Analysis of COVID-19 Pandemic on Supplement Usage and Its Combination with Self-Medication within the State of Arkansas

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus responsible for the COVID-19 pandemic that can lead to severe respiratory distress requiring hospitalization and can be fatal. Media have reported that various dietary supplements (DS) or their combination with different medications can prevent infection or decrease disease severity. Here, we analyzed data collected from 15,830 patient follow-up telephone interviews from the University of Arkansas for Medical Sciences COVID-19 testing sites from March 15 to August 1, 2020. Within the REDCap database, we recorded patient demographics and DS and medication use. In total, data on DS and medication use was available for 8,150 study participants, of whom 21.9% and 4.1% reported using DS or medications, respectively, to either prevent or treat COVID-19. The majority of respondents were female (64%) and non-Hispanic whites (44.5%). Most individuals (64.5%) who took DS were younger than 50 years of age. Products such as vitamin C (1,013, 33.2%), multivitamins (722, 23.6%), and vitamin D (294, 9.6%) were the most commonly used DS among the responders. Analysis of the DS use and symptom scores association did not provide a strong evidence of beneficial health effects of DS. The results of this study demonstrate that a significantly higher proportion of study participants considered usage of DS to mitigate or prevent COVID-19-related symptoms compared to those who preferred medications. However, lack of observable health benefits associated with ingestion of DS suggests that more rigorous research is needed to substantiate the label claims.

Visual outcomes of primary versus secondary epiretinal membrane following vitrectomy and cataract surgery

PURPOSE

To compare visual outcomes, incidence of cystoid macular edema (CME), and rate of repeat epiretinal membrane (ERM) surgery following phacovitrectomy for primary and secondary ERM.

METHODS

Retrospective review of 178,856 cataract surgeries from 2003 to 2015. Eyes that underwent cataract surgery combined with ERM peel were included (n = 708). Eyes were divided into primary (n = 538) and secondary (n = 170) ERM groups. Patient demographics, visual acuity (VA), and postoperative CME were recorded.

RESULTS

Patients with secondary ERM had worse preoperative VA, 0.9 ± 0.6 logMAR (20/160 Snellen equivalent) as compared to patients with primary ERM, 0.6 ± 0.3 (20/80), respectively (p < 0.0001). There was no difference between the secondary and primary ERM groups in postoperative vision (0.5 ± 0.4 logMAR vs. 0.5 ± 0.3; p = 0.9962) or proportion with VA ≥ 20/40 (46.4% vs. 43.1%; p = 0.6744) at 12-24 weeks. Postoperative CME was twice as likely in the secondary ERM group (16.5%) compared to the primary ERM group (7.8%) (p = 0.0018). There was no difference in the rate of repeat ERM surgery between the secondary ERM group (1.8%) and the primary ERM group (1.5%) (p = 0.7308).

CONCLUSION

Eyes with secondary ERM had significant postoperative improvement in VA. They had worse preoperative VA and had a twofold increase in postoperative CME than primary ERM.

Interprofessional identity development within a brief shadowing experience: An exploratory case study

The Deans' Interprofessional Honors Colloquium (DIHC) is an honors-level interprofessional elective course that provides a seminar-based forum for students from eleven academic programs to explore the characteristics and implications of collaborative interprofessional practice around a contemporary health topic. This project-based course combines didactic presentations, interactive group learning, and an interprofessional shadowing experience with a corresponding written reflection paper. Ten semesters of Interprofessional Shadowing Reflections (n = 401) were studied via thematic and content analyses to examine the extent to which a brief interprofessional shadowing experience influenced interprofessional identity development. Interprofessional socialization framework was employed as a lens to refine themes and to track students' trajectory in developing a dual professional identity. This exploratory case study indicated that nearly all participants' reflections included content indicative of the second stage (interprofessional role learning) of the interprofessional socialization framework, and many progressed toward the third stage (dual identity development). Major themes included emergent role learning, increased differentiation among roles and care models, and increased appreciation for other professionals. The experience provided an opportunity for correction of misconceptions and improved understanding of the role and practice of other professions. Nearly all of the participating students (1) reflected on the benefits of interprofessional collaboration and (2) indicated a desire to work interprofessionally in the future, an early indication of dual identity formation. Findings indicated that the interprofessional shadowing experience and written reflection were highly valuable elements of the DIHC and provided a critical opportunity for interprofessional identity development.

