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Objective:  This study aimed to assess thermoregulation and humidity within the Skincubator-a novel, wearable skin-to-skin incubator designed to attach to the caregiver., Study Design:  Preterm neonates (PN; born between 24 and 33 weeks gestational age [GA]) received skin-to-skin care (SSC) either via the Skincubator or traditional SSC (t-SSC) with continuous axillary temperature monitoring., Results:  Twenty PN were enrolled in the study and treated in the Skincubator. One couple who consented to Skincubator care during delivery subsequently revoked their consent and the baby was excluded from further analysis. Fifty-four paired sessions of Skincubator and t-SCC were performed and compared for 19 babies. The average GA was 29 weeks (range: 26-32), the average weight was -1,296 ± 271 g, and the average day of life was 5 ± 2. The temperature drop after transfer to Skincubator care was smaller than in t-SSC (0.2°C [0.2-0.3] vs. 0.4°C [0.3-0.6]; Wilcoxon's signed rank test [WSRT], p  < 0.001). The average hypothermia time per session was a median (25th-75th%) of 8.2 minutes (0-9) for Skincubator, compared to 27.8 minutes (0-56) for t-SSC, respectively (WSRT, p  = 0.002). No baby had moderate hypothermia (35.5-35.9°C) during Skincubator care as compared with eight babies who experienced moderate hypothermia during t-SSC (Fisher's exact test p  = 0.003). The average Skincubator humidity was 85 ± 7% and was above 70% during 93% of the time., Conclusion:  Skincubator SSC was superior to t-SSC in maintaining PN temperature while also maintaining an optimally humidified environment. The Skincubator may promote early SSC in very and extremely PN. (Trial registration number MOH&#95;2021-12-13&#95;010470 registration date 24/10/21.) KEY POINTS: · Early prolonged SSC improves preterm infants' outcomes but may be challenging to perform.. · To mitigate several SSC barriers we invented the Skincubator, a wearable incubator for SSC.. · We have shown that the Skincubator reduces transient moderate hypothermia at SSC initiation.. · Average Skincubator humidity was 85 ± 7% and above 70% during 93% of SSC time.., Competing Interests: I.N. is the inventor of the Skincubator and a founder and the chief medical officer of Skincubator Neocare, a company founded to develop the Skincubator and bring it to clinical use. He and Skincubator Neocare have submitted patents regarding the Skincubator system. Other authors do not have any conflict of interest., (Thieme. All rights reserved.)

Background: Whether non-syndromic connective tissue hyperlaxity is associated with myopia is unknown. The aim of this study was to examine the association between systemic signs of tissue hyperlaxity and myopia among adolescents., Methods: Included were adolescents assessed before mandatory military service at the age of 16-18 years between 2011 and 2022. Diagnoses of hernias, pes planus, genu varus, genu valgum, and scoliosis, as well as joint injuries were used as surrogate markers for tissue hyperlaxity. The prevalence of these events among adolescents with myopia was evaluated and compared to the non-myopic population., Results: Included were 920 806 adolescents. The mean age was 17.4 ± 1.4 years and 58.6% were men. Myopia was diagnosed in 290 759 adolescents (31.6%) and high myopia in 24 069 adolescents (2.6%). The prevalence of hernias was higher among adolescents with myopia, (2.76%, 95% confidence interval (95% CI): 2.69%-2.82% vs. 2.60%, 95% CI: 2.57%-2.65%), as were pes planus (14.92%, 95% CI: 14.79-15.05 vs. 13.51%, 95% CI: 13.42-13.59) and scoliosis (9.14%, 95% CI: 9.03-9.24 vs. 7.69%, 95%CI: 7.62-7.76). The prevalence of joint injuries was clinically similar between groups (less than 0.1% difference for ankle, shoulder, and knee injuries), as were genu varum and genu valgum (0.66%, 95%CI: 0.64%-0.69% vs. 0.68%, 95% CI: 0.66-0.70, respectively). Adjusted for possible confounders results remained consistent., Conclusions: Among a large sample of Israeli adolescents, those with myopia had a higher prevalence of hernias, pes planus, and scoliosis. These results could suggest a propensity for systemic conditions related to tissue laxity among myopic adolescents., (© 2024 Royal Australian and New Zealand College of Ophthalmologists.)

Background: Traumatic spinal injuries (TSI) pose a significant life-long burden, impacting both military and civilian populations. Assessing long-term outcomes is crucial for comprehending the enduring consequences of the initial insult and informing effective prevention and management strategies. Most existing studies have narrowly focused on subsets of traumatic cord injuries, leaving a gap in understanding the broader impact of severe spinal trauma. This study aims to examine severe TSIs in military personnel, who may face unique risk factors and injury patterns, and its association with long-term disability., Methods: A retrospective cohort study was conducted on all military personnel who suffered traumatic injuries (Injury Severity Score ≥ 9) from 1997 to 2020. Severe spinal injuries were defined using the spinal Abbreviated Injury Scale ≥ 3 (n = 95), and compared to all other injuries as a reference group (n = 1,394). Data were extracted and cross-referenced from three distinct nationwide registries-pre-hospital, admission, and rehabilitation. Logistic regression analysis was used to evaluate the impact of spinal injuries on long-term disabilities (defined as the highest possible disability tier). The study received approval from the institutional review board of the Israel Defense Forces Medical Corps., Results: Motor vehicle accidents and falls were the primary causes of spinal injuries (50.5% and 15.8%, respectively). The median age at injury was 20 years (interquartile range 19-22). Personnel with spinal trauma had a significantly higher prevalence of Injury Severity Score  ≥ 25 (46.3% vs. 19.9%, P < .001), longer median hospital stays (11 vs. 8 days, P = .036), and increased intensive care unit admissions (55% vs. 40%, P = .05). The median follow-up duration was 10.9 years (interquartile range 6.7-14.3). Spinal injuries were associated with a more than 10-fold increase in the adjusted odds ratio for severe permanent disability (11.92, 95% CI, 5.95-23.72)., Conclusion: Upon long-term follow-up, military personnel with severe TSI exhibit a significantly higher prevalence of debilitating disability compared to those with significant non-spinal traumatic injuries. These findings highlight the critical need for targeted prevention strategies and improved management of spinal injuries to reduce long-term disability. Strengths of this study include its extensive follow-up period and the use of multiple nationwide registries. However, the study may be limited by potential discrepancies in identity matching across databases and the reliance on disability claims, which may underrepresent the true prevalence of long-term disability. Future research should explore the efficacy of early interventions and rehabilitation strategies in mitigating long-term disability following spinal injuries. This study underscores the importance of developing evidence-based policies to enhance care for individuals with TSIs., (© The Association of Military Surgeons of the United States 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site–for further information please contact journals.permissions@oup.com.)

