bluuebunny/crossref_metadata_2025 huggingface dataset:
Observer-Reported Outcomes and Cosmetic Procedures: A Systematic Review
Authors: Shah Payal , Rieder Evan A.
Published: August 2020

BACKGROUND

Cosmetic procedures have demonstrated beneficial effects on physical appearance based on anatomic markers as well as patient-perceived self-image and quality of life. Recent studies of observer-reported outcomes (OROs) suggest an additional benefit from aesthetic interventions.

OBJECTIVE

The authors aimed to review the evidence of OROs from cosmetic procedures performed on the head and neck.

PATIENTS, METHODS AND MATERIALS

PubMed, Embase, and Cochrane Library databases were searched for relevant studies, yielding 24 included original investigations.

RESULTS

These studies captured 686 total patients, 8,257 observer evaluations, and a variety of interventions including face-lifts, blepharoplasty, rhinoplasty, and minimally invasive treatments including botulinum toxins and hyaluronic acid fillers. Forty-one distinct reported OROs were grouped into 12 descriptive domains. Domains were further grouped into 3 higher-order categories: aesthetics and wellness, social capacities, and skills and competencies. Improved perception after cosmetic intervention is most reproducibly demonstrated for the following ORO domains: age, attractiveness, sociability, relationship success, and occupational and financial competency.

CONCLUSION

The synthesized findings imply a tertiary layer of benefit for cosmetic intervention beyond anatomical and patient-centered outcomes through enhanced perceptions of others. These findings may inform the pre-procedure risk–benefit discussion with patients of cosmetic medicine and drive future research into longitudinal outcomes.
The Controversy of Renin–Angiotensin-System Blocker Facilitation Versus Countering COVID-19 Infection
Authors: Manolis Antonis S. , Manolis Theodora A. , Manolis Antonis A. , Melita Helen
Published: August 2020

The ongoing COVID-19 pandemic has produced serious turmoil world-wide. Lung injury causing acute respiratory distress syndrome seems to be a most dreaded complication occurring in ∼30%. Older patients with cardiovascular comorbidities and acute respiratory distress syndrome have an increased mortality. Although the precise mechanisms involved in the development of lung injury have not been fully elucidated, the role of the extended renin–angiotensin system seems to be pivotal. In this context, angiotensin-converting enzyme 2 (ACE2), an angiotensin-converting enzyme homologue, has been recognized as a facilitator of viral entry into the host, albeit its involvement in other counter-regulatory effects, such as converting angiotensin (Ang) II into Ang 1–7 with its known protective actions. Thus, concern was raised that the use of renin–angiotensin system inhibitors by increasing ACE2 expression may enhance patient susceptibility to the COVID-19 virus. However, current data have appeased such concerns because there has been no clinical evidence of a harmful effect of these agents as based on observational studies. However, properly designed future studies will be needed to further confirm or refute current evidence. Furthermore, other pathways may also play important roles in COVID-19 transmission and pathogenesis; spike (S) protein proteases facilitate viral transmission by cleaving S protein that promotes viral entry into the host; neprilysin (NEP), a neutral endopeptidase known to cleave natriuretic peptides, degrades Ang I into Ang 1–7; NEP can also catabolize bradykinin and thus mitigate bradykinin's role in inflammation, whereas, in the same context, specific bradykinin inhibitors may also negate bradykinin's harmful effects. Based on these intricate mechanisms, various preventive and therapeutic strategies may be devised, such as upregulating ACE2 and/or using recombinant ACE2, and exploiting the NEP, bradykinin and serine protease pathways, in addition to anti-inflammatory and antiviral therapies. These issues are herein reviewed, available studies are tabulated and pathogenetic mechanisms are pictorially illustrated.
The Care of Patients With Atrial Fibrillation and Heart Failure
Authors: Abbasi Mohammad H. , Maan Abhishek , Heist E. Kevin
Published: August 2020

Atrial fibrillation (AF) and heart failure (HF) are the 2 emerging epidemics in global cardiovascular disease. AF remains the most common cardiac arrhythmia, affecting over 33 million adults worldwide, and continues to increase in prevalence as the populations of many nations age. The prevalence of HF also surges, now afflicting 37 million adults globally. Interestingly, these 2 disease processes share many of the same risk factors and stem from many of the same pathophysiologic derangements, with AF occurring in over half of all patients with HF and HF occurring in over one third of all patients with AF. Furthermore, exacerbation of one of these ailments often drives decompensation or compromises therapy of the other, and it has been widely reported that coexistence of AF in patients with HF portends a poorer prognosis. As a result, many clinicians now routinely face the problem of AF in the patient with HF. In this review, we highlight the fundamental pathologic forces embedded in the relationship between AF and HF and then proceed to a discussion on the management of these complex patients with a detailed exploration of the clinical data.
Screening of the Abdominal Aorta During Routine Echocardiographic Examination Is Cost-effective and Leads to Increase in Statin Utilization by Detecting Subclinical Atherosclerosis
Authors: Dodge Melisa , Movahed Mohammad Reza
Published: August 2020

Background:

Performing abdominal aorta screenings during routine echocardiographic examination can be useful for quick detection of asymptomatic abdominal aortic aneurysms (AAAs) without additional cost. Furthermore, detection of any atherosclerosis of the aorta during this screening would qualify the patient for statin therapy, with potential to improve outcome. The goal of our study was to evaluate the effect of routine screening of abdominal aorta during echocardiographic examination.

