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Natalie R Barnett,1 Amanda M Bunnell,1 Matthew A Dow2 1Department of Anesthesiology and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA; 2Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USACorrespondence: Natalie R Barnett, Associate Professor in Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Medical University of South Carolina, 10 McClennan Banks Dr, Suite 2190, MSC 940, Charleston, SC, 29425, USA, Tel +1-843-792-5454, Email barnettn@musc.eduAbstract: Charcot Marie Tooth disease is a common cause of pediatric peripheral neuropathy, which can lead to distal muscle wasting and weakness necessitating orthopedic procedures. We present an eleven-year-old male with Charcot Marie Tooth disease who received peripheral nerve blocks for ankle surgery, with a total dose of 1.75 mg/kg of bupivacaine 0.25%. Upon follow-up, it was identified that the sensory blockade did not resolve until thirty-six hours, postoperatively. There were no noted long-term sequalae on surgical follow-up. If a patient with Charcot Marie Tooth receives a peripheral nerve block, the patient should receive close short- and long-term follow-up to monitor for block complication or disease exacerbation.Keywords: regional anesthesia, local anesthesia, peripheral neuropathy

Joshua Barnett,1 Sofia Pappa1,2 1Department of Mental Health, West London NHS Trust, London, UK; 2Department of Brain Sciences, Imperial College London, London, UKCorrespondence: Joshua Barnett, Department of Mental Health, West London NHS Trust, 43– 47 Avenue Road, London, W38NJ, UK, Tel +44 20 84831792, Email joshua.barnett2@nhs.netIntroduction: Poor adherence to antipsychotic medication is common in the treatment of schizophrenia and other psychotic disorders. Paliperidone palmitate 3-monthly (PP3M) is the first long-acting injectable (LAI) antipsychotic to allow for only four medication administrations per year, and although there is sufficient information available about the clinical effects, there is relatively limited insight into the subjective experience of people with lived experience.Methods: This descriptive, cross-sectional survey explored patient’s satisfaction and perspectives on the advantages and disadvantages of switching from monthly to 3-monthly paliperidone while also reporting on perceived levels of safety with regard to the reducing dose regimen during the Covid-19 pandemic. Information on discontinuation and hospitalisation rates at one year was also collected from the electronic records.Results: Of the 46 patients included in the study, the vast majority reported feeling satisfied (89.2%) and safer (93.5%) after switching to the three-monthly formulation. Participants highlighted several advantages of changing to PP3M, most notably convenience (93.5%), improved quality of life (58.7%), decreased stigma (39.1%) and better adherence (28.3%). Furthermore, 93.5% of respondents experienced no disadvantages, while 6.5% described worsening side effects or symptoms. In fact, only one patient discontinued PP3M at one year with the overall number of hospitalisations also reducing in the same period compared to the year before switching.Discussion: Our findings add to the small, but growing, body of evidence supporting patient satisfaction and acceptance with the use of PP3M and may reinforce the use of less frequent LAIs in clinical practice to enhance individual experience and treatment persistence and decrease levels of stigmatisation.Keywords: schizophrenia, paliperidone, long-acting injectable, patient satisfaction

Sarah E Schimschal,1 Michelle Cleary,2 Rachel A Kornhaber,3 Tony Barnett,1 Denis C Visentin4 1Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia; 2School of Nursing, Midwifery & Social Sciences, CQUniversity, Sydney, New South Wales, Australia; 3School of Nursing, University of Tasmania, Sydney, New South Wales, Australia; 4School of Health Sciences, University of Tasmania, Sydney, New South Wales, AustraliaCorrespondence: Sarah E Schimschal, Centre for Rural Health, School of Health Sciences, Locked Bag 1322, Launceston, Tasmania, 7250, Australia, Email sarah.schimschal@utas.edu.auBackground: Psychological resources have been shown to play a prominent role in buffering against stress and are associated with various positive constructs, including grit, defined as having the disposition to pursue long-term goals with both passion and perseverance.Objective: The objective of this study was to validate a new scale developed to measure the psychological resources of grit.Methods: A quantitative research study was conducted online with an international sample of 277 adults from a range of professional backgrounds. The psychometric properties of the 20-item Grit Psychological Resources Scale (GPRS) were evaluated by performing tests of reliability and validity.Results: Reliability tests provided evidence of high internal consistency (α = 0.91) and test–retest reliability (r = 0.75). Demographic variables did not significantly predict scores or influence survey completion. Face, content and convergent validity provided additional psychometric support for the GPRS with this sample. Confirmatory factor analysis results supported a second-order model with four sub-scales. The first-order factors loaded highly onto the second-order factor, with correlations ranging from 0.80 to 0.97.Conclusion: The GPRS showed satisfactory psychometric properties, indicating that the scale is a reliable and valid instrument for measuring the psychological resources of grit. This scale can be used to identify more targeted developmental approaches for personal and professional growth. Further, the tool enables information to be gathered on changes pre- and post-improvement initiatives to assess their effectiveness in training and continuing education.Keywords: grit, psychological resources, psychometrics, reliability, validity, factor analysis

