Perceptibility and acceptability of lightness difference of a single maxillary central incisor.

OBJECTIVES: The aim of this study was to assess the lightness difference perceptibility and acceptability thresholds, for a single maxillary central incisor, and to investigate possible differences in these thresholds regarding the direction (+ΔL* vs. -ΔL*), the observer group (dentists vs. laypersons), and the gender and age of the observers. MATERIALS AND METHODS: A series of images with varying lightness (L*), were created by altering the right maxillary central incisor of a male Caucasian, on a frontal view full-portrait image. Digital modification of one central incisor by 1 ΔL* unit resulted in 15 different images: one control, seven with increased and seven with decreased lightness. The images were presented in random order, on a digitally calibrated monitor, to 158 observers, grouped into 79 dentists, and 79 laypersons, who were asked to evaluate every image and answer whether they perceive a difference and if yes, whether they accept this difference. A multifactorial analysis of covariance was performed to analyze the perception and acceptance of any difference in the central incisors and to estimate the thresholds. The statistical significance level was α = 0.05. RESULTS: Overall, the magnitude of ΔL*, direction of ΔL*, observer group and age were each significant (p < 0.001), as was gender (p = 0.03). The effect of the magnitude of ΔL* interacted with its direction and the observer group (p = 0.045), and the effect of age interacted with the direction of ΔL*, and the gender and the group of the observers. Estimated 50%:50% perceptibility thresholds ranged from 0.1 to 2.7, and 50%:50% acceptability thresholds ranged from 2.3 to 4.5. Overall, dentists perceived lightness differences at lower magnitudes than laypersons; difference in lightness was perceived and accepted at lower magnitudes when the tooth become lighter instead of darker; and female observers perceived and accepted lightness differences at lower magnitudes compared to males. As age increased overall, differences of lightness were perceived and accepted at higher magnitudes. CONCLUSIONS: Perceptibility and acceptability of lightness differences of a single maxillary central incisor are affected by the magnitude and the direction of lightness change, as well as the gender, the age, and the type of the observers. CLINICAL SIGNIFICANCE: Even small changes in lightness are perceivable; however, thresholds of perception and acceptance are dependent on the magnitude and the direction of change and are also dependent on the observer, with women, dentists and younger people perceiving and accepting changes at lower magnitudes of ΔL*.

Assessing color mismatch in single-shade composite resins for enamel replacement.

STATEMENT OF PROBLEM: Shade selection is a challenge in restorative dentistry. While single-shade composite resins may simplify this process, whether the color mismatch between this composite resin and the substrate is within acceptable levels to ensure successful outcomes is unclear. PURPOSE: The purpose of this in vitro study was to assess the influence of background and surrounding shade, thickness, and proximity to the surrounding on color mismatch when shaded and single-shade composite resins are used in the center of an enamel layer. MATERIAL AND METHODS: Two-layer specimens mimicking dentin (the background) and enamel (the surrounding and center) were prepared. Two shades were used for the background and the surrounding layer (OA1/A1 and OA3/A3). At the Ø3-mm center, 2 single-shade composite resins were placed, Omnichroma (OM) and Admira Fusion x-tra (FU), and also shaded composite resins A1, WE, A3, and C2. For the OA1/A1 background and surrounding, shades A1 and WE served as positive controls, while the A3 and C2 were negative controls. For OA3/A3, these controls were reversed. Two enamel layer thicknesses were evaluated (0.5- and 1.0-mm). Reflectance measurements were made at 0.0, 1.0, 2.0, and 2.5 mm from the center. Color differences were calculated between those at 2.5 mm and at other distances (ΔE0, ΔE1, and ΔE2). Data analysis employed a 4-way repeated measure ANOVA with Bonferroni corrections for the pair-wise comparisons (α=.05). RESULTS: Background and surrounding shade, central shade, distance, and thickness affected color mismatch (P<.05). For the OA1/A1 specimens, single-shade color mismatch values were found between both the positive and negative controls (P<.05). For the OA3/A3 specimens, the color mismatch did not differ significantly from that of negative controls (P>.05). No difference was found between ΔE0 and ΔE1, but each was distinct from ΔE2. Thickness did not affect the color mismatch of the single-shade composite resins (P<.05). CONCLUSIONS: Single-shade composite resins for enamel replacement showed higher color mismatches compared with positive controls.

