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Article: Outcomes of Combined Phacovitrectomy Without Corneal Suturing.

Hadayer, Amir / Weinberger, Yehonatan / Corina Sela, Tal / Gal-Or, Orly / Weinberger, Dov / Ehrlich, Rita

The Israel Medical Association journal : IMAJ

2023 Volume 25, Issue 9, Page(s) 608–611

Abstract: Background: During combined phacovitrectomy, it is common practice to suture the main corneal incision to prevent intraoperative and postoperative wound leak. However, it may be possible to avoid suturing using a self-sealing corneal incision technique ... ...

Abstract	Background: During combined phacovitrectomy, it is common practice to suture the main corneal incision to prevent intraoperative and postoperative wound leak. However, it may be possible to avoid suturing using a self-sealing corneal incision technique as in standard cataract surgery. Objectives: To evaluate the clinical outcome, safety, and complications of combined phacovitrectomy without preventive suturing. Methods: This retrospective case series study included consecutive patients who underwent combined phacovitrectomy between January 2018 and June 2019 for mixed indications. Surgeries were performed at a tertiary university hospital. All surgeries were performed by the same two retinal surgeons. Cataract surgery was performed first, followed by insertion of trocars and vitrectomy. Corneal sutures were not planned but were used at the discretion of the surgeon. Results: The cohort included 106 eyes of 102 patients. Suturing of the main corneal incision was deemed necessary in five cases (5%) because of a main incision leak or anterior chamber shallowing during trocar insertion. No other complications related to the absence of prophylactic corneal sutures were encountered during surgery or follow-up. Conclusions: Preventive corneal suturing may not be necessary in combined phacovitrectomy surgery and can be used in the few cases in which it is indicated during surgery.
MeSH term(s)	Humans ; Retrospective Studies ; Neurosurgical Procedures ; Cornea/surgery ; Sutures ; Cataract
Language	English
Publishing date	2023-08-31
Publishing country	Israel
Document type	Journal Article
ZDB-ID	2008291-5
ISSN	1565-1088 ; 0021-2180
ISSN	1565-1088 ; 0021-2180
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Article ; Online: LASER PHOTOCOAGULATION FOR THE TREATMENT OF OPTIC NERVE HEAD PIT-RELATED MACULOPATHY IN A PATIENT WITH BILATERAL CHORIORETINAL COLOBOMA.

Weinberger, Yehonatan / Weinberger, Dov / Priel, Ethan / Gal-Or, Orly / Ehrlich, Rita

Retinal cases & brief reports

2023 Volume 17, Issue 2, Page(s) 181–185

Abstract: Purpose: To report a case of laser photocoagulation for the treatment of a combined coloboma and optic nerve head pit-related maculopathy in a patient with bilateral chorioretinal coloboma.: Methods: A case report.: Results: A 15-year-old woman, ... ...

Abstract	Purpose: To report a case of laser photocoagulation for the treatment of a combined coloboma and optic nerve head pit-related maculopathy in a patient with bilateral chorioretinal coloboma. Methods: A case report. Results: A 15-year-old woman, presented with the visual acuity of 20/100 in her right eye for six weeks. She was diagnosed with macular detachment secondary to optic nerve head pit in her right eye and bilateral chorioretinal coloboma. Multimodal imaging, including color photography, fluorescein angiography, and spectral-domain optical coherence tomography, was used to identify and demonstrate the location of the tract of fluid from the optic nerve head pit, isolated from the coloboma. Optical coherence tomography-guided laser photocoagulation treatment at the location of the tract resulted in complete resolution of macular fluid with visual recovery to 20/25. Conclusion: Our case stresses the value of correct diagnosis directing photocoagulation treatment of combined optic nerve head pit-related maculopathy in eyes with chorioretinal coloboma using multimodal imaging.
MeSH term(s)	Female ; Humans ; Adolescent ; Optic Disk ; Coloboma/diagnosis ; Retinal Diseases/diagnosis ; Light Coagulation ; Macular Degeneration/complications ; Tomography, Optical Coherence/methods ; Lasers
Language	English
Publishing date	2023-02-22
Publishing country	United States
Document type	Case Reports ; Journal Article
ISSN	1937-1578
ISSN (online)	1937-1578
DOI	10.1097/ICB.0000000000001137
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Article: Bayesian Model Averaging to Account for Model Uncertainty in Estimates of a Vaccine's Effectiveness.

