bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE EFFECT OF AGE ON AFLIBERCEPT (EYLEA) RESPONSE IN DIABETIC MACULAR EDEMA
Authors: Ozsaygili Cemal , Duru Zeynep , Cicek Ayse , Ulusoy Dondu Melek , Demirtas Atilim Armagan , Duru Necati 
Published: March 2019

Purpose:
To investigate the effect of age on aflibercept (Eylea) response in macular edema secondary to treatment-naive diabetic eyes.

Methods:
Two hundred seventy-three eyes of 273 treatment-naive patients with macular edema secondary to diabetes mellitus were enrolled in this study. The patients in the study were divided into the following 4 groups according to their ages: Group 1 (40–50 years), Group 2 (51–60 years), Group 3 (61–70 years), and Group 4 (>70 years). Three consecutive injections at intervals of 1 month were applied to all diabetic patients. The efficacy of the aflibercept treatment on macular edema according to age groups was assessed by optical coherence tomography by comparing the central foveal thickness (CFT) values and mean visual acuity changes after initial and three loading dose injections.

Results:
After three consecutive aflibercept injections, the mean reduction of CFT in Groups 1, 2, 3, and 4 were −256.4 ± 110.9, −197.4 ± 96.4, −189.4 ± 110.8, and −186.2 ± 118.9 µm, respectively. The changes of CFT was significantly different between age groups (P = 0.003, analysis of covariance). The improvement of visual acuity was significantly different in each group (P < 0.001 in all groups, paired-samples t-test), and changes of visual acuity was significantly different between age groups (P < 0.05, analysis of covariance). In addition, ages of patients were correlated with the mean reduction of CFT and mean improvement of visual acuity for the whole study group (r = −0.183, P = 0.002 for CFT; r = −0.682, P < 0.001 for visual acuity, Pearson correlation).

Conclusion:
In this study, it was observed that the efficacy of aflibercept treatment was found to be more effective in younger patients in treatment-naive diabetic macular edema patients.
MACULAR TELANGIECTASIA TYPE 2
Authors: Ersoz M. Giray , Hocaoglu Mumin , Sayman muslubas Isil , Arf Serra , Karacorlu Murat 
Published: March 2019

Purpose:
The purpose of this study was to investigate the foveal avascular zone area and its perimeter, the acircularity index of the foveal avascular zone, the vessel density surrounding the foveal avascular zone, and the vessel density in the foveal, parafoveal, and perifoveal areas and their associations with best-corrected visual acuity, central foveal average thickness, and volume of ellipsoid zone–retinal pigment epithelium in patients with macular telangiectasia Type 2 (MacTel 2).

Methods:
We retrospectively reviewed medical records of 22 eyes of 22 patients with MacTel 2 and 24 eyes of 24 healthy controls. Eyes with MacTel 2 were graded according to optical coherence tomography angiography: 1) vascular anomalies temporal to the fovea; 2) vascular anomalies temporal and nasal to the fovea; 3) markedly diffuse circumferential vascular anomalies; and 4) neovascularization in the outer retina.

Results:
Acircularity index was higher and superficial–parafoveal vessel density was lower, in MacTel 2 group (all P < 0.05). Acircularity index was associated with the severity of the disease and had strong correlations with best-corrected visual acuity, ellipsoid zone–retinal pigment epithelium thickness, and ellipsoid zone–retinal pigment epithelium volume (all P < 0.05).

Conclusion:
In conclusion, the increase in acircularity index is correlated with the severity of the disease, the decrease in ellipsoid zone–retinal pigment epithelium thickness and volume, and the decrease in best-corrected visual acuity. It may be used to monitor patients with MacTel 2.
ENDOGENOUS ENDOPHTHALMITIS IN WESTERN AUSTRALIA
Authors: Gounder Pavindran Arumugam , Hille David Matthew , Khoo Ying Jo , Phagura Ravinder Singh , Chen Fred Kuanfu 
Published: March 2019

Purpose:
To review the clinical features, microbiology spectrum, management, and outcomes of patients with endogenous endophthalmitis in Western Australia over a 16-year period.

Methods:
This is a retrospective chart review of all patients with endogenous endophthalmitis who presented to all tertiary ophthalmology departments between 2000 and 2015 in Western Australia.

