Hidden Impact of Molluscum Contagiosum: A Survey of Caregivers’ Experiences with Diagnosis, Treatment, and Impact on Quality of Life

Objective: Molluscum contagiosum (molluscum) is considered benign and self-limiting. However, the caregiver and patient experience largely remains a mystery. This online survey aimed to collect caregivers’ views on their experiences with molluscum infection in their children, including diagnosis, treatment, and the impact of the virus on the caregivers’ and their child’s life. Methods: Parents, caregivers, and/or legal guardians (ages 18+, 20% male and 80% female) of children diagnosed with molluscum in the past 4 years (ages 3-16 years of age) answered a 15-minute paid online survey with questions about their experience with molluscum. Results: Caregivers (n=150) were mostly Caucasian (85%), 25-44 years of age (87%) and had at least one child with active molluscum (75%) at the time of the survey. The average number of health care providers (HCPs) consulted for molluscum was 1.95 and diagnosis was made by a variety of HCP types. The spread of molluscum to ≥ 1 child in the household was reported by 60% of caregivers in multi-child households. The average number of treatments used were 2.36 including HCP-administered treatments and consumer products. Caregivers reported moderate to major impact on their lives (62%) or their child’s life (74%) due to molluscum. Limitations: Questions were not validated, recall time was up to 4 years. Conclusions: Molluscum patients may receive a diagnosis from many sources. Caregivers may utilize more than one treatment modality to help clear the infection including consumer products. Molluscum can cause an impact on quality of life for affected children and their caregivers.

In-vivo-wear in composite and ceramic full mouth rehabilitations over 3 years

The aim of this study was to quantify and to compare the wear rates of premolar (PM) and molar (M) restorations of lithium disilicate ceramic (LS2) and an experimental CAD/CAM polymer (COMP) in cases of complex rehabilitations with changes in vertical dimension of occlusion (VDO). Twelve patients with severe tooth wear underwent prosthetic rehabilitation, restoring the VDO with antagonistic occlusal coverage restorations either out of LS2 (n = 6 patients, n = 16 posterior restorations/patient; N = 96 restorations/year) or COMP (n = 6 patients; n = 16 posterior restorations/patient; N = 96 restorations/year). Data was obtained by digitalization of plaster casts with a laboratory scanner at annual recalls (350 ± 86 days; 755 ± 92 days; 1102 ± 97 days). Each annual recall dataset of premolar and molar restorations (N = 192) was overlaid individually with the corresponding baseline dataset using an iterative best-fit method. Mean vertical loss of the occlusal contact areas (OCAs) was calculated for each restoration and recall time. For LS2 restorations, the mean wear rate per month over 1 year was 7.5 ± 3.4 μm (PM), 7.8 ± 2.0 μm (M), over 2 years 3.8 ± 1.6 µm (PM), 4.4 ± 1.5 µm (M), over 3 years 2.8 ± 1.3 µm (PM), 3.4 ± 1.7 µm (M). For COMP restorations, the mean wear rate per month over 1 year was 15.5 ± 8.9 μm (PM), 28.5 ± 20.2 μm (M), over 2 years 9.2 ± 5.9 µm (PM), 16.7 ± 14.9 µm (M), over 3 years 8.6 ± 5.3 µm (PM), 9.5 ± 8.0 µm (M). Three COMP restorations fractured after two years and therefore were not considered in the 3-year results. The wear rates in the LS2 group showed significant differences between premolars and molars restorations (p = 0.041; p = 0.023; p = 0.045). The wear rates in COMP group differed significantly between premolars and molars only in the first two years (p < 0.0001; p = 0.007). COMP restorations show much higher wear rates compared to LS2. The presented results suggest that with increasing time in situ, the monthly wear rates for both materials decreased over time. On the basis of this limited dataset, both LS2 and COMP restorations show reasonable clinical wear rates after 3 years follow-up. Wear of COMP restorations was higher, however prosthodontic treatment was less invasive. LS2 showed less wear, yet tooth preparation was necessary. Clinicians should balance well between necessary preparation invasiveness and long-term occlusal stability in patients with worn dentitions.

