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Pain-related stoicism and cautiousness are theorized to be more prevalent in older than younger patients and to lead to greater pain under-reporting and consequently inadequate pain management in older patients. The Pain Attitudes Questionnaire-Revised (PAQ-R), which measures 5 pain-related stoicism (fortitude, concealment, superiority) and cautiousness (self-doubt, reluctance) factors in chronic pain, can help test this hypothesis in advanced cancer but requires validation. We conducted a psychometric evaluation of the PAQ-R in 155 younger (younger than 60 years) and 114 older (aged 60 years and older) patients with advanced cancer. Participants showed disagreement with self-doubt items and floor effects with the subscale. Confirmatory factor analyses revealed good fit of the PAQ-R's 5 factors to younger and older groups' data but collinearity between fortitude and concealment. Multisample confirmatory factor analyses supported partial scalar invariance between age groups. Few hypothesized age-related differences were observed. Younger patients reported higher superiority scores than older patients. Whereas older patients showed greater fortitude and superiority with lower average pain intensity, younger patients showed greater concealment or fortitude with greater worst and average pain intensity. Furthermore, whereas older patients displayed greater superiority with lower interference in relations with others, younger patients displayed greater concealment and superiority with greater interference in walking ability and greater concealment and self-doubt with more interference in relations with others. Cross-validation of the PAQ-R's factor structure and identification of pathways to the factors and effect on pain-related outcomes using multivariate approaches are warranted. Perspective This article presents the psychometric properties of a measure of 2 particular pain-related attitudes. The measure can help clarify whether these attitudes adversely influence pain reporting in older patients with advanced cancer as hypothesized and, in turn, explain the inadequate pain management frequently reported with this clinical group.

The present study was undertaken to evaluate the individual and combined effects of oxygen concentration and diet composition on the growth, nutrient utilization and intestinal morphology of Nile tilapia (Oreochromis niloticus). Two recirculating aquaculture systems were used to create the difference in oxygen concentration: normoxia (6.9 mg·L− 1) and hypoxia (3.5 mg·L− 1). Two diets were formulated using a different soybean meal (SBM) content to create a contrast in the potential to affect the gut barrier function. Triplicate groups of 35 fish with initial mean body weight of 23 g were fed “Control” diet containing 20% fish meal and “Test” diet containing only plant protein source at normoxia and hypoxia for 8 weeks. Six fish per treatment were sampled for intestinal morphological analysis at the end of week 1, 4 and 8. The proximal, middle and distal intestine were processed for quantitative histology, in order to count goblet cells (GC) and eosinophilic granulocytes (EG); and to measure the thickness of lamina propria (LP) and sub-epithelial mucosa (SM). The study showed that growth was best in the “Control” diet under normoxia, while no interaction between oxygen and diet composition was found. Hypoxia reduced nutrient digestibility significantly (p < 0.05). For the “Test” diet, the decline in digestibility was larger than for “Control” diet over time. Both diet composition and oxygen level induced changes in intestinal morphology of Nile tilapia. We observed a thickening of the LP and SM caused by an increased infiltration of inflammatory cells, and an increased number of GC and EG among the enterocytes. The negative effect of increased soybean meal on intestinal morphology was enhanced at low oxygen level and aggravated in time. The SBM enteritis-like symptoms were more pronounced in the proximal than in the distal intestine of Nile tilapia.

