Patient Perception of Physician Attire in a Military Ophthalmology Clinic.

Introduction The purpose of this study is to investigate patient preferences of physician attire in an outpatient military ophthalmology clinic to determine how these preferences affect patients' perceptions of physician competence and their overall clinical experience. Materials and methods This study is a prospective survey administered to patients at the ophthalmology clinic at Brooke Army Medical Center. USA. Patients who were willing to participate in a volunteer survey were included in this study. Demographic information and survey questions were utilized in this study along with words and pictures for patients to select a preference in physician attire in the clinic setting (scrubs, military uniform, or civilian professional attire) and surgical setting (surgical cap or a surgical bouffant). The survey asks patients if physician attire impacts patient confidence in physician abilities (yes or no) and if surgeon attire impacts the likelihood of the patient taking the surgeon's advice (yes or no). Results The demographic distribution includes 57-77 years old participants (53%), females (61%), retirees (49%), and dependent spouses (40%). The racial distribution includes 46% - Caucasian, 20% - African American, 22% - Hispanic, 6 - % Asian, and 6% - other. Most patient appointment types were established follow-up (77%) with only 12% new and 11% walk-in. The survey results (N=308) indicate that most patients (64%) did not have a preference in physician clinical attire, while 22% preferred scrubs, 11% preferred military uniform, and 3% preferred civilian attire. Most patients (66%) did not have a preference for surgical headwear, while 27% preferred the surgical cap, and 7% preferred the surgical bouffant. Only 9% of the patients surveyed indicated that physician attire impacted their confidence in their physician's ability, and 12% reported that attire impacted the likelihood of taking advice. Conclusions Most patients in an outpatient military ophthalmology clinic do not have a preference for physician attire or surgical headwear when surveyed. The majority of patients did not feel physician attire impacted their perception of physician's ability or their likelihood of taking advice. When indicating a preference, patients tended to prefer scrubs to outpatient civilian attire or military attire and trended towards preferring surgical cap over surgical bouffant for headwear.

Assessment of Factors Associated With Postoperative Pain After Photorefractive Keratectomy.

PURPOSE: To define the factors that affect patient's self-assessed postoperative pain after photorefractive keratectomy (PRK). METHODS: Patients who underwent PRK in 2016 were evaluated. Anonymized data collected included patient gender, age, and season at the time of surgery, ablation depth, surgeon status (attending vs. resident), topical tetracaine use, and subjective pain scores at postoperative days (PODs) 1 and 7. Average pain scores and amount of pain medication taken were analyzed for each of the previously mentioned variables. RESULTS: Overall, 231 patients who underwent PRK were analyzed. The mean pain score and SD were 0.78 ± 1.87 on POD 1 and 0.03 ± 0.37 by POD 7. Patients who used topical tetracaine reported significantly higher pain on POD 1 and 7 compared with patients who did not use tetracaine (P < 0.001 and P = 0.038, respectively). No significant differences in pain scores were seen based on surgeon status, ablation depth, gender, and season. Patients who used topical tetracaine took a higher amount of oral pain medication (9.44 ± 6.01) compared with those who did not (7.02 ± 4.71) (P = 0.022). CONCLUSIONS: Postoperative pain was significantly elevated in patients who used tetracaine on POD 1 and POD 7. These patients were also more likely to take oral pain medication than those who did not use topical tetracaine. Surgeon status, season, gender, and ablation depth showed no significant differences in subjective pain scores. Oral pain medication should be evaluated to assess efficacy and safety in inhibiting ocular pain after PRK.

Real-time geotracking and cataloging of mass casualty incident markers in a search and rescue training simulation: Pilot study.

