Development and validation of a patient-reported outcome measure for systemic sclerosis: the EULAR Systemic Sclerosis Impact of Disease (ScleroID) questionnaire

OBJECTIVES: Patient-reported outcome measures (PROMs) are important for clinical practice and research. Given the high unmet need, our aim was to develop a comprehensive PROM for systemic sclerosis (SSc), jointly with patient experts. METHODS: This European Alliance of Associations for Rheumatology (EULAR)-endorsed project involved 11 European SSc centres. Relevant health dimensions were chosen and prioritised by patients. The resulting Systemic Sclerosis Impact of Disease (ScleroID) questionnaire was subsequently weighted and validated by Outcome Measures in Rheumatology criteria in an observational cohort study, cross-sectionally and longitudinally. As comparators, SSc-Health Assessment Questionnaire (HAQ), EuroQol Five Dimensional (EQ-5D), Short Form-36 (SF-36) were included. RESULTS: Initially, 17 health dimensions were selected and prioritised. The top 10 health dimensions were selected for the ScleroID questionnaire. Importantly, Raynaud's phenomenon, impaired hand function, pain and fatigue had the highest patient-reported disease impact. The validation cohort study included 472 patients with a baseline visit, from which 109 had a test-retest reliability visit and 113 had a follow-up visit (85% female, 38% diffuse SSc, mean age 58 years, mean disease duration 9 years). The total ScleroID score showed strong Pearson correlation coefficients with comparators (SSc-HAQ, 0.73; Patient's global assessment, Visual Analogue Scale 0.77; HAQ-Disability Index, 0.62; SF-36 physical score, -0.62; each p<0.001). The internal consistency was strong: Cronbach's alpha was 0.87, similar to SSc-HAQ (0.88) and higher than EQ-5D (0.77). The ScleroID had excellent reliability and good sensitivity to change, superior to all comparators (intraclass correlation coefficient 0.84; standardised response mean 0.57). CONCLUSIONS: We have developed and validated the EULAR ScleroID, which is a novel, brief, disease-specific, patient-derived, disease impact PROM, suitable for research and clinical use in SSc

Graphene -- Based Nanocomposites as Highly Efficient Thermal Interface Materials

We found that an optimized mixture of graphene and multilayer graphene - produced by the high-yield inexpensive liquid-phase-exfoliation technique - can lead to an extremely strong enhancement of the cross-plane thermal conductivity K of the composite. The "laser flash" measurements revealed a record-high enhancement of K by 2300 % in the graphene-based polymer at the filler loading fraction f =10 vol. %. It was determined that a relatively high concentration of single-layer and bilayer graphene flakes (~10-15%) present simultaneously with thicker multilayers of large lateral size (~ 1 micrometer) were essential for the observed unusual K enhancement. The thermal conductivity of a commercial thermal grease was increased from an initial value of ~5.8 W/mK to K=14 W/mK at the small loading f=2%, which preserved all mechanical properties of the hybrid. Our modeling results suggest that graphene - multilayer graphene nanocomposite used as the thermal interface material outperforms those with carbon nanotubes or metal nanoparticles owing to graphene's aspect ratio and lower Kapitza resistance at the graphene - matrix interface.Comment: 4 figure

Psychobiological Protective Factors Modifying the Association Between Age and Sexual Health in Men: Findings From the Men’s Health 40+ Study

Sexual health severely decreases with age. For males older than 40 years, erectile dysfunction (ED) is the most common sexual disorder. Although physical and psychological risk factors for ED have been identified, protective factors are yet to be determined. To date, no study has examined endocrine and psychosocial factors in parallel with regard to their modifying effect on the age-related increase in ED. Two hundred and seventy-one self-reporting healthy men aged between 40 and 75 years provided both psychometric data on sexual function and a set of potential psychosocial protective factors, and saliva samples for the analysis of steroid hormones and proinflammatory cytokines. Around 35% of the participants reported at least a mild form of ED. Direct associations with ED were identified for perceived general health, emotional support, relationship quality, intimacy motivation but not for steroid hormones or proinflammatory markers. Moderation analyses for the association between age and ED revealed positive effects for testosterone (T), dehydroepiandrosterone (DHEA), perceived general health, emotional support, intimacy motivation, and a negative effect for interleukin-6 (all p .17). Group differences between older men with and without ED emerged for T, DHEA, and psychometric measures such as perceived general health, emotional support, satisfaction with life, and intimacy motivation (all p .3). Both psychosocial and endocrine parameters moderated the association between age and sexual health. Perceived general health, emotional support, intimacy motivation, and relationship quality emerged as psychosocial protective factors against ED. Higher T and DHEA and lower interleukin-6 levels also buffered against an age-related increase in ED

A Comparison of Buprenorphine + Naloxone to Buprenorphine and Methadone in the Treatment of Opioid Dependence during Pregnancy: Maternal and Neonatal Outcomes

Given that buprenorphine + naloxone is prescribed for opioid-dependent pregnant women, it is important to examine the extent to which it differs from buprenorphine alone, methadone, or methadone-assisted withdrawal on neonatal and maternal outcomes. Summary statistics on maternal and neonatal outcomes were collected from 7 previously published studies examining treatment for opioid-dependent pregnant women that represented a range of research methodologies. Outcomes from these studies were compared to the same outcomes for 10 women treated with the combined buprenorphine + naloxone product. There were no significant differences in maternal outcomes for buprenorphine + naloxone compared to buprenorphine, methadone, or methadone-assisted withdrawal. Preliminary findings suggest no significant adverse maternal or neonatal outcomes related to the use of buprenorphine + naloxone for the treatment of opioid dependence during pregnancy. However, further research should examine possible differences between buprenorphine + naloxone and buprenorphine alone or methadone in fetal physical development

Graphite nanoplatelet/rubbery epoxy composites as adhesives and pads for thermal interface applications

Composites of graphite nanoplatelets (GNPs) and rubbery epoxy (RE) resins as adhesives and pads are evaluated as thermal interface materials (TIM). GNP-15 and GNP-5 (15 and 5 µm across, respectively) were loaded in RE by 3-roll milling to produce GNP/RE composites. The role of composite processing techniques on the texture, thermal and electrical conductivities and compression properties of composites was studied and compared. Scanning electron microscopy revealed uniform dispersion of GNPs in RE, regardless of loading and X-ray diffraction texture measurement showed less platelet alignment in the composites at low loadings. Thermal conductivities of 20 wt% GNP-15/RE (3.29 W/m K) and 35 wt% GNP-5/RE composite (2.36 W/m K) were both significantly higher than pure RE (0.17 W/m K). GNP/RE retained good compliance, compressive moduli at 20 wt% loading being comparable to commercial BN/silicone TIM. Although thermal contact resistance of GNP/RE was higher than for commercial paste, its interfacial thermal transport outperformed GNP/silicone (due to RE’s strongly adhesive nature) and, across thick bond lines, outperformed reported GNP-pastes. The 20 wt% GNP-15/RE thermal pad had significantly lower thermal contact resistance than other GNP/RE pads. This decreased with increasing applied pressure, being comparable to commercial BN/silicone pad. GNP/RE composites are thus promising candidates for thermal interface adhesives and pads