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Background: Managed Access Agreements (MAAs) are a commercial arrangement that provide patients earlier access to innovative health technologies while uncertainties in the evidence base are resolved through data collection. In the UK, data collection agreements (DCAs) outline the evidence that will be collected during the MAA period and are intended to resolve uncertainties in the clinical- and cost-effectiveness of a technology sufficient for the National Institute of Health and Care Excellence (NICE) committee to make a final decision on reimbursement. Objective: The aim of this study was to identify the primary uncertainties leading to a recommendation for entry to the Cancer Drugs Fund (CDF) and evaluate how the corresponding DCAs attempt to address these. Methods: A database of MAAs agreed within the CDF was compiled with coverage between July 2016 and December 2020 (the time during which evidence generation was routinely collected within the CDF up until the time of analysis). Uncertainties in the evidence base for technologies entering the CDF were analysed alongside the outcomes planned for data collection during the MAA. These data provide an overview of the key uncertainties surrounding health technologies in the CDF on entry and the types of evidence targeted by DCAs. Results: In the assessment of 39 Cancer Drugs Fund (CDF) cases, NICE committees identified a total of 108 key uncertainties in cost-effectiveness estimates. Overall survival was the most commonly identified uncertainty, followed by generalisability of the evidence to the target population. DCAs specified a range of outcomes relevant to understanding the clinical effectiveness of the technology, though fewer than half (43.6%) of the DCAs addressed all the key uncertainties identified by the NICE committee. Conclusion: The analysis indicated that data collection within the CDF is not sufficient to resolve all the uncertainties identified by the NICE committee, meaning that other approaches will be needed at re-appraisal to ensure that the NICE committee can reach a final decision on reimbursement.

We present a wide-ranging interrogation of the border between single-molecule and solid-state magnetism through a study of erbium-based Ising-type magnetic compounds with a fixed magnetic unit, using three different charge-balancing cations as the means to modulate the crystal packing environment. Properties rooted in the isolated spin Hamiltonian remain fixed, yet careful observation of the dynamics reveals the breakdown of this approximation in a number of interesting ways. First, differences in crystal packing lead to a striking 3 orders of magnitude suppression in magnetic relaxation rates, indicating a rich interplay between intermolecular interactions governed by the anisotropic Ising lattice stabilization and localized slow magnetic relaxation driven by the spin-forbidden nature of quantum tunneling of the f-electron-based magnetization. By means of diverse and rigorous physical methods, including temperature-dependent X-ray crystallography, field, temperature, and time-dependent magnetometry, and the application of a new magnetization fitting technique to quantify the magnetic susceptibility peakshape, we are able to construct a more nuanced view of the role nonzero-dimensional interactions can play in what are predominantly considered zero-dimensional magnetic materials. Specifically, we use low field susceptibility and virgin-curve analysis to isolate metamagnetic spin-flip transitions in each system with a field strength corresponding to the expected strength of the internal dipole–dipole lattice. This behavior is vital to a complete interpretation of the dynamics and is likely common for systems with such high anisotropy. This collective interactivity opens a new realm of possibility for molecular magnetic materials, where their unprecedented localized anisotropy is the determining factor in building higher dimensionality.

AISI 5160 steel has high toughness and ductility. However, in specific applications, better tribological performance is required. In this sense, the study's objective was to perform plasma nitriding with Hastelloy’s cathodic cage followed by the conventional plasma nitriding in AISI 5160 steel to produce high hardness and wear resistance. The results showed that the samples and cutting tools subjected to this process showed higher wear resistance than untreated samples and high-speed steel tools. The sample submitted to treatments with 450°C and 3 h showed greater surface hardness and less volume loss in the mechanical and machining tests. Therefore, the duplex treatment presented in this work with posterior plasma nitriding proved efficient with the low processing time.

AISI 5160 steel has high toughness and ductility. However, in specific applications, better tribological performance is required. In this sense, the study's objective was to perform plasma nitriding with Hastelloy's cathodic cage followed by the conventional plasma nitriding in AISI 5160 steel to produce high hardness and wear resistance. The results showed that the samples and cutting tools subjected to this process showed higher wear resistance than untreated samples and high-speed steel tools. The sample submitted to treatments with 450°C and 3?h showed greater surface hardness and less volume loss in the mechanical and machining tests. Therefore, the duplex treatment presented in this work with posterior plasma nitriding proved efficient with the low processing time.