Background: Existing research on the relationship between body mass index (BMI) and astigmatism yields inconsistent results. This study analyses this association in a nationally representative sample of adolescents., Methods: This retrospective, cross-sectional study included Israeli adolescents who underwent medical assessments before mandatory military service between 2011 and 2022. BMI was categorised based on the US age- and sex-matched percentiles. Astigmatism was categorised by magnitude [low-moderate: 0.75 to <3.00 diopters (D), high: ≥3.00 D], and axis orientation [with-the-rule (WTR), against-the-rule (ATR), or oblique (OBL)]. Sex-stratified regression models adjusted for sociodemographic variables were used., Results: Of 935 989 adolescents evaluated, 887 325 were included [511 465 (57.6%) males, mean age 17.2 years]. Astigmatism was diagnosed in 123 675 (13.9%) adolescents, of whom 117 081 (13.2%) had low-moderate and 6594 (0.7%) had high astigmatism. WTR astigmatism was the most prevalent (8.2%), followed by ATR (4.1%) and OBL (1.6%) types. Compared with low-normal BMI (5th to 50th percentile), the adjusted ORs for total astigmatism increased with increasing BMI, peaking at 1.65 (1.57-1.74) in males and 1.74 (1.64-1.86) in females with severe obesity. ORs were accentuated for high astigmatism, reaching 3.51 (3.01-4.09) in males, and 3.45 (2.83-4.22) in females with severe obesity. WTR astigmatism demonstrated the strongest association with BMI, with ORs reaching 2.26 (2.13-2.40) in males and 2.04 (1.90-2.20) in females with severe obesity. The results persisted in a series of subgroup analyses., Conclusions: Obesity is associated with higher odds of astigmatism in adolescence. Further investigation into the role of weight management in astigmatism development is warranted., (© 2024 The Author(s). Clinical & Experimental Ophthalmology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Ophthalmologists.)

Purpose: This study aims to investigate the relationship between the type and severity of refractive error and anisometropia development in preschool children., Design: Retrospective cohort study., Methods: Data from Maccabi Healthcare Services, Israel's second-largest Health Maintenance Organization (HMO), were analyzed. The study included all isometropic children aged 1 to 6 years, re-examined for refraction at least 2 years following their initial examination between 2012 and 2022. Anisometropia was defined as a ≥1 diopter interocular difference in spherical equivalent. Relationships were assessed using logistic regression models adjusted for key sociodemographic factors., Results: Among 33,496 isometropic children (51.2% male, mean age 3.2 ± 1.5 years), the prevalences of emmetropia, myopia, and hyperopia were 26.7% (n = 8944), 4.2% (n = 1397), and 69.1% (n = 23,155), respectively. Over a mean follow-up period of 5.1 ± 2.4 years, 2593 children (7.7%) were diagnosed with anisometropia. Adjusted odds ratios (ORs) for anisometropia gradually increased with baseline refractive error severity, reaching 13.90 (5.32-36.34) in severe myopia and 4.19 (3.42-5.15) in severe hyperopia. This pattern was also evident in cylindrical anisometropia, where ORs increased with greater baseline astigmatism, peaking at 12.10 (9.19-15.92) in children with high astigmatism (≥3 D). Associations remained consistent in sensitivity and subgroup analyses including across both sexes and when using a stricter anisometropia criterion., Conclusions: Children aged 1 to 6 years, initially without anisometropia but showing increasing severity of myopia, hyperopia, or astigmatism, are more likely to develop anisometropia. This underscores the importance of follow-up refractive measurements within this population to promptly diagnose and treat anisometropia and prevent potential visual complications., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: Previous research highlights the adverse effects of visual impairment (VI) on academic achievement in children, yet its impact on cognitive performance among adolescents and young adults remains under-studied. Therefore, this investigation aimed to analyse this association in a nationwide sample of Israeli adolescents., Methods: A retrospective population-based cross-sectional study was conducted among 1,410,616 Israeli-born adolescents aged 16-19 years, who were assessed before mandatory military service between 1993 and 2017. The definition of VI was based on best-corrected visual acuity (BCVA) measurements using a standard Snellen chart. Adolescents with BCVA worse than 6/9 in either or both eyes were classified as having unilateral or bilateral VI, respectively. Cognitive performance was measured using the General Intelligence Score (GIS), based on a validated four-domain test. Relationships were analysed using regression models yielding adjusted odds ratios (ORs) for low (<-1 standard deviation [SD]) and high (≥1 SD) cognitive Z-scores., Results: Of 1,410,616 adolescents (56.1% men), 13,773 (1.0%) had unilateral and 3980 (0.3%) had bilateral VI. Unilateral VI was associated with adjusted ORs for low and high cognitive Z-scores of 1.24 (1.19-1.30) and 0.84 (0.80-0.89), respectively. ORs were accentuated for bilateral VI, reaching 1.62 (1.50-1.75) and 0.81 (0.74-0.90) for low and high cognitive Z-scores, respectively. Cognitive performance subscores mirrored these results, with the visual-spatial functioning subtest demonstrating the greatest effect size. These associations persisted in sub-analyses restricted to adolescents with amblyopia-related VI, mild VI and unimpaired health status., Conclusions: Visual impairment, including mild and unilateral cases, is associated with reduced cognitive performance scores assessed in late adolescence. Further research is required to gain a comprehensive understanding of the dynamics underlying this relationship., (© 2024 The Authors. Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.)

