Advances in Treatments for Epidermolysis Bullosa (EB): Emphasis on Stem Cell-Based Therapy.

Epidermolysis bullosa (EB) is a rare genetic dermatosis characterized by skin fragility and blister formation. With a wide phenotypic spectrum and potential extracutaneous manifestations, EB poses significant morbidity and mortality risks. Currently classified into four main subtypes based on the level of skin cleavage, EB is caused by genetic mutations affecting proteins crucial for maintaining skin integrity. The management of EB primarily focuses on preventing complications and treating symptoms through wound care, pain management, and other supportive measures. However, recent advancements in the fields of stem cell therapy, tissue engineering, and gene therapy have shown promise as potential treatments for EB. Stem cells capable of differentiating into skin cells, have demonstrated positive outcomes in preclinical and early clinical trials by promoting wound healing and reducing inflammation. Gene therapy, on the other hand, aims to correct the underlying genetic defects responsible for EB by introducing functional copies of mutated genes or modifying existing genes to restore protein function. Particularly for severe subtypes like Recessive Dystrophic Epidermolysis Bullosa (RDEB), gene therapy holds significant potential. This review aims to evaluate the role of new therapeutic approaches in the treatment of EB. The review includes findings from studies conducted on humans. While early studies and clinical trials have shown promising results, further research and trials are necessary to establish the safety and efficacy of these innovative approaches for EB treatment.

Linking Immigrants with Nutrition Knowledge (Project LINK): An Innovative Approach to Improve Cultural Competence in Dietetic Education.

Linking Immigrants with Nutrition Knowledge (Project LINK) was a service-learning cultural competence training programme completed by undergraduate dietetic students enrolled in the University of Saskatchewan's (USASK) nutrition and dietetic programme.This paper evaluates the impact of participation in the programme on students' cultural competence. We conducted a cross-sectional survey and qualitative analysis of reflective essays of 107 participants of Project LINK from 2011 to 2014. Cumulative logistic regression models assessed the impact of the intervention on students' cultural competencies. The Akaike information criterion compared models and Spearman correlation coefficient identified possible correlation among pre- and post-intervention data points. Student reflective essays were analyzed by inductive thematic analysis.All cultural competencies improved comparing pre- and post-participation in Project LINK. Odds of increasing one level of student knowledge were 110 times of that prior to Project LINK. Comparing student competencies before and after Project LINK, the odds of increasing one level of students' skills were six times greater, five times greater for increasing one level of students' ability to interact or encounter, and 2.8 times greater for increasing one level of students' attitude.The results of this study indicate Project LINK has successfully increased cultural competence and underscores the importance of combining opportunities for practical experience in addition to classroom-based training on cultural competence.

Urolithin B protects PC12 cells against glutamate-induced toxicity.

BACKGROUND: The involvement of malfunctioning glutamate systems in various central nervous system (CNS) disorders is widely acknowledged. Urolithin B, known for its neuroprotective and antioxidant properties, has shown potential as a therapeutic agent for these disorders. However, little is known about its protective effects against glutamate-induced toxicity in PC12 cells. Therefore, in this study, for the first time we aimed to investigate the ability of Urolithin B to reduce the cytotoxic effects of glutamate on PC12 cells. METHODS: Different non-toxic concentrations of urolithin B were applied to PC12 cells for 24 h before exposure to glutamate (10 mM). The cells were then analyzed for cell viability, intracellular reactive oxygen species (ROS), cell cycle arrest, apoptosis, and the expression of Bax and Bcl-2 genes. RESULTS: The results of MTT assay showed that glutamate at a concentration of 10 mM and urolithin B at a concentration of 114 µM can reduce PC12 cell viability by 50%. However, urolithin B at non-toxic concentrations of 4 and 8 µM significantly reduced glutamate-induced cytotoxicity (p < 0.01). Interestingly, treatment with glutamate significantly enhanced the intracellular ROS levels and apoptosis rate in PC12 cells, while pre-treatment with non-toxic concentrations of urolithin B significantly reduced these cytotoxic effects. The results also showed that pre-treatment with urolithin B can decrease the Bax (p < 0.05) and increase the Bcl-2 (p < 0.01) gene expression, which was dysregulated by glutamate. CONCLUSIONS: Taken together, urolithin B may play a protective role through reducing oxidative stress and apoptosis against glutamate-induced toxicity in PC12 cells, which merits further investigations.