Supplemental Digital Content is Available in the Text.We demonstrate a novel surgical technique to address persistent postoperative pupillary capture in a patient who underwent sutureless scleral intraocular fixation. The intraocular lens is imbricated with a suture to prevent reverse pupillary block and subsequent intraocular lens capture and to stabilize the anterior–posterior movement of the intraocular lens.

(Anesth Analg. 2021;133:151–159. doi: 10.1213/ANE.0000000000005526)Flexible epidural catheters have a lower incidence of both paresthesias and intravascular catheter placement. This study aimed to compare and analyze the efficacy of 2 commercially available epidural kits: kit “A” (single-end hole wire-reinforced polyurethane epidural catheter; n=135) and kit “B” (multi-orifice wire-reinforced polyamide nylon blend epidural catheter; n=122).

The emerging threat that microplastic pollution poses to soil and its biota necessitates the development of methods to detect microplastic ingestion by soil animals. Fluorescent staining with Nile red dye has proven to be effective at distinguishing microplastics from inorganic and some biological material but is not suitable for separating them from invertebrate remains. Here, we report on the development and validation of a novel fluorescent counterstaining technique for detection of microplastics within terrestrial invertebrate biomass and fecal material. After being stained with a blend of Calcofluor white and Evans blue dyes in addition to Nile red, ground arthropod biomass appeared blueish-purple, whereas different plastic polymers appeared red, green, and yellow when viewed under laser scanning confocal microscopy. Nonarthropod invertebrate biomass and fecal material were also distinguishable from plastic, though to a lesser extent. Our results highlight the value of this method for detecting microplastic ingestion by terrestrial invertebrates.

Subscapularis dysfunction and failure are the leading causes of complications of total shoulder arthroplasty (TSA). An approach to shoulder arthroplasty has been described that may improve exposure to the retroverted glenoid and spare the rotator cuff. This article details the 6-month clinical outcomes of the first 26 patients who underwent TSA using a posterior approach. Thirty-one patients who underwent TSA using a posterior approach between September 2016 and October 2017 were identified retrospectively. Patients were assessed for American Shoulder and Elbow Surgeons (ASES) scores, Simple Shoulder Test (SST) scores, range of motion, complications, radiographic outcomes, and patient satisfaction. Statistical models were used to compare the means for each outcome variable over time. Of the initial 31 patients, 26 patients were available for follow-up at a minimum of 6 months; the remaining 5 patients did not return for follow-up at 6 months. Significant improvement in each outcome variable from baseline was noted by 6 weeks postoperatively. Further improvement was observed at 3 months for SST and external rotation, and at 6 months for ASES function and forward flexion. All outcome variables demonstrated some improvement from one time point to the next. Posterior TSA is a safe and efficacious procedure at 6 months. Compared with traditional TSA, posterior cuff-sparing approaches may improve posterior joint access, posterior soft tissue balancing, and long-term rotator cuff issues. [Subscapularis dysfunction and failure are the leading causes of complications of total shoulder arthroplasty (TSA). An approach to shoulder arthroplasty has been described that may improve exposure to the retroverted glenoid and spare the rotator cuff. This article details the 6-month clinical outcomes of the first 26 patients who underwent TSA using a posterior approach. Thirty-one patients who underwent TSA using a posterior approach between September 2016 and October 2017 were identified retrospectively. Patients were assessed for American Shoulder and Elbow Surgeons (ASES) scores, Simple Shoulder Test (SST) scores, range of motion, complications, radiographic outcomes, and patient satisfaction. Statistical models were used to compare the means for each outcome variable over time. Of the initial 31 patients, 26 patients were available for follow-up at a minimum of 6 months; the remaining 5 patients did not return for follow-up at 6 months. Significant improvement in each outcome variable from baseline was noted by 6 weeks postoperatively. Further improvement was observed at 3 months for SST and external rotation, and at 6 months for ASES function and forward flexion. All outcome variables demonstrated some improvement from one time point to the next. Posterior TSA is a safe and efficacious procedure at 6 months. Compared with traditional TSA, posterior cuff-sparing approaches may improve posterior joint access, posterior soft tissue balancing, and long-term rotator cuff issues. [Orthopedics. 2020; 43(1):e15–e20.]

