bluuebunny/crossref_metadata_2025 huggingface dataset:
Laser-Trélat sign improved after the resection of a tiny ground-grass nodule: a case report
Authors: Nagata Masashi , Otani Shinichi , Kanai Yoshihiko , Yamamoto Shinichi , Tsubochi Hiroyoshi , Endo Shunsuke
Published: June 2021

The Laser-Trélat sign refers to eruptive seborrheic keratoses accompanied by internal malignancies, mainly abdominal advanced ones. Detailed associations remain unclear, and the skin lesions do not improve with the treatment of internal malignancies in half of the patients. Herein, we report a rare case of Laser-Trélat sign that improved after resection of a 0.6-cm pulmonary ground-glass nodule: adenocarcinoma in situ. The patient requested the resection with the hopes of improving the skin lesions, though immediate resection was not indicated oncologically. With informed consent, despite possible failure in improving cutaneous diseases, thoracoscopic partial resection of the right lower lobe was performed. Fortunately, her seborrheic keratoses substantially improved after the resection, without exacerbation. To our knowledge, this is the first report describing such a clinical course. It is essential to inform patients regarding the indication of treatment for internal malignancy and its limitation in improving eruptive seborrheic keratoses.
Treatment of relapsing Plasmodium vivax malaria during pregnancy
Authors: Spiegelenberg Janneke P , Bastiaens Guido J H , Hassing Robert-Jan
Published: June 2021

This case of a pregnant refugee from Eritrea supports the evidence that chloroquine prophylaxis is suitable for suppressing relapses of P. vivax until radical cure with primaquine is possible.
Development of an LC-MS/MS Method for Measurement of Irinotecan and Its Major Metabolites in Plasma: Technical Considerations
Authors: Aoullay Zineb , Van Wijk Xander M R , Yanhui Ma , Meddah Bouchra , Lynch Kara L , Cherrah Yahia , Wu Alan H B
Published: June 2021

Objective

Irinotecan (CPT-11) is an important drug used in the treatment of several solid tumor types. To minimize its toxicity, therapeutic drug monitoring of CPT-11 and its major metabolites (SN-38, SN-38-glucuronide [SN-38G], and APC) has been proposed. We aimed to develop a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the quantification of CPT-11 and its major metabolites in plasma.

Methods

Specimen preparation consisted of protein precipitation, evaporation, and reconstitution. Analyses were performed on a C18 column using reverse-phase gradient elution. Electrospray ionization and multiple reaction monitoring in positive mode were used for MS. The following heavy isotope–labeled internal standards were used: CPT-11 D10, SN-38 D3, SN-38G D3, and APC D3.

Results

We found that CPT-11, SN-38G, and APC eluted at ~4.6 to 4.7 minutes, and SN-38 eluted at ~5.1 to 5.2 minutes. A second peak for SN-38 was detected at ~4.6 to 4.7 minutes. Given that the structure of SN-38 is found in CPT-11, SN-38G, and APC, and in the CPT-11 D10 used here, in-source fragmentation was the likely cause. In addition, we found that a low-level SN-38 impurity was present in CPT-11 D10 and to a lesser extent in SN-38 D3.

Conclusion

When developing methods for CPT-11 and its metabolites, it is important to consider the effects of in-source fragmentation and the choice of internal standards.
Influence of the menopausal transition on polysomnographic sleep characteristics: a longitudinal analysis
Authors: Matthews Karen A , Lee Laisze , Kravitz Howard M , Joffe Hadine , Neal-Perry Genevieve , Swanson Leslie M , Evans Marissa A , Hall Martica H
Published: June 2021

Study Objectives

To evaluate how change in menopausal status related to spectral analysis and polysomnographic measures of sleep characteristics.

Methods

The Study of Women’s Health Across the Nation (SWAN) Ancillary Sleep Study evaluated sleep characteristics of 159 women who were initially pre- or early perimenopausal and repeated the assessment about 3½ years later when 38 were pre- or early perimenopausal, 31 late perimenopausal, and 90 postmenopausal. Participants underwent in-home ambulatory polysomnography for two to three nights. Average EEG power in the delta and beta frequency bands was calculated during NREM and REM sleep, and sleep duration, wake after sleep onset (WASO), and apnea hypopnea index (AHI) were based on visually-scored sleep.

Results

The women who transitioned to postmenopause had increased beta NREM EEG power at the second assessment, compared to women who remained pre-or early premenopausal; no other sleep measures varied by change in menopausal status. In multivariate models the associations remained; statistical controls for self-reported hot flashes did not explain findings. In secondary analysis, NREM beta power at the second assessment was greater among women who transitioned into the postmenopause after adjustments for initial NREM beta power.

