Environmental influences on ophthalmic conditions: A scoping review.

BACKGROUND: Environmental factors have been implicated in various eye pathologies. The purpose of this review is to synthesise the published research on environmental effects on eye disease. METHODS: Four databases were searched for terms relating to environmental exposures and ophthalmic disease. Titles and abstracts were screened followed by full-text review. Data was extracted from 118 included studies. Quality assessment was conducted for each study. RESULTS: Air pollutants, including nitrogen dioxide, nitrites, sulphur dioxide, particulate matter, carbon monoxide, ozone and hydrocarbons are associated with ocular conditions ranging from corneal damage to various retinopathies, including central retinal artery occlusion. Certain chemicals and metals, such as cadmium, are associated with increased risk of age-related macular degeneration. Climate factors, such as sun exposure, have been associated with the development of cataracts. Living in rural areas was associated with various age-related eye diseases whereas people living in urban settings had higher risk for dry eye disease and uveitis. CONCLUSION: Environmental exposures in every domain are associated with various ophthalmic conditions. These findings underscore the importance of continued research on the interplay between the environment and eye health.

Outcomes of primary root canal therapy: An updated systematic review of longitudinal clinical studies published between 2003 and 2020.

BACKGROUND: A comprehensive effort to evaluate outcomes of primary root canal therapy (RCT) between 1966 and 2002 was published by Ng et al. (2007, International Endodontic Journal, 40, 921; 2008, International Endodontic Journal, 41, 6). Changes in endodontic materials and treatment methods warrant an updated analysis of outcomes. OBJECTIVES: This study aimed to (1) quantify the success rates of primary RCT published between 2003 and 2020; and (2) investigate the influence of some characteristics known/suspected to be associated with treatment outcomes. METHODS: An electronic search was performed in the following databases (01-01-2003 to 12-31-2020): Pubmed, Embase, CINHAL, Cochrane and Web of Science. Included study designs were longitudinal clinical studies (randomized control trials, cohort studies, retrospective observational studies). Studies with at least twelve-months of post-operative review and success rates based on clinical and radiographic criteria were analysed. The terms 'strict' (complete resolution of periapical lesion) or 'loose' (reduction in size of existing periapical lesion) were used to describe the outcome criteria. Weighted, pooled success rates were calculated. Random effects meta-regression models were used to investigate potential sources of statistical heterogeneity. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to evaluate for quality assessment of the included studies. RESULTS: Forty-two studies were included in the review. Meta-analyses showed that the weighted pooled success rates were estimated to be 92.6% (95% CI: 90.5%-94.8%) under 'loose criteria' and 82.0% (95% CI: 79.3%-84.8%) under 'strict' criteria. The most significant areas of study heterogeneity were year of publication and qualification of operator. The majority (64.29%) of studies were considered to be of low quality of evidence. DISCUSSION: Biological factors continue to have the most significant impact on RCT outcomes. The technological method of instrumentation had no significant effect. The quality of evidence was based primarily on study design and only randomized control trials were considered to be 'high' quality of evidence. CONCLUSIONS: The reported success rates show improvement over time. Weighted success rates for studies with a minimum of four-years follow-up had better outcomes, compared to those with less than four years, when 'strict criteria' were used. REGISTRATION: PROSPERO database (CRD42021226311).

What is the societal economic cost of poor oral health among older adults in the United States? A scoping review.

OBJECTIVE: To assess the state of the literature in the United States quantifying the societal economic cost of poor oral health among older adults. BACKGROUND: Proponents of a Medicare dental benefit have argued that addressing the growing need for dental care among the US older adult population will decrease costs from systemic disease and other economic costs due to oral disease. However, it is unclear what the current economic burden of poor oral health among older adults is in the United States. METHODS: We conducted a scoping review examining the cost of poor oral health among older adults and identified cost components that were included in relevant studies. RESULTS: Other than oral cancer, no studies were found examining the economic costs of poor oral health among older adults (untreated tooth decay, gum disease, tooth loss and chronic disease/s). Only two studies examining the costs of oral cancer were found, but these studies did not assess the full economic cost of oral cancer from patient, insurer and societal perspectives. CONCLUSIONS: Future work is needed to assess the full economic burden of poor oral health among older adults in the United States, and should leverage novel linkages between medical claims data, dental claims data and oral health outcomes data.

Patient Extratherapeutic Interpersonal Problems and Response to Psychotherapy for Depression.

