Publications by authors named "John Herman"

29 Publications

  • Page 1 of 1

Cumene Contamination in Groundwater: Observed Concentrations, Evaluation of Remediation by Sulfate Enhanced Bioremediation (SEB), and Public Health Issues.

Int J Environ Res Public Health 2020 11 12;17(22). Epub 2020 Nov 12.

Emergent Technologies Institute, U. A. Whitaker College of Engineering, Florida Gulf Coast University, Fort Myers, FL 33901, USA.

Isopropylbenzene (cumene) is commonly encountered in groundwater at petroleum release sites due to its natural occurrence in crude oil and historical use as a fuel additive. The cumene concentrations detected at these sites often exceed regulatory guidelines or standards for states with stringent groundwater regulations. Recent laboratory analytical data collected at historical petroleum underground storage tank (UST) release sites have revealed that cumene persists at concentrations exceeding the default cleanup criterion, while other common petroleum constituents are below detection limits or low enough to allow natural attenuation as a remediation strategy. This effectively makes cumene the driver for active remediation at some sites. An insignificant amount of research has been conducted for the in-situ remediation of cumene. Sulfate Enhanced Biodegradation (SEB) is evaluated in a field case study. The results from the field case study show an approximate 92% decrease in plume area following three rounds of SEB injections. An additional objective of this research was to determine the cumene concentration in fuels currently being used to determine future impacts. A review of safety data sheets from several fuel suppliers revealed that cumene concentrations in gasoline are reported typically as wide ranges due to the proprietary formulations. Several fuels from different suppliers were analyzed to determine a baseline of cumene concentration in modern fuels. The results of the analysis indicated that cumene accounts for approximately 0.01% (diesel) to 0.13% (premium gasoline) of the overall fuel composition. Cumene generally is considered to be of low human health toxicity, with the principal concern being eye, skin, and respiratory irritation following inhalation of vapors in an occupational setting, but it has been regulated in Florida at very low concentrations based on organoleptic considerations.
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http://dx.doi.org/10.3390/ijerph17228380DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7696069PMC
November 2020

Trends and Factors Associated With Physician Burnout at a Multispecialty Academic Faculty Practice Organization.

JAMA Netw Open 2019 03 1;2(3):e190554. Epub 2019 Mar 1.

Department of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital, Harvard Medical School, Boston.

Importance: Physician burnout is common, and prevalence may differ throughout a clinician's career. Burnout has negative consequences for physician wellness, patient care, and the health care system. Identifying factors associated with burnout is critical in designing and implementing initiatives to reduce burnout.

Objective: To measure trends and identify factors associated with physician burnout.

Design, Setting, And Participants: Survey study conducted from May 16 to June 15, 2014, and again from May 16 to June 15, 2017, measuring rates of physician burnout in a large academic medical practice. Factors associated with burnout out were evaluated. In 2014, 1774 of 1850 eligible physicians (95.9%) completed the survey. In 2017, 1882 of 2031 (92.7%) completed the survey.

Exposures: Medical specialty, demographic characteristics, years in practice, and reported rates of burnout.

Main Outcomes And Measures: Burnout rates measured at 2 points and risk factors associated with burnout.

Results: Respondents included 1027 men (57.9%) and 747 women (42.1%) in 2014 and 962 men (51.1%) and 759 women (40.3%) in 2017. The mean (SD) number of years since training completion was 15.3 (11.3) in the 2014 survey data and 15.1 (11.3) in the 2017 data. Burnout increased from 40.6% to 45.6% between the 2 points. The increased rate was associated with an increase in exhaustion (from 52.9% in 2014 to 57.7% in 2017; difference, 4.8%; 95% CI, 1.6%-8.0%; P = .004) and cynicism (from 44.8% in 2014 to 51.1% in 2017; difference, 6.3%; 95% CI, 3.1%-9.6%; P < .001). Compared with midcareer physicians (11-20 years since training), early-career physicians (≤10 years since training) were more susceptible to burnout (odds ratio, 1.36; 95% CI, 1.05-1.77), while physicians in their late career (>30 years since training) were less vulnerable (odds ratio, 0.59; 95% CI, 0.40-0.88).

