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The Laryngoscope Jul 2024To compare patient access to urgent care centers (UCCs) with a diagnosis of sudden hearing loss based on insurance.
OBJECTIVES
To compare patient access to urgent care centers (UCCs) with a diagnosis of sudden hearing loss based on insurance.
METHODS
One hundred twenty-five random UCCs in states with Medicaid expansion and 125 random UCCs in states without Medicaid expansion were contacted by a research assistant posing as a family member seeking care on behalf of a patient with a one-week history of sudden, unilateral hearing loss. Each clinic was called once as a Medicaid patient and once as a private insurance (PI) patient for 500 total calls. Each phone encounter was evaluated for insurance acceptance and self-pay price. Secondary outcomes included other measures of timely/accessible care. Chi-square/McNemar's tests and independent/paired sample t-tests were performed to determine whether there were statistically significant differences between expansion status and insurance type. Calls ended before answering questions were not included in the analysis.
RESULTS
Medicaid acceptance rate was significantly lower than PI (68.1% vs. 98.4%, p < 0.001). UCCs in Medicaid expansion states were significantly more likely to accept Medicaid (76.8% vs. 59.2%, p = 0.003). The mean wage-adjusted self-pay price was significantly greater in states with Medicaid expansion at $169.84 than in states without at $145.34 when called as a Medicaid patient (mean difference: $24.50, 95% Confidence Interval: $0.45-$48.54, p = 0.046). The rates of referral to an emergency department and self-pay price nondisclosure rates were greater for Medicaid calls than for private insurance calls (8.2% vs. 0.4% and 17.4% vs. 5.8%; p < 0.001 for both).
CONCLUSION
Medicaid patients with otologic emergencies face reduced access to care at UCCs.
LEVEL OF EVIDENCE
NA Laryngoscope, 2024.
PubMed: 38953603
DOI: 10.1002/lary.31596 -
Acta Ophthalmologica Jul 2024Data regarding the effectiveness of prophylactic systemic antibiotics (PSA) in lacrimal surgery is scarce. Therefore, we determined the postoperative surgical site...
BACKGROUND/AIMS
Data regarding the effectiveness of prophylactic systemic antibiotics (PSA) in lacrimal surgery is scarce. Therefore, we determined the postoperative surgical site infection (SSI) rate in lacrimal surgery without PSA.
METHODS
We retrospectively analysed files of patients who underwent external (extDCR) or endoscopic endonasal dacryocystorhinostomy (endoDCR). We excluded patients with incomplete data (n = 68), acute a priori infection with the need for antibiotics (n = 15) and PSA post-operatively for other reasons (n = 28). Indications for surgery were canalicular stenosis (n = 51, 18.6% endoDCR vs n = 131, 19.5% extDCR), nasolacrimal duct obstruction (n = 118, 43.2% endoDCR vs n = 480, 64.3% extDCR) and mucocele/chronic dacryocystitis (n = 52, 19.0% endoDCR vs n = 187, 25.0% extDCR).
RESULTS
In this study, 1020 DCR surgeries were performed in 899 patients. Postoperative SSI was diagnosed in eight patients (0.8%); exclusively after extDCR (1.1% of all extDCR). No SSIs were found in endoDCR cases. The prevalence between SSI in extDCR versus endoDCR did not prove significant (n = 8/747 0.8% vs n = 0/273 0%, p = 0.13). All patients diagnosed with SSI were successfully treated with systemic oral antibiotics.
CONCLUSION
The prevalence of SSI after DCR is low and was effectively treated with oral antibiotics. In our study, SSI occurred rarely after extDCR and was not observed after endoDCR. We conclude that lacrimal surgery is safe without the routine administration of PSA.
PubMed: 38953540
DOI: 10.1111/aos.16735 -
Clinical Infectious Diseases : An... Jul 2024Screening for syphilis increasingly relies on positive treponemal rather than nontreponemal tests (rapid plasma reagin [RPR]). We compared ocular syphilis in patients...
BACKGROUND
Screening for syphilis increasingly relies on positive treponemal rather than nontreponemal tests (rapid plasma reagin [RPR]). We compared ocular syphilis in patients with nonreactive versus positive RPR.
METHODS
We conducted a retrospective observational cohort study of ocular syphilis treated at two New England hospitals 1996-2021 based on ophthalmologist-diagnosed eye findings and positive treponemal serology, regardless of RPR. We excluded patients with alternative diagnoses. We categorized RPR into nonreactive RPR, low-titer RPR (<1:8), and high-titer RPR (≥1:8) and compared early and long-term response to therapy.
