bluuebunny/crossref_metadata_2025_split huggingface dataset:
TRIANGULAR SIGN OF AMALRIC IN INTRAVASCULAR LYMPHOMA
Authors: Bavinger James Clay , Hamedani Ali G. , Lee Vivian , Brucker Alexander J. , Aleman Tomas S. 
Published: August 2020

Purpose and Methods:
To report a case of bilateral ocular ischemia caused by intravascular lymphoma with the presence of bilateral triangular sign of Amalric.

Results:
A 67-year-old woman was admitted to our hospital for progressive paraplegia and a 6-month history of acute painless vision loss in the right eye. Initial examination showed vision of counting fingers in the right eye and 20/20 in the left eye with normal anterior examination. Fundus examination revealed a likely previous central retinal artery occlusion in the right eye with pale nerve and attenuated vessels. Both fundi had triangular regions of pigmentary change known as the triangular sign of Amalric, indicative of choroidal ischemia. However, the left eye was asymptomatic. Neuroimaging revealed multifocal enhancing lesions throughout the central nervous system of unclear etiology. An extensive neurologic and systemic workup was unrevealing, including a brain biopsy, and empiric treatment for an unspecified inflammatory condition with intravenous corticosteroids was initiated. During her hospitalization, she developed acute painless vision loss in the left eye, and examination showed no light perception vision in both eyes with signs of acute retinal and choroidal ischemia in the left eye. A subsequent brain biopsy revealed intravascular lymphoma.

Conclusion:
Triangular pigmentary changes indicate choroidal ischemia and can be seen in many conditions. This patient presented with the triangular sign of Amalric in both eyes, including her asymptomatic left eye. Intravascular lymphoma should be considered in cases of concomitant inflammatory brain lesions and chorioretinal ischemia.
Immunohistochemical Study of SARS-CoV-2 Viral Entry Factors in the Cornea and Ocular Surface
Authors: Roehrich Heidi , Yuan Ching , Hou Joshua H. 
Published: August 2020

Purpose:
To confirm the ocular tropism of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by evaluating the expression of viral entry factors in human ocular tissues using immunohistochemistry.

Methods:
Fresh donor corneas and primary explant cultures of corneal, limbal, and conjunctival epithelial cells were evaluated for the expression of viral entry factors. Using immunohistochemistry, the samples were tested for the expression of angiotension-converting enzyme 2 (ACE2), dendritic cell–specific intracellular adhesion molecule 3-grabbing nonintegrin (DC-SIGN), DC-SIGN–related protein (DC-SIGNR), and transmembrane serine protease 2 (TMPRSS2).

Results:
In total, 5 donor corneas were evaluated for the expression of viral entry factors. In all specimens, both ACE2 and TMPRSS2 were expressed throughout the surface epithelium (corneal, limbal, and conjunctival) and corneal endothelium. In corneal stromal cells, ACE2 was sporadically expressed, whereas TMPRSS2 was absent. DC-SIGN/DC-SIGNR expression varied between donor specimens. Four specimens expressed DC-SIGN/DC-SIGNR in a similar distribution to ACE2, but 1 specimen from a young donor showed no expression of DC-SIGN/DC-SIGNR. ACE2, TMPRSS2, and DC-SIGN/DC-SIGNR were all expressed in the cultured corneal, limbal, and conjunctival epithelial cells.

Conclusions:
Both corneal and conjunctival epithelia express ACE2, DC-SIGN/DC-SIGNR, and TMPRSS2, suggesting that the ocular surface is a potential route for the transmission of SARS-CoV-2. The risk of viral transmission with corneal transplantation cannot be ruled out, given the presence of ACE2 in corneal epithelium and endothelium. Cultured corneal, limbal, and conjunctival epithelial cells mimic the expression of viral entry factors in fresh donor tissue and may be useful for future in vitro SARS-CoV-2 infection studies.
Silicone Scaffold Support Using a Bilayer Dermal Regeneration Matrix Template for Correction of Primary or Recurrent Eyelid Retraction
Authors: Boulter Tyler D. , Burkat Cat N. , Downie Elaine , Hawes Michael J. , Willoughby Brian , Fante Robert G. 
Published: August 2020

Purpose:
To evaluate the efficacy and safety of a bilayer dermal regenerative matrix for primary or complex/recurrent eyelid retraction.

