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Delirium is a marker of acute brain insufficiency and a harbinger of poor outcomes and increased healthcare costs. Despite success preventing delirium by nonpharmacologic measures, the incidence in the postcardiac surgical ICU population remains high. Dexmedetomidine, a selective alpha-2 agonist, is a plausible preventive agent with sedative, anxiolytic, analgesic, sympatholytic and anti-inflammatory properties, and is the subject of very active study in cardiac surgery populations.Recent trials, including DEXACET (2019), DECADE (2020), LOWDEXDEL (2021), and DIRECT (2022) individually, failed to show a benefit for dexmedetomidine and highlighted associated risks. Meta-analyses have offered conflicting results, highlighting the complexity of delirium, and likely interaction of multiple etiological pathways; those that concluded benefit often were driven by trials at high risk of bias. Meta-analyses excluding biased trials currently suggest no benefit for dexmedetomidine over control in unselected cardiac surgical populations.Although using dexmedetomidine to prevent delirium in unselected cardiac surgical patients is not supported by current evidence, there remains hope that it may offer benefits in highly selected populations, and further trials are ongoing.

Background: Erectile dysfunction (ED) is common after prostate cancer treatment. It has been studied for conventional radiotherapy, but associations in the hypofractionated radiotherapy context are less clear. This study aimed to determine which factors are predicted for worsening ED after highly conformal, modestly hypofractionated radiotherapy to the prostate. Methods: Two hundred and twelve patients treated with 6000 cGy in twenty fractions across four centers were included in this study. Demographic, clinical, and dosimetry factors were then evaluated for post-treatment declines in erectile function using logistic regression and an explainable machine learning-based neural network. Results: 212 patients with a median follow-up of 3.6 years were evaluated. A total of 104 (49%) patients received androgen deprivation therapy. Prior to treatment, 52 (25%) patients were on ED medication. Mean doses to the penile bulb, penile crus, and penile shaft were 2490 (IQR: 1529–3656) cGy, 2095 (1306–3036) cGy, and 444 (313–650) cGy, respectively. Fifty-nine (28%) patients had a worsening of ED after treatment. On multivariable analysis, only the mean dose to the penile shaft [OR >345 vs. ≤345: 4.47 (1.43–13.99); p = 0.010] and pretreatment use of ED medication [OR yes vs. no: 12.5 (5.7–27.5; p < 0.001)] predicted for worsening ED. The neural network confirmed that the penile shaft mean dose and pre-treatment ED medication use are the most important factors in predicting ED. Conclusions: Pre-treatment ED and penile shaft dosimetry are important predictors for ED after hypofractionated radiotherapy for prostate cancer.

Where patient-reported outcome measures (PROMs) may be administered at multiple patient visits, it is advantageous to capture these symptoms with as few questions as possible. In this study, the M.D. Anderson Head and Neck Symptom Inventory (MDASI-HN), and the M.D. Anderson Dysphagia Inventory (MDADI) is compared to determine if using the MDASI-HN alone would overlook symptoms identified with MDADI.The MDASI-HN and the MDADI were completed by 156 patients, postradiotherapy for head and neck cancer (HNC). Associations between the two instruments were analyzed using correlation analysis, unsupervised machine learning, and sensitivity analysis.Little correlation was found between the two surveys; however, there was overlap between MDASI-HN dry mouth and many MDADI items, confirming that dry mouth is an important factor in difficulty swallowing, and patient QoL. Taking longer to eat (MDADI), was the most commonly reported item overall, with 85 (54%) patients rating it as moderate-severe. Dry mouth was the most endorsed MDASI-HN item (68, 44%). There were 51 patients missed by the MDASI-HN, reporting no moderate-severe symptoms, but reported one or more moderate-severe QoL impacts on MDADI. If patients who reported a score of 2 or higher on the MDASI-HN Dry Mouth item are flagged as requiring follow-up, the number of patients missed by MDASI-HN drops to 15.In an HNC clinic where MDASI-HN is routinely administered, assessment of symptoms and QoL might be enhanced by reducing the value at which MDASI Dry Mouth is considered moderate-severe to 2.3 Laryngoscope, 132:2388-2395, 2022.

Atopic dermatitis (AD) is the most prevalent form of eczema and is a chronic disease with a relapsing-remitting nature. Multiple treatment options exist, yet little is known about patients’ ability to obtain recommended prescription treatments. The aim of this web-based survey was to ascertain the frequency, causes and patient impact of insurance delays and denials for AD prescription treatments. Adult AD patients (18 + years) or caregivers of pediatric AD patients were recruited to complete a survey about experiences with prescription treatment access in the last 12 months. Responses from 1234 AD patients (42.0 ± 16.7 years) and 248 caregivers (8.5 ± 4.7 years) were included in the analysis; 55.4% (n = 680) reported moderate or severe AD. Overall, there were 789 insurance delays or denials for AD prescriptions, with 37.0% (457/1234) of respondents experiencing at least one in the past 12 months. Overall, the majority of delays/denials were for topical steroids (38.3%; 302/789), which is likely due to the high number of patients using one or more topical steroid prescriptions (82.5%; 1018/1234). However, the highest individual drug class burden was on biologics, for which 38.7% of all prescriptions (122/315) faced a delay or denial. Coverage denials were caused primarily by step therapy (25.5%), and delays by prior authorization (61.1%), and only 62.0% of respondents said they would know what to do if they faced an issue getting a prescription covered by their insurer. Patient-reported impacts of prescription denials and delays included: AD flares (85.0%; n = 255), needing alternate medications (72.3%; n = 217), emergency care (49.0%; n = 147) and giving up on treatment altogether (59.0%; n = 177). Patients with AD and their families frequently experience issues obtaining recommended therapies which can result in detrimental health and quality of life impacts. As many as one-third of patients may not know how to respond if their prescriptions are met with insurance delays or denials, further exacerbating those impacts. These data may help identify strategies to improve timely and beneficial therapeutic access.

Atopic dermatitis (AD) and food allergies are more prevalent and more severe in people with skin of color than White individuals. The American College of Allergy, AsthmaImmunology (ACAAI) sought to understand the effects of racial disparities among patients with skin of color with AD and food allergies. ACAAI surveyed its members (N=200 completed), conducted interviews with healthcare providers and advocacy leaders, and hosted a roundtable to explore the challenges of diagnosis and management of AD and food allergies in people with skin of color and discuss potential solutions. The majority (68%) of survey respondents agreed that racial disparities make it difficult for people with skin of color to receive adequate treatment for AD and food allergies. The interviews and roundtable identified access to care, burden of costs, policies and infrastructure that limit access to safe foods and patient education, and inadequate research involving people with skin of color as obstacles to care. Proposed solutions included identifying ways to recruit more people with skin of color into clinical trials and medical school, educating healthcare providers about diagnosis and treating AD and food allergy in people with skin of color, improving access to safe foods, creating and disseminating culturally appropriate materials for patients, and working toward longer appointment times for patients who need them. Challenges inAD and food allergy in persons with skin of color were identified by ACAAI members. Solutions to these challenges were proposed to inspire actions to mitigate racial disparities in AD and food allergy.