Purpose: The relationship between poor hemoglobin A1c (HbA1c) control and risk of proliferative diabetic retinopathy (PDR) is well known. Nevertheless, some patients have discordant disease (controlled HbA1c and severe PDR or vice versa). One potential explanation for this discrepancy is the presence of underlying genetic mutations in the Wingless-related integration site (Wnt) signaling pathway. However, minimal clinical data exist on the presence of Wnt signaling mutations in patients with diabetes mellitus (DM) and the correlation with diabetic retinopathy.Methods: Retrospective, nonconsecutive case review of patients with type 1 or 2 DM who underwent genetic testing for at least 1 recognized Wnt signaling pathway mutation from 2011 to 2016. The clinical course and retinal images were reviewed for patients with identifiable mutations.Results: Thirty-six patients, ages 13 to 79 years, consented for genetic analysis. Three patients (8.3%) exhibited at least 1 recognized genetic mutation in the Wnt signaling pathway. Case 1 was a 65-year-old female with type 1 diabetes for > 20 years, HbA1c <7.0%, and no findings of diabetic retinopathy (Tetraspanin 12). Case 2 was a 13-year-old male with type 1 diabetes for 8 years, moderate HbA1c control (7.6-8.3%), and absence of diabetic retinopathy (Norrin). Case 3 was a 48-year-old male with severe PDR requiring multiple laser and antivascular endothelial growth factor (anti-VEGF) treatments despite well-controlled HbA1c (6.0%) (Frizzled-4).Conclusion: Wnt signaling pathway mutations exist in patients with DM. Further studies investigating the prevalence and clinical significance of these mutations in a larger diabetic population are warranted. Identification of these patients with genetic testing may enable earlier medical intervention.

Cyclic block copolymers are predicted to assemble into nanostructured domains up to 40% smaller than their linear analogues, making them promising alternatives for nanoscale patterning applications. The limited cyclic block copolymer structures observed experimentally, however, have not met the domain reductions predicted by scaling theory. Through a systematic dissipative particle dynamics simulation study of linear and cyclic block copolymer assembly into lamellar and cylindrical nanostructures, we explore these discrepancies. We find standard implementations of scaling theory, which assume a cyclic BCP behaves as a linear molecule of half the contour length, fail to account for finite chain size effects, resulting in overpredictions of the extent of domain shrinkage upon cyclization. We propose a revised scaling law that clarifies the interplay of chain length, segregation strength, and chain architecture in determining domain spacing reduction attainable by molecular cyclization and offers an explanation for the discrepancies between prior theoretical predictions and experimental results.

The hydrogenation of CO2in the presence of amines to formate, formamides, and methanol (MeOH) is a promising approach to streamlining carbon capture and recycling. To achieve this, understanding how catalyst design impacts selectivity and performance is critical. Herein we describe a thorough thermochemical analysis of the (de)hydrogenation catalyst, (PNP)Ru–Cl(PNP = 2,6-bis(di-tert-butylphosphinomethyl)pyridine; Ru = Ru(CO)(H)) and correlate our findings to catalyst performance. Although this catalyst is known to hydrogenate CO2to formate with a mild base, we show that MeOH is produced when using a strong base. Consistent with pKameasurements, the requirement for a strong base suggests that the deprotonation of a six-coordinate Ru species is integral to the catalytic cycle that produces MeOH. Our studies also indicate that the concentration of MeOH produced is independent of catalyst concentration, consistent with a deactivation pathway that is dependent on methanol concentration, not equivalency. Our temperature-dependent equilibrium studies of the dearomatized congener, (*PNP)Ru, with various H–X species (to give (PNP)Ru–X; X = H, OH, OMe, OCHO, OC(O)NMe2) reveal that formic acid equilibrium is approximately temperature-independent; relative to H2, it is more favored at elevated temperatures. We also measure the hydricity of (PNP)Ru–Hin THF and show how subsequent coordination of the substrate can impact the apparent hydricity. The implications of this work are broadly applicable to hydrogenation and dehydrogenation catalysis and, in particular, to those that can undergo metal–ligand cooperativity (MLC) at the catalyst. These results serve to benchmark future studies by allowing comparisons to be made among catalysts and will positively impact rational catalyst design.