Methods:

Recently, we started performing routine AAA screening during routine echocardiographic examinations. We retrospectively studied a total of 727 patients with successful screening between the ages of 33 and 96 years, with a median age of 72.4 years. We evaluate the presence of atherosclerosis of aorta and its effect on lipid therapy and detection of asymptomatic AAA.

Results:

We found 18 (2.4%) asymptomatic AAAs and 468 (64.3%) cases of atherosclerosis of abdominal aorta. Retrospectively, data were collected on preventative lipid therapy. Of the 468 patients who had detected atherosclerosis of aorta, 414 patients had clinical follow up; 240 (57.9%) patients were already treated with a statin due to another indication. However, 38 (9.1%) of these patients had been started on statin drugs for the first time, 85 (20.5%) were set a new lower low density lipoprotein cholesterol goal, and 41 (9.9%) had an intensified statin treatment.

Conclusions:

Using a routine screening of the abdominal aorta during standard echocardiograms can markedly improve preventive statin therapy in patients, with asymptomatic atherosclerosis detected during screening without additional cost and detect some AAA.
Fatigue in Children With Moderate or Severe Traumatic Brain Injury Compared With Children With Orthopedic Injury: Characteristics and Associated Factors
Authors: Bogdanov Stefan , Brookes Naomi , Epps Adrienne , Naismith Sharon L. , Teng Arthur , Lah Suncica
Published: August 2020

Objective:

To characterize fatigue in children with moderate or severe traumatic brain injury (TBI) and to identify associated factors.

Setting:

Urban tertiary pediatric healthcare facility.

Participants:

Children aged 5 to 15 years with a moderate TBI (n = 21), severe TBI (n = 23), or an orthopedic injury (OI; n = 38).

Design:

Case-control study.

Main Measures:

(i) Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL-MFS), completed by parents and children; (ii) Sleep Disturbance Scale for Children, completed by parents. Data on injury-specific factors and other factors of interest were also collected.

Results:

The 2 TBI groups did not differ on any of the fatigue outcomes (child or parent ratings). Relative to the OI group, parents rated children in both TBI groups as experiencing greater fatigue. However, on self-ratings, only children with moderate TBI endorsed greater fatigue. Sleep was commonly associated with fatigue, with child sleep disturbance and child sleep hygiene associated with parent-rated and self-rated child fatigue, respectively. Individually, there were no cases of “normal” fatigue coinciding with severe sleep disturbance. However, there were several cases of severe fatigue coinciding with normal sleep. Additional factors associated with fatigue were older age at injury, longer time since injury, and/or greater internalizing difficulties.

Conclusion:

Children with moderate and severe TBI experience greater fatigue than OI controls. Parent and child ratings of fatigue appear to be associated with different factors, indicating that fatigue management may require a broad range of treatments.
Reinjury After Moderate to Severe TBI: Rates and Risk Factors in the NIDILRR Traumatic Brain Injury Model Systems
Authors: Bannon Sarah M. , Kumar Raj G. , Bogner Jennifer , O'Neil-Pirozzi Therese M. , Spielman Lisa , Watson Eric M. , Dams-O'Connor Kristen
Published: August 2020

Objectives:

To compare characteristics of those who do and do not sustain subsequent traumatic brain injuries (TBIs) following index TBI and to identify reinjury risk factors.

Design:

Secondary data analysis of an ongoing longitudinal cohort study.

Setting:

TBI Model Systems Centers.

Participants:

In total, 11 353 individuals aged 16+ years.

Main Outcome Measures:

Ohio State University TBI Identification Method.

Results:

In total, 7.9% of individuals reported sustaining a TBI post–index TBI. Twenty percent of reinjuries occurred within a year of the index TBI. Reinjury risk followed an approximate U-shaped distribution such that risk was higher in the first year, declined 2 to 10 years postinjury, and then increased after 10 years. A multivariable Weibull model identified predictors of reinjury: younger (<29 years) and middle-aged and older (50+ years) age at index TBI relative to middle age, pre–index TBI, pre–index alcohol and illicit drug use, incarceration history, and less severe index TBI.

Conclusions:

A subset of individuals who receive inpatient rehabilitation for TBI are at an increased risk for reinjury, and an injury-prone phenotype may be characterized by engagement in risk behaviors. Factors associated with reinjury risk may differ for younger versus middle-aged and older adults. Findings underscore the need for empirically informed risk stratification models to identify TBI survivors at risk for reinjury.
Telebehavioral Interventions for Family Caregivers of Individuals With Traumatic Brain Injury: A Systematic Review
Authors: Coxe Kathryn A. , Liu Chang , Moore Megan
Published: August 2020

Objective:

To identify and examine research on telebehavioral interventions that support family caregivers of individuals with traumatic brain injury (TBI).

Methods:

A systematic review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies published between 1999 and 2019 were identified through CINHAL, EMBASE, ERIC, PsycINFO, PubMed, Scopus, and Web of Science.

