bluuebunny/crossref_metadata_2025 huggingface dataset:
Immunoglobulin and Complement Immunohistochemistry on Paraffin Sections in Autoimmune Bullous Diseases: A Systematic Review and Meta-analysis
Authors: Kasperkiewicz Michael , Lai Olivia , Kim Gene , DeClerck Brittney , Woodley David T. , Zillikens Detlef , Recke Andreas
Published: October 2020

Immunohistochemistry (IHC) on formalin-fixed, paraffin-embedded tissue has been proposed as a potential tool in the diagnosis of autoimmune bullous diseases (AIBDs) in lieu of standard direct immunofluorescence (DIF) microscopy. To comprehensively determine the diagnostic accuracy of immunoglobulin and complement IHC for diagnosis of AIBDs, we conducted a systematic review and multivariate Bayesian model-based meta-analysis of the literature. Quality and heterogeneity assessment of studies was performed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) checklist and the I2 index, respectively. Electronic searches using PubMed from April 1964 to July 2020 identified 14 articles meeting predetermined inclusion and exclusion criteria. Median sensitivities with 95% credible intervals in pemphigus and pemphigoid were 0.24 (0.01–0.89) and 0.22 (0.02–0.77) with immunoglobulin G (IgG), 0.77 (0.39–0.95) and 0.25 (0.02–0.85) with IgG4, 0.11 (0.02–0.32) and 0.86 (0.56–0.98) with C3d, and 0.84 (0.56–0.97) and 0.75 (0.37–0.94) with C4d, respectively. Specificities were 1.00 (0.00–1.00) with IgG, 0.98 (0.89–1.00) with IgG4, 0.99 (0.97–1.00) with C3d, and 0.99 (0.97–1.00) with C4d. The risk of bias and heterogeneity among studies was a serious problem, decreasing the level of evidence. Our work suggests that, in selected cases, paraffin-based IHC may be a helpful procedure to screen for AIBDs, especially when specialized laboratories and/or biopsy specimens for DIF do not exist. Nevertheless, more studies with a refined quality design are needed to explore the true usefulness of this diagnostic method in AIBDs.
Study of Tattoo Colorants in Skin by Conventional and Polarized Light Microscopy
Authors: Fernandez-Flores Angel , Cassarino David
Published: October 2020

Tattoos are a common practice in the 21st century. Although most modern pigments are organic and made of vegetable or plastic compounds, they still sometimes elicit an adverse reaction in the skin. Identifying the tattoo pigment in such biopsies is not always an easy task. To study how tattoo inks appear in the skin, we injected 14 different colors of commercial tattoo ink into normal skin obtained from a mastectomy specimen. One unstained section was obtained from each case, as well as one section stained with hematoxylin-eosin from each case. All sections were observed under the microscope. Stained and unstained sections were also examined under polarized light. We did not observe any modification of the ink color with the staining process with hematoxylin-eosin. However, some pigments appeared differently in stained and unstained sections than in the vial. Pink was the most difficult color to identify from the eosinophilic tissue. None of the colors showed any birefringent particles. However, in some unstained slides under polarized light, the color of the pigment appeared more similar to the one in the vial than in the stained slide.
Local Health Department and Hospital Collaboration Around Community Health Needs Assessment to Improve Health Outcomes
Authors: Isehunwa Oluwaseyi O. , Dobalian Aram , Ahn SangNam , Relyea George , Carlton Erik L.
Published: October 2020

The objectives of this study were to examine the relationships between local health department (LHD) and nonprofit hospital collaboration around community health needs assessment (CHNA), levels of collaboration, and selected community health outcomes. Data were obtained from multiple sources including the National Profile of Local Health Departments. Results showed that high levels of LHD-hospital collaboration around CHNA were associated with lower self-reported poor or fair health, lower years of potential life lost per 100 000 population, and lower premature age-adjusted mortality per 100 000 population. More research is needed to examine the influence of collaboration around CHNA on community health.
Promoting Interdisciplinary, Participatory Approaches to Address Childhood Asthma Disparities in an Urban Black Community
Authors: Ali Nida M. , Combs Ryan M. , Kakar Rishtya M. , Muvuka Baraka , Porter Jennifer
Published: October 2020

Black children are twice as likely as non-Hispanic white children to have asthma due to an interplay of socioeconomic, historical, and industrial factors. The underlying socio-economic and structural inequities result in poor adherence to recommended asthma management treatments. National guidelines suggest asthma action plans (AAPs) as a tool for patient self-management, yet they remain underutilized. Boot Camp Translation (BCT), rooted in community-based participatory research, provides a method for engaging communities to improve health literacy. This article describes the successful use of BCT to develop a culturally relevant AAP promotion campaign in West Louisville, a predominantly Black community that experiences social and health disparities.
ENDOPHTHALMITIS PRESENTING AS RETINAL VASCULITIS LESS THAN 24 HOURS AFTER AFLIBERCEPT INJECTION: A CASE REPORT
Authors: Weinstein Jessica E. , Greven Margaret A.
Published: October 2020

Purpose:

We describe a case of endophthalmitis caused by Streptococcus salivarius presenting as a retinal vasculitis less than 24 hours after intravitreal injection.

Methods:

A case report.

Results:

The patient progressed from a hemorrhagic retinal vasculitis to severe endophthalmitis with no view to the posterior segment within 24 hours. The visual acuity progressed from 20 of 20 preinjection to light perception within less than 48 after injection. Vitreous tap and injection was performed within 24 hours of intravitreal aflibercept injection, followed by pars plana vitrectomy the next day. The final visual acuity was hand motions.