The Genomic Landscape of Vulvar Squamous Cell Carcinoma.

Vulvar squamous cell cancer (VSC) accounts for 90% of vulvar cancers. Next-generation sequencing studies of VSC imply human papillomavirus (HPV) and p53 status play separate roles in carcinogenesis and prognosis. We sought to describe the genomic landscape and analyze the immunologic profiles of VSC with respect to HPV and p53 status. A total of 443 VSC tumors underwent tumor profiling. Next-generation sequencing was performed on genomic DNA isolated from formalin-fixed paraffin-embedded tumor samples. PD-L1, microsatellite instability were tested by fragment analysis, IHC, and next-generation sequencing. Tumor mutational burden-high was defined as >10 mutations per MB. HPV 16/18 positive (HPV+) status was determined using whole exome sequencing on 105 samples. Three cohorts were identified from 105 samples with known HPV: HPV+, HPV-/p53wt, and HPV-/p53mt. Where HPV and p53 status were examined, TP53 mutations were exclusive of HPV+ tumors. In all, 37% of samples were HPV+. Among the 66 HPV- tumors, 52 (78.8%) were HPV-/p53mt and 14 (21.2%) were HPV-/p53wt. The HPV-/p53wt cohort had a higher rate of mutations in the PI3KCA gene (42.9% HPV-/p53wt vs 26.3% HPV+ vs. 5.8% HPV-/p53mt, q =0.028) and alterations in the PI3K/AkT/mTOR pathway (57.1% HPV-/p53wt vs. 34.2% HPV+ vs. 7.7% HPV-/p53mt, q =0.0386) than the other 2 cohorts. Ninety-eight VSC tumors with HPV16/18 information underwent transcriptomic analysis and immune deconvolution method. No differences were observed in immune profiles. The HPV-/p53wt VSC tumors had significantly higher rates of mutations in the PI3KCA gene and alterations in the PI3K/AkT/mTOR pathway, a potential target that merits further investigation in this subgroup.

Effect of monomer composition and filler fraction on surface microhardness and depth of cure of experimental resin composites.

This study evaluated microhardness profiles and calculated depths of cure at 80% of the surface microhardness of experimental dental resin composites having different base monomer compositions and different filler fractions. Composites were prepared using four different base monomers (bisphenol A-glycidyl methacrylate [Bis-GMA], urethane dimethacrylate [UDMA], ethoxylated bisphenol-A dimethacrylate [Bis-EMA], and Fit-852) with triethylene glycol dimethacrylate (TEGDMA) used as a co-monomer at three filler:resin matrix weight percent fractions (50:50, 60:40, and 70:30). Uncured material was placed in 3D printed molds and light cured for 40 s from the top surface only. Knoop microhardness was measured at the top of the specimen, and at every 0.5 mm up to 4 mm in depth. Microhardness at the surface increased in all experimental composites as the filler fraction increased. When comparing base monomers, microhardness was the highest in UDMA-based composites, while Bis-GMA-based composites showed the lowest values. When comparing depth of cure as a function of base monomer type, both Bis-GMA and Bis-EMA showed significantly lower values than UDMA or Fit-852. Composites having 50 wt% filler showed a significantly higher depth of cure than those with 60 and 70 wt% filler. Base monomer and filler fraction significantly influence microhardness and depth of cure in these experimental composites.

Association Between California's State Insurance Gender Nondiscrimination Act and Utilization of Gender-Affirming Surgery.