Unfolded Protein Response Signaling in Hepatic Stem Cell Activation in Liver Fibrosis.

Frequent exposure to various external and internal adverse forces (stresses) disrupts cell protein homeostasis through endoplasmic reticulum (ER) capacity saturation. This process leads to the unfolded protein response (UPR), which aims to re-establish/maintain optimal cellular equilibrium. This complex mechanism is involved in the pathogenesis of various disorders, such as metabolic syndrome, fibrotic diseases, neurodegeneration, and cancer, by altering cellular metabolic changes integral to activating the hepatic stellate cells (HSCs). The development of hepatic fibrosis is one of the consequences of UPR activation. Therefore, novel therapies that target the UPR pathway effectively and specifically are being studied. This article covers the involvement of the UPR signaling pathway in cellular damage in liver fibrosis. Investigating the pathogenic pathways related to the ER/UPR stress axis that contribute to liver fibrosis can help to guide future drug therapy approaches.

New Insights into the Long Non-coding RNAs Dependent Modulation of Heart Failure and Cardiac Hypertrophy: From Molecular Function to Diagnosis and Treatment.

Heart failure (HF) is a public health issue that imposes high costs on healthcare systems. Despite the significant advances in therapies and prevention of HF, it remains a leading cause of morbidity and mortality worldwide. The current clinical diagnostic or prognostic biomarkers, as well as therapeutic strategies, have some limitations. Genetic and epigenetic factors have been identified to be central to the pathogenesis of HF. Therefore, they might provide promising novel diagnostic and therapeutic approaches for HF. Long non-coding RNAs (lncRNAs) belong to a group of RNAs that are produced by RNA polymerase II. These molecules play an important role in the functioning of different cell biological processes, such as transcription and regulation of gene expression. LncRNAs can affect different signaling pathways by targeting biological molecules or a variety of different cellular mechanisms. The alteration in their expression has been reported in different types of cardiovascular diseases, including HF, supporting the theory that they are important in the development and progression of heart diseases. Therefore, these molecules can be introduced as diagnostic, prognostic, and therapeutic biomarkers in HF. In this review, we summarize different lncRNAs as diagnostic, prognostic, and therapeutic biomarkers in HF. Moreover, we highlight various molecular mechanisms dysregulated by different lncRNAs in HF.

Nanotechnology-Based Drug Delivery Systems in the Transdermal Treatment of Melanoma.

The incidence rate of melanoma is dramatically increasing worldwide, raising it to the fifth most common cancer in men and the sixth in women currently. Resistance generally occurs to the agents used in chemotherapy; besides their high toxicity destroys the normal cells. This study reviewed a detailed summary of the structure, advantages, and disadvantages of nanotechnology-based drug delivery systems in the treatment of melanoma, as well as some nanocarrier applications in animal models or clinical studies. Respective databases were searched for the target keywords and 93 articles were reviewed and discussed. A close study of the liposomes, niosomes, transferosomes, ethosomes, transethosomes, cubosomes, dendrimers, cyclodextrins, solid lipid nanoparticles, and carbon nanotubes (CNTs) was conducted. It was found that these nanocarriers could inhibit metastasis and migration of melanoma cells and decrease cell viability. Conclusively, some nanocarriers like liposomes, niosomes, and transferosomes have been discussed as superior to conventional therapies for melanoma treatment.

Evaluation of the flavonol-rich fraction of Rosa damascena in an animal model of liver fibrosis by targeting the expression of fibrotic cytokines, antioxidant/oxidant ratio and collagen cross-linking.