Conclusion:

Streptococcus salivarius is a virulent organism that may cause an endophthalmitis early after intravitreal injection with an unusual presentation of hemorrhagic retinal vasculitis. A high index of suspicion for infectious endophthalmitis should be maintained for all patients presenting with ocular inflammation and worsening vision in the days after intravitreal injections.
The Role of Donor Rim Fungal Cultures
Authors: Terry Mark A.
Published: October 2020

Culturing all donor rims for fungus makes no sense. Only 1% of all cultures will be positive, and of those positive cultures, only 6% will also have a clinical infection. Prophylactically treating all positive cultures means 94% of patients will be treated unnecessarily. Fungal cultures do not reliably direct specific medication choice, and fungal infections of the interface in endothelial keratoplasty and deep anterior lamellar keratoplasty are nearly impervious to medical therapy. Suspected fungal infections of the deep stromal interface should be treated expeditiously with penetrating keratoplasty before peripheral spread or endophthalmitis occur.
Outcomes of Penetrating and Lamellar Corneal Patch Grafts
Authors: Sharma Supriya , Rathi Anubha , Murthy Somasheila I. , Trivedi Mihika , Patel Chaitali , Mohamed Ashik , Chaurasia Sunita
Published: October 2020

Purpose:

To report the indications, long-term structural and functional outcomes, and prognostic factors for the success of penetrating and lamellar corneal patch grafts.

Methods:

This is a retrospective analysis of 49 patients who underwent the corneal patch graft procedure over 8 years. The baseline, preoperative, and postoperative characteristics along with their outcomes were evaluated.

Results:

Forty-nine eyes (49 patients) with a mean follow-up of 20.3 ± 3.27 months (range 6–48) were included. Thirty-one patients underwent full-thickness grafts for corneal perforation, and 18 underwent lamellar grafts for severe thinning. The most common indication was corneal thinning and/or perforation secondary to microbial keratitis (17 eyes, 34.7%). Anatomic success was achieved in 31 eyes (63.2%), in which no further surgical intervention was required for tectonicity. Functional success was achieved in 22 of 37 eyes (59.5%), where along with anatomic success, significant visual gain was also obtained. Absolute graft failure was noted in 12 eyes (24.5%), which developed recurrence of primary pathology requiring reintervention within the first 6 months. Good prognostic factor for success included sterile corneal perforations. The presence of microbial keratitis was noted to be a guarded prognostic factor for success.

Conclusions:

Corneal patch graft can serve as a good therapeutic modality for corneal ulceration or thinning, not amenable to treatment with tissue adhesive application. Both anatomical success and functional success of 60% was achieved in our series. Those performed for immune-mediated conditions fared the best. Subsequent optical procedures may be performed for further visual rehabilitation at a later stage.
Clinical Evaluation of Electrolysis for Reis-Bücklers Corneal Dystrophies and In Vivo Histological Analysis Using Anterior Segment Optical Coherence Tomography
Authors: Nishino Tsubasa , Kobayashi Akira , Mori Natsuko , Yokogawa Hideaki , Sugiyama Kazuhisa
Published: October 2020

Purpose:

To report the effectiveness and clinical outcomes of corneal electrolysis for Reis-Bücklers corneal dystrophies (RBCDs) and provide in vivo histological analysis using anterior segment optical coherence tomography (AS-OCT).

Methods:

A total of 7 patients with RBCD (2 male patients, 5 female patients; mean age, 50.0 years) from 3 pedigrees were enrolled in this prospective study. All patients underwent corneal electrolysis for decreased visual acuity or blurred vision. Changes in visual acuity, refraction, and corneal thickness were evaluated 1 month after electrolysis and statistically analyzed. Changes observed in AS-OCT images before and after electrolysis were qualitatively and quantitatively assessed.

Results:

A total of 22 electrolysis procedures were performed on 7 patients during the median follow-up period of 10.7 years. Mean visual acuity significantly improved postoperatively, from 0.59 to 0.31 logarithm of the minimum angle of resolution (P = 0.013). Changes in refraction (from −2.42 to −2.12 D) and corneal thickness (from 570.8 to 577.6 μm) were not significant (P = 0.77 and P = 0.80, respectively). In all cases, assessment of AS-OCT images showed that the band lesion in Bowman's layer became less reflective after electrolysis. The mean thickness of the band lesion decreased from 101.5 to 88.3 μm (P = 0.002).

Conclusions:

Corneal electrolysis is an excellent treatment option for corneal opacities caused by RBCD. Corneal electrolysis improves visual acuity without changing corneal thickness or refraction. Therefore, repeat corneal electrolysis over the years might be a preferred long-term treatment strategy for RBCD. Moreover, AS-OCT is suitable for evaluating the effectiveness of this treatment and might be useful during postoperative follow-up.
Nasopharyngeal Microbiota Analysis in Healthy and Otitis-prone Children
Authors: Folino Francesco , Fattizzo Miriam , Ruggiero Luca , Oriano Martina , Aliberti Stefano , Blasi Francesco , Gaffuri Michele , Marchisio Paola , Torretta Sara
Published: October 2020

Background:

Recurrent acute otitis media (RAOM) is common in children, and it may result in spontaneous tympanic membrane perforation (STMP), management of which is often challenging. In the upper respiratory tract (URT), resident microorganisms play a pivotal role in otitis media pathogenesis and prevention, as they are able to inhibit the colonization process and otopathogens growth. In particular, Dolosigranulum spp. and Corynebacterium spp. have been associated with respiratory health in several studies. This study aims at comparing both nasopharyngeal microbiota of children with RAOM versus matched controls and nasopharyngeal microbiota of children with a history of RAOM with STMP.

