The road less taken: A scoping review of the utilisation of hand assessments in individuals with diabetes mellitus.

INTRODUCTION: Diabetic peripheral neuropathy (DPN) is one of the most prevalent chronic complications of diabetes mellitus (DM) that can significantly result in disability and impaired quality of life. The DPN of the foot has been extensively studied in diabetes care. Nevertheless, the DPN of hand has been the road less taken in research and clinical practice. Thus, a scoping review was conducted to identify all available standardized hand assessments which have been used, developed, or tested in individuals with DM. MATERIALS AND METHODS: This scoping review was reported in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Studies were identified through searches of five databases: Cochrane, Scopus, ProQuest, MEDLINE, and Web of Science (WoS). RESULTS: Of the 294 articles initially identified, 20 studies were included and analysed thematically after removing duplicates. The majority of these assessments measure body function and structure such as grip and pinch strength while the rest are measuring the activity and participation domain. Most of the hand assessments were performancebased measurements. It is suggestible to employ both types of assessments to obtain a comprehensive understanding of hand conditions in individuals with DM. While some validated hand assessments were identified, only the Duruöz Hand Index (DHI) has been validated as a reliable tool specifically for evaluating hand function in individuals with DM. CONCLUSION: There is a need to evaluate the measurement properties of existing instruments for assessing the hand function in individuals with DM, or to develop hand assessments specifically for the DM population. This scoping review was forging a new path, by discovering diabetes care through the utilisation of hand assessments.

Translation and psychometric validation of the traditional Chinese version of patient-reported outcomes measurement information system Pediatric-25 Profile version 2.0 (PROMIS-25) in Chinese Children with Cancer in Hong Kong.

PURPOSE: To translate and cross-cultural validate the PROMIS Pediatric-25 Profile 2.0 (PROMIS-25) into traditional Chinese, and to investigate its psychometric properties in children with cancer in Hong Kong. METHODS: The Functional Assessment of Chronic Illness Therapy translation methodology was adopted in this study. Three panel members evaluated the semantic equivalence and content validity. The psychometric properties were tested with 103 children with cancer (10-18 years). Internal consistency and structural validity were examined by Cronbach's alpha and Rasch analysis. Convergent and divergent validity were assessed by correlating it with traditional Chinese pediatric quality of life inventory™ 4.0 domains (traditional Chinese PedsQL™ 4.0), traditional Chinese Health Questionnaire-9 (C-PHQ-9), and the numeric pain rating scale (NPRS). RESULTS: The semantic equivalence score and content validity index were both 100%. All domains indicated good internal consistency (α = 0.83-0.88) and unidimensionality (variance explained > 55.5% and 1st contrast eigenvalues < 2.0). All items showed good item fit (0.6-1.4). For convergent validity, the traditional Chinese PROMIS-25 domains demonstrated moderate-to-large correlations with traditional Chinese PedsQL™ 4.0 domains (r ≥ ± 0.69), C-PHQ-9 Item-4 and total score (r = 0.75-0.80), except NPRS (r = 0.44). For divergent validity, traditional Chinese PROMIS-25 had low correlations with traditional Chinese PedsQL™ 4.0 domains (r < ± 0.21), C-PHQ-9 item-4 (r = 0.3), and NPRS (r = - 0.12). The traditional Chinese PROMIS-25 fatigue domain was weakly correlated with NPRS (r = 0.39). CONCLUSION: The traditional Chinese PROMIS-25 is semantically and conceptually like the original PROMIS-25 with satisfactory internal consistency, structural validity, and construct validity.

Participation in school-related activities that require hand use for children with and without developmental disabilities.

BACKGROUND: Children with developmental disabilities (DD) may experience limited participation in school activities. Little is known about whether school participation of children with DD who attend special schools is impacted. This study specifically focused on physical engagement in school-related activities that require hand use for the comparison between this group of children with DD and typically developing children. METHODS: The sample consisted of 97 children with DD who attended special schools (mean age 8.2 ± 2.9 years; 60 boys and 37 girls) and 105 typically developing children who attended mainstream schools/kindergartens (mean age 8.6 ± 2.4 years; 48 boys and 57 girls). Parents completed the Children's Assessment of Participation with Hands, one of the domains of which captures participation in eight school-related activities involving hand use. RESULTS: Parents of children with DD reported that their children participated less, in terms of the number (χ2  = 8.45-14.97, P ≤ 0.004) and frequency (t = 4.00-6.47, P < 0.001), in four activities than typically developing children. Parents of children with DD also reported that more assistance was needed for their children's participation in all activities (t = 6.93-11.92, P < 0.001), and they wanted their children to participate in most activities more often and more independently (χ2  = 18.46-59.34, P < 0.001). CONCLUSIONS: Differences in participation in school-related activities requiring hand use between children with DD and typically developing children were revealed generally across all participation dimensions (does participate, frequency, independence, and desired change). This study provides information on the areas in which greater efforts are needed to support children's school participation.

