bluuebunny/crossref_metadata_2025 huggingface dataset:
Sustainable transportation: the perspective of women community (a literature review)
Authors: Hayati A , Maryati S , Pradono P , Purboyo H
Published: November 2020

The vast and increasingly complex urban growth can change the characteristics of travel behavior in women. Women have very different and complex travel patterns than men. They have various destinations and modes of travel based on social, cultural, economic, and demographic characteristics. The result is a significant women-based community. This paper includes a literature review from various sources on a systemically pattern-oriented research, integrating the results of many studies for over the past 15 years, explaining that the travel behavior in women is seen in many variables (distance, time, travel mode, reasons for travel and travel patterns) which support sustainable transportation. However, a better transportation infrastructure design is needed in the form of transit or public transport that is more representative to support the travel of women in the framework of sustainable transportation. This study also gives evaluation towards the research which includes the issues of data accuracy, reliability and quality, application of research methods, and interpretation of data. These evaluations focus in detail on the interaction of socioeconomic factors that influence the travel patterns.
The vulnerability of COVID-19 pandemic based on urban density (a case study of the core urban area in Cirebon City, West Java)
Authors: Choerunnisa D N , Maula F K , Iman H K
Published: November 2020

COVID-19 has become a global concern due to its outbreak in early 2020. Not much is known yet about this disease so the only viable acts against it is prevention. City, specifically dense and large ones, has been the center of the pandemic, leading researchers to believe that there is a need to be concerned regarding COVID-19 prevention in particularly high-density area. This research aims to measure the level of COVID-19 spread susceptibility based on the urban density variables. There are four urban density variables used in this research namely density, intensity, built-up area, and mass activity or public facilities. Data was collected through primary observation and secondary data collection. Five types of analysis were employed to answer the research objective namely density analysis, intensity analysis, built-area analysis, mass attraction or public facilities analysis and COVID-19 spread susceptibility analysis. Each analysis shows the level of susceptibility in every variable. The results show that activity centers or agglomeration of public facilities have the highest level of vulnerability. The vulnerability can be compounded by the small road geometry and the informality around it. There are several ways that can be done to decrease the vulnerability based on urban dense area variables.
Challenges and advice for MD/PhD applicants who are underrepresented in medicine
Authors: Bannerman Carl , Guzman Natalie , Kumar Rachit , Nnebe Chelsea , Setayesh Jordan , Venapally Amitej , Sussman Jonathan H.
Published: November 2020

The importance of diversity is self-evident in medicine and medical research. Not only does diversity result in more impactful scientific work, but diverse teams of researchers and clinicians are necessary to address health disparities and improve the health of underserved communities. MD/PhD programs serve an important role in training physician-scientists, so it is critical to ensure that MD/PhD students represent diverse backgrounds and experiences. Groups who are underrepresented in medicine and the biomedical sciences include individuals from certain racial and ethnic backgrounds, individuals with disabilities, individuals from disadvantaged backgrounds, and women. However, underrepresented students are routinely discouraged from applying to MD/PhD programs due to a range of factors. These factors include the significant cost of applying, which can be prohibitive for many students, the paucity of diverse mentors who share common experiences, as well as applicants’ perceptions that there is inadequate support and inclusion from within MD/PhD programs. By providing advice to students who are underrepresented in medicine and describing steps programs can take to recruit and support minority applicants, we hope to encourage more students to consider the MD/PhD career path that will yield a more productive and equitable scientific and medical community.
A Critical Appraisal of the Venice Principles on the Protection and Promotion of the Ombudsman: An Equivalent to the Paris Principles?
Authors: Glušac Luka
Published: November 2020

This article offers a detailed critical appraisal of the Venice Principles on the Protection and Promotion of the Ombudsman, adopted in 2019 by the Venice Commission of the Council of Europe. It praises them for being the most comprehensive set of constitutional and legal principles relating to ombudsman to date, drafted to be applicable to different legal and political systems. However, the article finds that such adaptability also resulted in some trade-offs and came at the expense of conceptual clarity of some of the principles. Despite that, the Venice Principles present a more complete document than the Paris Principles on National Human Rights Institutions, with better internal logic and consistency when it comes to ombudsman’s issues. The article concludes that ombudsman institutions fully in line with the Venice Principles would, ipso facto, reach a normative threshold for the compliance with the Paris Principles.
The Temporal Ontology of the Human Rights Council’s Universal Periodic Review
Authors: McNeilly Kathryn
Published: November 2020

This article explores the relationship between the Universal Periodic Review (UPR) of the United Nations Human Rights Council and temporality. In contrast to dominant understandings that view time as an external constraint or pressure acting on the system—the UPR existing in time—I argue that internal temporal logics underpin the UPR in important and constitutive ways. In other words, time is an ontological feature of the UPR. This internal temporal ontology is multiple, complex and often paradoxical. It includes cyclicality, linearity, discontinuity and duration. Rather than threatening to undermine the UPR process, I argue that the tensions and paradoxes of these coexisting temporalities actually work to maintain its operation. This way of apprehending time and the UPR facilitates fresh insights for scholars and practitioners who wish to understand this monitoring mechanism more deeply as a phenomenon. It offers a new lens through which to read the UPR’s identity and operation.
The Islamic State
Authors: Byman Daniel
Published: November 2020

The Islamic State is Al Qaeda’s most important progeny and its greatest nemesis. The Islamic State grew out of Al Qaeda in Iraq, and both groups’ objectives, enemies, and tactics are all part of the broader jihadist movement that Al Qaeda so long sought...
Quantum Measurement and its Consequences
Authors: Raymer Michael G.
Published: November 2020

What is measurement in classical physics?