Method:

Nasopharyngeal swabs were collected from 132 children, median age 3.51 (2.13–4.72), including 36 healthy children, 50 with RAOM without STMP, and 46 with RAOM with STMP. Bacterial DNA was subsequently extracted and 16S rRNA gene V3-V4 regions were polymerase chain reaction amplified and sequenced using Illumina MiSeq technology.

Results:

A higher relative abundance of Dolosigranulum and Corynebacterium genera was detected in the nasopharynx of healthy children (16.5% and 9.3%, respectively) in comparison with RAOM without STMP (8.9% and 4.3%, respectively) and RAOM with STMP (5.2% and 2.8%, respectively). A decreasing pattern in relative abundance of these 2 pivotal genera through disease severity was detected. In all groups, the most abundant genera were Moraxella, Streptococcus and Haemophilus, followed by Dolosigranulum and Corynebacterium.

Conclusions:

Our study provides a characterization of the URT microbiota in otitis-prone children with and without history of recurrent STMP, suggesting that the role of Dolosigranulum and Corynebacterium in regulating the healthy URT microbiota should be further studied.
Antibiotic Prescriptions for Children With Community-acquired Pneumonia: Findings From Italy
Authors: Costenaro Paola , Cantarutti Anna , Barbieri Elisa , Scamarcia Antonio , Oletto Andrea , Sacerdoti Paolo , Lundin Rebecca , Cantarutti Luigi , Giaquinto Carlo , Donà Daniele
Published: October 2020

Introduction and Objective:

Community-acquired pneumonia (CAP) is one of the most common reasons of prescribing antibiotics for children, often with overuse of broad-spectrum antibiotics. The aim of this study is to describe the antibiotic prescriptions for Italian children with CAP, at the primary care level.

Study Design:

Retrospective cohort study conducted among children 3 months–14 years of age with CAP, enrolled in Pedianet (http://www.pedianet.it) from January 1, 2009 to December 31, 2018. Antibiotic treatment was defined as narrow-spectrum (NS-ABT) if amoxicillin and broad-spectrum (BS-ABT) if amoxicillin/clavulanic acid, cephalosporins or any combination. Crude and adjusted logistic regressions for the odds of receiving NS-ABT were conducted (all episodes of CAP and per patient). A P value <0.05 was considered statistically significant.

Results:

Among 9691 CAP, 7260 episodes from 6409 children followed by 147 pediatricians were analyzed. The 16.7% of CAP [1216/7260, 95% confidence interval (CI): 15.9%–17.6%] received an NS-ABT while 53.3% (3863/7260, 95% CI: 52%–54.4%) received BS-ABTs and 30% (2181/7260, 95% CI: 28.9%–31.1%) macrolides. Within 10 years, a slight but increasing trend of NS-ABT prescription was observed (P < 0.001). Factors independently associated with reduced odds of receiving an NS-ABT compared with BS-ABT including macrolides were being older than 5 years [odds ratio (OR) 0.45, 95% CI: 0.39–0.52], living in Central/Southern Italy (OR 0.13, 95% CI: 0.10–0.16) and being exposed to ABT 3 months before (OR 0.61, 95% CI: 0.53–0.70). These findings were confirmed comparing NS-ABT versus BS-ABT excluding macrolides (n = 5079) and when the analysis was limited to index CAP.

Conclusion:

Our findings report a very limited prescription of narrow-spectrum antibiotics for Italian children with CAP.
Urine Biomarker Assessment of Infant Adherence to Isoniazid Prophylaxis
Authors: LaCourse Sylvia M. , Leon Daniel , Panpradist Nuttada , Richardson Barbra A. , Maleche-Obimbo Elizabeth , Mecha Jerphason , Matemo Daniel , Escudero Jaclyn N. , Kinuthia John , Lutz Barry , John-Stewart Grace
Published: October 2020

We assessed adherence in an infant tuberculosis prevention trial in Kenya with a urine isoniazid metabolite–detecting dipstick. Ninety-seven infants had 155 assays performed; 77 (49.7%) were found to be positive despite caregiver-reported adherence. Positive assays were associated with maternal secondary education, HIV suppression and no reported missed doses in past 3 days, suggesting caregiver education and self-medication use influenced infant adherence.
Job Stress and Subclinical Cardiovascular Disease
Authors: Lorentz Luciana Bivanco de Lima , Santos Itamar de Souza , Bittencourt Márcio Sommer , Griep Rosane Harter , Lotufo Paulo Andrade , Bivanco-Lima Danielle , Benseñor Isabela J.M.
Published: October 2020

Objective:

We aimed to evaluate the relationship between job stress and subclinical cardiovascular disease at ELSA-Brasil.

Methods:

We considered job stress domains (demand, skill discretion, decision authority, and social support) as independent variables and coronary artery calcium (CAC more than 0) and carotid intima-media thickness (CIMT more than P75% as a continuous variable) as dependent ones. Odds ratio (OR) and 95% confidence interval (95% CI) were presented crude, with further adjustments for sociodemographic, cardiovascular risk factors, and lifestyle variables. Linear regression models were built for CIMT using the same covariates.

Results:

Although significant associations were observed in the crude models, after multivariate adjustment CAC and CIMT were not significantly associated with demand, skill discretion, decision authority, and social support.