Competing Interests: Competing interests: None declared.

Data regarding the contribution of COVID-19 vaccine rollouts to real-world uptake of influenza vaccination remains unclear. This cross-sectional survey-based study among Israel Defense Forces (IDF) soldiers aimed to assess the impact of the COVID-19 pandemic and specifically, previous COVID-19 vaccines uptake, on the intention to vaccinate for influenza during 2021-2022 season. Participants engaged in an online survey addressing vaccination history and current vaccine-related preferences. The survey was delivered prior to the initiation of the IDF's annual influenza immunization campaign. A multinomial logistic regression model was applied to analyze factors correlated with unwillingness to receive influenza vaccine. Overall, 825 invitations to participate in the survey were distributed and the overall response rate was 78.5%. Among the 648 participants who replied (61.6% males, median age of 20 years), 51.9% were willing to receive the upcoming influenza vaccine. Factors associated with vaccine reluctance included being female, not receiving the previous season's influenza vaccine, not having a previous diagnosis of COVID-19, and having decreased uptake of COVID-19 vaccines. Among participants not intending to receive an influenza vaccine, 50.3% stated that they are healthy and have no need for the vaccine and 36.2% stated they received too many vaccines over the previous year. The results of this study may suggest that influenza vaccination rates in the post-COVID-19 vaccine era may be reduced due to a perceived "vaccine saturation" phenomenon, owing to the density of COVID-19 vaccine administration. Future interventions such as campaigns related to maximizing influenza vaccination coverage should address repeated doses of COVID-19 vaccine administration.

Background: Previous research on the association between body mass index (BMI) and visual impairment (VI) in youth has reported inconsistent findings. We aimed to investigate this association in a national cohort of Israeli adolescents., Methods: This retrospective, population-based, cross-sectional study included 1 697 060 adolescents (56.4% men; mean age 17 years) who underwent mandatory pre-military service assessments from 1993 to 2017. BMI was classified based on the US age- and sex-matched percentiles. Unilateral or bilateral VI was classified as best-corrected visual acuity (BCVA) worse than 6/9 in either or both eyes, respectively. Sex-stratified regression models adjusted for sociodemographic variables were used to analyse the BMI-VI relationship., Results: Overall, 17 871 (1.05%) and 5148 (0.30%) adolescents had unilateral and bilateral VI, respectively. Compared with high-normal BMI (50th to 85th percentile), adjusted odds ratios (ORs) for unilateral and bilateral VI gradually increased with higher BMI, reaching 1.33 (1.13-1.55) and 1.80 (1.37-2.35) in men with severe obesity, and 1.51 (1.24-1.84) and 1.52 (1.08-2.14) in women with severe obesity, respectively. Men with underweight also had increased ORs for unilateral and bilateral VI (1.23; 1.14-1.33 and 1.59; 1.37-1.84, respectively), a pattern not observed in women (0.96; 0.86-1.07 and 1.02; 0.83-1.25, respectively). Results were maintained when the outcome was restricted to mild VI, as well as in subgroups of adolescents with unimpaired health and those without moderate-to-severe myopia., Conclusions: Abnormal BMI, and particularly obesity, is associated with increased OR for VI in late adolescence., (© 2023 The Authors. Pediatric Obesity published by John Wiley & Sons Ltd on behalf of World Obesity Federation.)

The purpose of this study is to examine the association between blepharoptosis and cognitive performance in late adolescence. This population-based, retrospective, cross-sectional study included 1,411,570 Israeli-born adolescents (620,107 women, 43.9%) aged 16-19 years who were medically examined before compulsory military service between 1993 and 2017. The diagnosis of blepharoptosis was verified by an ophthalmologist. Cognitive performance was assessed by a validated intelligence-quotient-equivalent test, comprising four domains (problem-solving, verbal abstraction and categorization, verbal comprehension, and mathematical abilities). Cognitive Z-scores were calculated and categorized as high (≥ 1 standard deviation (SD)), medium (- 1 to < 1 SD), and low (less than - 1 SD). Relationships were analyzed using regression models adjusted for sociodemographic variables including sex, year of birth, residential socioeconomic status, education level, body mass index, and familial country of origin. A total of 577 (41 per 100,000, 32.2% women) adolescents were diagnosed with blepharoptosis. The proportions of unilateral and bilateral visual impairment among adolescents with blepharoptosis were 13.0% and 3.5%, respectively. In a multivariable analysis, blepharoptosis was associated with a 0.18 SD reduction in cognitive Z-score (p < 0.001). The adjusted odds ratios for low and high cognitive Z-scores in adolescents with blepharoptosis were 1.54 (1.25-1.89) and 0.80 (0.62-1.04), respectively. This relationship persisted when adolescents with normal best-corrected visual acuity or unimpaired health status were analyzed separately.  Conclusions: Blepharoptosis is associated with reduced cognitive performance determined in late adolescence. Future prospective studies should investigate the causes of this link and their underlying mechanisms. What is Known: • While earlier investigations have examined the effects of blepharoptosis on vision and quality of life, the association between blepharoptosis and cognitive outcomes in youth has remained unexplored. What is New: • This nationwide study involving 1.4 million Israeli adolescents found a correlation between blepharoptosis and reduced cognitive performance. • Our findings suggest a potential interplay between blepharoptosis and cognitive development in the pediatric population, calling for increased focus on the educational needs of affected individuals., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: The application of myopia definition varies considerably within the literature. The purpose of this study was to examine the relationship between different myopia and high myopia definitions and resultant prevalence estimates., Methods: A population-based cross-sectional study of 1,588,508 Israeli adolescents assessed for medical fitness before mandatory military service at the age of 17 years between 1993 through 2015. Participants underwent non-cycloplegic autorefraction. Nine definitions of myopia and seven definitions of high myopia were examined. Prevalence estimates for each definition were calculated and compared with the reference definition (right eye spherical equivalent (SE)≤-0.50D and ≤-6.00D for myopia and high myopia, respectively), to yield a rate ratio (RR) across definitions., Results: Applying the right eye SE≤-0.50D reference definition yielded 31.0% myopia prevalence. While some definitions resulted in similar prevalence estimates, using the right eye SE of ≤-0.75D; ≤-1.00D or least minus meridian of ≤-0.75D definitions yielded 28.8%, 26.3%, and 26.9% myopia prevalence, respectively, which corresponded to a 7.1%, 15.1% and 13.4% reduction in myopia RR, respectively. The prevalence of high myopia demonstrated considerable alternations, with a 1.7-fold increase in prevalence for the narrower threshold of SE≤-5.00D compared with SE≤-6.00D reference definition (4.2% and 2.4%, respectively)., Conclusions: The prevalence of myopia and especially high myopia varies between frequently applied definitions, considering diverse thresholds, eye lateralization, and spherical vs. astigmatic refractive components. This variability highlights the pressing need for standardization of myopia definition in ophthalmic research. The results of this study provide crude estimates of a "conversion rate" across data, allowing comparisons between studies that utilize different myopia definitions.