AbstractBackground:From 2011 to 2016, the United States has experienced a 55% increase in overall overdose deaths and a 260% increase in fatal fentanyl-related overdoses. Increasing engagement in harm reduction practices is essential to reducing the rate of fentanyl-related overdoses. This study sought to examine the uptake of harm reduction practices among young adults who reported recent drug use and who were recruited for a study to assess the utility and acceptability of rapid fentanyl test strips. Methods:Between May and October 2017, 93 young adults who reported drug use in the past 30 days were recruited through word of mouth, Internet advertising, and public canvasing. Participants completed an interviewer-administered survey that assessed participants’ sociodemographic and behavioral characteristics, suspected fentanyl exposure, and overdose history. We assessed harm reduction practices and other correlates associated with experiencing a suspected fentanyl-related overdose. Results:Of 93 eligible participants, 36% (n = 34) reported ever having experienced an overdose, among whom 53% (n = 18) suspected having experienced a fentanyl-related overdose. Participants who had ever experienced a fentanyl-related overdose were more likely to keep naloxone nearby when using drugs compared with those who had never experienced an overdose and those who had experienced an overdose that they did not suspect was related to fentanyl (P < .001). Additionally, experiencing a suspected fentanyl-related overdose was associated with having previously administered naloxone to someone else experiencing an overdose (P < .001). Conclusion:Those who had experienced a suspected fentanyl-related overdose were more likely to carry and administer naloxone. Future overdose prevention interventions should involve persons who have experienced a suspected fentanyl overdose and/or responded to an overdose in order to develop harm reduction programs that meet the needs of those at risk of an overdose.

Background From 2011 to 2016, the United States has experienced a 55% increase in overall overdose deaths and a 260% increase in fatal fentanyl-related overdoses. Increasing engagement in harm reduction practices is essential to reducing the rate of fentanyl-related overdoses. This study sought to examine the uptake of harm reduction practices among young adults who reported recent drug use and who were recruited for a study to assess the utility and acceptability of rapid fentanyl test strips.Methods Between May and October 2017, 93 young adults who reported drug use in the past 30 days were recruited through word of mouth, Internet advertising, and public canvasing. Participants completed an interviewer-administered survey that assessed participants’ sociodemographic and behavioral characteristics, suspected fentanyl exposure, and overdose history. We assessed harm reduction practices and other correlates associated with experiencing a suspected fentanyl-related overdose.Results Of 93 eligible participants, 36% (n= 34) reported ever having experienced an overdose, among whom 53% (n= 18) suspected having experienced a fentanyl-related overdose. Participants who had ever experienced a fentanyl-related overdose were more likely to keep naloxone nearby when using drugs compared with those who had never experienced an overdose and those who had experienced an overdose that they did not suspect was related to fentanyl (P< .001). Additionally, experiencing a suspected fentanyl-related overdose was associated with having previously administered naloxone to someone else experiencing an overdose (P< .001).Conclusion Those who had experienced a suspected fentanyl-related overdose were more likely to carry and administer naloxone. Future overdose prevention interventions should involve persons who have experienced a suspected fentanyl overdose and/or responded to an overdose in order to develop harm reduction programs that meet the needs of those at risk of an overdose.