Results:
Sixty-six eyes of 57 patients with endogenous endophthalmitis were identified, and follow-up data were available for a mean of 554 days. The average frequency was 1.6 per 1,000,000 population per year. Diabetes mellitus (33%) and intravenous drug use (30%) were the most common risk factors. Concurrent systemic infections included urinary tract infection (28%), pneumonia (23%), and endocarditis (21%). Among culture-positive cases (93%), 57% were bacterial and 43% were fungal. Visual acuity improved in 33 (50%) and declined in 15 eyes (22.7%). Baseline visual acuity and the presence of Gram-negative or filamentous fungi were the only predictors of final visual acuity (P = 0.023 and P = 0.001).

Conclusion:
The population frequency of endogenous endophthalmitis has not changed over 16 years despite the changing profile of pathogen and risk factors. Similar to previous studies in Asian and Western countries, visual and anatomical prognosis depends on initial visual acuity and isolated pathogen. Gram-negative and filamentous fungi culture predicted a worse visual outcome.
Changes in Corneal Wound Healing and Graft Biomechanics After Primary Penetrating Keratoplasty Versus Repeat Penetrating Keratoplasty
Authors: Abdelkader Almamoun 
Published: March 2019

Purpose:
To evaluate and compare the influence of the wound healing process at the graft edge on corneal biomechanics after primary penetrating keratoplasty (PK) and repeat PK.

Methods:
This retrospective comparative study included 95 eyes: 35 eyes of 35 patients had PK, 40 eyes of 40 patients underwent repeat PK, and 20 eyes of 20 normal subjects served as the control group. The ocular response analyzer was used to measure and compare corneal hysteresis and corneal resistance factor among the study groups at least 6 months after all sutures were removed. In vivo confocal microscopy was used to study the corneal wound healing process at the graft edge in PK and repeat PK groups and to correlate these findings with corneal biomechanics.

Results:
Corneal hysteresis and corneal resistance factor were significantly lower in the PK group (6.71 ± 1.3 and 5.99 ± 1.2 mm Hg, respectively) as compared with the repeat PK group (9.4 ± 1.03 and 8.77 ± 1.1 mm Hg, respectively) (P < 0.0001). The repeat PK group demonstrated biomechanical parameters comparable with normal subjects (9.88 ± 1.29 and 9.24 ± 1.13 mm Hg, respectively) (P = 0.12). Confocal microscopy revealed more reflective and activated keratocytes at the graft edge in the repeat PK group as compared with the primary PK group.

Conclusions:
The healing process at the graft edge is the key to optimal corneal integrity after PK. Repeat PK stimulated more activated keratocytes than primary PK and hence a stronger healing response, providing superior corneal biomechanics comparable with normal subjects.
Incident injury is strongly associated with subsequent incident temporomandibular disorder: results from the OPPERA study
Authors: Sharma Sonia , Wactawski-Wende Jean , LaMonte Michael J. , Zhao Jiwei , Slade Gary D. , Bair Eric , Greenspan Joel D. , Fillingim Roger B. , Maixner William , Ohrbach Richard 
Published: March 2019

Abstract
Cross-sectional studies confirm, as expected, a positive association between jaw injury and painful temporomandibular disorders (TMDs), but prospective evaluations are lacking. We prospectively assessed incident jaw injury, injury type, and development of TMD in adults aged 18 to 44 years. Data were collected from 3258 individuals from communities surrounding 4 US academic institutes between 2006 and 2008. At enrollment, participants reported no TMD history and no facial injuries in the previous 6 months. Quarterly, follow-up questionnaires assessed incident jaw injury, which was classified as intrinsic (attributed to yawning or prolonged mouth opening) or extrinsic (attributed to other causes). Examiners classified incident TMD during a median follow-up period of 2.8 years (range 0.2-5.2 years). Cox regression models used jaw injury as a time-dependent covariate to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association with incident TMD. Among 1729 participants with complete data, 175 developed TMD. Eighty percent of injuries were intrinsic. Temporomandibular disorder annual incidence was nearly twice as high in those experiencing jaw injury (5.37%) compared with those who did not (3.44%). In the Cox model that accounted for timing of injury, the corresponding HR was 3.94 (95% CI = 2.82-5.50) after adjusting for study site, age, race, and sex. Hazard ratios did not differ (P = 0.91) for extrinsic injuries (HR = 4.03, 95% CI = 2.00-8.12) and intrinsic injuries (HR = 3.85, 95% CI = 2.70-5.49). Jaw injury was strongly associated with incident TMD. If surveillance and intervention after jaw injury is to be effective in preventing TMD, they should focus on both intrinsic and extrinsic injuries.
Effectiveness of Implementing a Predischarge Order to Discharge Patients Before 11 a.m.
Authors: Mallipudi Rajiv M. , Khan Qamar , Mbolu George U. , Alquran Lance , Mehta Bijal , Allusson Valerie 
Published: March 2019

