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Interdependence is a hallmark of romantic relationships, and first-person plural pronoun use (“we-talk”) can indicate interdependence between self and other. We-talk often positively, but sometimes negatively, relates to relationship and personal functioning. A meta-analysis of 30 studies supported a positive association overall between one’s own and partners’ we-talk and relationship and personal functioning, as well as each of five indicators (relationship outcomes, relationship behaviors, mental and physical health, and health behaviors) for individuals in romantic relationships. Partner use of we-talk was generally more strongly related to relationship functioning than own use. Females’ and spouses’ use of we-talk was related more to males’ and patients’ functioning, respectively. In general, our results revealed that we-talk was most strongly associated with relationship functioning and that partner effects tended to be stronger than actor effects. Both patterns of meta-analytic findings support the notion that we-talk reflects interdependence between romantic partners.

Referrals to other medical services are central to healthcare, including family planning service providers; however, little information exists on the nature of referral practices among health centers that offer family planning.We used a nationally representative survey of administrators from 1,615 publicly funded health centers that offered family planning in 2013-14 to describe the use of six referral practices. We focused on associations between various health center characteristics and frequent use of three active referral practices.In the prior 3 months, a majority of health centers (73%) frequently asked clients about referrals at clients' next visit. Under half (43%) reported frequently following up with referral sources to find out if their clients had been seen. A third (32%) of all health centers reported frequently using three active referral practices. In adjusted analysis, Planned Parenthood clinics (adjusted odds ratio 0.55) and hospital-based clinics (AOR 0.39) had lower odds of using the three active referral practices compared with health departments, and Title X funding status was not associated with the outcome. The outcome was positively associated with serving rural areas (AOR 1.39), having a larger client volume (AOR 3.16), being a part of an insurance network (AOR 1.42), and using electronic health records (AOR 1.62).Publicly funded family planning providers were heavily engaged in referrals. Specific referral practices varied widely and by type of care. More assessment of these and other aspects of referral systems and practices is needed to better characterize the quality of care.

Purpose Retinopathy of prematurity (ROP) may cause visual impairment in infants with very low birth weight. Lack of parent knowledge may contribute to gaps in screening and treatment. We studied parents' knowledge and education of ROP. Design Cross-sectional study. Methods Setting : Four high-acuity neonatal intensive care units in California (40-84 beds). Participants Total of 194 English- and Spanish-speaking parents of very low birth weight ( Main Outcome Measures We asked parents what they knew about ROP, how they were educated about ROP, and their experiences obtaining outpatient eye care. We used multivariate analysis to assess whether parent knowledge was associated with level of English proficiency and literacy, education modality (verbal, written, online, video), and hospital transfer status. Results Of the 194 participants, 131 (68%) completed surveys: 18% had both limited English proficiency and low literacy while overall 26% had limited English proficiency and 37% had low literacy; 17% did not know that ROP is an eye disease, and 38% did not know that very low birth weight and prematurity are both risk factors for ROP. Parents reported receiving verbal (62%) or written (56%) information; few used online resources (12%) or videos (3%). Half reported receiving information about infants' retinopathy status at discharge. No education modality was associated with higher knowledge. Limited English proficiency and low literacy were associated with lower knowledge (vs English-proficient, literate). Conclusions Parents of infants with very low birth weight, particularly those with limited English proficiency and low health literacy, lack knowledge about ROP.

Diabetes during pregnancy can adversely affect the health of women and infants. In this report, we provide an overview of the state of the science, and highlight Centers for Disease Control and Prevention (CDC) activities related to (1) surveillance of preexisting and gestational diabetes mellitus (GDM); (2) preconception care for women with preexisting diabetes; (3) postpartum diabetes screening among women with GDM-affected pregnancies; and (4) preventing the progression to Type 2 diabetes among women with GDM-affected pregnancies through lifestyle intervention programs. Improving preconception care, increasing postpartum diabetes screening rates, and promoting lifestyle interventions in the postpartum period all provide opportunities to improve the health of women and their infants.

INTRODUCTION: The ability to maintain functional independence in a rapidly aging population results in an increased life expectancy without corresponding increases in health care costs. The accelerated decline in VO(2peak) after the age of 65 is primarily due to peripheral tissue changes rather than centrally mediated factors. The purpose of this study was to determine if the PRIME (Peripheral Remodeling through Intermittent Muscular Exercise) approach, consisting of a low mass, high repetition/duration skeletal muscle focused training regimen would provide superior functional benefits in participants above 70 years old and at risk for losing functional independence. METHODS: In this clinical trial, 107 participants were randomized to four weeks of either standard aerobic exercise training (AT) or PRIME [Phase 1]. This was followed by eight weeks of a progressive whole-body aerobic and resistance training (AT+RT) for all participants [Phase 2]. The major outcome measures were cardiorespiratory fitness (peak oxygen consumption-VO(2peak)), muscular fitness (1 repetition maximal strength -1RM) and physical function (Senior Fitness Test scores-SFT). Results were analyzed under a pro-protocol criterion. RESULTS: Thirty-eight PRIME and 38 AT participants completed the 3-month protocols. VO(2peak), 1RM, and SFT scores all increased significantly after 12 weeks for both treatment groups (p

OBJECTIVES: In response to an expressed need for more focused measurement of preconception health, we identify a condensed set of preconception health indicators for state and national surveillance. METHODS: We used a systematic process to evaluate, prioritize, and select 10 preconception health indicators that maternal and child health programs can use for surveillance. For each indicator, we assessed prevalence, whether it was included in professional recommendations, Healthy People 2020 objectives, Centers for Disease Control and Prevention winnable battles, measurement simplicity, data completeness, and stakeholders’ input. RESULTS: A total of 50 preconception health indicators were evaluated and prioritized. The condensed set includes indicators that rely on data from the Pregnancy Risk Assessment Monitoring System (n=4) and the Behavioral Risk Factor Surveillance System (n=6). The content encompasses heavy alcohol consumption, depression, diabetes, folic acid intake, hypertension, normal weight, recommended physical activity, current smoking, unwanted pregnancy, and use of contraception. CONCLUSIONS: Having a condensed set of preconception health indicators can facilitate surveillance of reproductive-aged women’s health status that supports monitoring, comparisons, and benchmarking at the state and national levels.