“Screening” is a search for preclinical, asymptomatic disease, including cancer. Widespread cancer screening has led to large increases in early-stage cancers and pre-cancers. Ubiquitous public messages emphasize the potential benefits to screening for these lesions based on the underlying assumption that treating cancer at early stages before spread to other organs should make it easier to treat and cure, using more tolerable interventions. The intuition is so strong that public campaigns are sometimes launched without conducting definitive trials directly comparing screening to usual care. An effective cancer screening test should not only increase the incidence of early-stage preclinical disease but should also decrease the incidence of advanced and metastatic cancer, as well as a subsequent decrease in cancer-related mortality. Otherwise, screening efforts may be uncovering a reservoir of non-progressive and very slowly progressive lesions that were not destined to cause symptoms or suffering during the person's remaining natural lifespan: a phenomenon known as “overdiagnosis.” We provide here a qualitative review of cancer overdiagnosis and discuss specific examples due to extensive population-based screening, including neuroblastoma, prostate cancer, thyroid cancer, lung cancer, melanoma, and breast cancer. The harms of unnecessary diagnosis and cancer therapy call for a balanced presentation to people considering undergoing screening, even with a test of accepted benefit, with a goal of informed decision-making. We also discuss proposed strategies to mitigate the adverse sequelae of overdiagnosis.

Abstract Background The application of telehealth in the paediatric setting is growing, and yet, limited research has focused on using telehealth in developmental diagnostic assessment and the consumers' perceptions of their telehealth experience. This study explored parents'/carers' and staff experiences of using telehealth as part of the developmental diagnostic assessment. Methods Parents/carers who attended an assessment between June 2020 and July 2021 that incorporated a telehealth component within a hybrid service delivery model were invited to provide feedback about their experience of telehealth appointments at a multidisciplinary developmental assessment service. All parents were invited to complete an online survey, with a sample of families being offered a telephone interview. Staff members were invited to a focus group to explore their experiences of delivering services via telehealth. Data obtained were analysed descriptively and thematically using a mixed method of analysis. Codes were categorized, enabling facilitators and barriers to be explored. Results The use of telehealth in the diagnostic assessment of complex developmental disorders received high levels of acceptance from parents/carers and staff, despite having limitations such as technical issues, difficulties building rapport between families/clinicians and limited direct observations of the child. Telehealth services are perceived to reduce costs and increase flexibility, including increased ability to accommodate family needs. Conclusions Results demonstrated that telehealth is a highly acceptable mode of service in a developmental assessment service. The current study informs the development of a hybrid service delivery model by enhancing facilitators and reducing barriers commonly reported by consumers and provides direction for future research. Patient or Public Contribution Parents or carers of children who attended a tertiary paediatric assessment unit for a diagnostic developmental assessment completed the online survey and were interviewed.

Vector light beams feature a spatially varying optical polarisation and can exhibit localised structures reminiscent of the skyrmions familiar from the study of magnetic media. We present a theory and experimental measurements of such skyrmions in both paraxial and non-paraxial optics. A key feature for our analysis is the transverse skyrmion field which determines the properties of the skyrmions and traces out field lines. In paraxial optics these field lines are lines of constant polarisation, but in non-paraxial optics, the fact the polarisation ellipses are no longer restricted to the transverse plane, makes it necessary to introduce several different skyrmion fields, each representing a different aspect of the three-dimensional optical polarisation.