In the classical realm of human-scale objects such as motorcycles and buildings, it’s pretty clear what we mean by ‘measuring an object.’ If you wish to know the length of a wall in your bedroom, you use a...
Application: Sensing Gravity with Quantum Interference
Authors: Raymer Michael G.
Published: November 2020

What is the technology of sensing?

The human body has at least five senses: touch, taste, smell, sight, and hearing. A human sense is any biological process that generates a noticeable signal informing a person of a physical stimulus or condition. Each involves a...
Quantum Possibilities and Waves
Authors: Raymer Michael G.
Published: November 2020

How does the concept of waves enter quantum theory?

In quantum theory, probabilities are determined by considering all the possibilities that may be involved in a certain process. If there are intermediate possibilities involved in a process, quantum theory tells us how to combine...
Quantum Entanglement and Teleportation
Authors: Raymer Michael G.
Published: November 2020

What is quantum entanglement?

Quantum entanglement is a characteristic of special quantum states describing two or more quantum entities, such as photons or electrons. It represents a form of measurement correlation that occurs only in quantum physics. Recall from Chapter 8 that...
Application: Sensing Time, Motion, and Gravity with Quantum Technology
Authors: Raymer Michael G.
Published: November 2020

What are quantum physics–based sensing technologies?

Quantum physics–based sensing technologies are those that rely on quantum physics principles for their working. If classical physics were the whole story, we would not have access to these new technologies. In Chapter 5, I introduced...
Future Directions and Remaining Questions in Quantum Science
Authors: Raymer Michael G.
Published: November 2020

What is needed to make further progress?

To make further progress, quantum scientists need to understand better the nonintuitive aspects of quantum phenomena and their description by quantum theory, and they need to develop new technologies for building devices that rely on such phenomena...
The National Period and the Rise of Liberal–Conservative Conflicts
Authors: Ai Camp Roderic
Published: November 2020

What were the long-term consequences of Liberal–Conservative Conflicts in Mexico?

The Liberal–Conservative conflicts that emerged in Mexico after the 1830s reflect a pattern found in many other countries in South and Central America during the nineteenth century. Basically, these two parties represented opposing political and...
History: The Struggle for the Amazon
Authors: Plotkin Mark J.
Published: November 2020

What was the Treaty of Tordesillas?

Signed in a town 100 miles (161 km) northwest of Madrid on June 7, 1494, the Treaty of Tordesillas marked an important milestone in the history of the Amazon. At the time, Portugal and Spain were the world’s two major seafaring...
Polarization
Authors: McCarty Nolan
Published: November 2020

The 2016 election of Donald J. Trump invoked a time for reflection about the state of American politics and its deep ideological, cultural, racial, regional, and economic divisions. But one aspect that the contemporary discussions often miss is that these fissures have been opening over several decades and are deeply rooted in the structure of American politics and society. Nolan McCarty's Polarization: What Everyone Needs to Know® is an accessible introduction to polarization in America. McCarty takes readers through what scholars know and don't know about the origins, development, and implications of our rising political conflicts, delving into social, economic, and geographic determinants of polarization in the United States. While the current political climate makes it clear that extreme views are becoming more popular, McCarty also argues that, contrary to popular belief, the 2016 election was a natural outgrowth of 40 years of polarized politics, instead of a significant break with the past. He explains the factors that have created this state of affairs, including gerrymandered legislative districts, partisan primary nomination systems, and our private campaign finance system. He also considers the potential of major reforms such as instating proportional representation or single-transferable voting to remedy extreme polarization. A concise overview of a complex and crucial topic in US politics, this book is for anyone wanting to understand how to repair the cracks in our system.
Policies
Authors: Goldemberg José
Published: November 2020

What are policy targets for renewable energy?

By early 2010, policy targets for the introduction of renewable energy at the national level existed in at least 85 countries worldwide, including all 27 European Union member states. In addition, many national targets for shares of...
Pandemics, Epidemics, and Outbreaks
Authors: Doherty Peter C.
Published: November 2020

What is the exact definition of pandemic?

A novel infection—new and previously unconfronted—that spreads globally and results in a high incidence of morbidity (sickness) and mortality (death) has, for the past 300 years or more, been described as a “pandemic.” The word derives from...
Copyright in the International Arena
Authors: Netanel Neil Weinstock
Published: November 2020

Copyright markets are global in scope. U.S.-based copyright industries (some of which are multinational conglomerates) earn a significant share of their revenues from exports. Social media also transcend national borders. So do notorious file-sharing sites like Pirate Bay.

United States copyright industries complain bitterly that...
Mitochondrial Damage-Associated Molecular Patterns Exacerbate Lung Fluid Imbalance Via the Formyl Peptide Receptor-1 Signaling Pathway in Acute Lung Injury
Authors: Yuan Zhi-cheng , Zeng Ni , Liu Lian , Wang Tao , Dai Lu-qi , Wang Hao , Zeng Zi-jian , Cao Yu-fang , Zhou Yong-fang , Xu Dan , Shen Yong-chun , Wen Fu-qiang
Published: November 2020

OBJECTIVES:

To investigate the effect of mitochondrial damage–associated molecular patterns on the lung fluid homeostasis in experimental acute lung injury.

DESIGN:

Experimental study.