Notes from the Field: Outbreaks of Shigella sonnei Infection with Decreased Susceptibility to Azithromycin Among Men Who Have Sex with Men - Chicago and Metropolitan Minneapolis-St. Paul, 2014

Increasing rates of shigellosis among adult males, particularly men who have sex with men (MSM), have been documented in the United States, Canada, and Europe, and MSM appear to be at greater risk for infection with shigellae that are not susceptible to ciprofloxacin or azithromycin. Azithromycin is the first-line empiric antimicrobial treatment for shigellosis among children and is a second-line treatment among adults. Isolates collected in 2014 in two U.S. cities from outbreaks of shigellosis displayed highly similar pulsed-field gel electrophoresis (PFGE) patterns and decreased susceptibility to azithromycin (DSA). This report summarizes and compares the findings from investigations of the two outbreaks, which occurred among MSM in metropolitan Minneapolis-St. Paul, Minnesota, and Chicago, Illinois.

Importation and domestic transmission of Shigella sonnei resistant to ciprofloxacin - United States, May 2014-February 2015

In December 2014, PulseNet, the national molecular subtyping network for foodborne disease, detected a multistate cluster of Shigella sonnei infections with an uncommon pulsed-field gel electrophoresis (PFGE) pattern. CDC's National Antimicrobial Resistance Monitoring System (NARMS) laboratory determined that isolates from this cluster were resistant to ciprofloxacin, the antimicrobial medication recommended to treat adults with shigellosis. To understand the scope of the outbreak and to try to identify its source, CDC and state and local health departments conducted epidemiologic and laboratory investigations. During May 2014-February 2015, PulseNet identified 157 cases in 32 states and Puerto Rico; approximately half were associated with international travel. Nine of the cases identified by PulseNet, and another 86 cases without PFGE data, were part of a related outbreak of ciprofloxacin-resistant shigellosis in San Francisco, California. Of 126 total isolates with antimicrobial susceptibility information, 109 (87%) were nonsusceptible to ciprofloxacin (108 were resistant, and one had intermediate susceptibility). Travelers need to be aware of the risks of acquiring multidrug-resistant pathogens, carefully wash their hands, and adhere to food and water precautions during international travel. Clinicians should request stool cultures and antimicrobial susceptibilities when they suspect shigellosis, and counsel shigellosis patients to follow meticulous hygiene regimens while ill.

To stay or not to stay: issues in rural primary care physician retention in eastern Kentucky

An important aspect of primary care physician availability is the retention of physicians once they have located. While retention has been under-researched compared to recruitment, it is especially important in rural areas where physician shortages already exist. This study reports the results of a retention survey completed by 132 primary care physicians in rural eastern Kentucky. The survey sets up an objective, hypothetical retention scenario and asks physicians to respond to structured questions and to an open-ended question about factors not appearing in the survey. In response to the structured portion of the survey, physicians indicate that relief coverage is the most important factor in rural physician retention. A content analysis of 75 open-ended responses reveals that besides the other factors in the survey, "sociocultural integration" is the pre-eminent retention issue for rural practitioners. This article concludes that the role of the local rural community may be more important in retention than in recruitment. Finally, it is suggested that additional in-depth qualitative research be conducted within the local contexts to enhance the understanding of rural physician retention processes.

Enhanced detection of human telomerase activity

The detectability of telomerase activity in human cells almost always correlates with indefinite proliferation capability (immortalization). To make quantitative statements about telomerase activity levels, complete extraction of the telomerase activity is needed. A series of detergents was tested for this purpose, and a combination of NP-40 and sodium deoxycholate (NaDOC) was found to be the most efficient for extracting telomerase activity. Tumor-derived cell lines originally thought to contain differing amounts of telomerase on the basis of the original CHAPS bases extraction procedures have nearly equivalent amounts of activity when extracted with the NP-40/NaDOC lysis buffer. These results indicate that these lysis conditions can be used to extract telomerase activity more efficiently from tumor-derived cell lines.

