The climate signal imprinted in the snow isotopic composition allows to infer past climate variability from ice core stable water isotope records. The concurrent evolution of vapor and surface snow ...isotopic composition between precipitation events indicates that post‐depositional atmosphere‐snow humidity exchange influences the snow and hence the ice core isotope signal. To date, however, this is not accounted for in paeleoclimate reconstructions from isotope records. Here we show that vapor‐snow exchange explains 36% of the summertime day‐to‐day δ18O variability of the surface snow between precipitation events, and 53% of the δD variability. Through observations from the Greenland Ice Sheet and accompanying modeling we demonstrate that vapor‐snow exchange introduces a warm bias on the summertime snow isotope value relevant for ice core records. In case of long‐term variability in atmosphere‐snow exchange the relevance for the ice core signal is also variable and thus paleoclimate reconstructions from isotope records should be revisited.
Plain Language Summary
Ice core water isotope records are valuable climate proxies containing information about past climate. Climate reconstructions from ice cores have been based on the interpretation of the water isotope records as precipitation signal. Here we show that the humidity exchange between atmosphere and snow influences the surface snow isotopic composition in‐between precipitation events in summer. Thus, it is not the precipitation signal alone that defines the summer snow isotope signal but a combination of precipitation and post‐depositional atmospheric vapor‐snow exchange. This suggests, that climate reconstructions from ice core isotope records should account for post‐depositional processes in the interpretation of the water isotope signal, specifically when interpreting summer isotope signals.
Key Points
Atmosphere‐snow exchange of water vapor is a key process for the signal formation of the snow isotopic composition
Taking into account isotopic fractionation during sublimation we explain a significant share of the observed day‐to‐day isotope variability
Atmosphere‐snow exchange introduces a warm‐bias in the net summer snow isotope signal that is not accounted for in ice core interpretations
Abstract
Aims
To perform the first psychometric analysis of the Norwegian version of the eHLQ using confirmative factor analysis (CFA) procedures in a population of patients admitted to hospital ...using a cross-sectional design. The eHLQ consists of 35 items capturing the 7-dimensional eHealth Literacy Framework (eHLF) which describes users' attributes, user's interaction with technologies and user's experience with digital health systems.
Methods
The 7 independent scales of the eHLQ was translated from Danish and culturally adapted into the Norwegian language following a standardised protocol. Assessment of construct validity of the eHLQ was undertaken using data from a cross-sectional survey of 260 patients hospitalized at a Norwegian University Hospital in the Oslo area during a two-week period in June 2021. The analysis included using correlation analysis (Pearsons R), internal consistency (Cronbach’s alpha) and confirmatory factor analysis (CFA).
Results
All factor loadings were high to acceptable (i.e. > 0.6), except for five items which had somewhat lower loadings. Regarding internal consistency, alpha ranged from 0.73 to 0.90. For optimal CFA fit for the different scale models, correlated residuals were required for five of the seven scales. Overall our analysis shows an intermediate fit of the orginal construct. Scale intercorrelations were all below 0.8, indicating an overall acceptable discriminant validity between the 7 dimensions.
Conclusions
The results from the CFA analysis indicate that for almost all 7 eHLQ scales, an acceptable model fit was achieved. The 260 hospitalized patients included in this study represented a variety of diagnoses, recruited from a geographically limited area. Further studies on psychometric properties of the Norwegian version of eHLQ in larger samples, diverse settings and by using more comprehensive approaches are warranted.
Summary
Background
Psoriasis is a common skin disease with extensive comorbidity risks, which may affect multiple aspects of life. Self‐management is essential for skin treatment and lifestyle ...choices, but few disease‐specific tailored self‐management and educational programmes appear to be available.
Objectives
To evaluate the effects of a 3‐month individual motivational interviewing intervention in patients with psoriasis (with a total follow‐up of 6 months) after climate therapy/heliotherapy (CHT).
Methods
A randomized controlled trial with 169 patients with psoriasis was conducted in the context of CHT at Gran Canaria, Spain. The main outcome measures were Self‐Administered Psoriasis Area and Severity Index (SAPASI) and Health Education Impact Questionnaire (heiQ), and the secondary outcomes were illness perception, psoriasis knowledge and lifestyle change assessments. Outcomes were measured at baseline, after 3 weeks of CHT, and 3 months and 6 months later.