Methods:
Retrospective review of patients undergoing eyelid retraction repair using the bilayer dermal regenerative matrix from 2005 to 2019. Nineteen eyelid surgeries from 15 patients were identified. Collected data included patient demographics, symptoms, preoperative/postoperative lower eyelid position, inferior scleral show, lagophthalmos, etiology of retraction, history of prior retraction surgeries, major/minor complications, and follow-up duration (minimum 6 months). Postoperative measurements were taken at a minimum of 1 week, 3–6 weeks, 2–4 months, and 6 months.

Results:
Postoperatively, 90% of cases had good improvement of lower eyelid retraction (defined as 1 mm or less below the inferior limbus). Postoperative elevation of the lower eyelid ranged 1–3.5 mm compared with preoperative measurements. When used in the upper eyelid for conjunctival scarring, the implant improved the superior fornix depth. Complications were minimal and included transient conjunctival injection, eyelid edema, and foreign body sensation. No patients requested early removal of the silicone layer due to ocular pain.

Conclusions:
The bilayer dermal regeneration matrix template may be considered a reasonable alternative to other spacers to reduce the vertical palpebral fissure and eyelid malposition in primary, complex, or recurrent cases. It also worked well for first-line correction of thyroid retraction, which tend to be more challenging due to globe proptosis. Suboptimal results may have occurred due to active cicatrizing conjunctival disease, or residual negative vector of the cheek and orbit. High cost may be a consideration, and the bilayer dermal regeneration matrix template was not studied directly against hard palate and other spacer materials.
Pharmacological modulation of voltage-gated sodium (NaV) channels alters nociception arising from the female reproductive tract
Authors: Castro Joel , Maddern Jessica , Erickson Andelain , Caldwell Ashlee , Grundy Luke , Harrington Andrea M. , Brierley Stuart M. 
Published: August 2020

Abstract
Dyspareunia, also known as vaginal hyperalgesia, is a prevalent and debilitating symptom of gynaecological disorders such as endometriosis and vulvodynia. Despite this, the sensory pathways transmitting nociceptive information from female reproductive organs remain poorly characterised. As such, the development of specific treatments for pain associated with dyspareunia is currently lacking. Here, we examined, for the first time, (1) the mechanosensory properties of pelvic afferent nerves innervating the mouse vagina; (2) the expression profile of voltage-gated sodium (NaV) channels within these afferents; and (3) how pharmacological modulation of these channels alters vaginal nociceptive signalling ex vivo, in vitro, and in vivo. We developed a novel afferent recording preparation and characterised responses of pelvic afferents innervating the mouse vagina to different mechanical stimuli. Single-cell reverse transcription-polymerase chain reaction determined mRNA expression of NaV channels within vagina-innervating dorsal root ganglia neurons. Vagina-innervating dorsal root ganglia neuroexcitability was measured using whole-cell patch-clamp electrophysiology. Nociception evoked by vaginal distension was assessed by dorsal horn neuron activation within the spinal cord and quantification of visceromotor responses. We found that pelvic afferents innervating the vagina are tuned to detect various mechanical stimuli, with NaV channels abundantly expressed within these neurons. Pharmacological modulation of NaV channels (with veratridine or tetrodotoxin) correspondingly alters the excitability and mechanosensitivity of vagina-innervating afferents, as well as dorsal horn neuron activation and visceromotor responses evoked by vaginal distension. This study identifies potential molecular targets that can be used to modulate vaginal nociceptive signalling and aid in the development of approaches to manage endometriosis and vulvodynia-related dyspareunia.
A spider-venom peptide with multitarget activity on sodium and calcium channels alleviates chronic visceral pain in a model of irritable bowel syndrome
Authors: Cardoso Fernanda C. , Castro Joel , Grundy Luke , Schober Gudrun , Garcia-Caraballo Sonia , Zhao Tianjiao , Herzig Volker , King Glenn F. , Brierley Stuart M. , Lewis Richard J. 
Published: August 2020

