Communication and activation in pain to enhance relationships and treat pain with equity (COOPERATE): a randomized clinical trial.

ABSTRACT: Racialized disparities in chronic pain care are well-documented and persist despite national priorities focused on health equity. Similar disparities have been observed in patient activation (ie, having the knowledge, confidence, and skills to manage one's health). As such, interventions targeting patient activation represent a novel approach to addressing and reducing disparities in pain care. Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity is a randomized controlled trial of a 6-session telephone-delivered intervention to increase patient activation for Black patients with chronic pain. Two hundred fifty Black patients from a Midwestern Veterans Affairs medical center were randomized to the intervention or attention control. The primary outcome was patient activation; secondary outcomes included communication self-efficacy, pain, and psychological functioning. Outcomes were assessed at baseline and at 3 (primary endpoint), 6, and 9 months (sustained effects). Analyses used an intent-to-treat approach. Compared with baseline, patient activation increased 4.6 points at 3 months (versus +0.13 in control group, 95% CI: 0.48, 7.34; P = 0.03). These improvements in the intervention group were sustained, with +7 from baseline at 6 months and +5.77 at 9 months, and remained statistically significant from the control group. Communication self-efficacy increased significantly relative to the control group from baseline to 3 months. Pain intensity and interference improved at 3 months, but differences were not significant after adjusting for multiple comparisons. Most other secondary outcomes improved, but group differences were not statistically significant after controlling for multiple comparisons. Results suggest that increasing patient activation is a potentially fruitful path toward improving pain management and achieving health equity.

Development of Essential Oil-Loaded Polymeric Nanocapsules as Skin Delivery Systems: Biophysical Parameters and Dermatokinetics Ex Vivo Evaluation.

Essential oils (EOs) are natural antioxidant alternatives that reduce skin damage. However, EOs are highly volatile; therefore, their nanoencapsulation represents a feasible alternative to increase their stability and favor their residence time on the skin to guarantee their effect. In this study, EOs of Rosmarinus officinalis and Lavandula dentata were nanoencapsulated and evaluated as skin delivery systems with potential antioxidant activity. The EOs were characterized and incorporated into polymeric nanocapsules (NC-EOs) using nanoprecipitation. The antioxidant activity was evaluated using the ferric thiocyanate method. The ex vivo effects on pig skin were evaluated based on biophysical parameters using bioengineering techniques. An ex vivo dermatokinetic evaluation on pig skin was performed using modified Franz cells and the tape-stripping technique. The results showed that the EOs had good antioxidant activity (>65%), which was maintained after nanoencapsulation and purification. The nanoencapsulation of the EOs favored its deposition in the stratum corneum compared to free EOs; the highest deposition rate was obtained for 1,8-cineole, a major component of L. dentata, at 1 h contact time, compared to R. officinalis with a major deposition of the camphor component. In conclusion, NC-EOs can be used as an alternative antioxidant for skin care.

Texting is caring: a content analysis of clinical text messages by hospitalists.

BACKGROUND: Clinical texting systems (CTS) are widely used in hospitals for team communication about patients. With more institutions adopting such systems, there is a need to understand how texting is being used in clinical practice. METHODS: We conducted content analysis of 809 randomly selected message threads sent to and from hospitalists in a 9-month window. The process, purpose and content of messages were analysed. We also examined messages for personal content (to identify whether CTS was being used for professional matters) and discussion of near miss errors. The risk levels of these near misses were also assessed. RESULTS: Most messages focused on clinical management of patient needs (62%; n=498) and functioned to provide a notification or update regarding clinical care (64%; n=518) or make a request of the recipient (63%; n=510). Personal content was infrequent in message threads (10%; n=80). Five per cent (n=38) of message threads included discussion of a near miss, and most near misses posed low clinical risk overall (66%; n=25). CONCLUSION: Most CTS communication centred around direct clinical management. Fewer messages were focused on non-clinical areas such as administrative tasks or personal communication. Further examination of care delivery, error communication and the consequences of the care discussed in messages would help clinical leaders understand the impact of clinical texting on teamwork and quality of care.

Modulating the interaction of graphenic substrates with human interleukin-6 and its monoclonal antibody: a study by Raman images.