Conclusions

Sleep duration and WASO did not vary by menopause transition group across assessments. Consistent with prior cross-sectional analysis, elevated beta EEG power in NREM sleep was apparent among women who transitioned to postmenopause, suggesting that independent of self-reported hot flashes, the menopausal transition is associated with physiological hyperarousal during sleep.
Inclusive and Included? Practices of Civic Inclusivity of American Muslims in Los Angeles
Authors: Cantori Valentina
Published: June 2021

How do American Muslims practice inclusivity and bridge religious differences in U.S. civic life? Sociological research on bridging focuses mostly on bridging efforts on the part of majority groups, leaving unanswered the timely question of if and how inclusivity is practiced by minority groups, particularly religious minorities, in U.S. civic spaces. Drawing on participant observation among two Muslim groups in Los Angeles, this paper identifies two practices of inclusivity that participants adopt to bridge religious difference: the interreligious heritage practice and the shared ethics practice. Both practices simultaneously draw and diffuse group boundaries, emphasize sameness, albeit using different sets of religious meanings, and are grounded in an understanding of civic spaces as implicitly exclusionary of minorities. I find that these practices can create tension points in the pursuit of mutual understanding and create textures of meanings that operate differently depending on the situation and the participants in the interaction.
Woodsmoke Extracts Cross-Link Proteins and Induce Cornified Envelope Formation without Stimulating Keratinocyte Terminal Differentiation
Authors: Lin Lo-Wei , Denison Michael S , Rice Robert H
Published: June 2021

Air pollution poses a serious risk to human health. To help understand the contribution of smoke from wood burning to the harmfulness of air pollution toward the skin, we studied the effects of liquid smoke, aqueous extracts of wood smoke condensate, a commercially available food flavor additive, in cultured keratinocytes. We report that liquid smoke can react with and cross-link keratinocyte cellular proteins, leading to abnormal cross-linked envelope formation. Instead of inducing genes ordinarily involved in terminal differentiation, liquid smoke induced expression of genes associated with stress responses. When transglutaminase activity was inhibited, liquid smoke still promoted protein cross-linking and envelope formation in keratinocytes. This phenomenon likely results from oxidative stress and protein adducts from aldehydes as either preloading the cells with N-acetylcysteine or reducing the aldehyde content of liquid smoke decreased its ability to promote protein cross-linking and envelope formation. Finally, liquid smoke-induced envelopes were found to have elevated protein content, suggesting oxidative cross-linking and formation of protein adducts might impair barrier function by inducing abnormal incorporation of cellular proteins into envelopes. Since the cross-linked protein envelope provides structural stability to the stratum corneum and serves as a scaffold for the organization of the corneocyte lipid envelope (hydrophobic barrier to the environment), these findings provide new insight into the mechanism by which pro-oxidative air pollutants can impair epidermal function.
Hormones and carbohydrates are both involved in the negative effects of reproduction on vegetative bud outgrowth in the mango tree: consequences for irregular bearing
Authors: Capelli Mathilde , Lauri Pierre-Éric , Léchaudel Mathieu , Normand Frédéric
Published: June 2021

The negative effects of fruit production during one cycle on reproduction during the following cycle are generally explained by two complementary processes: hormone synthesis and carbohydrate mobilization. Our study focused on mango (Mangifera indica L.) for which it has been shown that reproduction decreases and delays vegetative bud outgrowth. This, in turn, affects flowering and fruiting in the following cycle. Vegetative growth therefore plays a pivotal role in irregular fruit production patterns across consecutive years. Our aim was to decipher the respective roles of hormones and carbohydrates on the negative effects of reproduction on vegetative growth. We analyzed the changes in various hormone (auxin, cytokinin, abscisic acid) and carbohydrate (glucose, sucrose, starch) concentrations in terminal axes with vegetative and reproductive fates of two mango cultivars, Cogshall and José, characterized by different bearing patterns, across consecutive phenological periods during a growing cycle. Auxin concentrations were high in inflorescences, fruit peduncles and axes bearing inflorescences or fruit, suggesting auxin-induced inhibition of vegetative bud outgrowth in the flowering and fruiting axes. Moreover, growing fruits, which are strong sink organs, depleted carbohydrates from non-fruiting axes. During vegetative growth, this starch depletion probably contributed to decreasing the probability of and to delaying vegetative bud outgrowth of reproductive axes for Cogshall, and of reproductive and nonreproductive axes for José. Starch dynamics in quiescent and flowering growth units during early fruit growth and their starch concentrations at fruit maturity differed between the two cultivars, presumably in relation to the observed contrasted crop loads and/or to differences in photosynthetic capacity or carbohydrate allocation. These differences between the two cultivars in terms of starch concentration in terminal axes during vegetative growth could partly explain their different bearing patterns.
PtrMYB120 functions as a positive regulator of both anthocyanin and lignin biosynthetic pathway in a hybrid poplar
Authors: Kim Min-Ha , Cho Jin-Seong , Bae Eun-Kyung , Choi Young-Im , Eom Seok Hyun , Lim You Jin , Lee Hyoshin , Park Eung-Jun , Ko Jae-Heung
Published: June 2021

