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Significance: This case highlights ocular adverse effects of a rare, potentially life-threatening complication from coronavirus disease 2019 (COVID-19). Papilledema can occur because of increased intracranial pressure caused by cerebral venous sinus thrombosis, the incidence of which may be more likely in patients with a history of COVID-19 because of an induced hypercoagulable state., Purpose: This case report presents a case of papilledema secondary to cerebral venous sinus thrombosis in a patient with a recent history of severe coronavirus disease (COVID-19)., Case Report: A 29-year-old man hospitalized with a complicated course of coronavirus disease (COVID-19) was referred to the ophthalmology department for episodic blurry vision of both eyes and intermittent binocular diplopia. Clinical examination revealed diffuse bilateral optic disc edema. Magnetic resonance venography of the brain during his admission revealed subtotal occlusion of the right transverse sinus by thrombosis. At the time of diagnosis, the patient was already taking systemic anticoagulation therapy for treatment of a recent pulmonary embolism also thought to be induced by COVID-19. After additional treatment with acetazolamide, there was improvement in his optic nerve edema., Conclusions: Cerebral venous sinus thrombosis, a serious and potentially life-threatening condition, can occur as a rare complication of COVID-19. In such cases, patients may develop increased intracranial pressure, papilledema, and subsequent vision loss. Magnetic resonance venography should be ordered in patients with suspected papilledema to help rule out the presence of cerebral venous sinus thrombosis., Competing Interests: Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest., (Copyright © 2023 American Academy of Optometry.)

Concussion imposes a substantial global health burden, and few evidence-based treatments that approach concussion treatment holistically are available. Moreover, early intervention is important before concussion symptoms become chronic and more refractory to treatment. In this pilot study, we evaluated the tolerability of a protocol called Mindfulness and Yoga for Treatment After Concussion (MYTAC), which was specifically designed for individuals with concussion. We also explored the possible benefit of the MYTAC protocol for concussion recovery. Participants were 15-60 years old with recent concussion and had presented to selected practices within a university health system. Participants used the video-based MYTAC protocol for 5 consecutive days and reported concussion symptoms on an abbreviated version of the Sports Concussion Assessment Tool version 3 (SCAT3). We compared the abbreviated SCAT3 scores across the intervention period, including immediately before and after each yoga session, using standard statistical methods for paired data. Of 25 participants enrolled in the study, 15 completed the MYTAC protocol and 1 completed 2 days of the protocol before withdrawing due to worsening symptoms; the remaining 9 participants did not complete the protocol. On average, total abbreviated SCAT3 scores decreased by 9.9 ± 7.6 points, or approximately 50%, over the intervention period (from an initial value of 18.8 ± 6.7 points prior to the yoga protocol). Although this pilot study had significant methodological limitations, we concluded that the MYTAC protocol had fair tolerability and possibly a beneficial effect on concussion recovery. However, future interventions should evaluate this protocol in larger, more rigorously designed studies.