Introduction: To this date, there is little known about the symptoms, their duration, and occupational implications of Coronavirus disease (COVID-19) in the military population. Decisions regarding implementing precaution measures are based on data deriving from the general population. Moreover, the Omicron variant seems to cause a disease with lesser severity than previous variants. We aimed to describe the clinical presentation and estimate the loss of workdays due to mild COVID-19 during an Omicron predominant wave among a young, healthy, and mostly vaccinated military population., Materials and Methods: A cross-sectional, survey-based study among IDF soldiers who replied to an online questionnaire following recovery from COVID-19. Data included self-reported vaccination status, symptoms presentation and duration, and service-related sick days. Student's t-test and chi-square test of independence were used to compare differences in continuous and categorical variables, respectively. A binary logistic regression analysis was performed to estimate the odds ratio and 95% CIs for prolonged symptom duration (4 days and above) by participants' characteristics. The IDF medical corps institutional review board approved this study., Results: A total of 199 soldiers, with a mean age of 21.9 years, were included in the study. Upper respiratory tract symptoms, headache, and constitutional symptoms were found to be the most common among symptomatic soldiers. The median reported time for inability to continue the daily routine, including work, was 5 days [Interquartile range (IQR), 0-10]. Median duration of symptoms was 4 days (IQR, 0-10). In addition, women were found to have longer symptomatic disease (odds ratio = 2.34; 95% CI, 1.20-4.52)., Conclusions: Our findings demonstrate that even among a young and fully vaccinated population, COVID-19 caused by the Omicron variant may result in substantial medical leave from military service, compared to common cold or influenza virus infection. Our study sample was relatively small; however, the response rate was high and our results shed light on the yet-to-be fully characterized Omicron variant-related COVID-19. Despite the current common perception of COVID-19 as a self-limiting mild disease with low burden of symptoms, our findings show the potential occupational burden of infection with COVID-19 on military units and their readiness and could be considered when discussing public health restrictions and further steps taken to minimize outbreaks ramifications., (© The Association of Military Surgeons of the United States 2022. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: Minimally Invasive Surfactant Treatment (MIST) is a common method for administering surfactant as a treatment for respiratory distress syndrome. However, tracheal catheter placement can be difficult to confirm. We assessed the presence of carbon dioxide (CO 2 ) in tracheal and esophageal gas aspirated using CO 2 detector., Study Design: Retrospective arm: 20 infants, MIST catheter placement was assessed with a CO 2 detector in two techniques and confirmed with clinical response. Prospective arm-10 infants, aimed to check for CO 2 presence in aspirated esophageal gas during routine nasogastric tube insertion., Results: Retrospective arm: All infants had positive capnography. One infant that had no clinical response to MIST was diagnosed with total anomalous pulmonary venous return. All 10 infants of the prospective arm had a Negative capnography (P < 0.001, Fisher's exact test)., Conclusions: Readily available CO 2 detectors can distinguish between tracheal and esophageal placement of MIST catheters prior to MIST., (© 2023. The Author(s), under exclusive licence to Springer Nature America, Inc.)

The surge of breakthrough COVID-19 among fully vaccinated individuals has raised the prospects of booster dose administration. In Israel, concerns of waning immunity and dominance of the B.1.617.2 (delta) variant resulted in approval of a third-dose (booster) vaccination for the entire eligible population starting on August 29, 2021. This study aims to evaluate vaccine uptake for booster doses among a population of previously vaccinated individuals during a rapid rollout and to analyze socio-demographic characteristics associated with vaccine uptake. A cross-sectional study among Israel Defense Forces soldiers with high access to booster doses of BNT162b2. Subjects eligible for booster doses were voluntarily vaccinated at three vaccine sites constructed within soldiers' bases. We analyzed associations between subjects' socio-demographic characteristics and booster vaccine uptake at the culmination of vaccine rollout using logistic regression models. 1157 soldiers from an IDF brigade were eligible for third dose vaccination (received second dose > 5-months before rollout), with 978 (84.5%) receiving a third, booster dose during the study's timeframe. Subjects' median age was 20.5 (IQR 19.7-21.5) and 791 (68.4%) were male. Notable socio-demographic characteristics associated with increased vaccine uptake in a multivariable model included increased age (OR 1.16, 95% CI 1.02-1.31), high socio-economic status (OR 2.12, 95% CI 1.25-3.59) and female sex (OR 1.87, 95% CI 1.26-2.74). Below-average cognitive function score was associated with decreased vaccine uptake (OR 0.61, 95% CI 0.39-0.95). This study demonstrates that real-world vaccine hesitancy remains a major obstacle, even among a population previously acceptant to COVID-19 vaccines. Decreased uptake for vaccines may be associated with socio-demographic variables in-spite of high-access vaccine rollouts. Reasons for vaccine hesitancy among previously vaccinated individuals, along with the benefits of population-wide booster administration should be further investigated., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