Establishment of cutpoints to categorize the severity of chronic pain using composite ratings with Rasch analysis.

BACKGROUND: Establishment of cutpoints for classifying mild, moderate and severe pain is commonly based on single rating of worst or average pain. However, single pain measure may serve as a brief and partial surrogate for composite pain ratings. This study aimed to base composite pain ratings to establish optimal cutpoint that maximized the difference of pain interference on daily function and compare its utility with those based on single worst and average pain. METHODS: Data were from a cohort study of 322 patients with chronic pain. Brief pain inventory (including four items measuring the least, worst, average and current pain) was administered. Rasch analysis and Serlin et al.'s (Pain, 61, 1995, 277) method were used to derive optimal cutpoint. RESULTS: Rasch analysis calibrated the least, worst, average and current pain items into a unidimensional hierarchy and produced composite pain measurement. The optimal cutpoint for composite pain (mild, ≤4; moderate, >4-6; severe, >6-10 on the 0-10 numeric rating scale) differed from those cutpoints for worst (≤6; >6-8; >8-10) and average pain (≤5; >5-7; >7-10). The optimal cutpoint for composite pain was better able than those for worst and average pain to distinguish among groups on patient-rated pain quality and quality of life. The optimal cutpoint for average pain had better discriminant ability than that for worst pain. CONCLUSION: The results suggest that using optimal cutpoint for composite pain may be useful to classify clinically important groups in patients with chronic pain and that average pain may be an alternative choice if a single item is used. WHAT DOES THIS STUDY ADD?: Using composite pain, optimal classification for mild, moderate and severe pain exhibited better discriminant ability than using single worst/average pain. The difficulty hierarchy of the least, worst, average and current pain helps to screen people with irregular responses.

Targeting TYRO3 inhibits epithelial-mesenchymal transition and increases drug sensitivity in colon cancer.

Colon cancer is the third leading cause of death from cancer worldwide with less than 10% survival rate at the late stage. Although mutations of certain genes have been implicated in familial colon cancer development, the etiology of the majority of colon cancer remains unknown. Herein, we identified TYRO3 as a potential oncogene. Immunohistochemical staining results demonstrated that levels of TYRO3 were markedly elevated in polyps and colon cancer cells and were negatively correlated with prognosis. Overexpression of TYRO3 enhanced cell motility, invasion, anchorage-independent growth and metastatic ability, while knockdown of TYRO3 impaired all these processes. Results from meta-analysis showed that TYRO3 was associated with epithelial-mesenchymal transition (EMT) signatures. Gain-of-function and loss-of-function experiments demonstrated that expression of SNAI1, the master regulator of EMT, was regulated by TYRO3 and played a major role in mediating TYRO3-induced EMT processes. The murine model also demonstrated that Tyro3 and Snai1 were upregulated in the early stage of colon cancer development. To provide a proof-of-concept that TYRO3 is a druggable target in colon cancer therapy, we raised anti-TYRO3 human antibodies and showed that treatment with the human antibody abolished TYRO3-induced EMT process. More importantly, administration of this anti-TYRO3 antibody increased drug sensitivity in primary cultured colon cancer cells and xenografted mouse tumors. These findings demonstrate that TYRO3 is a novel oncogene and a druggable target in colon cancer.

The contributing role of real-life hand skill performance in self-care function of children with and without disabilities.