OBJECTIVES: This paper aimed to synthesize empirical findings of patient extratherapeutic interpersonal variables associated with individual psychotherapy treatment outcomes in adult outpatients with depression. METHODS: A systematic search strategy was used to identify relevant studies. Thematic analysis was used to identify recurring themes in the findings. RESULTS: Forty studies met search criteria. Three themes of patient extratherapeutic interpersonal variables were identified: capacity to engage with others, capacity to navigate relationships, and capacity to achieve intimacy, progressing from basic to advanced levels of interpersonal interaction. Interpersonal variables such as interpersonal distress and style, attachment orientation, and quality of object relations were particularly useful in predicting treatment outcomes, whereas access to social support and marital status provided mixed results, likely because they do not account for relationship quality. CONCLUSIONS: Recognizing variables associated with treatment response can help clinicians identify patients at risk for nonresponse and guide efforts for adapting existing therapies and developing new ones.

World Workshop on Oral Medicine VI: a systematic review of medication-induced salivary gland dysfunction: prevalence, diagnosis, and treatment.

OBJECTIVES: Medication-induced salivary gland dysfunction (MISGD) causes significant morbidity resulting in decreased quality of life. This systematic review assessed the literature on the prevalence, diagnosis, treatment, and prevention of MISGD. MATERIALS AND METHODS: Electronic databases were searched for articles related to MISGD through June 2013. Four independent reviewers extracted information regarding study design, study population, interventions, outcomes, and conclusions for each article. Only papers with acceptable degree of relevance, quality of methodology, and strength of evidence were retained for further analysis. RESULTS: There were limited data on the epidemiology of MISGD. Furthermore, various methods were used to assess salivary flow rate or xerostomia. Preventive and therapeutic strategies included substitution of medications, oral, or systemic therapy with sialogogues, use of saliva substitutes or of electro-stimulating devices. Although there are promising approaches to improve salivary gland function, most studies are characterized by small numbers and heterogeneous methods. CONCLUSIONS: Physicians and dentists should identify the medications associated with xerostomia and salivary gland dysfunction through a thorough medical history. Preferably, health care providers should measure the unstimulated and stimulated whole salivary flow rates of all their patients so that these values can be used as a baseline to rate the complaints of patients who subsequently claim to experience xerostomia or salivary gland dysfunction as well as the possibilities of effectively treating this condition. CLINICAL RELEVANCE: MISGD remains a major burden for the population. This systematic review provides a contemporary in-depth description of the diagnosis and treatment of MISGD.

Leveraging technology and staffing in developing a new liaison program.

With nearly all library resources and services delivered digitally, librarians working for the New York University Health Sciences Library struggled with maintaining awareness of changing user needs, understanding barriers faced in using library resources and services, and determining knowledge management challenges across the organization. A liaison program was created to provide opportunities for librarians to meaningfully engage with users. The program was directed toward a subset of high-priority user groups to provide focused engagement with these users. Responsibility for providing routine reference service was reduced for liaison librarians to provide maximum time to engage with their assigned user communities.

Health literacy and ophthalmology: A scoping review.

As of 2020, it is estimated that 43.3 million people are blind, and an additional 553 million have mild to severe vision impairment.50 At least 1 billion worldwide have a vision impairment that could have been prevented or has yet to be addressed.54 Poor health literacy may be a significant contributor to the prevalence of eye disease. With implications on disease burden, progression, and health outcomes, a greater understanding of the role health literacy plays in ophthalmology is needed. This is the first scoping review to assess the impact of health literacy on eye health outcomes and blindness, including ocular screening rates and/or follow-up rates, treatment adherence, and self-care practices. PubMed, Embase, and CINAHL databases were searched systematically through November 12, 2021, and we evaluated the association between health literacy and ophthalmic outcomes in 4 domains: clinical outcomes, treatment adherence rates, screening and/or follow-up rates, and self-care practices. There is evidence to suggest that health literacy is associated with ophthalmic outcomes in all these domains. To better understand how health literacy impacts eye health, further longitudinal studies examining the effect of health literacy (using standardized health literacy measures) on ophthalmic outcomes are needed. We believe a specific ophthalmic health literacy survey could help achieve this goal and help target interventions to ultimately improve outcomes among ophthalmology patients.

The Lived Experience of Pediatric Gene Therapy: A Scoping Review.