Conclusions:

Our results did not support an association between job stress and subclinical cardiovascular disease measured by CAC or CIMT.
Longitudinal Evaluation of Lung Function in Gulf War I Veterans Exposed to Depleted Uranium
Authors: Glick Danielle R. , Brown Clayton H. , Li Lan , Weiler-Lisowski Bethany , Gaitens Joanna M. , McDiarmid Melissa , Hines Stella E.
Published: October 2020

Objective:

Gulf War I (GWI) Veterans exposed to depleted uranium (DU) have undergone biennial surveillance to assess for DU-related health effects. No DU-specific respiratory effects have been observed cross-sectionally, but longitudinal lung function decline has not been assessed.

Methods:

A dynamic cohort of 71 Veterans underwent spirometry testing between 1999 and 2019. Longitudinal rates of decline of spirometry values were compared among Veterans with high versus low uranium levels using a linear mixed model.

Results:

There was no significant difference in rate of decline of spirometry values between Veterans with high versus low uranium levels. The overall rate of decline was similar to that of the general population.

Conclusions:

In 20 years of follow-up, there does not appear to be an accelerated rate of decline of lung function among veterans exposed to depleted uranium.
Sleep Problems and Melatonin Prescription After Concussion Among Youth Athletes
Authors: Howell David R. , Potter Morgan N. , Provance Aaron J. , Wilson Pamela E. , Kirkwood Michael W. , Wilson Julie C.
Published: October 2020

Objectives:

To examine the effect of sleep disturbances on concussion symptom recovery and to examine the effect of melatonin prescription on symptom improvement among concussed adolescents with sleep problems.

Design:

Longitudinal test–retest.

Setting:

Sports medicine clinic.

Participants:

Patients aged 8 to 18 years, diagnosed with a concussion, evaluated within 14 days after injury, and evaluated again 15 to 35 days after injury.

Independent Variables:

We grouped patients based on whether they reported sleep disturbances within 14 days of injury.

Main Outcome Measures:

Outcome measures included symptom severity, headache severity, melatonin prescription, and the change in symptom severity between visits.

Results:

Two hundred twenty-five patients were included: 36% who reported sleep problems (44% female; age = 14.4 ± 2.0 years; evaluated 7.3 ± 3.8 and 23.2 ± 5.4 days after injury) and 64% who did not (32% female; age = 14.6 ± 2.3 years; evaluated 7.2 ± 3.4 and 23.0 ± 5.3 days after injury). Those with sleep problems reported higher symptom severity than those without across the 2 visits (22.1 ± 14.3 vs 14.6 ± 12.5; P < 0.001). There was no significant difference in the change in symptom severity between visits among those who received [median = 9-point improvement; interquartile range (IQR) = 1-14] and did not (median = 9, IQR = 2-18) receive a melatonin prescription (P = 0.80).

Conclusions:

Sleep problems among pediatric patients within 2 weeks of concussion are associated with more severe symptoms. Melatonin prescription was not associated with faster symptom recovery.
Embracing Change in the Pursuit of Excellence: Transitioning to the Clinical Internship Evaluation Tool for Student Clinical Performance Assessment
Authors: North Sara , Sharp Amanda
Published: October 2020

Background and Purpose.

The assessment of physical therapist student competence in the clinical learning environment is valuable and necessary. However, educators and clinicians are becoming increasingly disenchanted with their chosen assessment tools and delivery platforms. The profession recently called for a pursuit of excellence that includes an analysis of performance evaluation practices and consideration of assessment tools. In line with this call, the purpose of this report was to disseminate one academic institution's exploration, implementation, and early outcomes of the transition from the Clinical Performance Instrument (CPI) to the Clinical Internship Evaluation Tool (CIET) for full-time student clinical performance assessment.

Case Description.

After identification of key stakeholders, the authors completed an initial exploration and comparison of CPI versus CIET, executed a pilot trial of CIET use, and implemented a transition from CPI to CIET for all full-time clinical experiences.

Outcomes.

This report presents the outcomes of the initial exploration and comparison of assessment tools, the CIET pilot, the academic processes in transitioning to the CIET, and the post-implementation evaluation results, each with consideration of unique stakeholder perspectives.

Discussion and Conclusion.

The transition from CPI to CIET for full-time student clinical performance assessment was successful in meeting the needs of key stakeholders. This report presents the first known addition to the literature regarding CIET implementation since the original institution's publications. Ongoing use and evaluation of the CIET and other alternative tools for student performance assessment, both within and across institutions, is necessary to address the profession's pursuit of excellence and to better meet the demand for contemporary educational practices in the clinical learning environment.
A Perspective on the State of the World's Nursing Report
Authors: Malone Beverly
Published: October 2020

This article is a review and US view of the State of the World's Nursing (SOWN) report, released in April 2020 during the COVID-19 pandemic and authored and promoted by nurses and nonnurses from the World Health Organization and Nursing Now. The report offers a comprehensive analysis of how national governments, educational, and health care institutions, public agencies, and private partners must collaborate over the coming decade to meet the anticipated growing stress on the nursing workforce. It also details the case to overcome geographic, economic, and demographic disparities that block access to effective, affordable universal health care. As an early participant in the research and preparation of this document, the National League for Nursing has been a vocal advocate for one of its key themes: serious investment in nursing education and leadership as a vital link in cocreating equitable, sustainable access to outstanding, inclusive, culturally sensitive universal health care.
An Exploration of New Graduate Nurses’ Transition to Specialty Practice
Authors: Baldwin Kathleen M. , Sleutel Martha , Urban Regina Wilder , Wells Jo Nell , Behan Deborah , Walsh Judith , Newcomb Patricia
Published: October 2020