ABSTRACT
Barriers to early discharges include poor communication among the healthcare team and families, pending laboratory test results, delays in discharge orders, medical reconciliation list, and patient transport. The baseline data at our hospital in October 2017 (N = 1,021) showed that 5% of patients were discharged before 11 a.m., with the mean discharge processing time being 145 minutes. The goal of this study was to assess the effectiveness of using an electronic predischarge order to discharge more than 40% of patients before 11 a.m. A predischarge order set was created in the electronic record, which notified the nurses, pharmacists, and case and social workers to complete all tasks related to discharge (medication reconciliation, complete laboratory test results and imaging, and arrange transport with family and nursing homes). The resident teaching service group (N = 381) from November 2017 to September 2018 discharged 22% of their patients before 11 a.m. (baseline: 5%, p value = 3.38638E-22), and the mean total discharge time was 77 minutes (baseline: 145 minutes; p value = 1.12013E-19). Our inability to discharge more than 40% of patients from the resident teaching service group before 11 a.m. was attributed to 3 limitations. We propose three viable recommendations to meet our goal in a future intervention.
Mental and Physical Quality of Life by Age Groups in People Living With HIV
Authors: Jang Hannah J. , Satre Derek D. , Leyden Wendy , Leibowitz Amy , Silverberg Michael J. 
Published: March 2019

Abstract
Quality of life (QoL) is relevant to people living with HIV (PLWH) with increased life expectancy because of antiretroviral therapy. Our cross-sectional study examined associations between sociodemographic, HIV-related and psychological variables, and QoL, overall and by age. PLWH (n = 614) completed questionnaires at enrollment in an alcohol treatment study. QoL was assessed by the 12-item Short Form Survey, which includes physical and mental domains. Linear regression models evaluated the association of age and other factors with mental and physical QoL. PLWH younger than 50 years (n = 310) reported poorer mental QoL but better physical QoL compared to older PLWH (n = 304). Poorer mental QoL was associated with substance use, depression, and anxiety. Poorer physical QoL was associated with depression and history of injection drug use. We identified age-group differences in QoL for this primary care-based sample. Health care providers can use our findings to guide patient-centered care.
Symptom Profile and Technology Use of Persons Living With HIV Who Access Services at a Community-Based Organization in the Deep South
Authors: Schnall Rebecca , Musgrove Karen , Batey D. Scott 
Published: March 2019

Abstract
Currently, the Southern United States has the highest rates of new HIV diagnoses with the largest percentage of people living with HIV (PLWH), and the most Americans dying from the disease. Given the increase of the HIV epidemic in the Deep South and the availability of evidence-based self-management tools for PLWH, we conducted an in-person survey in Birmingham, Alabama, to understand the symptom profile and the use of technology by PLWH. Muscle aches or joint pain was the most frequently (67%) reported symptom followed by fatigue, sleep difficulties, neuropathy, and depressive symptoms. We also assessed mobile technology use and ownership and found that 83.7% of persons own a smartphone, with most of these (79.9%) being Android users. Given these findings, there is strong scientific premise to support the feasibility of a mobile-delivered symptom self-management tool in the Deep South for improving health outcomes for PLWH.
AMSSM Position Statement Update: Blood-Borne Pathogens in the Context of Sports Participation
Authors: McGrew Christopher , MacCallum Daisy-Scarlett , Narducci Dustymarie , Nuti Rathna , Calabrese Leonard , Dimeff Robert , Paul Stephen , Poddar Sourav K. , Rao Ashwin , McKeag Douglas 
Published: March 2019