SETTING:

Research laboratory.

SUBJECTS:

Patients with acute respiratory distress syndrome and control subjects, wild-type C57BL/6 and formyl peptide receptor-1 gene knockout mice, and primary rat alveolar epithelial type II cells.

INTERVENTIONS:

Samples of bronchoalveolar lavage fluid and serum were obtained from patients and control subjects. Mice were intratracheally instilled with lipopolysaccharide and mitochondrial damage–associated molecular patterns. The primary rat alveolar epithelial type II cells were isolated and incubated with mitochondrial damage–associated molecular patterns.

MEASUREMENTS AND MAIN RESULTS:

Patients were divided into direct (pulmonary) and indirect (extrapulmonary) injury groups based on etiology. The release of mitochondrial peptide nicotinamide adenine dinucleotide dehydrogenase 1 in both bronchoalveolar lavage fluid and serum was induced in patients and was associated with etiology. In the lipopolysaccharide-induced lung injury, administration of mitochondrial damage–associated molecular patterns exacerbated the lung fluid imbalance, which was mitigated in formyl peptide receptor-1 knockout mice. Proteomic analysis of mouse lung tissues revealed the involvement of ion channels and tight junction proteins in this process. Treatment with mitochondrial damage–associated molecular patterns decreased the expression of epithelial sodium channel α, zonula occludens-1, and occludin via the formyl peptide receptor-1/p38 pathway in the primary rat alveolar epithelial type II cells.

CONCLUSIONS:

Mitochondrial damage–associated molecular patterns exacerbate lung fluid imbalance in the experimental acute lung injury model through formyl peptide receptor-1 signaling, the inhibition of which may prevent exacerbation of lung fluid imbalance induced by mitochondrial damage–associated molecular patterns. Thus, formyl peptide receptor-1 is a potential therapeutic target for acute respiratory distress syndrome.
Reconstruction of Distal Nasal Defects Using Free Cartilage Batten Grafting With Secondary Intention Healing: A Retrospective Case Series of 129 Patients
Authors: Kim Dong Joo , Makdisi Joy , Regan Christina , Chen Pin-Chun , Chao Elizabeth , Rotunda Adam M.
Published: November 2020

BACKGROUND

Surgical defects of the distal nose can pose significant reconstructive challenges. Free cartilage batten graft (FCBG) with secondary intention healing is an underreported yet effective repair option with cosmetically and functionally satisfying outcomes.

OBJECTIVE

To share the authors' experience using FCBG with secondary intention healing on multiple nasal subunits, including a detailed evaluation of wound/graft characteristics and design modifications to optimize success with this single-stage approach.

METHODS

A retrospective study of 129 patients who underwent FCBG with secondary intention healing after Mohs surgery from 2011 to 2018, using statistical analysis of numerous outcome measures graded independently by 2 fellowship-trained Mohs surgeons.

RESULTS

Overall, healed wounds were graded aesthetically as follows: excellent (24%), very good (31%), good (31%), or poor (14%). Excellent/very good outcomes were seen for superficial (p < .001), small-to-medium sized wounds (p < .0001) repaired with cartilage that closely approximated the defect size (p < .05). Consistently optimal outcomes were seen in the 19 repairs involving the alar lobule (mid-ala) alone, graded excellent (47%), very good (32%), and good (21%). A majority of patients (86%) experienced mild to no alar retraction. Although 67% of all patients had some skin surface contour irregularity, only 8% of patients sought dermabrasion. Neither hematoma, infection, ear deformity, chondritis, nor graft desiccation were reported.

CONCLUSION

A modified approach to FCBG with secondary intention healing provides a reliable, minimalistic, low-risk reconstructive option for mid-alar defects.
Safety Profile of Combined Same-Day Treatment for Botulinum Toxin With Full Face Nonablative Fractionated Laser Resurfacing
Authors: Pomerantz Hyemin , Akintilo Lisa , Shaw Katharina , Lederhandler Margo , Anolik Robert , Geronemus Roy G.
Published: November 2020

BACKGROUND

Spread of botulinum toxin outside the treated muscle is a concern, when energy-based device treatment is performed on the same day as toxin injection.

OBJECTIVE

We assessed the frequency of eyelid ptosis after the glabella/periorbital botulinum toxin injection and nonablative fractionated laser performed at the same session.

METHODS AND MATERIALS

This single-center, retrospective study identified treatments consisting of glabella and/or periorbital botulinum toxin injection and nonablative fractionated laser treatment to full face from 2017 to 2019 and eyelid ptosis determined by documentation of the complication at a follow-up encounter, or prescription of apraclonidine.

RESULTS

Six hundred sixteen treatments of glabella/periorbital botulinum toxin injection and full-face nonablative fractionated laser on the same day on 393 individuals were identified. Five hundred eighty treatments (94%) included botulinum toxin injected in the glabella, 541 (88%) in the periorbital areas, and 508 (82%) in the forehead. Nonablative fractionated lasers used to treat the cohort were a 1,927-nm thulium and a 1,550-nm er:glass laser. Eyelid ptosis complication was documented in one case (0.2%) following the combined laser and toxin treatment.

CONCLUSION

The risk of spread of glabella/periorbital botulinum toxin to an unintended muscle was minimal in the setting of the concomitant full-face nonablative fractionated laser.
PrabotulinumtoxinA for the Treatment of Moderate-to-Severe Glabellar Lines in Adult Patients With Skin of Color: Post Hoc Analyses of the US Phase III Clinical Study Data
Authors: Taylor Susan C. , Grimes Pearl E. , Joseph John H. , Jonker Anneke , Avelar Rui L.
Published: November 2020

BACKGROUND

Limited US clinical data are available on the use of aesthetic products in patients with skin of color (SOC).