Results:

Twelve studies met inclusion criteria; 3 used quasi-experimental designs, 7 were randomized controlled trials (RCTs) with 1-group comparison, 1 was RCT with a 2-group comparison, and 1 was RCT with a 3-group comparison. Outcomes primarily focused on caregiver depression, distress, self-efficacy, anxiety, stress, burden, and problem solving. Eleven studies found significant differences between the intervention and control groups on at least 1 outcome indicator, and 10 of these reported effect sizes supporting clinical significance. However, studies lacked data on caregiver and injury characteristics, and most studies lacked diverse study samples that may contribute to psychosocial outcomes. Nearly all studies demonstrated methodological bias (PEDro-P M = 5.5).

Conclusions:

Caregiver psychosocial outcomes following telebehavioral interventions were generally positive, but caution should be used when generalizing outcomes due to lack of sample diversity. Additional research is needed to assess how caregiver demographics and injury severity moderate caregiver outcomes.
Revealing the Invisible Emotion Work of Caregivers: A Photovoice Exploration of Informal Care Provided by Family Caregivers for Post-9/11 Veterans With Traumatic Brain Injuries
Authors: Abraham Traci H. , Ono Sarah S. , Moriarty Helene , Winter Laraine , Bender Ryan E. , Facundo Ray , True Gala
Published: August 2020

Objective:

Describe the different forms of emotion work performed by family caregivers of veterans living with a traumatic brain injury (TBI).

Design:

Collaborators were provided cameras to take photographs illustrating their experiences as family caregivers. The meaning behind caregiver photographs was solicited using photoelicitation interviews and coded.

Setting:

Homes of veterans or other informal settings in 2 regions of the United States served by the Southeast Louisiana Veterans Health Care System and the Veterans Affairs Portland Health Care System.

Participants:

Twenty-six family caregivers of post-9/11 era veterans with TBI.

Results:

Caregivers described performing different types of intangible, and largely invisible, work centered on emotion management. Emotion work primarily involved creating a new normal, keeping things calm, and suppressing their own emotional experiences to “put on a brave face.” Although having derived a sense of satisfaction and identity from their role, caregivers acknowledged that emotion work was challenging and sometimes stressful. The Photovoice method allowed caregivers to express through metaphor experiences that otherwise would have been hard to articulate and share with others.

Conclusion:

Findings signal a need for healthcare systems and providers to acknowledge emotion work as a potential source of stress and to provide multifaceted support for veterans and family caregivers.
Access to Care for Persons With Brain Injury: Ethical Frameworks to Promote Health Systems Change
Authors: Meixner Cara , O'Donoghue Cynthia R.
Published: August 2020

The challenges of providing optimal healthcare for individuals with brain injuries are heightened by the unique complexity of the injury itself. Survivors with long-term needs often encounter precarious situations where they struggle to receive services in health systems focused on cost containment driven by medical necessity and managed care. This article draws inductively from the rehabilitation experiences of 2 survivors to highlight neuroethical considerations representing the person, the rehabilitation system, and the medical model. Drawing upon our experience studying the provision of care in the Commonwealth of Virginia, we seek to explicate the challenge of providing longitudinal services. Three diverse and intersecting ethical considerations are applied: (1) teleological implications within rehabilitation medicine; (2) a care ethics framework, nested in the scholarship of feminist and disability ethics; and (3) the literature on pragmatism and dehumanization. This article uses these frameworks to explore the challenge posed by current healthcare practices and the needs of individuals with chronic brain injury.
Negative Attribution Bias and Related Risk Factors After Brain Injury
Authors: Neumann Dawn , Sander Angelle M. , Perkins Susan M. , Bhamidipalli Surya Sruthi , Hammond Flora M.
Published: August 2020

Objective:

In participants with traumatic brain injury (TBI) and peer controls, examine (1) differences in negative attributions (interpret ambiguous behaviors negatively); (2) cognitive and emotional factors associated with negative attributions; and (3) negative attribution associations with anger responses, life satisfaction, and participation.

Setting:

Two TBI outpatient rehabilitation centers.

Participants:

Participants with complicated mild to severe TBI (n = 105) and peer controls (n = 105).

Design:

Cross-sectional survey study.

Main Measures:

Hypothetical scenarios describing ambiguous behaviors were used to assess situational anger and attributions of intent, hostility, and blame. Executive functioning, perspective taking, emotion perception and social inference, alexithymia, aggression, anxiety, depression, participation, and life satisfaction were also assessed.

Results:

Compared with peer controls, participants with TBI rated behaviors significantly more intentional, hostile, and blameworthy. Regression models explained a significant amount of attribution variance (25%-43%). Aggression was a significant predictor in all models; social inference was also a significant predictor of intent and hostility attributions. Negative attributions were associated with anger responses and lower life satisfaction.

Conclusion:

People with TBI who have higher trait aggression and poor social inferencing skills may be prone to negative interpretations of people's ambiguous actions. Negative attributions and social inferencing skills should be considered when treating anger problems after TBI.
Risk Factors for Suicidal Ideation Following Mild Traumatic Brain Injury: A TRACK-TBI Study
Authors: Campbell-Sills Laura , Jain Sonia , Sun Xiaoying , Fisher Lauren B. , Agtarap Stephanie D. , Dikmen Sureyya , Nelson Lindsay D. , Temkin Nancy , McCrea Michael , Yuh Esther , Giacino Joseph T. , Manley Geoffrey T.
Published: August 2020

Objective:

To identify risk factors for suicidal ideation (SI) following mild traumatic brain injury (mTBI).