Oliveira, Carlos R / Shapiro, Eugene D / Weinberger, Daniel M

Clinical epidemiology

2022 Volume 14, Page(s) 1167–1175

Abstract: Purpose: Vaccine effectiveness (VE) studies are often conducted after the introduction of new vaccines to ensure they provide protection in real-world settings. Control of confounding is often needed during the analyses, which is most efficiently done ... ...

Abstract	Purpose: Vaccine effectiveness (VE) studies are often conducted after the introduction of new vaccines to ensure they provide protection in real-world settings. Control of confounding is often needed during the analyses, which is most efficiently done through multivariable modeling. When many confounders are being considered, it can be challenging to know which variables need to be included in the final model. We propose an intuitive Bayesian model averaging (BMA) framework for this task. Patients and methods: Data were used from a matched case-control study that aimed to assess the effectiveness of the Lyme vaccine post-licensure. Cases were residents of Connecticut, 15-70 years of age with confirmed Lyme disease. Up to 2 healthy controls were matched to each case subject by age. All participants were interviewed, and medical records were reviewed to ascertain immunization history and evaluate potential confounders. BMA was used to systematically search for potential models and calculate the weighted average VE estimate from the top subset of models. The performance of BMA was compared to three traditional single-best-model-selection methods: two-stage selection, stepwise elimination, and the leaps and bounds algorithm. Results: The analysis included 358 cases and 554 matched controls. VE ranged between 56% and 73% and 95% confidence intervals crossed zero in <5% of all candidate models. Averaging across the top 15 models, the BMA VE was 69% (95% CI: 18-88%). The two-stage, stepwise, and leaps and bounds algorithm yielded VE of 71% (95% CI: 21-90%), 73% (95% CI: 26-90%), and 74% (95% CI: 27-91%), respectively. Conclusion: This paper highlights how the BMA framework can be used to generate transparent and robust estimates of VE. The BMA-derived VE and confidence intervals were similar to those estimated using traditional methods. However, by incorporating model uncertainty into the parameter estimation, BMA can lend additional rigor and credibility to a well-designed study.
Language	English
Publishing date	2022-10-18
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2494772-6
ISSN	1179-1349
ISSN	1179-1349
DOI	10.2147/CLEP.S378039
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Article: Morphogenesis Dynamics in Leishmania Differentiation.

Dandugudumula, Ramu / Fischer-Weinberger, Renana / Zilberstein, Dan

Pathogens (Basel, Switzerland)

2022 Volume 11, Issue 9

Abstract: Leishmania, the causative agent of leishmaniasis, is an obligatory intracellular parasite that cycles between phagolysosome of mammalian macrophages, where it resides as round intracellular amastigotes, and the midgut of female sandflies, where it ... ...

Abstract	Leishmania, the causative agent of leishmaniasis, is an obligatory intracellular parasite that cycles between phagolysosome of mammalian macrophages, where it resides as round intracellular amastigotes, and the midgut of female sandflies, where it resides as extracellular elongated promastigotes. This protozoan parasite cytoskeleton is composed of stable and abundant subpellicular microtubules (SPMT). This study aims to determine the kinetics of developmental morphogenesis and assess whether microtubules remodelling is involved in this process. Using image-streaming technology, we observed that rounding of promastigotes during differentiation into amastigotes was initiated promptly after exposure to the differentiation signal. Stabilizing microtubules with taxol sped rounding, but later killed differentiating parasites if taxol was not removed. Microtubule destabilizers such as vinblastine had no effect on the rate of rounding, nor on the viability of differentiating parasites. In the reverse process, elongation is initiated after a delay of 7.5 and completed 72 h after exposure to the amastigote to the promastigote differentiation signal. During the delay, parasites became highly sensitive to treatment with microtubule destabilizers. The addition of vinblastine during the first 7.5 h halted differentiation and killed parasites. Between 8 and 24 h, parasites gradually became resistant to vinblastine and, in parallel, started to elongate. In contrast, taxol had no effect on parasite elongation, nor on the viability of these cells. In a parallel study, we showed that the Leishmania-specific protein kinase A (PKA) holoenzyme containing the LdPKAR3-C3 complex is essential for promastigote elongation. Mutant promastigotes lacking either of these proteins are round, but maintain their flagella. Here, we observed that during differentiation into amastigotes, these mutants round at the same rate as the wild type, but never exceed the WT density of round amastigotes. In the reverse process, these mutants undergo the same initial delay and then elongate at the same rate as the WT. They stop elongating when they reach 20% of elongated cells in mature promastigotes. Our analysis indicates that while promastigote rounding into amastigotes did not require microtubule remodelling, morphogenesis of round amastigotes into elongated promastigotes required microtubule rearrangement before elongation was initiated. This is the first study that investigates the dynamics of microtubules during parasite development.
Language	English
Publishing date	2022-08-23
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2695572-6
ISSN	2076-0817
ISSN	2076-0817
DOI	10.3390/pathogens11090952
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Article ; Online: The Pneumococcus-Respiratory Virus Connection-Unexpected Lessons From the COVID-19 Pandemic.