Interleukin-6 (IL-6) is a cytokine with wide-ranging biological effects, playing an important role on the immune system and inflammatory responses. Therefore, it is important to develop alternative, highly sensitive and reliable analytical methodologies for the accurate detection of this biomarker in biological fluids. Graphene substrates (GS), such as pristine graphene (G), graphene oxide (GO), and reduced graphene oxide (rGO), have shown great benefits for biosensing and in the development of novel biosensor devices. In this work, we present a proof of concept for the development of a new analytical platform for the specific recognition of human interleukin-6, that is based on the coffee-ring formation of monoclonal antibodies of interleukin-6 (mabIL-6) onto amine functionalized GS. The prepared GS/mabIL-6/IL-6 systems were successfully used to show that IL-6 was specifically and selectively adsorbed onto the area of the mabIL-6 coffee-ring. Raman imaging was confirmed as a versatile tool to investigate different antigen-antibody interactions and their surface distribution. This experimental approach can be used to develop a wide variety of substrates for antigen-antibody interaction allowing the specific detection of an analyte in a complex matrix.

Presence of Human Papillomavirus DNA in Malignant Neoplasia and Non-Malignant Breast Disease.

Breast cancer is the leading cause of cancer death among women worldwide. Multiple extrinsic and intrinsic factors are associated with this disease's development. Various research groups worldwide have reported the presence of human papillomavirus (HPV) DNA in samples of malignant breast tumors. Although its role in mammary carcinogenesis is not fully understood, it is known that the HPV genome, once inserted into host cells, has oncogenic capabilities. The present study aimed to detect the presence of HPV DNA in 116 breast tissue biopsies and classify them according to their histology. It was found that 50.9% of the breast biopsies analyzed were malignant neoplasms, of which 74.6% were histologically classified as infiltrating ductal carcinoma. In biopsies with non-malignant breast disease, fibroadenoma was the most common benign neoplasm (39.1%). Detection of HPV DNA was performed through nested PCR using the external primer MY09/11 and the internal primer GP5+/6+. A hybridization assay genotyped HPV. HPV DNA was identified in 20.3% (12/59) of malignant neoplasms and 35% non-malignant breast disease (16/46). It was also detected in 27.3% (3/11) of breast tissue biopsies without alteration. However, there are no statistically significant differences between these groups and the existence of HPV DNA (p = 0.2521). Its presence was more frequent in non-malignant alterations than in malignant neoplasias. The most frequent genotypes in the HPV-positive samples were low-risk (LR) HPV-42 followed by high-risk (HR) HPV-31.

Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity (COOPERATE): Rationale, study design, methods, and sample characteristics.

BACKGROUND: Chronic pain is associated with profound negative effects, and racial disparities are well-documented in chronic pain treatment. In addition, Black patients report poorer communication with providers and exhibit lower levels of patient activation (self-management self-efficacy) than White patients. Although the causes of healthcare disparities are complex and require intervention at multiple levels, empowering patients is one critical path to achieving health equity. The current study is a coaching intervention focused on increasing patient activation and building communication skills for Black patients with chronic pain. METHODS: In this randomized controlled trial, 250 Black patients with chronic pain were randomized to either the coaching intervention or an attention control arm. Intervention patients attended 6 telephone-delivered individual coaching sessions over 12 weeks. Coaching focused on clarifying and prioritizing goals and on communication skills, such as agenda setting. The primary outcome is patient activation. Secondary outcomes include communication self-efficacy, pain intensity and interference, and psychological functioning. DISCUSSION: Having the knowledge and confidence to participate in one's pain care, coupled with the skills needed to effectively communicate with providers, is essential to optimize chronic pain care. This is particularly important for Black patients who often experience lower quality pain care. Interventions such as COOPERATE hold promise for helping patients to acquire the requisite tools to take greater control of their chronic pain care. TRIAL REGISTRATION: clinicaltrials.gov, # NCT03562793.

Platelet Membrane: An Outstanding Factor in Cancer Metastasis.