Setting:

Eleven US level 1 trauma centers.

Participants:

A total of 1158 emergency department patients with mTBI (Glasgow Coma Scale score = 13-15) enrolled in the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study.

Design:

Prospective observational study; weights-adjusted multivariable logistic regression models (n's = 727-883) estimated associations of baseline factors and post-TBI symptoms with SI at 2 weeks and 3, 6, and 12 months postinjury.

Main Measures:

Patient Health Questionnaire, Rivermead Post-Concussion Symptoms Questionnaire.

Results:

Preinjury psychiatric history predicted SI at all follow-ups (adjusted odds ratios [AORs] = 2.26-6.33, P values <.05) and history of prior TBI predicted SI at 2 weeks (AOR = 2.36, 95% confidence interval [CI] = 1.16-4.81, P = .018), 3 months (AOR = 2.62, 95% CI = 1.33-5.16, P = .005), and 6 months postinjury (AOR = 2.54, 95% CI = 1.19-5.42, P = .016). Adjusting for these baseline factors, post-TBI symptoms were strongly associated with SI at concurrent (AORs = 1.91-2.88 per standard deviation unit increase in Rivermead Post-Concussion Symptoms Questionnaire score; P values <.0005) and subsequent follow-up visits (AORs = 1.68-2.53; P values <.005). Most of the associations between post-TBI symptoms and SI were statistically explained by co-occurring depression.

Conclusion:

Screening for psychiatric and prior TBI history may help identify patients at risk for SI following mTBI. Awareness of the strong associations of post-TBI symptoms with SI may facilitate interventions to prevent suicide-related outcomes in patients with mTBI.
Mood, Psychological, and Behavioral Factors of Health-Related Quality of Life Throughout Recovery From Sport Concussion
Authors: Walton Samuel R. , Broshek Donna K. , Kranz Sibylle , Malin Steven K. , Hertel Jay , Resch Jacob E.
Published: August 2020

Objective:

To measure alterations in mood, psychological, and behavioral factors in collegiate athletes throughout recovery from sport concussion (SC) compared with matched controls.

Setting:

University research laboratory.

Participants:

Twenty (55% female) division I collegiate athletes with SC (19.3 ± 1.08 years old, 1.77 ± 0.11 m, 79.6 ± 23.37 kg) and 20 (55% female) uninjured matched controls (20.8 ± 2.17 years old, 1.77 ± 0.10 m, 81.9 ± 23.45 kg).

Design:

Longitudinal case control.

Main Measures:

Self-reported concussion-related symptoms, anxiety, resilience, stigma, sleep disturbance, fatigue, and appetite were assessed at 3 time points in the SC group: T1 (≤72 hours of SC), T2 (7 days after T1), and TF (after symptom resolution). Control participants were evaluated at similar intervals. Group and group-by-sex differences were assessed using repeated-measures analyses of variance. Post hoc analyses were performed with Tukey's honestly significant difference (HSD) and paired-sample t tests.

Results:

The SC group had greater sleep disturbance than controls at T1 (P = .001; d = 1.21) and endorsed greater stigma at all time points (P ≤ .03; d ≥ 0.80). Stigma (F
(2) = 3.68; P = 0.03; η2
p = 0.12), sleep disturbance (F
(2) = 5.27; P = .008; η2
p = 0.15), and fatigue (F
(2) = 3.46; P = .04; η2
p = 0.11) improved throughout recovery in those with SC only. No differences were observed between males and females (P > .05).

Conclusion:

Sleep disturbance and stigma were negatively affected by SC, highlighting potential areas for clinical interventions to maximize recovery in males and females.
Preclinical Studies of a Novel Microfabricated Device to Treat Corneal Epithelial Disease
Authors: Chaum Edward
Published: August 2020

Purpose:

Anterior stromal puncture is an inexpensive technique for treating recurrent corneal erosions but is often ineffective and cannot be used in the optical axis because of scarring. These studies tested a novel microfabricated imprinting instrument to assess its potential efficacy for the treatment of corneal epithelial disease in the optical axis.

Methods:

The device is made using glass rods, bundled and drawn through multiple iterative cycles, and then fused under high heat to generate a solid rod comprised of many parallel, aligned, cladded fibers. The rods are sliced into discs and then etched to yield designable spikes based on the borosilicate composition of the glass.

Results:

Imprinting the cornea yields a regular pattern of imprints. Histologic studies showed both nonpenetrating stable deformations of Bowman layer, with formation of stable epithelial attachments, and full thickness penetration, with superficial ingrowth of the basal epithelium.

Conclusions:

Microimprinted corneal tissue shows focal subepithelial scarring without evidence of optically evident anterior stromal scarring, and may be an effective way of treating recurrent corneal erosions in the optical axis, which is not currently possible using standard anterior stromal puncture methods.
Corynebacterium Species of the Conjunctiva and Nose: Dominant Species and Species-Related Differences of Antibiotic Susceptibility Profiles
Authors: Hoshi Saichi , Todokoro Daisuke , Sasaki Takashi
Published: August 2020

Purpose:

Nondiphtherial Corynebacterium species are normal residents of human skin and mucosa, including the conjunctiva and nose, but can cause conjunctivitis and keratitis. Recently, resistance against various classes of antibiotics has been reported in Corynebacterium. The present study investigated the type of species and antibiotic susceptibilities of the conjunctival and nasal Corynebacterium species.