OBJECTIVE

To compare the efficacy and safety of prabotulinumtoxinA for the treatment of glabellar lines in patients with and without SOC.

METHODS AND MATERIALS

Post hoc analyses were performed on the pooled population of all 492 patients treated with 20U prabotulinumtoxinA in the 2 US single-dose Phase III glabellar line clinical studies. Patients were grouped by Fitzpatrick skin Type: IV + V + VI (with SOC) versus I + II + III (without SOC). The primary efficacy end point was the proportion of responders with a ≥1-point improvement from baseline at maximum frown on the 4-point Glabellar Line Scale. Adverse events (AEs) were also summarized.

RESULTS

Responder rates among patients with SOC (n = 140) were lower than those without SOC (n = 352), by 5.9% on average across all visits; at no time point were differences statistically significant. At Day 30, responder rates were 94.0% and 96.0%, respectively (p = .401). Headache was the most common treatment-related AE, occurring in 12.1% and 8.2% of patients with and without SOC, respectively.

CONCLUSION

A single dose of 20U prabotulinumtoxinA was well tolerated and similar in effectiveness in patients with and without SOC for the treatment of glabellar lines.
Meta-analysis of Total Effect Decomposition in the Presence of Multiple Mediators
Authors: Zhu Yiwen , Centorrino Franca , Jackson John W. , Fitzmaurice Garrett M. , Valeri Linda
Published: November 2020

Background:

Causal mediation analysis addresses mechanistic questions by decomposing and quantifying effects operating through different pathways. Because most individual studies are underpowered to detect mediating effects, we outlined a parametric approach to meta-analyzing causal mediation and interaction analyses with multiple mediators, compared it with a bootstrap-based alternative, and discussed its limitations.

Methods:

We employed fixed- and random-effects multivariate meta-analyses to integrate evidence on treatment–mediators and mediators–outcome associations across trials. We estimated path-specific effects as functions of meta-analyzed regression coefficients; we obtained standard errors using the delta method. We evaluated the performance of this approach in simulations and applied it to assess the mediating roles of positive symptoms of schizophrenia and weight gain in the treatment effect of paliperidone ER on negative symptoms across four efficacy trials.

Results:

Both simulations and the application showed that the meta-analytic approaches increased statistical power. In the application, we observed substantial mediating effects of positive symptoms (proportions mediated from fixed-effects meta-analysis:

JOURNAL/epide/04.03/00001648-202101000-00016/inline-graphic1/v/2023-09-08T094005Z/r/image-tiff

). Weight gain may have beneficial mediating effects; however, such benefit may disappear at high doses when metabolic side effects were excessive.

Conclusions:

Meta-analyzing causal mediation analysis combines evidence from multiple sources and improves power. Targeting positive symptoms may be an effective way to reduce negative symptoms that are challenging to treat. Future work should focus on extending the existing methods to allow for more flexible modeling of mediation.
PROGRESSION OF MYOPIC MACULOPATHY IN CHINESE CHILDREN WITH HIGH MYOPIA
Authors: Guo Yin , Liu Lijuan , Tang Ping , Lv Yanyun , Wu Min , Liang Xu , Zhang Lin , Jonas Jost. B. , Wang Yan
Published: November 2020

Purpose:

To investigate the progression of myopic maculopathy and associated factors in highly myopic Chinese children.

Methods:

In this retrospective observational case series, biometric fundus features were morphometrically measured on photographs. Myopic maculopathy was defined as recommended by the Meta-analysis of Pathologic Myopia Study Group.

Results:

The study included 274 children (mean age: 11.7 ± 2.5 years; mean refractive error: −7.66 ± 1.87 diopters [D]) with a mean follow-up of 4.9 ± 1.2 years. Myopic maculopathy progression was detected in 52 eyes (18.9%; 95% confidence interval [CI]: 14.3–23.7%). In multivariable analysis, myopic maculopathy progression was associated with a decrease in refractive error (odds ratio [OR]: 0.72; 95% CI: 0.56–0.92; P < 0.001) (i.e., higher myopization) and enlargement of parapapillary gamma zone (OR: 7.68; 95% CI: 1.63–36.2; P = 0.002). Incident peripapillary diffuse choroidal atrophy, noted in 47 of 236 eyes (20.0%; 95% CI: 14.8–25.2%), was correlated with a decrease in refractive error (OR: 0.70; 95% CI: 0.54–0.92; P = 0.009) (i.e., higher myopization) and greater gamma zone enlargement (OR: 8.28; 95% CI: 1.33–51.7; P = 0.02).

Conclusion:

Myopia in schoolchildren may have a considerable risk of progressing to myopic maculopathy. Enlargement of parapapillary gamma zone was a main independent risk factor.
MINIMAL GAS VITRECTOMY TECHNIQUE FOR REDUCING RISK OF RETINAL DISPLACEMENT FOLLOWING RHEGMATOGENOUS RETINAL DETACHMENT REPAIR
Authors: Muni Rajeev H. , Felfeli Tina , Figueiredo Natalia , Marafon Samara B. , Escaf Luis C. , Juncal Verena R.
Published: November 2020

Purpose:

To present a novel technique, minimal gas vitrectomy, as a means of potentially minimizing retinal displacement compared with standard vitrectomy for select cases.