Abstract
Chronic pain is a serious debilitating condition that affects ∼20% of the world's population. Currently available drugs fail to produce effective pain relief in many patients and have dose-limiting side effects. Several voltage-gated sodium (NaV) and calcium (CaV) channels are implicated in the etiology of chronic pain, particularly NaV1.1, NaV1.3, NaV1.7–NaV1.9, CaV2.2, and CaV3.2. Numerous NaV and CaV modulators have been described, but with few exceptions, they display poor potency and/or selectivity for pain-related channel subtypes. Here, we report the discovery and characterization of 2 novel tarantula-venom peptides (Tap1a and Tap2a) isolated from Theraphosa apophysis venom that modulate the activity of both NaV and CaV3 channels. Tap1a and Tap2a inhibited on-target NaV and CaV3 channels at nanomolar to micromolar concentrations and displayed moderate off-target selectivity for NaV1.6 and weak affinity for NaV1.4 and NaV1.5. The most potent inhibitor, Tap1a, nearly ablated neuronal mechanosensitivity in afferent fibers innervating the colon and the bladder, with in vivo intracolonic administration reversing colonic mechanical hypersensitivity in a mouse model of irritable bowel syndrome. These findings suggest that targeting a specific combination of NaV and CaV3 subtypes provides a novel route for treatment of chronic visceral pain.
The Economic Burden of Lost Productivity due to Presenteeism Caused by Health Conditions Among Workers in Japan
Authors: Yoshimoto Takahiko , Oka Hiroyuki , Fujii Tomoko , Nagata Tomohisa , Matsudaira Ko 
Published: August 2020

Objective:
To identify the primary health conditions that cause presenteeism, and to estimate the economic cost of lost productivity due to presenteeism in Japan.

Methods:
We conducted an Internet survey among 10,000 Japanese workers. Participants were asked to answer the health condition most affecting their work. Presenteeism was evaluated using the Quantity and Quality methods, and we estimated an annualized cost per capita and nation.

Results:
The common health conditions most interfering with work were neck pain or stiff shoulders, low back pain, and mental illnesses. The annualized costs of presenteeism per capita for each were $414.05, $407.59, and $469.67, respectively. The estimated national costs for each were all above $27 billion.

Conclusions:
Mental illnesses and musculoskeletal symptoms were the leading causes of presenteeism in Japan, and the economic burden of presenteeism was considerably large.
Influence of Incentive Design and Organizational Characteristics on Wellness Participation and Health Outcomes
Authors: Grossmeier Jessica , Mangen David J. , Anderson David R. , Gingerich Stefan B. , Mitchell Rebecca J. , Imboden Mary T. , Kaplan Gordon D. , Gascon Gregg M. , Serxner Seth A. , Bodak Tony 
Published: August 2020

Objective:
To explore how changing incentive designs influence wellness participation and health outcomes.

Methods:
Aggregated retrospective data were evaluated using cluster analysis to group 174 companies into incentive design types. Numerous statistical models assessed between-group differences in wellness participation, earning incentives, and over-time differences in health outcomes.

Results:
Four incentive design groups based on requirements for earning incentives were identified. The groups varied in support for and participation in wellness initiatives within each company. All four design types were associated with improved low density lipoprotein (LDL) (P < 0.01), three with improved blood pressure (P < 0.001), and two with improved fasting glucose (P < 0.03). No incentive plan types were associated with improved body mass index (BMI), but designs predominantly focused on health outcomes (eg, Outcomes-Focused) exhibited a significant increase over time in BMI risk.

Conclusion:
Incentive design and organizational characteristics impact population-level participation and health outcomes.
Coming of Age in Physician Assistant Education: Evolution of Program Characteristics
Authors: Quincy Brenda , Snyder Jennifer 
Published: August 2020

Purpose
This study aimed to describe the characteristics of physician assistant (PA) programs developed in 3 previously defined time periods.

Methods
Data were extracted from the websites of 238 PA programs, including admissions, curriculum, faculty, and program characteristics. Institutional characteristics were gathered from the Carnegie Classification website and the US Census Bureau. Program characteristics were analyzed in 3 groups based on when the program was first accredited—early (before 1980), middle (1980–1999), and current (2000–2019).

Results
Early (n = 40), middle (n = 69), and current (n = 129) phase programs are similar regarding the number of admissions, curriculum, faculty, program, and institutional characteristics. Program phase had the greatest effect on undergraduate GPA of matriculating students, the number of PA faculty at the rank of professor, and the size of the admitted cohort. The effect size was medium for outcomes including the number of required biology, chemistry, or physics prerequisites; the probability that the program required a graduate record examination for admission; the number of PA program faculty at the rank of associate professor; the annual tuition and fees; and the probability that the PA program was housed with a medical school.