Methods:

This study examined 183 strains of Corynebacterium species that were isolated from patients undergoing preoperative examinations for cataract surgery. Species were identified by RNA polymerase β-subunit-encoding gene (rpoB) sequencing. Antibiotic susceptibility tests were performed by the microdilution method according to the Clinical and Laboratory Standards Institute standard method M45.

Results:

Corynebacterium macginleyi was the most predominant species (84%; 46 of 55) in the conjunctiva. The 2 major species in the nasal cavity were Corynebacterium accolens and Corynebacterium propinquum (44% and 31%, respectively), followed by Corynebacterium pseudodiphtheriticum (8%), Corynebacterium jeikeium (7%), and C. macginleyi (3%). In contrast to other nasal Corynebacterium species, only C. macginleyi showed a high susceptibility to macrolides. However, among nonconjunctival Corynebacterium species, C. propinquum, was unique in having a high resistance rate to levofloxacin (29%), comparable with that observed in C. macginleyi (36%). Penicillin G and tobramycin showed good susceptibility in almost all strains.

Conclusions:

Drug resistance against fluoroquinolones and macrolides was observed in Corynebacterium species, with the antibiotic susceptibility profiles correlating with differences of the species and niche. Nasal and conjunctival Corynebacterium profiles of drug resistance suggest habitat segregation strictly at the species level.
A Retrospective Case Series of Uveal Effusion Syndrome
Authors: Claeys Emilie , Stalmans Peter , Van Calster Joachim , Casteels Ingele , Stalmans Ingeborg , Vandewalle Evelien
Published: August 2020

Purpose:

This study aimed to describe the clinical findings and management of eyes affected by uveal effusion syndrome.

Methods:

We retrospectively evaluated the charts of 13 eyes of 8 consecutive patients diagnosed with uveal effusion syndrome attending the Ophthalmology Unit of the University Hospitals Leuven, Belgium, between 2007 and 2018. The presenting features, investigations, management, and outcomes were analyzed for each case.

Results:

Cataract surgery was the predisposing factor for uveal effusion in 6 eyes, 2 bilateral uveal effusions (4 eyes) were considered to be medication-induced, and in 3 eyes, the uveal effusion was described as idiopathic. Fundus examination of 5 of 13 eyes showed bullous choroidal detachment, treated with pars plana vitrectomy with superotemporal sclerectomy or transscleral punction. Fundoscopy showed uveal effusion without serous retinal detachment in 3 eyes. Serous retinal detachment accompanied by uveal swelling was observed in 3 eyes and the 2 remaining eyes presented with uveal swelling only. The 8 nonbullous choroidal detachments were treated in a conservative way. A rapid resolution of subretinal fluid and uveal effusion was observed in all cases.

Conclusions:

A conservative approach with acetazolamide treatment or just observation was used in our case series in choroidal detachment without substantial visual loss if, over time, slow improvement was documented. However, further studies are needed to verify the effectiveness of the reported therapy.
Primary Congenital Glaucoma: Trends in Presentation Over 3 Decades at a Tertiary Eye Care Center in India
Authors: Mandal Anil K. , Sulthana Shaik S. , Gothwal Vijaya K.
Published: August 2020

Precis:

In this study, huge time delay was observed between first primary congenital glaucoma (PCG) symptom recognition by parents to ophthalmological diagnosis and this delay was unchanged over time. Bilateral affliction and mean presenting intraocular pressure (IOP) remained unaltered.

Purpose:

To compare the trends in presentation of patients with PCG over 3 different time periods at 10-year intervals (1998, 2008, and 2018) managed by a single surgeon at one of the largest tertiary eye care centers in South India.

Methods:

Retrospective analysis of 313 eyes of 172 patients diagnosed to have PCG and treated at the L V Prasad Eye Institute (LVPEI) between January and December of the 3 specified years. Data collected included age at symptom recognition and at presentation, sex, affected eye, signs and symptoms, time between onset of symptoms and diagnosis (diagnostic delay), corneal clarity, and IOP.

Results:

Of the 172 patients, 48 (27.9%), 76 (44.2%), and 48 (27.9%) belonged to 1998, 2008, and 2018, respectively. Bilateral affliction (79% to 84%) was common and there was no sex predilection. The median age at recognition of first symptoms by caregivers/parents was 1 day (interquartile range, 1 to 30), and at diagnosis was 120 days (interquartile range, 30 to 378). Overall, presentation to LVPEI was delayed by >3 months in 80 (46.5%) children, and there was no statistically significant difference in the duration of delay over time (P=0.13). There was no significant difference in the mean presenting IOP over time (P>0.05).