Tessnim R Ahmad,1 Marcus L Turner,2 Charis Hoppe,2 Alan W Kong,2 Jackson S Barnett,2 Gurbani Kaur,2 Neel D Pasricha,1 Maanasa Indaram1 1Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA; 2School of Medicine, University of California San Francisco, San Francisco, CA, USACorrespondence: Maanasa Indaram, Department of Ophthalmology, University of California San Francisco, 490 Illinois Street, San Francisco, CA, 94158, USA, Email maanasa.indaram@ucsf.eduPurpose: To assess the impact of parental socioeconomic status and keratoconus literacy on pediatric eye rubbing and keratoconus severity.Methods: In this mixed-methods study, pediatric keratoconus patients (age ≤ 18 years) were retrospectively identified. Sociodemographic and clinical characteristics were extracted from the electronic medical record (EMR). Telephone surveys were subsequently conducted to assess parental keratoconus literacy, receipt of counseling on keratoconus prevention, eye rubbing, and household socioeconomic factors not available in the EMR. Parents reporting poor keratoconus literacy were probed via semi-structured interview to explore barriers to their understanding.Results: Forty-eight patients met inclusion criteria, 22 (46%) of whom were reached by telephone. Most patients were insured by Medicaid (73%) and current eye rubbers (82%). Few parents reported good or excellent keratoconus literacy now (32%) or at the time of diagnosis (18%). Parents with a high-school education, limited English proficiency, lower income level, and Medicaid insurance tended to have lower keratoconus literacy, though this was not statistically significant. Parental keratoconus literacy was not correlated with disease severity. High-school education, limited English proficiency, lower income level, and Medicaid insurance were correlated with steeper keratometry readings, which was statistically significant for high-school education. In-depth interviews revealed parents felt unconfident with eye health in general and perceived a personal responsibility for learning more.Conclusion: This is the first study exploring keratoconus literacy from a socioeconomic perspective, demonstrating lower literacy among socioeconomically marginalized parents and a tendency toward more severe disease in their children.Keywords: keratoconus, social determinants of health, health literacy, disparities

Alan W Kong,1 Tessnim R Ahmad,2 Marcus L Turner,1 Jackson Barnett,1 Gurbani Kaur,1 Neel D Pasricha,2,3 Maanasa Indaram2 1School of Medicine, University of California San Francisco, San Francisco, CA, USA; 2Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA; 3Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USACorrespondence: Maanasa Indaram, Department of Ophthalmology, University of California San Francisco, 490 Illinois Street, San Francisco, CA, 94158, USA, Email maanasa.indaram@ucsf.eduPurpose: To describe trends in the use of corneal topography and tomography for the management of keratoconus patients at a single academic institution and to identify how these trends may be associated with different procedural interventions.Patients and Methods: In this retrospective cohort study, keratoconus patients treated from 2012 to 2019 were identified. The electronic health record was reviewed for the presence of corneal topography or tomography imaging completed within seven days of the first visit and the highest level of intervention at the first and most recent visit. Patients were grouped as pediatric (< 18 years) or adult (≥ 18 years). Chi-square tests and linear regressions were used to evaluate trends and to determine which factors were predictive for receiving corneal collagen cross-linking (CXL) versus other surgical interventions (intrastromal corneal ring segments, lamellar keratoplasty, or penetrating keratoplasty) by the most recent visit.Results: A total of 873 keratoconus patients met inclusion criteria. The use of corneal topography at the first visit remained relatively consistent from 2012 to 2019, while corneal tomography usage at the first visit increased from 3.9% in 2015, when corneal tomography was introduced, to 52.8% in 2019. Each year was associated with an 11.2% ± 1.9% increase in the use of corneal tomography at the first visit in pediatric patients and 6.7% ± 0.5% in adult patients. Use of corneal tomography at the first visit was a significant predictor for receiving CXL procedures (P < 0.001) and a negative predictor for requiring other surgical interventions (P = 0.032) when controlling for the year of the first visit.Conclusion: Obtaining corneal tomography at the first visit has become the standard of care in keratoconus, especially for pediatric patients. Moreover, the increase in corneal tomography imaging has coincided with an increase in CXL procedures and decrease in other surgical interventions.Keywords: keratoconus, topography, tomography, corneal collagen cross-linking, keratoplasty

Rute J Macedo-de-Araújo,1 Daddi Fadel,2 Melissa Barnett3 1Clinical & Experimental Optometry Research Laboratory (CEORLab), Physics Centre of Minho and Porto Universities (CF-UM-UP), University of Minho, Braga, Portugal; 2Private Practice, Rieti, Italy; 3Davis Eye Center, University of California, Sacramento, CA, USACorrespondence: Rute J Macedo-de-Araújo, Email rjfmaraujo@gmail.comAbstract: Scleral lenses (SLs) present several unique advantageous characteristics for patients. As these lenses are mainly fitted in severely diseased eyes, a thorough evaluation of the ocular surface before and after SL fitting and the on-eye SL fitting evaluation are essential and help minimize potential physiological complications. This review will explore the current and emerging techniques and instrumentation to best measure SL performance ensuring optimal lens fitting, visual quality, comfort and physiological responses, highlighting some potential complications and follow-up recommendations. A single physician could perform the great majority of evaluations. Still, the authors consider that the assessment of SL fitting should be a collaborative and multidisciplinary job, involving contact lens practitioners, ophthalmologists and the industry. This publication has reviewed the most up-to-date work and listed the most used techniques; however, the authors encourage the development of more evidence-based recommendations for SL clinical practice.Keywords: scleral lens, performance, instrumentation