Objectives: Silk-Hyaluronic Acid (Silk-HA) is a novel vocal fold augmentation material that has been used in humans since July 2020. There is a paucity of published data on Silk-HA and its longevity remains a question. This study aimed to evaluate a single surgeon's initial experience performing Silk-HA injection laryngoplasty for the treatment of glottic insufficiency., Methods: Retrospective chart review of Silk-HA injections between July 2020 and December 2021. Subject demographics, diagnoses, volume of material injected, VHI-10 data, and complications were collected. A blinded perceptual voice analysis of voice samples was performed by two voice-specialized speech-language pathologists (SLP) for a subset of unilateral vocal fold paralysis patients before and 3-months following silk-HA injection. Univariate assessment of the change in VHI-10 and perceptual voice analyses at 3-month follow up was determined., Results: 58 patients (43.1% female) underwent Silk-HA injection with a mean age of 64 (range 21-88). 38 subjects had unilateral paralysis (65.6%), and the remaining had scar, atrophy, paresis or a combination thereof. 49 injections were unilateral (84.5%). Mean volume of silk injected was 0.26 mL. Complications were rare, most notable though for 2 admissions for dyspnea and laryngoscopic evidence of hemi-laryngeal edema (3.4%). Mean change in CAPE-V overall severity rating was -32.9 (P<0.0001), and VHI-10 was -14.6 ± 10 (P=0.0013). 14 patients underwent a repeat silk-HA injection for ongoing glottic insufficiency (loss of augmentation vs under-augmentation)., Conclusions: Preliminary results for Silk-HA show potential for ongoing improvement of glottic insufficiency at 3 months from date of augmentation. Clinician and patient perception of voice outcomes showed overall improvement at three months, though longevity remains to be determined. While overall well tolerated and without serious complications in 96% of the cohort, patients should be counseled on the potential for airway edema and symptomatic dyspnea requiring steroid management and observation., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: As large single-surgeon series in the literature are lacking, we sought to review a single-surgeon's experience with parotidectomy in an academic center, with a focused analysis of pathology, technique, and facial nerve (FN) weakness. Benchmark values for complications and operative times with routine trainee involvement and without continuous FN monitoring are offered., Materials and Methods: All patients who underwent parotidectomy, performed by D. G. D., for benign and malignant disease between January 2004 and December 2018 at an academic center were reviewed., Results: A total of 924 parotidectomies, with adequate evaluatable data were identified. The majority of patients had benign tumors (70.9%). Partial/superficial parotidectomy was the most common approach (65.7%). Selective FN branch sacrifice was rare (12.3%), but significantly more common among patients with malignant pathology (33.8% vs 3.5% for benign, P  < .0001). Among patients with intact FN, post-operative short- and long-term FN weaknesses were rare (6.5% and 1.7%, respectively). These rates were lower among patients with benign tumors (5.4% and 1.3%). Partial/superficial parotidectomy for benign tumors was associated with a low rate of short- and long-term FN weaknesses (2.7% and 0.9%). Mean OR time was 185 minutes., Conclusion: This is the largest single-surgeon series on parotidectomy, spanning 15 years. We demonstrate excellent long- and short-term FN paresis rates with acceptable operative times without regular use of continuous FN monitoring and with routine trainee involvement. These findings may provide valuable insight into parotid tumor pathology, FN outcomes, and feasibility and expectations of performing parotidectomy in an academic setting., Level of Evidence: 4., Competing Interests: The authors declare no conflicts of interest., (© 2020 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)

Background: With three out of four new bladder cancer (BCa) cases occurring in men, an apparent gender disparity exists. We aimed to investigate the role of hormonal and reproductive factors in BCa risk using two large female US prospective cohorts., Methods: Our study population comprised 118 256 and 115 383 female registered nurses who were recruited in the Nurses' Health Study (NHS) and NHS II, respectively. Reproductive and hormonal factors and other relevant data were recorded in biennial self-administered questionnaires. Cox-regression analyses were performed to estimate age- and multivariable-adjusted incidence risk ratios (IRRs) and 95% confidence intervals (CIs). Inverse-variance-weighted meta-analysis was used to pool estimates across cohorts., Results: During up to 36 years of follow-up, 629 incident BCa cases were confirmed. In the NHS, 22 566 women (21.3%) were postmenopausal at baseline, compared with 2723 women (2.4%) in the NHS II. Among women in the NHS, younger age at menopause (≤45 years) was associated with an increased risk of BCa (IRR: 1.41, 95% CI: 1.11-1.81, Ptrend = 0.01) compared with those with menopause onset at age 50+ years, particularly among ever-smokers (IRR for age at menopause ≤45 years: 1.53, 95% CI: 1.15-2.04; PIntx = 0.16). Age at menarche and first birth, parity, oral-contraceptive use and postmenopausal hormone use were not associated with BCa risk., Conclusions: Overall, we found little support for an association between female reproductive factors and BCa risk in these prospective cohort studies. Earlier age at menopause was associated with a higher risk of BCa, particularly among smokers, indicating the potential for residual confounding., (© The Author(s) 2020; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.)

