Longitudinal Change of Refractive Error in Retinopathy of Prematurity Treated With Intravitreal Bevacizumab or Laser Photocoagulation.

PURPOSE: To compare progression of myopia and refractive error in former premature infants with retinopathy of prematurity (ROP) treated using intravitreal bevacizumab (IVB) or laser. DESIGN: Retrospective clinical cohort study. METHODS: We identified premature infants with ROP treated using IVB from 2011 to 2020 and compared their longitudinal cycloplegic refraction data to that of infants with ROP treated using laser during the same timeframe. A subset of infants treated using IVB also underwent additional treatment using laser. We included cycloplegic refractions from 789 cumulative visits over a median 3.2 years. We used a linear mixed-effects model with a log decay function to evaluate how refraction changed with age after treatment. RESULTS: In aggregate, the model estimated a significant (P < .001) trend in refraction-from slight hyperopia to relatively more myopic states. However, progression in laser-treated eyes was significantly (P < .001) more rapid, regardless of treatment with IVB. The number of laser spots resulted in increased myopic progression by approximately 0.16 diopters per 100 laser spots. Both ROP stage and zone had a significant effect on myopic progression, with more severe disease resulting in faster myopic progression. Random effects, including individual subject variation with nested variance for left and right eye, accounted for 86.4% of the remaining variance not explained by age and treatment. CONCLUSIONS: Laser treatment for severe ROP increases the trend to severe myopia. In our sample, IVB did not affect myopic progression but did substantially reduce the amount of consequent laser required to treat ROP. The effect of laser persists after accounting for differences in ROP stage and zone.

How Multidimensional Health Locus of Control predicts utilization of emergency and inpatient hospital services.

Health locus of control may be an important predictor of health care utilization. We analyzed associations between health locus of control and frequency of emergency department visits and hospital admissions, and investigated self-rated health as a potential mediator. Overall, 863 patients in an urban emergency department completed the Multidimensional Health Locus of Control instrument, and self-reported emergency department use and hospital admissions in the last year. We found small but significant associations between Multidimensional Health Locus of Control and utilization, all of which were mediated by self-rated health. We conclude that interventions to shift health locus of control may change patients' perceptions of their own health, thereby impacting utilization.

Acute toxicity of peroxy sulfonated oleic acids (PSOA) to freshwater aquatic species and sludge microflora as observed in laboratory environments.

BACKGROUND: Peroxy sulfonated oleic acids (PSOA) is a novel surfactant peracid. The commercial applications of PSOA result in the chemical primarily being disposed of via industrial waste water effluent. Given this manner of disposal, it is important to understand the aquatic hazards of the chemical to better assess the risk posed to aqueous environments. Acute aquatic toxicity laboratory experiments were performed to evaluate aquatic hazards and were conducted according to standard OECD test guidelines with rainbow trout (Oncorhynchus mykiss), water fleas (Daphnia magna) and algae (Pseudokirchneriella subcapitata). In addition, microbial toxicity was evaluated in activated sludge obtained from a domestic sewage treatment facility. RESULTS: Lethal concentration in 50 % of test species (LC50) and effect concentration in 50 % of test species (EC50) values for PSOA ranged from 0.75 to 5.44 mg/L, representing a relatively small range spanning less than an order of magnitude. No observed effect concentration (NOEC) and lowest observed effect concentration (LOEC) ranges were also relatively small, with ranges of 0.25-1.66 and 0.5-3.6 mg/L, respectively. The EC50, LOEC and NOEC values for microbial toxicity were 216, 60 and 20 mg/L, respectively. Predicted no effect concentrations (PNEC) for aqueous media were based on the 96-h LC50 (0.75 mg/L) for O. mykiss, the organism displaying the greatest sensitivity to PSOA. These values were derived for freshwater, marine water and intermittent releases to water and ranged from 7.5 × 10-5 to 7.5 × 10-3 mg/L. A sewage treatment plant PNEC of 2 mg/L was derived based on an activated sludge 3-h NOEC of 20 mg/L. CONCLUSION: These values, along with the anticipated environmental fate and transport for PSOA, were considered in assessing the overall aquatic risk posed by this chemical. Despite the relatively high acute aquatic hazards for PSOA, environmental modeling suggests the overall risk of PSOA to aqueous environments is low based on its anticipated uses. This conclusion is consistent with the significant processing of industrial wastewater by onsite or municipal wastewater treatment facilities prior to release to the environment.

Evaluation of the toxicity data for peracetic acid in deriving occupational exposure limits: a minireview.

Peracetic acid (PAA) is a peroxide-based chemistry that is highly reactive and can produce strong local effects upon direct contact with the eyes, skin and respiratory tract. Given its increasing prominence in industry, attention has focused on health hazards and associated risks for PAA in the workplace. Occupational exposure limits (OEL) are one means to mitigate risks associated with chemical hazards in the workplace. A mini-review of the toxicity data for PAA was conducted in order to determine if the data were sufficient to derive health-based OELs. The available data for PAA frequently come from unpublished studies that lack sufficient study details, suffer from gaps in available information and often follow unconventional testing methodology. Despite these limitations, animal and human data suggest sensory irritation as the most sensitive endpoint associated with inhalation of PAA. Rodent RD50 data (the concentration estimated to cause a 50% depression in respiratory rate) were selected as the critical studies in deriving OELs. Based on these data, a range of 0.36-0.51mg/m(3) (0.1-0.2ppm) was calculated for a time-weighted average (TWA), and 1.2-1.7mg/m(3) (0.4-0.5ppm) as a range for a short-term exposure limit (STEL). These ranges compare favorably to other published OELs for PAA. Considering the applicable health hazards for this chemistry, a joint TWA/STEL OEL approach for PAA is deemed the most appropriate in assessing workplace exposures to PAA, and the selection of specific values within these proposed ranges represents a risk management decision.

Characterization of a novel two-component system in Burkholderia cenocepacia.

Two-component systems are important regulatory systems that allow bacteria to adjust to environmental conditions, and in some bacteria are used in pathogenesis. We identified a novel two-component system in Burkholderia cenocepacia, an opportunistic pathogen that causes pneumonia in cystic fibrosis (CF) patients. The putative operon encodes BceS, a sensor kinase, and BceR, a response regulator. Our studies indicated that the bceR mutant showed a statistically significant decrease in protease, swimming motility, and quorum sensing when compared to the wild-type, but there was no significant difference in phospholipase C activity, swarming, and biofilm formation. In addition, the mutant showed a statistically significant reduction in virulence compared to the wild-type using the alfalfa plant model. Examination of the Burkholderia cepacia complex (a group of organisms that are phenotypically similar, but genotypically distinct) revealed that this system is prevalent in B. ambifaria, B. multivorans, B. vietnamiensis and B. dolosa. Interestingly, all these organisms have been associated with CF patients. The collective results indicate that BceSR influences various activities important in Burkholderia physiology and possibly pathogenesis. This information could be important in the design of novel therapeutics for Burkholderia infections.