INTRODUCTION: The flavonoid-rich fraction of Rosa damascena (FRFRD) contains antioxidant and active compounds. Therefore, this study aimed to investigate the role of FRFRD, rich in quercetin and kaempferol, in liver fibrosis induced by CCl4. MATERIALS AND METHODS: The FRFRD fraction was separated and standardized by High-Performance Liquid Chromatography (HPLC) based on the levels of quercetin and kaempferol. Liver fibrosis was induced over CCl4 over 12 weeks in 30 male Wistar rats, and three concentrations of FRFRD were administered to them during the last four weeks. Subsequently, after evaluation of liver serum markers and fibrotic parameters, the relative expression of transforming growth factor-beta-1 (TGF-ß1), platelet-derived growth factor (PDGF), and lysyl oxidase homolog 2 (Loxl2) genes were assessed, along with the measurement of lysyl oxidase activity and oxidative markers. RESULTS: Fibrotic markers demonstrated progressive recovery of liver damage in the treated group compared to the non-treatment group (p < 0.01). These results were accompanied by a significant decrease in the expression of TGF-ß1, PDGF, and Loxl2 genes, as well as, a reduction in lysyl oxidase activity (p < 0.001). The antioxidant effects of the treatment were observed through a significant decrease in malondialdehyde (MDA) levels and an increase in catalase enzyme (CAT) and glutathione peroxidase (GPx) activity in the treatment group compared to the fibrotic group (p < 0.01). CONCLUSION: The flavonoid-rich fraction of Rosa damascena ameliorates liver damage by affecting collagen cross-linking and lowering oxidative and inflammatory levels.

The influence of synaptic pathways on the synchronization patterns of regularly structured mChialvo map network.

Synchronization of interconnecting units is one of the hottest topics many researchers are interested in. In addition, this emerging phenomenon is responsible for many biological processes, and thus, the synchronization of interacting neurons is an important field of study in neuroscience. Employing the memristive Chialvo (mChialvo) neuron map, this paper investigates the effect of electrical, inner-linking, chemical, and hybrid coupling functions on the synchronization state of a neuronal network with regular structure. Master stability function (MSF) analysis is performed to obtain the necessary conditions for synchronizing the built networks. Afterward, the MSF-based results are confirmed by calculating the synchronization error. Besides, the dynamics of the synchronous neurons are discussed based on the bifurcation analysis. Our results suggest that, compared to the electrical and inner-linking functions, chemical synapses facilitate mChialvo neurons' synchronization since the neurons can achieve synchrony with a negligible chemical coupling strength. Further studies reveal that based on the active synapses, coupled mChialvo neurons can reach cluster synchronization, chimera state, sine-like synchronization, phase synchronization, and cluster phase synchronization.

Identification, Isolation, Cloning, and Expression of a New Alkaline Serine Protease Gene from Native Iranian Bacillus sp. RAM 53 for Use in the Industry.

Proteases are one of the most important and widely applicable proteolytic enzymes that are used in various industries. The aim of this study was to identify, isolate, characterize, and clone the new extracellular alkaline protease from the native bacterium Bacillus sp. RAM53 that was isolated from rice fields in Iran. In this study, first, the primary assay of protease production was performed. The bacteria were cultured in a nutrient broth culture medium at 37° C for 48 h, and then, the enzyme extraction was performed. Enzyme activity was measured by standard methods in the range of 20 to 60 °C and the range of pH 6.0 to 12. Degenerate primers were designed to alkaline protease gene sequences. The isolated gene was cloned into the pET28a+ vector, the positive clones were transferred to Escherichia coli BL21, and the expression of the recombinant enzyme was optimized. The results showed that the optimum temperature and pH of the alkaline protease were 40° C and 9.0, respectively, and were stable at 60° C for 3 h. The molecular weight of the recombinant enzyme was 40 kDa in SDS-PAGE. The recombinant alkaline protease was inhibited by the PMSF inhibitor, indicating that the enzyme was serine protease. The results showed that the sequence alignment of the enzyme gene with the other alkaline protease gene sequences related to Bacillus was 94% identity. The result of Blastx showed about 86% identity to the S8 peptidase family in Bacillus cereus and Bacillus thuringiensis and other Bacillus species. The enzyme may be useful for various industries.

The landscape of exosomal non-coding RNAs in breast cancer drug resistance, focusing on underlying molecular mechanisms.