Both anthocyanins and lignins are essential secondary metabolites in plant growth and development. Their biosynthesis is metabolically interconnected and diverges in the central metabolite 4-coumaroyl CoA of the phenylpropanoid pathway. Considerable progress has been made in understanding transcriptional regulation of genes involved in lignin and anthocyanin synthesis pathways, but the concerted regulation of these pathways is not yet fully understood. Here, we functionally characterized PtrMYB120, a R2R3-MYB transcription factor from Populus trichocarpa. Overexpression of PtrMYB120 in a hybrid poplar (i.e., 35S::PtrMYB120) was associated with increased anthocyanin (i.e., cyanidin 3-O-glucoside) accumulation and upregulation of anthocyanin biosynthetic genes. However, transgenic poplars with dominant suppression of PtrMYB120 function achieved by fusing the ERF-associated amphiphilic repression motif to PtrMYB120 (i.e., 35S::PtrMYB120-SRDX) had a dramatic decrease in not only anthocyanin but also Klason lignin content with downregulation of both anthocyanin and lignin biosynthetic genes. Indeed, 35S::PtrMYB120-SRDX poplars had irregularly shaped xylem vessels with reduced S-lignin content in stems, which was proportionally related to the level of the introduced PtrMYB120-SRDX gene. Furthermore, protoplast-based transcriptional activation assay using the PtrMYB120-GR system suggested that PtrMYB120 directly regulates genes involved in both anthocyanin and lignin biosynthesis, including chalcone synthase and ferulate-5 hydroxylase. Interestingly, the saccharification efficiency of line #6 of 35S::PtrMYB120-SRDX poplars, which had slightly reduced lignin content with a normal growth phenotype, was dramatically enhanced (>45%) by NaOH treatment. Taken together, our results suggest that PtrMYB120 functions as a positive regulator of both anthocyanin and lignin biosynthetic pathways and can be targeted to enhance saccharification efficiency in woody perennials.
A comprehensive analysis of genetic diversity of EBV reveals potential high-risk subtypes associated with nasopharyngeal carcinoma in China
Authors: Xue Wen-Qiong , Wang Tong-Min , Huang Jing-Wen , Zhang Jiang-Bo , He Yong-Qiao , Wu Zi-Yi , Liao Ying , Yuan Lei-Lei , Mu Jianbing , Jia Wei-Hua
Published: June 2021

Epstein–Barr virus (EBV), a widespread oncovirus, is associated with multiple cancers including nasopharyngeal carcinoma (NPC), gastric cancer and diverse lymphoid malignancies. Recent studies reveal that specific EBV strains or subtypes are associated with NPC development in endemic regions. However, these NPC specific subtypes were only identified in a portion of infected individuals due possibly to the limited samples size studied or the complicated population structures of the virus. To identify additional high-risk EBV subtypes, we conducted a comprehensive genetic analysis of 22 critical viral proteins by using the largest dataset of 628 EBV genomes and 792 sequences of single target genes/proteins from GenBank. The phylogenetic, principal component and genetic structure analyses of these viral proteins were performed through worldwide populations. In addition to the general Asia-Western/Africa geographic segregation, population structure analysis showed a ‘Chinese-unique’ cluster (96.57% isolates from China) was highly enriched in the NPC patients, compared to the healthy individuals (89.6% vs. 44.5%, P < 0.001). The newly identified EBV subtypes, which contains four Chinese-specific NPC-associated amino acid substitutions (BALF2 V317M, BNRF1 G696R, V1222I and RPMS1 D51E), showed a robust positive association with the risk of NPC in China (Odds Ratio = 4.80, 20.00, 18.24 and 32.00 for 1, 2, 3 and 4 substitutions, respectively, Ptrend <0.001). Interestingly, the coincidence of positively selected sites with NPC-associated substitutions suggests that adaptive nonsynonymous mutation on critical proteins, such as BNRF1, may interact with host immune system and contribute to the carcinogenesis of NPC. Our findings provide a comprehensive overview of EBV genetic structure for worldwide populations and offer novel clues to EBV carcinogenesis from the aspect of evolution.
Transition to Practice and Back Again: The Journey Into Nursing Academia
Authors: Ruiz Diana , Gonzales Minerva
Published: June 2021

There is little research on the transition of experienced nurses from acute/clinical practice to academia. The transition into a faculty role can be overwhelming, isolating, and intimidating, even for expert nurse leaders and clinicians. This article presents the journey of two experienced nurse leaders who transitioned into academia and explores how to overcome challenges during the transition period.
An Auxiliary Medical Education: The Evolution of a Medical Student-Founded Organization in Response to the COVID-19 Era Personal Protective Equipment Shortage
Authors: Sayyed Adaah , Baker Melissa L. , Peesay Tejasvi , Rooney Allison , Syed Zuby
Published: June 2021

At the outset of the COVID-19 pandemic, many medical students were removed from clinical duties and had their education put on hold. Some found novel ways to join efforts to respond to the pandemic. Georgetown University School of Medicine medical students created Medical Supply Drive (MSD or MedSupplyDrive), a 501(c)(3), on March 17, 2020, in response to the national shortage of personal protective equipment (PPE). This article reviews the formation of a national response to the pandemic, the methods employed to distribute PPE, and the results of MSD’s work from March 17, 2020, through June 20, 2020. A focus was placed on equitable distribution, both within local regions and on the national scale, by distinguishing COVID-19 hotspots, including Native American reservations. As of June 20, 2020, over half a million items were donated, with 1,001 deliveries made to 423 hospitals, 182 clinics, 175 long-term care facilities, 25 homeless shelters, 32 public health departments, and 164 other facilities. From 46 states and the District of Columbia, 1,514 individuals volunteered, and 202 signed up as regional coordinators. MSD formed 2 international organizations, MedSupplyDrive UK and MedSupplyDrive Scotland, and established U.S.-based partnerships with 19 different PPE and aid organizations. MSD gained local, national, and international media attention with over 45 interviews conducted about the organization. While the pandemic temporarily disrupted formal medical education, MSD empowered medical students to actively learn about the needs of their communities and organize ways to address them while incorporating these values into their professional identities. The framework that this organization employed also provides a potential model for future disaster relief efforts in times of crisis. MSD hopes to motivate budding physicians to collaborate and play an active role in tackling public health inequities beyond hospitals and within the communities students will one day serve.
Intraoperative neuromonitoring during distal femoral extension osteotomy in children with cerebral palsy
Authors: Erdal Ozan A. , Gorgun Baris , Sarikaya Ilker A. , Inan Muharrem
Published: June 2021