New graduates’ adjustment to high-acuity specialty areas was evaluated using qualitative methods in a hospital system that uses the Versant New Graduate Residency Program. Subjects were interviewed at baseline in person, answered interview questions at 6 months via computer, and were interviewed at 12 months in person. Twelve themes emerged from the interviews, reflecting intrinsic and extrinsic factors affecting new graduate nurse adjustment. Study results were used to evaluate the program and improve the program implementation.
Rabbit as an Animal Model for Ocular Surface Disease, Tear Osmolarity, Electrolyte, and Tear Ferning Profiles
Authors: Lantyer-Araujo Nayone Lima , Lacerda Ariane de Jesus , Mendonça Marcos Antônio , da Silva Ana Paula de Souza Martins , Dórea Neto Francisco de Assis , Portela Ricardo Dias , Oriá Arianne Pontes
Published: October 2020

SIGNIFICANCE

The tear film promotes ocular surface health and protection through its various constituents' functions. The application of methods for ocular surface examination is essential in the research of diseases that affect the tear film. Rabbits have been used as a model to study some human ocular diseases and to test ophthalmic products.

PURPOSE

The aim of the present study was to determine the biochemical profile, osmolarity, and tear ferning patterns of rabbit tears.

METHODS

Ten rabbits (Oryctolagus cuniculus) were evaluated for tear osmolarity, tear ferning types and grades (using Rolando and Masmali scales), and biochemical analysis of total protein, urea, and electrolytes (chloride, phosphorus, iron, sodium, potassium, and calcium).

RESULTS

Median ± semi-interquartile range for tear osmolarity was 283.5 ± 7.5 mOsm/L. Tear ferning test grades were type 1.0 ± 0.5 on the Rolando scale and 1.0 ± 0.5 on the Masmali scale. Type I and grade 1 were the most commonly observed ferning classifications (60 and 50%, respectively) for the rabbits' tears. Results for electrolytes and other biochemical compounds were as follows: total protein 4.40 g/dL, urea 130.60 mg/dL, chloride 196.51 mEq/L, phosphate 7.35 mg/dL, iron 95.76 μg/dL, sodium 202.04 mmol/L, potassium 12.74 mmol/L, and calcium 11.53 mg/dL.

CONCLUSIONS

The results of the various tests described herein may serve as a basis for research using rabbits as an ophthalmic disease model and in the development of diagnostic and therapeutic agents used for ocular health.
Visual Demand and Acuity Reserve of Chinese versus English Newspapers
Authors: Zhang Jun , Liu Jingbo , Jasti Srichand , Suryakumar Rajaraman , Bullimore Mark A.
Published: October 2020

SIGNIFICANCE

This study suggests that Chinese newspaper characters are more legible than English newspaper letters. Characters in Chinese newspapers have higher acuity reserve than English newspapers.

PURPOSE

The purpose of this study was to evaluate visual demand and acuity reserve for Chinese newspapers in comparison with published data on U.S. newspapers.

METHODS

The test distances for visual acuity in Chinese clinical studies were reviewed systematically. Characters from different sections of newspapers printed in simplified Chinese were evaluated. The character height, frequency, and visual demand and acuity reserve of each newspaper section were determined for Chinese characters of the six different levels of complexity.

RESULTS

More than 70% of Chinese clinical studies measure near visual acuity at either 33 or 40 cm. The height of Chinese characters ranged from 1.95 to 3.28 mm across different sections of five newspapers compared with 1.0 to 2.0 mm for English letters. The frequency of Chinese characters from least to most complex ranged from 7 to 34% across 12 sections of one Chinese newspaper. The angular threshold across the six complexity levels of Chinese characters ranged from 4.62 to 5.93 arcmin (0.54 to 0.69 mm at 40-cm reading distance) with a weighted angular threshold of 5.18 arcmin compared with 3.37 arcmin (0.39 mm) for the English letters. For Chinese newspapers, at 40-cm reading distance, the acuity reserve for the smallest and largest median size was 3.55 and 4.61, respectively.

CONCLUSIONS

Chinese characters are larger than English characters in all newspaper sections newspapers by a factor of 1.60 to 2.34. Given that Chinese characters need to be 1.54 times larger than English letters to provide the same acuity reserve, on average, Chinese newspapers are more legible than U.S. English newspapers.
A Saccadic Choice Task for Target Face Detection at Large Visual Eccentricities in Patients with Glaucoma
Authors: Boucart Muriel , Bachet Valentin , Corveleyn Xavier , Bacchetti Pascal , Rouland Jean François
Published: October 2020

SIGNIFICANCE

Little is known about the perception of glaucomatous patients at large visual eccentricities. We show that the patients' performance drops beyond 40° eccentricity even for large images of scenes, suggesting that clinical tests should assess the patients' vision at larger eccentricities than 24 or 30°.

PURPOSE

Daily activities such as visual search, spatial navigation, and hazard detection require rapid scene recognition on a wide field of view. We examined whether participants with visual field loss at standard automated perimetry 30-2 were able to detect target faces at large visual eccentricities.

METHODS

Twelve patients with glaucoma and 14 control subjects were asked to detect a face in a two-alternative saccadic forced choice task. Pairs of scenes, one containing a face, were randomly displayed at 10, 20, 40, 60, or 80° eccentricity on a panoramic screen covering 180° horizontally. Participants were asked to detect and to saccade toward the scene containing a face.