RESULTS
Our sample included 115 patients with ocular syphilis (median follow-up 2.5 years): 25 (22%) nonreactive RPR, 21 (18%) low-titer RPR, 69 (60%) high-titer RPR. Compared with nonreactive and low-titer RPR, people with high-titer RPR were younger (mean 47 years, p<0.001), more likely male (93%, p<0.001) and more likely to be living with HIV (49%, p<0.001). People with nonreactive and low-titer RPR were less likely than high-titer RPR to have posterior/panuveitis (32% and 29% versus 75%, p<0.001) or abnormal CSF (26% and 35% versus 75%, p<0.001), and more likely to present with chronic eye findings (20% and 29% versus 1%, p<0.001). In long-term follow up, eye findings improved and did not recur in most patients (62% nonreactive, 68% low-titer, 96% high-titer RPR); improved but recurred in 29%, 11%, and 4%, respectively; and were stable in 10%, 21%, and 0%, respectively.
CONCLUSION
Patients with ocular syphilis and nonreactive RPR are similar to patients with low-titer RPR, and antibiotic therapy is beneficial in most.
PubMed: 38953389
DOI: 10.1093/cid/ciae354 -
Physical Chemistry Chemical Physics :... Jul 2024This study addresses the effect of electron-phonon coupling (EPC) on the electro-optical properties of gated β-borophene. The focus is on how EPC influences the orbital...
This study addresses the effect of electron-phonon coupling (EPC) on the electro-optical properties of gated β-borophene. The focus is on how EPC influences the orbital hybridization of boron atoms, particularly within the Bariśic-Labbe-Friedel-Su-Schrieffer-Heeger framework, and considers the role of gate electrodes in this process. The results reveal a redshift in the optical spectrum only when there is positive feedback from one electrode on EPC. In other configurations, except for the -direction, a blueshift spectrum is observed. The study emphasizes the importance of tuning these spectral shifts for maximizing the performance of solar cells in converting sunlight into usable energy.
PubMed: 38953345
DOI: 10.1039/d4cp02153c -
Chemical Record (New York, N.Y.) Jul 2024pH has been considered one of the paramount factors in bodily functions because most cellular tasks exclusively rely on precise pH values. In this context, the current... (Review)
Review
pH has been considered one of the paramount factors in bodily functions because most cellular tasks exclusively rely on precise pH values. In this context, the current techniques for pH sensing provide us with the futuristic insight to further design therapeutic and diagnostic tools. Thus, pH-sensing (electrochemically and optically) is rapidly evolving toward exciting new applications and expanding researchers' interests in many chemical contexts, especially in biomedical applications. The adaptation of cutting-edge technology is subsequently producing the modest form of these biosensors as wearable devices, which are providing us the opportunity to target the real-time collection of vital parameters, including pH for improved healthcare systems. The motif of this review is to provide insight into trending tech-based systems employed in real-time or in-vivo pH-responsive monitoring. Herein, we briefly go through the pH regulation in the human body to help the beginners and scientific community with quick background knowledge, recent advances in the field, and pH detection in real-time biological applications. In the end, we summarize our review by providing an outlook; challenges that need to be addressed, and prospective integration of various pH in vivo platforms with modern electronics that can open new avenues of cutting-edge techniques for disease diagnostics and prevention.
PubMed: 38953343
DOI: 10.1002/tcr.202300369 -
Nanoscale Jul 2024A moiré lattice in a twisted-bilayer transition metal dichalcogenide (tBL-TMD) exhibits a complex atomic reconstruction effect when its twist angle is less than a few...
A moiré lattice in a twisted-bilayer transition metal dichalcogenide (tBL-TMD) exhibits a complex atomic reconstruction effect when its twist angle is less than a few degrees. The influence of the atomic reconstruction on material properties of the tBL-TMD has been of particular interest. In this study, we performed scanning transmission electron microscopy (STEM) imaging of a moiré lattice in -BN-encapsulated twisted bilayer WSe with various twist angles. Atomic-resolution imaging of the moiré lattice revealed a reconstructed moiré lattice below a crossover twist angle of ∼4° and a rigid moiré lattice above this angle. Our findings indicate that -BN encapsulation has a considerable influence on lattice reconstruction, as the crossover twist angle was larger in -BN-encapsulated devices compared to non-encapsulated devices. We believe that this difference is due to the improved flatness and uniformity of the twisted bilayers with -BN encapsulation. Our results provide a foundation for a deeper understanding of the lattice reconstruction in twisted TMD materials with -BN encapsulation.