Little is known about patients' and families' lived experiences of participating in pediatric gene therapy (GT) clinical trials. Currently, pediatric GT research targets a broad range of indications--including rare and ultra-rare diseases--which vary in severity and in the availability of alternative therapies. Pediatric GT differs meaningfully from adult GT because the decision to participate involves a dyad of both the child and parent or caregiver/s. It is critical to understand patients' and caregivers' perceptions and experiences of social, emotional, physical, and logistical burdens or benefits of participating in such trials, and how they weigh and prioritize these factors when deciding whether to participate. We conducted a scoping review of the current literature in this subject area with objectives to (1) provide an overview of existing literature, (2) identify gaps and areas for further research, and (3) better understand the lived impact of pediatric GT research on patients and their parents/caregivers. Four themes emerged, including (1) weighing risks and benefits (2) timing of GT trial participation, (3) value of clear communication, and (4) potential impact on quality of life. Notably, our sample surfaced articles about how patients/parents/caregivers were thinking about GT-their understanding of its safety, efficacy, and risks-rather than accounts of their experiences, which was our initial intention. Nevertheless, our findings offer useful insights to improve the informed consent process and promote a more patient- and family-centered approach. Moreover, our findings can contribute to patient advocacy organizations' efforts to develop educational materials tailored to patients' and families' expressed informational needs and perspectives, and can inform more patient- and family-centered policies from GT clinical trial sponsors.

Source-tract interaction with prescribed vocal fold motion.

An equation describing the time-evolution of glottal volume velocity with specified vocal fold motion is derived when the sub- and supra-glottal vocal tracts are present. The derivation of this Fant equation employs a property explicated in Howe and McGowan [(2011) J. Fluid Mech. 672, 428-450] that the Fant equation is the adjoint to the equation characterizing the matching conditions of sub- and supra-glottal Green's functions segments with the glottal segment. The present aeroacoustic development shows that measurable quantities such as input impedances at the glottis, provide the coefficients for the Fant equation when source-tract interaction is included in the development. Explicit expressions for the Green's function are not required. With the poles and zeros of the input impedance functions specified, the Fant equation can be solved. After the general derivation of the Fant equation, the specific cases where plane wave acoustic propagation is described either by a Sturm-Liouville problem or concatenated cylindrical tubes is considered. Simulations show the expected skewing of the glottal volume velocity pulses depending on whether the fundamental frequency is below or above a sub- or supra-glottal formant. More complex glottal wave forms result when both the first supra-glottal fundamental frequencies are high and close to the first sub-glottal formant.

A study of high front vowels with articulatory data and acoustic simulations.

The purpose of this study is to test a methodology for describing the articulation of vowels. High front vowels are a test case because some theories suggest that high front vowels have little cross-linguistic variation. Acoustic studies appear to show counterexamples to these predictions, but purely acoustic studies are difficult to interpret because of the many-to-one relation between articulation and acoustics. In this study, vocal tract dimensions, including constriction degree and position, are measured from cinéradiographic and x-ray data on high front vowels from three different languages (North American English, French, and Mandarin Chinese). Statistical comparisons find several significant articulatory differences between North American English /i/ and Mandarin Chinese and French /i/. In particular, differences in constriction degree were found, but not constriction position. Articulatory synthesis is used to model the acoustic consequences of some of the significant articulatory differences, finding that the articulatory differences may have the acoustic consequences of making the latter languages' /i/ perceptually sharper by shifting the frequencies of F(2) and F(3) upwards. In addition, the vowel /y/ has specific articulations that differ from those for /i/, including a wider tongue constriction, and substantially different acoustic sensitivity functions for F(2) and F(3).

Analyses of vocal tract cross-distance to area mapping: an investigation of a set of vowel images.

Traditional models of mappings from midsagittal cross-distances to cross-sectional areas use only local cross-distance information. These are not the optimal models on which to base the construction of a mapping between the two domains. This can be understood because phonemic identity can affect the relation between local cross-distance and cross-sectional area. However, phonemic identity is not an appropriate independent variable for the control of an articulatory synthesizer. Two alternative approaches for constructing cross-distance to area mappings that can be used for articulatory synthesis are presented. One is a vowel height-sensitive model and the other is a non-parametric model called loess. These depend on global cross-distance information and generally perform better than the traditional models.

Sagittal area of the vocal tract in young female children.

