementing interventions that either fail to account for the complexity of this public health problem or are not evidence-based. Consequently, in September 2015, the National Institute on Alcohol Abuse and Alcoholism published CollegeAIM, which was developed to support higher education administrators and campus health/wellness professionals in selecting appropriate interventions for reducing harmful and underage drinking. CollegeAIM is a user-friendly, matrix-based tool that evaluates and synthesizes the peer-reviewed literature associated with nearly 60 campus and community interventions. This review uses the social ecological model to highlight individual- and environmental-level strategies evaluated in CollegeAIM matrices and is intended to be a tool in determining how best to implement resources to reduce college student alcohol use and associated harms. While CollegeAIM outlines strategies to be implemented among currently enrolled college students, it is important to note drinking behaviors for some students are established prior to entering college. Thus, interventions prior to enrolling in higher education are needed. As a resource for parents and for practitioners to use and share, the "Talk. They Hear You." mobile health (mHealth) app is also discussed and recommended.

COPD360social Online Community: A Social Media Review.

People living with chronic obstructive pulmonary disease (COPD) commonly report feelings of loneliness and social isolation due to lack of support from family, friends, and health care providers. COPD360social is an interactive and disease-specific online community and social network dedicated to connecting people living with COPD to evidence-based resources. Through free access to collaborative forums, members can explore, engage, and discuss an array of disease-related topics, such as symptom management. This social media review provides an overview of COPD360social, specifically its features that practitioners can leverage to facilitate patient-provider communication, knowledge translation, and community building. The potential of COPD360social for chronic disease self-management is maximized through community recognition programming and interactive friend-finding tools that encourage members to share their own stories through blogs and multimedia (e.g., images, videos). The platform also fosters collaborative knowledge dissemination and helping relationships among patients, family members, friends, and health care providers. Successful implementation of COPD360social has dramatically expanded patient education and self-management support resources for people affected by COPD. Practitioners should refer patients and their families to online social networks such as COPD360social to increase knowledge and awareness of evidence-based chronic disease management practices.

Racial differences in the pain management of children recovering from anesthesia.

BACKGROUND: When pain management has been studied in settings such as pediatric emergency departments, racial disparities have been clearly identified. To our knowledge, this has not been studied in the pediatric perioperative setting. We sought to determine whether there are differences based on race in the administration of analgesia to children suffering from pain in the postanesthesia care unit. METHODS: This is a prospective, observational, study of 771 children aged 4-17 years who underwent elective outpatient surgery. Racial differences in probability of receiving analgesia for pain in the recovery room were assessed using bivariable and multivariable logistic regression analyses. RESULTS: A total of 294 children (38.2%) received at least one class of analgesia (opioid or nonopioid); while 210 (27.2%) received intravenous (i.v.) opioid analgesia in the recovery room. Overall postanesthesia care unit analgesia utilization was similar between white and minority children (white children 36.8% vs minority children 43.4%, OR 1.3; 95% CI=0.92-1.89; P=.134). We found no significant difference by racial/ethnic group in the likelihood of a child receiving i.v. opioid for severe postoperative pain (white children 76.0% vs 85.7%, OR 1.89; 95% CI=0.37-9.67; P=.437). However, minority children were more likely to receive i.v. opioid analgesia than their white peers (white children 24.5% vs minority children 34.2%, OR 1.5; 95% CI=1.04-2.2; P=.03). On multivariable analysis, minority children had a 63% higher adjusted odds of receiving i.v. opioids in the recovery room (OR=1.63; 95% CI, 1.05-2.62; P=.03). CONCLUSIONS: Receipt of analgesia for acute postoperative pain was not significantly associated with a child's race. Minority children were more likely to receive i.v. opioids for the management of mild pain.

Association of elevated preoperative blood pressure with preincision hypotension in pediatric surgical patients.