BACKGROUND AND OBJECTIVE:To quantify vessel tortuosity among infants with retinopathy of prematurity (ROP).PATIENTS AND METHODS:This was a retrospective study including 61 RetCam images from 33 infants. The laser treatment (LT) group included 17 infants who underwent laser for ROP. The no-treatment (NT) group included 16 infants. The modified ROPtool was used to calculate mean vessel tortuosity (MVT) and highest vessel tortuosity (HVT) for the participants and for the standard plus disease photograph from the Early Treatment for Retinopathy of Prematurity (ETROP) study.RESULTS:The median MVT was 1.226 versus 1.056 for the LT and NT groups, respectively (The median MVT was 1.226 versus 1.056 for the LT and NT groups, respectively (P< .001). The median HVT was 1.346 versus 1.088 (P< .001). An MVT of 1.124 was 96.7% sensitive and 100% specific for identifying infants with treatment-requiring ROP. Both MVT and HVT cutoff values correctly captured plus disease in the standard ETROP trial photograph.CONCLUSION:The modified ROPtool can be used to identify infants who have treatment-requiring ROP with a high level of sensitivity and specificity.[[Ophthalmic Surg Lasers Imaging Retina. 2019;50:215–220.]

Colorectal cancer remains common, with the “80 per cent by 2018” initiative proposed by the National Colorectal Cancer Roundtable. This study was designed to examine obstacles for patients who did not receive their scheduled colonoscopy, focusing on the impact of insurance status. Retrospective chart review was carried out on patients who did not complete their colonoscopy as scheduled from January 2013 to June 2017. The control group consisted of patients who completed their scheduled colonoscopy. One hundred and seventy five patients missed 200 colonoscopies. The most common reasons for cancellation were patient illness (16%), no-show (14%), no prep carried out (13%), inadequate prep (10%), and no transportation (11%). The canceled patients were significantly more likely to have the combination of no insurance and no Primary Care Provider (PCP) (13% vs 4%, P = 0.008), personal history of cancer (22% vs 12%, P = 0.02), and higher rates of prior GI issues (78% vs 50%, P < 0.001). The canceled group had a significantly lower history of colon polyps (37% vs 53%, P = 0.006). Difficulty with the bowel prep in addition to lack of insurance and poverty likely does create a barrier, even in a system that has a safety net, atop other issues such as transportation and inability to miss work playing a role.

Purpose: The purpose of this article is to report the characteristics of patients with retinoschisis-related retinal detachments and to summarize their clinical outcomes after surgical repair.Methods: A single-center interventional case series of 37 eyes from 35 patients who underwent surgery to repair a retinoschisis-related retinal detachment between January 1, 2009 and January 1, 2017 was conducted.Results: The mean ± SD age at the time of the first retinal detachment repair was 63 ± 13 years. As the initial surgery, scleral buckle was performed in 14 eyes, scleral buckle + vitrectomy in 14 eyes, and vitrectomy in 9 eyes. The single-operation success rate for the entire cohort was 65% (24/37), and the final anatomic success rate was 97% (36/37). Among eyes requiring more than 1 surgery, 46% (6/13) developed proliferative vitreoretinopathy. Best-corrected visual acuity improved or remained stable after 1 year of follow-up in the majority (n = 27, 73%) of eyes. The mean (SD) number of surgeries required to achieve the final anatomic and visual result was 1.8 (1.2) for all eyes (range, 1-5 surgeries).Conclusion: The single-surgery success rate for retinoschisis-related retinal detachments was lower than that reported for typical rhegmatogenous retinal detachments, and the incidence of proliferative vitreoretinopathy was higher. When counseling patients with retinoschisis-related retinal detachments, it is important to caution them that they may require more than 1 surgery to achieve anatomic success.

To determine the incidence of endophthalmitis after anti–vascular endothelial growth factor (VEGF) therapy at our institution and to identify potential risk factors for endophthalmitis occurring after injection.

This paper represents an effort by the New York City Department of Transportation (NYCDOT) to develop, by means of geographically weighted regression (GWR), an empirical pavement deterioration model for the five boroughs of New York City. Evaluation of probabilistic and deterministic models from existing literature, as well as statistical modeling techniques and applications, were examined to inform model selection. A model using GWR was selected as the preferred methodology. Validation tests demonstrated an adjusted R2of .808 and a standard error (σ) representing 4.8% of the mean. Emphasis is placed on the novelty and practicality of GWR as a means for pavement deterioration prediction. Future applications of this model will aid decision makers in strategically allocating limited funds to priority projects.