Enhancement of strand invasion by oligonucleotides through manipulation of backbone charge

The ability of DNA oligonucleotides, neutral peptide nucleic acids (PNAS), and oligonucleotide conjugates to hybridize to inverted repeat sequences within supercoiled double-stranded DNA by Watson-Crick base-pairing is examined. PNAs and oligonucleotide conjugates initiate and maintain strand invasion under more stringent conditions than do unmodified DNA oligonucleotides. PNAs hybridize rapidly and, once bound, hold open a target site allowing oligonucleotides to base-pair to the displaced strand under conditions that would otherwise preclude hybridization. The ability to manipulate hybridization efficiency through different options for the alteration of oligomer charge should have important implications for optimizing sequence-specific recognition of DNA.

Inhibition of human telomerase activity by peptide nucleic acids

We report the inhibition of human telomerase activity by peptide nucleic acids (PNAs). PNAs recognize the RNA component of human telomerase (hTR) and inhibit activity of the enzyme with IC50 values in the picomolar to nanomolar range. Inhibition depends on targeting exact functional boundaries of the hTR template and is 10- to 50-fold more efficient than inhibition by analogous phosphorothioate (PS) oligomers. In contrast to high selectivity of inhibition by PNAs, PS oligomers inhibit telomerase in a non-sequence-selective fashion. These results demonstrate that PNAs can control the enzymatic activity of ribonucleoproteins and possess important advantages relative to PS oligomers in both the affinity and the specificity of their recognition. These observations should facilitate the development of effective inhibitors of telomerase activity and affinity probes of telomerase structure.

Retinal degeneration slow (rds) in mouse results from simple insertion of a t haplotype-specific element into protein-coding exon II

Retinal degeneration slow (rds) is a semidominant mutation of mice that causes dysplasia and degeneration of rod and cone photoreceptors. Mutations in RDS, the human ortholog of the rds gene, are responsible for several inherited retinal dystrophies including a subset of retinitis pigmentosa. The normal rds locus encodes rds/peripherin, an integral membrane glycoprotein present in outer segment discs. Genomic libraries from wildtype and rds/rds mice were screened with an rds cDNA, and phage lambda clones that span the normal and mutant loci were mapped. We show that in mice, rds is caused by the insertion into exon II of a 9.2-kb repetitive genomic element that is very similar to the t haplotype-specific element in the H-2 complex. The entire element is included in the RNA products of the mutant locus. We present evidence that rds in mice represents a null allele.

Accelerated hybridization of oligonucleotides to duplex DNA

We report two strategies for accelerating the hybridization of oligonucleotides to DNA. We demonstrate that oligodeoxyribonucleotides and peptide nucleic acid oligomers hybridize to inverted repeats within duplex DNA by D-loop formation. Oligonucleotides and duplex template form an active complex, which can be recognized by T7 DNA polymerase to prime polymerization. Quantitation of polymerization products allowed the rate of hybridization to be estimated, and peptide nucleic acid oligomers and oligonucleotide-protein adducts anneal with association constants 500- and 12,000-fold greater, respectively, than the analogous unmodified oligonucleotides. Together, these results indicate that sequences within duplex DNA can be targeted by Watson-Crick base pairing and that chemical modifications can dramatically enhance the rate of strand association. These findings should facilitate targeting of oligomers for priming DNA polymerization, the detection of diagnostic sequences, and the disruption of gene expression. The observed acceleration of hybridization may offer a new perspective on the ability of RecA or other proteins to accelerate strand invasion.

Targeting peptide nucleic acid-protein conjugates to structural features within duplex DNA

A convenient small scale synthesis has been developed for obtaining peptide nucleic acid oligomers (PNAs). PNAs have been conjugated to a protein, staphylococcal nuclease, through disulfide exchange between a cysteine at the 3'-(carboxy) end of the PNA and an introduced cysteine on the surface of the nuclease. Site specific DNA cleavage by the attached nuclease has been used to examine the Watson-Crick hybridization of the PNAs to duplex DNA. Substantial affinity cleavage occurred when target sites contained inverted repeats which have the potential to form non B-DNA structures such as cruciforms. No affinity cleavage was observed at a site lacking apparent potential for non B-DNA structures. These results indicate that the Watson-Crick hybridization of PNAs to duplex DNA by strand displacement is favored by the presence of potential alternative secondary structures within the target sequence.

