Validity and internal consistency of four scales in patients with TMD: PHQ8, GAD7, PHQ15 and JFLS20

OBJECTIVES: The aim of this cross-sectional study was to explore the structural validity and internal consistency reliability of General Anxiety Disorder-7, Patient Health Questionnaire-8, 15 and Jaw Functional Limitation Scale-20 in patients with chronic pain of temporomandibular disorders. MATERIALS AND METHODS: Validity and reliability were assessed in 129 patients diagnosed according to the diagnostic criteria for temporomandibular disorders. Structural validity was explored using factor analysis, and internal consistency by calculating Cronbach α. RESULTS: Confirmatory factor analysis revealed a suitable 2-factor model for Patient Health Questionnaire-8, with Cronbach α of 0.89, and 0.86. One and 2-factor models were suitable for General Anxiety Disorder-7, with overall Cronbach α of 0.93 for the 1-factor model, and 0.91 and 0.84 for both factors in a 2-factor model. A 4-factor solution was appropriate for Patient Health Questionnaire-15, with Cronbach α of 0.72, 0.57, 0.71 and 0.73 for each factor separately. Exploratory factor analysis was conducted to explore the factor structure of Jaw Functional Limitation Scale 20, and a 3-factor solution was appropriate. CONCLUSIONS: This study provides positive evidence of structural validity and internal consistency of these questionnaires in patients with pain of temporomandibular disorders. However, additional testing is required to explore further psychometric properties

A meta-synthesis of qualitative data exploring the experience of living with temporomandibular disorders: The patients' voice

Objective: The aim of this review was to systematically review the qualitative evidence related to the experience of patients with temporomandibular disorder (TMD) and to explore the effect it has on their lives. Materials and methods: The following databases were searched systemically: Medline, Embase, PsycINFO, Web of Science, CINAHL Complete and the Cochrane database. Thematic synthesis was used to analyse and synthesise the data from the qualitative studies which explored the experience of adult patients with TMD. The Critical Appraisal Skills Programme (CASP) tool was used to critically appraise the quality of the included studies. Results: The search strategies yielded 3588 articles across all databases. A total of 20 articles were eventually included. Six themes were derived: TMD causes uncertainty and doubt, TMD had disruptive effects on life, TMD causes distress, understanding TMD—the illness and the causes, dealing with the pain and aims and hopes. Conclusion: The findings highlight the impact TMD could have on the quality of life and confirms the psychological and social challenges these patients experience

A Flow Induced Autoimmune Response and Accelerated Senescence of Red Blood Cells in Cardiovascular Devices

Red blood cells (RBCs) passing through heart pumps, prosthetic heart valves and other cardiovascular devices undergo early senescence attributed to non-physiologic forces. We hypothesized that mechanical trauma accelerates aging by deformation of membrane proteins to cause binding of naturally occurring IgG. RBCs isolated from blood of healthy volunteers were exposed to high shear stress in a viscometer or microfluidics channel to mimic mechanical trauma and then incubated with autologous plasma. Increased binding of IgG was observed indicating forces caused conformational changes in a membrane protein exposing an epitope(s), probably the senescent cell antigen of band 3. The binding of immunoglobulin suggests it plays a role in the premature sequestration and phagocytosis of RBCs in the spleen. Measurement of IgG holds promise as a marker foreshadowing complications in cardiovascular patients and as a means to improve the design of medical devices in which RBCs are susceptible to sublethal trauma.Research in this publication was supported by the National Institutes of Health Small Business Innovation Research program under award number R44HL114246 as a subcontract to the University of Oklahoma from VADovations and NIH grant R21HL132286 to DWS and TAS. Open Access fees paid for in whole or in part by the University of Oklahoma Libraries.Ye