The most common treatment method for a fixed knee flexion contracture more than 10 degrees in cerebral palsy (CP) is distal femoral extension osteotomy (DFEO). However, a serious complication after a DFEO is neurological impairment. Its rates were reported as 5– 40%. Intraoperative neuromonitoring (IONM), widely used in spinal surgery and in other fields, is a valuable tool to define any neurological injury during operation. The aim of our study was to determine surgical steps with risk of neurological injury and to report if precautions would be effective in recovering signal loss. We performed IONM during DFEO of 23 knees of 12 children with CP. IONM was performed by recording somatosensory evoked potentials, transcranial motor evoked potentials and free-run electromyography during defined steps throughout the surgery. Preoperative and postoperative popliteal angles, flexion contractures and physeal posterior distal femoral angles were evaluated. We detected alert signals at osteotomy or manipulation steps of surgeries of all patients. We observed persistent alert signals in two cases (2 out of 23 knees; Group 2). In this group, the action potentials recovered only after 5 and 10 degrees of undercorrection at the osteotomy sites. Alert signals disappeared after a brief period of waiting in other cases. Throughout mean 37 months of follow-up, none of our patients experienced any neurological complication. The study concludes that the surgical steps in DFEO with a higher risk for a neurological complication were the osteotomy and manipulation steps. Alert signals were detected with the help of IONM, and preventive measures were effective in recovering neuromonitoring recordings.
The use of real-time sonography-assisted fracture reduction in children with displaced forearm fractures
Authors: Kotlarsky Pavel , Feldman Oren , Shavit Itai , Eidelman Mark
Published: June 2021

Pediatric forearm and wrist fractures are common; furthermore, some are displaced and require manipulation and reduction. The procedure is commonly performed without real-time image guidance and evaluated radiographically after reduction and casting, leading to multiple reduction attempts and malalignment. Although fluoroscopy can provide real-time assessment of fracture alignment during the procedure, it is not readily available in many emergency departments (EDs) and involves radiation exposure. Ultrasonography is an alternative real-time imaging modality that is inexpensive and readily available. The purpose of this study was to determine whether the use of real-time bedside sonography during closed reduction of distal and middle third forearm fractures can decrease the number of reduction attempts and reduce the number of patients requiring surgery. We compared the results of a conventional blind manipulation, fracture reduction, and casting to fracture reduction under real-time ultrasonographic guidance, in patients treated in our ED between 2014 and 2016. Overall, 458 patients with distal or middle third fractures were included. Of these reductions, 289 were performed without real-time imaging (group 1) and 169 under real-time ultrasound guidance (group 2). In group 1, 10% of patients required re-reduction, and 5% of patients needed surgery. In group 2, only one patient (0.6%) required re-reduction and 1% of patients required surgery due to fracture instability. In conclusion, the current study shows that real-time ultrasound-guided forearm fracture reduction is an effective and inexpensive method for correction of displaced forearm and wrist fractures in children, which does not involve any radiation exposure.
Validated Outcome Measures and Postsurgical Scar Assessment Instruments in Auricular Surgery: A Systematic Review
Authors: Chu Sherman , Ramanathan Diya , Thuener Jason E. , Carroll Bryan T.
Published: June 2021

BACKGROUND

The utilization of an assessment instrument that successfully analyzes validated outcome measures for auricular surgery is important for advancing evidence-based medicine.

OBJECTIVE

To systematically review postsurgical scar assessment instruments and outcome measures after auricular surgery to assess if any individual or combination of 2 assessment instruments encompass all relevant, validated auricular outcome measures.

METHODS

Two systematic reviews were conducted using the PubMed/MEDLINE and Ovid databases: one for postauricular surgical outcome measures and another for postsurgical scar assessment instruments. Auricular outcome measure articles were selected for inclusion if they included at least one auricular-specific validated outcome measure, and assessment tool articles were included if they referenced one or more specific tool(s) specifically designed to assess postsurgical scars. Assessment tools were evaluated based on which outcome measures each covered.

RESULTS

There was no single postsurgical scar assessment instrument or combination of 2 instruments that covered all outcome measures within the 5 different categories (psychosocial well-being, functional, objective appearance, subjective appearance, and clinical-related outcomes) after auricular surgery. None of the instruments measured functional outcomes, such as the ability to wear glasses and hearing outcomes.