Supplemental Digital Content is Available in the Text.Clinical outcomes from 122 patients who underwent sutureless intrascleral fixation of secondary intraocular lenses were assessed and correlated with anatomical and structural analysis in cadaveric human eyes.

IMPORTANCE: Neovascular age-related macular degeneration (nvAMD) is a leading cause of vision loss. The optimal screening protocol to detect choroidal neovascularization (CNV) in fellow eyes of patients undergoing treatment for unilateral CNV has not been determined. OBJECTIVE: To compare the visual outcomes of eyes with established, active nvAMD in index eyes with outcomes of fellow eyes that subsequently developed CNV during the management protocol. DESIGN, SETTING, AND PARTICIPANTS: In this retrospective single-center case series conducted at a private vitreoretinal practice, data were collected for all patients treated for bilateral nvAMD between October 1, 2015, and October 1, 2016, for whom we could determine the date of index eye and fellow eye conversion to nvAMD (n = 1600). Per institutional protocol, patients were screened for new CNV in the fellow eye at every office visit. Patients were excluded if they had a condition that could result in marked asymmetric vision loss. EXPOSURES: Development of nvAMD. MAIN OUTCOMES AND MEASURES: Visual acuity (VA) at the time of diagnosis of nvAMD and at equivalent time points following conversion to nvAMD for both index eyes and fellow eyes. RESULTS: A total of 264 patients met the inclusion criteria; 197 (74.6%) were women and 253 (95.8%) were white, and the mean (SD) age was 79.1 (8.2) years at time of index eye conversion to nvAMD and 80.6 (8.2) years at time of fellow eye conversion to nvAMD. Fellow eyes presented with better VA (mean VA, 20/50 [0.40 logMAR]) compared with index eyes (mean VA, 20/90 [0.67 logMAR]) at the time of conversion (difference, 14 letters [0.27 logMAR]; 95% CI, 10-17 [0.20-0.34]; P &lt; .001). Index eyes did not achieve the same level of VA as fellow eyes after an equivalent postconversion follow-up of approximately 20 months (mean VA: index eye; 20/70 [0.56 logMAR]; fellow eye, 20/50 [0.40 logMAR]; difference, 8 letters [0.15 logMAR]; 95% CI, 4-11 [0.08-0.22]; P &lt; .001). No difference was detected between the mean number of anti–vascular endothelial growth factor injections received by fellow eyes and index eyes (9.7 vs 10.0 injections, respectively). CONCLUSIONS AND RELEVANCE: This retrospective study suggests that fellow eyes of previously treated patients with nvAMD may achieve better VA than their index eye counterparts after an equivalent amount of follow-up. This may be because the CNV was detected and treated earlier and at a better level of VA, although it is unknown whether the frequent office visits, VA measurements, or optical coherence tomography testing was responsible for the detection at a better level of VA.

BACKGROUND AND OBJECTIVE:To describe a novel technique of scleral indentation and transillumination for single-surgeon, unassisted vitrectomy and vitreous base shaving enhanced with a digital heads-up display system (NGENUITY 3D Visualization System; Alcon, Fort Worth, TX).PATIENTS AND METHODS:This technique was utilized in six eyes of six patients during vitrectomy surgery for common vitreoretinal surgical diagnoses. In each case, the transillumination was performed with the traditional intraocular light pipe set at 100% power, placed obliquely just posterior to the vitreous base insertion, with or without a transillumination adapter. The visualization of the vitreous cavity was digitally enhanced using a heads-up display system (NGENUITY 3D) with light amplification settings increased to near-maximal gain. In each case, the adequacy of the surgical view was judged intraoperatively by two independent surgeons who shared the same surgical view as the primary surgeon.RESULTS:In this series, the surgical view provided by the scleral transillumination was deemed adequate to safely perform surgery in five of six cases. In the one patient in whom this was not the case, vitrectomy was completed using traditional endo-illumination and scleral depression performed by a skilled assistant. Lighter fundus pigmentation, myopia, thin sclera, and absence of dense peripheral media opacities were associated with improved view with scleral transillumination. There were no intraoperative complications.CONCLUSION:Digitally enhanced scleral transillumination affords surgeons another option for safe and effective simultaneous scleral depression and illumination for unassisted peripheral vitrectomy.[[Ophthalmic Surg Lasers Imaging Retina. 2018;49:436–439.]