Age differences are not evident in pain-related stoicism and cautiousness in people with cancer pain. Little is known about the factors associated with these pain-related attitudes or age-related patterns in these associations. The present cross-sectional study investigated the biopsychosocial correlates of the attitudes in younger and older patients with advanced cancer. Pain-related stoicism (fortitude, concealment, superiority) and cautiousness (self-doubt, reluctance) were assessed using the Pain Attitudes Questionnaire-Revised (PAQ-R). Participants, 155 younger (younger than 60 years old) and 114 older (60 years old or older) patients with advanced cancer completed the PAQ-R and measures of sociodemographic and medical characteristics, pain intensity, cognitive-affective pain-related responses, physical functioning, psychological distress and well-being, and psychosocial functioning. Backwards regression analyses identified correlates for each PAQ-R factor separately for younger and older patients. Activity engagement was a frequent correlate, but its relationship with concealment was the only association common to both age groups. Younger and older patients exhibited different avoidance-related constructs suggesting relational challenges in the former group (avoidant attachment) and intrapersonal fear in the latter (cognitive avoidance). Medical correlates also showed age differences: younger patients showed symptom-focused correlates, whereas older patients showed aging-related correlates. Findings support a biopsychosocial framework of cancer-pain adaptation incorporating a lifespan-developmental perspective. Perspective To our knowledge, this article is the first to identify biopsychosocial correlates of stoic and cautious attitudes toward cancer pain in younger and older patients with advanced cancer. Findings highlight possible age-related motivations for greater pain-related stoicism or cautiousness and can potentially inform interventions addressing challenges in cancer-pain adaptation in advanced cancer.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Gentamicin pharmacokinetics show wide inter-individual variability across all age groups and impaired gentamicin clearance is associated with impaired creatinine clearance in older people. • Changes in body composition and renal function with old age and frailty are likely to affect the pharmacokinetics of gentamicin. • There is current debate on whether the Modification of Diet in Renal Disease (MDRD) equation estimate of glomerular filtration rate (GFR) should replace the Cockcroft Gault equation estimate of creatinine clearance for calculation of doses of renally excreted drugs. WHAT THIS STUDY ADDS • The volume of distribution of gentamicin is not significantly lower in frail than in non frail older people. • The correlation between volume of distribution of gentamicin and actual bodyweight is poor in frail and moderate in non frail older people. • Gentamicin clearance is significantly lower in frail than in non frail older people. • The Cockcroft Gault calculation of creatinine clearance, calculated using ideal bodyweight, gave the best estimate of gentamicin clearance in this population of frail and non frail older people. • The MDRD estimate of GFR and Cockcroft Gault estimate of creatinine clearance, calculated using actual bodyweight, overestimate gentamicin clearance in frail and non frail older people. AIMS Frailty, a syndrome of decreased physiological reserve that is prevalent in old age, impacts on clinical pharmacology. The aims of the study were to (1) determine whether frailty affects the pharmacokinetics of gentamicin and (2) assess the accuracy of different estimates of body size and renal clearance as estimates of gentamicin pharmacokinetics in older inpatients. METHODS This was an observational study of gentamicin pharmacokinetics in a cohort of Australian hospital inpatients aged ≥65 years, who were administered prophylactic intravenous gentamicin. RESULTS Of the 31 participants, 14 were frail and 17 non frail on the Reported Edmonton Frail Scale. The mean volume of distribution of gentamicin was 14.8 ± 1.4 l in frail participants and 15.3 ± 2.2 l in non frail (NS). Volume of distribution correlated best with lean bodyweight. Gentamicin clearance was significantly lower in frail participants (46.6 ± 10.7 ml min−1) than in non frail (58.2 ± 12.4 ml min−1, P= 0.01). The Cockcroft Gault estimate of creatinine clearance calculated using ideal bodyweight gave the best estimate of gentamicin clearance (mean error – 0.15 ml min−1, 95% CI −2.67, 2.39). The Cockcroft Gault creatinine clearance calculated using actual bodyweight and the estimated glomerular filtration rate from the modified diet in renal disease equation overestimated gentamicin clearance, with mean errors of −10.15 ml min−1 (95%CI −13.60, −6.71) and −18.86 ml min−1 (95% CI −22.45, −15.27), respectively. The Cockcroft Gault creatinine clearance calculated using lean bodyweight underestimated gentamicin clearance (mean error 6.54 ml min−1, 95% CI 4.18, 8.90). CONCLUSIONS Frail older people have significantly lower gentamicin clearance than non frail. The best estimate of gentamicin clearance is obtained from the Cockcroft Gault creatinine clearance calculated using ideal bodyweight.

A variety of lasers are used for many oral soft tissue procedures. Each dental laser has specific parameters giving a wide range of operation. Lasers such as the carbon dioxide, argon and diode operate in continuous wave, while Nd:YAG, Er:YAG, Ho:YAG, and Er,Cr:YSGG are free-running pulsed lasers with high peak power and very short pulse duration. Laser tissue interaction is basically a photothermal effect and the biologic effect is dependent on the laser operating parameters, such as emission wavelength, power, emission mode, pulse duration, energy/pulse, energy density, duration of exposure, total energy and tissue characteristics. This article reviews current knowledge of laser parameters, laser-tissue interaction and applied preclinical and clinical safety and effectiveness scientific support.