Search

Presbyopia may represent the largest segment of refractive errors that is without an established and effective refractive surgery treatment. Corneal Inlays are materials (synthetic or allogenic) implanted in the stroma of patients' corneas to improve presbyopia. These inlays, introduced into the United States in 2015 via the small-aperture corneal inlay (KAMRATM, SightLife Surgical/CorneaGen, Seattle, Washington, United States), were met with an initial wave of enthusiasm. Subsequent models like the shape-changing corneal inlay (RAINDROPTM, Revision Optics, Lake Forest, California, United States) offered excellent results for patients, but longer-term research raised questions about patient safety. At the time of this article, no synthetic corneal inlays are available in the United States for the correction of presbyopia. Other options for presbyopia correction include allograft corneal inlays, trifocal synthetic corneal inlays, pharmacologic therapies, scleral incisions or additive techniques and PresbyLASIK. Presently, allograft inlays consist of corneal lenticules removed from patients undergoing Small Incision Lenticule Extraction (SMILE). We will review corneal inlays and other alternative procedures that may provide effective and predictable treatments for patients with presbyopia. [ABSTRACT FROM AUTHOR]

Background Current and future pandemics will require informatics solutions to assess the risks, resources and policies to guide better public health decision-making. Methods Cross-sectional study of all COVID-19 cases and deaths in the USA on a population- and resource-adjusted basis (as of 24 April 2020) by applying biomedical informatics and data visualization tools to several public and federal government datasets, including analysis of the impact of statewide stay-at-home orders. Results There were 2753.2 cases and 158.0 deaths per million residents, respectively, in the USA with variable distributions throughout divisions, regions and states. Forty-two states and Washington, DC, (84.3%) had statewide stay-at-home orders, with the remaining states having population-adjusted characteristics in the highest risk quartile. Conclusions Effective national preparedness requires clearly understanding states' ability to predict, manage and balance public health needs through all stages of a pandemic. This will require leveraging data quickly, correctly and responsibly into sound public health policies. [ABSTRACT FROM AUTHOR]

Background: Creutzfeldt-Jakob disease (CJD) is a rare, fatal, neurodegenerative prion disease potentially transmissible through corneal transplantation. While statistical analyses performed two decades ago estimated the overall prevalence of CJD in the corneal donor pool to be low, the recent significant increase in corneal transplants performed and deaths due to CJD in the U.S. warrants a contemporary risk analysis. Methods: A literature review was conducted to determine the overall number of globally reported cases of CJD transmission through corneal transplantation. U.S. mortality and cornea donation data were utilized to estimate the age-stratified prevalence of undiagnosed, latent CJD in the cornea donor pool in 2018. A historical statistical analysis was performed to estimate the number of corneas from donors with latent CJD entering the U.S. donor pool for each year between 1979 and 2018. From these statistical analyses, risk factors of iatrogenic transmission were identified and summarized. Results: Ten reported cases of iatrogenic transmission of CJD through corneal transplants were identified globally. In 2018, an estimated 3.8 corneas from donors with undiagnosed latent CJD potentially entered the pool of 111,703 transplant-intended corneas harvested from individuals aged 31–80. Between 1979 and 2018, an estimated 47 corneas may have entered the U.S. transplant-intended pool from donors with latent CJD aged 35 to 84. The advanced age of donors and a history of multiple transplants in recipients were both prominent risk factors for iatrogenic transmission. Conclusions: The 10 reported global cases of iatrogenic transmission likely under-represent the number of individuals with a coinciding history of death by CJD and prior corneal transplantation, as supported by our statistical analysis and lack of geographical diversity of reported cases. As effective screening methods develop and globalization of cornea transplantation broadens, it is of utmost importance that cornea transplantation history among victims of CJD should be investigated and reported. [ABSTRACT FROM AUTHOR]

The recent emergence of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its resultant human disease, COVID-19, will likely have a significant impact on the corneal tissue donor pool. Current recommendations from the United States and global eye bank associations call for the outright avoidance of tissues from donors recently infected with or exposed to COVID-19. This conservative recommendation is currently appropriate given the reported ocular sequelae, tear film viral detectability, and transmissibility of COVID-19. However, the rapidly increasing global prevalence and mortality of COVID-19 threatens the tenability of current tissue exclusion guidelines, and may necessitate their relaxation in the near future. [ABSTRACT FROM AUTHOR]

The article discusses how to reduce readmissions for heart failure (HF) in the U.S. According to data, the HF mortality rate remains high despite advances in both medical and device therapies for treating it. The Valley Hospital in Ridgewood, New Jersey, has created a strategy to reduce 30-day all-cause readmissions among their patients with HF which includes the role of critical care nurses in the implementation of interventions and processes.