Objective: To evaluate the use of a novel retinal projection display in vitreoretinal surgery.Methods: The Avegant Glyph virtual retinal display, which uses a light-emitting diode and micromirror array to project directly onto the retinas of the user, was evaluated. This unit was modified for better operating room characteristics. It was evaluated by 6 surgeons performing mock vitreoretinal surgeries.Results: The majority reported high 3-dimensional (3-D) depth rendition, little hindrance to communication, and high confidence to perform procedures. Due to a small ocular size, surgeons conveyed that the Glyph provides a novel enhanced view for performing procedures benefiting from simultaneous intra- and extraocular visualization such as scleral depression. Safety analysis by performing fundus autofluorescence after 2 hours of Glyph operation did not reveal any gross qualitative change.Conclusion: Use of the Avegant Glyph to perform vitreoretinal surgery may provide ergonomic advantages, while its visualization and high 3-D stereoscopic depth rendition instill high surgeon confidence to safely perform procedures. We are performing further studies with objective data to validate the potential of this technology.

Additive manufacturing allows for the production of intricate geometries with reduced material waste. However, due to the complex thermal gyrations that are linked to the processing parameters and geometry, inconsistencies in microstructures and mechanical properties occur from build to build. These inconsistencies are exemplified in multi-phase alloys such as 17–4 precipitation hardened (PH) stainless steel where the formation of ferrite, austenite, and martensite is sensitive to the powder composition and thermal conditions. The work presented here investigates a concentric scan strategy’s impact on thermal conditions within laser powder bed fusion (PBF-LB/M) processed 17–4 PH stainless steel, and the resulting phase formation and morphologies that occur. Through the combined use of computational materials science and experimental characterization, complex phase transformation routes were identified as being dependent on the site-specific thermal gyrations within the builds. Within the outer regions of the builds, a primarily δ-ferrite solidification microstructure was identified with two notable morphologies of austenite detected, allotriomorphic and Widmanstätten austenite. Within the center of the sample, however, a primarily austenite microstructure that nucleated from the prior δ-ferrite was identified. Small fractions of α-ferrite and/or martensite were potentially identified within the austenite grains. These results are rationalized using computational thermodynamics and kinetics in conjunction with proposals for pathways towards site-specific control of phase formation and morphology in PBF-LB/M stainless steels.

Purpose: To report the clinical findings in patients ≥100 years old who have age-related macular degeneration (AMD).Methods: We identified patients ≥100 years old who had non-neovascular AMD, neovascular AMD or both.Results: Sixty-two patients were included. The mean (SD) age was 102 (1.4) years (range, 100-106 years). Most patients were white (n = 51, 82%), women (n = 51, 82%), and had at least 1 eye affected by neovascular AMD (n = 55, 89%). The mean Snellen visual acuity (VA) among eyes with neovascular AMD was worse than that for eyes with non-neovascular AMD (20/600 [range, 20/40-hand motions] vs 20/250 [range, 20/20-hand motions], respectively, P= .03). Eyes with an intact subfoveal ellipsoid zone (EZ) had much better mean VA than eyes with an absent or disrupted EZ (20/50 vs 20/500, P= .002).Conclusion: Most centenarians with AMD in our cohort had the neovascular form, and these individuals tended to have poorer vision than those with non-neovascular AMD. The presence of an intact subfoveal EZ is associated with better VA in eyes with neovascular or non-neovascular AMD compared to eyes with an absent or disrupted EZ.