RESULTS

Saccade latencies were significantly slower in patients (264 milliseconds; confidence interval [CI], 222 to 306 milliseconds) than in control subjects (207 milliseconds; CI, 190 to 226 milliseconds), and accuracy was significantly lower in patients (70% CI, 65 to 85%) than in control subjects (75.7% CI, 71.5 to 79.5%). Although still significantly above chance at 60°, the patients' performance dropped beyond 40° eccentricity. The control subjects' performance was still above chance at 80° eccentricity.

CONCLUSIONS

In patients with various degrees of peripheral visual field defect, performance dropped beyond 40° eccentricity for large images at a high contrast. This result could reflect reduced spread of exploration in glaucoma.
2017 Charles F. Prentice Award Lecture: Peripheral Prisms for Visual Field Expansion: A Translational Journey
Authors: Peli Eli
Published: October 2020

On the occasion of being awarded the Prentice Medal, I was asked to summarize my translational journey. Here I describe the process of becoming a low-vision rehabilitation clinician and researcher, frustrated by the unavailability of effective treatments for some conditions. This led to decades of working to understand patients' needs and the complexities and subtleties of their visual systems and conditions. It was followed by many iterations of developing vision aids and the techniques needed to objectively evaluate their benefit. I specifically address one path: the invention and development of peripheral prisms to expand the visual fields of patients with homonymous hemianopia, leading to our latest multiperiscopic prism (mirror-based design) with its clear 45° field-of-view image shift.
Detectable HIV RNA in late pregnancy associated with low tenofovir hair levels at time of delivery among women living with HIV in the United States
Authors: Pintye Jillian , Huo Yanling , Kacanek Deborah , Zhang Kevin , Kuncze Karen , Okochi Hideaki , Gandhi Monica
Published: October 2020

Objective:

We evaluated peripartum tenofovir (TFV) exposure via hair measures among women living with HIV in the United States.

Design:

Observational cohort study.

Methods:

Hair samples were collected at or shortly after childbirth among mothers enrolled in the Surveillance Monitoring for Antiretroviral Therapy Toxicities Study of the Pediatric HIV/AIDS Cohort Study between 6/2014 and 7/2016. Among mothers receiving TFV disoproxil fumarate (TDF)-based regimens during pregnancy, TFV hair concentrations were analyzed using liquid chromatography/tandem mass spectrometry. Weight-normalized TFV concentrations were log10 transformed. Multivariable linear regression assessed correlates of TFV concentrations.

Results:

Overall, 121 mothers on TDF-based antiretroviral therapy during pregnancy had hair specimens tested for TFV concentrations and were included in the analysis. Median age at delivery was 31 years [interquartile range (IQR) 26–36]; 71% self-identified as non-Hispanic black, and 10% had unsuppressed viral loads in late pregnancy (HIV RNA ≥ 400 copies/ml). Median time from birth to hair collection was 3 days (IQR 1–14) and median TFV hair concentration was 0.02 ng/mg (IQR 0.01–0.04). In multivariable models, an unsuppressed viral load in late pregnancy was associated with 80% lower adjusted mean peripartum TFV concentrations than pregnancies with viral suppression (95% confidence interval: −90% to −59%, P < 0.001). Use of TDF only in the first trimester and attaining high school graduation were also associated with lower TFV hair concentrations.

Conclusion:

Unsuppressed viral load during late pregnancy was strongly associated with lower maternal TFV hair concentrations at birth, though viremia was rare. Efforts to improve maternal virological outcomes and eliminate vertical HIV transmission could incorporate drug exposure monitoring using hair or other metrics.
Nationwide Perioperative Analysis of Endoscopic Versus Open Surgery for Craniosynostosis: Equal Access, Unequal Outcomes
Authors: Rochlin Danielle H. , Sheckter Clifford C. , Lorenz Hermann Peter , Khosla Rohit K.
Published: October 2020

The purpose of this study is to evaluate national differences in inpatient outcomes and predictors of treatment type for endoscopic versus open surgery for craniosynostosis, with particular consideration of racial, socioeconomic, and geographic factors. The 2016 Kids’ Inpatient Database was queried to identify patients aged 3 years or younger who underwent craniectomy for craniosynostosis. Multivariable regression modeled treatment type based on patient-level (gender, race, income, comorbidities, payer) and facility-level (bed size, region, teaching status) variables, and was used to assess outcomes. The weighted sample included 474 patients, of whom 81.9% (N = 388) of patients underwent open repair and 18.1% (N = 86) underwent endoscopic repair. A total of 81.1% of patients were under 1 year of age and 12.0% were syndromic. Patients were more likely to be treated open if they were older (odds ratio [OR] 3.07, P = 0.005) or syndromic (OR 8.56, P = 0.029). Patients who underwent open repair were more likely to receive transfusions (OR 2.86, P = 0.021), and have longer lengths of stay (OR 1.02, P < 0.001) and more costly hospitalizations (OR 5228.78, P = 0.018). Complications did not significantly vary between procedure type. The authors conclude that United States national data confirm benefits of endoscopic surgery, including a lower risk of transfusion, shorter hospital stay, and lower hospital costs, without a significant change in the rate of inpatient complications. Racial, socioeconomic, and geographic factors were not significantly associated with treatment type or perioperative surgical outcomes. Future studies are needed to further investigate the influence of such variables on access to craniofacial care.
Considerations for Clinical Use of Concentrated Growth Factor in Maxillofacial Regenerative Medicine
Authors: Chen Jianguo , Wan Yingying , Lin Yan , Jiang Haiyue
Published: October 2020