PubMed: 38953240
DOI: 10.1039/d4nr01863j -
Nanoscale Jul 2024Liquid crystalline materials have attracted significant attention in chiroptical research due to their ability to form long range ordered helical superstructures....
Liquid crystalline materials have attracted significant attention in chiroptical research due to their ability to form long range ordered helical superstructures. Research focus has been on exploiting the unique properties of liquid crystalline materials to demonstrate highly dissymmetric circularly polarised luminescent (CPL) systems. In this study, we present a thermally driven, facile approach to fabricate CPL-active materials utilizing cholesteryl benzoate as the active substrate. Cholesteryl benzoate, a well-known thermotropic liquid crystal, has been found to manifest intriguing optical characteristics upon subjecting to repeated heating-cooling cycles. Despite the absence of conventional fluorescent moieties, the material exhibited luminescence through aggregation induced clustering triggered emission mechanism. Systematic investigations revealed excitation-dependent CPL for solid cholesteryl benzoate films when subjected to multiple thermal cycles. The excited state chiroptical investigation performed after multiple thermal cycles showed a luminescence anisotropy () of 8 × 10, which is a high value for simple organic molecules. Moreover, upon co-assembly with lanthanide-based upconversion nanophosphors (UCNPs), the hybrid system demonstrated upconverted circularly polarised luminescence (UC-CPL). Benefiting from the ability to endow upconversion nanoparticles of various sizes, fabrication of UCNP-ChB hybrid nanocomposites exhibiting multicoloured upconversion CPL was demonstrated. These findings highlight the potential of liquid crystalline materials for diverse applications, including 3D optical displays and anticounterfeiting technologies.
PubMed: 38953233
DOI: 10.1039/d4nr00865k -
Circulation. Genomic and Precision... Jul 2024Accessory pathways are a common cause of supraventricular tachycardia (SVT) and can lead to sudden cardiac death in otherwise healthy children and adults when associated...
BACKGROUND
Accessory pathways are a common cause of supraventricular tachycardia (SVT) and can lead to sudden cardiac death in otherwise healthy children and adults when associated with Wolff-Parkinson-White syndrome. The goal of this study was to identify genetic variants within a large family with structurally normal hearts affected by SVT and Wolff-Parkinson-White syndrome and determine causality of the gene deficit in a corresponding mouse model.
METHODS
Whole exome sequencing performed on 2 distant members of a 3-generation family in which multiple members were affected by SVT or Wolff-Parkinson-White pattern (preexcitation) on ECG identified as a candidate gene. Serial electrocardiograms, intracardiac electrophysiology studies, echocardiography, optical mapping studies, and histology were performed on both mutant and WT (wild-type) mice.
RESULTS
A rare HET (heterozygous) missense variant c.2969A>G;p.Glu990Gly (E990G) in was identified as the leading candidate gene variant segregating with the cardiac phenotype following an autosomal-dominant Mendelian trait segregation pattern with variable expressivity. In vivo electrophysiology studies revealed reentrant SVT in E990G mice. Optical mapping studies in E990G mice demonstrated abnormal retrograde conduction, suggesting the presence of an accessory pathway. Histological analysis of E990G mouse hearts showed a disordered ECM (extracellular matrix) in the annulus fibrosus. Finally, knockdown in human cardiac fibroblasts enhanced accelerated cell migration.
CONCLUSIONS
This study identified a rare nonsynonymous variant in the gene in individuals with familial reentrant SVT, Wolff-Parkinson-White ECG pattern, and structurally normal hearts. Furthermore, knock-in mice revealed an increased incidence of reentrant SVT and bypass tract formation in the setting of preserved cardiac structure and function.
PubMed: 38953222
DOI: 10.1161/CIRCGEN.124.004614 -
Indian Journal of Ophthalmology Jul 2024
Topics: Humans; Angiogenesis Inhibitors; Vascular Endothelial Growth Factor A; Visual Acuity; Intravitreal Injections; Diabetic Retinopathy; Macular Edema; Bevacizumab; Ranibizumab; Treatment Outcome; Tomography, Optical Coherence
PubMed: 38953138
DOI: 10.4103/IJO.IJO_40_24 -
Indian Journal of Ophthalmology Jul 2024
Topics: Humans; Intravitreal Injections; Administration, Oral; Central Serous Chorioretinopathy; Rifampin; Vascular Endothelial Growth Factor A; Propranolol; Angiogenesis Inhibitors; Adrenergic beta-Antagonists
PubMed: 38953136
DOI: 10.4103/IJO.IJO_3022_23