On average, arterial oxygen saturation measured by pulse oximetry (SpO 2 ) is higher in hypoxemia than the true oxygen saturation measured invasively (SaO 2 ), thereby increasing the risk of occult hypoxemia. In the current article, measurements of SpO 2 on 17 cyanotic newborns were performed by means of a Nellcor pulse oximeter (POx), based on light with two wavelengths in the red and infrared regions (660 and 900 nm), and by means of a novel POx, based on two wavelengths in the infrared region (761 and 820 nm). The SpO 2 readings from the two POxs showed higher values than the invasive SaO 2 readings, and the disparity increased with decreasing SaO 2 . SpO 2 measured using the two infrared wavelengths showed better correlation with SaO 2 than SpO 2 measured using the red and infrared wavelengths. After appropriate calibration, the standard deviation of the individual SpO 2 -SaO 2 differences for the two-infrared POx was smaller (3.6%) than that for the red and infrared POx (6.5%, p < 0.05). The overestimation of SpO 2 readings in hypoxemia was explained by the increase in hypoxemia of the optical pathlengths-ratio between the two wavelengths. The two-infrared POx can reduce the overestimation of SpO 2 measurement in hypoxemia and the consequent risk of occult hypoxemia, owing to its smaller increase in pathlengths-ratio in hypoxemia.

Objective: The study aimed to assess the association of nucleated red blood cells (NRBC), a surrogate of intrauterine hypoxia, and elevated pulmonic vascular resistance (E-PVR) and oxygen requirement after minimally invasive surfactant therapy (MIST)., Study Design: Retrospective study of a cohort of preterm neonates that received MIST in a single unit., Results: NRBC were measured in 65 of 75 (87%) neonates administered MIST during the period. In total, 22 of 65 (34%) infants had pre-MIST echocardiography (ECHO).Neonates with elevated NRBC (predefined as >5 × 10 9 /L, n  = 16) required higher post-MIST fraction of inspired oxygen (FiO 2 ) than neonates with normal NRBC (<1 × 10 9 /L, n  = 17; FiO 2  = 0.31 ± 0.10 and 0.24 ± 0.04, respectively, p  = 0.02).NRBC correlated positively with % of time in right to left ductal shunt (r = 0.51, p  = 0.052) and inversely with right ventricular stroke volume (r = -0.55, p  = 0.031) and time to peak velocity to right ventricular ejection time ratio (r = -0.62, p  < 0.001)., Conclusion: Elevated NRBC are associated with elevated FiO 2 after MIST and elevated E-PVR. Intrauterine hypoxia may impact postnatal circulatory adaptations and oxygen requirement., Key Points: · Post-MIST FiO2 requirements are significantly higher in infants with elevated NRBC.. · NRBC correlates positively with elevated PVR in neonates requiring.. · Intrauterine hypoxia may play a role in postnatal circulatory adaptations in neonates with RDS.., Competing Interests: None declared., (Thieme. All rights reserved.)

Personalized management of diseases by considering relevant patient features enables optimal treatment, instead of management according to an average patient. Precision management of hypertension is important, because both susceptibility to complications and response to treatment vary between individuals. While the use of genomic and proteomic personal features for widespread precision hypertension management is not practical, other features, such as age, ethnicity, and cardiovascular diseases, have been utilized in guidelines for hypertension management. In precision medicine, more blood-pressure-related clinical and physiological characteristics in the patient's profile can be utilized for the determination of the threshold of hypertension and optimal treatment. Several non-invasive and simple-to-use techniques for the measurement of hypertension-related physiological features are suggested for use in precision management of hypertension. In order to provide precise management of hypertension, accurate measurement of blood pressure is required, but the available non-invasive blood pressure measurement techniques, auscultatory sphygmomanometry and oscillometry, have inherent significant inaccuracy-either functional or technological-limiting the precision of personalized management of hypertension. A novel photoplethysmography-based technique for the measurement of systolic blood pressure that was recently found to be more accurate than the two available techniques can be utilized for more precise and personalized hypertension management.

This report describes a case of central serous chorioretinopathy (CSCR) occurring following cessation of terbinafine treatment. A 51-year-old man presented for a routine ophthalmic examination. He was treated with oral terbinafine for onychomycosis up to 3 months before the presentation. Spectral-domain optical coherence tomography (OCT) showed extrafoveal subretinal fluid in both eyes with small underlying pigment epithelial detachments. There were no additional relevant findings in the patient history or ocular examination. A diagnosis of CSCR was made. After 10 weeks without treatment, OCT demonstrated almost complete resolution of subretinal fluid in both eyes. The exact key ingredients of the perfect storm leading to CSCR in young, healthy individuals are still unknown. Here, we describe, to our knowledge, the first documented case, where the appearance of CSCR was apparently triggered by cessation of antifungal treatment. This unusual case may provoke further research that will bring us closer to understanding the mechanism behind the appearance of CSCR. It may also widen the scope of the routine anamnesis when dealing with patients newly diagnosed with this enigmatic condition., Competing Interests: The authors have no conflicts of interest to declare., (© 2022 The Author(s). Published by S. Karger AG, Basel.)

Consumers tend to have negative perceptions of service providers that limit their freedom. People might therefore be expected to respond particularly negatively to service providers that physically limit their freedom of movement. Yet, we suggest that physical constraints that a service provider unapologetically imposes with no obvious logical justification (e.g., closing a door and restricting consumers to stay inside a room) may, in fact, boost consumers' evaluations of the service provider. We propose that this effect occurs because consumers perceive such constraints as creating a structured environment, which they inherently value. Six studies lend converging support to these propositions, while ruling out alternative accounts (cognitive dissonance, self-attribution theory). We further show that the positive effect of physical constraints on evaluations is reversed when consumers perceive the constraints as excessively restrictive (rather than mild). These findings suggest that service providers may benefit from creating consumption conditions that mildly restrict consumers' freedom of movement., Competing Interests: The authors have declared that no competing interests exist.