Importance: Gender-affirming surgery is often beneficial for gender-diverse or -dysphoric patients. Access to gender-affirming surgery is often limited through restrictive legislation and insurance policies. Objective: To investigate the association between California's 2013 implementation of the Insurance Gender Nondiscrimination Act, which prohibits insurers and health plans from limiting benefits based on a patient's sex, gender, gender identity, or gender expression, and utilization of gender-affirming surgery among California residents. Design, Setting, and Participants: Population epidemiology study of transgender and gender-diverse patients undergoing gender-affirming surgery (facial, chest, and genital surgery) between 2005 and 2019. Utilization of gender-affirming surgery in California before and after implementation of the Insurance Gender Nondiscrimination Act in July 2013 was compared with utilization in Washington and Arizona, control states chosen because of geographic similarity and because they expanded Medicaid on the same date as California-January 1, 2014. The date of last follow-up was December 31, 2019. Exposures: California's Insurance Gender Nondiscrimination Act, implemented on July 9, 2013. Main Outcomes and Measures: Receipt of gender-affirming surgery, defined as undergoing at least 1 facial, chest, or genital procedure. Results: A total of 25 252 patients (California: n = 17 934 [71%]; control: n = 7328 [29%]) had a diagnosis of gender dysphoria. Median ages were 34.0 years in California (with or without gender-affirming surgery), 39 years (IQR, 28-49 years) among those undergoing gender-affirming surgery in control states, and 36 years (IQR, 22-56 years) among those not undergoing gender-affirming surgery in control states. Patients underwent at least 1 gender-affirming surgery within the study period in 2918 (11.6%) admissions-2715 (15.1%) in California vs 203 (2.8%) in control states. There was a statistically significant increase in gender-affirming surgery in the third quarter of July 2013 in California vs control states, coinciding with the timing of the Insurance Gender Nondiscrimination Act (P < .001). Implementation of the policy was associated with an absolute 12.1% (95% CI, 10.3%-13.9%; P < .001) increase in the probability of undergoing gender-affirming surgery in California vs control states observed in the subset of insured patients (13.4% [95% CI, 11.5%-15.4%]; P < .001) but not self-pay patients (-22.6% [95% CI, -32.8% to -12.5%]; P < .001). Conclusions and Relevance: Implementation in California of its Insurance Gender Nondiscrimination Act was associated with a significant increase in utilization of gender-affirming surgery in California compared with the control states Washington and Arizona. These data might inform state legislative efforts to craft policies preventing discrimination in health coverage for state residents, including transgender and gender-diverse patients.

Effect of cross-polarization filters on the trueness of colors obtained with a single-lens reflex camera, macro lens, and a ring flash.

OBJECTIVE: To investigate the effect of cross-polarization filters on the colors of shade tabs obtained with a digital single-lens reflex (DSLR) camera, macrolens, and a ring flash. MATERIALS AND METHODS: Digital images of four shade tables (1M1, 3L2.5, 3R2.5, and 5M3) from the VITA Toothguide 3D-Master shade guide were taken using a DSLR camera, 100 mm macrolens, and ring flash with two different cross-polarizing filters (Polar_eyes and Filtropolar), and without (Nonpolarizer; n = 7). The CIE L*a*b* color coordinates of digital images were calculated and remeasured with a spectroradiometer (SR). The color differences (ΔE00 ) between the SR and digital images were calculated and analyzed with the two-way analysis of variance (ANOVA) and Tukey HSD test (α = 0.05). RESULTS: ΔE00 values of all test groups were higher than the clinically acceptable threshold (∆E00 > 1.80). While the ∆E00 values of Filtropolar (6.19 ± 0.44) and Polar_eyes (7.82 ± 0.23) groups were significantly higher than the Nonpolarizer (4.69 ± 0.32) for the 1M1 shade tab, ∆E00 value of Polar_eyes (6.23 ± 0.34) was significantly lower than Nonpolarizer (10.71 ± 0.48) group for 5M3 shade tab (p < 0.05). CONCLUSION: The color-matching results of tested digital photography techniques with and without cross-polarization were unacceptable, compared to a spectroradiometer. While digital photography with Polar_eyes cross-polarizing filter has closer results to the reference device for the low-in-value shade table (5M3), for the high-in-value shade table (1M1), improved results were obtained without a cross-polarizing filter. CLINICAL SIGNIFICANCE: The cross-polarization filters are increasingly used in dentistry for tooth color communication with digital photography techniques. However, the digital photography techniques with-without cross-polarization filterers should be improved to obtain clinically acceptable color-matching results.