Dagan, Ron / Danino, Dana / Weinberger, Daniel M

JAMA network open

2022 Volume 5, Issue 6, Page(s) e2218966

MeSH term(s)	COVID-19/epidemiology ; Humans ; Influenza A Virus, H1N1 Subtype ; Influenza, Human/epidemiology ; Pandemics ; Streptococcus pneumoniae
Language	English
Publishing date	2022-06-01
Publishing country	United States
Document type	Journal Article ; Comment
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2022.18966
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Article ; Online: Metal Allergy in Tracheostomy Tube Placement Resulting in Complete Subglottic Stenosis: A Case Report.

Bui, Roger / Boven, Lindsay / Kaufman, David / Weinberger, Paul

The Annals of otology, rhinology, and laryngology

2022 Volume 131, Issue 12, Page(s) 1394–1397

Abstract: Objectives: Metal hypersensitivity reaction to surgical implants is a well- known phenomenon that is associated with pain, swelling, inflammation, and decreased efficacy of the implant. We present a unique case of a patient with placement a metal ... ...

Abstract	Objectives: Metal hypersensitivity reaction to surgical implants is a well- known phenomenon that is associated with pain, swelling, inflammation, and decreased efficacy of the implant. We present a unique case of a patient with placement a metal Jackson tracheostomy tube that led to expeditious total subglottic stenosis. Methods: The patient was a 33-year old, severely atopic woman with history of asthma exacerbations requiring several intubations for acute respiratory failure with several subsequent tracheal dilations with steroid injections, and eventual tracheostomy placement with a metal Jackson tracheostomy tube that led to expeditious total subglottic stenosis. Results: Initial intervention included performing an airway evaluation, CO Conclusions: Metal hypersensitivity reactions are well known phenomena as it relates to surgical implants in other surgical specialties but are seldom reported within the ear, nose and throat literature. Oftentimes, it takes astute observation to diagnose and establish a connection. Prompt recognition and treatment can be acquired from interdisciplinary collaboration with allergy.
MeSH term(s)	Adult ; Carbon Dioxide ; Constriction, Pathologic/surgery ; Female ; Humans ; Hypersensitivity/complications ; Intubation, Intratracheal/adverse effects ; Laryngostenosis/etiology ; Laryngostenosis/surgery ; Steroids ; Tracheal Stenosis/diagnosis ; Tracheal Stenosis/etiology ; Tracheal Stenosis/surgery ; Tracheostomy/adverse effects ; Tracheostomy/methods
Chemical Substances	Steroids ; Carbon Dioxide (142M471B3J)
Language	English
Publishing date	2022-01-06
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	120642-4
ISSN	1943-572X ; 0003-4894
ISSN (online)	1943-572X
ISSN	0003-4894
DOI	10.1177/00034894211070135
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Article ; Online: Optimizing iron supplementation by monitoring serum ferritin levels in premature infants.