Conclusions:

We provide unique single center-based information of trends in the presentation of patients with PCG over 3 decades. Diagnostic delay was common, and a large number of characteristics of patients with PCG in South India have remained unchanged, particularly, age at onset and at diagnosis and laterality.
Peripapillary and Macular Microcirculation in Glaucoma Patients of African and European Descent Using Optical Coherence Tomography Angiography
Authors: Taylor Logan , Bojikian Karine D. , Jung Hoon , Chu Zhongdi , Zhou Xiao , Zhang Qinqin , Mudumbai Raghu C. , Waang Ruikang K. , Chen Philip P.
Published: August 2020

Précis:

We found no significant differences in peripapillary and macula microcirculation blood flow metrics in eyes with open-angle glaucoma of African descent (AD) and European descent (ED) as detected by optical coherence tomography angiography (OCTA).

Purpose:

The purpose of this study was to investigate the peripapillary retinal nerve fiber layer (RNFL) and macular vascular microcirculation in subjects of AD and ED with open-angle glaucoma using OCTA.

Patients and Methods:

One eye from each subject was scanned using AngioPlex OCTA system covering both a 6×6 mm scanning area centered at the optic nerve head and at the foveola. Peripapillary RNFL and macular microcirculation were measured by calculating the overall flux and vessel area density excluding the large retinal vessels. Two-sample, independent t tests were used to compare the OCTA metrics between AD and ED eyes. Linear regression models were used to investigate the correlation between OCTA metrics and structural and functional parameters.

Results:

Twenty-eight eyes of AD and 56 eyes of ED were included in the study. There was no significant difference in age, sex, hypertension, antihypertensive medications, diabetes, systolic and diastolic blood pressure, mean ocular perfusion pressure, RNFL thickness and visual field (VF) mean deviation and VF pattern standard deviation (P≥0.054) between AD and ED eyes included. Both groups had similar OCTA blood flow metrics (P≥0.161). OCTA blood flow metrics were significantly correlated with VF mean deviation (r≥0.466), VF pattern standard deviation (r≤−0.366) and RNFL thickness (r≥0.333).

Conclusions:

No significant differences were found in peripapillary and macular microcirculation detected by OCTA between AD and ED glaucomatous eyes. Peripapillary and macular microcirculation were significantly correlated with disease severity in AD and ED glaucomatous eyes.
Effect of combined pharmacological, behavioral, and physical interventions for procedural pain on salivary cortisol and neurobehavioral development in preterm infants: a randomized controlled trial
Authors: Gao Haixia , Xu Guihua , Li Fang , Lv Hui , Rong Hui , Mi Yuanyuan , Li Mei
Published: August 2020

Repeated procedural pain may lead to increased secretion of cortisol and future neurobehavioral development disorders in preterm infants. Changes in the cortisol level may mediate the effect of neonatal repetitive procedural pain on altered childhood neurobehavioral development in preterm infants. However, few studies have investigated the effect of combined pharmacological, behavioral, and physical interventions over repeated painful procedures on pain response, cortisol level, and neurobehavioral development. This study examined (1) the efficacy and safety of sucrose combined with massage, music, non-nutritive sucking, and gentle human touch to treat preterm infants with repeated procedural pain; (2) the cortisol level at discharge from the neonatal intensive care unit (NICU); (3) neurobehavioral development at 40 weeks' corrected gestational age; and (4) the potential mediating effect of the cortisol level in the combined interventions on neurobehavioral development. Stable preterm infants (n = 76) were randomized to receive routine care or combined interventions across repeated painful procedures throughout their NICU stay. The Premature Infant Pain Profile scores in the early, middle, and late periods of the NICU stay were measured, as were the basal salivary cortisol level at admission and discharge, the Neonatal Behavioral Neurological Assessment score at 40 weeks' corrected gestational age, and the incidence of adverse effects during the study period. Our findings indicated that the combined interventions remained efficacious and safe for reducing repeated procedural pain, decreased the cortisol level at discharge, and promoted early neurobehavioral development in preterm infants. This effect may have been mediated through decreased cortisol levels and reduced repeated procedural pain.
Differential sensory and clinical phenotypes of patients with chronic widespread and regional musculoskeletal pain
Authors: Finnern Marina M. , Kleinböhl Dieter , Flor Herta , Benrath Justus , Hölzl Rupert
Published: August 2020

The differentiation of chronic primary pain syndromes into those with widespread vs regional musculoskeletal pain has been characterized by controversial discussions about common or distinct mechanisms and core clinical and sensory criteria. For example, the recent revision of fibromyalgia criteria has discarded sensory characteristics such as number of “tender points.” This study examined empirical evidence related to this diagnostic shift and aimed to identify basic sensory-clinical pain phenotypes in patients with chronic local primary pain (chronic primary back pain [CBP]) and patients with chronic widespread primary pain (fibromyalgia syndrome). Combined sensory-clinical pain phenotypes of 185 patients with previous CBP and fibromyalgia syndrome diagnoses were derived by a stepwise data reduction through descriptive statistical, correlational, principal components and latent class analyses. Clusters were cross-validated by linear discriminant analysis. Four clusters of patients were identified, requiring 4 pressure pain sensitivity markers (number of sensitive tender and control points, pain intensity, and pressure pain threshold at the trapezius) and 2 clinical pain characteristics (pain regions and present pain intensity). Subsequent discriminant analysis revealed that 3 discriminant functions of pressure sensitivity markers sufficed to differentiate the clusters. These sensory-clinical phenotypes differed also in somatic symptoms and impairment but neither in psychopathology nor in psychosocial cofactors. The results highlight the relevance of sensory testing in combination with clinical pain assessment in chronic primary pain syndromes.
A combination of pain indices based on momentary assessments can predict placebo response in patients with fibromyalgia syndrome
Authors: Obbarius Alexander , Schneider Stefan , Stone Arthur A.
Published: August 2020