INTRODUCTION: High blood pressure (BP) in childhood is associated with left ventricular hypertrophy and abnormal vascular reactivity even in apparently healthy children. This study examined the prevalence of high BP in children undergoing elective noncardiac operations. We also determined the association of preoperative high BP with preincision hypotension (PIH). METHODS: This was a retrospective cohort study that used clinical and anthropometric data on children aged 3-17 years who underwent elective, noncardiac operations from January 2006 to January 2014. Preoperative blood pressure (BP) was used to stratify children into three categories: normal BP (systolic and diastolic BP below the 90th percentile), prehypertension (systolic and/or diastolic BP ≥90th percentile but <95th percentile or if the BP exceeds 120/80 mmHg even if it is below the 90th percentile), and hypertension (systolic and/or diastolic BP ≥95th percentile). Multivariable logistic regression analysis was used to calculate adjusted odds ratios for PIH using age, gender, body mass index (BMI), and BP categories as covariates. RESULTS: Among 35832 children, the overall prevalence of prehypertension, hypertension, and hypertension by adult standards were 16.4%, 6.8%, and 3.3%, respectively. Overweight and obese children had higher rates of elevated BP. Presence of elevated baseline BP, high BMI category, and presence of OSA diagnosis were independent predictors of multiple episodes of PIH in a logistic regression model. CONCLUSION: In children, preoperative high BP is an independent predictor of PIH. Although the longtime consequences of high BP are well known, this report provides the first intraoperative evidence of adverse event associated with preoperative high BP in children. Mechanisms underlying this hypotensive response are unclear.

Continuous Lidocaine Infusions to Manage Opioid-Refractory Pain in a Series of Cancer Patients in a Pediatric Hospital.

BACKGROUND: Research on the safety and efficacy of continuous lidocaine infusions (CLIs) for the treatment of pain in the pediatric setting is limited. This article describes a series of pediatric oncology patients who received lidocaine infusions for refractory, longstanding, cancer-related pain. PROCEDURE: This is a retrospective review of patients who underwent lidocaine infusions to manage severe, opioid-refractory, cancer-related pain. Four patients ranging in age from 8 to 18 years were admitted to a pediatric hospital for their medical conditions and/or pain management. Structured chart review established demographic and diagnosis information, infusion rates, side effects, and efficacy of infusions in providing pain relief. Lidocaine bolus doses, infusion rates, serum concentrations, and subjective pain scores were analyzed. RESULTS: Median pain scores prior to lidocaine infusions were 8/10, falling to 2/10 at the infusion termination (P < 0.003), and rising to 3/10 in the first 24 hr after lidocaine (P < 0.029 compared to preinfusion pain). The infusions were generally well tolerated, with few side effects noted. In most cases, the improvement in pain scores persisted beyond termination of the infusion. CONCLUSIONS: CLIs were a helpful adjuvant in the four cases presented and may be an effective therapy for a more diverse array of refractory cancer pain. The majority of patients experienced pain relief well beyond the metabolic elimination of the lidocaine, corroborating a modulation effect on pain windup. Additional research regarding infusion rates, serum concentrations, side effects, and outpatient follow-up in a larger group of patients will provide additional insight into the role and safety of this therapy in children.

Obtaining Accelerometer Data in a National Cohort of Black and White Adults.

PURPOSE: The objective of this study is to report methodological details and feasibility of conducting an accelerometer ancillary study in a large US cohort being followed for stroke and cognitive decline. METHODS: Reasons for Geographic and Racial Differences in Stroke is a national population-based study of 30,239 blacks and whites, age ≥45 yr, enrolled January 2003 to October 2007. Baseline evaluations were conducted through computer-assisted telephone interview and an in-home visit. Participants are followed by computer-assisted telephone interview every 6 months. Starting with May 2009 follow-up, contingent on accelerometer availability, participants were invited to wear an accelerometer for 7 d. Device inventory was 1150. Accelerometer, instructions, log sheet, and stamped addressed return envelope were mailed to consenting participants. Postcard acknowledgement and reminders and two calls or less were made to encourage compliance. RESULTS: Between May 2009 and January 2013, 20,076 were invited to participate; 12,146 (60.5%) consented. Participation rates by race-sex groups were similar: black women, 58.6%; black men, 59.6%; white women, 62.3%; and white men, 60.5%. The mean age of the 12,146 participants to whom devices were shipped was 63.5 ± 8.7 yr. Return rate was 92%. Of 11,174 returned, 1187 were not worn and 14 had device malfunction, and of 9973 with data, 8096 (81.2%) provided usable data, defined as ≥4 d of 10+ h of wear time, ranging from 74.4% among black women to 85.2% among white men. CONCLUSIONS: Using mail and telephone methods, it is feasible to obtain objective measures of physical activity from a sizeable proportion of a national cohort of adults, with similar participation rates among blacks and whites. Linked with the clinical health information collected through follow-up, these data will allow future analyses on the association between objectively measured sedentary time, physical activity, and health outcomes.