CONCLUSION

There is currently no existing postsurgical scar assessment instrument that covers all outcome measures after auricular surgery.
Spirituality in Pregnancy
Authors: Keegan Mary B.
Published: June 2021

Spirituality with its impact on health outcomes continues to emerge in the medical literature. This article discusses the role of spirituality in pregnancy, childbirth, and postpartum. It highlights the importance of more fully integrating this concept into births traditionally attended by physicians and midwives in the hospital setting. This discussion covers birthing practices ingrained with culture and spirituality. The article concludes with strategies to elicit and integrate spirituality into routine practice to provide improved health care to patients and to find more fulfillment in the role as birth attendant.
Peak Efficiency of NaI Detector and Coincidence Summing Factor for Different Cylindrical Sources Using Geant4 Simulation
Authors: Alzahrani Jamila S. , Almuqrin Aljawhara H.
Published: June 2021

Geant4 simulation is used to calculate peak efficiency and correct the effect of coincidence summing in detecting volumetric gamma-ray sources; this simulation was applied to a standard 152Eu source with different volumes as a test case. The source is a liquid cylindrical shape of various volumes. Peak efficiency was calculated using two tracks in the Geant4 simulation: single-energy track and “monoenergetic Track” without coincidence summing. Here, the energy of the source is known, and the track of radionuclides, including the coincidence summing, depends on the decay scheme of the radioactive source. The ratio between the peak efficiency of the two tracks gives us the correction factor (CF). The experimental method was used to calculate the peak efficiency and was amended by the correction factor computed with Geant4 tracks. The results showed a good agreement between experimental efficiency after correction and free-summing simulated efficiency. The comparison indicated that the present method is valid and useful for voluminous gamma-ray sources.
Clinical significance of olfactory dysfunction in patients of COVID-19
Authors: Chang Chin-Chuan , Yang Ming-Hui , Chang Shu-Min , Hsieh Ya-Ju , Lee Che-Hsin , Chen Yi-Ming Arthur , Yuan Cheng-Hui , Chen Yi-Ling , Ho Sheng-Yow , Tyan Yu-Chang
Published: June 2021

Background:

Currently, as the coronavirus disease (COVID-19) has become a pandemic, rapidly obtaining accurate information of patient symptoms and their progression is crucial and vital. Although the early studies in China have illustrated that the representative symptoms of COVID-19 include (dry) cough, fever, headache, fatigue, gastrointestinal discomfort, dyspnea, and muscle pain, there is increasing evidence to suggest that olfactory and taste disorder are related to the COVID-19 pandemic. Therefore, we conduct this study to review the present literature about the correlation between anosmia or dysgeusia and COVID-19.

Methods:

A comprehensive literature search in 2020 of the electronic journal databases, mainly PubMed or Web of Science, was performed using the keywords COVID-19 or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with hyposmia, anosmia, dysgeusia, olfactory disorder, or olfactory dysfunction. The country, study period, case number, inpatient or outpatient medical visit, evaluation method (subjective complaints of dysfunction or objective evaluation), and occurrence rate of olfactory or gustatory function were reviewed.

Results:

Many studies reported that the recoverable olfactory or gustatory dysfunction may play an important role as the early clinical symptom of COVID-19. It is associated with better prognosis, although further investigation and validation should be carried out.

Conclusion:

Studies have shown that smell and taste disturbances may represent an early symptom of COVID-19 and healthcare professionals must be very vigilant when managing patients with these symptoms. In the pandemic era, this implies testing for COVID-19 by healthcare workers with full personal protective equipment.
The Effect of the Neuman Systems Model on Anxiety in Patients Undergoing Coronary Artery Bypass Graft: A Randomized Controlled Trial
Authors: AKHLAGHI Elham , BABAEI Sima , MARDANI Abbas , ESKANDARI Fatemeh
Published: June 2021

Background

Coronary artery bypass graft (CABG) surgery is the most commonly used surgical procedure for patients with coronary artery disease. Anxiety is a significant psychological problem associated with CABG surgery that may reduce related treatment outcomes.

Purpose

This study was designed to investigate the effect on anxiety of applying the Neuman Systems Model in patients awaiting and undergoing CABG surgery.

Methods

A single-blind, parallel-group randomized controlled trial was conducted on patients scheduled to receive coronary artery bypass surgery in an urban area of Iran. Seventy participants were enrolled using a convenience sampling method and randomly assigned to either the intervention group (n = 35) or the control group (n = 35). Participants in the intervention group received intervention in accordance with the Neuman Systems Model format, including meetings held at three levels of prevention. Patients' anxiety was measured using the State Anxiety Inventory before the intervention, immediately after the intervention, and at discharge time. The chi-square test, Fisher's exact test, independent sample t test, one-way repeated measures analysis of variance test, and Fisher's least significant difference were used to analyze the data.

Results

No significant difference was found between the mean anxiety scores of the two groups before the intervention (p = .48, t = 0.71). However, the mean anxiety score of the intervention group was significantly lower than that of the control group immediately after the intervention (p = .008, t = 2.73) and at discharge time (p = .007, t = 2.77).

Conclusions

The Neuman-based program is an effective and low-cost intervention that may be applied to reduce anxiety in patients awaiting and undergoing CABG surgery. This program may be a good guide in providing healthcare services.
A Health Surveillance Study of Workers Employed at a Copper Smelter—Effects of Long-Term Exposure to Copper on Lung Function Using Spirometric Data
Authors: Haase Lisa-Marie , Birk Thomas , Bachand Annette M. , Mundt Kenneth A.
Published: June 2021

Objective:

Significantly lower permissible occupational exposure limits for copper dust are being discussed in Europe and other jurisdictions. However, little data are published on exposures in occupational settings and copper-specific effects in humans. Hence, a health surveillance study was performed among workers employed at a copper smelter between 1972 and 2018.