Objective: This study analyzed the association between adolescent BMI and myopia severity., Methods: This cross-sectional study comprised 1,359,153 adolescents who were medically examined before mandatory military service. Mild-to-moderate and high myopia were defined based on right-eye refractive data. BMI was categorized based on the US age- and sex-matched percentiles. Logistic regression models were applied separately for women and men to estimate odds ratios (ORs) for myopia per BMI category., Results: A total of 318,712 adolescents had mild-to-moderate myopia and 23,569 had high myopia. Compared with low-normal BMI (reference group), adjusted ORs for mild-to-moderate and high myopia increased with increasing BMI status, reaching 1.39 (95% CI: 1.23-1.57) and 1.73 (95% CI: 1.19-2.51) for men with severe obesity, respectively, and 1.19 (95% CI: 1.12-1.27) and 1.38 (95% CI: 1.14-1.65) for women with mild obesity, respectively. ORs for mild-to-moderate and high myopia were also higher in men with underweight (OR = 1.20; 95% CI: 1.18-1.23 and OR = 1.39; 95% CI: 1.30-1.47) and women with underweight (OR = 1.06; 95% CI: 1.03-1.09 and OR = 1.12; 95% CI: 1.04-1.22). The overall size effect was greater for men than women (p interaction  < 0.001), in whom the group with severe obesity did not reach statistical significance., Conclusions: BMI was associated with myopia in a J-shaped pattern, with the size effect being greater for adolescent men than women. This study indicates that both low BMI and high BMI are associated with mild-to-moderate and severe myopia., (© 2022 The Obesity Society.)

Purpose of the Review: To perform a systematic review of prospective clinical trials to determine whether improving vitamin D status improves asthma control., Recent Findings: In cross sectional studies suboptimal viramin D status is often associated with poor asthma control. However, decreased 25-hydroxycholecalciferol (25 (OH) D) concentrations might not be causally associated with asthma control. We performed a systematic review until December 15, 2021 according to PRISMA guideline, searching MEDLINE, MEDLINE In-Process, Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials. Two searches were performed, the first using "vitamin D" and the second using "Vitamin D" or "ergocalciferol" or "cholecalciferol" and "Asthma". From 419 retrieved papers, after removal of duplicate and after using exclusion criteria, 28 full-text articles were eligible, of which 6 remained for quantitative analysis and 11 (9 studies) for qualitative analysis. From both analyses, prospective studies do not support that improving the vitamin D status of asthmatic children improves asthma control., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

To evaluate the efficacy of dual patent ductus arteriosus (PDA) pharmacotherapy compared to monotherapy we searched Medline, Embase, Cochrane Library, and references of relevant articles through October 20, 2021 for randomized clinical trials (RCTs) and cohort studies comparing dual PDA treatment vs. monotherapy. Data were analyzed using a fixed effects model. The fixed effects model assumes that all studies included in a meta-analysis are estimating a single true underlying effect, that of ductal closure. Primary outcome was ductal closure; secondary outcome was surgical ligation. Of 170 articles retrieved, three cohort studies and two RCTs were included, totaling 470 patients: 384 babies received monotherapy and 86 dual therapy. Because of the small numbers, RCTs and cohort studies were pooled for analysis. Ductus closed in 67% of those who received combination compared with 58% those with monotherapy. Overall fixed effect shows an OR of 1.97 [1.10; 3.53; p = 0.023] favoring dual therapy. Dual pharmacologic treatment appears more effective than monotherapy. Future well-powered, high-quality, prospective RCTs are needed to further investigate this potential approach., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Cardiac output (CO) assessment in neonates is commonly done by echocardiography. It is unclear which is the best site to measure the left ventricular (LV) outflow tract for CO assessment (the aortic valve [AV] aortic sinus [AS] or the sinotubular junction [STJ]). In the normal heart, the blood flow entering the LV equals the blood ejected from it. Therefore, measuring the blood flow into the LV through the mitral valve (MV) is an alternative way to measure CO., Methods: In stable preterm infants the MV CO was compared with the right ventricular (RV) CO and the three ways to measure LV CO, in 30 stable preterm neonates. Interobserver variability for MV CO was established., Results: In the 30 neonates studied, MV CO was best correlated and had a minimal bias to the RV CO and LV CO measured at the STJ. Left ventricular CO measured at the AV and AS had significant bias relative to RV CO and MV CO. MV CO inter-observer variability was similar to other echocardiographic CO assessment methods., Conclusion: MV CO may be used as an alternative way to assess CO. The STJ may be the optimal site to measure LV outflow tract., (© 2022 Wiley Periodicals LLC.)

Aims: To study paracetamol (PCM) use as first line therapy for significant patent ductus arteriosus (sPDA) closure, stratified by echocardiography., Methods: In this retrospective observational study, a prepublished score comprising PDA size and velocity, PDA:left pulmonary artery ratio, diastolic flow in main and LPA, LA:Ao ratio and left ventricular:aortic ratio were included for shunt severity. Successful closure was defined a priori as closure or ≥50% reduction in score. Comparisons were made between infants with sPDA who were treated and not treated., Results: During November 2017-2018, 227 infants from 23 to 31 +6 weeks' gestational age (GA) were admitted; 50 (22%) infants were diagnosed with PDA, 32 treated with PCM, overall treatment rate of 32/227 (14%). Successful therapy was noted in 23/32 (72%) and was higher when treated at ≤7 days (80 versus 68%, p  = .68), in infants >26 weeks GA (62.5 versus 100%, p  = .07) and BW >1000 g (65.4 versus 100%, p  = .14). Univariate analysis noted statistical significance only for GA. Eighteen infants were managed conservatively. Treated infants had a lower GA and BW, higher composite ECHO score (14.4 ± 0.5 versus 19 ± 0.4, p  < .001)., Conclusions: Composite scoring helped reduce exposure, and focus more on infants with lower GA and BW with greater shunt severity.