In schizophrenia-spectrum populations, analyzing the words people use has offered promise for unlocking information about affective states and social behaviors. The electronically activated recorder (EAR) is an application-based program that is combined with widely used smartphone technology to capture a person's real-world interactions via audio recordings. It improves on the ecological validity of current methodologies by providing objective and naturalistic samples of behavior. This study is the first to implement the EAR in people endorsing elevated traits of schizophrenia-spectrum personality disorders (i.e., schizotypy), and we expected the EAR to (a) differentiate high and low schizotypy groups on affective disturbances and social engagement and (b) show that high schizotypy status moderates links between affect and social behavior using a multimethod approach. Lexical analysis of EAR recordings revealed greater negative affect and decreased social engagement in those high in schizotypy. When assessing specific traits, EAR and ecological momentary assessment (EMA) converged to show that positive schizotypy predicted negative affect. Finally, high schizotypy status moderated links between negative affect and social engagement when the EAR was combined with EMA. Adherence did not influence results, as both groups wore the EAR more than 90% of their waking hours. Findings supported using the EAR to assess real-world expressions of personality and functioning in schizotypy. Evidence also showed that the EAR can be used alongside EMA to provide a mixed-method, real-world assessment that is high in ecological validity and offers a window into the daily lives of those with elevated traits of schizophrenia-spectrum personality disorders. (PsycINFO Database Record

We present the case of a 77-year-old woman with adult-onset divergence insufficiency esotropia in which a bifid medial rectus muscle was identified intraoperatively. The patient had no past ocular, medical, syndromic, or traumatic history associated with this isolated horizontal rectus anomaly. Following identification of the bifid muscle, the original surgical plan was altered to asymmetric recession of the superior and inferior medical rectus heads.

Retinopathy of prematurity (ROP) screening, an integral part of pediatric ophthalmology, can be time consuming and resource intensive. The purpose of this study was to evaluate the economic landscape of ROP screening and treatment among pediatric ophthalmologists in the United States.An online survey was distributed to US pediatric ophthalmologists through a pediatric ophthalmology email listserv. Survey results were compiled, and responses were deidentified and analyzed, with particular focus on factors affecting financial compensation.A total of 97 responses were collected. Almost half of respondents worked in private practice settings. Over 80% of respondents had a formal contract to perform ROP care, but only 26% enlisted the assistance of an attorney to negotiate their contract. Just over half of respondents believed themselves adequately compensated for their services. Respondents that had retained an attorney for contractual negotiations were more likely to have a higher mean annual compensation rate ($126,545 ± $145,133 vs $70,214 ± $50,671; P = 0.05). Physicians who believed themselves adequately compensated were more likely to be in academic practice settings (78% academic vs 55% combo/other vs 24% private; P 0.001) and were more likely to have contracts to perform ROP care (68% with contracts vs 15% without; P = 0.001). Average annual compensation was $82,968 ± $84,132, approximately $24,000 higher than reported in 2013.More pediatric ophthalmologists among our respondents obtained contracts for their services, and compensation rates have increased since 2013. Nevertheless, concerns regarding under-compensation and time commitment persist, raising concerns about the long-term sustainability of current models for providing ROP services.

Introduction: This study evaluates the extent of patient care and revenue losses within Pediatric Ophthalmology (PO) practices as they rebound from the COVID-19 pandemic shutdown. Methods: Two surveys of active AAPOS members were performed in 2020 at the pandemic peak “lockdown” phase 1 and again in the early recovery phase comparing practice data to the prior year. The authors extrapolated from AAO/ AAPOS 2018 Academetrics to identify specific clinical and financial outcomes. Results: Median surgical volume in April was 26% of normal, improving to 66% by mid-July, consequently, 76,892 surgeries were not performed. As of July, clinic examinations decreased by 27%, accounting for 461 lost examinations perprovider or 484,065 examinations not performed. Medicaid patients were disproportionately affected with 242,033 clinic examinations not performed. Clinical revenue decreased 77% in April and 55% in July. University/hospital and private practice/employed POs whose salary was consistent with the prior year were 69% and 9% respectively in July. As of July, the average doctor lost $85,358 in salary revenue translating into cumulative loss of $233,606,100 for PO physicians. Assuming PO practices continue functioning at current levels, 73% of capacity, through next April, over 1,480,670 examinations and 113,360 surgeries will not have occurred over a 1-year period since the initial survey. Conclusion/Relevance: While there has been healthy economic rebound for many, this historic event continues to jeopardize access to care for patients and threaten the economic viability of many PO practices. Societal and financial costs of morbidity due to past and future missed/delayed examinations cannot be measured at this time.

Increasing global CO2 and local land use changes coupled with increased nutrient pollution are threatening estuaries worldwide. Local changes of estuarine chemistry have been documented, but regional associations and trends comparing multiple estuaries latitudinally have not been evaluated. Rapid climate change has impacted the annual and decadal chemical trends in estuaries, with local ecosystem processes enhancing or mitigating the responses. Here, we compare pH, dissolved oxygen, temperature, and salinity data from 10 Florida shellfish estuaries and hundreds of shellfish bed stations. Over 80,000 measurements, spanning from 1980 to 2008, taken on Atlantic Ocean and West Florida coast showed significant regional trends of consistent pH decreases in 8 out of the 10 estuaries, with an average rate of decrease on the Gulf of Mexico side estuaries of Florida of 7.3 × 10−4 pH units year−1, and average decrease on the Atlantic Coast estuaries of 5.0 × 10−4 pH units year−1. The rates are approximately 2–3.4 times slower than observed in pH decreases associated with ocean acidification in the Atlantic and Pacific. Other significant trends observed include decreasing dissolved oxygen in 9 out of the 10 estuaries, increasing salinity in 6 out of the 10, and temperature increases in 3 out of the 10 estuaries. The data provide a synoptic regional view of Florida estuary trends which reflect the complexity of changing climate and coastal ocean acidification superimposed on local conditions. These data provide context for understanding, and interpreting the past and predicting future of regional water quality health of shellfish and other organisms of commercial and ecological significance along Florida’s coasts.