Results
There were significant overall treatment effects in the study group in terms of the SAPASI score, three self‐management domains of heiQ and the self‐efficacy scores (P < 0∙05). The lifestyle change parameters were significantly better in the study group. Illness perception differed between the groups at 3 months (P = 0∙014), and psoriasis knowledge was significantly better in the study group at 6 months (P = 0∙017).
Conclusions
A 3‐month motivational interviewing intervention following CHT had positive overall effects on disease severity, self‐efficacy, psoriasis knowledge and health behaviour change. This approach has the potential to be an important complement to medical management, self‐management and education in patients with psoriasis.
What's already known about this topic?
Psoriasis requires extensive self‐management with respect to skin treatment and lifestyle choices.
Motivational interviewing is a form of patient‐centred counselling that aims to facilitate change and increase self‐efficacy.
What does this study add?
The first evaluation of motivational interviewing in patients with psoriasis.
Motivational interviewing could be an important self‐management support method in psoriasis, leading to reduced disease severity, increased self‐efficacy and psoriasis knowledge, and better lifestyle patterns.
Objective: A study was undertaken to test the psychometric properties of the Fatigue Severity Scale (FSS), and to explore the relationship between fatigue and sociodemographic variables in the ...general population. Method: A national representative sample of 1893 respondents was randomly selected from a pool of 4,000 Norwegians aged 19-81 years. A mailed questionnaire that included the FSS was used to measure fatigue severity. Results: The FSS showed satisfactory internal consistency (Cronbach's alpha 0.88). The prevalence of high fatigue (FSS score > =5) was 23.1% in the total sample. More women (26.2%) than men (19.8%) experienced high fatigue (p=0.004). Respondents with chronic illness (more than six months) reported a higher mean (M=4.69, SD=1.35) than the rest of the sample (M=3.67, SD=1.17) (p<0.001). An inverse correlation was found between fatigue and level of formal education (r=0.20, p<0.001). Conclusion: The psychometric properties of the Norwegian version of FSS were satisfactory. To avoid over-diagnosing people for high level of fatigue, the threshold for high fatigue probably should be 5 on the FSS scale instead of 4 as had been suggested originally, but further validation of the cut-off point is needed.
Summary
Background
Health literacy (HL) – the ability to seek, understand and utilize health information – is important for good health. Suboptimal HL has been associated with poorer health outcomes ...in other chronic conditions, although this has not previously been studied in patients with psoriasis.
Objectives
To investigate the HL strengths and weaknesses of a cohort of patients with moderate‐to‐severe psoriasis. Another aim was to examine possible associations between patients’ quality of life, their demographic, clinical and self‐management characteristics, and dimensions of HL.
Methods
A cross‐sectional study was conducted. Data were collected from a cohort of patients with psoriasis who had received climate helio therapy from 2011 to 2016 (n = 825). HL was assessed by the Health Literacy Questionnaire (HLQ). The association between HL domains, demographic, clinical and self‐management variables were analysed using bivariate correlation and a four‐step linear multiple regression model.
Results
The scores on all HLQ dimensions indicated lower health literacy than other populations. The linear regression models showed a significant association between HL, quality of life and self‐management variables, with higher HL predicting higher quality of life, self‐efficacy and psoriasis knowledge. Sex, educational attainment, age and disease severity had less influence on health literacy.
Conclusions
Improving HL may be a useful strategy for reducing disparities in self‐management skills for patients with psoriasis. Interventions that aim to reduce disease severity and increase psoriasis knowledge, self‐efficacy and quality of life may positively increase HL.
What's already known about this topic?
Health literacy (HL) has increasingly been acknowledged as an essential component of an individual's resources and competency to self‐manage chronic conditions such as psoriasis.
HL negatively affects healthcare utilization.
HL has not yet been investigated in patients with psoriasis.
What does this study add?
This is the first comprehensive HL assessment of psoriasis.
Patients with psoriasis who have received climate helio therapy have lower HL scores than people with other chronic conditions.