In addition to being biological barriers where the internalization or release of biomolecules is decided, cell membranes are contact structures between the interior and exterior of the cell. Here, the processes of cell signaling mediated by receptors, ions, hormones, cytokines, enzymes, growth factors, extracellular matrix (ECM), and vesicles begin. They triggering several responses from the cell membrane that include rearranging its components according to the immediate needs of the cell, for example, in the membrane of platelets, the formation of filopodia and lamellipodia as a tissue repair response. In cancer, the cancer cells must adapt to the new tumor microenvironment (TME) and acquire capacities in the cell membrane to transform their shape, such as in the case of epithelial-mesenchymal transition (EMT) in the metastatic process. The cancer cells must also attract allies in this challenging process, such as platelets, fibroblasts associated with cancer (CAF), stromal cells, adipocytes, and the extracellular matrix itself, which limits tumor growth. The platelets are enucleated cells with fairly interesting growth factors, proangiogenic factors, cytokines, mRNA, and proteins, which support the development of a tumor microenvironment and support the metastatic process. This review will discuss the different actions that platelet membranes and cancer cell membranes carry out during their relationship in the tumor microenvironment and metastasis.

Understanding Cervical Cancer through Proteomics.

Cancer is one of the leading public health issues worldwide, and the number of cancer patients increases every day. Particularly, cervical cancer (CC) is still the second leading cause of cancer death in women from developing countries. Thus, it is essential to deepen our knowledge about the molecular pathogenesis of CC and propose new therapeutic targets and new methods to diagnose this disease in its early stages. Differential expression analysis using high-throughput techniques applied to biological samples allows determining the physiological state of normal cells and the changes produced by cancer development. The cluster of differential molecular profiles in the genome, the transcriptome, or the proteome is analyzed in the disease, and it is called the molecular signature of cancer. Proteomic analysis of biological samples of patients with different grades of cervical intraepithelial neoplasia (CIN) and CC has served to elucidate the pathways involved in the development and progression of cancer and identify cervical proteins associated with CC. However, several cervical carcinogenesis mechanisms are still unclear. Detecting pathologies in their earliest stages can significantly improve a patient's survival rate, prognosis, and recurrence. The present review is an update on the proteomic study of CC.

Effects of Cacao By-Products and a Modest Weight Loss Intervention on the Concentration of Serum Triglycerides in Overweight Subjects: Proof of Concept.

Therapeutic approaches to decrease serum triglyceride (TG) concentrations are not successful mainly due to poor adherence or adverse effects of therapies. In consequence, the search for new low-cost and safer therapeutic alternatives is mandatory. Dark chocolate and cacao have shown promising results improving lipid profiles. Recently, using cacao by-products to reduce elevated cardiometabolic risk markers in an animal model of obesity induced by a high-fat diet and fructose, we showed that TGs, low-density lipoprotein cholesterol, and the TG/high-density lipoprotein (HDL) ratio decreased, suggesting that cacao by-products improved the metabolic function of obese animals. Based on these results, as a proof of concept, a blinded placebo-controlled study was implemented to explore the effects of cacao by-products on anthropometric and biochemical variables in a group of overweight subjects participating in a program composed of reduced-calorie-diet counseling plus a simple aerobic exercise plan. The results showed that counseling induced weight and abdominal circumference reductions in both groups. TGs did not change in the control group; however, TG decreased significantly by 54.9 mg/dL (27.9%) in the experimental group. The TG/HDL cholesterol ratio changed markedly (1.5) in the experimental group. The results reported suggest the use of cacao by-products as an alternative for the treatment of hypertriglyceridemia.

Simultaneous GC-FID Quantification of Main Components of Rosmarinus officinalis L. and Lavandula dentata Essential Oils in Polymeric Nanocapsules for Antioxidant Application.

The essential oils (EO) of R. officinalis and L. dentata have been widely used due to their antioxidant activity. However, due to their high volatility, the loading of EO into polymeric nanocapsules (NC) represents an efficient way of retaining their effect in future topical administration. In this way, the quantitative determination of EO incorporated into NC is necessary for simultaneous monitoring of the main components of the EO during the nanoencapsulation process as well as for precise and exact dosing of the components used during the performance of in vitro and in vivo biological tests. In this study, EO were isolated by hydrodistillation in a Clevenger-type apparatus and characterized by GC-MS and GC-FID analyses. The major constituents of EO-R. officinalis were camphor (39.46%) and 1,8-cineole (14.63%), and for EO-L. dentata were 1,8-cineole (68.59%) and ß-pinene (11.53%). A new analytical method based on GC-FID for quantification of free and encapsulated EO was developed and validated according to ICH. Linearity, limit of detection and quantification, and intra- and interday precision parameters were determined. The methods were linear and precise for the quantification of the main components of EO. The EO were encapsulated by nanoprecipitation and were analyzed by the GC-FID method validated for their direct quantification. The NC size was 200 nm with homogeneous size distribution. The quantification of the incorporated EO within a NC is an important step in NC characterization. In this way, an encapsulation efficiency of at least 59.03% and 41.15% of total EO-R. officinalis and EO-L. dentata, respectively, was obtained. Simple, repeatable, and reproducible methods were developed as an analytical tool for the simultaneous quantification of the main components of EO loaded in polymeric nanocapsules as well as their monitoring in biological assays.