Atopic dermatitis (AD) is associated with substantial financial cost, including increased out-of-pocket (OOP) expenses. Associations and impact of OOP costs are poorly understood.The aim of the study was to characterize the impact and associations of OOP health care expenses for AD.A 25-question online survey was administered to National Eczema Association members (N = 113,502). Inclusion criteria (US residents aged ≥18 years; self-reported AD or primary caregiver of individual with AD) were met by 77.3% (1118 of 1447).Respondents with monthly OOP expenses greater than $200 were more likely to have increased AD severity, flares, health care provider visits, prescription polypharmacy, use of step-up therapy, frequent skin infections, and poorer disease control ( P0.005 for all). Respondents with OOP yearly expenditures greater than $1000 had similar associations and additionally increased rates of comorbid asthma, allergic rhinitis, and anxiety/depression ( P0.005 for all). A total of 64.6% (n = 624) reported harmful household financial impact of OOP expenses. Predictors of harmful impact included severe AD (adjusted odds ratio [95% confidence interval], 2.62 [1.11-6.19], P = 0.04), comorbid asthma (1.42 [1.07-1.87], P = 0.03), 5 health care provider visits or more in a year (2.80 [1.62-4.82], P = 0.0007), greater than $200 OOP monthly expenditures (2.16 [1.45-3.22], 0.0006), and $1000 annual OOP expenditures or more (4.56 [3.31-6.27], P0.0001).Out-of-pocket expenses for AD significantly impact household finances. Clinical interventions are needed to minimize OOP expenses while optimizing care outcomes.Capsule Summary:• Atopic dermatitis (AD) is associated with significant financial cost, including increased out-of-pocket (OOP) expenses, although the impact and associations of OOP health care expenses for AD management are not well understood.• The OOP health care expenses related to AD are associated with increased disease severity and health care utilization and significantly impact the household finances of patients and caregivers.• Health care providers should be mindful of the OOP financial burden related to AD management and engage in shared decision making to create a treatment plan that is practical and effective and minimizes household financial impact.

Black race is associated with increased atopic dermatitis (AD) severity and healthcare resource utilization. However, the burden of out-of-pocket (OOP) expenses among black individuals with AD is not well understood. We sought to characterize the categories and impact of OOP healthcare expenses associated with AD management among black individuals. A 25-question voluntary online survey was administered to National Eczema Association members (N = 113,502). Inclusion criteria (US residents age ≥ 18 years; self-report of AD or primary caregivers of individuals with AD) was met by 77.3% (1118/1447) of respondents. Black individuals with AD were younger, had lower household income, Medicaid, urban residence, poor AD control and frequent skin infections (P ≤ 0.02). Blacks vs. non-blacks reported more OOP costs for prescription medications covered (74.2% vs. 63.6%, P = 0.04) and not covered (65.1% vs. 46.5%, P = 0.0004) by insurance, emergency room visits (22.1% vs. 11.8%, P = 0.005), and outpatient laboratory testing (33.3% vs. 21.8%, P = 0.01). Black race was associated with increased household financial impact from OOP expenses (P = 0.0009), and predictors of financial impact included minimally controlled AD (adjusted OR [95% CI] 13.88 [1.63–117.96], P = 0.02), systemic therapy (4.34 [1.63–11.54], 0.003), > $200 monthly OOP expenses (14.28 [3.42–59.60], P = 0.0003), and Medicaid (4.02 [1.15–14.07], P = 0.03). Blacks with Medicaid had higher odds of harmful financial impact (3.32 [1.77–6.24], P = 0.0002) than those of black race (1.81 [1.04–3.15], P = 0.04) or with Medicaid (1.39 [1.02–1.88], P = 0.04) alone. Black race is associated with increased OOP costs for AD and significant household financial impact. Targeted interventions are needed to address financial disparities in AD.

Introduction: For most, wishes and preferences for end-of-life care are outlined in wills or advanced care plans (ACPs). However, these often do not encompass our digital lives, meaning that information on how bereaved loved ones can access and close down the deceased digital accounts are not passed on, including passwords. Digital assets may be owned by the deceased person, beneficiaries or the online service(s) used. Furthermore, digital information laws and policies, such as General Data Protection Regulation (GDPR), can obstruct this information being shared following death. As a result, loved ones may be unable to access precious and sentimental personal memories, photographs, videos and more.Theory: It has been estimated that approximately 96% of households in Great Britain have internet access, with 76% of adults using internet banking.[1] Online accounts can span from social media and TV streaming to online banking and digital currency.Use of these accounts after death is rarely considered by the general public. With the increasing use of electronic storage, more work needs to be done to ensure the safe and easy transfer of digital information before death. Digital legacies, defined as the digital information available about someone after their death, are one safety mechanism to ensure this process.Highlights: In August 2021, the Compassionate IOM Community Network presented the concept of digital legacies to the IOM Chamber of Commerce Digital Forum who are responsible for actively promoting the digital sector. It was agreed that procedures would be updated to accept digital legacies and to identify best practices. Following this, a representative from the IOM Law Society presented it back to the Society. Collaboration between Compassionate IOM and the Law Society is ongoing through exploration of procedures that could be taken by local solicitors, such as prompting discussions during the will- or ACP-writing process. Advice could include making plans for digital assets, approving a digital executor, or simply encouraging people to leave their online affairs in order.In addition to this, the IOM Government Department of Enterprise has recently released an open consultation on electronic transactions. The Compassionate IOM Community Network are lobbying the Government to extend this consultation to digital legacies and electronic death certificates.Conclusions: While the work around digital legacies on the IOM remains in its infancy, a new framework is being constructed through collaboration between the IOM Law Society and Compassionate IOM.Implications for applicability/transferability, sustainability and limitations: There remains work to be done to ensure that the process of digital legacies on the IOM is sustainable, uncomplicated and protects people when they are at their most vulnerable. Future work will aim to work with local banks to prompt discussions surrounding online banking post death.References1. Office for National Statistics. Internet access - households and individuals, Great Britain: 2020 [webpage on the internet]. [cited 2021 30 Nov]; updated 2020 Aug 7]. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/householdcharacteristics/homeinternetandsocialmediausage/bulletins/internetaccesshouseholdsandindividuals/2020