Methods:

A patient with a macula off retinal detachment and break at 12 o'clock underwent a 23-gauge pars plana vitrectomy, endodiathermy of the superior break in detached retina and endolaser of the inferior break in attached retina, without air–fluid exchange. Suturing of sclerotomies, anterior chamber paracentesis of 0.3 mL followed by intravitreal injection of 0.6 mL pure SF6 was then performed. Positioning was face down for 6 hours and then steamroll up with laser retinopexy to the superior break the following day.

Results:

Postoperative fundus autofluorescence imaging demonstrated no retinal displacement.

Conclusion:

The minimal gas vitrectomy technique has the potential to minimize retinal displacement by using a smaller gas tamponade compared to standard vitrectomy in certain cases with specific postoperative positioning instructions.
REVERSIBLE BILATERAL SUBFOVEAL ELLIPSOID ZONE FOCAL THICKENING ASSOCIATED WITH OVERDOSE OF PHOSPHODIESTERASE TYPE 5 INHIBITORS INTAKE
Authors: Elizalde Javier , Laiseca Andrea , García de Oteyza Gonzalo
Published: November 2020

Purpose:

To describe the clinical findings and outcome of an unusual case of subfoveal yellowish deposits associated with excessive doses of phosphodiesterase Type 5 inhibitors intake.

Methods:

Single retrospective case report.

Results:

A 50-year-old South American man with a personal history of multiple orally administered phosphodiesterase Type 5 inhibitors drugs to treat a chronic erectile dysfunction complained of dyschromatopsia, photophobia, and a 3-month history of blurred vision. The fundus examination revealed a symmetrical yellowish lesion in both eyes with a subfoveal hyperreflective signal on the spectral domain optical coherence tomography at the level of the ellipsoid zone. Dysregulation of the blue–yellow axis was noticed in the color vision test and the electroretinogram demonstrated a tiny decrease in the b-wave amplitude. The use of phosphodiesterase Type 5 inhibitors was discontinued and the patient was examined 3 months later. Optical coherence tomography revealed complete disappearance of the deposit in both eyes and the associated symptoms resolved rapidly with discontinuation of the drug.

Conclusion:

A bilateral ellipsoid zone subfoveal focal thickening may be related to a yellowish symmetrical spot on the fovea in patients with a history of phosphodiesterase Type 5 inhibitors overdose intake. Functional and structural findings are reversible in a short-term period after discontinuing the oral treatment.
A CASE OF MIGRATING AND RESOLVING SUBRETINAL PERFLUOROCARBON LIQUID FOLLOWING RETINAL DETACHMENT SURGERY
Authors: de Vries Ewout W , de Hoog Joeri
Published: November 2020

Purpose:

To demonstrate unique behavior of subretinal perfluorocarbon liquid (PFCL) following macular reattachment surgery.

Methods:

An observational case report. Changes in visual functioning and consecutive optical coherence tomograms are described.

Results:

Following macular reattachment surgery with the aid of PFCL, a small residual PFCL bubble, measuring 175 μm in diameter, is noted beneath the fovea on optical coherence tomogram. During nine months of follow-up, the bubble is shown to elongate and migrate toward the vitreous space. Once the bubble reaches the inner retinal surface, it gradually becomes smaller and disappears completely. We observed anatomical restoration of the retinal layers, and maintenance of fair visual acuity (20/32 feet) without scotoma.

Conclusion:

This report shows the potential of PFCL to migrate through the retina toward the vitreous. Rather than opt for a second surgery to remove small PFCL bubbles, observation may be clinically appropriate in selected cases.
LONGITUDINAL SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY OF EXTRAFOVEAL POLYPS AFTER COMBINATION THERAPY
Authors: Gupta Charu , Shroff Daraius , Gupta Priyanka , Atri Neelam , Bhatia Gagan , Shroff Cyrus M.
Published: November 2020

Purpose:

To study the efficacy of swept source optical coherence tomography angiography (SSOCTA) to longitudinally follow-up patients with extrafoveal polyps post-laser photocoagulation and anti–vascular endothelial growth factor injection.

Methods:

Observational case series. Four patients diagnosed as polypoidal choroidal vasculopathy with extrafoveal polyps on multimodal imaging were followed up serially on SSOCT, en face and cross-sectional SSOCTA at a month and then 3 monthly for a year. Indocyanine green angiography was repeated at 4 months and 1 year.

Results:

Anatomical regression of extrafoveal polyps was documented on a combination of en face and cross-sectional SSOCTA, 3 months post-laser photocoagulation and anti–vascular endothelial growth factor. Regression of polyps was maintained at the 12-month follow-up visit in all cases. Changes in branching vascular network morphology post-treatment were well-delineated on en face SSOCTA. Swept source optical coherence tomography angiography findings correlated well with the gold standard indocyanine green angiography.