Lamport, L / Schanler, R / Weinberger, B

Journal of neonatal-perinatal medicine

2022 Volume 15, Issue 3, Page(s) 567–574

Abstract: ... practice was to supplement 2 mg/kg/d Fe for all preterm infants receiving human milk when they achieved ... when full feeds were achieved, and then every 2 weeks. Fe was started at 2 mg/kg/d or continued at current ... dose for ferritin 40-300μg/L, increased by 1-2 mg/kg/d for < 40μg/L, or discontinued for > 300μg/L ...

Abstract	Background: Iron (Fe) is essential for growth, but optimal intake is controversial. Our NICU practice was to supplement 2 mg/kg/d Fe for all preterm infants receiving human milk when they achieved full feeding volume. Adjusting Fe supplementation based on ferritin levels is thought to better address physiologic requirements. Our objective was to assess the impact of therapeutic monitoring of ferritin levels on the initiation and dosing of iron supplementation, hematocrit, transfusions, and oxygen radical diseases in preterm infants. Methods: Preterm infants (< 32 weeks gestation, n = 100) were included. Ferritin was measured when full feeds were achieved, and then every 2 weeks. Fe was started at 2 mg/kg/d or continued at current dose for ferritin 40-300μg/L, increased by 1-2 mg/kg/d for < 40μg/L, or discontinued for > 300μg/L. Outcomes were compared with a historical control group. Results: Ferritin levels were not predictable by dietary or transfusion histories. Using the ferritin protocol, 70% of infants received Fe at the time of full feeds, compared to 100% of controls. In contrast, all infants received Fe 4 weeks later, compared to 87% of controls. Mean age at Fe initiation increased (14.8±6.3 to 21.0±11.76 days). Peak doses were higher, with 32% receiving > 2 mg/kg day by 6 weeks, with fewer transfusions. The incidence of bronchopulmonary dysplasia and necrotizing enterocolitis did not change. Conclusion: An iron protocol based on ferritin levels results in later initiation, higher doses, and fewer transfusions, without increasing oxygen radical diseases.
MeSH term(s)	Dietary Supplements ; Ferritins ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases ; Iron ; Reactive Oxygen Species
Chemical Substances	Reactive Oxygen Species ; Ferritins (9007-73-2) ; Iron (E1UOL152H7)
Language	English
Publishing date	2022-06-04
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2435387-5
ISSN	1878-4429 ; 1934-5798
ISSN (online)	1878-4429
ISSN	1934-5798
DOI	10.3233/NPM-210912
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Book ; Online: Mean Estimation in High-Dimensional Binary Markov Gaussian Mixture Models

Zhang, Yihan / Weinberger, Nir

2022

Abstract: ... _{*}\in\mathbb{R}^{d}$, multiplied by a random sign $ S_i $ ($1\le i\le n$), and corrupted by isotropic standard ... optimal (up to logarithmic factors) estimation error rate, as a function of $\|\theta_{*}\|,\delta,d,n$ ... inference. In this model, an estimator observes $n$ samples of a $d$-dimensional parameter vector $\theta ...

Abstract	We consider a high-dimensional mean estimation problem over a binary hidden Markov model, which illuminates the interplay between memory in data, sample size, dimension, and signal strength in statistical inference. In this model, an estimator observes $n$ samples of a $d$-dimensional parameter vector $\theta_{}\in\mathbb{R}^{d}$, multiplied by a random sign $ S_i $ ($1\le i\le n$), and corrupted by isotropic standard Gaussian noise. The sequence of signs $\{S_{i}\}_{i\in[n]}\in\{-1,1\}^{n}$ is drawn from a stationary homogeneous Markov chain with flip probability $\delta\in[0,1/2]$. As $\delta$ varies, this model smoothly interpolates two well-studied models: the Gaussian Location Model for which $\delta=0$ and the Gaussian Mixture Model for which $\delta=1/2$. Assuming that the estimator knows $\delta$, we establish a nearly minimax optimal (up to logarithmic factors) estimation error rate, as a function of $\\|\theta_{}\\|,\delta,d,n$. We then provide an upper bound to the case of estimating $\delta$, assuming a (possibly inaccurate) knowledge of $\theta_{}$. The bound is proved to be tight when $\theta_{}$ is an accurately known constant. These results are then combined to an algorithm which estimates $\theta_{*}$ with $\delta$ unknown a priori, and theoretical guarantees on its error are stated.
Keywords	Mathematics - Statistics Theory ; Computer Science - Information Theory ; Computer Science - Machine Learning
Subject code	519
Publishing date	2022-06-06
Publishing country	us
Document type	Book ; Online
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Article: Prediction of intrapartum fever using continuously monitored vital signs and heart rate variability.