Problem/condition Receipt of key preventive health services among women and men of reproductive age (i.e., 15-44 years) can help them achieve their desired number and spacing of healthy children and improve their overall health. The 2014 publication Providing Quality Family Planning Services: Recommendations of CDC and the U.S. Office of Population Affairs (QFP) establishes standards for providing a core set of preventive services to promote these goals. These services include contraceptive care for persons seeking to prevent or delay pregnancy, pregnancy testing and counseling, basic infertility services for those seeking to achieve pregnancy, sexually transmitted disease (STD) services, and other preconception care and related preventive health services. QFP describes how to provide these services and recommends using family planning and other primary care visits to screen for and offer the full range of these services. This report presents baseline estimates of the use of these preventive services before the publication of QFP that can be used to monitor progress toward improving the quality of preventive care received by women and men of reproductive age. Period covered 2011-2013. Description of the system Three surveillance systems were used to document receipt of preventive health services among women and men of reproductive age as recommended in QFP. The National Survey of Family Growth (NSFG) collects data on factors that influence reproductive health in the United States since 1973, with a focus on fertility, sexual activity, contraceptive use, reproductive health care, family formation, child care, and related topics. NSFG uses a stratified, multistage probability sample to produce nationally representative estimates for the U.S. household population of women and men aged 15-44 years. This report uses data from the 2011-2013 NSFG. The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing, state- and population-based surveillance system designed to monitor selected maternal behaviors and experiences that occur before, during, and shortly after pregnancy among women who deliver live-born infants in the United States. Annual PRAMS data sets are created and used to produce statewide estimates of preconception and perinatal health behaviors and experiences. This report uses PRAMS data for 2011-2012 from 11 states (Hawaii, Maine, Maryland, Michigan, Minnesota, Nebraska, New Jersey, Tennessee, Utah, Vermont, and West Virginia). The National Health Interview Survey (NHIS) is a nationally representative survey of noninstitutionalized civilians in the United States. NHIS collects data on a broad range of health topics, including the prevalence, distribution, and effects of illness and disability and the services rendered for or because of such conditions. Households are identified through a multistage probability household sampling design, and estimates are produced using weights that account for the sampling design, nonresponse, and poststratification adjustments. This report uses data from the 2013 NHIS for women aged 18-44 years. Results Many preventive health services recommended in QFP were not received by all women and men of reproductive age. For contraceptive services, including contraceptive counseling and advice, 46.5% of women aged 15-44 years at risk for unintended pregnancy received services in the past year, and 4.5% of men who had vaginal intercourse in the past year received services in that year. For sexually transmitted disease (STD) services, among all women aged 15-24 years who had oral, anal, or vaginal sex with an opposite sex partner in the past year, 37.5% were tested for chlamydia in that year. Among persons aged 15-44 years who were at risk because they were not in a mutually monogamous relationship during the past year, 45.3% of women were tested for chlamydia and 32.5% of men were tested for any STD in that year. For preconception care and related preventive health services, data from selected states indicated that 33.2% of women with a recent live birth (i.e., 2-9 months postpartum) talked with a health care professional about improving their health before their most recent pregnancy; of selected preconception counseling topics, the most frequently discussed was taking vitamins with folic acid before pregnancy (81.2%), followed by achieving a healthy weight before pregnancy (62.9%) and how drinking alcohol (60.3%) or smoking (58.2%) during pregnancy can affect a baby. Nationally, among women aged 18-44 years irrespective of pregnancy status, 80.9% had their blood pressure checked by a health care professional and 31.7% received an influenza vaccine in the past year; 54.5% of those with high blood pressure were tested for diabetes, 44.9% of those with obesity had a health care professional talk with them about their diet, and 55.2% of those who were current smokers had a health professional talk with them about their smoking in the past year. Among all women aged 21-44 years, 81.6% received a Papanicolaou (Pap) test in the past 3 years. Receipt of certain preventive services varied by age and race/ethnicity. Among women with a recent live birth, the percentage of those who talked with a health care professional about improving their health before their most recent pregnancy increased with age (range: 25.9% and 25.2% for women aged ≤19 and 20-24 years, respectively, to 35.9% and 37.8% for women aged 25-34 and ≥35 years, respectively). Among women with a recent live birth, the percentage of those who talked with a health care professional about improving their health before their most recent pregnancy was higher for non-Hispanic white (white) (35.2%) compared with non-Hispanic black (black) (30.0%) and Hispanic (26.0%) women. Conversely, across most STD screening services evaluated, testing was highest among black women and men and lowest among their white counterparts. Receipt of many preventive services recommended in QFP increased consistently across categories of family income and continuity of health insurance coverage. Prevalence of service receipt was highest among women in the highest family income category (>400% of federal poverty level [FPL]) and among women with insurance coverage for each of the following: contraceptive services among women at risk for unintended pregnancy; medical services beyond advice to help achieve pregnancy; vaccinations (hepatitis B and human papillomavirus [HPV], ever; tetanus, past 10 years; influenza, past year); discussions with a health care professional about improving health before pregnancy and taking vitamins with folic acid; blood pressure and diabetes screening; discussions with a health care professional in the past year about diet, among those with obesity; discussions with a health care professional in the past year about smoking, among current smokers; Pap tests within the past 3 years; and mammograms within the past 2 years. Interpretation Before 2014, many women and men of reproductive age were not receiving several of the preventive services recommended for them in QFP. Although differences existed by age and race/ethnicity, across the range of recommended services, receipt was consistently lower among women and men with lower family income and greater instability in health insurance coverage. Public health action Information in this report on baseline receipt during 2011-2013 of preventive services for women and men of reproductive age can be used to target improvements in the use of recommended services through the development ofresearch priorities, information for decision makers, and public health practice. Health care administrators and practitioners can use the information to identify subpopulations with the greatest need for preventive services and make informed decisions on resource allocation. Public health researchers can use the information to guide research on the determinants of service use and factors that might increase use of preventive services. Policymakers can use this information to evaluate the impact of policy changes and assess resource needs for effective programs, research, and surveillance on the use of preventive health services for women and men of reproductive age.

“Whiting” in oceanography is a term used to describe a sharply defined patch of water that contains high levels of suspended, fine-grained calcium carbonate (CaCO 3 ). Whitings have been reported in many oceanic and lake environments, and recently have been reported in southwest Florida coastal waters. Here, field and laboratory measurements were used to study optical, biological, and chemical properties of whiting waters off southwest Florida. No significant difference was found in chlorophyll a concentrations between whiting and outside waters (non-whiting water), but average particle backscattering coefficients in whiting waters were double those in outside waters, and remote sensing reflectance in whiting waters was higher at all wavelengths (400–700 nm). While other potential causes cannot be completely ruled out, particle composition and biochemical differences between sampled whiting water, contiguous water, and outside water indicate a biologically precipitated mode of whiting formation. Taxonomic examination of marine phytoplankton samples collected during a whiting event revealed a community dominated by autotrophic picoplankton and a small ( Thalassiosira sp. through the use of scanning electron microscopy. Amorphous to fully formed crystals of CaCO 3 were observed along the girdle bands of Thalassiosira sp. cells and autotrophic picoplankton cells. Although carbonate parameters differed from whiting and contiguous to outside water, more sampling is needed to determine if these results are statistically significant.