Conclusion:

Swept source optical coherence tomography angiography is an effective noninvasive imaging modality to diagnose and longitudinally follow-up extrafoveal polyps postintervention. Laser photocoagulation with anti–vascular endothelial growth factor achieved regression of polyps in all cases and this was maintained over 12 months.
Sulfadiazine Hypersensitivity and Desensitization in Children With Congenital Toxoplasmosis: A Report on Two Cases
Authors: Yamamoto Kei , Kutsuna Satoshi , Kato Yasuyuki , Goishi Keiji , Shichino Hiroyuki , Ohmagari Norio
Published: November 2020

Combination therapy for toxoplasmosis consists of sulfadiazine, pyrimethamine and leucovorin. Although sulfadiazine can cause hypersensitivity reactions, such as fever, rash and liver dysfunction, there is no consensus on an effective therapy for congenital toxoplasmosis (CTox) without sulfadiazine. We attempted desensitization to sulfadiazine in 2 patients with CTox and sulfadiazine hypersensitivity. Desensitization was achieved for 1 patient.
Impact on binocular visual function of small-incision lenticule extraction for high myopia
Authors: Gyldenkerne Anders , Ivarsen Anders , Nisted Ivan , Hjortdal Jesper
Published: November 2020

Purpose:

To assess whether small-incision lenticule extraction (SMILE) for high myopia reduces the binocular visual function assessed by stereoacuity, binocular visual acuity, binocular contrast sensitivity, and binocular summation.

Setting:

University hospital.

Design:

Prospective case series.

Methods:

Patients with a myopic spherical equivalent of at least 6.00 diopters (D) scheduled for SMILE aimed at emmetropia were included. Psychophysical testing was performed with correction preoperatively but no correction postoperatively. Stereoacuity was assessed with the Randot Circles test and the near Frisby test, visual acuity (monocular and binocular) was assessed with high-contrast Early Treatment Diabetic Retinopathy Study charts, and contrast sensitivity (monocular and binocular) was assessed with the Pelli-Robson chart and the Freiburg Acuity and Contrast Test. Binocular summation was calculated by comparing the binocular score against the best monocular score.

Results:

A total of 138 eyes of 69 patients were included. The mean spherical equivalent changed from −7.46 D ± 1.06 (SD) to −0.23 D ± 0.40 postoperatively. Stereoacuity did not change significantly postoperatively; median change (interquartile range) was −0.32 (−6.21 to 1.55) seconds of arc with the Frisby test and 0.00 (−7.5 to 5.0) seconds of arc with the Randot test (P ≥ .06). Binocular postoperative uncorrected distance visual acuity was not different from the preoperative corrected distance visual acuity (P = .40). Contrast sensitivity declined slightly monocularly with both tests of contrast sensitivity but was unaltered binocularly (P ≥ .08). Binocular summation for visual acuity and contrast sensitivity was unaltered following surgery (P ≥ .09).

Conclusions:

SMILE for high myopia did not reduce the binocular function assessed by stereoacuity, binocular visual acuity, binocular contrast sensitivity, and binocular summation.
Distribution of angle α and angle κ in a population with cataract in Shanghai
Authors: Meng Jiaqi , Du Yu , Wei Ling , Yao Yunqian , He Wenwen , Qian Dongjin , Lu Yi , Zhu Xiangjia
Published: November 2020

Purpose:

To describe the distribution of angle α and angle κ in a population with cataract in Shanghai.

Setting:

Eye and Ear, Nose, Throat Hospital, Fudan University, Shanghai, China.

Design:

Hospital-based, cross-sectional study.

Methods:

Angle α, angle κ, and other ocular biometric parameters were determined by IOLMaster 700. The distributions of angle α and angle κ and their associations with systemic and ocular parameters were assessed.

Results:

This study included 15 127 eyes of 15 127 cataract patients. The mean angle α and angle κ values were 0.45 ± 0.21 mm and 0.30 ± 0.18 mm, respectively. Angle α and angle κ were both predominantly located temporal to the visual axis. A greater angle α or angle κ was associated with older age, lower corneal power, shorter white-to-white distance, and shallower anterior chamber depth (all P < .05). Angle α correlated positively with angle κ. With increasing axial length (AL), angle α gradually decreased in a nonlinear way and shifted to the nasal side of the visual axis, whereas angle κ decreased in eyes with AL less than 27.5 mm but increased again in eyes with longer AL.

Conclusions:

Angle α and angle κ, both predominantly located temporal to the visual axis, were influenced by multiple anterior segment parameters. As AL increased, the changes in angle α and angle κ were nonlinear, and their locations gradually shifted from the temporal to the nasal side of the visual axis.
Comparison of rotational stability and repositioning rates of 2 presbyopia-correcting and 2 monofocal toric intraocular lenses
Authors: Lee Bryan S. , Onishi Alex C. , Chang David F.
Published: November 2020

Purpose:

To compare the rotational stability of 2 commonly used toric presbyopia-correcting (PC) intraocular lenses (IOLs) and their monofocal toric counterparts.

Setting:

Single 2-surgeon private practice.

Design:

Retrospective study.

Methods:

This study included 2 cohorts: (1) all eyes receiving a toric ReSTOR (n = 61 eyes, 49 patients) or toric Symfony (n = 779 eyes, 520 patients) IOL from September 2016 to January 2019; and (2) all eyes receiving an AcrySof (n = 2 393) or TECNIS (n = 731) monofocal toric IOL (TIOL) from April 2015 to January 2019. Eyes were only excluded if digital marking could not be used. All patients had image-guided digital marking to verify TIOL position at the conclusion of surgery. Postoperative rotation was determined by dilated examination performed later on the day of surgery or the following morning.