Breast cancer (BC) is the most common malignancy among women worldwide. Like many other cancers, BC therapy is challenging and sometimes frustrating. In spite of the various therapeutic modalities applied to treat the cancer, drug resistance, also known as, chemoresistance, is very common in almost all BCs. Undesirably, a breast tumor might be resistant to different curative approaches (e.g., chemo- and immunotherapy) at the same period of time. Exosomes, as double membrane-bound extracellular vesicles 1) secreted from different cell species, can considerably transfer cell products and components through the bloodstream. In this context, non-coding RNAs (ncRNAs), including miRNAs, long ncRNAs (lncRNAs), and circular RNAs (circRNAs), are a chief group of exosomal constituents with amazing abilities to regulate the underlying pathogenic mechanisms of BC, such as cell proliferation, angiogenesis, invasion, metastasis, migration, and particularly drug resistance. Thereby, exosomal ncRNAs can be considered potential mediators of BC progression and drug resistance. Moreover, as the corresponding exosomal ncRNAs circulate in the bloodstream and are found in different body fluids, they can serve as foremost prognostic/diagnostic biomarkers. The current study aims to comprehensively review the most recent findings on BC-related molecular mechanisms and signaling pathways affected by exosomal miRNAs, lncRNAs, and circRNAs, with a focus on drug resistance. Also, the potential of the same exosomal ncRNAs in the diagnosis and prognosis of BC will be discussed in detail.

Correlation of Expression of MMP-2, ACE2, and TMPRSS2 Genes with Lymphopenia for Mild and Severity of COVID-19.

Some risk causes may be associated with the severity of COVID-19. The central host-pathogen factors might affect infection are human receptor angiotensin-converting enzyme 2 (ACE2), trans-membrane protease serine 2 (TMPRSS2), and SARS-CoV-2 surface spike (S)-protein. The main purpose of this study was to determine the differences in the expression the metalloproteinases-2  (MMP-2), MMP-9, ACE2, and TMPRSS2 genes and their correlation with lymphopenia in the mild and severe types of the COVID-19 patients. Eighty-eight patients, aged 36 to 60 years old with the mild (n=44) and severe (n=44) types of COVID-19 were enrolled. Total RNA was isolated from the peripheral blood mononuclear cells (PBMCs). The changes of MMP-2, MMP-9, ACE2 and TMPRSS2 gene expression in PBMCs from mild and severe COVID-19 patients were examined by the real time-quantitative polymerase chain reaction (RT-qPCR) assay and, compared between the groups. Data were collected from May 2021 to March 2022. The mean age of the patients in both groups was 48 (interquartile range, 36-60), and there were no appreciable differences in age or gender distribution between the two groups. The present study showed that a significant increase in the expression of ACE2, TMPRSS2, MMP-2, and MMP-9 genes in the severe type of the COVID-19 patients compared, to the mild type of the COVID-19 patients. Overall, it suggests the expression levels of these genes on the PBMC surface in the immune system are susceptible to infection by SARS-COV-2 and therefore could potentially predict the patients' outcome.

Selection of reference genes for RT-qPCR analysis of rice with Rhizoctonia solani infection and biocontrol PGPR/KSi application.

BACKGROUND: Rhizoctonia solani (AG1 IA) is an important pathogen of rice (Oryza sativa L.) that causes rice sheath blight (RSB). Since control of RSB by breeding and fungicides have had limited success, novel strategies like biocontrol with plant growth-promoting rhizobacteria (PGPR) can be an effective alternative. METHOD AND RESULTS: Seven commonly used reference genes (RGs), 18SrRNA, ACT1, GAPDH2, UBC5, RPS27, eIF4a and CYP28, were evaluated for their stability in rice-R. solani-PGPR interaction for real-time quantitative PCR (RT-qPCR) analysis. Different algorithms were examined, Delta Ct, geNorm, NormFinder, BestKeeper, and comprehensive ranking by RefFinder, to evaluate RT-qPCR of rice in tissues infected with R. solani and treated with the PGPR strains, Pseudomonas saponiphilia and Pseudomonas protegens, with potassium silicate (KSi) alone or in combination with each PGPR strain. RG stability was affected for each treatment and treatment-specific RG selection was suggested. Validation analysis was done for nonexpressor of PR-1(NPR1) for each treatment. CONCLUSION: Overall, ACT1 was the most stable RG with R. solani infection alone, GAPDH2 with R. solani infection plus KSi, UBC5 with R. solani infection plus P. saponiphilia, and eIF4a with R. solani infection plus P. protegens. Both ACT1 and RPS27 were the most stable with the combination of KSi and P. saponiphilia, while RPS27 was the most stable with the combination of KSi and P. protegens.