Conclusions And Relevance: Efforts to alleviate physician burnout and administrative burden require a combination of a shared commitment from physicians and organizations and central and locally implemented programs. Continued research is necessary to establish the most effective initiatives to decrease physician burnout at the individual and organizational level.
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http://dx.doi.org/10.1001/jamanetworkopen.2019.0554DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6484653PMC
March 2019

Behavioral Health Factors as Predictors of Emergency Department Use in the High-Risk, High-Cost Medicare Population.

Psychiatr Serv 2018 12 26;69(12):1230-1237. Epub 2018 Sep 26.

Dr. Weilburg, Dr. Taylor, and Dr. Herman are with the Department of Psychiatry and Dr. Benzer is with the Department of Emergency Medicine, all at Massachusetts General Hospital, Boston; all are also with Harvard Medical School, Boston. Dr. Wong is with the School of Health Policy and Management, York University, Toronto. Dr. Sistrom is with the Department of Radiology, Massachusetts General Hospital, Boston and the Department of Radiology, University of Florida Health Center, Gainesville. Ms. Rockett is with the Department of Performance Analysis and Improvement and Ms. Neagle is with the Integrated Care Management Program, both at the Massachusetts General Physicians Organization, Boston.

Objective: This study measured the presence, extent, and type of behavioral health factors in a high-cost Medicare population and their association with the probability and intensity of emergency department (ED) use.

Methods: Retrospective claims analysis and a comprehensive electronic medical record-based review were conducted for patients enrolled in a 65-month prospective care management program at an academic tertiary medical center (N=3,620). A two-part model used multivariable logistic regression to evaluate the effect of behavioral health factors on the probability of ED use, complemented by a Poisson model to measure the number of ED visits. Control variables included demographic characteristics, poststudy survival, and hierarchical condition category risk score.

Results: After analyses controlled for comorbidities and other relevant variables, patients with two or more behavioral health diagnosis categories or two or more behavioral health medications were about twice as likely as those without such categories or medications to use the ED. Patients with a diagnosis category of psychosis, neuropsychiatric disorders, sleep disorders, or adjustment disorders were significantly more likely than those without these disorders to use the ED. Most primary ED diagnoses were not of behavioral health conditions.

Conclusions: Behavioral health factors had a substantial and significant effect on the likelihood and number of ED visits in a population of high-cost Medicare patients. Attention to behavioral health factors as independent predictors of ED use may be useful in influencing ED use in high-cost populations.
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http://dx.doi.org/10.1176/appi.ps.201800083DOI Listing
December 2018

Meesmann epithelial corneal dystrophy: recurrence following photorefractive keratectomy.

Can J Ophthalmol 2017 12 27;52(6):e211-e213. Epub 2017 Jun 27.

The Schepens Eye Research Institute, Massachusetts Eye & Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.

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http://dx.doi.org/10.1016/j.jcjo.2017.05.009DOI Listing
December 2017

Avery D. Weisman, M.D.

Psychosomatics 2017 Nov - Dec;58(6):592-593. Epub 2017 Aug 12.

Department of Psychiatry, Massachuetts General Hospital, Boston, MA.

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http://dx.doi.org/10.1016/j.psym.2017.08.007DOI Listing
August 2017

National Sleep Foundation's updated sleep duration recommendations: final report.

Sleep Health 2015 Dec 31;1(4):233-243. Epub 2015 Oct 31.

Division of Sleep Medicine, Eastern Virginia Medical School, Norfolk, VA, USA.

Objective: To make scientifically sound and practical recommendations for daily sleep duration across the life span.

Methods: The National Sleep Foundation convened a multidisciplinary expert panel (Panel) with broad representation from leading stakeholder organizations. The Panel evaluated the latest scientific evidence and participated in a formal consensus and voting process. Then, the RAND/UCLA Appropriateness Method was used to formulate sleep duration recommendations.