Methods:

Possible effects of long-term exposures to dust containing copper on lung function were assessed. Specifically, declines in forced expiratory volume in 1 second (FEV1) were compared between a copper-exposed and control group. Cumulative copper exposures were derived from historical airborne monitoring data.

Results:

FEV1 declines among exposed and control never smokers were similar to a typical age-dependent decline of 29 mL/y.

Conclusion:

The study findings indicate that cumulative inhalable copper dust exposure averaging 4.61 mg/m3-years over an exposure duration of ∼22 years is not associated with adverse effects on lung function.
Biotensegrity Focused Therapy for Pelvic Organ Prolapse: A Nonrandomized Prospective Clinical Case Series
Authors: Crowle Anna , Harley Clare
Published: June 2021

Background:

Traditional treatments for pelvic organ prolapse (POP) assume weak pelvic tissue as the cause. Pelvic floor muscle training has been shown to improve POP symptoms but not prolapse stage and does not reduce rates of referral for future treatment (eg, pessary or surgery). An alternative hypothesis is proposed that excessive tissue stiffness causes tension and pulling, which disrupts pelvic organ arrangement.

Objectives:

Treating pelvic tissue stiffness through Biotensegrity Focused Therapy is anticipated to improve organ position and prolapse symptoms.

Study Design:

Nonrandomized prospective clinical case series.

Methods:

Women presenting to a private physiotherapy practice in the United Kingdom with POP received Biotensegrity Focused Therapy. Treatment included a series of 1-hour physiotherapy sessions focusing on identifying areas of stiff pelvic tissue and using a direct myofascial release technique to normalize elasticity to restore dynamic equilibrium within the pelvis. Prolapse grade (mild, moderate, severe), pelvic floor strength (Modified Oxford Grading Scale), and self-reported symptoms (Pelvic Floor Distress Inventory, PFDI-20) were assessed at baseline and after final treatment.

Results:

Thirty-three women received treatment. At baseline, 23 of 33 (70%) women presented with moderate to severe prolapse. After final treatment, 3 of 33 (9%) women had moderate prolapse and 0 of 33 (0%) women had severe prolapse. A total of 12 of 33 (36%) women achieved complete recovery of organ position and shape. A total of 27 of 33 (81.82%) women improved by at least 1 prolapse stage. Pelvic floor strength improved from mean: 1.28 (SD: 0.85) at baseline to 3.33 (SD: 0.78) after final treatment. Self-reported PFDI-20 scores corroborated clinical observations, reducing from mean: 98.77 (SD: 42.43) at baseline to 49.87 (SD: 27.28) after final treatment, suggesting a clinically meaningful improvement. Mean treatment received was 6.06 (SD: 2.28) sessions over a duration of 4.39 (SD: 2.46) months.

Discussion:

Biotensegrity Focused Therapy was shown to have a beneficial impact on organ position and prolapse symptoms and may be an appropriate treatment for women with POP.
Living with COVID-19: Voices from the grassroots
Authors: Sheer Barbara , Russell Naila
Published: June 2021

COVID-19 has had a significant impact on the lives of nurses. To capture these experiences, the AANP history committee sponsored a writing contest. The stories, essays, and poems were heartfelt and ranged from personal experiences to future implications. One essay entitled “The Five Stages of COVID Grief: One Nurse Practitioner's Coronavirus Story,” captured the essence of the time and is applicable to all nurses as we continue our journey and document our legacy. Using the framework of COVID Grief, this article seeks to outline the shared experience and range of emotions represented in the writing contest submissions. Through this lens, the Year of the Nurse and the toll of coronavirus can be framed by the emotions of disbelief, bitterness, guilt, fear and anxiety, and resilience.
Cost-sharing With Medicaid Expansion in Michigan
Authors: Hirth Richard A. , Cliff Betsy Q. , Kullgren Jeffrey T. , Ayanian John Z.
Published: June 2021

Background:

Six states expanding Medicaid under the Affordable Care Act have obtained waivers to incorporate cost-sharing.

Objective:

We describe the magnitude and distribution of cost-sharing imposed by the Healthy Michigan Plan and enrollees’ propensity to pay.

Research Design:

Enrollees are followed for at least 18 months (6-mo baseline period for utilization and spending before receipt of first cost-sharing statement; ≥12 mo follow-up thereafter to ascertain obligations and payments). Analyses stratified by income, comparing enrollees with income less than Federal Poverty Level (FPL) who faced only utilization-based copayments and those greater than or equal to FPL who also faced premium contributions.

Subjects:

A total of 158,322 enrollees aged 22–62 who initially enrolled during the first year of the program and remained continuously enrolled ≥18 months.

Results:

Among those enrolled ≥18 months, 51.0% faced cost-sharing. Average quarterly invoices were $4.85 ($11.11 for those with positive invoices) for income less than FPL and $26.71 ($30.93 for those with positive invoices) for incomes greater than or equal to FPL. About half of enrollees with obligations made at least partial payments, with payments being more likely among those >100% FPL. Payment of the full obligation was highest in the initial 6 months.