OBJECTIVE: To measure the sagittal areas of the front and back cavities of the vocal tract in children acquiring speech. PATIENTS AND METHODS: Ten female children were selected from the Serial Experimental collection of the Burlington Growth Centre in Toronto, Canada. Each of the 10 children was seen annually from ages 3 through 8. Data collections included lateral cephalograms in occlusion. We traced those cephalograms and identified landmarks to delineate the front and back cavities. The sagittal areas of the front and back cavities were calculated. A measure of the angle of the head to the cervical vertebrae was made. RESULTS: Front cavities were larger and grew faster. For both front and back cavities, age, angle measure, and the interaction of age and angle measure were significant. CONCLUSION: Space available for the tongue to maneuver is greater anteriorly than posteriorly even when the jaw is maximally elevated.

Implications of peripheral muscular and anatomical development for the acquisition of lingual control for speech production: a review.

OBJECTIVES: Normally developing children learn to produce intelligible speech during rapid, non-uniform growth of their articulators and other vocal tract structures. The purpose of this review is to focus attention on the consequences of peripheral growth and development for the acquisition of lingual control for speech production. This paper (1) reviews physiological underpinnings of tongue shaping and movements that are likely to be changing in young children; (2) estimates, from previously published studies, the net consequences of growth of multiple vocal tract structures on lingual control; (3) integrates our findings with the example of [R] production, and (4) highlights areas where further investigations would be most helpful. PATIENTS AND METHODS: The authors searched the literature, including the PubMed database, for studies of the development of muscle proteins, muscle fibers, and motor units of the tongue, and of the growth of the tongue, jaw, adenoids, soft and hard palates, oral and pharyngeal cavities, and the vocal tract as a whole. CONCLUSIONS: Substantial anatomical and muscular data sets focused on children from 1-4 years of age, and rigorous definitions of the tongue boundaries are needed.

Optimizing the management of rotator cuff problems.

Of the 31 recommendations made by the work group, 19 were determined to be inconclusive because of the absence of definitive evidence. Of the remaining recommendations, four were classified as moderate grade, six as weak, and two as consensus statements of expert opinion. The four moderate-grade recommendations include suggestions that exercise and nonsteroidal anti-inflammatory drugs be used to manage rotator cuff symptoms in the absence of a full-thickness tear, that routine acromioplasty is not required at the time of rotator cuff repair, that non-cross-linked, porcine small intestine submucosal xenograft patches not be used to manage rotator cuff tears, and that surgeons can advise patients that workers' compensation status correlates with less favorable outcomes after rotator cuff surgery.

Anti-IL-6 Therapies for Neuromyelitis Optica Spectrum Disorders: A Systematic Review of Safety and Efficacy.

BACKGROUND: Neuromyelitis Optica Spectrum Disorder (NMOSD) is a chronic autoimmune disease of the central nervous system that causes recurrent attacks of optic neuritis, myelitis, and brainstem symptoms, resulting in severe neurological disability. Preventive treatment with immunosuppressive agents reduces relapse rate and improves long-term prognosis. In recent years, the potential therapeutical effect of new agents has been investigated. Two of these, the anti-interleukin 6 (IL-6) agents tocilizumab and satralizumab, have been studied in active NMOSD. OBJECTIVE: To systematically review the current data regarding the efficacy and safety of anti-IL-6 agents in NMOSD. RESULTS: Fourteen case reports and 5 case series of intravenous tocilizumab have shown beneficial clinical and paraclinical effects compared to commonly used therapies, and another case series of subcutaneous tocilizumab has shown it is as effective as the IV formulation. A phase 2 comparative trial has shown tocilizumab IV to be more effective than azathioprine for relapse prevention. A phase 3 trial of subcutaneous satralizumab versus placebo, has shown a lower risk of relapse in the sartralizumab-treated group, both as add-on therapy to stable immunosuppressant and as monotherapy. Tocilizumab also reduced pain severity in two trials and fatigue scores in one trial, but satralizumab did not significantly improve pain and fatigue. Adverse events with both agents were relatively mild and comparable to placebo and azathioprine. CONCLUSION: The anti-Il-6 agents tocilizumab and satralizumab show promising results in active NMOSD. Further randomized, larger-scale trials are needed to better define the role of these agents in the growing arsenal of NMOSD treatments.

Virtual Reality and Augmented Reality in Ophthalmology: A Contemporary Prospective.