Objectives: Night shift work has been suggested as a possible risk factor for multiple sclerosis (MS). The objective of the present analysis was to prospectively evaluate the association of rotating night shift work history and MS risk in two female cohorts, the Nurses' Health Study (NHS) and NHSII., Methods: A total of 83 992 (NHS) and 114 427 (NHSII) women were included in this analysis. We documented 579 (109 in NHS and 470 in NHSII) incident physician-confirmed MS cases (moderate and definite diagnosis), including 407 definite MS cases. The history (cumulative years) of rotating night shifts (≥3 nights/month) was assessed at baseline and updated throughout follow-up. Cox proportional hazards models were used to estimate HRs and 95% CIs for the association between rotating night shift work and MS risk adjusting for potential confounders., Results: We observed no association between history of rotating night shift work and MS risk in NHS (1-9 years: HR 1.03, 95% CI 0.69 to 1.54; 10+ years: 1.15, 0.62 to 2.15) and NHSII (1-9 years: HR 0.90, 95% CI 0.74 to 1.09; 10+ years: 1.03, 0.72 to 1.49). In NHSII, rotating night shift work history of 20+ years was significantly associated with MS risk, when restricting to definite MS cases (1-9 years: HR 0.88, 95% CI 0.70 to 1.11; 10-19 years: 0.98, 0.62 to 1.55; 20+ years: 2.62, 1.06 to 6.46)., Conclusions: Overall, we found no association between rotating night shift work history and MS risk in these two large cohorts of nurses. In NHSII, shift work history of 20 or more years was associated with an increased risk of definite MS diagnosis., Competing Interests: Competing interests: ED has received consulting fees from Epi Excellence and Bohn Epidemiology. AA receives research support from the US Department of Defense (Army) (W81XWH-05-1-0117 (PI)) and the NIH (R01 NS045893 (PI), R01 NS047467 (PI), R01 NS48517 (PI), NINDS R01 NS042194 (PI) and R01 NS046635 (PI))., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Inflammatory reaction has been linked to bladder cancer. Diet, which drives systemic inflammation, may be considered a modifiable risk factor for bladder cancer. We examined the association of diet with pro-inflammatory potential and bladder cancer risk using the novel EDIP (empirical dietary inflammatory pattern) score comprising predefined food groups determining a pattern most predictive of plasma inflammatory markers., Materials and Methods: We followed a total of 172,802 women in the NHS (Nurses' Health Study) from 1984 to 2012 and the NHS II from 1991 to 2013 as well as 45,272 men in the HPFS (Health Professionals Follow-Up Study) from 1986 to 2012. Multivariable adjusted Cox regression models were used to estimate the RR and 95% CI of bladder cancer across EDIP score quintiles. We performed inverse variance weighted meta-analysis to pool estimates across cohorts stratified by smoking status., Results: During 4,872,188 person-years of observation 1,042 incident bladder cancer cases were identified. Overall, high EDIP scores reflecting dietary patterns with pro-inflammatory potential were not associated with a higher risk of bladder cancer (quintile 5 vs 1 pooled multivariable adjusted RR 0.92, 95% CI 0.75-1.12, p trend = 0.67). Results were consistent across individual cohorts (quintile 5 vs 1 in the NHS RR 1.04, 95% CI 0.78-1.37, p trend = 0.71; in the NHS II RR 1.44, 95% CI 0.53-3.91, p trend = 0.13; and in the HPFS RR 0.74, 95% CI 0.55-1.01, p trend = 0.11). Results were similar regardless of smoking status., Conclusions: We observed no association between diets with pro-inflammatory potential and bladder cancer risk. Although additional studies are needed to explore other nutritional pathways with the potential for bladder cancer prevention, our results suggest that diets associated with inflammation are not associated with bladder cancer risk.

In this study, we examined the relations between drag queens' gendered performance styles and body change attitudes and behaviors. We also examined potential mediating and moderating variables in these links via two moderated mediation models. Participants consisted of 192 drag queen performers who completed a web-based survey. Hyper-feminine but not gender fluid drag was positively related to disordered eating, acceptance of cosmetic surgery, internalization of cultural standards of beauty, and upward appearance comparison. Both internalization of cultural standards of beauty and upward appearance comparison mediated the hyper-feminine drag and disordered eating link. Beauty internalization also mediated the hyper-feminine drag and acceptance of cosmetic surgery link but upward appearance comparison did not. We discovered two significant conditional indirect effects, in which the indirect effect of the hyper-feminine drag on both disordered eating and acceptance of cosmetic surgery via internalization of cultural standards of beauty were stronger for those with high levels of drag identity salience. Finally, we found a conditional direct effect, where hyper-feminine drag predicted acceptance of cosmetic surgery among drag queens with high and average levels of drag identity salience but not low levels., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Recent studies suggest an intergenerational influence of stress such that maternal exposure even before pregnancy could impact offspring health outcomes later in life. In humans, investigations on the impact of maternal stressors on offspring health outcomes, including stress-sensitive biomarkers, have largely been limited to extreme stressors. Prior studies have not addressed more moderate maternal stressors, such as rotating night shift work, on offspring stress markers in young adulthood., Methods: We investigated the association between maternal rotating night shift work before conception and offspring salivary cortisol and alpha amylase (sAA) patterns in young adulthood among mothers enrolled in the Nurses' Health Study II (NHSII) and their offspring participating in the Growing Up Today Study 2 (GUTS2). Our sample included over 300 mother-child pairs where, between 2011 and 2014, the children provided 5 saliva samples over the course of one day. We used piecewise linear mixed models to compare awakening responses, overall slopes as well as several other diurnal patterns of cortisol and sAA between offspring born to shift working versus non-shift working mothers., Results: Offspring born to shift working mothers had a flattened late decline in cortisol (percent differences in slope (%D): 2.1%; 95%CI: 0.3, 3.8) and their sAA awakening response was steeper (%D -37.4%; 95%CI: -59.0, -4.4), whereas sAA increase before bedtime appeared less pronounced (%D -35.9%; 95%CI: -55.3, -8.3), compared to offspring born to mothers without shift work. For cortisol, we observed a significant difference in the Area Under the Curve (AUC) (%D 1.5%; 95%CI: 0.3, 2.7) with higher AUC for offspring of mothers who worked rotating night shifts. In offspring-sex-stratified analyses we found differences primarily among males., Conclusion: Our results provide some - albeit modest - evidence that maternal rotating night shift work-a moderate stressor-influences offspring stress markers. Future studies with larger samples sizes, more detailed exposure assessment (particularly during maternal pregnancy), and multiple offspring biomarker assessments at different developmental stages are needed to further investigate these associations., (Copyright © 2019 Elsevier Inc. All rights reserved.)