Introduction: The care needed at end of life can go beyond what services can offer. This is where volunteers can make a difference, however the nature of their support can vary. Dodd et al. [1] recognised two types of input: ‘being there’ and ‘doing for’. Similarly, Burbeck et al. [2] examined the volunteer role and found three themes; the distinctness, characteristics and experience of the role. Here, a volunteer can be mediating between patients and staff, sometimes acting as a surrogate family member. Such complexity requires further study and more detailed information about the impact on care recipients, and the volunteers themselves, would greatly assist the training and development of volunteers as well as decisions on how to maximise the use of volunteers to achieve the most benefit. Compassionate Isle of Man (IOM) has been developing the role of volunteers as Palliative Care Companions in the community. This evaluation aims to capture the impact and experience of volunteers and care recipients and examine the explicit and implicit needs for palliative care that they address. This paper will report on the pilot of the methods and initial findings.Aims: To use capability measures, qualitative and other data to identify the implicit and explicit needs for volunteer support, the short-term impact(s) on care recipients and volunteers and the implications for the training of volunteers. Methods: A prospective study will enrol care recipients and their carers at the outset of Compassionate IOM support. Baseline data will include stated needs as well as the ICEpop CAPability (ICECAP) measures [3] and interviews. Data collection will be repeated at 6 and 12 weeks and will include specially designed questionnaires and interviews to elicit perceptions of impact, satisfaction and details of the support experience. This information will be set within a cost-benefit framework to quantify the extent to which declared and undeclared needs are met, at what cost and with what benefits to care recipients and volunteers. The initial pilot study will test the methods and include at least 10 care recipients, their main carers and the related volunteers.Conclusion and implications: This pilot study will form the basis for a longer-term study which will provide essential information on the potential scope of volunteer support and their place in the overall service delivery of palliative care in the community.References1. Dodd S, Hill M, Ockenden N, Algorta GP, Payne S, Preston N, et al. ‘Being with’ or ‘doing for’? How the role of an end-of-life volunteer befriender can impact patient wellveing: interviews from a multiple qualitative case study (ELSA). Supportive Care in Cancer 2018;26(9):3163-3172. doi: https://doi.org/10.1007/s00520-018-4169-22. Burbeck R, Candy B, Low J, Rees R. Understanding the role of the volunteer in specialist palliative care: a systematic review and thematic synthesis of qualitative studies. BMC Palliative Care 2014;13(3):1-12. doi:https://doi.org/10.1186/1472-684X-13-33. University of Birmingham. ICECAP capability measures [webpage on the Internet]. [cited 2021 30 Nov]. Available from: https://www.birmingham.ac.uk/research/activity/mds/projects/haps/he/icecap/index.aspx

Entre los mecanismos de divulgación de la investigación de la Facultad de Psicología se cuenta con la publicación semestral de Carta de Psicología, espacio en el cual se publican artículos cortos resultado de investigaciones desarrolladas en los diferentes escenarios de formación, para visibilizar los productos derivados de los semilleros innovo, de investigación o grupos de estudio; al igual que aquellos derivados de la interacción académica con instituciones de orden nacional e internacional, los derivados de ejercicios de investigación en el aula de clase y de actividades de extensión. Esta publicación parte de un doble reconocimiento: en su comienzo, los artículos científicos fueron epístolas de las comunidades científicas, grupos cercanos de interlocución franca y abierta. En su avance, Carta de Psicología propende por la reflexión y el diálogo a partir del reconocimiento de las experiencias valiosas que construyen universidad y diversidad en la formación, los ejercicios de investigación del aula, los avances de los proyectos de semilleros de investigación, los avances de maestría y doctorado, las voces de los egresados, entre otros, de tal manera que sirva como referencia de lo que hacemos y de lo que somos. Esta filosofía orienta el último desarrollo de la política editorial de Carta de Psicología en cuatro secciones: Investigación formativa, Interacción académica, Investigación de aula y Extensión. Investigación, integración curricular y divulgación como ejes para el cumplimiento de las funciones sustantivas en la Facultad de Psicología. El cambio de la comunicación en las relaciones afectivosexuales debido al uso de las redes sociales. Consumo de sustancias psicoactivas: una problemática juvenil. Flexibilidad cognitiva en el deterioro cognitivo leve. Relación entre clima organizacional y engagement en empleados de Bogotá. Relación entre el estrés y el desempeño laboral: revisión teórica. Percepción del liderazgo transformacional con relación a las variables sociodemográficas de la población colombiana. Programas de Outplacement para trabajadores en relación con su calidad de vida. Violencia sexual y redes sociales. Los juegos en redes y la violencia autoinfligida. El sentido de comunidad y la crisis económica, social y política en Colombia. Consumo de alcohol de estudiantes universitarios antes y durante la pandemia COVID-19. Resultados preliminares. Uso de la tecnología para la aplicación del instrumento para valorar la comprensión de síntesis. Consecuencias de los modelos de pautas de crianza en el desarrollo infantil. La justicia más allá de la equidad: un breve comentario del libro Las fronteras de la justicia, de Martha Nussbaum. Conceptualización y consecuencias del maltrato Infantil Exploración de factores de riesgo y los efectosdel reclutamiento forzado en el desarrollo infantil. Indicadores de aprendizaje para la educación integral de la sexualidad. Instrumento de medición de afectividad y erotismo en trabajadoras sexuales de Bogotá. Toma de decisiones y vida sexual: autocuidado, relaciones afectivas y toma de decisiones en niños/niñas. Convicciones y conductas sobre virginidad. Significado y valor de acuerdo con las diferencias generacionales. Percepción sobre el concepto, situación y vulneración de los derechos humanos en el departamento de Santander, Colombia. Factores que influyen en la vulnerabilidad frente al delito de la trata de personas en estudiantes universitarios de la Universidad Cooperativa de Colombia. Violencia intrafamiliar desde la perspectiva del agresor: un estudio de caso en la cárcel de máxima seguridad de Palogordo de Bucaramanga.

Engaging in shared decision-making (SDM) can help patients understand and choose treatments according to their values and has been shown to improve patient satisfaction and adherence with treatment. It is well suited for conditions like eczema for which several medically appropriate treatment options exist. However, little is known about the use and experience of SDM in eczema.To understand experiences, preferences, and expectations for SDM in eczema care settings from the patient and caregiver perspective.The National Eczema Association conducted an online survey in January 2021 among self-selected patients and caregivers. Inclusion criteria (US resident, patient with eczema or caregiver of a patient with eczema aged ≤17 years, respondent age ≥18 years) were met by 1313 of 1387 respondents (94.7%). Data analysis was performed from May 2021 to November 2021.Outcomes were past SDM (using a 9-item SDM questionnaire [SDMQ9]; score ranges transformed to 0-100), present SDM (Control Preferences Scale), and future SDM (self-reported confidence and motivation to engage in SDM) behavior.Among the 1313 respondents included in the study, most were female (1046 of 1313 [79.7%]) adult (1086 of 1313 [82.7%]) patients with a mean (SD) patient Recap of Atopic Eczema score of 11.7 (7.2), mean (SD) patient age of 39.5 (22.2) years, and mean (SD) SDMQ9 score of 65.1 (27.4). For present SDM, 479 of 966 (49.6%) reported "I prefer to make the final decision after seriously considering my doctor's opinion," and 655 of 955 (69.4%) reported being very or extremely confident to engage in SDM in the future. Those who reported feeling "very well informed" about the causes of eczema had a 14.7-point higher (95% CI, 9.2-20.2; P .001, multiple linear regression) SDMQ9 score than those "not adequately informed" and were 3.4 times more likely (95% CI, 2.1-5.7; P .001, multiple logistic regression) to be confident to engage in future SDM. Respondents reported that they would be motivated to engage in SDM if the clinician initiated SDM, valued input from the patient, and acknowledged that patients are experts on their own bodies or if a treatment is no longer working.Results of this survey study suggest that a majority of patients with eczema and caregivers prefer a large role in decision-making for their care and that clinicians can initiate and facilitate SDM to improve patient satisfaction with care.