Results: The Panel made sleep duration recommendations for 9 age groups. Sleep duration ranges, expressed as hours of sleep per day, were designated as recommended, may be appropriate, or not recommended. Recommended sleep durations are as follows: 14-17 hours for newborns, 12-15 hours for infants, 11-14 hours for toddlers, 10-13 hours for preschoolers, 9-11 hours for school-aged children, and 8-10 hours for teenagers. Seven to 9 hours is recommended for young adults and adults, and 7-8 hours of sleep is recommended for older adults. The self-designated basis for duration selection and critical discussions are also provided.

Conclusions: Consensus for sleep duration recommendations was reached for specific age groupings. Consensus using a multidisciplinary expert Panel lends robust credibility to the results. Finally, limitations and caveats of these recommendations are discussed.
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http://dx.doi.org/10.1016/j.sleh.2015.10.004DOI Listing
December 2015

Sleep Medicine and Psychiatric Disorders in Children.

Sleep Med Clin 2015 Jun;10(2):xiii-xiv

Baylor College of Medicine, Houston, TX, USA; Stanford University School of Medicine, Palo Alto, CA, USA. Electronic address:

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http://dx.doi.org/10.1016/j.jsmc.2015.04.001DOI Listing
June 2015

Attention Deficit/Hyperactivity Disorder and Sleep in Children.

Authors:
John H Herman

Sleep Med Clin 2015 Jun 18;10(2):143-9. Epub 2015 Mar 18.

University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA. Electronic address:

Basic assumptions about ADHD in children and sleep are not supported by research. It is unclear that children with hyperactivity or inattention have disrupted sleep. Parents of children with ADHD consistently report more bedtime resistance, but there is no objective evidence that sleep is subsequently disrupted. Treatment of ADHD with stimulants may disrupt sleep. Studies of comorbid sleep or psychiatric disorders consistently show that they disrupt sleep. Melatonin is an effective treatment of sleep problems in children with ADHD. Before any child is placed on stimulants, the pediatrician or other health care professional should insure that the child is obtaining adequate sleep.
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http://dx.doi.org/10.1016/j.jsmc.2015.02.003DOI Listing
June 2015

Sleep and Psychiatry in Adults.

Sleep Med Clin 2015 Mar;10(1):xiii-xiv

Baylor College of Medicine, Houston, TX, USA; Stanford University School of Medicine, Palo Alto, CA, USA. Electronic address:

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http://dx.doi.org/10.1016/j.jsmc.2014.12.001DOI Listing
March 2015

National Sleep Foundation's sleep time duration recommendations: methodology and results summary.

Sleep Health 2015 Mar 8;1(1):40-43. Epub 2015 Jan 8.

Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA.

Objective: The objective was to conduct a scientifically rigorous update to the National Sleep Foundation's sleep duration recommendations.

Methods: The National Sleep Foundation convened an 18-member multidisciplinary expert panel, representing 12 stakeholder organizations, to evaluate scientific literature concerning sleep duration recommendations. We determined expert recommendations for sufficient sleep durations across the lifespan using the RAND/UCLA Appropriateness Method.

Results: The panel agreed that, for healthy individuals with normal sleep, the appropriate sleep duration for newborns is between 14 and 17 hours, infants between 12 and 15 hours, toddlers between 11 and 14 hours, preschoolers between 10 and 13 hours, and school-aged children between 9 and 11 hours. For teenagers, 8 to 10 hours was considered appropriate, 7 to 9 hours for young adults and adults, and 7 to 8 hours of sleep for older adults.

Conclusions: Sufficient sleep duration requirements vary across the lifespan and from person to person. The recommendations reported here represent guidelines for healthy individuals and those not suffering from a sleep disorder. Sleep durations outside the recommended range may be appropriate, but deviating far from the normal range is rare. Individuals who habitually sleep outside the normal range may be exhibiting signs or symptoms of serious health problems or, if done volitionally, may be compromising their health and well-being.
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http://dx.doi.org/10.1016/j.sleh.2014.12.010DOI Listing
March 2015

Interprofessional differences in disposition decisions: results from a standardized web-based patient assessment.

Psychiatr Serv 2013 Aug;64(8):808-11

Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA.

Objective: This study examined differences in disposition decisions among mental health professionals using a standardized Web-based simulation.

Methods: Using a Web-based simulation that described, across users, the same complex psychiatric patient, credentialed clinicians in a psychiatry department conducted a violence risk assessment and selected a level of follow-up care.