OBJECTIVE: Search and rescue after mass casualty incidents relies on robust data infrastructure. Federal Emergency Management Agency (FEMA's) Task Force 1 (TF1) trains its volunteers to locate and virtually tag scene incidents using a global positioning satellite (GPS) device programmed with markers for each incident (Iron Sights). The authors performed a pilot study comparing Iron Sights™ to a Wi-Fi-based real-time incident geolocation and virtual tagging dashboard (Panacea™) in creating a dynamic common operating picture. DESIGN: Twenty-nine stations were placed at a predefined scene incident, each featuring a set of varying waypoint markers using standard FEMA/TF1 nomenclature. Two volunteers performed the experiment for both the Iron Sights and Panacea systems, digitally tagging all station waypoints. SETTING: TF1 simulation training field. MAIN OUTCOME MEASURE(S): Metrics compared included GPS location precision, marker accuracy, and delay between scene sweep and common operational picture (COP) generation. RESULTS: Two hundred and sixty-one waypoints were digitally tagged after excluding three stations for missing data. The average GPS location difference for all waypoints between Iron Sights and Panacea was 3.65 m. Marker tagging accuracy between Iron Sights and Panacea was equivalent and not statistically different (78.8 percent vs 66.2 percent, respectively, p = 0.11). Waypoints were tagged in 26.59 minutes and 10.55 minutes on average, respectively. Time from scene sweep to virtual COP generation was 7.97 minutes for Iron Sights after complete scene sweep and 37 seconds for Panacea for each waypoint posting in real-time. CONCLUSIONS: Panacea generated the COP in real-time compared to a delay with Iron Sights while maintaining the same location precision and marker accuracy. This pilot trial successfully demonstrated the ability to provide real-time actionable intelligence to incident commanders during mass casualty search and rescue missions. Larger field trials are recommended to refine the system and broaden its capabilities.

Current and future disease progression of the chronic HCV population in the United States.

Chronic hepatitis C virus (HCV) infection can lead to advanced liver disease (AdvLD), including cirrhosis, decompensated cirrhosis, and liver cancer. The aim of this study was to determine recent historical rates of HCV patient progression to AdvLD and to project AdvLD prevalence through 2015. We first determined total 2008 US chronic HCV prevalence from the National Health and Nutrition Evaluation Surveys. Next, we examined disease progression and associated non-pharmacological costs of diagnosed chronic HCV-infected patients between 2007-2009 in the IMS LifeLink and CMS Medicare claims databases. A projection model was developed to estimate AdvLD population growth through 2015 in patients diagnosed and undiagnosed as of 2008, using the 2007-2009 progression rates to generate a "worst case" projection of the HCV-related AdvLD population (i.e., scenario where HCV treatment is the same in the forecasted period as it was before 2009). We found that the total diagnosed chronic HCV population grew from 983,000 to 1.19 million in 2007-2009, with patients born from 1945-1964 accounting for 75.0% of all patients, 83.7% of AdvLD patients, and 79.2% of costs in 2009, indicating that HCV is primarily a disease of the "baby boomer" population. Non-pharmacological costs grew from $7.22 billion to $8.63 billion, with the majority of growth derived from the 60,000 new patients that developed AdvLD in 2007-2009, 91.5% of whom were born between 1945 and 1964. The projection model estimated the total AdvLD population would grow from 195,000 in 2008 to 601,000 in 2015, with 73.5% of new AdvLD cases from patients undiagnosed as of 2008. AdvLD prevalence in patients diagnosed as of 2008 was projected to grow 6.5% annually to 303,000 patients in 2015. These findings suggest that strategies to diagnose and treat HCV-infected patients are urgently needed to increase the likelihood that progression is interrupted, particularly for patients born from 1945-1964.

Microarray evidence of glutaminyl cyclase gene expression in melanoma: implications for tumor antigen specific immunotherapy.

BACKGROUND: In recent years encouraging progress has been made in developing vaccine treatments for cancer, particularly with melanoma. However, the overall rate of clinically significant results has remained low. The present research used microarray datasets from previous investigations to examine gene expression patterns in cancer cell lines with the goal of better understanding the tumor microenvironment. METHODS: Principal Components Analyses with Promax rotational transformations were carried out with 90 cancer cell lines from 3 microarray datasets, which had been made available on the internet as supplementary information from prior publications. RESULTS: In each of the analyses a well defined melanoma component was identified that contained a gene coding for the enzyme, glutaminyl cyclase, which was as highly expressed as genes from a variety of well established biomarkers for melanoma, such as MAGE-3 and MART-1, which have frequently been used in clinical trials of melanoma vaccines. CONCLUSION: Since glutaminyl cyclase converts glutamine and glutamic acid into a pyroglutamic form, it may interfere with the tumor destructive process of vaccines using peptides having glutamine or glutamic acid at their N-terminals. Finding ways of inhibiting the activity of glutaminyl cyclase in the tumor microenvironment may help to increase the effectiveness of some melanoma vaccines.

An avian influenza vaccine for humans targeting the polymerase B2 protein inside the capsid instead of hemagglutinin or neuramidase on the virus surface.