Different strategies have been utilized to facilitate mineralized/soft tissues. Concentrated growth factor (CGF) emerges as a promising biomaterial for regenerative therapy due to high levels of platelets, growth factors, and nucleated cells entrapped in the fibrin scaffold. This review aimed to collect extensive studies on CGF used in maxillofacial regenerative medicine, discussing current obstacles, and expressing some considerations of CGF use. Articles were retrieved systematically without time limitation. In total, 27 human studies were included and separated accordingly. In general, CGF has been most evaluated in implant related therapy and maxillofacial bone regeneration where a majority of articles have revealed favorable outcomes. Little studies have supported the effects on improving probing periodontal depth reductions and clinical attachment level gains for intrabony and furcation defect regeneration. Very little data with high-level evidence was available directly to investigate its effects on the soft tissue regeneration and postoperative complications reduction. The evidence supporting the clinical efficacy of CGF in maxillofacial regenerative medicine is limited. Some conflicting results are worrisome. In addition, the characterization of CGF preparation protocols and CGF's components was not performed in most studies. Further studies should make a consensus on standardized end-product of CGF including characterization of protocols and optimal ratio of CGF’ components. Defined algorithms and evidence-based protocols for the clinical use of CGF should be also available.
Analysis of Narcotic Use in Isolated Facial Fractures: Potential Targets for a Narcotic Reduction Protocol
Authors: Morgan Austin C. , Davis Greta L. , Mehta Ishan H. , Stark Phoebe , Paap Michael K. , Gosman Amanda A.
Published: October 2020

Anecdotal evidence suggests that patients with isolated traumatic facial fractures have high narcotic usage, yet there is a lack of literature delineating this relationship. This study aimed to characterize total amount and factors predictive of narcotic usage following isolated traumatic facial fracture. Study participants (n = 35) were predominantly male (91.4%), mean age 40.5, Caucasian (34.3%), suffered some form of assault (62.9%), and remained hospitalized for an average of 3.0 days. Average morphine milligram equivalent (MME) use in the inpatient setting was 967.6 for operative (n = 30) and 37.5 for nonoperative (n = 5) patients. Average total narcotic use across inpatient and outpatient settings was 1256.6 MME for operative and 105 MME for nonoperative patients. Operative intervention predicted a significant difference in total inpatient narcotic usage (P = 0.009). For patients who underwent surgical intervention, significant variations in narcotic usage were found based on mechanism of injury (24-hour postoperative, P = 0.030), but not injury severity or number of procedures. Specifically, individuals suffering highly traumatic fractures (eg, gunshot wound) demonstrated increased total postoperative narcotic usage of 1194.1 MME (P = 0.004). Interestingly, non-narcotic analgesic use including acetaminophen and lidocaine-epinephrine resulted in significantly lower narcotic usage in the postoperative setting. These findings suggest a role for narcotic-reducing enhanced recovery after surgery protocols in the setting of isolated facial trauma.
Performance Assessment of Subjects With Nursing Education Trained in Sigmoidoscopy by Means of a Simulator
Authors: Dokoutsidou Eleni , Alodat Moussa , Mavrogiannis Christos , Georgiou Konstantinos , Giannakoulopoulou Eleftheria , Galanis Petros , Loukas Constantinos , Enochsson Lars , Georgiou Evangelos
Published: October 2020

Reports evaluating simulation-based sigmoidoscopy training among nurses are scarce. The aim of this prospective nonrandomized study was to assess the performance of nurses in simulated sigmoidoscopy training and the potential impact on their performance of endoscopy unit experience, general professional experience, and skills in manual activities requiring coordinated maneuvers. Forty-four subjects were included: 12 nurses with (Group A) and 14 nurses without endoscopy unit experience (Group B) as well as 18 senior nursing students (Group C). All received simulator training in sigmoidoscopy. Participants were evaluated with respect to predetermined validated metrics. Skills in manual activities requiring coordinated maneuvers were analyzed to draw possible correlations with their performance. The total population required a median number of 5 attempts to achieve all predetermined goals. Groups A and C outperformed Group B regarding the number of attempts needed to achieve the predetermined percentage of visualized mucosa (p = .017, p = .027, respectively). Furthermore, Group A outperformed Group B regarding the predetermined duration of procedure (p = .046). A tendency was observed for fewer attempts needed to achieve the overall successful endoscopy in both Groups A and C compared with Group B. Increased score on playing stringed instruments was associated with decreased total time of procedure (r
s = −.34, p = .03) and with decreased number of total attempts for successful endoscopy (r
s = −.31, p = .046). This study suggests that training nurses and nursing students in simulated sigmoidoscopy is feasible by means of a proper training program. Experience in endoscopy unit and skills in manual activities have a positive impact on the training process.
Does the Emergency Surgery Score predict failure to discharge the patient home? A nationwide analysis
Authors: AlSowaiegh Reem , Naar Leon , Mokhtari Ava , Parks Jonathan J. , Fawley Jason , Mendoza April E. , Saillant Noelle N. , Velmahos George C. , Kaafarani Haytham M.A.
Published: October 2020

BACKGROUND

The Emergency Surgery Score (ESS) is a point-based scoring system validated to predict mortality and morbidity in emergency general surgery (EGS). In addition to demographics and comorbidities, ESS accounts for the acuity of disease at presentation. We sought to examine whether ESS can predict the destination of discharge of EGS patients, as a proxy for quality of life at discharge.