Error analysis of stages involved in CBCT-guided implant placement with surgical guides when different printing technologies are used.

STATEMENT OF PROBLEM: Digital light processing (DLP), continuous liquid interface printing (CLIP), and stereolithography (SLA) technologies enable 3-dimensional (3D) printing of surgical guides. However, how their accuracy compares and how accuracy may affect subsequent steps in guided surgery is unclear. PURPOSE: The purpose of this in vitro study was to investigate the fabrication and seating accuracy of surgical guides printed by using DLP, SLA, and CLIP technologies and evaluate the positional deviation of the osteotomy site and placed implant compared with the digital implant plan. MATERIAL AND METHODS: Twenty-one polyurethane models were divided into 3 groups and used to plan implants and design surgical guides. The guides were fabricated by using DLP, SLA, or CLIP 3D printers (n=7) and scanned, and the scan file was compared with the digital design file to analyze the fabrication accuracy at the intaglio and overall external surfaces using root mean square (RMS) values. The triple scan protocol was used to evaluate the seating accuracy of the guides on their respective models. Osteotomies were prepared on models by using the guides followed by a microcomputed tomography image of each osteotomy. The implants were placed through the guides, the scan bodies were tightened to implants, and the models were scanned to obtain the images of placed implant position. Osteotomy and placed implant images were used to calculate the entry point, apex, and long axis deviations from the planned implant position with a software program. A 2-way repeated-measures ANOVA of the RMS data was used to analyze printing and seating trueness, and homogeneity of variance analyses were used at each surface for precision. A 3-way repeated-measures ANOVA was used to analyze distance deviations over the stages (osteotomy and final implant) and locations studied, and a 2-way repeated-measures ANOVA was used for angular deviations. Homogeneity of variance analyses were performed for precision (α=.05). RESULTS: The 3D printer type significantly affected the trueness of the guide at the intaglio surface (P<.001). SLA guides had the lowest mean RMS (59.04 µm) for intaglio surface, while CLIP had the highest mean RMS (117.14 µm). Guides from all 3D printers had low variability among measured deviations and therefore were similarly precise. The seating accuracy of SLA and DLP guides was not significantly different, but both had lower mean RMS values than CLIP (P=.003 for SLA, P=.014 for DLP). There were no significant interactions between the stage of surgery, the printer type, or the location of implant deviation (P=.734). Only the location of deviation (cervical versus apical) had a significant effect on distance deviations (P<.001). The printer type, stage of surgery, and their interaction did not significantly affect angular deviations (P=.41). CONCLUSIONS: The 3D printing technology affected printing trueness. The intaglio surface trueness was higher with SLA and overall trueness was higher with the CLIP printer. The precision of all guides was similarly high. Guides from SLA and DLP printers had more accurate seating than those from CLIP. Higher deviations were observed at the apex; however, osteotomy and final implant position did not significantly differ from the digitally planned position.

The association between caffeine intake and testosterone: NHANES 2013-2014.