CONTEXT Federal and clinical guidelines recommend integrating reproductive life plan assessments into routine family planning encounters to increase provision of preconception care. Yet, the prevalence of clinical protocols and of relevant practices at publicly funded health centers is unknown. METHODS Administrators and providers at a nationally representative sample of publicly funded health centers that provide family planning services were surveyed in 2013–2014; data from 1,039 linked pairs were used to explore the reported prevalence of reproductive life plan protocols, frequent assessment of patients’ reproductive life plan and frequent provision of preconception care. Chi-square tests and multivariable general linear models were used to examine differences in reports of protocols and related practices. RESULTS Overall, 58% of centers reported having reproductive life plan assessment protocols, 87% reported frequently assessing reproductive life plans and 55% reported frequently providing preconception care. The proportions reporting protocols were lower in community health centers than in other center types (32% vs. 52–91%), in primary care centers than in those with another focus (33% vs. 77–80%) and in centers not receiving Title X funding than in those with such support (36% vs. 77%). Reported existence of a written protocol was positively associated with reported frequent assessment (prevalence ratio, 1.1), and the latter was positively associated with reported frequent preconception care (1.4). CONCLUSION Further research is needed on associations between written protocols and clinical practice, and to elucidate the preconception care services that may be associated with reproductive life plan assessment.

The capabilities offered to psychology researchers by new technology have catapulted the field toward a deeper understanding of people’s social experiences. However, it concurrently increases the n...

Florida has one of the highest concentrations of springs in the world, with many discharging into rivers and predominantly into eastern Gulf of Mexico coast, and they likely influence the hydrochemistry of these adjacent waters; however, temporal and spatial trends have not been well studied. We present over 20 yr of hydrochemical, seasonally sampled data to identify temporal and spatial trends of pH, alkalinity, partial pressure of carbon dioxide (pCO2), and CO2 flux from five first-order-magnitude (springs that discharge greater than 2.83 m3 s−1) coastal spring groups fed by the Floridan Aquifer System that ultimately discharge into the Gulf of Mexico. All spring groups had pCO2 levels (averages 3174.3–6773.2 μatm) that were much higher than atmospheric levels of CO2 and demonstrated statistically significant temporal decreases in pH and increases in CO2 flux, pCO2, and alkalinity. Total carbon flux emissions increased from each of the spring groups by between 3.48 × 107 and 2.856 × 108 kg C yr−1 over the time period. By 2013 the Springs Groups in total emitted more than 1.1739 × 109 kg C yr−1. Increases in alkalinity and pCO2 varied from 90.9 to 347.6 μmol kg−1 and 1262.3 to 2666.7 μatm, respectively. Coastal data show higher CO2 evasion than the open Gulf of Mexico, which suggests spring water influences nearshore waters. The results of this study have important implications for spring water quality, dissolution of the Florida carbonate platform, and identification of the effect and partitioning of carbon fluxes to and within coastal and marine ecosystems.

A 10-year-old girl presented with painless unilateral left upper lid ptosis. A nontender hard mass was palpated in the left upper lid. Blood smear was compatible with the diagnosis of leukemia. The cause of ptosis was now thought to be a mass composed of myeloid blast cells (myeloid sarcoma).

There is a growing necessity for healthcare professionals to collaborate across disciplines in order to adequately treat patients. Interprofessional education (IPE) is one strategy that can be used to strengthen student attitudes, skill mastery, and preparedness toward working in interprofessional teams prior to joining the healthcare workforce. The current study evaluated the effects of a four-session IPE training program for students from four New England universities across nine different health professions. Participants (N = 46) were placed into teams to create an assessment plan, evaluated their patient volunteer, developed a treatment plan, and presented treatment plan decisions to the group. Students reported attitudes, skills and readiness to work on interprofessional teams before and after the training; additionally, students completed a free-response posttest questionnaire. Paired samples t-tests, repeated measures ANCOVA, and thematic analysis were conducted to analyze the data. Results showed that following program completion, participants expressed more positive attitudes toward team collaboration and demonstrated higher skill mastery to function within healthcare teams. The presence of prior IPE experience did not positively or negatively influence changes in attitudes, skills, or readiness from pretest to posttest. Results suggest that this IPE program demonstrated preliminary feasibility and effectiveness by actively improving the attitudes and skills of healthcare students to engage in interprofessional teamwork.

Purpose: To report a case of septic thrombophlebitis producing bilateral abducens nerve palsy. Observation: A 65 year-old woman with recent sinus surgery experienced the onset of horizontal diplopia during treatment for bacteremia. Computer tomography of head and a neck ultrasonography showed right internal jugular vein occlusion. Ophthalmology examination was consistent with bilateral abducens nerve palsy. She was treated with systemic antibiotics and antiplatelet therapy with resolution of the internal jugular vein occlusion. The diplopia improved over a six-months. Conclusion and importance: Our patient had Lemierre syndrome with an unusual presentation. The patient was treated for septic thrombophlebitis with a resolution of her ocular symptoms. Keywords: Lemierre syndrome, Septic thrombophlebitis, Abducens nerve, Sixth cranial nerve

Supplemental Digital Content is available in the text., Background. Socioeconomic barriers can prevent successful kidney transplant (KT) but are difficult to measure efficiently in clinical settings. We created and validated an individual-level, single score Kidney Transplant Derailers Index (KTDI) and assessed its association with waitlisting and living donor KT (LDKT) rates. Methods. The dataset included 733 patients presenting for KT evaluation in a transplant center in California. Exploratory factor analysis was used to identify socioeconomic barriers to KT (derailers) to include in the index. Potential KT derailers included health insurance, employment, financial insecurity, educational attainment, perception of neighborhood safety, access to a vehicle, having a washer/dryer, and quality of social support. Validity was tested with associations between KTDI scores and the following: (1) the Area Deprivation Index (ADI) and (2) time to KT waitlisting and LDKT. Results. Nine derailers were retained, omitting only social support level from the original set. The KTDI was scored by summing the number of derailers endorsed (mean: 3.0; range: 0–9). Black patients had higher estimated KTDI scores than other patient groups (versus White patients, 3.8 versus 2.1; P < 0.001, effect size = 0.81). In addition, the KTDI was associated with the ADI (γ = 0.70, SE = 0.07; P < 0.001). Finally, in comparison to the lower tertile, patients in the upper and middle KTDI tertiles had lower hazard of waitlisting (upper tertile hazard ratio [HR]: 0.34, 95% confidence interval [CI]: 0.25-0.45; middle tertile HR: 0.54, 95% CI: 0.40-0.72) and receiving an LDKT (upper tertile HR: 0.15, 95% CI: 0.08-0.30; middle tertile HR: 0.35, 95% CI: 0.20-0.62). These associations remained significant when adjusting for the ADI and other patient characteristics. Conclusions. The KTDI is a valid indicator of socioeconomic barriers to KT for individual patients that can be used to identify patients at risk for not receiving a KT.