Vaccines for avian influenza typically are aimed at hemagglutinin or neuramidase on the outside of the virus capsid. A major problem with such an approach is that the genes coding for these proteins have a very rapid mutation rate, forcing commercial producers to wait for mutations to occur before developing effective new versions of standard vaccines. However, a recent study has revealed that the 1918 flu virus, like the H5N1 avian flu virus, has an E627K mutation in its polymerase B2 component, which is located inside the virus capsid. Other research has indicated that this mutation strongly influences the virulence of H5N1. It seems reasonable to believe that the constancy, over more than 80 years, of the E627K mutation could be exploited to begin developing a vaccine now, rather than waiting for new mutations. Consequently, a publicly available database at the National Center for Biotechnology Information (NCBI) website, and the SYFPEITHI online computer algorithm, were used to generate a hypothesis about a peptide-based vaccine targeted at the E627K mutation in PB2 of the avian influenza virus. It was found that the peptide sequence, DTVQIIKLL, present in the PB2 protein of the H5N1 virus, would be expected to bind to HLA-A26 restricted immune system cell surface receptors. Hence, the bound peptide might be capable of stimulating protection from cytotoxic T lymphocytes. Should the present hypothesis be confirmed in laboratory studies, and an effective vaccine developed for individuals expressing the HLA-A26 receptor; further research would be indicated. This research would be aimed at determining whether molecular modifications to the DTVQIIKLL peptide could make it effective with other members of the HLA-A1 supertype to which HLA-A26 belongs. In addition to allowing vaccine development to begin now, this peptide-based approach would have the advantage of avoiding the use of dangerous, live, avian influenza virus during mass production.

Evaluating the formulae for integrated lethality in ethylene oxide sterilization using six different endospore forming strains of bacteria, and comparisons of integrated lethality for ethylene oxide and steam systems.

Bacterial endospores from six different species of bacteria were exposed to a spectrum of ethylene oxide (EtO) sterilizing conditions. Temperature was varied from 40 to 60 degrees C and the ethylene oxide concentration was varied from 300 to 750 mg/L. Relative humidity was maintained at 60+/-10% RH. The fraction negative procedure was used to determine the D value for each of the test conditions. Bacterial species tested included Bacillus atrophaeus ATCC # 9372, Bacillus smithii ATCC # 51232, Bacillus subtilis "5230" ATCC # 35021, Bacillus subtilis, DSM # 4181, Bacillus pumilus ATCC # 27142, and Geobacillus stearothermophilus ATCC # 7953. All spore preparations were inoculated on filter paper strips packaged in blue, sterilizable glassine pouches. G. stearothermophilus was the least resistant organism tested. The most resistant organisms tested were B. atrophaeus and B. subtilis "5230". The B. subtilis "5230" strain was slightly more resistant than B. atrophaeus at conditions of 54C and EtO concentrations of 400, 600, and 750 mg/L, as well as at 60C/750mg/L EtO. The other species were between these extremes. This empirical data allowed the application of the recently published formula for converting D values from one set of conditions to another and evaluations of accuracy. The measured D values also allowed the determination of Z values based on temperature variations. These formulae, when applied to process temperatures independent of gas concentration, result in a Z value of approximately 32 degrees C that appears to be similar for all species tested. These data support the application of the previously published formulae 1-6 and allow the same approach to integrated lethality for ethylene oxide processes as is commonly applied to steam sterilization. A review of steam sterilization and related principles was conducted for comparison of integrated lethality for these two methods of sterilization. Errors associated with D values, Z values, extrapolation, and integrated lethality for both methods of sterilization are discussed.

Factors affecting tailing in ethylene oxide sterilization part 1: When tailing is an artifact... and scientific deficiencies in ISO 11135 and EN 550.

Current approaches for validation of EtO sterilization cycles identified in ISO 11135 and EN 550 are scientifically deficient and result in full cycle times that are too short. This review article identifies the scientific flaws promulgated in the standards that lead to overestimation of process lethality. The reasons for these deficiencies are design-of-experiment errors that either fail to mathematically account for lag factors or that treat dissimilar samples as a single statistical sample set. Industry's movement toward parametric release, based on erroneous assumptions where exposure time rather than equivalent time is used, may create serious problems. The authors discuss these errors in detail, as well as reasonable methods for correcting them based on formulae for integrated lethality. Application of these methods will allow more accurate calculations of process lethality that are supported by biological data and appropriate mathematical analyses.