Targeted L1-Regularization and Joint Modeling of Neural Networks for Causal Inference.

The calculation of the Augmented Inverse Probability Weighting (AIPW) estimator of the Average Treatment Effect (ATE) is carried out in two steps, where in the first step, the treatment and outcome are modeled, and in the second step, the predictions are inserted into the AIPW estimator. The model misspecification in the first step has led researchers to utilize Machine Learning algorithms instead of parametric algorithms. However, the existence of strong confounders and/or Instrumental Variables (IVs) can lead the complex ML algorithms to provide perfect predictions for the treatment model which can violate the positivity assumption and elevate the variance of AIPW estimators. Thus the complexity of ML algorithms must be controlled to avoid perfect predictions for the treatment model while still learning the relationship between the confounders and the treatment and outcome. We use two NN architectures with an L1-regularization on specific NN parameters and investigate how their certain hyperparameters should be tuned in the presence of confounders and IVs to achieve a low bias-variance tradeoff for ATE estimators such as AIPW estimator. Through simulation results, we will provide recommendations as to how NNs can be employed for ATE estimation.

Normalized Augmented Inverse Probability Weighting with Neural Network Predictions.

The estimation of average treatment effect (ATE) as a causal parameter is carried out in two steps, where in the first step, the treatment and outcome are modeled to incorporate the potential confounders, and in the second step, the predictions are inserted into the ATE estimators such as the augmented inverse probability weighting (AIPW) estimator. Due to the concerns regarding the non-linear or unknown relationships between confounders and the treatment and outcome, there has been interest in applying non-parametric methods such as machine learning (ML) algorithms instead. Some of the literature proposes to use two separate neural networks (NNs) where there is no regularization on the network's parameters except the stochastic gradient descent (SGD) in the NN's optimization. Our simulations indicate that the AIPW estimator suffers extensively if no regularization is utilized. We propose the normalization of AIPW (referred to as nAIPW) which can be helpful in some scenarios. nAIPW, provably, has the same properties as AIPW, that is, the double-robustness and orthogonality properties. Further, if the first-step algorithms converge fast enough, under regulatory conditions, nAIPW will be asymptotically normal. We also compare the performance of AIPW and nAIPW in terms of the bias and variance when small to moderate L1 regularization is imposed on the NNs.

The effect of job stress management training on observance of professional ethics by nurses.

The present study was conducted to investigate the effect of job stress management training on observance of professional ethics by nurses. This quasi-experimental study was performed on 50 clinical nurses in Shiraz, Iran. Data collection tools included a questionnaire. The research intervention consisted of six two-hour sessions of stress management training. SPSS 21 were used to analyze the data. Data analysis showed that before intervention, the level of professional ethics of 64% of nurses was relatively good, but after intervention, the level of professional ethics of the majority of nurses (94%) was at the desired level. The results showed that the levels of professional ethics after job stress management training has increased significantly compared to before. The results showed that stress management training has led to improving the level of professional ethics of nurses.

Fast-Food Dietary Pattern Is Linked to Higher Prevalence of Metabolic Syndrome in Older Canadian Adults.