PURPOSE: Most published systematic reviews have focused on the use of virtual reality (VR)/augmented reality (AR) technology in ophthalmology as it relates to surgical training. To date, this is the first review that investigates the current state of VR/AR technology applied more broadly to the entire field of ophthalmology. METHODS: PubMed, Embase, and CINAHL databases were searched systematically from January 2014 through December 1, 2020. Studies that discussed VR and/or AR as it relates to the field of ophthalmology and provided information on the technology used were considered. Abstracts, non-peer-reviewed literature, review articles, studies that reported only qualitative data, and studies without English translations were excluded. RESULTS: A total of 77 studies were included in this review. Of these, 28 evaluated the use of VR/AR in ophthalmic surgical training/assessment and guidance, 7 in clinical training, 23 in diagnosis/screening, and 19 in treatment/therapy. 15 studies used AR, 61 used VR, and 1 used both. Most studies focused on the validity and usability of novel technologies. CONCLUSIONS: Ophthalmology is a field of medicine that is well suited for the use of VR/AR. However, further longitudinal studies examining the practical feasibility, efficacy, and safety of such novel technologies, the cost-effectiveness, and medical/legal considerations are still needed. We believe that time will indeed foster further technological advances and lead to widespread use of VR/AR in routine ophthalmic practice.

Comments on single-mass models of vocal fold vibration.

Proposed mechanisms for single-mass oscillation in the vocal tract are examined critically. There are two areas that distinguish single-mass models: in the sophistication of the air flow modeling near the oscillator and whether or not oscillation depends on acoustic feedback. Two recent models that do not depend on acoustic feedback are examined in detail. One model that depends on changing flow separation points is extended with approximate calculations.

A method for finding constrictions in high front vowels.

The purpose of this study was to devise a consistent and robust method for defining vocal tract constrictions in high front vowels. A procedure was devised to find the length and position of the articulatory constriction in high front vowels that is not sensitive to local fluctuations in vocal tract shape and to the constriction-defining parameters. A method based on a visual examination of plots for constriction length and position as functions of the constriction-defining parameters was found to provide stable constriction definitions.

Influence of the ventricular folds on a voice source with specified vocal fold motion.

The unsteady drag on the vocal folds is the major source of sound during voiced speech. The drag force is caused by vortex shedding from the vocal folds. The influence of the ventricular folds (i.e., the "false" vocal folds that protrude into the vocal tract a short distance downstream of the glottis) on the drag and the voice source are examined in this paper by means of a theoretical model involving vortex sheets in a two-dimensional geometry. The effect of the ventricular folds on the output acoustic pressure is found to be small when the movement of the vocal folds is prescribed. It is argued that the effect remains small when fluid-structure interactions account for vocal fold movement. These conclusions can be justified mathematically when the characteristic time scale for change in the velocity of the glottal jet is large compared to the time it takes for a vortex disturbance to be convicted through the vocal fold and ventricular fold region.

Treatment of carpal tunnel syndrome.

In September 2008, the Board of Directors of the American Academy of Orthopaedic Surgeons approved a clinical practice guideline on the treatment of carpal tunnel syndrome. This guideline was subsequently endorsed by the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. The guideline makes nine specific recommendations: A course of nonsurgical treatment is an option in patients diagnosed with carpal tunnel syndrome. Early surgery is an option with clinical evidence of median nerve denervation or when the patient so elects. Another nonsurgical treatment or surgery is suggested when the current treatment fails to resolve symptoms within 2 to 7 weeks. Sufficient evidence is not available to provide specific treatment recommendations for carpal tunnel syndrome associated with such conditions as diabetes mellitus and coexistent cervical radiculopathy. Local steroid injection or splinting is suggested before considering surgery. Oral steroids or ultrasound are options. Carpal tunnel release is recommended as treatment. Heat therapy is not among the options to be used. Surgical treatment of carpal tunnel syndrome by complete division of the flexor retinaculum is recommended. Routine use of skin nerve preservation and epineurotomy is not suggested when carpal tunnel release is performed. Prescribing preoperative antibiotics for carpal tunnel surgery is an option. It is suggested that the wrist not be immobilized postoperatively after routine carpal tunnel surgery. It is suggested that instruments such as the Boston Carpal Tunnel Questionnaire and the Disabilities of the Arm, Shoulder, and Hand questionnaire be used to assess patient responses to carpal tunnel syndrome treatment for research.