Results:

The toric ReSTOR IOL was more likely to rotate 5 degrees or less than the toric Symfony IOL, 91.8% vs 79.0% (P = .01). This remained true for rotation of 10 degrees or less (100% vs 89.5%, P < 0.003). The mean rotation was 2.3 degrees for toric ReSTOR IOL compared with 4.5 for toric Symfony IOL (P = .01). Statistically significantly more eyes with toric Symfony IOL required a return to the operating room for repositioning (6.9% vs 0%, P < .03). More TECNIS monofocal TIOL eyes required surgical repositioning than AcrySof monofocal TIOL eyes (3.5% vs 1.2%, P < .001).

Conclusions:

Between these PC-TIOLs, the Symfony IOL was more likely to rotate and to require surgical repositioning than the ReSTOR IOL. The TECNIS TIOL built on the same platform as the Symfony IOL was more likely to require surgical repositioning than that by the AcrySof TIOL. Despite comparable rotational stability between the Symfony and TECNIS monofocal TIOLs, the Symfony was twice as likely to require surgical repositioning.
Keratoconus detection using OCT corneal and epithelial thickness map parameters and patterns
Authors: Yang Yuli , Pavlatos Elias , Chamberlain Winston , Huang David , Li Yan
Published: November 2020

Purpose:

To detect keratoconus using optical coherence tomography (OCT) corneal map parameters and patterns.

Setting:

Casey Eye Institute, Oregon Health and Science University, Portland, Oregon.

Design:

Cross-sectional observational study.

Methods:

A spectral-domain OCT was used to acquire corneal and epithelial thickness maps in normal, manifest keratoconic, subclinical keratoconic, and forme fruste keratoconic (FFK) eyes. A 2-step decision tree was designed. An eye will be classified as keratoconus if both decision tree conditions are met. First, at least 1 of the 4 quantitative corneal thickness (minimum, minimum–maximum, and superonasal–inferotemporal) and epithelial thickness (standard deviation) map parameters exceed cutoff values. Second, presence of both concentric thinning pattern on the epithelial thickness map and coincident thinning patterns on corneal and epithelial thickness maps by visual inspection.

Results:

The study comprised 54 eyes from 29 normal participants, 91 manifest keratoconic eyes from 65 patients, 12 subclinical keratoconic eyes from 11 patients, and 19 FFK eyes from 19 patients. The decision tree correctly classified all normal eyes (100% specificity) and had good sensitivities for detecting manifest keratoconus (97.8%), subclinical keratoconus (100.0%), and FFK (73.7%).

Conclusions:

The 2-step decision tree provided a useful tool to detect keratoconus, including cases at early disease stages (subclinical keratoconus and FFK). OCT corneal and epithelial thickness map parameters and patterns can be used in conjunction with topography to improve keratoconus screening.
Effect of Preoperative Educational Schedule on Anxiety and Coping Mechanism Among Children and Their Parents
Authors: Yadav Madhu , Malar Kodi S , Deol Rupinder
Published: November 2020

Introduction

Surgery is one of the main reasons for anxiety and fearful experiences of children and their parents. It is reported that up to 60% of young children experience significant preoperative anxiety. Preoperative anxiety is also common among parents, which directly leads to anxiety among children. Parental anxiety can lead to a negative impact on children's coping during new or stressful situations like children's hospitalization and going to surgery.

Material and Method

A prospective, parallel-group, randomized controlled trial was conducted on a sample of 56 children aged 7–12 years and their parents. The intervention group (n = 28) received a 15-minute virtual teaching (video) containing information about preoperative care, operation theater visit, use of common medical instruments, and postoperative care. The control group (n = 28) received standard routine care. The Hamilton Anxiety Rating Scale and Modified Observed Scale of Behavioral Distress-Revised were used to assess anxiety and coping mechanisms in both the children and their parents; nonparametric, Mann–Whitney U, and Wilcoxon signed rank tests were used for analysis.

Results

Children's level of anxiety and coping mechanisms were significantly improved in the intervention group as compared with the control group. Parents' level of anxiety and coping mechanisms were also significantly improved.

Conclusion

The Preoperative Educational Schedule virtual teaching video was effective to minimize anxiety and improve coping mechanisms among children and their parents.
Factors in Successful Humanities Integration: A Case Study of One Physical Therapist Education Program
Authors: Cammarata Jessica Lieb
Published: November 2020

Introduction.

Humanities have been recognized as an effective pedagogical tool for developing professional behaviors and a patient-centered approach. Physical therapy education programs may aspire to add humanities to their curricula but lack knowledge of how to do it successfully. The purpose of this study was to examine methods of humanities integration and supporting factors contributing to success in one physical therapist education program.

Methods.

This research used a qualitative single case study approach. Seventeen participants from one physical therapist education program were interviewed, including faculty, students, and alumni. An onsite visit to campus also included review of artifacts and observations of campus events. Interviews were transcribed, coded, and analyzed for themes.

Results.

Four main themes emerged: learning about the human experience through real patient encounters, including narrative writing, guest speakers, and experiential learning; pedagogical approaches can increase successful use of humanities, including repeated exposure, explicitness about the benefits, and sensitivity to time constraints; strong support systems help with success of humanities integration, including culture, leadership, mentorship, and resources; and challenges remain in humanities integration, including lack of buy-in and comfort, time constraints, difficulty with assessment, and devaluing of the humanities by the profession.

Discussion.

Successful humanities integration may be cultivated by informed pedagogical approaches and attention to the institutional and departmental factors which support humanities.

Conclusion.