BACKGROUND: Caffeine is one of the most commonly used psychoactive drugs in the world, and provides many health benefits including alertness, improved memory, and reducing inflammation. Despite these benefits, caffeine has been implicated in a number of adverse health outcomes possibly due to effects within the endocrine system, effects that may contribute to impaired reproductive function and low testosterone in men. Previous studies have investigated associations between caffeine consumption and testosterone levels in men, although the quantity and generalizability of these studies is lacking, and the results between studies are conflicting and inconclusive. METHODS: Using data from a cross-sectional study of 372 adult men in the 2013-2014 NHANES survey cycle, the researchers set out to characterize the association between serum testosterone levels, caffeine, and 14 caffeine metabolites. RESULTS: Multivariable, weighted linear regression revealed a significant inverse association between caffeine and testosterone. Multivariable, linear regression revealed significant, inverse associations between 6 xanthine metabolic products of caffeine and testosterone. Inverse associations were observed between 5-methyluric acid products and testosterone, as well as between 5-acetlyamino-6-amino-3-methyluracil and testosterone. A significant, positive association was observed for 7-methyl xanthine, 3,7-dimethyluric acid, and 7-methyluric acid. Logistic regression models to characterize the association between 2 biologically active metabolites of caffeine (theobromine and theophylline) and odds of low testosterone (< 300 ng/dL) were non-significant. CONCLUSIONS: These findings suggest a potential role for caffeine's contribution to the etiology of low testosterone and biochemical androgen deficiency. Future studies are warranted to corroborate these findings and elucidate biological mechanisms underlying this association.

Transient peripheral vestibular hypofunction measured with vestibular short-latency evoked potentials following noise exposure in rats.

Exposure to 120 dB sound pressure level (SPL) band-limited noise results in delayed onset latency and reduced vestibular short-latency evoked potential (VsEP) responses. These changes are still present 4 wk after noise overstimulation. Noise-induced hearing loss (NIHL) has been shown to vary in extent and duration based on the noise intensity. This study investigated whether noise-induced peripheral vestibular hypofunction (NPVH) would also decrease in extent and/or duration with less intense noise exposure. In the present study, rats were exposed to a less intense noise (110 dB SPL) but for the same duration (6 h) and frequency range (500-4,000 Hz) as used in previous studies. The VsEP was assessed 1, 3, 7, 14, 21, and 28 days after noise exposure. In contrast to 120 dB SPL noise exposure, the 110 dB SPL noise exposures produced smaller deficits in VsEP responses that fully recovered in 62% (13/21) of animals within 1 wk. These findings suggest that NPVH, a loss or attenuation of VsEP responses with a requirement for elevated stimulus intensity to elicit measurable responses, is similar to NIHL, that is, lower sound levels produce a smaller or transient deficit. These results show that it will be important to determine the extent and duration of vestibular hypofunction for different noise exposure conditions and their impact on balance.NEW & NOTEWORTHY This is the first study to show a temporary noise-induced peripheral vestibular hypofunction that recovers following exposure to continuous noise.

YouTube as a Source of Medical Information About Spinal Cord Stimulation.

BACKGROUND: Social media platforms may play an important role in the dissemination of medical information on interventional pain procedures. This cross-sectional study quantitatively assessed the reliability and quality of information from YouTube regarding spinal cord stimulation. MATERIALS AND METHODS: YouTube was queried on May 20, 2020 using keywords "spinal cord stimulator," "spinal cord stimulation experience," and "spinal cord stimulation risks." The top 50 viewed videos from each search were analyzed. The primary outcome was video quality, which was analyzed using the modified DISCERN (mDISCERN) criteria. RESULTS: Seventy-nine of 103 (77%) videos were classified as useful. Fifteen of 103 (14%) videos were classified as misleading and contained nonfactual information on spinal cord stimulation. Hospitals, group practices, or physicians produced a greater proportion of useful videos compared to misleading videos (63.3% vs. 26.7%, p = 0.008). Nonmedical independent users produced a greater proportion of misleading videos compared to useful videos (73.3% vs. 16.4%, p < 0.001). Useful videos had significantly higher mDISCERN scores compared to misleading videos (2.6 vs. 1.9, p = 0.009). Nonmedical independent users produced a greater proportion of low-quality videos (mDISCERN score < 3) than high-quality videos (mDISCERN score ≥ 3; 50.8% vs. 2.4%, respectively, p < 0.001). Educational videos from professional pain medicine societies were not captured. CONCLUSION: YouTube is an accessible platform for medical information on spinal cord stimulation, yet a significant amount of nonfactual information is present. As social media platforms continue to gain prominence in health care, future efforts to appraise the quality of medical content delivered to the public are warranted. In addition, reputable sources including professional pain medicine societies should consider collaborating with producers to disseminate high-quality video content that reaches a wider audience.