Conclusions:

Many payment obligations go uncollected, suggesting that in a system without the threat of disenrollment, the impacts of cost-sharing may be muted. Similarly, the ability of cost-sharing to defray the program’s budgetary impact may also be less than anticipated.
Seeing through the evidence for corneal neurotization
Authors: Jowett Nate , Pineda Roberto
Published: June 2021

Purpose of review

Trigeminal anesthesia causes neurotrophic keratopathy, which may yield facial disfigurement and corneal blindness.

Recent findings

We summarize approaches and evidence for corneal neurotization.

Regional sensory nerve transfer appears safe and effective for therapeutic management of neurotrophic keratopathy. Prospective randomized clinical trials are necessary to confirm the utility of corneal neurotization.
A Comparative Analysis of Reported Chlamydia and Gonorrhea Cases Among US Army Soldiers, 2015 to 2019
Authors: Jordan Nikki N. , Gaydos Joel C. , Garges Eric C.
Published: June 2021

Background

Chlamydia and gonorrhea have increased nationally and in the US Army. Rates reported in the Army are elevated relative to the general population, partly because of differing population demographics.

Methods

Age- and sex-specific chlamydia and gonorrhea case rates among Army active component soldiers and the wider 18- to 64-year-old US adult population were computed from reports submitted through national and military surveillance systems in 2015 to 2019. Rates were standardized using the 2015 Army age and sex population distribution. Multivariable generalized linear models were generated to evaluate associated risk factors.

Results

Army age- and sex-adjusted chlamydia rates (per 100,000 person-years) were nearly twice those of US adults (2019 rates, 2317 vs. 1241), whereas US age- and sex-adjusted gonorrhea rates surpassed Army rates (2019 rates, 536 vs. 396). Chlamydia and gonorrhea rates were significantly elevated in Army women younger than 25 years relative to US women aged 18 to 24 years (2015–2019 crude rates, 10,404 Army/4243 US for chlamydia and 1014 Army/694 US for gonorrhea). Gonorrhea rates were significantly elevated in US men aged 25 to 44 years (2015–2019 crude rates, 506 US/251 Army and 223 US/86 Army for men aged 25–34 and 35–44 years, respectively). Age, sex, and race-ethnicity were significantly associated with infection among soldiers.

Conclusions

Observed increases in chlamydia and gonorrhea and identified risk factors are consistent with those reported nationally. Higher adjusted chlamydia rates among soldiers may reflect greater individual or sexual network risks, screening biases, or increased health care access. The Army's lower adjusted gonorrhea rates may reflect differences in high-risk subgroups (e.g., men who have sex with men), differing sexual networks, or other confounders.
Head-mounted Visual Assistive Technology–related Quality of Life Changes after Telerehabilitation
Authors: Lorenzini Marie-Céline , Wittich Walter
Published: June 2021

SIGNIFICANCE

Head-mounted low vision devices have become a viable alternative to enhance residual vision. This study supports the use of a head-mounted display to improve aspects of functional vision and quality of life. Much is still unknown regarding the required frequency, duration, or potential effectiveness of this telerehabilitation training protocol or what characteristics best identify optimal users.

PURPOSE

A randomized study explored the effect of telerehabilitation on quality of life and functional vision in individuals with low vision using a head-mounted display.

METHODS

We recruited 57 participants (age, 21 to 82 years; mean, 54.5 years) among new prospective eSight Eyewear users, randomized 1:1 into two parallel groups; the experimental group received the telerehabilitation training provided by a low vision therapist, whereas the control group received the self-training standard offered by the device manufacturer and without involvement of a low vision therapist. The primary outcome measures were the impact of telerehabilitation on validated measures of assistive technology–related quality of life: the Psychosocial Impact of Assistive Devices Scale and the Quebec User Evaluation of Satisfaction with Assistive Technology scale. Exploratory outcomes were the assessment of self-reported functional vision using the Veterans Affairs Low Vision Visual Functioning Questionnaire-48 and cybersickness associated with head-mounted display use with the Simulator Sickness Questionnaire.

RESULTS

Assistive technology–related quality of life was improved when measured by the satisfaction scale but not the psychosocial scale within the first 3 months, independently of training type. Overall, functional vision improvement was observed within the first 2 weeks of device use and maintained during the 6-month study, independently of group type. Cybersickness outcomes were similar between training groups and did not change significantly for 6 months.

CONCLUSIONS

eSight Eyewear, either with telerehabilitation or with the manufacturer self-training comparison, improved functional vision and increased users' quality of life within the initial 3 months of device training and practice.
Evaluation of Corneal Densitometry and Endothelial Layer in Soft Contact Lens Users
Authors: Ozek Dilay , Karaca Emine Esra , Kazanci Burcu , Evren Kemer Ozlem
Published: June 2021

SIGNIFICANCE

Soft contact lens wear may lead to physiological changes in the cornea. Corneal densitometry is a new software tool that may detect these physiological changes by monitoring their effects on corneal transparency.

PURPOSE

This study aimed to assess corneal densitometry values and corneal endothelium in patients using soft contact lenses.