Reviewer Acknowledgements for International Journal of Statistics and Probability, Vol. 12, No. 3

Reviewer Acknowledgements for International Journal of Statistics and Probability, Vol. 12, No. 2

ImportancePatient values and preferences can inform atopic dermatitis (AD) care. Systematic summaries of evidence addressing patient values and preferences have not previously been available.ObjectiveTo inform American Academy of Allergy, Asthma & Immunology (AAAAI)/American College of Allergy, Asthma and Immunology (ACAAI) Joint Task Force on Practice Parameters AD guideline development, patient and caregiver values and preferences in the management of AD were systematically synthesized.Evidence ReviewPaired reviewers independently screened MEDLINE, Embase, PsycINFO, and CINAHL databases from inception until March 20, 2022, for studies of patients with AD or their caregivers, eliciting values and preferences about treatment, rated risk of bias, and extracted data. Thematic and inductive content analysis to qualitatively synthesize the findings was used. Patients, caregivers, and clinical experts provided triangulation. The GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation–Confidence in the Evidence from Reviews of Qualitative Research) informed rating of the quality of evidence.FindingsA total of 7780 studies were identified, of which 62 proved eligible (n = 19 442; median age across studies [range], 15 years [3-44]; 59% female participants). High certainty evidence showed that patients and caregivers preferred to start with nonmedical treatments and to step up therapy with increasing AD severity. Moderate certainty evidence showed that adverse effects from treatment were a substantial concern. Low certainty evidence showed that patients and caregivers preferred odorless treatments that are not visible and have a minimal effect on daily life. Patients valued treatments capable of relieving itching and burning skin and preferred to apply topical corticosteroids sparingly. Patients valued a strong patient-clinician relationship. Some studies presented varied perspectives and 18 were at high risk for industry sponsorship bias.Conclusions and RelevanceIn the first systematic review to address patient values and preferences in management of AD to our knowledge, 6 key themes that may inform optimal clinical care, practice guidelines, and future research have been identified.

Background Atopic dermatitis (AD) is associated with considerable financial cost. However, the full burden of out-of-pocket (OOP) expenses is not well understood. Objective We sought to characterize the OOP health care expenses associated with AD management. Methods A 25-question voluntary online survey was administered to National Eczema Association members worldwide (n = 113,502). Inclusion criteria (US residents age ≥18 years who either self-reported had AD or were primary caregivers of individuals with AD) were met by 77.3% (1118/1447) of respondents. Results Respondents reported OOP expenses in 3 categories: (1) health care providers and prescriptions, including health care provider visit deductibles (68.7% [686]), prescription co-pays (64.3% [635]), and prescriptions not covered by insurance (48.6% [468]); (2) nonprescription health care products, including moisturizers (94.3% [934]), hygiene products (85.0% [824], allergy medications (75.1% [715]), itch relievers (68.25% [647]), dietary supplements (52.2% [491]), and sleep aids (37.0% [336]); and (3) complementary approaches, including cleaning products (74.7% [732]), clothing/bedding (44.8% [430]), alternative medications (19.0% [180]), and adjunctive therapies (15.9% [150]). The median annual AD OOP expense was US $600 (range, US $0-$200,000), with 41.9% (364) reporting expenditures US $1000 or greater. Conclusions Out-of-pocket expenses place a significant financial burden on individuals with AD. Additional studies are needed to better understand associations and impact of OOP costs.

BACKGROUND Atopic dermatitis (AD) is a pruritic chronic condition associated with significant sleep disturbance, inattention, and sometimes behavioral problems. Enhancing resiliency in children with AD may promote coping strategies to improve quality of life. One strategy for strengthening resiliency is via positive psychology. OBJECTIVE Our objective was to identify positive psychology concepts mentioned by children with AD and their parent to inform strategies to strengthen resiliency in children with AD. METHODS Twenty patient-parent dyads were interviewed to provide feedback on a novel brief Cognitive Behavioral Therapy (CBT) intervention for itch rumination. Patients were 8-17 years-old and diagnosed with AD. Trained coders analyzed transcripts using a coding dictionary developed based on Seligman’s PERMA (Positive emotion, Engagement, Relationships, Meaning, Achievement) model of positive psychology. The frequency of unprompted mentions of PERMA themes and relevant quotations were captured. Transcripts were also separately coded for resiliency, the ultimate goal of PERMA. RESULTS Positive psychology concepts were mentioned by 100% of children and 95% of parents. Engagement and relationships, both negative and positive aspects, were the most common unprompted PERMA themes mentioned by children (70%) and parents (65%). Emotion elicited the most negative comments from children (95%) and parents (85%). When analyzed for resiliency, 8 participants were identified with at least one resiliency code. On average, participants with a resiliency code versus none mentioned PERMA concepts 9.1±4.7 times versus 5.9±4.6 (p = 0.14). When participants were stratified by disease severity, positive psychology concepts were mentioned more by mild patients vs moderate patients vs severe patients, 13±3.0 vs 6.2±4.9 vs 6.13±4.0, respectively (p = 0.034). CONCLUSIONS Among PERMA themes, engagement and relationships are the two most commonly mentioned categories for children with AD. Strategies targeting PERMA such as affirmations and positive reframing may improve psychosocial wellbeing and resiliency in pediatric AD. Future directions will look at incorporating “positive medicine” in AD treatment to not only relieve symptoms but also strengthen positive aspects of life.

Characteristics of Parametric Risk Transfer Extreme heat events are an underrecognized natural hazard impacting many parts of society, and especially the vulnerable poor. Sometimes the effects of a heat event, or a heat wave, are measurable, such as in the relationship between heat and reproductive outcomes in agriculture, or directly as damaged infrastructure or higher cost of industrial cooling. More often, the true impacts and social costs are more difficult to quantify such as in the case of reduced labor productivity, spikes in moribundity and mortality and a variety of other business interruptions.We present a parametric risk transfer product targeting extreme heat effects. The initial application of the product is for heat emergencies in working poor urban settings of Northern India, but the objective is to generalize the product globally.Heat Index SelectionCentral to a parametric risk transfer product is an index that is closely related to the damaging effects. This index should be based on an undisputed data source, that neither the insured or the insurance provider can influence. In parametric risk transfer, payouts are based on the index value, rather than an ex-post loss assessment. The main strengths of parametric products is that payments for an event can be made nearly immediately following a triggering event, providing financial resources to quickly address and mitigate losses.We tested and present a large sample of the many extreme heat indexes which exist in the literature pertaining to human physiology for their historical impacts on mortality and on business interruption from historical data in Europe and India.We characterize the risk in terms of maximum severity as well as the bivariate relationship of severity and duration and derive exceedance probabilities. Based on this assessment, we adopt a generalized form of the Wet Bulb Globe Temperature as extreme heat index, based on the ERA5 atmospheric reanalysis. Implementation in Gujarat, IndiaThe index will be implemented as part of a resilience building program with women’s network Mahila Housing Trust, across three cities in the Gujurat state of India. The index will form the basis of a risk transfer product with local credit cooperatives in these regions - ultimate beneficiaries will be individual cooperative members, women employed in the informal sector. A climate risk education program will also be offered concurrently to inform mitigation and adaptation measures for the cooperative members. Global applicabilityThe use of parametric risk transfer schemes to mitigate the effects of extreme heat is possible beyond the implementation in India. Based ont he lessons learnt in this pilot project, parametric products can be used in extreme heat risk adaptation if:1. the index and data sources are defined and accepted by all local parties.2. a strong local distribution channel is present3. strong capacity is built to deal with basis risk