To evaluate if there is a nasal displacement of the vertical rectus muscles in heavy eye syndrome (HES) and/or sagging eye syndrome (SES) compared with age-matched controls. We reviewed the charts of all patients with the diagnosis of HES or SES who were seen at the University of California San Diego (UCSD) between the years 2008–2016 who underwent magnetic resonance imaging (MRI) of the brain and orbits. The control group included patients who had brain and orbital MRIs at UCSD in the absence of known pathology in the orbits or globes. Measurements were taken by 3 separate examiners for all groups. Twenty-four patients (16 with SES and 8 with HES) and 24 age-matched controls were retrospectively reviewed. The superior rectus (SR) of patients with HES and SES was more nasally displaced from the midline compared with that of age-matched controls (p = 0.04, p = 0.03, respectively). The inferior rectus (IR) of patients with HES but not with SES was more nasally displaced from the midline compared with that of age-matched controls (p = 0.04, p = 0.62, respectively). In all groups, the IR nasal displacement from the midline was approximately double compared with the SR. There is a significant nasal displacement of the SR in HES and SES and IR in HES. The observed IR nasal displacement in HES is a new finding and may explain the residual hypotropia and/or esotropia following surgical interventions for HES not involving the IR.

Objective Electronic health records (EHRs) are widely adopted, but the time demands of EHR use on ophthalmology trainees are not well understood. This study evaluated ophthalmology trainee time spent on clinical activities in an outpatient clinic undergoing EHR implementation. Design Prospective, manual time-motion observations of ophthalmology trainees in 2018. Participants Eleven ophthalmology residents and fellows observed during 156 patient encounters. Methods Prospective time-motion study of ophthalmology trainees 2 weeks before and 6 weeks after EHR implementation in an academic ophthalmology department. Manual time-motion observations were conducted for 11 ophthalmology trainees in 6 subspecialty clinics during 156 patient encounters. Time spent documenting, examining, and talking with patients were recorded. Factors influencing time requirements were evaluated using linear mixed effects models. Main Outcome Measures Total time spent by ophthalmology residents and fellows per patient, time spent on documentation, examination, and talking with patients. Results Seven ophthalmology residents and four ophthalmology fellows with mean (standard deviation) postgraduate year of 3.7 (1.2) were observed during 156 patient encounters. Using paper charts, mean total time spent on each patient was 11.6 (6.5) minutes, with 5.4 (3.5) minutes spent documenting (48%). After EHR implementation, mean total time spent on each patient was 11.8 (6.9) minutes, with 6.8 (4.7) minutes spent documenting (57%). Total time expenditure per patient did not significantly change after EHR implementation (+0.17 minutes, 95% confidence interval [CI] for difference in means: –2.78, 2.45; p = 0.90). Documentation time did not change significantly after EHR implementation in absolute terms (+1.42 minutes, 95% CI: –3.13, 0.29; p = 0.10), but was significantly greater as a proportion of total time (48% on paper to 57% on EHR; +9%, 95% CI: 2.17, 15.83; p = 0.011). Conclusion Total time spent per patient and absolute time spent on documentation was not significantly different whether ophthalmology trainees used paper charts or the recently implemented EHR. Percentage of total time spent on documentation increased significantly with early EHR use. Evaluating EHR impact on ophthalmology trainees may improve understanding of how trainees learn to use the EHR and may shed light on strategies to address trainee burnout.

Heavy eye syndrome is an important type of myopia-induced strabismus. We provide an overview of heavy eye syndrome, from its history to its most salient features. The theory of the orbital and rectus muscle pulley system as it relates to heavy eye syndrome and the prevailing theories on the pathophysiology of heavy eye syndrome in the current literature are discussed. We also highlight the presentation of heavy eye syndrome, its typical features on imaging, and differential diagnosis. Finally, we provide an overview on the management of heavy eye syndrome, including a description of several current surgical techniques.

Summary:. Because nearly all the vascularized composite allotransplants performed in the United States have been proposed and carried out as research, the ethical duty to report outcomes pertains. This duty is set forth in several international statements, including the World Health Organization’s Statement on Public Disclosure of Clinical Trial Results, the 2013 Helsinki Declaration, and the Singapore Statement on Research Integrity. These international statements call for the reporting of negative and inconclusive outcomes as well as positive outcomes, and for the reporting of results from previously unreported past research. In 2014, the Organ Procurement and Transplant Network vascularized composite allotransplant committee proposed mandatory data collection and submission requirements for transplants, but only for those which took place in September 2015 or later. Reporting of data for the allotransplants which took place before September 2015 was regarded as optional, even though the pre-September 2015 transplants represent the majority of vascularized composite allotransplants in the United States and all the long-term outcome data. We encourage the American Society of Reconstructive Transplantation and the Organ Procurement and Transplant Network committee to embrace the international ethical standards and to hold all vascularized composite allotransplant programs in the United States accountable for reporting data on outcomes of pre-September 2015 transplants.