Infection with a chlorophyllic eukaryote after a traumatic freshwater injury.

Infections with chlorophyllic algae are uncommon. Invasive infection with Desmodesmus armatus developed in two patients independently after they each sustained a penetrating freshwater injury.

Biogas Stoves Reduce Firewood Use, Household Air Pollution, and Hospital Visits in Odisha, India.

Traditional cooking using biomass is associated with ill health, local environmental degradation, and regional climate change. Clean stoves (liquefied petroleum gas (LPG), biogas, and electric) are heralded as a solution, but few studies have demonstrated their environmental health benefits in field settings. We analyzed the impact of mainly biogas (as well as electric and LPG) stove use on social, environmental, and health outcomes in two districts in Odisha, India, where the Indian government has promoted household biogas. We established a cross-sectional observational cohort of 105 households that use either traditional mud stoves or improved cookstoves (ICS). Our multidisciplinary team conducted surveys, environmental air sampling, fuel weighing, and health measurements. We examined associations between traditional or improved stove use and primary outcomes, stratifying households by proximity to major industrial plants. ICS use was associated with 91% reduced use of firewood (p < 0.01), substantial time savings for primary cooks, a 72% reduction in PM2.5, a 78% reduction in PAH levels, and significant reductions in water-soluble organic carbon and nitrogen (p < 0.01) in household air samples. ICS use was associated with reduced time in the hospital with acute respiratory infection and reduced diastolic blood pressure but not with other health measurements. We find many significant gains from promoting rural biogas stoves in a context in which traditional stove use persists, although pollution levels in ICS households still remained above WHO guidelines.

Disease Status and Pubertal Stage Predict Improved Growth in Antitumor Necrosis Factor Therapy for Pediatric Inflammatory Bowel Disease.

BACKGROUND: Growth failure is well-recognized in pediatric inflammatory bowel disease (PIBD; <18 years). We aimed to examine whether antitumor necrosis factor (TNF) therapy improves growth in a PIBD population-based cohort. METHODS: A retrospective review of all Scottish children receiving anti-TNF (infliximab [IFX] and adalimumab [ADA]) from 2000 to 2012 was performed; height was collected at 12 months before anti-TNF (T-12), start (T0), and 12 (T+12) months after anti-TNF. RESULTS: Ninety-three of 201 treated with IFX and 28 of 49 with ADA had satisfactory growth data; 66 had full pubertal data. Univariate analysis demonstrated early pubertal stages (Tanner 1-3 n = 44 vs T4-5 n = 22), disease remission, disease duration ≥2 years, and duration of IFX ≥12 months were associated with improved linear growth for IFX; for ADA only improvement was seen in Tanner 1-3. For IFX, Tanner 1-3 median Δ standard deviation scores for height (Ht SDS) -0.3 (-0.7, 0.2) at T0 changed to 0.04 (-0.5, 0.7) at T+12 (P < 0.001) versus -0.01 (-0.5, 0.9) at T0 in T4-5 changed to -0.01 (-0.4, 0.2) at T+12 (P > 0.05). For IFX disease duration ≥2 year, median Δ Ht SDS was -0.13 (-0.6, 0.3) at T0 then 0.07 (-0.3, 0.6) at T+12 (P < 0.001). Remission improved Δ Ht SDS (median Δ Ht SDS -0.14 [-0.6, 0.3] at T0 to 0.17 [-0.2, 0.7] at T+12 [P < 0.001]). Multiple regression analysis demonstrated corticosteroid usage at T0 predicted improved Δ Ht SDS at T+12 for IFX and ADA. CONCLUSIONS: Anti-TNF therapy is more likely to be associated with growth improvement when used at earlier stages of puberty with remission a key growth-promoting strategy in pediatric Crohn disease.