Conclusion
The data describe some of the similarities and differences among the programs established in the 3 previously described time periods in the history of PA education. With the recent surge in new programs, there is value in deepening our understanding of how newer programs compare with more established programs.
Characteristics of recurrent in-stent restenosis after second- and third-generation drug-eluting stent implantation
Authors: Shimono Hirokazu , Kajiya Takashi , Takaoka Junichiro , Miyamura Akihiro , Inoue Takafumi , Kitazono Kazunari , Ninomiya Toshiko , Atsuchi Yoshihiko , Atsuchi Nobuhiko , Ohishi Mitsuru 
Published: August 2020

Background
In second- and third-generation drug-eluting stent (DES) era, in-stent restenosis (ISR) is not commonly seen. However, a few patients still need repeat revascularizations for recurrent ISR even after second- and third-generation DES implantation.

Methods
From January 2012 to March 2017, 2339 lesions underwent second- and third-generation DES (Nobori, Promus Element, Resolute Integrity, Xience, Ultimaster and Synergy) implantation, of which 95 lesions (4.1%) underwent revascularization for first ISR. All lesions were divided into two groups of recurrent ISR group and non-recurrent ISR group. After successful optical coherence tomography (OCT) guided revascularization for all lesions, we investigated characteristics of recurrent ISR, and 2 years follow-up were completed.

Results
The mean age was 70.8 ± 11.7 years, and 73.2% were males. Among 56 DES-ISR lesions which were assessed by OCT, recurrent ISR was seen in 33.9% (N = 19) at 2 years follow-up after revascularization for first ISR. Serum low-density lipoprotein-cholesterol (LDL-C) level was higher in recurrent ISR group compared with non-recurrent ISR group (114.1 ± 53.9 mg/dl vs. 90.9 ± 27.8 mg/dl, P = 0.04) and heterogeneous tissue pattern was more frequently found in recurrent ISR group compared with non-recurrent ISR group (63.2% vs. 27.0%, P = 0.03). Multivariate analysis identified a heterogeneous tissue pattern (odds ratio 3.71; 95% confidence interval 1.09–12.59; P = 0.03) as an independent predictor of recurrent restenosis.

Conclusion
Recurrent ISR of second- and third-generation DES was associated with heterogeneous tissue pattern of first ISR, and high LDL-C level was associated with recurrence.
An Implementation Framework for the Clinically Indicated Removal Policy for Peripheral Intravenous Catheters
Authors: Takashima Mari , Cooke Marie , DeVries Michelle , Kleidon Tricia M. , Alexandrou Evan , Chopra Vineet , Rickard Claire M. 
Published: August 2020

Background:
Equivalent clinical outcomes, lower costs, and fewer invasive procedures have resulted in revised recommendations for the removal of peripheral intravenous catheters (PIVCs) from the traditional 72- to 96-hourly removal to removal based upon clinical indication.

Problem:
Uptake of this evidence-based innovation to health systems is often delayed, in part due to the lack of a guiding framework for successful implementation strategies to guide systems to transition to and sustain clinically indicated PIVC removal.

Approach:
We used the Consolidated Framework for Implementation Research (CFIR) to reflect on strategies likely important for the successful implementation of PIVC removal evidence into policy and practice.

Outcomes:
We discuss and provide a critique of salient strategies for successful implementation of clinically indicated PIVC removal with regard to intervention characteristics, the outer and inner settings, characteristics of individuals, and implementation processes.

Conclusions:
Successful implementation of clinically indicated PIVC removal can be achieved through planned and systematic processes within the CFIR framework.
Implementing and Sustaining Bedside Shift Report for Quality Patient-Centered Care
Authors: Becker Sherry , Hagle Mary , Amrhein Andra , Bispo Jeffrey , Hopkins Sarah , Kogelmann Mary , Porras Elizabeth , Smith Melissa M. 
Published: August 2020

Background:
Two evidence-based practice projects and an innovative model provided best evidence and a framework for the implementation and sustainment of a bedside shift report (BSR) quality improvement project.

Problem:
Without a standardized BSR process, there was a lack of Veteran involvement in care planning decisions and nurse dissatisfaction related to missed communication of pertinent patient information.

Approach:
Facilitators and barriers were identified and addressed during planning. Key elements of BSR were incorporated. After approval by shared governance, unit-based champions and leaders supported the change. Implementation began every 2 weeks on a different unit.

Outcomes:
Implementation was completed in 4 months for 11 units. After 15 months, there was consistent BSR on 82% of the units and improved patient satisfaction with nurses taking time to listen.