Adult Children of Alcoholics (ACOAs) have shown poorer psychosocial outcomes compared to their counterparts (non-ACOAs). These poorer outcomes, however, are not consistently present between groups. Investigating psychological markers of such functioning can help to highlight nuances between ACOAs and non-ACOAs even when mean differences of psychosocial outcomes are not present. This is pertinent to the study of ACOAs to understand predictors of positive well-being trajectories.The aim of the present study was to compare the linguistic content of ACOAs and non-ACOAs in relation to psychological functioning.A quasi-experimental design was employed; ACOAs (n = 53) and non-ACOAs (n = 80) were asked to write a significant memory in which they went through a change of some kind (i.e., turning point) regarding a parent. Participants were then asked to complete measures of psychological functioning. Using a word counting software, we identified verbal immediacy, a combination of words signifying psychological closeness, within participants' memories.Results indicated no mean differences in the amount of verbal immediacy amid ACOAs and non-ACOAs, but there were differences in its predictive ability between groups. Among ACOAs, verbal immediacy predicted better psychological functioning. Yet, there was no association found among non-ACOAs. Conclusions/Importance: These results show that psychological closeness, among ACOAs, is indicative of better psychological functioning, even though it is typically associated with worse outcomes. This suggests that vulnerable individuals may have nontraditional correlates between psychological markers, like verbal immediacy, and such functioning and should be assessed when comparing these populations.

PURPOSE: To assess time requirements for patient encounters and estimate after-hours demands of paper-based clinical workflows in ophthalmology. DESIGN: Time-and-motion study with a structured survey METHODS: Setting: Single academic ophthalmology department. Participants and Observation Procedures: Convenience sample of seven attending ophthalmologists from six subspecialties observed during 414 patient encounters for the time-motion analysis and twelve attending ophthalmologists for the survey. Main Outcome Measures: Total time spent by attending ophthalmologists per patient, and time spent on documentation, examination, and talking with patients. The survey assessed time requirements of documentation-related activities performed outside of scheduled clinic hours. RESULTS: Among the 7 attending ophthalmologists observed (6 men and 1 woman, mean (SD) age, 43.9 (7.1) years) during encounters with 414 patients (mean (SD) age of 57.8 (24.6) years), the mean (SD) total time spent per patient was 8.1 (4.8) minutes, with 2.8 (1.4) minutes (38%) for documentation, 1.2 (0.9) minutes (17%) for examination, and 3.3 (3.1) minutes (37%) for talking with patients. New patient evaluations required significantly more time than routine follow-up visits and postoperative visits. Higher clinical volumes were associated with less time per patient. Survey results indicated that paper-based documentation was associated with minimal after-hours work on weeknights and weekends. CONCLUSIONS AND RELEVANCE: Paper-based documentation comprises a substantial portion of the total time spent for patient care in outpatient ophthalmology clinics but is associated with minimal after-hours work. Understanding paper-based clinical workflows may help inform targeted strategies for improving electronic health record use in ophthalmology.

Bipolar disorder affects 2-8% of pregnant and postpartum women; untreated illness is associated with poor outcomes. This study aimed to describe bipolar disorder screening rates in obstetric settings and associated characteristics.Women were recruited during pregnancy through three months postpartum from 14 obstetric clinics in Massachusetts. The Mood Disorder Questionnaire (MDQ) was used to screen for bipolar disorder; a subset previously diagnosed with bipolar was also examined. Differences in characteristics by screening outcome were tested using chi-square and t-tests.Of 574 participating women, 18.8% screened positive for bipolar disorder. Compared to those with negative, those with positive bipolar screens had 18.5-times the prevalence of positive substance use screens (11.1% vs. 0.6%, p 0.001) and 3.4-times reported feeling they were not receiving adequate psychiatric help (24.0 vs. 7.0%, p 0.001). Less than half of those with positive bipolar screens (42.0%) and 61.3% with pre-existing bipolar reported receiving current psychiatric care.Almost one in five perinatal women screened positive for bipolar disorder. Positive screenings were associated with comorbid substance use and low treatment rates. This study highlights the importance of screening for bipolar disorder during the perinatal period and the need for systematic approaches to ensure adequate assessment and follow-up.ClinicalTrials.gov identifier: NCT02760004.

Women with chronic diseases are at increased risk of having unintended pregnancies. Little is known whether chronic diseases are associated with increased likelihood of effective/highly effective contraceptive use.We analyzed 2008-2010 Florida Behavioral Risk Factor Surveillance System data for women aged 18-44 years who were at risk of unintended pregnancy. Multivariable Poisson regression estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for contraceptive use in relation to diabetes, cardiovascular disease (CVD), and current asthma. We assessed the association of chronic disease status with use of three different contraception outcomes: (1) any method versus none, (2) less effective methods (methods associated with ≥10 unintended pregnancies/100 women/year) versus none, and (3) effective/highly effective methods (10 unintended pregnancies/100 women/year) versus none.Among 4473 women at risk for unintended pregnancy, 87% were using any method of contraception (22.5% less effective methods and 64.5% effective/highly effective methods). Women with CVD were more likely than those without CVD to use any contraception (aPR = 1.09, 95% CI: 1.04, 1.15), less effective (aPR = 1.39, 95% CI: 1.13, 1.70), and effective/highly effective (aPR = 1.10, 95% CI: 1.03, 1.19) contraception. Women with diabetes were more likely to use less effective methods than women without diabetes (aPR = 1.34, 95% CI: 1.05, 1.72). No significant associations were observed for asthma, regardless of contraceptive effectiveness.Self-reported use of effective/highly effective contraception was higher than nonuse or use of less effective methods among all women at risk of unintended pregnancy, but could be improved, especially among women with chronic diseases.

Dyadic adjustment is integral for couples facing breast cancer; therefore, it is important to identify its everyday indicators. A total of 52 couples coping with breast cancer wore the Electronically Activated Recorder (EAR) for one weekend and completed the Dyadic Adjustment Scale to investigate how dyadic adjustment manifests in noncancer-related word use. Multilevel models revealed that partners', rather than one's own, positive emotion words positively related to dyadic adjustment. Conversely, spouses' negative emotion words and patients' anger words were negatively related to dyadic adjustment. Furthermore, focus on spouses rather than patients (spouses “I” and patients “you”) positively related to dyadic adjustment. Results revealed that dyadic adjustment can be reflected in couples' everyday word use, serving as an objective indicator of marital quality.