BACKGROUND: Children's hand skills when performing in real-life contexts have been commonly thought as a possible determinant of their self-care function; however, there is a paucity of research investigating this potential predictive relationship. The purpose of this study was to provide evidence regarding whether children's real-life hand skill performance is contributive to or predictive of their self-care function by considering other child and cultural factors. METHODS: A total of 139 typically developing children and 114 with disabilities, ages 2-12 years from Australia and Taiwan, participated in the study. The outcome measures used were the Assessment of Children's Hand Skills (a measure of real-life hand skill performance) and the Personal Living Skills subscale of the Vineland Adaptive Behavior Scales - Classroom Edition (a measure of self-care function). RESULTS: Hierarchical regression analysis revealed that the children's demographic variables (age, gender, disability status, handedness and cultural context) accounted for 43% of the variance of the self-care function in the combined group of children with and without disabilities. Age, presence of disability and cultural context were the statistically significant independent factors. However, after the entry of the real-life hand skill performance factor, the contributing values of age and disability status decreased and the age factor became non-significant. The hand skill performance factor was found to be the strongest, and its addition led to significant increments of 24.6% of the explained variance for children's self-care function. Similar results were also found in the regression analyses based on separate groups of typically developing children or those with disabilities. CONCLUSIONS: The findings provide evidence that children's real-life hand skill performance is a contributing factor of their self-care function. The assessment of children's hand skill performance in real-life contexts is therefore needed.

Measures of participation outcomes related to hand use for 2- to 12-year-old children with disabilities: a systematic review.

Many interventions have been used to improve children's hand-related impairments or hand skill performance in functional activities so as to promote life participation. There is thus a need to have suitable instruments assessing children's participation in life situations that specifically require hand use in order to support and evaluate such interventions. This systematic review investigated the availability of potential instruments that can be used to assess children's participation specifically in life situations requiring hand use. Clinical utility and evidence for psychometric properties were also sourced. Database searches initially identified measures that were used to evaluate participation of children aged 2-12 years, involved self- or proxy report or interview administration and had generic application for a range of disabilities/diagnoses. These measures were further evaluated to determine if they fulfilled the above inclusion criteria and contained at least 60% of the items involving hand use. Further searches for psychometric evidence were undertaken for the eligible measures. Fourteen measures were identified and nine met the inclusion criteria. However, none of these measures, except for the Children Helping Out: Responsibilities, Expectations, and Supports (CHORES), contained all items related to hand use. Most of the included measures had limited psychometric properties. Only the Children's Assessment of Participation and Enjoyment/Preferences for Activities of Children (CAPE/PAC), the School Function Assessment-Participation section (SFA-P) and the Children Participation Questionnaire (CPQ) revealed sufficient evidence of validity and reliability. The findings suggest a need for adapting existing participation measures or developing new ones that specifically assess participation in life situations requiring hand use to support interventions.

A framework of children's hand skills for assessment and intervention.

UNLABELLED: BACKGROUND; Hand skill development or mastery has a huge influence on children's early development and participation in everyday activities. Assessment of difficulties with children's hand skills typically involves a systematic process considering all potential factors that may impact on hand skills. This helps identify key hand skill difficulties and select specific interventions that are relevant to the individual child. This paper describes the development of the Children's Hand Skills Framework (CHSF) that can be used as a conceptual guide to analyse and describe children's hand skills in the assessment and intervention process. METHODS: A comprehensive literature review of the existing hand skill models and instruments was conducted to develop the CHSF content, and experts' reviews via an evaluation feedback questionnaire were used as a means to validate the CHSF. RESULTS: The literature review revealed that the functional repertoire of children's hand skills can be divided into six distinct categories. Manual gesture and body contact hand skills are two categories, in which the hands do not make contact with any object. Arm-hand use, adaptive skilled hand use and bimanual use are object-related hand skill categories where the hands do contact objects. The final category is related to the general quality of children's hand skills. Each of the six hand skill categories can be further broken down into three to seven subcategories. The feedback from the experts further demonstrated high levels of agreement for the inclusion of the CHSF subcategories. CONCLUSIONS: The CHSF offers a helpful guide to comprehensively describe the complexity of children's hand skills in the assessment process and has the potential to enhance and promote communication about functional use of children's hand skills among professionals. The CHSF is also conceptually compatible with the International Classification of Functioning, Disability, and Health, providing a holistic consideration of both children's hand skills and relevant International Classification of Functioning, Disability, and Health factors for further assessment and intervention planning.

Comparison of artificial neural networks with logistic regression in prediction of gallbladder disease among obese patients.

