bluuebunny/crossref_metadata_2025_split huggingface dataset:
Biotensegrity Focused Therapy for Pelvic Organ Prolapse: A Nonrandomized Prospective Clinical Case Series
Authors: Crowle Anna , Harley Clare 
Published: June 2021

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

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

Study Design:
Nonrandomized prospective clinical case series.

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

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

Discussion:
Biotensegrity Focused Therapy was shown to have a beneficial impact on organ position and prolapse symptoms and may be an appropriate treatment for women with POP.
Cost-sharing With Medicaid Expansion in Michigan
Authors: Hirth Richard A. , Cliff Betsy Q. , Kullgren Jeffrey T. , Ayanian John Z. 
Published: June 2021

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

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

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

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

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

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

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

Recent findings
We summarize approaches and evidence for corneal neurotization.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

CONCLUSIONS
The results of the present study showed a high prevalence of convergence insufficiency in the geriatric population. Clinicians should give special attention to this binocular vision disorder in this age group.
A Comparison between Automated Subjective Refraction and Traditional Subjective Refraction in Keratoconus Patients
Authors: Carracedo Gonzalo , Carpena-Torres Carlos , Pastrana Cristina , Privado-Aroco Ana , Serramito María , Espinosa-Vidal Teresa María , Rodríguez-Lafora María 
Published: June 2021

SIGNIFICANCE
The performance of the Eye Refract (Luneau Technology, Chartres, France), a new instrument to perform aberrometry-based automated subjective refraction, has been previously evaluated in healthy subjects. However, its clinical implications in other ocular conditions are still unknown.

PURPOSE
The purpose of this study was to evaluate the agreement between the Eye Refract and the traditional subjective refraction, as the criterion standard, in keratoconus patients with and without intracorneal ring segments (ICRSs).

METHODS
A total of 50 eyes of 50 keratoconus patients were evaluated, dividing the sample into 2 groups: 27 eyes without ICRS (37.78 ± 9.35 years) and 23 eyes with ICRS (39.26 ± 13.62 years). An optometrist conducted the refraction with the Eye Refract, and another different optometrist conducted the traditional subjective refraction on the same day. Spherical equivalent (M), cylindrical vectors (J
0 and J
45), and corrected distance visual acuity were compared between both methods of refraction. In addition, Bland-Altman analysis was performed to assess the agreement between both methods of refraction.

RESULTS
There were no statistically significant differences (P ≥ .05) between the Eye Refract and the traditional subjective refraction for all the variables under study in either group. Without ICRS, the mean difference and 95% limits of agreement (upper, lower) were −0.20 (+1.50, −1.89) D for M, −0.14 (+1.40, −1.68) D for J
0, and +0.05 (+1.23, −1.14) D for J
45. With ICRS, these values worsened to −0.62 (+3.89, −5.12) D for M, +0.06 (+2.46, −2.34) D for J
0, and −0.02 (+2.23, −2.28) D for J
45.

CONCLUSIONS
The Eye Refract seems to offer similar results compared with the traditional subjective refraction in keratoconus patients not implanted with ICRS. However, some patients could show abnormal measurements, especially those with ICRS, who should be treated with caution in clinical practice.
Multifaceted Public Health Response to a COVID-19 Outbreak Among Meat-Processing Workers, Utah, March-June 2020
Authors: Rogers Tia M. , Robinson Susan J. , Reynolds Laura E. , Ladva Chandresh N. , Burgos-Garay Maria , Whiteman Ari , Budge Holly , Soto Natalie , Thompson Mariela , Hunt Estee , Barson Todd , Boyd Andrew T. 
Published: June 2021

Objective:
To identify potential strategies to mitigate COVID-19 transmission in a Utah meat-processing facility and surrounding community.

Design/Setting:
During March-June 2020, 502 workers at a Utah meat-processing facility (facility A) tested positive for SARS-CoV-2. Using merged data from the state disease surveillance system and facility A, we analyzed the relationship between SARS-CoV-2 positivity and worker demographics, work section, and geospatial data on worker residence. We analyzed worker survey responses to questions regarding COVID-19 knowledge, beliefs, and behaviors at work and home.

Participants:
(1) Facility A workers (n = 1373) with specimen collection dates and SARS-CoV-2 RT-PCR test results; (2) residential addresses of all persons (workers and nonworkers) with a SARS-CoV-2 diagnostic test (n = 1036), living within the 3 counties included in the health department catchment area; and (3) facility A workers (n = 64) who agreed to participate in the knowledge, attitudes, and practices survey.

Main Outcome Measures:
New cases over time, COVID-19 attack rates, worker characteristics by SARS-CoV-2 test results, geospatially clustered cases, space-time proximity of cases among workers and nonworkers; frequency of quantitative responses, crude prevalence ratios, and counts and frequency of coded responses to open-ended questions from the COVID-19 knowledge, attitudes, and practices survey.

Results:
Statistically significant differences in race (P = .01), linguistic group (P < .001), and work section (P < .001) were found between workers with positive and negative SARS-CoV-2 test results. Geographically, only 6% of cases were within statistically significant spatiotemporal case clusters. Workers reported using handwashing (57%) and social distancing (21%) as mitigation strategies outside work but reported apprehension with taking COVID-19–associated sick leave.

Conclusions:
Mitigating COVID-19 outbreaks among workers in congregate settings requires a multifaceted public health response that is tailored to the workforce.

Implications for Policy and Practice:
Tailored, multifaceted mitigation strategies are crucial for reducing COVID-19–associated health disparities among disproportionately affected populations.
Evaluating and Assessing Radon Testing in Multifamily Housing
Authors: Kitto Michael E. , Murphy Calvin , Dixon Sherry L. , Jacobs David E. , Wilson Jonathan , Malone Jane 
Published: June 2021

Context:
To determine if radon mitigation is needed to protect occupants of multifamily housing, reliable testing procedures are needed. Yet, protocols on how many ground-contact housing units must be tested vary from 10% to 25% to 100%.

Objectives:
To estimate the probability of failing to identify a building containing at least one unit with elevated radon level when all ground-contact units are not tested.

Design:
Retrospective analysis of previously collected data from licensed (ie, certified) radon measurement professionals using hypergeometric and Monte Carlo statistical methods to estimate the confidence that there are no units with radon levels of 4 picoCuries/liter of air (pCi/L) or more based on various testing percentages.

Setting:
Testing data were obtained from 29 US states for 7892 ground-contact units in 687 multifamily buildings, primarily 5 to 20 units per building.

Main Outcome Measure:
Probability of failing to identify elevated radon levels in untested units.

Results:
About 15% (n = 1163) of the units had radon levels of more than 4 pCi/L (the EPA action level); 59 units had more than 20 pCi/L (maximum of 96 pCi/L). For building sizes of 5 to 20 ground-contact units, the 2018 federal testing protocols that currently require testing of 10% and 25% of ground-contact units in each building failed to identify 47%-69% and 32%-46% of the units, respectively, depending on building size.

Conclusions:
Measurement of 90% of the ground-contact units in buildings with 5 to 20 ground-contact units results in up to 4% of the units with elevated radon levels being missed. To achieve 95% confidence that no units in the building have radon levels of 4 pCi/L or more in buildings up to 20 units, 100% sampling is required. For the vast majority of multifamily buildings, all ground-contact units in multifamily buildings should be tested for radon.