Epigenetic-based hormesis and age-dependent altruism: Additions to the behavioural constellation of deprivation.

We support Pepper and Nettle's (P&N's) hypothesised adaptive responses to deprivation. However, we argue that adaptive responses to stress shift with age. Specifically, present-oriented behaviours are adaptive for young people (e.g., in terms of mating and reproduction) but costly for older people in deprived communities who would benefit from investing in grandchildren. Epigenetic mechanisms may be responsible for age-related tactical shifts.

Monothermal Caloric Screening to Improve Healthcare Value.

OBJECTIVES: To evaluate whether monothermal caloric screening can reduce the number of caloric irrigations required in the vestibular testing battery while maintaining diagnostic accuracy. DESIGN: Prospective controlled cohort study. Three hundred and ninety patients referred for vestibular testing at this tertiary referral health system over a 1-year period were evaluated; 24 patients met exclusion or failure criteria and 366 patients were included in the study. Population was 35.6% male; average age was 50.4 years old. Each patient underwent caloric testing using either warm or cool water irrigation initially and this data was used for monothermal screening data. All patients then completed bithermal binaural caloric testing to obtain the "gold standard" bithermal data for comparison. The sensitivity and specificity of monothermal cool or monothermal warm caloric tests were calculated using a receiver operating characteristic curve analysis. RESULTS: Using a monothermal interear difference threshold of 25%, warm monothermal screening had sensitivity of 98.0%, specificity of 91.3%, false negative rate of 2%, and false positive rate of 8.7%. Cool monothermal screening also had excellent sensitivity (92.3%) and specificity (95.3)%, with a false negative rate of 7.7%, and a false positive rate of 4.7%. The diagnosis associated with the single false negative warm monothermal caloric test was compensated vestibular paresis. In the study population, 71.9% had a negative monothermal screen; if the monothermal data were accepted, 2 fewer irrigations would have been performed resulting in an average saving of $264 (typical Medicare reimbursement for 2 irrigations) billed per patient screened as well as shortening the average testing battery by about 15 min. CONCLUSIONS: Warm monothermal caloric screening can reduce time and cost of vestibular testing while nearly matching the diagnostic accuracy of bithermal testing.

Evaluating the need for firearms in healthcare security.

This article is a condensed version of a document/position paper written by the authors for ODS Security Solutions on "Defensive Weapons and Equipment in the Healthcare Environment." For the complete paper, which also includes a review of alternative weapons and equipment and other equipment carried by security officers go to: http://ods-security.com/wp-content/uploads/2016/05/Defensive-Weapons _Digital-2.pdf?utm_source=Defensive+Weapons&utm_campaign=spring+sentinel&utm_medium=email.

Patient beliefs and behaviors about genomic risk for type 2 diabetes: implications for prevention.

Type 2 diabetes is a major health burden in the United States, and population trends suggest this burden will increase. High interest in, and increased availability of, testing for genetic risk of type 2 diabetes presents a new opportunity for reducing type 2 diabetes risk for many patients; however, to date, there is little evidence that genetic testing positively affects type 2 diabetes prevention. Genetic information may not fit patients' illness representations, which may reduce the chances of risk-reducing behavior changes. The present study aimed to examine illness representations in a clinical sample who are at risk for type 2 diabetes and interested in genetic testing. The authors used the Common Sense Model to analyze survey responses of 409 patients with type 2 diabetes risk factors. Patients were interested in genetic testing for type 2 diabetes risk and believed in its importance. Most patients believed that genetic factors are important to developing type 2 diabetes (67%), that diet and exercise are effective in preventing type 2 diabetes (95%), and that lifestyle changes are more effective than drugs (86%). Belief in genetic causality was not related to poorer self-reported health behaviors. These results suggest that patients' interest in genetic testing for type 2 diabetes might produce a teachable moment that clinicians can use to counsel behavior change.

Population analysis of Escherichia coli isolates with discordant resistance levels by piperacillin-tazobactam broth microdilution and agar dilution testing.