BACKGROUND: Obesity is a risk factor for gallbladder disease. The authors retrospectively analyse the prevalence and risk factors of gallbladder disease using logistic regression and artificial neural networks among obese patients in Taiwan. METHODS: Artificial neural networks is a popular technique, which can detect complex patterns within data. They have not been applied to risk of gallbladder disease in obese population. We studied the risk factors associated with gallstones in 117 obese patients who were undergoing bariatric surgery between February 1999 and October 2005. Artificial neural networks, constructed with three-layered back-propagation algorithm, were trained to predict the risk of gallbladder disease. Thirty input variables including clinical data (gender, age, body mass index and associated diseases), laboratory evaluation and histopathologic findings of gallbladder were obtained from the patient records. The result was compared with a logistic regression model developed from the same database. RESULTS: Artificial neural networks demonstrated better average classification rate and lower Type II errors than those of logistic regression. The risk factors from both data mining techniques were diastolic blood pressure, inflammatory condition, abnormal glucose metabolism and cholesterolosis. The biological significance of inflammatory condition in obese population requires further investigation. CONCLUSION: Artificial neural networks might be a useful tool to predict the risk factors and prevalence of gallbladder disease and gallstone development in obese patients on the basis of multiple variables related to laboratory and pathological features. The performance of artificial neural networks was better than traditional modeling techniques.

Munificent environments, management control, and the cost of rural hospital care.

Rural hospitals have been threatened by declining revenues. Control over costs will be necessary to help these hospitals survive. Investigation of the determinants of hospital costs in Iowa reveals that costs are primarily caused by environmental factors, rather than variables over which managers have control. Furthermore, efforts by policy makers to improve hospital efficiency by stimulating competition among hospitals may have been ineffective, since the level of competition was not found to be associated with hospital production costs.

Proton-exchanged periodically segmented waveguides in LiNbo(3).

We report on the characterization of single-mode and multimode proton-exchanged periodically segmented waveguides in lithium niobate. Variation of effective indices of different modes for different annealing times as a function of duty cycle and period of segmentation is presented. It is shown that the proton-exchanged periodically segmented waveguide can be modeled by an equivalent z-invariant depth-independent graded-index waveguide with a Gaussian index distribution. Although the depth of the equivalent waveguide is independent of duty cycle, the peak refractive-index change increases almost linearly with the duty cycle and saturates at large duty cycles. The results should benefit the design of linear and nonlinear devices that are based on segmented waveguides.

Cobalt hemoglobin: pH dependence of Adair constants and the Bohr effects.

Precise oxygen equilibrium curves have been obtained for cobalt hemoglobin at pH values from 5.5 to 8.2. The Hill plots are symmetric having asymptotes with slopes of unity. At pH 7.0, cobalt hemoglobin has p0.5 = 116 toor (15.45 kPa), pm = 117 torr (15.58 kPa) and a Hill coefficient of n = 1.72. The values of n decrease slightly with either decrease or increase of pH; the protein is almost non-cooperative at pH greater than 8.2. The Adair constants have been calculated with a non-linear least-squares program. From deltalnpm/deltapH a maximum of 2.5 Bohr protons was calculated at physiological pH values. The majority of alkaline Bohr protons are released after binding of the first and the third oxygen with maxima at pH 7.6 and 7.3, respectively. The acid Bohr effect was also observed with the majority of the protons taken up following the first and third oxygen bound. Smaller alkaline Bohr effects were obtained by differential titration and at higher pH than that calculated from oxygen equilibria. The discrepancy can be largely attributed to the binding of salt components to cobalt hemoglobin.

Nickel cytochrome c. Effect of protein moiety on the metal ion coordination.

Nickel cytochrome c has been synthesized by the reaction of metal-free porphyrin cytochrome c with Ni(II) ions in 0.6 Mglycylglycine and 4 M KSCN. Electronic spectra and susceptibility measurement showed the nickel to be in a high-spin octahedral configuration exemplifying the strong influence of the protein moiety as a macrocyclic ligand on the coordination chemistry of the metal ion. Nickel cytochrome c has the same electrophoretic mobility, helicity and pK values of conformational transitions as the native enzyme. At high pH, the partially denatured nickel cytochrome c becomes dimeric. Nitric oxide reacts with nickel cytochrome c to form the nitrosyl derivative with (formula: see text). Reaction of NO with nickel protoporphyrin IX dimethyl ester in toluene, pyridine, or methylthioethanol produced no stable nitrosyl products, clearly demonstrating the effect of protein on metal ion ligation.