Results: Of 410 clinicians who completed the simulation, 60% of psychiatrists were more likely than other types of clinicians to select higher levels of care (inpatient or emergency services) for the standardized virtual patient (odds ratio=2.67, 95% confidence interval=1.67-4.25), even after adjustment for other factors. Virtual actions taken, such as contracting with the patient for safety and discussing hospitalization, elucidated these training differences.

Conclusions: Training backgrounds were important determinants of clinicians' actions and the dispositions they recommended for a psychiatric patient at high risk of self-harm and harm to others in the educational setting and may suggest the need for further training to standardize and optimize care.
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http://dx.doi.org/10.1176/appi.ps.201200461DOI Listing
August 2013

Simulation-based ongoing professional practice evaluation in psychiatry: a novel tool for performance assessment.

Jt Comm J Qual Patient Saf 2013 Jul;39(7):319-23

Massachusetts General Hospital, Boston, MA, USA.

Background: Ongoing professional practice evaluation (OPPE) activities consist of a quantitative, competency-based evaluation of clinical performance. Hospitals must design assessments that measure clinical competencies, are scalable, and minimize impact on the clinician's daily routines. A psychiatry department at a large academic medical center designed and implemented an interactive Web-based psychiatric simulation focusing on violence risk assessment as a tool for a departmentwide OPPE.

Methods: Of 412 invited clinicians in a large psychiatry department, 410 completed an online simulation in April-May 2012. Participants received scheduled e-mail reminders with instructions describing how to access the simulation. Using the Computer Simulation Assessment Tool, participants viewed an introductory video and were then asked to conduct a risk assessment, acting as a clinician in the encounter by selecting actions from a series of drop-down menus. Each action was paired with a corresponding video segment of a clinical encounter with a standardized patient. Participants were scored on the basis of their actions within the simulation (Measure 1) and by their responses to the open-ended questions in which they were asked to integrate the information from the simulation in a summative manner (Measure 2).

Results: Of the 410 clinicians, 381 (92.9%) passed Measure 1,359 (87.6%) passed Measure 2, and 5 (1.2%) failed both measures. Seventy-five (18.3%) participants were referred for focused professional practice evaluation (FPPE) after failing either Measure 1, Measure 2, or both.

Conclusions: Overall, Web-based simulation and e-mail engagement tools were a scalable and efficient way to assess a large number of clinicians in OPPE and to identify those who required FPPE.
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http://dx.doi.org/10.1016/s1553-7250(13)39045-xDOI Listing
July 2013

False accusations against residents: a training program's perspective.

Acad Psychiatry 2011 Jul-Aug;35(4):215-216

Dept. of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

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http://dx.doi.org/10.1176/appi.ap.35.4.215DOI Listing
December 2011

Measuring outcomes in adult outpatient psychiatry.

Clin Psychol Psychother 2012 May-Jun;19(3):203-13. Epub 2011 Mar 17.

Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.

Despite growing pressure for accountability, mental health professionals continue to debate the value of routinely measuring treatment outcomes. This paper sought to move the outcomes measurement debate forward by reviewing some of the current limitations in outcomes methodology and by providing initial strategies to address them. Using these strategies, we evaluated outcomes for a large diagnostically diverse group of adult outpatients receiving treatment as usual (TAU) within an academic medical centre. Initial self-report and clinician-rated assessments were obtained from 5546 patients, and follow-up data were obtained from 1572 (28%) patients. Using the subset of patients with the follow-up data, we determined treatment effect sizes, rates of reliable improvement (and deterioration) and rates of clinically significant improvement for all patients and for specific diagnostic groups (depression, anxiety, substance abuse, mood disorders not otherwise specified, bipolar and psychotic conditions). TAU outcomes for depression and anxiety were also compared with benchmarks derived from the randomized controlled trial literature. Lastly, the impact of patient or sample characteristics on outcome was explored. Overall, these findings generally support the benefit of TAU over no treatment while also highlighting both the utility and limitations inherent in the current approaches to evaluating treatment outcomes. Suggestions for improving outcomes measurement are provided.
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http://dx.doi.org/10.1002/cpp.749DOI Listing
September 2012

Increasing the value of the state medical license.