Population analysis was performed for 42 Escherichia coli isolates to determine whether heterogeneity of resistance was a factor in piperacillin-tazobactam category differences between agar dilution and broth microdilution. Of 20 isolates discordant between methods, 80% were heterogeneous. Of 22 isolates in agreement, 59% were homogeneous. Heterogeneity and homogeneity rates for those in agreement were significantly different from those that were discordant (P value, 0.010). Heterogeneity of resistance expression appears to be an important factor in category differences observed between broth microdilution and agar dilution for piperacillin-tazobactam.

Identification and use of the sugarcane bacilliform virus enhancer in transgenic maize.

BACKGROUND: Transcriptional enhancers are able to increase transcription from heterologous promoters when placed upstream, downstream and in either orientation, relative to the promoter. Transcriptional enhancers have been used to enhance expression of specific promoters in transgenic plants and in activation tagging studies to help elucidate gene function. RESULTS: A transcriptional enhancer from the Sugarcane Bacilliform Virus - Ireng Maleng isolate (SCBV-IM) that can cause increased transcription when integrated into the the genome near maize genes has been identified. In transgenic maize, the SCBV-IM promoter was shown to be comparable in strength to the maize ubiquitin 1 promoter in young leaf and root tissues. The promoter was dissected to identify sequences that confer high activity in transient assays. Enhancer sequences were identified and shown to increase the activity of a heterologous truncated promoter. These enhancer sequences were shown to be more active when arrayed in 4 copy arrays than in 1 or 2 copy arrays. When the enhancer array was transformed into maize plants it caused an increase in accumulation of transcripts of genes near the site of integration in the genome. CONCLUSIONS: The SCBV-IM enhancer can activate transcription upstream or downstream of genes and in either orientation. It may be a useful tool to activate enhance from specific promoters or in activation tagging.

Development and implementation of a pregnancy heart team at a Southeastern United States tertiary hospital: a qualitative study.

BACKGROUND: The United States has seen a significant rise in maternal mortality and morbidity associated with cardiovascular disease over the past 4 decades. Contributing factors may include an increasing number of parturients with comorbid conditions, a higher rate of pregnancy among women of advanced maternal age, and more patients with congenital heart disease who survive into childbearing age and experiencing pregnancy. In response, national medical organizations have recommended the creation of multidisciplinary obstetric-cardiac teams, also known as pregnancy heart teams, to provide comprehensive preconception counseling and coordinated pregnancy management that extend through the postpartum period. OBJECTIVE: We sought to describe the development and implementation of a pregnancy heart team for parturients with cardiac disease at a southeastern United States tertiary hospital. STUDY DESIGN: This was a qualitative study that was conducted among healthcare team members involved during the pregnancy heart team formation. Semi-structured interviews were conducted between April and May 2022, professionally transcribed, and the responses were thematically coded for categories and themes using constructs from The Consolidated Framework for Implementation Research. RESULTS: Themes identified included intentional collaboration to improve outpatient and inpatient coordination through earlier awareness of patients who meet the criteria and via documented care planning. The pregnancy heart team united clinicians around best practices and coordination to promote the success and safety of pregnancies and not only to minimize maternal health risks. Developing longitudinal care plans was critical among the pathway team to build on collective expertise and to provide clarity for those on shift to reduce hesitancy and achieve timely, vetted practices without additional consults. Establishing a proactive approach of specialists offering their perspectives was viewed as positively contributing to a culture of speaking up. Barriers to the successful development and sustainability of the pregnancy heart team included unmet administrative needs and clinician turnover within a context of shortages in staffing and high workload. CONCLUSION: This study described the process of developing and implementing a pregnancy heart team at 1 institution, thereby offering insights for future multidisciplinary care for maternal cardiac patients. Establishing pregnancy heart teams can enhance quality care for high-risk patients, foster learning and collaboration among physician and nursing specialties, and improve coordination to manage complex maternal cardiac cases.