During three years of study (2010-2012), the western Arctic Ocean was found to have unique aragonite saturation profiles with up to three distinct aragonite undersaturation zones. This complexity is produced as inflow of Atlantic- and Pacific-derived water masses mix with Arctic-derived waters, which are further modified by physiochemical and biological processes. The shallowest aragonite undersaturation zone, from the surface to ∼ 30 m depth is characterized by relatively low alkalinity and other dissolved ions. Besides local influence of biological processes on aragonite undersaturation of shallow coastal waters, the nature of this zone is consistent with dilution by sea-ice melt and invasion of anthropogenic CO2 from the atmosphere. A second undersaturated zone at ∼ 90-220 m depth (salinity ∼31.8–35.4) occurs within the Arctic Halocline and is characterized by elevated pCO2 and nutrients. The nature of this horizon is consistent with remineralization of organic matter on shallow continental shelves bordering the Canada Basin and the input of the nutrients and CO2 entrained by currents from the Pacific Inlet. Finally, the deepest aragonite undersaturation zone is at greater than 2000 m depth and is controlled by similar processes as deep aragonite saturation horizons in the Atlantic and Pacific Oceans. The comparatively shallow depth of this deepest aragonite saturation horizon in the Arctic is maintained by relatively low temperatures, and stable chemical composition. Understanding the mechanisms controlling the distribution of these aragonite undersaturation zones, and the timescales over which they operate will be crucial to refine predictive models. This article is protected by copyright. All rights reserved.

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Surface pCO2 data from the West Florida Shelf (WFS) have been collected during 25 cruise surveys between 2003 and 2012. The data were scaled up using remote sensing measurements of surface water properties in order to provide a more nearly synoptic map of pCO2 spatial distributions and describe their temporal variations. This investigation involved extensive tests of various model forms through parsimony and Principal Component Analysis, which led to the development of a multi-variable empirical surface pCO2 model based on concurrent MODIS (Moderate Resolution Imaging Spectroradiometer) estimates of surface chlorophyll a concentrations (CHL, mg m−3), diffuse light attenuation at 490 nm (Kd_Lee, m−1), and sea surface temperature (SST, °C). Validation using an independent dataset showed a pCO2 Root Mean Square Error (RMSE) of

Background Pulled-in-two syndrome (PITS) is a serious complication of strabismus surgery that occurs when an extraocular muscle ruptures under tension. The purpose of this study was to establish a database of PITS patients to identify risk factors and management of PITS. Methods Strabismus surgeons from around the world contributed cases of PITS through an online survey. Risk factors, management, and outcomes were identified. Results A total of 40 cases of PITS from 29 physicians in 6 countries were collected. The most commonly involved muscles were the medial rectus (18/40 [45%]) and the inferior rectus (17/40 [43%]). The most commonly identified risk factors were previous ocular surgery (11/40 [28%]) and cranial nerve palsy (11/40 [28%]). Advanced age was also a significant risk factor, with 28/40 (70%) of reported patients being ≥50 years of age. In most cases the muscle was found and reattached to the globe (28/40 [70%]). The muscle was lost in 12 cases (30%). Half of these patients received a transposition surgery; the other half were followed by observation. Conclusions Our data suggests that strabismus surgeons might encounter one case of PITS approximately every 10 years. Major risk factors for PITS appear to be changes in the extraocular muscle due to cranial nerve palsy, prior surgery, and advancing age. The preferred management for PITS is surgical recovery and reattachment of the muscle; however, if the muscle is lost, transposition surgery or observation are common forms of management.

The purpose of this article is to provide an update for the GP on selected common vulvar concerns in prepubertal girls. Presentation, diagnostic criteria, and management of common vulvar conditions will be described. The following conditions are frequently encountered and may pose diagnostic or management challenges if unrecognized.The article is a review of current literature on pediatric vulvar conditions and was conducted through searching PubMed and published books on this topic. Areas of interest frequently encountered by providers are presented, including vulvovaginitis, genital ulcers, lichen sclerosus, and labial adhesions along with the most recent North American Society for Pediatric and Adolescent Gynecology recommendations for diagnosis and management.Vulvar complaints in prepubertal girls are common. Many present with nonspecific symptoms and consequently, the diagnosis may be missed or delayed. Prompt recognition improves long-term outcomes and importantly, provides a positive introduction to longitudinal women's health for young girls.

Objective To highlight the opportunities and challenges of developing and implementing performance outcome measures in rheumatology for accountability purposes. Methods We constructed a hypothetical performance outcome measure to demonstrate the benefits and challenges of designing quality measures that assess patient outcomes. We defined the data source, measure cohort, reporting period, period at risk, measure outcome, outcome attribution, risk adjustment, reliability and validity, and reporting approach. We discussed outcome measure challenges specific to rheumatology and to fields where patients have predominantly chronic, complex, ambulatory care–sensitive conditions. Results Our hypothetical outcome measure was a measure of rheumatoid arthritis disease activity intended for evaluating Accountable Care Organization performance. We summarized the components, benefits, challenges, and tradeoffs between feasibility and usability. We highlighted how different measure applications, such as for rapid cycle quality improvement efforts versus pay for performance programs, require different approaches to measure development and testing. We provided a summary table of key take-home points for clinicians and policymakers. Conclusion Performance outcome measures are coming to rheumatology, and the most effective and meaningful measures can only be created through the close collaboration of patients, providers, measure developers, and policymakers. This study provides an overview of key issues and is intended to stimulate a productive dialogue between patients, practitioners, insurers, and government agencies regarding optimal performance outcome measure development.

Tuberous sclerosis or tuberous sclerosis complex (TSC), one of the phakomatoses, is characterized by hamartomas of the heart, kidney, brain, skin and eyes. Ophthalmologic examinations are required in all cases of TSC. Retinal hamartomas are the most common ocular finding in tuberous sclerosis. The majority of hamartomas are non-progressive; however, lesions with subretinal fluid and progression have been reported. This paper details the genetics, clinical features and ocular findings of TSC and reviews potential therapeutic options for ophthalmic manifestations.