Background Atopic dermatitis (AD) is associated with considerable financial cost. However, the full burden of out-of-pocket (OOP) expenses is not well understood. Objective We sought to characterize the OOP health care expenses associated with AD management. Methods A 25-question voluntary online survey was administered to National Eczema Association members worldwide (n = 113,502). Inclusion criteria (US residents age ≥18 years who either self-reported had AD or were primary caregivers of individuals with AD) were met by 77.3% (1118/1447) of respondents. Results Respondents reported OOP expenses in 3 categories: (1) health care providers and prescriptions, including health care provider visit deductibles (68.7% [686]), prescription co-pays (64.3% [635]), and prescriptions not covered by insurance (48.6% [468]); (2) nonprescription health care products, including moisturizers (94.3% [934]), hygiene products (85.0% [824], allergy medications (75.1% [715]), itch relievers (68.25% [647]), dietary supplements (52.2% [491]), and sleep aids (37.0% [336]); and (3) complementary approaches, including cleaning products (74.7% [732]), clothing/bedding (44.8% [430]), alternative medications (19.0% [180]), and adjunctive therapies (15.9% [150]). The median annual AD OOP expense was US $600 (range, US $0–$200,000), with 41.9% (364) reporting expenditures US $1000 or greater. Conclusions Out-of-pocket expenses place a significant financial burden on individuals with AD. Additional studies are needed to better understand associations and impact of OOP costs.

Carcinoid crisis is a life-threatening manifestation of carcinoid syndrome characterized by profound autonomic instability in the setting of catecholamine release from stress, tumor manipulation, or anesthesia. Here, we present an unusual case of carcinoid crisis leading to acute systolic heart failure requiring mechanical circulatory support. (Level of Difficulty: Intermediate.), Graphical abstract

This study quantified plan quality differences across the 4 cancer centers in Alberta, Canada for plans that followed the PROstate Fractionated Irradiation Trial protocol.Prostate plans of 235 patients were retrospectively reviewed. Interinstitutional plan quality comparisons were made based on distributions of protocol-specified parameters using 1-way analysis of variance with Games-Howell post hoc analysis. Dosimetrically representative cases were selected from each center using k-medoid clustering, enabling side-by-side comparison of dose-volume histograms and dose distributions. Fourteen anatomic features were investigated to explore interinstitutional patient population differences. Anatomically representative cases were selected from each center to explore differences in planning practices. Tumor control probability (TCP), as well as rectal wall and bladder wall normal tissue complication probabilities (NTCPs), were calculated to quantify the clinical effect of the differences in plan quality.Comparing the mean value of each center to the other 3, statistically significant differences were observed for bladder wall D30% and D50%, left and right femoral heads D5%, planning target volume D99% and D1cc, and clinical target volume D99%. Dosimetrically representative cases demonstrated consistent results. Although anatomic differences were observed between the center-specific populations, an analysis using anatomically similar cases demonstrated consistent trends in the dosimetric differences, suggesting the dosimetric variation is not exclusively due to anatomic differences. Minimal differences (1%) among the 4 centers were noted for TCP and NTCPs, suggesting the reported differences in plan quality may not have any clinical significance.Despite common guidelines, statistically significant differences in plan quality metrics occurred among the 4 investigated centers. The differences are due at least in part to variation in local planning practices. TCP and NTCP calculations suggest that the clinical significance of the differences is minimal. These results can serve as a reference for the degree of variation among centers that can be accepted when a common protocol is adopted.

Emergency tracheostomy is a timely life saving procedure bringing to the fore the expert skills of the difficult airway team comprising the otolaryngologist, anaesthesiologist and theatre team or emergency department staff. Adequate advanced planning has to be adopted in these situations for achieving a good outcome. We present our optimal pathway practiced within our team to achieve successful outcomes during emergency tracheostomies starting from planning to the use of pressure bag in cases of failed intubations.

This ongoing study focuses on a fundamental understanding of researcher awareness, through the synthesis of interdisciplinary and traditional research methods. An arts-based inquiry (Finley, 2006; Sullivan, 2005; Turner, 2015) will be employed as a methodological enhancement to developmental phenomenography (Green & Bowden, 2009). A devised short film-making initiative intends to persuade both the participants and audience to revisit their figured worlds (Holland, Lachicotte, Skinner & Cain, 1998; Nash, Kent & Reid, 2014) by actively questioning what they perceive. Becoming critically aware of diverse perspectives may call into question a singular, conformist point of view, represented by mainstream traditional research. Multiple theories and methods can provide a more comprehensive understanding of young adults’ perceptions from various perspectives. Freire (1970, 1972), Greene (2001), and Allsup’s theories are used to develop a potentially transformative learning space for a sample of five conveniently selected post-school participants with Dance, Drama and Music experience. For the individuals who will participate in this study, ‘transformation’ may not only indicate imagining alternative scenarios (Allsup, 2003; Greene, 2001) but entering new figured worlds (Holland et al., 1998; Nash et al., 2014) through critical reflection on their situations instead. KEYWORDS Arts-based inquiry, critical awareness, critical citizenship, developmental phenomenography, figured worlds, post-school youth, short film-making, transformative learning, transpersonal growth.