Many factors are known to affect assay sensitivity; however, limited attention has been devoted to understanding whether characteristics of patients' baseline pain impact assay sensitivity. In this study, we tested whether a combination of 3 baseline pain indices based on ecological momentary assessments (EMA) could detect patients with enhanced responses to placebo. The analysis was conducted with secondary data from 2 clinical trials in fibromyalgia patients (N = 2084). For each patient, pain intensity, pain variability (individual SD), and pain consistency (first-order autocorrelation) were computed from baseline EMA. A latent profile analysis identified 3 subgroups of patients based on these indices. Group 1 (n = 857, 41.3%) showed the lowest pain intensity levels, coupled with the highest consistency and greatest variability of pain. Group 3 (n = 110, 5.3%) showed the opposite pattern, and group 2 (n = 1109, 53.4%) showed intermediate levels on all pain indices. It was then tested whether the subgroups moderated treatment effects (changes in pain for active treatment vs placebo) using repeated-measures analysis of variance. Treatment effects varied significantly between subgroups. Patients in group 3 demonstrated greater reduction in pain in response to placebo then those in groups 1 and 2. Further analysis showed that the removal of patients in class 3 would significantly enhance the observed treatment effect by 8% to 15%. In conclusion, profiles of pain characteristics derived from baseline EMA may be useful for detecting patient subgroups with enhanced placebo responses that can diminish assay sensitivity in pain clinical trials.
Sex-dependent role of microglia in disulfide high mobility group box 1 protein-mediated mechanical hypersensitivity
Authors: Agalave Nilesh M. , Rudjito Resti , Farinotti Alex Bersellini , Khoonsari Payam Emami , Sandor Katalin , Nomura Yuki , Szabo-Pardi Thomas A. , Urbina Carlos Morado , Palada Vinko , Price Theodore J. , Erlandsson Harris Helena , Burton Michael D. , Kultima Kim , Svensson Camilla I.
Published: August 2020

High mobility group box 1 protein (HMGB1) is increasingly regarded as an important player in the spinal regulation of chronic pain. Although it has been reported that HMGB1 induces spinal glial activation in a Toll-like receptor (TLR)4-dependent fashion, the aspect of sexual dimorphisms has not been thoroughly addressed. Here, we examined whether the action of TLR4-activating, partially reduced disulfide HMGB1 on microglia induces nociceptive behaviors in a sex-dependent manner. We found disulfide HMGB1 to equally increase microglial Iba1 immunoreactivity in lumbar spinal dorsal horn in male and female mice, but evoke higher cytokine and chemokine expression in primary microglial culture derived from males compared to females. Interestingly, TLR4 ablation in myeloid-derived cells, which include microglia, only protected male mice from developing HMGB1-induced mechanical hypersensitivity. Spinal administration of the glial inhibitor, minocycline, with disulfide HMGB1 also prevented pain-like behavior in male mice. To further explore sex difference, we examined the global spinal protein expression using liquid chromatography-mass spectrometry and found several antinociceptive and anti-inflammatory proteins to be upregulated in only male mice subjected to minocycline. One of the proteins elevated, alpha-1-antitrypsin, partially protected males but not females from developing HMGB1-induced pain. Targeting downstream proteins of alpha-1-antitrypsin failed to produce robust sex differences in pain-like behavior, suggesting that several proteins identified by liquid chromatography-mass spectrometry are required to modulate the effects. Taken together, the current study highlights the importance of mapping sex dimorphisms in pain mechanisms and point to processes potentially involved in the spinal antinociceptive effect of microglial inhibition in male mice.
Views of Patients With Heart Failure on Their Value-Based Self-care Decisions
Authors: Karimi-Dehkordi Mehri , Clark Alexander M.
Published: August 2020

Background

Self-care adherence remains low in patients with heart failure (HF); little is known about the influence of patients' values on self-care decisions and behaviors.

Objectives

The aim of this study was to explore how participants living with HF perceive their values and how those values are reportedly expressed in self-care decision making.

Methods

The Interpretative Phenomenological Analysis approach was used. Semistructured interviews were conducted with 12 patients 60 years or older; with New York Heart Association class II and III HF; and able to speak, read, and understand English. Participants recruited via convenience sampling (January–December 2016) from 2 urban sites in Western Canada.

Results

Values were reported to pivotally influence HF self-care decisions and behaviors. Overarching themes addressed aspects of values and decision making: notably, directness and complexity. Two main types of values, functional and emotional values, were involved in both adherent and nonadherent decisions. Values were often in flux, with the pursuit of these values being frequently in conflict with physical ability and changing over time.