Methylphenidate plasma concentrations in chronically and acutely treated latency-age children

In 5 latency-age boys, methylphenidate plasma concentrations following multiple doses of methylphenidate were consistently higher than those obtained after a single dose. Pharmacological and clinical implications are discussed.

Effect of age on the digit blood flow response to sedative concentrations of nitrous oxide

Twenty healthy male subjects [11 young, x̄ = 25.4 ± 0.8 (SEM) years old; 9 elderly, x̄ = 64.5 ± 0.7 years] volunteered for a study designed to investigate the effect of age on several cardiovascular parameters to inhaled N(2)O-O(2). The protocol was designed to mimic the administration of N(2)O-O(2) for sedation in the dental office, although no dental treatment was performed. Clinical criteria were used to judge the appropriate sedative level for each subject; no attempt was made to establish doseresponse relationships. Digit blood flow was measured by strain-gauge plethysmography, and heart rate, arterial blood pressure, respiratory rate, and skin temperature were monitored and recorded. N(2)O and CO(2) levels were monitored in end-tidal gas samples by gas chromatography; machine gauge readings were calibrated against known gas mixtures by the same technique.Under the conditions of this experiment both healthy young and healthy elderly subjects experienced a marked (200-300%) increase in digit blood flow during N(2)O inhalation, compared to that during air and 100% O(2) inhalation. There was no significant difference in the degree of flow increase between young and elderly subjects. Also, there were no significant differences in the response of these healthy young and healthy elderly subjects to sedative concentrations of N(2)O with regard to heart rate, arterial blood pressure, respiratory rate, skin temperature, or mean end-tidal CO(2) levels. The data indicate that N(2)O, in the concentrations routinely administered in the dental office for sedation, does not have a differential effect on the measured parameters in healthy elderly and healthy young males.

The effect of nitrous oxide and age on psychological and psychomotor performance

Healthy older and younger males were compared on several psychomotor and cognitive measures before, during, and after N(2)O inhalation. Age did not appear to be a significant factor in determining response to N(2)O though on several measures younger subjects are superior to older under all conditions. N(2)O had a significant effect only on reaction time and facial recognition tasks. The relation of these findings to previous work is discussed.

The effects of nitrous oxide administration in the healthy elderly: N2O elimination and alveolar CO2

Healthy young and elderly males were administered sedative concentrations of nitrous oxide/oxygen (N(2)O/O(2)) under a protocol designed to mimic that used in a dental operatory. Samples of end-tidal expired gas were taken at the end of 30-minutes inhalation of, and periodically for 70 minutes after withdrawal from, nitrous oxide/oxygen. Samples were analyzed to monitor the decline of alveolar nitrous oxide levels and any changes in alveolar carbon dioxide levels, to determine if there were any age-related differences. The fall in alveolar N(2)O following cessation of administration was rapid, and in a double-exponental manner as was expected. No age-related difference in N(2)O decline was observed. Alveolar carbon dioxide (CO(2)) levels were lower and more variable in the elderly group. Both groups exhibited elevated CO(2) levels at the end of the N(2)O period, and an unexplained rise in CO(2) at approximately 30 min post N(2)O.

Psychomotor skills and technical ability in dental school

Graduating dental students were grouped according to technical ability and compared with regard to admissions variables and a variety of psychomotor skills. Neither class of variable differentiated the groups. This article discusses implications for efforts to identify technically marginal students.

Wechsler variables as a function of age and neurologic status

Scores on Wechsler variables were analyzed in groups of patients broken down by age and neurologic status. No differences as a function of age were found in intelligence or memory. Timed Performance subtest results were related to age, but apparent Verbal subtest age differences were eliminated by the introduction of education as a covariate. Neurologic status showed significant effects on intelligence and memory and on all but 3 Wechsler subtests. No significant interactions between age and neurologic status were seen.

The Trail Making Test and Bender Background Interference Procedure as screening devices

The Trail Making Test and Bender Background Interference Procedure were evaluated with 598 Ss against both external neurologic criteria and against psychological opinion derived from a more complete evaluation. For Trails, highly significant differences in mean scores were seen when preselected neurologic patients and patients without neurologic stigmata were compared. Similarly, the distribution of classification of these patients by Bender is significantly different from chance. Application of these measures in a screening paradigm, however, yielded large numbers of false negatives against both neurological and psychological criteria. It was not possible to establish an optimal cutting score to justify application of these measures as screening devices, either alone or in concert.