Background Diagnosis of necrotizing otitis externa is often delayed despite patients having severe pain disproportionate to the clinical findings as well as cranial nerve palsies. The incidence is increasing in elderly, diabetic or immunocompromised patients and can be fatal without ‘appropriate’ antibiotic therapy.1,2 Objectives CT, MRI, and technetium 99 bone scans are often performed but poorly correlate to the clinical response to empirical treatment.3 This novel study evaluated the use of erythrocyte sedimentation rate (ESR) and pain scores as measures of response to determine the dose and duration of antibiotic therapy in patients diagnosed with NOE over a 4 year period from November 2015. Methods Patients diagnosed with NOE were evaluated using pain scores (0–10/10 where 0 = no pain and 10 = worst pain) and ESR at presentation and then at subsequent outpatient visits. Patients received 6 weeks of IV antibiotics (most receiving piperacillin/tazobactam 13.5 g daily via a 24 h infusion pump administered through a ‘mid-line’ as an outpatient when they were clinically well to go home) followed by oral ciprofloxacin. Initially ciprofloxacin was prescribed at 750 to 500 mg twice daily and the dose and duration of treatment was personalized according to pain scores and ESR. No ethical approval was required since this was an observational study of standard management of this condition at the Trust. Results Twelve patients (10 males; 2 females) aged 49 to 91 years (median 74.5 years) were treated. Five had diabetes mellitus and three had been treated for a malignancy. The time of first symptoms to diagnosis ranged from 3 weeks to 32 months (median 3 months). Six had developed facial nerve palsies; three of whom had additional cranial nerve involvement. All had swabs positive for Pseudomonas aeruginosa which in four patients was resistant to gentamicin and in two of these patients also to ciprofloxacin. At presentation pain score was 10/10 in all but three patients (5/10 in one patient and 8/10 in two patients) and ESR values ranged from 31 to 82 (median 66). Both values fell within 1–2 weeks of commencing IV antibiotics and after 6 weeks pain scores were 0/10 in eight patients, 3/10 in the others. ESR at this stage fell to 10–33 (median 15). One patient developed diarrhoea and stopped ciprofloxacin after only 2 weeks remaining well at 6 months follow-up. Eight patients required 3 to 12 months ciprofloxacin. Four patients required restarting or increasing ciprofloxacin dose to control rising pain scores which reflected an increase in their ESR values but in one of these patients having grown Pseudomonas resistant to ciprofloxacin, two further 6 week courses of piperacillin/tazobactam were required. Three patients currently remain on ciprofloxacin at the lowest dose to keep their pain scores and ESR under control Conclusions Pain scores with ESR values are invaluable in determining the activity of NOE thereby personalizing the antibiotic dose and duration in patients with this life-threatening infection.

IntroductionBehavioural interventions in early life appear to show some effect in reducing childhood overweight and obesity. However, uncertainty remains regarding their overall effectiveness, and whether effectiveness differs among key subgroups. These evidence gaps have prompted an increase in very early childhood obesity prevention trials worldwide. Combining the individual participant data (IPD) from these trials will enhance statistical power to determine overall effectiveness and enable examination of intervention-covariate interactions. We present a protocol for a systematic review with IPD meta-analysis to evaluate the effectiveness of obesity prevention interventions commencing antenatally or in the first year after birth, and to explore whether there are differential effects among key subgroups.Methods and analysisSystematic searches of Medline, Embase, CENTRAL, CINAHL, PsycInfo, and trial registries for all ongoing and completed randomised controlled trials evaluating behavioural interventions for the prevention of early childhood obesity have been completed up to March 2020 and will be updated annually to include additional trials. Eligible trialists will be asked to share their IPD; if unavailable, aggregate data will be used where possible. An IPD meta-analysis and a nested prospective meta-analysis (PMA) will be performed using methodologies recommended by the Cochrane Collaboration. The primary outcome will be body mass index (BMI) z-score at age 24 +/- 6 months using World Health Organisation Growth Standards, and effect differences will be explored among pre-specified individual and trial-level subgroups. Secondary outcomes include other child weight-related measures, infant feeding, dietary intake, physical activity, sedentary behaviours, sleep, parenting measures and adverse events.Ethics and disseminationApproved by The University of Sydney Human Research Ethics Committee (2020/273) and Flinders University Social and Behavioural Research Ethics Committee (project no. HREC CIA2133-1). Results will be relevant to clinicians, child health services, researchers, policy-makers and families, and will be disseminated via publications, presentations, and media releases.RegistrationProspectively registered on PROSPERO: CRD42020177408STRENGTHS AND LIMITATIONS OF THIS STUDYThis will be the largest individual participant data (IPD) meta-analysis evaluating behavioural interventions for the prevention of early childhood obesity to date, and will provide the most reliable and precise estimates of early intervention effects to inform future decision-making.IPD meta-analysis methodology will enable unprecedented exploration of important individual and trial-level characteristics that may be associated with childhood obesity or that may be effect modifiers.The proposed innovative methodologies are feasible and have been successfully piloted by members of our group.It may not be possible to obtain IPD from all eligible trials; in this instance, aggregate data will be used where available, and sensitivity analyses will be conducted to assess inclusion bias.Outcome measures may be collected and reported differently across included trials, potentially increasing imprecision; however, we will harmonise available data where possible, and encourage those planning or conducting ongoing trials to collect common core outcomes following prospective meta-analysis methodology.

Bleach bathing is frequently recommended to treat atopic dermatitis (AD), but its efficacy and safety are uncertain.To systematically synthesize randomized controlled trials (RCTs) addressing bleach baths for AD.We searched MEDLINE, EMBASE, CENTRAL, and GREAT from inception to December 29, 2021, for RCTs assigning patients with AD to bleach vs no bleach baths. Paired reviewers independently and in duplicate screened records, extracted data, and assessed risk of bias (Cochrane version 2) and GRADE quality of evidence. We obtained unpublished data, harmonized individual patient data and did Frequentist and Bayesian random-effects meta-analyses.There were 10 RCTs that enrolled 307 participants (median of mean age 7.2 years, Eczema Area Severity Index baseline mean of means 27.57 [median SD, 10.74]) for a median of 6 weeks (range, 4-10). We confirmed that other trials registered globally were terminated. Bleach baths probably improve AD severity (22% vs 32% improved Eczema Area Severity Index by 50% [ratio of means 0.78, 95% credible interval 0.59-0.99]; moderate certainty) and may slightly reduce skin Staphylococcal aureus colonization (risk ratio, 0.89 [95% confidence interval, 0.73-1.09]; low certainty). Adverse events, mostly dry skin and irritation, along with itch, patient-reported disease severity, sleep quality, quality of life, and risk of AD flares were not clearly different between groups and of low to very low certainty.In patients with moderate-to-severe AD, bleach baths probably improve clinician-reported severity by a relative 22%. One in 10 will likely improve severity by 50%. Changes in other patient-important outcomes are uncertain. These findings support optimal eczema care and the need for additional large clinical trials.PROSPERO Identifier: CRD42021238486.

BackgroundOcular toxoplasmosis is common across all regions of the world. Understanding of the epidemiology and approach to diagnosis and treatment have evolved recently. In November 2020, an international group of uveitis-specialised ophthalmologists formed the International Ocular Toxoplasmosis Study Group to define current practice.Methods192 Study Group members from 48 countries completed a 36-item survey on clinical features, use of investigations, indications for treatment, systemic and intravitreal treatment with antiparasitic drugs and corticosteroids, and approach to follow-up and preventive therapy.ResultsFor 77.1% of members, unilateral retinochoroiditis adjacent to a pigmented scar accounted for over 60% of presentations, but diverse atypical presentations were also reported. Common complications included persistent vitreous opacities, epiretinal membrane, cataract, and ocular hypertension or glaucoma. Most members used clinical examination with (56.8%) or without (35.9%) serology to diagnose typical disease but relied on intraocular fluid testing—usually PCR—in atypical cases (68.8%). 66.1% of members treated all non-pregnant patients, while 33.9% treated selected patients. Oral trimethoprim–sulfamethoxazole was first-line therapy for 66.7% of members, and 60.9% had experience using intravitreal clindamycin. Corticosteroid drugs were administered systemically by 97.4%; 24.7% also injected corticosteroid intravitreally, almost always in combination with an antimicrobial drug (72.3%). The majority of members followed up all (60.4%) or selected (35.9%) patients after resolution of acute disease, and prophylaxis against recurrence with trimethoprim–sulfamethoxazole was prescribed to selected patients by 69.8%.ConclusionOur report presents a current management approach for ocular toxoplasmosis, as practised by a large international group of uveitis-specialised ophthalmologists.