Monitoring Backbone Hydrogen-Bond Formation in ß-Barrel Membrane Protein Folding.

ß-barrel membrane proteins are key components of the outer membrane of bacteria, mitochondria and chloroplasts. Their three-dimensional structure is defined by a network of backbone hydrogen bonds between adjacent ß-strands. Here, we employ hydrogen-deuterium (H/D) exchange in combination with NMR spectroscopy and mass spectrometry to monitor backbone hydrogen bond formation during folding of the outer membrane protein X (OmpX) from E. coli in detergent micelles. Residue-specific kinetics of interstrand hydrogen-bond formation were found to be uniform in the entire ß-barrel and synchronized to formation of the tertiary structure. OmpX folding thus propagates via a long-lived conformational ensemble state in which all backbone amide protons exchange with the solvent and engage in hydrogen bonds only transiently. Stable formation of the entire OmpX hydrogen bond network occurs downhill of the rate-limiting transition state and thus appears cooperative on the overall folding time scale.

Síndrome de Desgaste Ocupacional (Burnout) y su Relación con Salud y Riesgo Psicosocial en Funcionarios Públicos que Imparten Justicia en México, D.F. / Occupational Wear Syndrome (Burnout) and its Relationship to Health and Psychosocial Risk in Public Officials who Administer Justice in Mexico City

Los propósitos de este estudio fueron conocer la prevalencia de riesgo psicosocial en importantes funcionarios públicos que imparten justicia en México, D.F., así como identificar la relación entre variables socio-demográficas, desgaste ocupacional (burnout) y trastornos psicosomáticos. Se obtuvo información de 75 trabajadores que imparten justicia en México, D.F. (n=75) mediante la Escala de Desgaste Ocupacional de Uribe-Prado (2010). Los resultados mostraron que el burnout es la mejor variable para pronosticar trastornos psicosomáticos en términos de factores psicosociales en el trabajo; los análisis de este trabajo se discuten en términos de la importancia de conocer el riesgo psicosocial para efectos de prevención, diagnóstico e intervención a partir de la respuesta al estrés crónico. Se utilizaron correlaciones, análisis de varianza, regresiones y un modelo estructural para ajustar las variables en términos estructurales. El alfa de Cronbach para las variables evaluadas se ubico entre .63 y .83 de confiabilidad. Se enfatiza la importancia de que secretarios, jueces y magistrados que imparten justicia desempeñen su trabajo en términos de salud ocupacional.

The purposes of this study were to determine the prevalence of psychosocial risk in major public officials who administer justice in Mexico City, and to identify the relationship between socio-demographic variables, occupational wear (burnout) and psychosomatic disorders. Information of 75 workers who administer justice was obtained in Mexico, DF (n = 75) by the Occupational Scale Wear of Uribe-Prado (2010). The results showed that burnout is the best variable to predict psychosomatic disorders in terms of psychosocial factors at work; analyzes of this study are discussed in terms of the importance of understanding the effects of psychosocial risk prevention, diagnosis and intervention from the response to chronic stress. Correlations, analysis of variance, regressio'ns and a structural model to adjust the variables used in structural terms. Cronbachs alpha for the evaluated variables was located between .63 and .83 reliability. The importance of secretaries, judges and magistrates to administer justice undertake their work in terms of occupational health is emphasized.

Comparison of high-performance liquid chromatographic and thin-layer chromatographic methods for determination of aloin in herbal products containing Aloe vera.

Aloe vera is a medicinal plant used worldwide to treat a variety of conditions and, as such, has important commercial value. Aloin is a principal component of aloe vera leaves and is used for quality control of products containing it. A semiquantitative thin-layer chromatographic (TLC) method for determining the concentration of aloin in aloe-based products was validated. The results were similar to those of a validated high-performance liquid chromatographic method; therefore, TLC, which is a simple, sensitive, specific, rapid, and cheap method, may be ideal for use in any laboratory for routine analysis of commercial products containing aloe vera.