Abstract:
This AMSSM position statement update is directed toward health care providers of patients involved in sport and exercise. There have been significant advances in clinical and scientific research in the understanding of blood-borne pathogens (BBPs), and this update incorporates these advancements. This document is intended as a general guide to clinical practice based on the current state of evidence, while acknowledging the need for modification as new knowledge becomes available. Confirmed transmission of BBPs during sport is exceedingly rare. There are no well-documented reports of HIV, hepatitis C virus, or hepatitis D virus transmission during sport. There is also no evidence for universal testing for BBPs as a specific requirement for participation in sports. Competitive athletes and nonathletes should follow appropriate general public health agency recommendations for screening for BBPs, considering their individual risk factors and exposures. Standard (universal) precautions must be followed by those providing care to athletes. Exercise and athletic participation can help promote a healthy lifestyle for persons living with BBPs. Those with acute symptomatic BBP infection should limit exercise intensity based on their current health status. Education is the key tool for preventing BBP transmission. Research gaps include evaluation of the prevalence of BBP infections in competitive athletes, the effects of long-term, intense training on infected athletes, and the effects of BBP treatment therapies on performance.
Enhancing Pediatric Education for Physical Therapy Students Through the Development of Community Partnerships to Facilitate Experiential Learning: A Case Report
Authors: Wolden Mitch , Anderson Brittany 
Published: March 2019

Background and Purpose.
Doctoral physical therapy (DPT) programs are expected to provide students with educational experiences in classroom and in clinical settings and with all age demographics, including pediatrics. There is significant discrepancy in the delivery and assessment of pediatric content in DPT programs. One effective and evidence-based strategy to address this discrepancy and deliver pediatric content is experiential learning (EL). Our case report illustrates how EL with a symbiotic community partner can enable DPT programs to effectively address the current limitations in direct contact hours and clinical experiences in pediatrics.

Case Description.
We formed a structured and formal partnership with a local community fitness and gymnastics facility to provide our students with pediatric EL opportunities outside of the classroom and traditional clinic settings. Each student is required to engage in structured and focused play-based interactions with typically and atypically developing children 1 hour per week for two 8-week EL periods under direct supervision of a certified pediatric clinical specialist.

Outcomes.
Students demonstrated appropriate professional behaviors, increased self-efficacy, achievement of the pediatric course learning objectives, and attainment of 3 Academy of Pediatric Physical Therapy essential core competencies. With our community partner, 87% of the children demonstrated improvement in their gross motor skills.

Discussion and Conclusion.
Our case report details an innovative approach to use EL to increase the number of direct contact hours with the pediatric population through a symbiotic community partnerships that positions our students to reach entry-level competency with the pediatric population upon graduation.
Adjusting to the transition into assisted living: Opportunities for nurse practitioners
Authors: Scott Judith M. , Mayo Ann M. 
Published: March 2019

ABSTRACT

Background and purpose:
Transition from an independent living residence to assisted living (AL) is challenging. The study purpose was to understand such a transition from the perspective of older women.

Methods:
A hermeneutic phenomenological approach was used to explore how 17 older women living in a Continuing Care Retirement Community, many of whom were recently widowed, experienced this transition.

Conclusions:
Three major themes emerged from the interviews: preplanning, executing, and adjusting to the transition. Even with facility, family and staff assistance, the transition was challenging, and adjustment was affected when participants had physical or sensory impairments.

Implications for practice:
Older adult women transitioning to AL settings should be assessed for adjustment to the new setting. Those with sensory, cognitive, emotional, or physical problems will need additional supportive strategies to help with adjustment. With a rapidly expanding population, AL settings offer new opportunities for nurse practitioners to promote the health and well-being of older adults.
CD101 Topical Compared With Oral Fluconazole for Acute Vulvovaginal Candidiasis: A Randomized Controlled Trial
Authors: Nyirjesy Paul , Alessio Cynthia , Jandourek Alena , Lee Jon D. , Sandison Taylor , Sobel Jack D. 
Published: March 2019

Objectives
Vulvovaginal candidiasis (VVC) is an infection of the vagina's mucous membranes, caused by Candida albicans in more than 90% of acute VVC. Several topical and oral azole agents are available in a variety of formulations, and all seem to have similar effectiveness. Azoles are fungistatic, meaning that the fungi are inhibited from growth or replication but are not eradicated. Recurrent infection and developing azole resistance demonstrate a significant need for alternative treatments.

Materials and Methods
One hundred twenty-six women were randomized to 1 of the following 3 treatment cohorts: CD101 3% gel (n = 50) applied intravaginally on days 1 and 2, CD101 6% ointment (n = 50) applied intravaginally on day 1, or oral fluconazole 150 mg (n = 26) on day 1. Primary outcomes of clinical and mycological cure, as demonstrated by changes in the vaginal scores and mycological culture, were assessed on day 7 (±2 days), day 14 (±2 days), and day 28 (±7 days). Safety assessments included treatment-emergent adverse events.