Background: Amblyopia, when not diagnosed at appropriate age, leads to uncorrectable visual impairment with considerable social and financial implications. The aim of this study was to assess socio-demographic disparities in amblyopia prevalence among Israeli adolescents, in order to identify susceptible groups in the population., Methods: A nationwide, population-based, cross-sectional study of Israeli adolescents examined between 1993 and 2017. All study participants underwent visual acuity examination with socio-demographic data and previous medical history documented. Associations were analyzed using univariable and multivariable logistic regression models., Results: Among 1 334 650 Israeli-born candidates aged 17.15±0.26 years, amblyopia was diagnosed in 1.07%. The overall prevalence of amblyopia has declined from 1.59% in 1993 to 0.87% in 2017. Being in the lowest socioeconomic status and below average cognitive function scores increased the odds of amblyopia in both males [odds ratio (OR) 1.64, 95% confidence interval (CI) 1.45-1.87; OR 1.27, 95% CI 1.19-1.35, respectively] and females (OR 1.61, 95% CI 1.30-1.98; OR 1.27, 95% CI 1.18-1.36, respectively). Among males, Orthodox and ultra-Orthodox educational systems were associated with increased odds of amblyopia (OR 1.16, 95% CI 1.09-1.25; OR 1.90, 95% CI 1.73-2.09). A significantly higher prevalence of amblyopia was recorded among 219 983 immigrants (1.51%, P<0.001)., Conclusions: Although the overall prevalence of amblyopia has decreased during the observed years, we found substantial evidence of socio-demographic disparities in amblyopia prevalence among adolescents, suggesting disparities in the prevention of the disease and its treatment. Demonstration of inequities at a national level could aid future guidance of health policy and augment current vision screening programs., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Vaccine hesitancy is an obstacle to achieving high vaccination rates for COVID-19. Current knowledge on vaccine uptake is mostly based on hypothetical intention to vaccinate surveys. We compared intention to vaccinate and real-world vaccine uptake among 511 soldiers in a military unit during an unrestricted, on-site COVID-19 vaccine rollout. Soldiers were offered group lectures, on-site consultations and primary care office visits, discussing concerns on vaccination with a primary care physician. Overall, 359 (70.3%) soldiers participated in the group lectures, 33 (6.5%) in on-site consultations and 19 (3.7%) attended primary care visits. Overall, 459 (89.8%) of 511 soldiers vaccinated for COVID-19. Of the 90 soldiers initially refusing, 38 (42.2%) had agreed to receive a vaccine. On-site COVID-19 vaccine rollout joined with primary care communication interventions may maximize vaccine uptake within a young-adult community. Future studies should evaluate the effectiveness of these efforts across different populations in a controlled and comparative manner., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Adequate oxygen delivery to a tissue depends on sufficient oxygen content in arterial blood and blood flow to the tissue. Oximetry is a technique for the assessment of blood oxygenation by measurements of light transmission through the blood, which is based on the different absorption spectra of oxygenated and deoxygenated hemoglobin. Oxygen saturation in arterial blood provides information on the adequacy of respiration and is routinely measured in clinical settings, utilizing pulse oximetry. Oxygen saturation, in venous blood (SvO 2 ) and in the entire blood in a tissue (StO 2 ), is related to the blood supply to the tissue, and several oximetric techniques have been developed for their assessment. SvO 2 can be measured non-invasively in the fingers, making use of modified pulse oximetry, and in the retina, using the modified Beer-Lambert Law. StO 2 is measured in peripheral muscle and cerebral tissue by means of various modes of near infrared spectroscopy (NIRS), utilizing the relative transparency of infrared light in muscle and cerebral tissue. The primary problem of oximetry is the discrimination between absorption by hemoglobin and scattering by tissue elements in the attenuation measurement, and the various techniques developed for isolating the absorption effect are presented in the current review, with their limitations.

Objectives: To ascertain the impact of skin-to-skin care between parents and infants on cardiac function and cerebral blood flow in preterm infants., Study Design: We undertook a prospective study of 40 self-ventilating preterm infants at a quaternary center and assessed cardiac performance and cerebral blood flow. Assessments were carried out two hours before skin-to-skin care and then 60 minutes after skin-to-skin care (with the infant still on parent and turned supine)., Results: Infants were 30.5 ± 0.6 weeks' gestational age and 1378 ± 133 g birthweight. Axillary temperature noted a nonsignificant increase during skin-to-skin care from 36.7 ± 0.07°C to 36.9 ± 0.07°C (P = .07). Cardiac contractility (right ventricular fractional area change [26.5% ± 0.3% vs 27.8% ± 0.4; P < .001] and tricuspid annular plane systolic excursion [0.73 ± 0.03 cm vs 0.77 ± 0.03 cm; P = .02]) increased significantly, coincident with decreased measures of pulmonary vascular resistance. An increase in systemic cardiac output was associated with increased cerebral blood flow and reduced middle cerebral artery resistive index (0.81 ± 0.02 vs 0.74 ± 0.02; P = .0001)., Conclusions: We documented a significant circulatory beneficial adaptation to a common neonatal practice. These findings align with previously documented physiologic benefits in cardiorespiratory stability and cardiac rhythm in preterm infants, and may be mediated through modulation of the autonomic nervous system., (Copyright © 2020 Elsevier Inc. All rights reserved.)