This study helps to guide programs looking to increase presence of humanities by providing an example of how the humanities are integrated throughout the curriculum at one physical therapist education program and the factors that have affected the success of the integration.
Outcomes From Three Decades of Infant and Pediatric Heart Transplantation
Authors: Cohen William , Combs Pamela , El-Zein Chawki , Ilbawi Michel , Kim Gene , Jeevanandam Valluvan , Vricella Luca , Hibino Narutoshi
Published: November 2020

Infants are a unique transplant population due to a suspected immunologic advantage, in addition to differences in size and physiology. Consequently, we expect infants to have significantly different diagnoses, comorbidities, and outcomes than pediatric transplant recipients. In this study, we compare patterns and trends in pediatric and infant heart transplantation during three decades. The United Network for Organ Sharing (UNOS) database was queried for transplants occurring between January 1990 and December 2018. Patients were categorized as pediatric (1–17) or infant (0–1). Congenital heart disease (CHD) primary diagnoses have increased from 37% to 42% in pediatric patients (p = 0.001) and decreased from 80% to 61% in infants during the 1990s and 2010s (p < 0.001). Those with CHD had worse outcomes in both age groups (p < 0.001). Infants who underwent ABO-incompatible transplants had similar survival as compared to those with compatible transplants (p = 0.18). Overall, infants had better long-term survival and long-term graft survival than pediatric patients; however, they had worse short-term survival (p < 0.001). Death due to rejection or graft failure was less likely in infants (p = 0.034). However, death from infection was over twice as common (p < 0.001). In summary, pediatric and infant heart transplant recipients differ in diagnoses, comorbidities, and outcomes, necessitating different care for these populations.
Diagnostic performances of lung ultrasound associated with inferior vena cava assessment for the diagnosis of acute heart failure in elderly emergency patients: a diagnostic study
Authors: Balen Frederic , Houze Cerfon Charles-Henri , Lauque Dominique , Hebrad Manon , Legourrierec Thibault , Delmas Clement , Charpentier Sandrine
Published: November 2020

Background and importance

Few studies are looking at the usefulness of lung ultrasound combined with inferior vena cava (ultrasound strategy) in the particularly challenging diagnosis of acute heart failure (AHF) in elderly dyspneic patients attending the emergency department (ED).

Objective, design, settings, and participants

This was a prospective diagnostic study conducted in two French EDs from December 2015 to March 2019, aimed to determine the accuracy of an ultrasound strategy for the diagnosis of AHF in the elderly. Patients aged 65 and older referred to the ED for dyspnea were screened for inclusion.

Intervention

An emergency physician, blinded to the first findings, performed chest ultrasound, and assessment of inferior vena cava (ultrasound strategy).

Outcome measure and analysis

The primary endpoint was a final diagnosis of AHF, adjudicated by two independent experts after reviewing the entire medical record. The sensitivity and specificity of ultrasound and standard strategies were calculated.

Main results

A total of 116 patients were included, mean age 84 years (SD 9). Among them, there were 76 (66%) cases of AHF and 51 (44%) cases of pneumonia. The ultrasound work up had a sensitivity of 82% [95% confidence interval (CI), 71–90] and a specificity of 68% (95% CI, 51–90] for AHF. The standard strategy had a sensitivity of 92% (95% CI, 84–97) and a specificity of 53% (95% CI, (36–68).

Conclusions

In this prospective study, there was no statistically significant difference between point-of-care ultrasound and a combination of clinical, radiographic, and biological findings for the diagnosis of acute heart failure.
Surgical procedures for male infertility: an update
Authors: Visser William R. , Smith-Harrison L.I. , Krzastek Sarah C.
Published: November 2020

Purpose of review

The aim of this review is to provide an overview of surgical treatment options for male infertility including varicocelectomy, treatment of ejaculatory duct obstruction, vasovasostomy, and sperm extraction, and to review recent advances in techniques and technologies that may improve operative outcomes.

Recent findings

Microscopic subinguinal varicocelectomy has been shown to have the highest success rates with lowest rates of complications, and may be facilitated by the use of Doppler, indocyanine green angiography, and the 4K3D operating video microscope. The standard treatment for ejaculatory duct obstruction by transurethral resection of the ejaculatory ducts has changed little over time, but vesiculoscopy may allow for temporary dilation of an obstruction to allow for natural conception, while also offering diagnostic capabilities. Use of the robotic platform has gained popularity for vasectomy reversals but controversy remains regarding the cost-effectiveness of this option. Recently, a reinforcing suture technique has been described for vasovasostomy to minimize anastomotic breakdown and reversal failure. Finally, gray-scale and color-enhanced ultrasound may improve ability to predict successful sperm retrieval during extraction procedures.

Though the fundamentals of surgical treatment options for male infertility have changed little with time, technological advancements have contributed to improved surgical outcomes over recent years.
Tramadol Treatment for Chemotherapy-induced Mucositis Pain in Children
Authors: Yaffe Ornstein Michal , Stocki Daniel , Levin Dror , Dvir Rina , Manisterski Michal , Berger-Achituv Sivan , Rosenfeld Keidar Hila , Peled Yair , Hazan Shoshana , Rosenberg Tom , Oppenheimer Noga , Elhasid Ronit
Published: November 2020

Mucositis, a painful and debilitating condition, is a common side effect of chemotherapy. The role of tramadol in the treatment of mucositis in pediatric patients has not yet been determined. In this retrospective study, we evaluate whether tramadol as single agent achieved a reduction of pain intensity among oncologic children admitted for mucositis. In total, 34 of 54 (63%) episodes were treated with tramadol alone and achieved adequate pain relief. Tramadol’s side effects were mild and manageable.