Purpose Over 8 million cataract surgeries are performed in the United States and the European Union annually, with many patients choosing to pay out of pocket for premium options including premium intraocular lens implants (IOLs) or laser-assisted cataract surgery (LACS). This report provides a systematic review evaluating patient-centered and visual quality outcomes comparing standard monofocal IOLs to premium cataract surgery options.Methods PubMed and EMBASE were searched for publications published between January 1, 1980, and September 18, 2016, on multifocal, accommodative, and toric IOLs, monovision, and LACS, which reported on 1) dysphotopsias, 2) contrast sensitivity, 3) spectacle independence, 4) vision-related quality of life or patient satisfaction, and 5) IOL exchange.Results Multifocal lenses achieved higher rates of spectacle independence compared to monofocal lenses but also had higher reported frequency of dysphotopsia and worse contrast sensitivity, especially with low light or glare. Accommodative lenses were not associated with reduced contrast sensitivity or more dysphotopsia but had only modest improvements in spectacle independence compared to monofocal lenses. Studies of monovision did not target a sufficiently myopic outcome in the near-vision eye to achieve the full potential for spectacle independence. Patients reported high levels of overall satisfaction regardless of implanted IOL. No studies correlated patient-reported outcomes with patient expectations.Conclusions Studies are needed to thoroughly compare patient-reported outcomes with concomitant patient expectations. In light of the substantial patient costs for premium options, patients and their surgeons will benefit from a better understanding of which surgical options best meet patients’ expectations and how those expectations can be impacted by premium versus monofocal—including monovision—options.

IMPORTANCE: The rate of endophthalmitis following dexamethasone intravitreal implant (DEX) has varied in large clinical trials. Furthermore, to our knowledge, the optimal management of eyes with endophthalmitis associated with DEX has not been established. OBJECTIVE: To report the incidence of culture-proven endophthalmitis in a single vitreoretinal practice over the course of 3 years and describe the clinical outcomes associated with each case of endophthalmitis. DESIGN, SETTING, AND PARTICIPANTS: All patients who received DEX between January 14, 2013, and August 31, 2016, were included in this retrospective single-center case series at a private vitreoretinal practice. The patients were identified during a search of the billing records over the period of interest. Cases of endophthalmitis associated with DEX were also identified. EXPOSURES: Treatment with DEX. MAIN OUTCOMES AND MEASURES: Development of endophthalmitis following DEX and the clinical management and outcomes of each case of endophthalmitis. RESULTS: Of the 1051 participants who collectively received 3593 injections of DEX, 4 patients developed endophthalmitis; all 4 patients were white, female, and 60 years or older (mean [SD] age, 75.6 [13] years). Two patients had culture-proven bacterial endophthalmitis after DEX monoinjections (0.06% of injections and 0.2% of patients). Three other cases of endophthalmitis developed after coinjection with bevacizumab (aggregate rate: 0.14% of injections and 0.38% of patients), of which 2 were culture positive. One patient developed endophthalmitis on 2 separate occasions. Vitrectomy was performed in 2 patients, and in 1 of these patients, the implant was removed. All 4 patients were treated with injection of intravitreous vancomycin and ceftazidime. CONCLUSIONS AND RELEVANCE: These data suggest that endophthalmitis is a rare event following injection of DEX. However, given the rarity of endophthalmitis following DEX and the heterogeneity among our reported cases, it remains unclear whether the DEX endophthalmitis rate approximates that of intravitreous anti–vascular endothelial growth factor therapy. These data also suggest that vitrectomy with removal of DEX may not be necessary in all cases of DEX-associated endophthalmitis.

Intraocular lenses (IOLs) can have inadequate support for placement in the capsular bag as a result of ocular trauma, metabolic or inherited conditions such as Marfan syndrome or pseudoexfoliation, or complicated cataract surgery. Surgical options for patients with inadequate capsular support include alternative placement of the IOL in the anterior chamber, fixation to the iris, or fixation to the sclera. The surgical techniques for each of these approaches have improved considerably over the last several decades resulting in improved visual and ocular outcomes. If no capsular or iris support exists, the surgeon can fixate an IOL to the sclera or the patient can remain aphakic. IOLs can be fixated to the sclera using sutures or by tunneling the IOL haptics into the sclera without sutures. This review summarizes the preoperative considerations, surgical techniques, outcomes, and unique complications associated with implantation of scleral-fixated IOLs.