Childhood Trauma in Women and Fragmented Interview Narratives – Some Interdisciplinary Methodological and Clinical Implications

Trauma experience is understood through its expression in language, with implications for psycholinguistic and clinical research and analysis. Clinical research approaches often approach childhood trauma through investigative, semi-structured, retrospective interviews (e.g. Childhood Experience of Care and Abuse, CECA). This facilitates the narration of abuse history for systematic analysis in relation to clinical disorder. Interview techniques assist such history-telling, for example by ‘scaffolding’ the account, aiding memory through chronological questioning, using a factual focus and using probing questions to collect detail and resolve inconsistencies. However, some personal narratives are fragmented, incomplete, contradictory or highly emotional/dissociated from emotion. This can be explained by trauma impacts such as being emotionally frozen (forgetting and avoidance) or overwhelmed (emotional over-remembering) and is termed ‘unresolved trauma’ with links to attachment vulnerability. These narratives can make investigative interview research more challenging but can offer opportunities for secondary psycholinguistic analysis. Illustrative interview quotes from CECA childhood physical and sexual abuse narratives of three women are provided with comment on style of reporting. The women had recurrent trauma experience and later life depression and anxiety. The interview responses are examined in terms of seven characteristics taken from available literature (e.g. incoherent, contradictory, lack recall, time lapses, emotionality, blame and vividness). The concept of unresolved loss is discussed and whether the linguistic characteristics are specific to a trauma or to an individual. Factual investigative interviews and psycholinguistic analysis of narrative may find ways of combining for greater depth of understanding of unresolved trauma, to extend available methods and aid therapy.

Exploiting Long-Term Temporal Cache Access Patterns for LRU Insertion Prioritization

In a CPU cache utilizing least recently used (LRU) replacement, cache sets manage a buffer which orders all cache lines in the set from LRU to most recently used (MRU). When a cache line is brought into cache, it is placed at the MRU and the LRU line is evicted. When re-accessed, a line is promoted to the MRU position. LRU replacement provides a simple heuristic to predict the optimal cache line to evict. However, LRU utilizes only simple, short-term access patterns. In this paper, we propose a method that uses a buffer called the history queue to record longer-term access-eviction patterns than the LRU buffer can capture. Using this information, we make a simple modification to LRU insertion policy such that recently-recalled blocks have priority over others. As lines are evicted, their addresses are recorded in a FIFO history queue. Incoming lines that have recently been evicted and now recalled (those in the history queue at recall time) remain in the MRU for an extended period of time as non-recalled lines entering the cache thereafter are placed below the MRU. We show that the proposed LRU insertion prioritization increases performance in single-threaded and multi-threaded workloads in simulations with simple adjustments to baseline LRU.

Does recall time matter in verbal autopsies? Evidence from urban informal settlements in Nairobi, Kenya

Background: To assign a cause of death to non-medically certified deaths, verbal autopsies (VAs) are widely used to determine the cause of death. The time difference between the death and the VA interview, also referred to as recall time, varies depending on social and operational factors surrounding the death. We investigated the effect of recall time on the assignment of causes of death by VA. Methods: This is a secondary analysis of 2002-2015 survey data of the Nairobi Urban Health Demographic Surveillance System (NUHDSS). The independent variable recall time was derived from the date of death and the date when the VA was conducted. Univariate and multivariate logistic regression methods were used to calculate odds ratios of assigning a cause of death in defined categories of recall time. Results: There were 6218 deaths followed up between 2002 and 2016, out of which 5495 (88.3%) had VAs done. Recall time varied from 1-3001 days (median 92 days, IQR 44-169 days). Majority of the VAs (45.7%) were conducted between 1-3 months after death. The effect of recall time varied for different diseases. Compared to VAs conducted between 1-3 months, there was a 24% higher likelihood of identifying HIV/AIDS as the cause of death for VAs conducted 4-6 months after death (AOR 1.24; 95% CI 1.01-1.54; p-value = 0.043) and a 40% increased chance of identifying other infectious diseases as the cause of death for VAs conducted <1 month after death (AOR 1.4; 95% CI 1.02-1.92, p-value = 0.024). Conclusions: Recall time affected the assignment of VA cause of death for HIV/AIDS, other infectious diseases,maternal/neonatal and indeterminate causes. Our analysis indicates that in the urban informal setting, VAs should be conducted from one month up to 6 months after the death to improve the probability of accurately assigning the cause of death.

Stochastic Behavior of a Two-Unit Parallel System with Dissimilar Units and Optional Vacations under Poisson Shocks

This article examines the impact of some system parameters on an industrial system composed of two dissimilar parallel units with one repairman. The active unit may fail due to essential factors like aging or deteriorating, or exterior phenomena such as Poisson shocks that occur at various time periods. Whenever the value of a shock is larger than the specified threshold of the active unit, the active unit will fail. The article assumes that the repairman has the right to take any of two decisions at the beginning of the system operation: either a takes a vacation if the two units work in a normal way, or stay in the system to monitor the system until the first system failure. In case of having a failure in any of the two units during the absence of the repairman, the failing unit will have to wait until the repairman is called back to work. We suppose that the value of every shock is assumed to be i.i.d. with some known distribution. The length of the repairman’s vacation, repair time, and recall time are arbitrary distributions. Various reliability measures have been calculated by the supplementary variable technique and the Markov’s vector process theory. At last, numerical computation and graphical analysis have been given for a particular case to validate the derived indices.