BACKGROUND: Metabolic syndrome (MetS) is known to increase the risk of cardiovascular diseases and diabetes. Diet is a key factor in prevention and development of MetS. This study aimed to determine the association between dietary patterns and MetS among Canadians 12-79 years old using the Canadian Health Measures Survey (CHMS) combined Cycles 1 and 2 data from 2007-11. We hypothesized that MetS varies among different sociodemographic and lifestyle factors and that Canadians who have less healthy dietary patterns are more likely to have MetS. METHODS: In the CHMS, MetS was determined using objective health measures. The principal component analysis method was used to determine the dietary patterns. Using logistic regression, the association between MetS and dietary patterns, controlling for potential covariates, was investigated for age groups of 12-19, 20-49, and 50-79 years. Survey data were weighted and bootstrapped to be representative at the national level. RESULTS: The prevalence of MetS was 16.9% for ages 12-79 y (n = 4,272, males = 49.6%), representing 26,038,108 Canadians aged 12-79 years. MetS was significantly different across sociodemographic variables; Canadians with less education, income, and activity had higher MetS prevalence than their counterparts. In older adults (50-79 years of age), the "fast-food" dietary pattern was associated with 26% (odds ratio = 1.26; 95% CI: 1.04 to 1.54; p=0.0195) higher likelihood of having MetS. CONCLUSIONS: Among older Canadians, MetS is associated with a "fast-food" dietary pattern after adjustment for socioeconomic/lifestyle factors. Findings suggest the importance of diet quality/composition in the development of MetS among older Canadians and the need for further longitudinal studies on MetS and diet across the lifespan.

Association between the 10-year predicted risk of atherosclerotic cardiovascular disease and dietary patterns among Canadian adults 40-79 years.

BACKGROUND/OBJECTIVES: Identifying groups at risk for atherosclerotic cardiovascular disease (ASCVD) and improving prevention strategies are important due to the high rates of these diseases in the world. We aimed to determine the 10-year ASCVD risk and cardiovascular age gap (CAG) of Canadians 40-79 and the association between prevalent dietary patterns and ASCVD risk, and CAG. SUBJECTS/METHODS: Health measures and dietary intake information were obtained from 2088 respondents representative of 13,655,671 Canadians 40-79 years in the cross-sectional Canadian Health Measures Survey Cycles 1 and 2 (2007-11). The estimated 10-year ASCVD risk and CAG were determined for 40-79 years adults across different levels of sociodemographic/lifestyle factors. Dietary patterns emerged using the principal component analysis from 32 food groups collected using food frequency questionnaire. The association between 10-year ASCVD risk, and CAG, with dietary patterns was investigated controlling for potential covariates. Survey data were weighted and bootstrapped to be nationally representative. RESULTS: The mean 10-year ASCVD risk of 40-79 years was 6.9%. The mean CAG for men was -4.1 years (older) and for females was +0.4 years (younger). Four dietary patterns emerged. Of note, the "High carbohydrate and protein" dietary pattern, which included potatoes, red meat, sausage, egg and ice-cream/frozen yoghurt was positively associated with 10-year ASCVD (Ptrend = 0.013). The "Healthy like" and "Fast food" dietary patterns had an inverse (p < 0.0001) and positive (p = 0.005) association, respectively, with CAG. CONCLUSIONS: Dietary patterns prevalent among this population were associated with CAG and ASCVD risk. Interventions for promoting healthy dietary patterns may be beneficial to reduce ASCVD in Canada.

Cytotoxic Effect of Saffron Stigma Aqueous Extract on Human Prostate Cancer and Mouse Fibroblast Cell Lines.

PURPOSE: Several lines of experimental evidence have shown that saffron has anticarcinogenic effects. This study aimed at evaluating the possible anticancer effect of saffron stigma aqueous extract on human prostate cancer (PC3) and mouse fibroblast cells (L929) as non-cancerous control cells. MATERIALS AND METHODS: Saffron stigma aqueous extract at concentrations of 100, 200, 400, 600, 800, 1600 and 3200 µg/mL were prepared. PC3 and L929 cells were incubated with different concentrations of saffron extracts in different time intervals (24, 48, 72, 96 and 144 hours). MTT assay was used for each cell line to investigate the cytotoxic effect of saffron. Morphological alterations were also observed under light inverted microscope. RESULTS: In fibroblast cell line after 24 hours, Saffron extract did not affect significantly the normal cells and they were intact in morphologic view. After 96 hours in the cells with highest concentration (1600 µg/mL), cell death and cellular form changes as well as severe granulation was observed. In prostate cell line after 24 hours, the only changes were observed in cells with the concentration of 1600 µg/mL. The cells were granulated and the form of the cells were spherule. After 72 hours, in group with the concentration of 1600 µg/mL, severe granulation was observed and the cell count decreased and some cells were dead. CONCLUSION: Saffron aqueous extract has an in vitro inhibitory effect on the proliferation of human prostate cell and mouse L929 cells which is dose-dependent.