IntroductionLittle is known about how early (e.g., commencing antenatally or in the first 12 months after birth) obesity prevention interventions seek to change behaviour and which components are or are not effective. This study aims to 1) characterise early obesity prevention interventions in terms of target behaviours, delivery features, and behaviour change techniques (BCTs), 2) explore similarities and differences in BCTs used to target behaviours, and 3) explore effectiveness of intervention components in preventing childhood obesity.Methods and analysisAnnual comprehensive systematic searches will be performed in Epub Ahead of Print/MEDLINE, Embase, Cochrane (CENTRAL), CINAHL, PsycINFO, as well as clinical trial registries. Eligible randomised controlled trials of behavioural interventions to prevent childhood obesity commencing antenatally or in the first year after birth will be invited to join the TOPCHILD Collaboration. Standard ontologies will be used to code target behaviours, delivery features and BCTs in both published and unpublished intervention materials provided by trialists. Narrative syntheses will be performed to summarise intervention components and compare applied BCTs by types of target behaviours. Exploratory analyses will be undertaken to assess effectiveness of intervention components.Ethics and disseminationThe study has been approved by The University of Sydney Human Research Ethics Committee (project no. 2020/273) and Flinders University Social and Behavioural Research Ethics Committee (project no. HREC CIA2133-1). The study’s findings will be disseminated through peer-reviewed publications, conference presentations, and targeted communication with key stakeholders.DiscussionOur study will provide an in depth understanding of behavioural components and delivery features used in obesity prevention interventions starting antenatally or in the first 12 months after birth. Understanding common intervention approaches in a systematic way will provide much needed insight to advance the design of early obesity prevention interventions and provide the opportunity to undertake future quantitative predictive modelling.RegistrationPROSPERO registration no. CRD42020177408STRENGTHS AND LIMITATIONS OF THIS STUDYThis study provides an understanding of behaviours targeted, behaviour change techniques and delivery features used in early childhood obesity prevention trials identified in a systematic review as being eligible for inclusion in the Transforming Obesity Prevention in CHILDren (TOPCHILD) Collaboration.Extends previous methods by coding behaviour change techniques in published and unpublished intervention materials and performing cross validation with trialists through the TOPCHILD Collaboration.Using standardised coding taxonomies will allow for comparisons across studies, and we will pilot test new ontologies from the Human Behaviour Change Project.Explores the complex area of targeting parent and caregivers’ behaviours to impact child outcomes across four key obesity prevention behavioural domains (relating to infant feeding practices, food provision and parent feeding practices, movement practices, sleep health practices).This study will provide preliminary results regarding the examination of intervention components’ effectiveness based on exploratory analysis. Yet, the internationally unique database this project creates will further our understanding of effective intervention components in future research.To date we already have 38 out of 65 eligible trials agreeing to share data, since not all trials may provide unpublished material we may perform sensitivity analyses comparing trials that have shared data to trials that have not shared materials.

Background: \ud The SARS-CoV-2 delta (B.1.617.2) variant was first detected in England in March, 2021. It has since rapidly become the predominant lineage, owing to high transmissibility. It is suspected that the delta variant is associated with more severe disease than the previously dominant alpha (B.1.1.7) variant. We aimed to characterise the severity of the delta variant compared with the alpha variant by determining the relative risk of hospital attendance outcomes.\ud \ud Methods: \ud This cohort study was done among all patients with COVID-19 in England between March 29 and May 23, 2021, who were identified as being infected with either the alpha or delta SARS-CoV-2 variant through whole-genome sequencing. Individual-level data on these patients were linked to routine health-care datasets on vaccination, emergency care attendance, hospital admission, and mortality (data from Public Health England's Second Generation Surveillance System and COVID-19-associated deaths dataset; the National Immunisation Management System; and NHS Digital Secondary Uses Services and Emergency Care Data Set). The risk for hospital admission and emergency care attendance were compared between patients with sequencing-confirmed delta and alpha variants for the whole cohort and by vaccination status subgroups. Stratified Cox regression was used to adjust for age, sex, ethnicity, deprivation, recent international travel, area of residence, calendar week, and vaccination status.\ud \ud Findings: \ud Individual-level data on 43 338 COVID-19-positive patients (8682 with the delta variant, 34 656 with the alpha variant; median age 31 years [IQR 17–43]) were included in our analysis. 196 (2·3%) patients with the delta variant versus 764 (2·2%) patients with the alpha variant were admitted to hospital within 14 days after the specimen was taken (adjusted hazard ratio [HR] 2·26 [95% CI 1·32–3·89]). 498 (5·7%) patients with the delta variant versus 1448 (4·2%) patients with the alpha variant were admitted to hospital or attended emergency care within 14 days (adjusted HR 1·45 [1·08–1·95]). Most patients were unvaccinated (32 078 [74·0%] across both groups). The HRs for vaccinated patients with the delta variant versus the alpha variant (adjusted HR for hospital admission 1·94 [95% CI 0·47–8·05] and for hospital admission or emergency care attendance 1·58 [0·69–3·61]) were similar to the HRs for unvaccinated patients (2·32 [1·29–4·16] and 1·43 [1·04–1·97]; p=0·82 for both) but the precision for the vaccinated subgroup was low.\ud \ud Interpretation: \ud This large national study found a higher hospital admission or emergency care attendance risk for patients with COVID-19 infected with the delta variant compared with the alpha variant. Results suggest that outbreaks of the delta variant in unvaccinated populations might lead to a greater burden on health-care services than the alpha variant.\ud \ud Funding: \ud Medical Research Council; UK Research and Innovation; Department of Health and Social Care; and National Institute for Health Research.