Keratoconus is a degenerative structural disease of the cornea. Progression leads to poor acuity that is not easily correctable by standard means. New treatments, such as collagen cross-linking, lead to better long-term outcomes if performed early in the disease course. Currently, children in the USA are screened for acuity in school, but not for keratoconus. Due to the severity of the disease in children, we recommend topographic screening in elementary schools as a way to provide early detection and treatment. Funding Research to Prevent Blindness provided funding for the Rapid Service Fees. [ABSTRACT FROM AUTHOR]

Context Medical software has become an increasingly critical component of health care, yet the regulatory landscape for digital health is inconsistent and controversial. To understand which policies might best protect patients, we examined the impact of the US Food and Drug Administration's (FDA's) regulatory safeguards on software-related technologies in recent years and the implications for newly passed legislative changes in regulatory policy. Methods Using FDA databases, we identified all medical devices that were recalled from 2011 through 2015 primarily because of software defects. We counted all software-related recalls for each FDA risk category and evaluated each high-risk and moderate-risk recall of electronic medical records to determine the manufacturer, device classification, submission type, number of units, and product details. Findings A total of 627 software devices (1.4 million units) were subject to recalls, with 12 of these devices (190,596 units) subject to the highest-risk recalls. Eleven of the devices recalled as high risk had entered the market through the FDA review process that does not require evidence of safety or effectiveness, and one device was completely exempt from regulatory review. The largest high-risk recall categories were anesthesiology and general hospital, with one each in cardiovascular and neurology. Five electronic medical record systems (9,347 units) were recalled for software defects classified as posing a moderate risk to patient safety. Conclusions Software problems in medical devices are not rare and have the potential to negatively influence medical care. Premarket regulation has not captured all the software issues that could harm patients, evidenced by the potentially large number of patients exposed to software products later subject to high-risk and moderate-risk recalls. Provisions of the 21st Century Cures Act that became law in late 2016 will reduce safeguards further. Absent stronger regulations and implementation to create robust risk assessment and adverse event reporting, physicians and their patients are likely to be at risk from medical errors caused by software-related problems in medical devices. [ABSTRACT FROM AUTHOR]

Purpose: Population health is of growing importance in the changing health care environment. The Cooperative Extension Service, housed in each state's land grant university, has a major impact on population health through its many community-based efforts, including the Supplemental Nutrition Assistance Program - Education (SNAP-Ed) nutrition programs, 4-H youth engagement, health and wellness education, and community development. Can the agricultural and health sectors, which usually operate in parallel, mostly unknown to each other, collaborate to address population health? We set out to provide an overview of the collaboration between the Cooperative Extension Service and the health sector in various states and describe a case study of 1 model as it developed in New Mexico.Methods: We conducted a literature review and personally contacted states in which the Cooperative Extension Service is collaborating on a "Health Extension" model with academic health centers or their health systems. We surveyed 6 states in which Health Extension models are being piloted as to their different approaches. For a case study of collaboration in New Mexico, we drew on interviews with the leadership of New Mexico State University's Cooperative Extension Service in the College of Agricultural, Consumer and Environmental Sciences; the University of New Mexico (UNM) Health Science Center's Office for Community Health; and the personal experiences of frontline Cooperative Extension agents and UNM Health Extension officers who collaborated on community projects.Results: A growing number of states are linking the agricultural Cooperative Extension Service with academic health centers and with the health care system. In New Mexico, the UNM academic health center has created "Health Extension Rural Offices" based on principles of the Cooperative Extension model. Today, these 2 systems are working collaboratively to address unmet population health needs in their communities. Nationally, the Cooperative Extension Service has formed a steering committee to guide its movement into the health arena.Conclusion: Resources of the agricultural and health sectors offer communities complementary expertise and resources to address adverse population health outcomes. The collaboration between Cooperative Extension and the health sector is 1 manifestation of this emerging collaboration model termed Health Extension. Initial skepticism and protection of funding sources and leadership roles can be overcome with shared funding from new sources, shared priority setting and decision making, and the initiation of practical, collaborative projects that build personal relationships and trust. [ABSTRACT FROM AUTHOR]

Research on tribal governance in the United States is scarce within modern public administration scholarship. Nonetheless, tribal governance is a pre-Columbian practice that predates the U.S. Constitution and federal law. Drawing from several disciplines, John C. Ronquillo of the University of Georgia demonstrates that interdisciplinary sources offer rich information for present-day public administration research about Native American tribes. Tribal governance literature is definitely not 'missing,' but instead is moderately 'unassembled' as a subfield of public administration. Building on what is available, the author suggests several key issues within tribal governance in need of urgent academic attention. [ABSTRACT FROM AUTHOR]

Discusses the development of effective family-centered interagency partnerships for service delivery to students with emotional and behavioral disabilities. Contributing factors to failure to develop partnerships; Statement on goal of partnership; Identification of individuals available for participation; Commitment.

Hyperopia is a common form of refractive error in the United States. Many refractive errors can be treated with refractive surgery methods such as laser in-situ keratomileusis and photorefractive keratectomy; however, in patients with large degrees of hyperopia (>=+5.0 diopters [D]), these surgical methods are limited because of higher rates of refractive regression. Lenticule Intrastromal Keratoplasty (LIKE) is a surgical procedure that can be used to correct refractive errors in patients with high hyperopia. The authors describe the first intrastromal implantation of an allograft lenticule performed for the primary correction of hyperopia in the United States, and demonstrate that LIKE is potentially an effective procedure for the correction of high hyperopia. Mechanisms for achieving the intended refractive correction and the complications our patient experienced, including epithelial ingrowth and flap necrosis, are discussed. [ABSTRACT FROM AUTHOR]