Hemodynamic-based Assessment and Management of Cardiogenic Shock

Cardiogenic shock (CS) remains a deadly disease entity challenging patients, caregivers, and communities across the globe. CS can rapidly lead to the development of hypoperfusion and end-organ dysfunction, transforming a predictable hemodynamic event into a potential high-resource, intense, hemometabolic clinical catastrophe. Based on the scalable heterogeneity from a cellular level to healthcare systems in the hemodynamic-based management of patients experiencing CS, we present considerations towards systematic hemodynamic-based transitions in which distinct clinical entities share the common path of early identification and rapid transitions through an adaptive longitudinal situational awareness model of care that influences specific management considerations. Future studies are needed to best understand optimal management of drugs and devices along with engagement of health systems of care for patients with CS

Development of optimal strategies for water harvesting and utilization in arid lands, Jordan

In IDL-987

Effect of rainfall intensity, slope, land use and antecedent soil moisture on soil erosion in an arid environment

Most climate change scenarios predict a significant increase in the frequency of high intensity rainfall events especially in the dry areas, which will increase runoff and soil erosion. Understanding the factors that control soil erosion is crucial to recommending appropriate measures to protect soils and reduce their vulnerability. The objective of this research was to investigate the effect of rainfall intensity, slope, land use and antecedent soil moisture on soil erosion and runoff. Twelve sites from Al-Muwaqqar watershed, Jordan, were selected to represent six slope angles: 1, 2, 3, 5, 7 and 9%. Two sites, one cultivated with barley and one as rangeland, were selected within each slope. Erosion was measured under three rainfall intensities: 3, 5 and 10 mm h−1; and three different antecedent soil moisture contents: dry, wet and very wet; using a rotating disk rainfall simulator. Regression equations indicated that rainfall intensity was the most important factor affecting soil erosion and that erosion could occur at a relatively small intensity on wet soils as a result of subsequent rainfall events. Soil erosion on cultivated land was primarily affected by moisture content, while on uncultivated land, it was mostly affected by slope steepness. Rainfall intensity, slope and antecedent moisture explained 84–89 and 59–66% of the variation in runoff and soil loss, respectively. The results indicated the significant influence of cultivating the land on soil erosio

Development and validation of a Patient Reported Experience Measure (PREM) for patients with Temporomandibular disorders

Temporomandibular disorders are a group of conditions which affect the temporomandibular joint, surrounding muscles or both. They can manifest in an array of symptoms such as persistent pain, joint noises, alteration in mandibular movement and limitation in mouth opening. Patient Reported Experience Measures (PREMs) are validated questionnaires that reflect the patient experience while receiving healthcare and aim to capture the experience of the patients to ascertain whether specific aspects of care have or have not occurred. They can be tailored for use in specific settings and conditions such as mental health, rheumatoid arthritis and Parkinson’s disease. A comprehensive search of the literature revealed that no such instrument exists for patients with TMD or indeed chronic facial pain. The aims of this project were: 1. To explore the experiences of temporomandibular disorder patients with the public healthcare services in England. 2. To develop a Patient Reported Experience Measure (PREM) designed for use in a cohort of patients with pain-related temporomandibular disorders. 3. To evaluate the validity and reliability of the designed instrument. A mixed method study was designed to achieve the outlined aims. A qualitative study was conducted in collaboration with 15 TMD patients to explore their experiences with the NHS when seeking treatment for their symptoms. The arising results helped generate the items of the questionnaire. A subsequent series of interviews with seven patients and six healthcare providers evaluated the suitability, relevance and comprehensibility of the suggested items. The following phase was a quantitative prospective study of 139 patients which investigated the structural validity, internal consistency and test-retest reliability of the new tool. The newly developed questionnaire consisted of 21 items and was based on the NHS patient experience framework. Factor analysis revealed a suitable five-factor structure for the instrument, Cronbach-α was 0.7285 indicating good internal consistency, and interclass correlation coefficient was 0.732 indicating good test-retest reliability. PREM-TMD is a brief measure to evaluate the experience of adult patients with pain related TMD within the healthcare services. It can be useful in service evaluation schemes, audits, and clinical research. The outlined psychometric properties are satisfactory, and hence support its use to evaluate the experience of TMD patients in a valid and reliable manner