The value of CT imaging of Horus in determining the method of mummification and the sex of the mummy.

INTRODUCTION: Radiology was used to determine the sex of a child mummy who had conflicting records based on two different translations of a name written in a section of papyrus inserted into the mummy wrappings and also to determine the type of mummification used to preserve the body. METHODS: Ancient texts of Herodotus and Diodorus Siculus were consulted for references to mummification, and Nicholson Museum records provided details of the mummy which was examined at Central Sydney Imaging using Toshiba Aquilion 64 CT machine (Toshiba Medical Systems Corporation, Tochigi, Japan). The original CT scan data were loaded into a Vitrea 2 (Vital Images, Minnetonka, MN, USA) workstation at the Victorian Institute of Forensic Medicine, Melbourne, Australia, for further study. RESULTS: The scans showed that the child had been elaborately mummified according to ancient descriptions albeit with one variation. The provenance of the child was unknown but stylistically appeared to be from the Greco-Roman Period of ancient Egypt. Interpretation of the CT images determined that the child was male, had died of unknown cause and had been excerebrated and eviscerated post-mortem when the heart was removed. Unexplained inclusions were identified within the abdomen and thorax. Broken and displaced ribs showed evidence of a previous endoscopic investigation. CONCLUSION: This study provided evidence that CT scanning was an excellent non-invasive modality to evaluate ancient mummies in its ability to demonstrate fine anatomical detail and identify post-mortem changes. The study underlined the role of using current medical practice to determine sex rather than relying on ancient texts and uncorroborated opinion.

Infrared nanoscopy of dirac plasmons at the graphene-SiO2 interface.

We report on infrared (IR) nanoscopy of 2D plasmon excitations of Dirac fermions in graphene. This is achieved by confining mid-IR radiation at the apex of a nanoscale tip: an approach yielding 2 orders of magnitude increase in the value of in-plane component of incident wavevector q compared to free space propagation. At these high wavevectors, the Dirac plasmon is found to dramatically enhance the near-field interaction with mid-IR surface phonons of SiO(2) substrate. Our data augmented by detailed modeling establish graphene as a new medium supporting plasmonic effects that can be controlled by gate voltage.

Evaluation of methods to determine causes of sediment toxicity in San Diego Bay, California, USA.

Regulation of waterbodies impaired due to sediment toxicity may require development of Total Maximum Daily Load (TMDL) allocations to reduce chemicals of concern. A key step in this process is the identification of chemicals responsible for toxicity, and sediment toxicity identification evaluation procedures (TIEs) are the primary tools used to accomplish this. Several sites in San Diego Bay (CA, USA) are listed as impaired due to sediment toxicity associated with organic chemicals and metals, and due to degraded benthic macroinvertebrate communities. Sediment was collected from one of these sites, at the confluence of Switzer Creek in San Diego Harbor. The sediment was subjected to selected whole-sediment TIE treatments to evaluate the efficacy of these procedures for identifying the causes of toxicity at Switzer Creek. Toxicity was assessed using the estuarine amphipod Eohaustorius estuarius. The results indicated that toxicity of San Diego Bay sediment was likely partly due to mixtures of pyrethroid pesticides. These experiments showed that the effectiveness of the individual TIE procedures varied by treatment. Variability was mainly due to inconsistency between results of samples subjected to various Phase II TIE procedures, including chemical analyses of samples subjected to high-pressure liquid chromatography and direct analyses of acetone extractions of carbonaceous resin. The procedures require further refinement to ensure maximum sorption and complete elution and detection of sorbed chemicals. Despite these inconsistencies, the results indicate the utility of these procedures for identifying chemicals of concern in this system.