Factors associated with lower HL in people with psoriasis include lower educational attainment, lower psoriasis severity, lack of knowledge, lower self‐efficacy, fewer comorbidities, shorter disease duration and lower quality of life.
Assessing HL in psoriasis may help tailor self‐management support interventions.
Linked Comment: Rowlands. Br J Dermatol 2019; 180:1299–1300.
Plain language summary available online
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Flood risk assessments commonly use event‐based approaches to reduce the number of scenarios required to be run through computationally intensive physical process models. Often the return period of ...the response variable (e.g., a fluvial water level or overtopping discharge) generated by an event (e.g., upstream/downstream water level or set of sea state variables) does not match that of the event itself; a limitation of event‐based approaches which can lead to the misspecification of flood risk. We present a transferable hybrid statistical‐hydraulic modeling framework for rapidly locating transition zones; river reaches where extreme water levels are driven by both upstream riverine discharge and downstream sea level. Instead of an event‐based approach the framework utilizes a surrogate model to reduce computational expense of the hydraulic model. The surrogate‐based approach allows the empirical estimation of response‐based along‐river return levels from a large number of plausible discharge–coastal still water level events simulated from the statistical model. We assess the robustness of the event‐based approach by comparing the associated return levels with the response‐based return levels. The framework is applied to the Suwannee River in Florida (United States). Three surrogate models are evaluated, highlighting the enhanced ability of non‐linear models to accurately capture discharge‐sea level interactions along the river. The along‐river return levels of the “most‐likely” design event are found to lie within the range of variability of the response‐based return levels for most of the transition zone.
Plain Language Summary
Transition zones are stretches of river where water level is driven by upstream river flow and downstream sea level. Techniques for evaluating flood risk in coastal rivers commonly model a single or small number of flow ‐ sea level combinations representing rare flooding scenarios, for example, the flood event expected on average, once every 100 years. In transition zones, many different flow ‐ sea level combinations can generate flooding consequently the 100‐year flood generated from a single or few combinations may not represent the true 100‐year flood. We develop a framework linking a statistical model with a river flow model to locate transition zones. Thousands of plausible flow ‐ sea level combinations are simulated from the statistical model with their dependence preserved. Estimating along‐river levels by running these combinations through a river flow model takes a very long time, thus we develop a proxy for the flow model. The transition zone is located by comparing combinations driving the 100‐year water level with the upstream river flow and sea level expected with the same frequency. At our case study site, we find the 100‐year water level extracted from our framework differ from those produced by existing techniques thus the latter may need to be reconsidered.
Key Points
Transition zone of the Suwannee River, FL is approximately 45 km long and shifts depending on event frequency
Return levels associated with the “most‐likely” design event closely match the response‐based return levels for most of the transition zone
Scatter interpolation outperforms multiple linear regression and radial basis functions as a surrogate for the computationally expensive hydraulic model
Background and aims Psoriasis is a common chronic skin condition, causing skin lesions with thickened and scaling skin, as well as erythema and inflammation that may involve painful sores, cracks, ...and pustules. Previously psoriasis was regarded as a painless skin condition. However, over the past decade studies show that skin pain is a frequently reported and bothersome symptom in patients with psoriasis. There is however a lack of rich narratives describing the experience of skin pain in these patients. The aims of this qualitative study were therefore to explore in depth how patients experience psoriasis-related skin pain, and how they deal with it. Methods Thirteen patients with psoriasis were recruited from a dermatology ward and outpatient clinic. One of the investigators (TML) performed individual, semi-structured interviews at an undisturbed room in the hospital. Interviews were thematically analyzed using the method of Systematic Text Condensation as described by Malterud (2012). Results Three main themes were identified from the interviews. First, the skin pain experience was complex. Patients used a variety of adjectives and metaphors to describe their pain, and their skin was sensitive to stimuli of every-day activities. Itch was a common cosymptom, and could both mask pain but also cause severe pain due to excessive scratching and damage to the skin. Second, skin pain had a negative impact on patients' life. Skin pain reduced their physical activity level, impaired their sleep, and made them irritable, depressed, unconcentrated on tasks, as well as withdrawn from other people and social activities. Third, patients dealt with their skin pain in various ways. Although some took action to relieve the pain and distract themselves from pain, most of the patients applied maladaptive and passive coping strategies such as put up with it, avoid painful activities, become fearful or trivialize their pain. Conclusions The experience of psoriasis related skin pain is complex. The pain has a major negative impact on patients' life in terms of physical, emotional, cognitive, and social functions. Patients use a variety of adaptive but most frequently maladaptive coping strategies in order to deal with their skin pain. Implications This study provides new and in-depth knowledge on psoriasis related skin pain. This information is valuable for further work on pain assessment tools and pain management recommendations customized for skin pain experienced by patients with psoriasis.