Results
Ninety-nine women with positive Candida culture remained in the modified intent-to-treat population with 40 in each CD101 arm and 19 in the fluconazole arm. In the CD101 gel, CD101 ointment, and oral fluconazole groups, 35%, 30%, and 52.6% demonstrated clinical cure and 45%, 40%, and 57.9% had mycological cure at day 28, respectively.

Conclusions
CD101 3% gel and CD101 6% ointment were well tolerated and produced similar rates of clinical and mycological cure in patients with an acute, moderate-to-severe episode of VVC. However, cure rates for these 2 formulations and regimens of CD101 were lower than those in patients treated with fluconazole.
Risk of Stroke in Liver Cirrhosis
Authors: Zheng Kexin , Yoshida Eric M. , Tacke Frank , Li Yingying , Guo Xiaozhong , Qi Xingshun 
Published: March 2019

Background and Aims:
Liver cirrhosis can lead to abnormal coagulation, rendering patients at risk for bleeding but also thrombotic complications. We conducted a systematic review and meta-analysis to explore the epidemiology of stroke in liver cirrhosis and the potential association between them.

Materials and Methods:
Studies were searched through the PubMed, EMBASE, and Cochrane Library databases. Incidence and prevalence of unspecific stroke, hemorrhagic stroke, intracranial hemorrhage, subarachnoid hemorrhage, and ischemic stroke were pooled by using a random-effect model. Meta-regression analyses were employed to explore the sources of heterogeneity. As for the cohort studies, hazard ratios (HRs) with 95% CIs were pooled to evaluate the association between liver cirrhosis and stroke.

Results:
Twenty-seven studies with 93,191 cirrhotic patients were included, of which 23 explored the incidence and 10 explored the prevalence. The pooled incidence of unspecific stroke, hemorrhagic stroke, intracranial hemorrhage, and ischemic stroke was 4.1%, 1.3%, 2.0%, and 3.7%, respectively. The pooled prevalence of unspecific and ischemic stroke was 9.0% and 2.6%, respectively. Heterogeneity among studies was significant in most of meta-analyses. Meta-regression analyses indicated that the sample size might explain the potential source of heterogeneity (P=0.018). Liver cirrhosis significantly increased the risk of subarachnoid (HR=2.36; 95% CI, 1.80-3.09; P=0.000) and intracranial hemorrhage (HR=1.48; 95% CI, 1.06-2.05; P=0.020), but not unspecific (HR=1.02; 95% CI, 0.49-2.14; P=0.960), ischemic (HR=0.79; 95% CI, 0.46-1.35; P=0.380), or hemorrhagic stroke (HR=1.88; 95% CI, 0.52-6.81; P=0.335).

Conclusions:
Stroke is uncommon in cirrhotic patients. However, considering a positive relationship of liver cirrhosis with subarachnoid and intracranial hemorrhage, the prophylactic strategy may be selectively adopted in cirrhotic patients.
Serum steroid profiling by mass spectrometry in adrenocortical tumors: diagnostic implications
Authors: Fanelli Flaminia , Di Dalmazi Guido 
Published: March 2019

Purpose of review
Liquid chromatography–tandem mass spectrometry (LC–MS/MS), allowing the reliable measurement of large panels of steroids, opened a new era in the characterization of adrenal diseases. This review summarizes the most recent findings on serum steroid profile in benign adrenocortical tumors and provides a focus on the most promising analytical developments.

Recent findings
Recently developed LC–MS/MS assays included challenging compounds, providing new knowledge on adrenal steroid secretion. Pioneering studies highlighted the potential of incoming technologies in increasing measurement selectivity and implementing the steroidomic approach. In primary aldosteronism, several studies highlighted the signature of aldosterone-producing adenomas, mainly characterized by secretion of hybrid steroids. The combination of steroid panel and radiological data reached an agreement with adrenal vein sampling-based classification in more than 80% of the cases. The serum steroid profiling in patients with Cushing's syndrome, mainly characterized by reduced androgens and increased 11-dexoycorticosterone in adrenal hypercortisolism, showed a good discriminant power for patients’ subtyping (90% correct classification rate). Finally, a selected panel of steroids, including 11-deoxycortisol as the main discriminant compound, was able to achieve a good separation of patients with and without adrenocortical carcinomas.

Summary
The constantly evolving serum steroid profiling by MS may improve the diagnosis of different types of adrenocortical tumors.