Patient-Reported Symptoms Improve Performance of Risk Prediction Models for Emergency Department Visits Among Patients With Cancer: A Population-Wide Study in Ontario Using Administrative Data.

CONTEXT: Prior work shows measurements of symptom severity using the Edmonton Symptom Assessment System (ESAS) which are associated with emergency department (ED) visits in patients with cancer; however, it is not known if symptom severity improves the ability to predict ED visits. OBJECTIVES: To determine whether information on symptom severity improves the ability to predict ED visits among patients with cancer. METHODS: This was a population-based study of patients who were diagnosed with cancer and had at least one ESAS assessment completed between 2007 and 2015 in Ontario, Canada. After splitting the cohort into training and test sets, two ED visit risk prediction models using logistic regression were developed on the training cohort, one without ESAS and one with ESAS. The predictive performance of each risk model was assessed on the test cohort and compared with respect to area under the curve and calibration. RESULTS: The full cohort consisted of 212,615 unique patients with a total of 1,267,294 ESAS assessments. The risk prediction model including ESAS was superior in sensitivity, specificity, accuracy, and discrimination. The area under the curve was 73.7% under the model with ESAS, whereas it was 70.1% under the model without ESAS. The model with ESAS was also better calibrated. This improvement in calibration was particularly noticeable among patients in the higher deciles of predicted risk. CONCLUSION: This study demonstrates the importance of incorporating symptom measurements when developing an ED visit risk calculator for patients with cancer. Improved predictive models for ED visits using measurements of symptom severity may serve as an important clinical tool to prompt timely interventions by the cancer care team before an ED visit is necessary.

Resident-Level Factors Associated with Hospitalization Rates for Newly Admitted Long-Term Care Residents in Canada: A Retrospective Cohort Study.

Chez les résidents en soins de longue durée (SLD), l'hospitalisation peut amener des complications telles que le déclin fonctionnel. L'objectif de notre étude était d'examiner l'association entre les données démographiques et de santé et le taux d'hospitalisation des résidents nouvellement admis en SLD. Nous avons mené une étude de cohorte rétrospective incluant tous les centres de SLD de six provinces et d'un territoire du Canada, à l'aide des données de la RAI-MDS 2.0 et de la Discharge Abstract Database. Nous avons inclus les résidents nouvellement admis ayant eu une évaluation entre le 1er janvier et le 31 décembre 2013 (n = 37 998). Les résidents de sexe masculin avec une santé plus instable et une déficience fonctionnelle de modérée à grave présentaient des taux d'hospitalisation plus élevés, tandis que les résidents avec une déficience cognitive de modérée à grave avaient des taux moindres. Les résultats de notre étude pourraient contribuer à l'identification des résidents nouvellement admis qui seraient plus à risque d'hospitalisation et à l'élaboration de stratégies préventives plus ciblées, incluant la réadaptation, la planification préalable de soins, les soins palliatifs et les services gériatriques spécialisés.Hospitalizations of long-term care (LTC) residents can result in adverse outcomes such as functional decline. The objective of our study was to investigate the association between demographic and health information and hospitalization rate for newly admitted LTC residents. We conducted a retrospective cohort study of all LTC homes in six provinces and one territory in Canada, using data from the Resident Assessment Instrument­Minimum Data Set (RAI-MDS) 2.0 and the Discharge Abstract Database. We included newly admitted residents with an assessment between January 1 and December 31, 2013 (n = 37,998). Residents who were male, had higher health instability, and had moderate or severe functional impairment had higher rates of hospitalization, whereas residents who had moderate or severe cognitive impairment had decreased rates. The results of our study can be used to identify newly admitted residents who may be at risk for hospitalization, and appropriately target preventative interventions, including rehabilitation, advance care planning, palliative care, and geriatric specialty services.