We report an association between higher absolute nucleated red blood cells and mean corpuscular volume and idiopathic persistent pulmonary hypertension of the newborn in neonates with Down syndrome. Elevation of these blood indicies should prompt echocardiographic studies to monitor pulmonary arterial pressures., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: To assess changes in clinical condition and oxygenation in neonates after rewarming following moderate therapeutic hypothermia (MTH) for neonatal encephalopathy., Methods: Retrospective study of 28 neonates receiving MTH in a tertiary neonatal intensive care unit in Israel. We compared pre-and 24 h post-rewarming arterial oxygen saturation (SaO 2 ) as measured by the blood gases analyzer, pulse-oximetry saturation (SpO 2 ), and cardio-respiratory condition., Results: The SpO 2 declined from 96.9% (±2.9) before rewarming to 95.2% (±2.6) after rewarming (p < 0.001). Twelve neonates (42.9%) had clinical respiratory impairment (needing higher respiratory support or had new onset desaturations). In 16 neonates (57.1%) with no change in respiratory support after rewarming, SpO 2 decreased from 98.3 ± 1.9% to 95.6 ± 3.0% (p < 0.001) and SaO 2 decreased from 97.1 ± 1.7% to 96.0 ± 2.3% (p = 0.002). The mean SpO 2 decrease was greater than mean SaO 2 decrease (2.63 ± 1.8 and 1.1 ± 1.3 respectively, p = 0.021)., Conclusion: Neonates who underwent MTH showed reduction in oxygenation after rewarming either by decreasing SpO 2 or increasing FiO 2 requirements. The SpO 2 decline was larger than the SaO 2 decline. We suggest careful monitoring of neonates after rewarming., (Copyright © 2018. Published by Elsevier B.V.)

Background/objectives: The hemodynamically insignificant (hisPDA) ductus arteriosus often progresses to hemodynamic significance. In this review, we sought risk factors predictive of progression., Methods: Early hisPDAs were subdivided into those that closed spontaneously vs. those that progressed to hsPDA., Results: Sixty percent of early hisPDAs subsequently progressed to hsPDAs. In all but one, the ductus never closed, but rather became progressively more significant over time. The echocardiographic parameters best associated with subsequent progression were an increased transductal diameter (1.81 ± 0.77 vs. 1.21 ± 0.44 mm; p < 0.001) and the presence of diastolic flow reversal. ROC curve analysis showed that the best ductal diameter criterion for predicting the progression to hsPDA was >1.4 (sensitivity = 91; specificity = 81). The combined morbidity score was higher in those infants who progressed to hsPDA as compared with those who did not (p = 0.0038)., Conclusions: Increased ductal diameter and diastolic flow reversal on the first echocardiogram were best correlated with progression of hisPDA to hsPDA.

Oxygen saturation in arterial blood (SaO₂) provides information about the performance of the respiratory system. Non-invasive measurement of SaO₂ by commercial pulse oximeters (SpO₂) make use of photoplethysmographic pulses in the red and infrared regions and utilizes the different spectra of light absorption by oxygenated and de-oxygenated hemoglobin. Because light scattering and optical path-lengths differ between the two wavelengths, commercial pulse oximeters require empirical calibration which is based on SaO₂ measurement in extracted arterial blood. They are still prone to error, because the path-lengths difference between the two wavelengths varies among different subjects. We have developed modified pulse oximetry, which makes use of two nearby infrared wavelengths that have relatively similar scattering constants and path-lengths and does not require an invasive calibration step. In measurements performed on adults during breath holding, the two-infrared pulse oximeter and a commercial pulse oximeter showed similar changes in SpO₂. The two pulse oximeters showed similar accuracy when compared to SaO₂ measurement in extracted arterial blood (the gold standard) performed in intensive care units on newborns and children with an arterial line. Errors in SpO₂ because of variability in path-lengths difference between the two wavelengths are expected to be smaller in the two-infrared pulse oximeter.

Objective: The ductus arteriosus is a blood vessel that connects the pulmonary artery to the descending aorta during fetal life and generally undergoes spontaneous closure shortly after birth. In premature neonates it often fails to close (patent ductus arteriosus-PDA), which can result in diversion of a significant part of the left-ventricular cardiac output to the pulmonary circulation. This left-to-right shunt may result in significant increase of pulmonary blood flow and decrease of systemic perfusion (hemodynamically significant PDA-hsPDA), which may lead to severe neonatal morbidity. The study objective was to find the relationship between hsPDA and perfusion index (PI), a photoplethysmographic parameter related to systemic perfusion., Approach: PI measures the relative systolic increase in tissue light absorption due to the systolic increase in the tissue blood volume. PI has been found to be directly related to tissue perfusion and is therefore expected to be affected by hsPDA., Main Results: PI was found to be higher in preterm neonates with hsPDA after first week of life, in comparison to those with closed DA, despite the lower systemic perfusion, probably due to reverse flow during diastole., Significance: In our study, perfusion index increased despite the lower systemic perfusion, indicating that in neonates with hsPDA, perfusion index is not necessarily a measure of perfusion. Nevertheless, PI can be used as a screening tool for suspicious PDA, in order to select a relatively small group of neonates for a more definitive examination by echocardiography, which is not suitable for universal screening.

Objective: To assess the effect of blood transfusions in neonates on partial pressure of oxygen in arterial blood (PaO 2 ), arterial hemoglobin oxygen saturation (SaO 2 ) and arterial hemoglobin oxygen saturation as measured by pulse oximetry (SpO 2 )., Study Design: Retrospective study of neonates that received a first blood transfusion while having an indwelling arterial line. We compared PaO 2 , SaO 2, SpO 2, SaO 2 /PaO 2 ratio and fraction of inspired oxygen (FiO 2 ) 12 h before and after blood transfusion., Results: Post-transfusion neonates had higher PaO 2 and SaO 2 , had lower SaO 2 /PaO 2 ratio, and received higher FiO 2 with no change in SpO 2 ., Conclusions: Post-transfusion, neonates had lower hemoglobin oxygen affinity. They received higher FiO 2 and had higher PaO 2 at the same SpO 2 . We speculate that FiO 2 was increased in order to maintain SpO 2 . Larger prospective trials are needed to confirm our findings.