Authors:
John B Herman

N Engl J Med 2010 Apr;362(16):1459-61

Massachusetts General Hospital, Boston, USA.

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http://dx.doi.org/10.1056/NEJMp0912754DOI Listing
April 2010

Prevalence of lid wiper epitheliopathy in subjects with dry eye signs and symptoms.

Cornea 2010 Apr;29(4):377-83

Korb Associates, Boston, MA, USA.

Purpose: The purpose of this study was to investigate the prevalence of lid wiper epitheliopathy (LWE) in patients diagnosed with dry eye disease (DED).

Methods: Patients were recruited for two groups. Inclusion criteria for the DED group (n = 50) was: a score greater than 10 with the Standard Patient Evaluation of Eye Dryness questionnaire, fluorescein break-up time 5 seconds or less, corneal and conjunctival staining with fluorescein, lissamine green Grade 1 or greater (scale 0-3), and Schirmer test with anesthesia 5 mm or less. For the asymptomatic group (n = 50), inclusion criteria were: no dry eye symptoms, fluorescein break-up time 10 seconds or greater, no corneal or conjunctival staining, and Schirmer test 10 mm or greater. Sequential instillations (n = 2, 5 minutes apart) of a mixture of 2% fluorescein and 1% lissamine green solution were used to stain the lid wipers of all patients. LWE was graded (scale 0-3) using the horizontal lid length and the average sagittal lid widths of the stained wiper.

Results: In symptomatic patients, 88% had LWE, of which 22% was Grade 1, 46% Grade 2, and 20% Grade 3. In asymptomatic patients, 16% had LWE, of which 14% was Grade 1, 2% was Grade 2, and 0% Grade 3. The difference in prevalence of lid wiper staining between groups was significant (P < 0.0001).

Conclusions: The prevalence of LWE was six times greater for the DED group and the prevalence of LWE Grade 2 or greater was 16 times greater for the DED group than for the control group. These data further establish LWE as a diagnostic sign of dry eye disease.
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http://dx.doi.org/10.1097/ICO.0b013e3181ba0cb2DOI Listing
April 2010

Over the rainbow: a case of traumatic brain injury.

Harv Rev Psychiatry 2010 Jan-Feb;18(1):56-66

University of New Mexico Psychiatric Center, Albuquerque, NM, USA.

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http://dx.doi.org/10.3109/10673220903523953DOI Listing
March 2010

Secondary nocturnal enuresis caused by central sleep apnea from Chiari malformation type 1.

J Pediatr Urol 2010 Jun 24;6(3):265-9. Epub 2009 Oct 24.

Department of Urology, The University of Texas Southwestern Medical Center and Children's Medical Center Dallas, TX, USA.

Objective: To report a novel cause of nocturnal enuresis (NE) and highlight the literature giving insight into this novel mechanism.

Patient: A 12-year-old morbidly obese female with 2-year history of nightly secondary monosymptomatic NE.

Results: On evaluation, a history of severe sleep disturbed breathing was elicited. Anticipating obstructive sleep apnea (OSA), polysomnography was performed, detecting severe central sleep apnea (CSA) without OSA. Brain magnetic resonance imaging revealed severe Chiari malformation Type I (CM1) with abnormal cerebrospinal fluid dynamics. She had no other classic signs or symptoms of CM1. Neurosurgical decompression halted the NE and normalized nocturnal breathing and cerebrospinal fluid dynamics, confirming that the CSA was caused by the CM1 and resulted in the NE. A thorough literature review found no prior reports of CSA-induced NE. Since CSA and OSA differ by the absence of negative intrathoracic pressures in CSA, this case suggests that such pressures are not a key mechanistic component of SA-induced NE.

Conclusion: This first report of secondary NE caused by CSA from CM1 emphasizes obtaining a sleep history in the enuretic child, introduces a new cause of NE, and challenges hypotheses underlying SA-induced NE.
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http://dx.doi.org/10.1016/j.jpurol.2009.08.009DOI Listing
June 2010

Circadian rhythm disorders in pediatrics.