Debnath, Shubham / Koppel, Robert / Saadi, Nafeesa / Potak, Debra / Weinberger, Barry / Zanos, Theodoros P

Digital health

2023 Volume 9, Page(s) 20552076231187594

Abstract: Objectives: Neonatal early onset sepsis (EOS), bacterial infection during the first seven days of life, is difficult to diagnose because presenting signs are non-specific, but early diagnosis before birth can direct life-saving treatment for mother and ... ...

Abstract	Objectives: Neonatal early onset sepsis (EOS), bacterial infection during the first seven days of life, is difficult to diagnose because presenting signs are non-specific, but early diagnosis before birth can direct life-saving treatment for mother and baby. Specifically, maternal fever during labor from placental infection is the strongest predictor of EOS. Alterations in maternal heart rate variability (HRV) may precede development of intrapartum fever, enabling incipient EOS detection. The objective of this work was to build a predictive model for intrapartum fever. Methods: Continuously measured temperature, heart rate, and beat-to-beat RR intervals were obtained from wireless sensors on women ( Results: Fever (>38.0 °C) was detected by manual or continuous measurements in 48 women. Compared to afebrile mothers, average SDNN and RMSSD in febrile mothers decreased significantly ( Conclusions: HRV-based predictive models could identify mothers at risk for fever and infants at risk for EOS, guiding maternal antibiotic prophylaxis and neonatal monitoring.
Language	English
Publishing date	2023-07-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	2819396-9
ISSN	2055-2076
ISSN	2055-2076
DOI	10.1177/20552076231187594
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Article ; Online: Assessing the causal effects of a stochastic intervention in time series data: are heat alerts effective in preventing deaths and hospitalizations?

Wu, Xiao / Weinberger, Kate R / Wellenius, Gregory A / Dominici, Francesca / Braun, Danielle

Biostatistics (Oxford, England)

2023 Volume 25, Issue 1, Page(s) 57–79

Abstract: The methodological development of this article is motivated by the need to address the following scientific question: does the issuance of heat alerts prevent adverse health effects? Our goal is to address this question within a causal inference ... ...

Abstract	The methodological development of this article is motivated by the need to address the following scientific question: does the issuance of heat alerts prevent adverse health effects? Our goal is to address this question within a causal inference framework in the context of time series data. A key challenge is that causal inference methods require the overlap assumption to hold: each unit (i.e., a day) must have a positive probability of receiving the treatment (i.e., issuing a heat alert on that day). In our motivating example, the overlap assumption is often violated: the probability of issuing a heat alert on a cooler day is near zero. To overcome this challenge, we propose a stochastic intervention for time series data which is implemented via an incremental time-varying propensity score (ItvPS). The ItvPS intervention is executed by multiplying the probability of issuing a heat alert on day $t$-conditional on past information up to day $t$-by an odds ratio $\delta_t$. First, we introduce a new class of causal estimands, which relies on the ItvPS intervention. We provide theoretical results to show that these causal estimands can be identified and estimated under a weaker version of the overlap assumption. Second, we propose nonparametric estimators based on the ItvPS and derive an upper bound for the variances of these estimators. Third, we extend this framework to multisite time series using a spatial meta-analysis approach. Fourth, we show that the proposed estimators perform well in terms of bias and root mean squared error via simulations. Finally, we apply our proposed approach to estimate the causal effects of increasing the probability of issuing heat alerts on each warm-season day in reducing deaths and hospitalizations among Medicare enrollees in 2837 US counties.
MeSH term(s)	Aged ; Humans ; United States ; Time Factors ; Hot Temperature ; Medicare ; Propensity Score ; Hospitalization
Language	English
Publishing date	2023-02-23
Publishing country	England
Document type	Meta-Analysis ; Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	2031500-4
ISSN	1468-4357 ; 1465-4644
ISSN (online)	1468-4357
ISSN	1465-4644
DOI	10.1093/biostatistics/kxad002
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