Enhanced Artificial Intelligence System for Diagnosing and Predicting Breast Cancer Using Deep Learning

Breast cancer is the leading cause of death among women with cancer. Computer-aided diagnosis is an efficient method for assisting medical experts in early diagnosis, improving the chance of recovery. Employing artificial intelligence (AI) in the medical area is very crucial due to the sensitivity of this field. This means that the low accuracy of the classification methods used for cancer detection is a critical issue. This problem is accentuated when it comes to blurry mammogram images. In this paper, convolutional neural networks (CNNs) are employed to present the traditional convolutional neural network (TCNN) and supported convolutional neural network (SCNN) approaches. The TCNN and SCNN approaches contribute by overcoming the shift and scaling problems included in blurry mammogram images. In addition, the flipped rotation-based approach (FRbA) is proposed to enhance the accuracy of the prediction process (classification of the type of cancerous mass) by taking into account the different directions of the cancerous mass to extract effective features to form the map of the tumour. The proposed approaches are implemented on the MIAS medical dataset using 200 mammogram breast images. Compared to similar approaches based on KNN and RF, the proposed approaches show better performance in terms of accuracy, sensitivity, spasticity, precision, recall, time of performance, and quality of image metrics.

Further validation of the Gothenburg Trismus Questionnaire (GTQ)

This study aimed to update and, if necessary, revise the Gothenburg Trismus Questionnaire (GTQ), the only existing trismus-specific questionnaire, and retest its psychometric properties. Semi-structured interviews were performed with 10 trismus patients of which 5 had head and neck cancer (HNC) and 5 suffered from benign temporomandibular disorders. Trismus was defined as a maximal incisal opening of ≤ 35mm. An expert panel discussed and revised the GTQ based on interview information, expertise knowledge and the original questionnaire. The revised questionnaire was then tested in a study sample consisting of benign jaw-related conditions (n = 26), patients treated for HNC (n = 90) and an age- and gender-matched control group with no trismus (n = 116). The revised version of the GTQ (GTQ 2) was well accepted by patients. The original three domains continued to show high internal consistency (Cronbach’s alpha 0.74–0.94) and construct validity. Two dually posed single items were split into four questions and the wording was altered in another three items. Moreover, a new domain (Facial pain) was identified, which had excellent internal consistency (α = 0.96) and good construct validity. The revision of the original Gothenburg Trismus Questionnaire (GTQ 1) with inclusion of patient-input, resulted in splitting of ambiguous items, identifying a fourth domain named Facial pain and the recall time shortened for some items. Additionally, the remaining domains and items were re-confirmed as strong in the psychometric analysis. Henceforth, the new version, GTQ 2 should be used.

Does recall time matter in verbal autopsies? Evidence from urban informal settlements in Nairobi, Kenya

Background: To assign a cause of death to non-medically certified deaths, verbal autopsies (VAs) are widely used to determine the cause of death. The time difference between the death and the VA interview, also referred to as recall time, varies depending on social and operational factors surrounding the death. We investigated the effect of recall time on the assignment of causes of death by VA. Methods: This is a secondary analysis of 2002-2015 survey data of the Nairobi Urban Health Demographic Surveillance System (NUHDSS). The independent variable recall time was derived from the date of death and the date when the VA was conducted. Univariate and multivariate logistic regression methods were used to calculate odds ratios of assigning a cause of death in defined categories of recall time. Results: There were 6218 deaths followed up between 2002 and 2016, out of which 5495 (88.3%) had VAs done. Recall time varied from 1-3001 days (mean 115.5 days, sd216.8). Majority of the VAs (45.7%) were conducted between 1-3 months after death. The effect of recall time varied for different diseases. Compared to VAs conducted between 1-3 months, there was a 24% higher likelihood of identifying HIV/AIDS as the cause of death for VAs conducted 4-6 months after death (AOR 1.24; 95% CI 1.01-1.54; p-value = 0.043) and a 40% increased chance of identifying other infectious diseases as the cause of death for VAs conducted <1 month after death (AOR 1.4; 95% CI 1.02-1.92, p-value = 0.024). Conclusions: Recall time affected the assignment of VA cause of death for HIV/AIDS, other infectious diseases and maternal/neonatal causes. Our analysis indicates that in the urban informal setting, VAs should be conducted from one month up to 6 months after the death to improve the probability of accurately assigning the cause of death.