Previous studies have documented the high patient and caregiver burden associated with atopic dermatitis (AD). Less is known about the factors-especially those related to treatment options and the delivery of medical care-that may relate to burden and unmet needs among patients and their caregivers.Our primary aim was to characterize and compare health-related quality of life, long-term control of symptoms, satisfaction with treatments, the financial burden, and the prevalence of patient-centered care among adult and pediatric patients with AD in 8 developed nations.We developed a 53-item anonymous online survey for adult patients and caregivers of children with AD (N = 3171; self-reported disease severity: 8.2% clear, 33.2% mild, 41.1% moderate, 17.6% severe). The survey included questions across 7 domains selected by a steering committee of 11 patient organizations that advocate for patients with AD in the 8 countries. We used validated instruments when available including the 5-level EuroQol five-dimensional questionnaire and the Atopic Dermatitis Control Tool. The survey was offered in 5 languages and promoted through social media and other communication channels of the patient organizations.The health-related quality-of-life scores for adult patients with AD (driven by 2 domains: pain/discomfort and anxiety/depression) were worse than those reported for asthma and type 2 diabetes in previous studies (0.72; 95% CI, 0.65-0.78). Patients and caregivers reported substantial financial impacts even in countries with government-funded health care systems, though the greatest impact was in the United States. In all countries, adults reported better control of symptoms than children, but neither group nor any nationality reported adequate control on average (rescaled mean, 57.5; 95% CI, 56.1-58.9), and control correlated negatively with disease severity. Similarly, satisfaction with treatments, which was moderate across countries on average, was much lower for respondents with more severe disease symptoms (F(3,3165) = 5.5; P.001). Patients who saw a specialist (a dermatologist or an allergist) instead of a general practitioner for AD care indicated better long-term control of symptoms (by 4 points on average on the 100-point scale; 95% CI, 2.6-5.4; P.001). Finally, self-management training and shared decision making were uncommonly reported by patients in all countries except by respondents from the United States, but both were associated with better long-term control of symptoms and higher satisfaction.The burden of AD, evaluated as health-related quality-of-life detriments, financial impacts, and uncontrolled symptoms, is significant and highest for patients with more severe atopic dermatitis who report greater challenges in achieving symptom resolution with existing treatments and approaches to care. The better outcomes associated with respondents who saw specialists suggest that patients, especially those with more severe AD, might benefit from medical care that is guided by providers with more in-depth knowledge of this complex condition. Finally, wider use of patient-centered care practices (specifically, self-management training and shared decision making) could improve outcomes and boost satisfaction with treatments for AD, though more research on this topic is warranted.

Reviewer Acknowledgements for International Journal of Statistics and Probability, Vol. 12, No. 1

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections were rising during early summer 2021 in many countries as a result of the Delta variant. We assessed reverse transcription polymerase chain reaction swab positivity in the Real-time Assessment of Community Transmission–1 (REACT-1) study in England. During June and July 2021, we observed sustained exponential growth with an average doubling time of 25 days, driven by complete replacement of the Alpha variant by Delta and by high prevalence at younger, less-vaccinated ages. Prevalence among unvaccinated people [1.21% (95% credible interval 1.03%, 1.41%)] was three times that among double-vaccinated people [0.40% (95% credible interval 0.34%, 0.48%)]. However, after adjusting for age and other variables, vaccine effectiveness for double-vaccinated people was estimated at between ~50% and ~60% during this period in England. Increased social mixing in the presence of Delta had the potential to generate sustained growth in infections, even at high levels of vaccination.

PurposeTo identify which patient-reported outcomes (PROs) may be most improved through adaptive radiation therapy (ART) with the goal of reducing toxicity incidence among head and neck cancer patients.MethodsOne hundred fifty-five head and neck cancer patients receiving radical VMAT (chemo)radiotherapy (66-70 Gy in 30-35 fractions) completed the MD Anderson Symptom Inventory, MD Anderson Dysphagia Inventory (MDADI), and Xerostomia Questionnaire while attending routine follow-up clinics between June-October 2019. Hierarchical clustering characterized symptom endorsement. Conventional statistical approaches indicated associations between dose and commonly reported symptoms. These associations, and the potential benefit of interfractional dose corrections, were further explored via logistic regression.ResultsRadiotherapy-related symptoms were commonly reported (dry mouth, difficulty swallowing/chewing). Clustering identified three patient subgroups reporting: none/mild symptoms for most items (60.6% of patients); moderate/severe symptoms affecting some aspects of general well-being (32.9%); and moderate/severe symptom reporting for most items (6.5%). Clusters of PRO items broadly consisted of acute toxicities, general well-being, and head and neck-specific symptoms (xerostomia, dysphagia). Dose-PRO relationships were strongest between delivered pharyngeal constrictor Dmean and patient-reported dysphagia, with MDADI composite scores (mean ± SD) of 25.7 ± 18.9 for patients with Dmean vs. 32.4 ± 17.1 with Dmean ≥50 Gy. Based on logistic regression models, during-treatment dose corrections back to planned values may confer ≥5% decrease in the absolute risk of self-reported physical dysphagia symptoms ≥1 year post-treatment in 1.2% of patients, with a ≥5% decrease in relative risk in 23.3% of patients.ConclusionsPatient-reported dysphagia symptoms are strongly associated with delivered dose to the pharyngeal constrictor. Dysphagia-focused ART may provide the greatest toxicity benefit to head and neck cancer patients, and represent a potential new direction for ART, given that the existing ART literature has focused almost exclusively on xerostomia reduction.

Reviewer Acknowledgements for International Journal of Statistics and Probability, Vol. 11, No. 6

Background Atopic dermatitis is a pruritic chronic condition associated with significant sleep disturbance, inattention, and sometimes behavioral problems. Enhancing resiliency in children with atopic dermatitis may promote coping strategies to improve quality of life. Positive psychology is one strategy that can be used to strengthen resiliency. Objective Our objective was to identify positive psychology concepts mentioned by children with atopic dermatitis and their parent to inform strategies to strengthen resiliency in children with atopic dermatitis. Methods A total of 20 patient-parent dyads were interviewed to share their experience with atopic dermatitis to help develop a novel psychologic intervention for atopic dermatitis. Patients were 8 to 17 years old and diagnosed with atopic dermatitis. Trained coders analyzed transcripts using a coding dictionary developed based on Seligman’s PERMA (positive emotion, engagement, relationships, meaning, and accomplishment) model of positive psychology. The frequency of unprompted mentions of PERMA themes and relevant quotations was captured. Transcripts were also separately coded for resiliency, which is the ultimate goal of PERMA. Results Positive psychology concepts were mentioned by 100% (20/20) of children and 95% (19/20) of parents. Engagement and relationships, both negative and positive aspects, were the most common unprompted PERMA themes mentioned by children (14/20, 70%) and parents (13/20, 65%). Emotion elicited the most negative comments from children (19/20, 95%) and parents (17/20, 85%). When analyzed for resiliency, 8 participants were identified with at least one resiliency code. On average, participants with a resiliency code mentioned PERMA concepts 9.1 (SD 4.7) times compared to those who mentioned none (mean 5.9, SD 4.6) (P=.14). When participants were stratified by disease severity, on average, more positive psychology concepts were mentioned by patients with mild atopic dermatitis (mean 13, SD 3.0) than those with moderate symptoms (mean 6.2, SD 4.9) or severe symptoms (mean 6.1, SD 4.0) (P=.03). Conclusions Among PERMA themes, engagement and relationships are the two most commonly mentioned categories for children with atopic dermatitis. Strategies targeting PERMA such as affirmations and positive reframing may improve psychosocial well-being and resiliency in pediatric atopic dermatitis. Future directions will look at incorporating “positive medicine” into atopic dermatitis treatment to not only relieve symptoms but also strengthen positive aspects of life.

Reviewer Acknowledgements for International Journal of Statistics and Probability, Vol. 11, No. 5