Human brown adipose tissue (BAT) presence, metabolic activity, and estimated mass are typically measured by imaging 18Ffluorodeoxyglucose (FDG) uptake in response to cold exposure in regions of the ...body expected to contain BAT, using positron emission tomography combined with X-ray computed tomography (FDG-PET/CT). Efforts to describe the epidemiology and biology of human BAT are hampered by diverse experimental practices, making it difficult to directly compare results among laboratories. An expert panel was assembled by the National Institute of Diabetes and Digestive and Kidney Diseases on November 4, 2014 to discuss minimal requirements for conducting FDG-PET/CT experiments of human BAT, data analysis, and publication of results. This resulted in Brown Adipose Reporting Criteria in Imaging STudies (BARCIST 1.0). Since there are no fully validated best practices at this time, panel recommendations are meant to enhance comparability across experiments, but not to constrain experimental design or the questions that can be asked.
Brown adipose tissue was recently discovered to be a functional organ in adult humans, with great therapeutic potential. To better advance the field through standardization of experimental methods and reporting, Chen et al. provide recommendations (“BARCIST 1.0”) by an expert panel for conducting human clinical studies using FDG-PET/CT.
Background Patients with psoriasis commonly report severe sensory skin symptoms, sleep disturbance, psychological distress and impaired health related quality of life (HRQoL). However, the complex ...associations among these factors are poorly investigated in this patient group.
Objectives The purpose of this study was to investigate the association between skin pain or skin discomfort and HRQoL, and explore whether sleep disturbance and psychological distress were mediators of these associations.
Methods A total of 139 psoriasis patients from a university hospital setting participated in this exploratory, cross‐sectional study. Data were obtained through interviews and questionnaires (Dermatology Life Quality Index, General Sleep Disturbance Scale, Illness Perception Questionnaire) and analysed using a series of multiple regression analyses. HRQoL was the dependent variable. Independent variables and assumed mediators were entered into the model in a predefined order.
Results Skin pain, skin discomfort, sleep disturbance and psychological distress were significantly associated with HRQoL (all P < 0.05). Sleep disturbance was a partial mediator for the association between skin pain and HRQoL. No such mediation effect was found in terms of psychological distress. The total model explained 40% of the variance in HRQoL.
Conclusion In this study, skin pain and skin discomfort were significantly related to HRQoL when controlling for demographic and clinical characteristics. In addition, sleep disturbance mediated the association between skin pain and HRQoL. An understanding of the complex association among physiological and psychological factors, and HRQoL is clinically important in order to provide proper treatment and care of patients with psoriasis.
The aim of the present study was to compare postoperative pain and convalescence in patients randomized to laparoscopic or open donor surgery in a prospective, controlled trial. The donors were ...randomly assigned to undergo laparoscopic (n = 63) or open (n = 59) donor nephrectomy. Our end points were amount of administered analgesics in the recovery period, postoperative pain on the second postoperative day and at one month after surgery and duration of sick leave.
There was a significant difference in favor of the laparoscopic group regarding administered analgesics on day of surgery (p < 0. 02). No difference was observed between groups regarding self‐reported pain on the second postoperative day. One month post donation, significantly fewer donors in the laparoscopic group reported pain (p < 0. 02) or had used analgesics (p < 0.05). The duration of sick leave was significantly shorter in the laparoscopic group (p = 0.01).
The laparoscopic group experienced a more rapid convalescence and a shorter period of sick leave. Although immediate postoperative pain can be managed efficiently regardless of procedure, a lower consumption of opioids and incidence of pain in the convalescent period suggest a clinically relevant patient‐experienced benefit from a successful laparoscopic procedure.
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