METHODS

The study included 36 eyes of 36 subjects with soft contact lens use (group 1) and 36 eyes of 36 healthy control subjects (group 2). Anterior segment parameters and corneal densitometry of all subjects were evaluated using Scheimpflug corneal topography (Pentacam; Oculus Inc., Wetzlar, Germany). A total corneal area of 12 mm was divided into four annular zones (0 to 2, 2 to 6, 6 to 10, and 10 to 12 mm) and into three regions as anterior, central, and posterior for densitometry examination. Cell density, cell distribution, and cell morphology (quadrangular, pentagonal, hexagonal, and other cell percentages) of the endothelial layer were examined in both groups using specular microscopy (Nidek CEM 530; Nidek Co., Gamagori, Aichi, Japan).

RESULTS

In group 1, the mean duration of contact lens wear was 4.45 ± 2.15 years. The anterior segment parameters were not significantly different between the two groups (P > .05). The anterior 0- to 2- and 2- to 6-mm corneal densitometry values were significantly higher in group 1 compared with group 2 (23.2 ± 4.7 for group 1 and 17.3 ± 5.6 for group 2 [P = .03]; 22.4 ± 6.4 for group 1 and 17.8 ± 1.4 for group 2 [P = .03], respectively). There were no significant differences between the groups for corneal densitometry values between 6 and 12 mm, or for cell density, cell distribution, and cell morphology (P > .05).

CONCLUSIONS

Although the cornea remains transparent in soft contact lens wearers, corneal densitometry may increase in the 0- to 6-mm annular zone of the anterior region.
Agreement of Fixation Disparity Curve between Two Different Instruments
Authors: Hashemi Hassan , Mirzaeian Maryam , Narooie Foroozan , Nabovati Payam , Yekta Abbasali , Ostadimoghaddam Hadi , Sardari Sara , Khabazkhoob Mehdi
Published: June 2021

SIGNIFICANCE

Fixation disparity tests with various characteristics of fusional stimulus are very important for assessment of decompensated heterophoria. The results suggest that there was no reasonable agreement between the fixation disparity curve's parameters of the modified near Mallett unit and the Sheedy disparometer.

PURPOSE

The purpose of this study was to determine the agreement of the fixation disparity curve parameters between the modified near Mallett unit and the Sheedy disparometer in patients with decompensated near heterophoria.

METHODS

A total of 147 young adults (mean age, 22.7 ± 4.8 years) participated in this cross-sectional study. After applying the exclusion criteria, the statistical analysis was done on the data of 134 individuals. All participants underwent preliminary optometric examinations including the measurement of uncorrected and best-corrected visual acuity, objective and subjective refraction, and unilateral and alternating cover tests. The fixation disparity was evaluated using the modified near Mallett unit and the Sheedy disparometer at 40 cm, and forced-vergence fixation disparity curves were generated.

RESULTS

There were statistically significant differences in the fixation disparity curve parameters (except the center of symmetry) between the two devices. The median fixation disparity measured by the Sheedy disparometer was more positive compared with the modified near Mallett unit (toward more esodisparity or less exodisparity). The median associated phoria measured by the Sheedy disparometer was more positive compared with the Mallett unit. Also, the slope of the curve obtained by the Mallett unit was steeper. The wide limits of agreement indicated the poor agreement of all fixation disparity curve parameters between the two instruments.
Convergence Insufficiency in the Geriatric Population
Authors: Hashemi Hassan , Nabovati Payam , Yekta Abbasali , Aghamirsalim Mohamadreza , Rafati Shokoofeh , Ostadimoghaddam Hadi , Razmjoo Hassan , Khabazkhoob Mehdi
Published: June 2021

SIGNIFICANCE

The present study is the first population-based study to examine the prevalence of convergence insufficiency and its associations specifically in the geriatric population. Knowledge of the population-based determination of prevalence of this disorder in the elderly is necessary to support proper clinical diagnosis and management.

PURPOSE

This study aimed to determine the prevalence of convergence insufficiency and its associated factors in a geriatric population.

METHODS

In this study, all residents older than 60 years in Tehran city were selected through random stratified cluster sampling. All participants underwent a complete ocular examination including the measurement of uncorrected and best-corrected visual acuity, objective and subjective refraction, binocular vision assessments including unilateral and alternating cover tests, measurement of the near point of convergence, the positive fusional vergence, and finally ocular health examination.

RESULTS

In this population-based sample of 1793 participants, the overall prevalences of two-sign and three-sign convergence insufficiency were 29.6% (95% confidence interval, 27.2 to 32.0%) and 21.5% (95% confidence interval, 19.5 to 23.6%), respectively. There were no statistically significant differences in the prevalence of both two-sign (P = .19) and three-sign (P = .41) convergence insufficiency between men and women. The highest and lowest prevalences of two-sign and three-sign convergence insufficiency were in the age groups 70 to 74 and 75 to 79 years, respectively. The prevalence showed no significant trend with age (P = .26 for two-sign convergence insufficiency, P = .33 for three-sign convergence insufficiency). In the multiple logistic regression model, none of the variables, including age, sex, and refractive errors, showed a significant relationship with convergence insufficiency (all, P > .05).

CONCLUSIONS

The results of the present study showed a high prevalence of convergence insufficiency in the geriatric population. Clinicians should give special attention to this binocular vision disorder in this age group.