The Surface Ocean CO2 Atlas (SOCAT) is a synthesis of quality-controlled fCO2 (fugacity of carbon dioxide) values for the global surface oceans and coastal seas with regular updates. Version 3 of SOCAT has 14.7 million fCO2 values from 3646 data sets covering the years 1957 to 2014. This latest version has an additional 4.6 million fCO2 values relative to version 2 and extends the record from 2011 to 2014. Version 3 also significantly increases the data availability for 2005 to 2013. SOCAT has an average of approximately 1.2 million surface water fCO2 values per year for the years 2006 to 2012. Quality and documentation of the data has improved. A new feature is the data set quality control (QC) flag of E for data from alternative sensors and platforms. The accuracy of surface water fCO2 has been defined for all data set QC flags. Automated range checking has been carried out for all data sets during their upload into SOCAT. The upgrade of the interactive Data Set Viewer (previously known as the Cruise Data Viewer) allows better interrogation of the SOCAT data collection and rapid creation of high-quality figures for scientific presentations. Automated data upload has been launched for version 4 and will enable more frequent SOCAT releases in the future. High-profile scientific applications of SOCAT include quantification of the ocean sink for atmospheric carbon dioxide and its long-term variation, detection of ocean acidification, as well as evaluation of coupled-climate and ocean-only biogeochemical models. Users of SOCAT data products are urged to acknowledge the contribution of data providers, as stated in the SOCAT Fair Data Use Statement. This ESSD (Earth System Science Data) "living data" publication documents the methods and data sets used for the assembly of this new version of the SOCAT data collection and compares these with those used for earlier versions of the data collection (Pfeil et al., 2013; Sabine et al., 2013; Bakker et al., 2014). Individual data set files, included in the synthesis product, can be downloaded here: doi:10.1594/PANGAEA.849770. The gridded products are available here: doi:10.3334/CDIAC/OTG.SOCAT_V3_GRID.

This article describes the Leadership Education in Adolescent Health (LEAH) interdisciplinary training program in the United States. The Maternal and Child Health Bureau authorized by legislation provides monies to train leaders in adolescent health through a competitive grant process. Currently, seven academic medical centers have funding to provide leadership in adolescent health (LEAH) training in five core disciplines: medicine, nursing, psychology, social work and nutrition. LEAH training programs both ensure high clinical competence in core disciplines serving adolescents and prepare trainees for leadership positions in adolescent health and public health care realms. Together, these programs trained almost 1000 long-term trainees across these five disciplines, and graduates from these programs are working in 45 of the 50 states within the United States. About 90% of these graduates are working with maternal and child/adolescent health populations, and almost all have held leadership positions in the areas of public health, advocacy, public policy, academic medical centers and/or clinical care settings.

An infant presented with bilateral disk edema and an acute left sixth cranial nerve (CN VI) palsy because of pseudotumor cerebri (PTC). PTC is rare in infants where it is often associated with endocrine abnormalities, medications, viral infections, systemic conditions, and nutritional etiologies such as vitamin A toxicity. We report a case of PTC in an infant associated with hypervitaminosis A with an unlikely source-a common prenatal vitamin.

Background Noncommunicable disease (NCD) risk factors increase the risk of adverse reproductive health outcomes and are becoming increasingly common in Brazil. Methods We analyzed VIGITEL 2011 telephone survey data for 13,745 Brazilian women aged 18–44 years in a probabilistic sample from 26 Brazilian state capitals and the Federal District. We examined associations between NCD risk factors (fruit and vegetable intake, leisure time physical activity, alcohol consumption, smoking status, BMI and hypertension status) and race, education, and insurance using chi-square tests and multivariable logistic regression models, estimating the average marginal effects to produce adjusted relative risk ratios (aRRs). Analyses were conducted using SAS 9.3 survey procedures and weighted to reflect population estimates. Results Women with less than a college education were more likely to report physical inactivity (adjusted relative risk (aRR) and 95% confidence interval = 1.1 (1.1–1.2)), smoking (aRR = 1.7 (1.3–2.2)), and self-reported diagnoses of hypertension (aRR = 2.0 (1.6–2.5)) compared to women with a college education or greater. Similarly, women without health insurance were more likely to report physical inactivity (aRR = 1.1 (1.1–1.2)), smoking (aRR = 1.4 (1.1–1.8)), and self-reported diagnoses of hypertension aRR = 1.4 (1.1–1.7)) compared to women with health insurance. Less variation was found by race and NCD risk factors. Conclusion Targeted public health strategies and policies are needed to increase healthcare access and decrease educational and racial disparities in NCD risk factors among women of reproductive age in Brazil., Highlights • Examine prevalence of NCD risk factors with race, education, and insurance status • We analyzed data from a probabilistic sample of 13,745 non-pregnant Brazilian women. • Less educated women reported more physical inactivity, smoking, and hypertension. • Uninsured women reported more physical inactivity, smoking and hypertension. • Less variation was found by race and noncommunicable disease risk factors.

Large benthic foraminifera (LBF) are prolific producers of calcium carbonate sediments in shallow, tropical environments that are being influenced by ocean acidification (OA). Two LBF species, Amphistegina gibbosa (Order Rotaliida) with low-Mg calcite tests and Archaias angulatus (Order Miliolida) with high-Mg calcite tests, were studied to assess the effects of pH 7.6 on oxygen and carbon isotopic fractionation between test calcite and ambient seawater. The δ18O and δ13C values of terminal chambers and of whole adult tests of both species after 6 weeks were not significantly different between pH treatments of 8.0 and 7.6. However, tests of juveniles produced during the 6-week treatments showed significant differences between δ18O and δ13C values from control (pH 8.0) when compared with the treatment (pH 7.6) for both species. Although each individual's growth was photographed and measured, difficulty in distinguishing and manually extracting newly precipitated calcite from adult specimens likely confounded any differences in isotopic signals. However, juvenile specimens that resulted from asexual reproduction that occurred during the experiments did not contain old carbonate that could confound the new isotopic signals. These data reveal a potential bias in the design of OA experiments if only adults are used to investigate changes in test chemistries. Furthermore, the results reaffirm that different calcification mechanisms in these two foraminiferal orders control the fractionation of stable isotopes in the tests and will reflect decreasing pH in seawater somewhat differently.

US pediatric transplant candidates have limited access to lung transplant due to the small number of donors within current geographic boundaries, leading to assertions that the current lung allocation system does not adequately serve pediatric patients. We hypothesized that broader geographic sharing of pediatric (adolescent, 12-17 years; child

Two unusual cases of intravascular fasciitis arising in a 25-year-old female and a 26-year-old male are presented here. The lesions apparently presented as firm, raised, submucosal nodules on the tongue. Intravascular fasciitis (IVF) shares the microscopic features of nodular fasciitis (NF), but with intraluminal, intramural, and extramural involvement of small- to medium-sized veins and arteries with a multinodular or serpentine growth pattern along the course of affected blood vessels. NF is a benign lesion occurring on the trunk and upper extremities with a strong predilection for young adults 20 to 40 years of age. Intraoral NF is uncommon, and intraoral IVF is extremely rare, with only sporadic reports in the literature. In both of our cases, the patient's main concern was rapid growth of the lesion, which was nontender, on the tongue. The clinical, histologic, and immunohistochemical features and treatment are presented, along with a review of the literature.