: Purpose: This study sought to evaluate midlife hypertension and hypercholesterolemia in relation to cognitive function later in life among black women., Methods: Participants were drawn from the Nurses' Health Study and the Women's Health Study databases. In these studies, health professionals reported health information by questionnaire at baseline and at regular follow-up intervals, including diagnoses of hypertension, hypercholesterolemia, or both; and they completed telephone-based cognitive assessments later in life. Multivariable-adjusted linear regression models were used to estimate mean differences in global cognition and executive function scores, comparing women with and without a history of hypertension at midlife and women with and without a history of hypercholesterolemia at midlife., Results: Data for 363 black female health professionals were analyzed. Those with a history of hypertension or hypercholesterolemia at midlife did not have lower global cognition and executive function scores later in life compared with those without such a history, although there were trends in this direction., Conclusion: In the study sample, a history of hypertension or hypercholesterolemia at midlife was not related to worse cognitive function in later life. But there was a suggestive pattern of trends that warrants further exploration in larger studies.

Objective: To estimate how symptom severity, extent of bother, and quality of life differ across urinary incontinence (UI) subtypes., Methods: We evaluated prevalent UI cases from the Nurses' Health Studies, including women aged 41-83 years. Women with UI (leaking more than once per month) were subclassified according to reported symptoms such as stress UI (SUI, leakage with activity), urge UI (UUI, leakage with urgency), or mixed UI (SUI and UI co-occurring equally). The UI severity was assessed in 102,418 women based on the Sandvik severity index. In a subset of older women with weekly UI, we asked about bother (n=1,697) and quality of life (Incontinence Impact Questionnaire; n=1,748). The UI severity, bother, and quality of life were compared across subtypes using polytomous logistic regression, adjusting for other characteristics., Results: The distributions of UI subtypes were 51% SUI, 27% UUI, and 22% mixed UI. Approximately half had slight UI, 26% had moderate UI, and 23% had severe UI. Severe UI was more common in women reporting mixed UI (37%) than UUI (27%) or SUI symptoms (15%) (P<.001). More women with severe mixed (21%; P=.02) and UUI symptoms (13%; P=.1) reported being "greatly" bothered by their UI compared with SUI (10%). Women with severe mixed (mean 18.0; P<.001) and UUI symptoms (mean 13.4; P=.004) had higher mean incontinence effect scores compared with SUI (mean 9.8)., Conclusion: Women reporting mixed UI symptoms describe more severe and bothersome incontinence, with higher effect on quality of life., Level of Evidence: II.

In this large-scale prospective epidemiological study, we examined associations of long-term adherence to the Mediterranean diet (MeDi) and subsequent cognitive function and decline. We included 16,058 women from the Nurses' Health Study, aged ≥70 y, who underwent cognitive testing by telephone 4 times during 6 y, beginning in 1995-2001, and provided repeated information on diet between 1984 and the first cognitive exam. Primary outcomes were the Telephone Interview for Cognitive Status (TICS) and composite scores of verbal memory and global cognition. MeDi adherence was based on intakes of: vegetables, fruits, legumes, whole grains, nuts, fish, red and processed meats, moderate alcohol, and the ratio of monounsaturated:saturated fat. Long-term MeDi exposure was estimated by averaging all repeated measures of diet (>13 y, on average). In primary analyses of cognitive change, the MeDi was not associated with decline in global cognition or verbal memory. In a secondary approach examining cognitive status in older age, determined by averaging all 4 repeated measures of cognition, each higher quintile of long-term MeDi score was linearly associated with better multivariable-adjusted mean cognitive scores [differences in mean Z-scores between extreme quintiles of MeDi = 0.06 (95% CI: 0.01, 0.11); = 0.05 (95% CI: 0.01, 0.08); and = 0.06 (95% CI: 0.03, 0.10) standard units; P-trends = 0.004, 0.002, and <0.001 for TICS, global cognition, and verbal memory, respectively]. These associations were similar to those observed in women 1-1.5 y apart in age. In summary, long-term MeDi adherence was related to moderately better cognition but not with cognitive change in this very large cohort of older women.