Conclusions:
Best evidence, unit-based champions, leadership support, project coordinators, and persistence are critical to implementing and sustaining practice change.
Prospective Implementation and Evaluation of a Decision-Tree Algorithm for Route of Hysterectomy
Authors: Schmitt Jennifer J. , Baker Mary V. , Occhino John A. , McGree Michaela E. , Weaver Amy L. , Bakkum-Gamez Jamie N. , Dowdy Sean C. , Pasupathy Kalyan S. , Gebhart John B. 
Published: August 2020

(Abstracted from Obstet Gynecol 2020;135:761–769)
Between 2007 and 2010, the rate of total vaginal hysterectomy (TVH) in the United States among commercially insured patients undergoing hysterectomy decreased from 21.7% to 19.8% and by 2013 decreased to 11.5%. Between 2007 and 2010, use of robotic-assisted hysterectomy increased from 0.5% to 9.5%.
Impacts of Sexually Transmitted Disease/HIV Outreach Sites on the Effectiveness of Detecting New Infections in Baltimore City, 2015 to 2018
Authors: Nguyen Minh Phuong , Sembajwe Sophie , Rompalo Anne Marie , Zenilman Jonathan Mark 
Published: August 2020

Background
Effectiveness of sexually transmitted disease (STD)/HIV mobile van outreach programs has been shown to assist in identifying new cases of syphilis and HIV among high-risk populations. However, specific types of mobile outreach testing and their varying abilities to assist in STD/HIV case identification have not been thoroughly explored.

Methods
We analyzed data from the Baltimore City Health Department syphilis and HIV testing intake interviews and subsequent laboratory results for clients at any of the 6 different Baltimore City Health Department mobile outreach testing setting types between 2015 and 2018. A total of 8098 syphilis and 7946 HIV testing encounters were included. Cross-tabulation and proportion estimates were used to obtain the volume of new syphilis and HIV diagnoses across the different mobile outreach testing setting types. Multivariable firth logistic regressions for rare events were used to obtain odds ratios for new syphilis diagnoses across the different mobile outreach setting categories.

Results
Testing at street corners yielded the highest proportion of new syphilis cases (0.83%), whereas at community centers, it produced the highest proportion of new HIV cases (0.48%). The adjusted odds for new syphilis were 2.14 among street corners compared with community centers.

Conclusions
The findings indicated that street corners were the most successful at detecting new syphilis cases, whereas community centers were the most successful at detecting new HIV cases. However, because of the small number of new cases detected and low uptake per testing event between 2015 and 2018, STD/HIV mobile testing does not seem to be effective overall.
Brief Report: Understanding Preferences for HIV Care Among Patients Experiencing Homelessness or Unstable Housing: A Discrete Choice Experiment
Authors: Conte Madellena , Eshun-Wilson Ingrid , Geng Elvin , Imbert Elizabeth , Hickey Matthew D. , Havlir Diane , Gandhi Monica , Clemenzi-Allen Angelo 
Published: August 2020

Background:
Homelessness and unstable housing (HUH) negatively impact care outcomes for people living with HIV (PLWH). To inform the design of a clinic program for PLWH experiencing HUH, we quantified patient preferences and trade-offs across multiple HIV-service domains using a discrete choice experiment (DCE).

Methods:
We sequentially sampled PLWH experiencing HUH presenting at an urban HIV clinic with ≥1 missed primary care visit and viremia in the last year to conduct a DCE. Participants chose between 2 hypothetical clinics varying across 5 service attributes: care team “get to know me as a person” versus not; receiving $10, $15, or $20 gift cards for clinic visits; drop-in versus scheduled visits; direct phone communication to care team versus front-desk staff; and staying 2 versus 20 blocks from the clinic. We estimated attribute relative utility (ie, preference) using mixed-effects logistic regression and calculated the monetary trade-off of preferred options.

Results:
Among 65 individuals interviewed, 61% were >40 years old, 45% White, 77% men, 25% heterosexual, 56% lived outdoors/emergency housing, and 44% in temporary housing. Strongest preferences were for patient-centered care team [β = 3.80; 95% confidence interval (CI): 2.57 to 5.02] and drop-in clinic appointments (β = 1.33; 95% CI: 0.85 to 1.80), with a willingness to trade $32.79 (95% CI: 14.75 to 50.81) and $11.45 (95% CI: 2.95 to 19.95) in gift cards/visit, respectively.

Conclusions:
In this DCE, PLWH experiencing HUH were willing to trade significant financial gain to have a personal relationship with and drop-in access to their care team rather than more resource-intensive services. These findings informed Ward 86's “POP-UP” program for PLWH-HUH and can inform “ending the HIV epidemic” efforts.