Remote monitoring of implantable cardioverter defibrillators versus quarterly device interrogations in clinic: results from a randomized pilot clinical trial.

INTRODUCTION: Remote monitoring is increasingly becoming the new standard of care for implantable cardioverter defibrillator (ICD) follow-up. We sought to determine whether remote monitoring of ICDs improves patient outcomes compared with quarterly device interrogations in clinic. METHODS AND RESULTS: In this single-center pilot clinical trial, adult patients with an ICD were randomly assigned to remote monitoring versus quarterly device interrogations in clinic. The primary endpoint was a composite of cardiovascular hospitalization, emergency room visit for a cardiac cause, and unscheduled visit to the electrophysiology clinic for a device-related issue at 1 year. We also examined health-related quality of life, costs, and patient satisfaction with their ICD care. Of 151 patients enrolled in this trial, 76 were randomized to remote monitoring and 75 to quarterly device interrogations in clinic. There was no significant difference in the primary endpoint (32% in the remote monitoring arm vs 34% in the control arm; P = 0.8), mortality, or cost between the 2 arms. Quality of life and patient satisfaction were significantly better in the control arm than in the remote monitoring arm at 6 months (83 [25th, 75th percentiles 70, 90] vs 75 [50, 85]; P = 0.002 and 88 [75, 100] vs 75 [75, 88]; P = 0.03, respectively), but not at 12 months. CONCLUSION: We showed no significant reduction in cardiac-related resource utilization with remote monitoring of ICDs. However, given the small number of patients in our study, the real clinical and health economics impact of remote monitoring needs to be verified by a large, multicenter, randomized clinical trial.

Evaluation of phase II toxicity identification evaluation methods for freshwater whole sediment and interstitial water.

Phase I whole sediment toxicity identification evaluation (TIE) methods have been developed to characterize the cause of toxicity as organic chemicals, metals, or ammonia. In Phase II identification treatments, resins added to whole sediment to reduce toxicity caused by metals and organics can be separated and eluted much like solid-phase extraction (SPE) columns are eluted for interstitial water. In this study, formulated reference sediments spiked with toxic concentrations of copper, fluoranthene, and nonylphenol were subjected to whole sediment and interstitial water TIE treatments to evaluate Phase I and II TIE procedures for identifying the cause of toxicity to Hyalella azteca. Phase I TIE treatments consisted of adding adsorbent resins to whole sediment, and using SPE columns to remove spiked chemicals from interstitial water. Phase II treatments consisted of eluting resins and SPE columns and the preparation and testing of eluates for toxicity and chemistry. Whole sediment resins and SPE columns significantly reduced toxicity, and the eluates from all treatments contained toxic concentrations of the spiked chemical except for interstitial water fluoranthene. Toxic unit analysis based on median lethal concentrations (LC50s) allowed for the comparison of chemical concentrations among treatments, and demonstrated that the bioavailability of some chemicals was reduced in some samples and treatments. The concentration of fluoranthene in the resin eluate closely approximated the original interstitial water concentration, but the resin eluate concentrations of copper and nonylphenol were much higher than the original interstitial water concentrations. Phase II whole sediment TIE treatments provided complementary lines of evidence to the interstitial water TIE results.

Physiological basis of habitat partitioning in Jamaican Eleutherodactylus.

Rate of evaporation, resistance to drying, temperature selection, and critical thermal maximum were measured for Jamaican Eleutherodactylus acclimated to 20° C and a 12:12 L:D photoperiod. Two introduced species, E. planirostris and E. johnstonei, selected higher temperatures and had higher CTMs than two native species, E. cundalli and E. gossei. The introduced species lost water as rapidly as the native species, but tolerated 30-73% greater water loss before losing their righting response. The physiological differences are reflected in the microhabitat selection and activity patterns of the four species.