Authors:
John H Herman

Pediatr Ann 2008 Jul;37(7):488-95

Republican Board of Sleep Medicine, UT Southwestern Medical Center, Dallas, TX, USA.

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http://dx.doi.org/10.3928/00904481-20080701-07DOI Listing
July 2008

Teaching the teachers: a model course for psychodynamic psychotherapy supervisors.

Acad Psychiatry 2008 May-Jun;32(3):259-64

Department of Psychiatry, Massachusetts General Hospital, Wang ACC 812, 15 Parkman St., Boston, MA 02114, USA.

Objective: There are no standard training programs for teaching psychotherapy supervisors effective, ethical, and legal aspects of supervision. This article describes an eight session training course containing essential information for supervisors.

Methods: The literature on psychotherapy supervision was reviewed and an evening seminar series was offered to veteran supervisor. The seminars were then translated into a course for faculty supervisors and trainees interested in becoming supervisors.

Results: Participants completed a postcourse survey and ranked as high the quality and content of the course and course satisfaction on Likert scales. Participants felt well prepared and reported increased confidence in going forward in their supervisory roles.

Conclusion: While current Residency Review Committee guidelines do not define standards for competency in psychotherapy supervision, the authors suggest that a course containing these principles of psychodynamic psychotherapy supervision be a prerequisite for those supervising residents. New and veteran supervisors reported learning essential aspects of supervision unknown before their course enrollment.
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http://dx.doi.org/10.1176/appi.ap.32.3.259DOI Listing
August 2008

An evaluation of the efficacy of fluorescein, rose bengal, lissamine green, and a new dye mixture for ocular surface staining.

Eye Contact Lens 2008 Jan;34(1):61-4

Korb Associates, Boston, MA 02116, USA.

Purpose: Sodium fluorescein is considered the premier dye for corneal staining and, similarly, rose bengal (RB) for conjunctival staining. A mixture of 1% fluorescein and 1% rose bengal has been reported as advantageous in daily practice. Mixtures of lissamine green with other ocular stains have not been reported. The purposes of this study were to review the clinical staining characteristics of fluorescein, rose bengal, and lissamine green in controlled dose and concentration and determine whether optimal staining of the cornea and bulbar conjunctiva are possible by using dye mixtures.

Methods: Sixteen 10-microL solutions of fluorescein, rose bengal, lissamine green, and their mixtures were evaluated. Fourteen subjects with a diagnosis of dry eye were tested for staining with various combinations of the dyes. Examination of staining was made by using standard clinical practices.

Results: A mixture of 2% fluorescein and 1% rose bengal was the most efficacious staining mixture for the cornea and conjunctiva, but moderate to marked discomfort was reported. The mixture of 2% fluorescein and 1% lissamine green did not result in discomfort and provided optimal corneal and conjunctival staining with only slightly less efficacy than 2% fluorescein and 1% rose bengal; 2% and 3% lissamine green produced burning and discomfort. The fluorescent characteristics of fluorescein were not significantly altered by the addition of 1% lissamine green. The preferred mixture for simultaneous and efficacious staining of the cornea and conjunctiva without an adverse sensation was 2% fluorescein and 1% lissamine green.

Conclusions: A mixture of 2% fluorescein and 1% lissamine green offers excellent simultaneous corneal and bulbar conjunctival staining and could replace the use of individual dyes for ocular staining and contact lens practice.
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http://dx.doi.org/10.1097/ICL.0b013e31811ead93DOI Listing
January 2008

Warm compress induced visual degradation and Fischer-Schweitzer polygonal reflex.

Optom Vis Sci 2007 Jul;84(7):580-7

Schepens Eye Research Institute, Boston, Massachusetts, USA.

Purpose: To document adverse visual effects of warm compress therapy and determine potential etiologies in subjects with dry eye symptoms.