METHODS

Using the 2007 to 2017 American College of Surgeons National Surgical Quality Improvement Program database, we identified all EGS patients. EGS cases were defined as per American College of Surgeons National Surgical Quality Improvement Program as those performed by a general surgeon within a short interval from diagnosis or the onset of related symptomatology, when the patient’s well-being and outcome may be threatened by unnecessary delay and patient’s status could deteriorate unpredictably or rapidly. Emergency Surgery Score patients were then categorized by their discharge disposition to home versus rehabilitation or nursing facilities. All patients with missing ESS or discharge disposition and those discharged to hospice, senior communities, or separate acute care facilities were excluded. Emergency Surgery Score was calculated for each patient. C statistics were used to study the correlation between ESS and the destination of discharge.

RESULTS

Of 6,485,915 patients, 84,694 were included. The mean age was 57 years, 51% were female, and 79.6% were discharged home. The mean ESS was 5. Emergency Surgery Score accurately and reliably predicted the discharge destination with a C statistic of 0.83. For example, ESS of 1, 10, and 20 were associated with 0.9%, 56.5%, and 100% rates of discharge to a rehabilitation or nursing facility instead of home.

CONCLUSION

Emergency Surgery Score accurately predicts which EGS patients require discharge to rehabilitation or nursing facilities and can thus be used for preoperatively counseling patients and families and for improving early discharge preparations, when appropriate.

LEVEL OF EVIDENCE

Prognostic and epidemiological, level III.
Naturally occurring fluorescence protects the eutardigrade
Paramacrobiotus
sp. from ultraviolet radiation
Authors: Suma Harikumar R. , Prakash Swathi , Eswarappa Sandeep M.
Published: October 2020

Naturally occurring fluorescence has been observed in multiple species ranging from bacteria to birds. In macroscopic animals such as birds, fluorescence provides a visual communication signal. However, the functional significance of this phenomenon is unknown in most cases. Though photoprotection is attributed to fluorescence under ultraviolet (UV) light in some organisms, it lacks direct experimental evidence. Here, we demonstrate naturally occurring fluorescence under UV light in a eutardigrade belonging to the genus
Paramacrobiotus
. Using a natural variant that lacks fluorescence, we show that the fluorescence confers tolerance to lethal UV radiation. Remarkably, the fluorescent extract from
Paramacrobiotus
sp. could protect the UV-sensitive tardigrade
Hypsibius exemplaris
and nematode
Caenorhabditis elegans
from germicidal UV radiation. We propose that
Paramacrobiotus
sp. possess a protective fluorescent shield that absorbs harmful UV radiation and emits harmless blue light.
Flow and epiphyte growth effects on the thermal, optical and chemical microenvironment in the leaf phyllosphere of seagrass (
Zostera marina
)
Authors: Noisette Fanny , Depetris Anna , Kühl Michael , Brodersen Kasper Elgetti
Published: October 2020

Intensified coastal eutrophication can result in an overgrowth of seagrass leaves by epiphytes, which is a major threat to seagrass habitats worldwide, but little is known about how epiphytic biofilms affect the seagrass phyllosphere. The physico-chemical microenvironment of
Zostera marina
L. leaves with and without epiphytes was mapped with electrochemical, thermocouple and scalar irradiance microsensors as a function of four irradiance conditions (dark, low, saturating and high light) and two water flow velocities (approx. 0.5 and 5 cm s
−1
), which resemble field conditions. The presence of epiphytes led to the build up of a diffusive boundary layer and a thermal boundary layer which impeded O
2
and heat transfer between the leaf surface and the surrounding water, resulting in a maximum increase of 0.8°C relative to leaves with no epiphytes. Epiphytes also reduced the quantity and quality of light reaching the leaf, decreasing plant photosynthesis. In darkness, epiphyte respiration exacerbated hypoxic conditions, which can lead to anoxia and the production of potential phytotoxic nitric oxide in the seagrass phyllosphere. Epiphytic biofilm affects the local phyllosphere physico-chemistry both because of its metabolic activity (i.e. photosynthesis/respiration) and its physical properties (i.e. thickness, roughness, density and back-scattering properties). Leaf tissue warming can lead to thermal stress in seagrasses living close to their thermal stress threshold, and thus potentially aggravate negative effects of global warming.
Tipping point and noise-induced transients in ecological networks
Authors: Meng Yu , Lai Ying-Cheng , Grebogi Celso
Published: October 2020

A challenging and outstanding problem in interdisciplinary research is to understand the interplay between transients and stochasticity in high-dimensional dynamical systems. Focusing on the tipping-point dynamics in complex mutualistic networks in ecology constructed from empirical data, we investigate the phenomena of noise-induced collapse and noise-induced recovery. Two types of noise are studied: environmental (Gaussian white) noise and state-dependent demographic noise. The dynamical mechanism responsible for both phenomena is a transition from one stable steady state to another driven by stochastic forcing, mediated by an unstable steady state. Exploiting a generic and effective two-dimensional reduced model for real-world mutualistic networks, we find that the average transient lifetime scales algebraically with the noise amplitude, for both environmental and demographic noise. We develop a physical understanding of the scaling laws through an analysis of the mean first passage time from one steady state to another. The phenomena of noise-induced collapse and recovery and the associated scaling laws have implications for managing high-dimensional ecological systems.