The Kepler mission was designed to determine the frequency of Earth-sized planets in and near the habitable zone of Sun-like stars. The habitable zone is the region where planetary temperatures are suitable for water to exist on a planet's surface. During the first 6 weeks of observations, Kepler monitored 156,000 stars, and five new exoplanets with sizes between 0.37 and 1.6 Jupiter radii and orbital periods from 3.2 to 4.9 days were discovered. The density of the Neptune-sized Kepler-4b is similar to that of Neptune and GJ 436b, even though the irradiation level is 800,000 times higher. Kepler-7b is one of the lowest-density planets (approximately 0.17 gram per cubic centimeter) yet detected. Kepler-5b, -6b, and -8b confirm the existence of planets with densities lower than those predicted for gas giant planets.

Aims: To examine the association between moderate drinking, cognitive function, and cognitive decline in women with type 2 diabetes., Methods: From 1995 to 2001, we assessed cognitive function in 1,698 women aged 71-80 years with type 2 diabetes in the Nurses' Health Study. Assessments were repeated twice at 2-year intervals. We used linear regression to estimate multivariable-adjusted mean differences in initial cognitive function and longitudinal models to estimate cognitive decline over 4 years, according to average alcohol intake between diagnosis with diabetes and the initial cognitive measurement., Results: At the initial assessment, the mean score on our test of general cognition was 0.31 (95% CI 0.02, 0.60) points higher in women who were moderate alcohol drinkers (those consuming 1.0-9.9 g of alcohol, or about 1 drink, per day) compared with abstainers. However, moderate alcohol was not associated with cognitive decline. Higher alcohol consumption (10.0-30.0 g of alcohol per day) was not associated with initial cognition or cognitive decline, although there was no apparent harm either., Conclusions: Among women with type 2 diabetes, moderate alcohol was associated with better initial cognition, but not reduced rates of cognitive decline. Thus, we found no clear and consistent cognitive benefits of moderate alcohol in diabetes.

Objective: To determine whether community pharmacist-initiated interventions containing a recommendation to adjust prescribed asthma therapy are more helpful to prescribers than similar communications without such a recommendation., Design: Prospective, multicenter, quasi-experimental design with posttest., Setting: Wisconsin and Minnesota., Patients and Participants: 33 community and clinic pharmacies throughout the Coulee Region of Wisconsin and Minnesota enrolled eligible patients from October 1, 2004, to January 31, 2005. Patients were between 12 and 60 years of age, had used three or more short-acting beta-agonist (SABA) canisters with-in the previous 90 days, and did not meet any exclusion criteria., Interventions: Based on an evaluation of each patient's inhaler technique and adherence to controller medications, pharmacists sent to the prescriber a fax containing a recommendation (for patients with proper technique and appropriate adherence to prescribed controller medications) or information (for those who had any combination of inappropriate inhaler technique or inappropriate adherence)., Main Outcome Measure: Health care professionals' yes-or-no response to the question, "Do you find this form helpful for making clinical decisions?", Results: Pharmacists offered to enroll 235 patients who were identified as meeting preliminary inclusion criteria. Of those, 112 people met exclusion criteria, 28 were not interested in their pharmacists' involvement, 13 stated that they did not have time to participate, 11 took the forms home but did not return them, and 11 other patients were excluded by the pharmacists for other reasons. The remaining 60 patients were in enrolled in the study, 60 faxes were sent from 16 pharmacies, and 40 of those were analyzed further. For 24 recommendation faxes sent, prescribers rated 15 as helpful (62.5%) and 4 as not helpful (16.7%). Of 16 informational faxes sent, 10 were marked helpful (62.5%) and 2 were marked not helpful (12.5%)., Conclusion: Recommendation and informational faxes were overall helpful to health care professionals in making clinical decisions. Respondents found the two types of faxed interventions as equally helpful, suggesting that pharmaceutical care initiated by community pharmacists is helpful to prescribers.