Methods: Subjects (n = 24) with dry eye symptoms were recruited. Group 1 (n = 13): baseline measurements for each eye included subjective blur, visual acuity (VA), autorefraction (AR), corneal topography (CT), central corneal curvature (CCC), lipid layer thickness (LLT), and evaluation for corneal striae and edema. A warm, moist compress (44.4-45 degrees C) was applied with gentle pressure for 30 min to the closed eyelids of the randomized experimental eye; nothing was applied to the contralateral control eye. Subjective blur, VA, AR, CT, CCC, and LLT were evaluated for each eye at 5, 15, and 30 min and 5 min after application. Striae and edema were assessed for each eye at 30 and 5 min after application. Group 2 (n = 11): the above warm compress protocol was repeated to investigate the Fischer-Schweitzer polygonal reflex at the times stated.

Results: At 5 and 30 min, 71% and 88% of all subjects experienced increased subjective blur and decreased VA. At 30 min: Group 1: Of 13 experimental eyes: 13 experienced subjective blur; nine exhibited a VA decrease > or =2 lines (mean = 3.4 +/- 0.7). For the control eye, two subjects reported blur and none exhibited decreased VA. The findings for AR, CT, CCC, LLT, striae and edema did not correlate with blur or with VA decline. Group 2: Of 11 experimental eyes: 10 exhibited the polygonal reflex compared with 0 controls (p < 0.001); eight exhibited subjective blur; seven exhibited VA decrease > or =2 lines (mean = 2.9 +/- 0.9). The polygonal reflex correlated positively to visual blur (r = 0.88, p = 0.04) and to VA decrease (r = 0.79, p = 0.1).

Conclusions: Warm compress application induces transient visual degradation. Although there was no correlation between visual degradation and AR, CT, CCC, LLT, or the presence of striae or corneal edema, visual degradation correlated positively with the polygonal reflex, which was observed following warm compress application.
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http://dx.doi.org/10.1097/OPX.0b013e3180dc99d5DOI Listing
July 2007

The effect of two novel lubricant eye drops on tear film lipid layer thickness in subjects with dry eye symptoms.

Optom Vis Sci 2005 Jul;82(7):594-601

Korb Associates, Boston, MA 02116, USA.

Purpose: Because the lipid layer of the tear film is recognized as a critical component in dry eye disease, this study was designed to determine if a single eye drop of either Soothe or Systane produces a significant increase in lipid layer thickness (LLT) for subjects reporting symptoms indicative of dry eyes.

Methods: A double-blind, internally paired study was performed. A custom-built lipid layer interferometer, enabling characterization of lipid layer interference patterns, was used to quantify baseline LLT (OU) of eligible subjects. Inclusion criteria included: 1) presence of dry eye symptoms and 2) baseline LLT < or =75 nm. Subjects (n = 40) received a single eye drop of Soothe in one eye and a single eye drop of Systane in the contralateral eye. After the instillation of each test drop, LLT was reanalyzed for all subjects.

Results: The mean +/- standard error baseline LLT pre-eye drop instillation was 60.0 +/- 1.8 nm for eyes treated with Soothe and 61.5 +/- 1.8 nm for eyes treated with Systane. These means were not significantly different (p > 0.5). The mean LLT for eyes treated with Soothe increased to 124.4 +/- 4.9 nm (p < 0.0001). The mean LLT for eyes treated with Systane increased to 71.3 +/- 2.6 nm (p < 0.0001). The LLT increase from Soothe was significantly greater than that from Systane (p < 0.0001).

Conclusions: In subjects with symptoms indicative of dry eye states and LLT < or =75 nm, one eye drop of Soothe more than doubled LLT, a 107% mean increase, whereas Systane increased LLT by 16%.
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http://dx.doi.org/10.1097/01.opx.0000171818.01353.8cDOI Listing
July 2005

The awarding experience.

Authors:
John B Herman

Acad Psychiatry 2005 ;29(1):19-20

Massachusetts General Hospital, Bulfinch 355, Fruit Street, Boston, MA 02114, USA.

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http://dx.doi.org/10.1176/appi.ap.29.1.19DOI Listing
July 2005

Lid wiper epitheliopathy and dry eye symptoms.

Eye Contact Lens 2005 Jan;31(1):2-8

Korb Associates, Boston, MA, USA.

Objectives: The lid wiper is defined as that portion of the marginal conjunctiva of the upper eyelid that wipes the ocular surface during blinking. The purpose of this study was to investigate whether lid wiper epitheliopathy occurred with patients who reported dry eye symptoms, yet had normal fluorescein breakup time (FBUT) and Schirmer test values and an absence of fluorescein corneal staining.