Conclusion

Two types of values serve influence self-care decisions and adherence. As HF and its self-care prevent patients from pursuing their prioritized values, patients are often nonadherent. Thus, patients with HF should be supported to find alternative ways to enact their values.
Inflammatory Genotype Moderates the Association Between Anxiety and Systemic Inflammation in Adults at Risk for Cardiovascular Disease
Authors: Key Kaitlin Voigts , Mudd-Martin Gia , Moser Debra K. , Rayens Mary Kay , Morford Lorri A.
Published: August 2020

Background

Cardiovascular disease is a significant health problem in the United States, attributed to more than 30% of all deaths annually. Anxiety has been associated with cardiovascular disease risk and is thought to be associated with cardiovascular disease risk through inflammatory pathways.

Objective

The purposes of this study were to examine the relationship between anxiety and systemic inflammation in individuals at risk for cardiovascular disease and to determine if single-nucleotide polymorphisms (SNPs) associated with inflammation moderate this relationship.

Methods

A secondary analysis was conducted using baseline data from a study investigating the impact of genetics on response to a cardiovascular disease risk reduction intervention. Anxiety was measured using the Brief Symptom Inventory. Protein levels for C-reactive protein and interleukin-6 (IL-6) were measured in serum, and genomic DNA was assayed for SNPs in the C-reactive protein, IL-6, and IL-6R genes. Multiple linear regressions were performed to examine if anxiety predicted inflammation and if SNPs moderated associations.

Results

Participants (N = 398) were white, aged 51 ± 13 years, and 73% women. There was a significant interaction between rs4129267 genotype and anxiety (P = .010), with the association significant only for individuals with the CC genotype (b = 0.243, SE = 0.04, P < .001). No moderation effect existed for rs1205 or rs1800797.

Conclusion

Anxiety was positively associated with IL-6 protein levels, but moderation analysis indicated that this was significant only for individuals with the rs4129267 CC genotype. This suggests that genotypic differences may exist in anxiety response, placing certain individuals at higher risk for inflammation and, subsequently, cardiovascular disease.
A Systematic Review of Behavioral Outcomes for Leadership Interventions Among Health Professionals
Authors: CLEARY Michelle , KORNHABER Rachel , THAPA Deependra Kaji , WEST Sancia , VISENTIN Denis
Published: August 2020

Background

Healthcare requires effective leadership to improve patient outcomes, manage change, and achieve organizational goals.

Purpose

The purpose of this study was to evaluate interventions aimed at improving leadership behavior in health professionals.

Methods

A systematic literature review of key databases (PubMed, CINAHL, Embase, and Scopus) was performed in September 2018. Data were extracted and synthesized.

Results

Thirty-three articles from 31 studies met the inclusion criteria. Self-reported leadership behavior showed a significant postprogram improvement. Objective observations were more likely to show improved leadership behavior than subjective observations. Face-to-face delivery of leadership development was more effective than online delivery. Interventions incorporating the elements of personal development planning, self-directed learning, workplace-based learning, and reflection were more likely to develop leadership behavior.

Conclusions/Implications for Practice

Leadership interventions had a beneficial effect on the leadership behaviors of participants based on both subjective and objective changes in behavior. In addition to focusing on individual skill development, interventions that aim to develop leadership should consider the organizational, social, cultural, and political contexts in which behavioral change is expected. Workplace-based learning should be included in program development.
A Population-Based Survey of the Workplace Costs for Caregivers of Persons With Treatment-Resistant Depression Compared With Other Health Conditions
Authors: Lerner Debra , Lavelle Tara A. , Adler David , Chow Wing , Chang Hong , Godar Sean C. , Rogers William H.
Published: August 2020

Objective:

To describe caregiving work outcomes and related indirect (ie, productivity) and direct (ie, caregiving hours and expenses) costs.

Methods:

A national, population-based survey to identify employed caregivers assisting a person with treatment-resistant depression (TRD) and a comparison group of employed caregivers assisting others (No TRD).

Results:

Screening identified 169 TRD caregivers and 1070 No TRD caregivers providing 23.3 and 14.6 mean weekly caregiving hours, respectively. Adjusted annual indirect cost estimates were $11,121 for caregivers of TRD and $7761 for caregivers in the No TRD group (P ≤ 0.0001). At-work productivity loss (presenteeism) was the largest component. Adjusted annual direct cost estimates were $29,805 for caregivers of TRD and $20,642 for caregivers in the No TRD group (P ≤ 0.0001).

Conclusions:

TRD exacts a toll on caregivers and their employers exceeding that for other caregivers.
Do Injured Workers Receive Opioid Prescriptions Outside the Workers’ Compensation System?
Authors: Asfaw Abay , Quay Brian , Chang Chia-Chia
Published: August 2020

Objectives:

We explored the impact of workplace injury on receiving opioid prescriptions from employer-sponsored private group health insurances (GHI) and how long injured workers receive opioid prescriptions after injury.

Methods:

We used a difference-in-differences method and MarketScan® databases for the years 2013 to 2015.

Results:

Estimated odds for injured workers relative to noninjured workers to receive opioid prescriptions from the GHI within 60 and 180 days from the index date of injury were 4.9 and 1.5, respectively. In addition, the number of opioid prescriptions received within 60 days of injury was 2.5 times higher.

Conclusion:

Workplace injury could be a risk factor for both short and long-term prescription opioid use. Studies that use only workers’ compensation medical claim data likely underestimate the magnitude of the impact of workplace injuries on opioid prescriptions.