Screening alcoholics for medical problems with the Cornell Medical Index

Scores on the Cornell Medical Index were not useful in distinguishing alcoholic patients who required medical attention from those who did not.

Validation of the Watson-Thomas rules for MMPI diagnosis

The Watson-Thomas rules for MMPI diagnosis of organic versus functional disorder were applied to the profiles of five groups of 14 male veteran patients, one neurologic and four psychiatric. The psychiatric groups were married schizophrenics, unmarried schizophrenics, alcoholics, and mixed functional diagnosis. Rule 4 was found to discriminate among the groups most reliably. In the psychiatric samples, married schizophrenics were not successfully categorized by any of the Rules.

A programmed training technique that uses reinforcement to facilitate acquisition and retention in brain-damaged patients

Hospitalized brain-damaged patients were Ss in a study designed to evaluate the effectiveness of a treatment technique used with contingent reinforcement to facilitate acquisition and retention of environmentally relevant information. Ss were divided into three groups that were equated diagnostically and demographically. Group I received the treatment technique with contingent material and verbal reinforcement. Group II received the treatment technique with only contingent verbal reinforcement, and Group III was a control. Both treatment groups showed significant acquisition of the experimental information, and 1 week after training the two treatment groups showed no significant loss of acquired information. None of the groups showed any significant change in ward behavior during the experiment. It was concluded that the treatment technique used with contingent reinforcement can be used in the retraining of memory in brain-damaged patients.

The Ward Function Inventory (WFI): a scale for use with geriatric and demented inpatients

A behavioral rating scale for use with the geriatric and/or demented inpatient population is reported. It is called the Ward Function Inventory (WFI) and assesses 12 functions. Six independent reliability studies employing a total of 83 patients and 63 raters were done, yielding a mean reliability for the scale of .81 with a range of .73 to .93. The reliability stuides were done on a variety of patient types. The practical utility of the WFI is stressed.

Object, intensity and subject variables in visual evoked response

10 subjects were studied to determine AEP effects of square, circle, and blank stimuli with variable stimulus intensity. For the group as a whole, object and intensity effects were significant on a number of amplitude and latency measures, but the object effect appears largely to reflect the presence or absence of a figure, rather than its nature. Increased intensity differentially affected latency, shortening the first negative deflection while lengthening the second positive. Amplitude is generally increased with higher intensity. Analysis of within-subjects effects showed considerable variability as to which parameters were significantly related to the independent variables in individual subjects. A repeated-measures, within-subjects research strategy is seen as appropriate on the basis of these data.

Patterns of neuropsychological test performance in Huntington's disease

Neuropsychological test performance of Huntington's disease (HD) and a mixed brain-damaged group were compared. Wechsler patterns in the present samples were compared to those of HD patients in the study of Boll et. al (1), and some correspondence specific to HD is suggested. Minnesota Multiphasic Personality Inventories (MMPIs) were found not to differ between the HD and mixed brain-damaged groups.

Effect of set size, age, and mode of stimulus presentation on information-processing speed

First, second, and third grade pupils served as Ss in an experiment designed to show the effect of age, mode of stimulus presentation, and information value on recognition time. Stimuli were presented in picture and printed word form and in groups of 2, 4, and 8. The results of the study indicate that first graders are slower than second and third graders who are neatly equal. There is a gross shift in reaction time as a function of mode of stimulus presentation with increase in age. The first graders take much longer to identify words than pictures, while the reverse is true of the older groups. With regard to set size, a slope appears in the pictures condition in the older groups, while for first graders, a large slope occurs in the words condition and only a much smaller one for pictures. For the older groups, there is no increase in reaction time with larger set sizes in the words condition, and, in fact, the values tend to decrease.

Discrimination learning, social class, and type of reward

A visual discrimination task was used to determine the effectiveness of verbal reward alone (Verbal group) vs a combination of candy and verbal reward (Combined group) with 16 middle-class 5-yr.-olds and 16 5-yr.-olds from a Head Start class. Social class proved to be the only significant variable, the performance of the higher status group being superior to that of the lower status group. Only a tendency for the verbally rewarded Ss to be superior to combined reward Ss was noted.