Methods: One hundred patients were divided into two groups based on the presence or absence of dry eye symptoms, as determined with the Standard Patient Evaluation of Eye Dryness questionnaire. Other criteria for admission to both groups were FBUT of 10 seconds or more, Schirmer test value of 10 mm or more, and absence of fluorescein corneal staining. After instillation of fluorescein and rose bengal dyes, the lid wipers of 50 asymptomatic and 50 symptomatic patients were graded for staining from grade 0 (absent) to grade 3 (severe).

Results: Of the symptomatic patients, 76% had staining of the lid wiper: 44%, grade 1; 22%, grade 2; and 10%, grade 3. Of the asymptomatic patients, 12% had staining; 8%, grade 1; 4%, grade 2; and 0%, grade 3. The difference in prevalence of lid wiper staining between the symptomatic and asymptomatic groups was significant (P<0.0001).

Conclusions: Lid wiper epitheliopathy, diagnosed by staining with fluorescein and rose bengal dyes, is a frequent finding when symptoms of dry eye are experienced in the absence of routine clinical dry eye findings.
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http://dx.doi.org/10.1097/01.icl.0000140910.03095.faDOI Listing
January 2005

Predicting length of stay on an acute care medical psychiatric inpatient service.

Adm Policy Ment Health 2003 Sep;31(1):15-29

Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.

The goal of this study was to identify variables associated with length of stay (LOS) and to incorporate into the authors' routine preadmission assessment the measurement of these variables. A retrospective study of 80 discharged patients explored the association of 25 variables reflecting a mixture of patient/demographic variables, illness variables, and treatment variables with LOS. Multivariate analysis revealed that 10 variables independently accounted for 62% of the variance in LOS. The information used was obtained primarily in the preadmission screening. The predictive power of the variables shrank in the prospective study. However, fewer individual variables were significantly associated with LOS; the summed score of the variables predicted 17% of the LOS variance. Results indicated that factors important for estimating LOS are available at the time of admission, and these variables can be systematically assessed and incorporated into clinical decision making.
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http://dx.doi.org/10.1023/a:1026044106172DOI Listing
September 2003

Effects of fluorescein instillation methods on the tear film lipid layer.

Adv Exp Med Biol 2002 ;506(Pt A):507-12

Schepens Eye Research Institute and Harvard Medical School, Boston, Massachusetts, USA.

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http://dx.doi.org/10.1007/978-1-4615-0717-8_71DOI Listing
May 2003

Lid-wiper epitheliopathy and dry-eye symptoms in contact lens wearers.

CLAO J 2002 Oct;28(4):211-6

Korb Associates, Boston, MA 02116, USA.

Purpose: To evaluate whether dry-eye symptoms are associated with epitheliopathy of that portion of the upper eyelid marginal conjunctiva-the lid wiper-that wipes the ocular, or contact lens surface, during blinking.

Methods: Subjects were divided into two groups based on the presence or absence of dry-eye symptoms. The lid wiper of asymptomatic (n=75) and symptomatic (n=30) soft contact lens wearers was examined, following the instillation of fluorescein and rose bengal dyes. Lid-wiper staining was graded zero to 3.

Results: Eighty percent of the symptomatic subjects displayed lid-wiper staining compared to 13% of the asymptomatic subjects. The difference in staining between the two groups was significant (P<0.0001). Of the symptomatic subjects, 20% showed no staining; 26.6%, grade 1 staining; 36.6%, grade 2; and 16.6% showed grade 3 staining. Of the asymptomatic subjects, 87% exhibited no staining; 9%, grade 1 staining; 3%, grade 2; and 1% showed grade 3 staining.

Conclusions: This study describes a new clinical condition, lid-wiper epitheliopathy, an alteration of the epithelium of that portion of the marginal conjunctiva of the upper eyelid that wipes the ocular surface, diagnosed by staining with fluorescein and rose bengal dyes.
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http://dx.doi.org/10.1097/01.ICL.0000029344.37847.5ADOI Listing
October 2002