Ali Cheetham,1,2 Louisa Picco,1 Anthony Barnett,1,2 Dan I Lubman,1,2 Suzanne Nielsen1,2 1Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, 3199, Australia; 2Turning Point, Eastern Health, Richmond, Victoria, 3121, AustraliaCorrespondence: Suzanne NielsenMonash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, 47-49 Moorooduc Hwy, Frankston, Victoria, 3199, Australia, Tel +61 3 9904 4641, Email suzanne.nielsen@monash.eduAbstract: Illicit drug use disorders are the most stigmatised health conditions worldwide, and stigma acts as a meaningful barrier to treatment entry and treatment provision. In the context of dramatically rising opioid-related harms, it is critical that we understand the drivers of stigma and how it affects opioid use disorder treatment and policy. The aim of this narrative review is to discuss how opioid-related stigma impacts treatment provision and harm reduction, and provide potential strategies to reduce stigma at a social and structural level. We used the Framework for Integrating Normative Influences on Stigma (FINIS) to identify sources of opioid-related stigma at the macro (structural stigma), meso (public stigma) and micro (internalised stigma) levels. Reducing stigma requires strategies that target multiple levels, however addressing inequity in the laws, regulations, and rules that segregate people with opioid and other substance use disorders from mainstream society is essential.Keywords: stigma, opioid use disorder, FINIS, opioid-related disorders, analgesics, Opioid, social stigma

Quincy K Tran,1,2 Jeremy Barnett,3 Francis O’Connell,3 Brian D’Anza,4 Ali Pourmand3 1Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; 2Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA; 3Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA; 4Department of Otolaryngology - Head and Neck Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USACorrespondence: Quincy K Tran Email qtran@som.umaryland.eduAbstract: We performed a narrative review of epistaxis management in the emergency department. First, we examined the pathophysiology, the current types of treatment that are available to emergency clinicians. When nasal packing is indicated, we examined the efficacy of nasal packing in addition to other topical treatment such as tranexamic acid and the evidence of prophylactic antibiotics. We detailed current studies involving tranexamic acid and prophylactic antibiotics for nasal packing. Finally, we introduced an epistaxis clinical care pathway, based on current evidence, to aid emergency clinicians with their clinical decision-making processes.Keywords: epistaxis, tranexamic acid, nasal packing, clinical care pathway

Background: To provide an understanding of important aspects of the participant recruitment and data collection, become aware of any potential problems, and obtain necessary information in order to design a large-scale randomized controlled trial (RCT) for lung cancer and colorectal cancer (CRC) screening in China. Methods: This feasibility study was a multicentered, open-label, pilot randomized trial. A total of 2696 participants who were at high risk of lung cancer were recruited from three screening centers and randomly allocated to arm 1 (n = 894), annual low-dose computed tomography (LDCT) plus a baseline colonoscopy; arm 2 (n = 902), biennial LDCT plus annual fecal immunochemical test (FIT) with OC-Sensor (OC-FIT); and arm 3 (n = 900), annual Insure-FIT plus Septin 9 blood test. Information on randomization, compliance, positivity rate, cancer case detection, and contamination with screening for lung cancer and CRC were collected. Results: Participant characteristics were similar across study arms. The compliance rate of annual LDCT screening in arm 1 was 86.4% (95% CI: 83.9%, 88.5%) at baseline (T0), and 69.0% (95% CI: 65.8%, 72.0%) and 70.7% (95% CI: 67.6%, 73.7%) at the following two rounds (T1 and T2). The compliance rates of biennial LDCT screening in arm 2 were similar to those in arm 1 in the corresponding rounds. The compliance rate was 55.5% (95% CI: 52.2%, 58.8%) for colonoscopy in arm 1, while the compliance rates of OC-FIT, Insure-FIT, and the Septin 9 test in arms 2 and 3 were all approximately 90% at T0, decreasing to 65%–80% at T1 and T2. The positivity rate, cancer case detection rate, and contamination rate of screening for lung cancer and CRC were also reported. Conclusion: In this pilot study, the feasibility of an RCT in China of lung cancer and CRC screening was demonstrated.

Daniel H Chang,1 George O Waring 4th,2 Milton Hom,3 Melissa Barnett4 1Empire Eye and Laser Center, Bakersfield, CA, USA; 2Waring Vision Institute, Mt. Pleasant, SC, USA; 3Canyon City Eyecare, Azusa, CA, USA; 4University of California, Davis Eye Center, Sacramento, CA, USACorrespondence: Daniel H ChangEmpire Eye and Laser Center, 4105 Empire Drive, Bakersfield, CA, 93309, USAEmail dchang@empireeyeandlaser.comAbstract: Presbyopia, a loss of accommodative ability associated with aging, is a significant cause of vision impairment globally. At the clinical level, it is a frustrating and difficult issue that negatively impacts patients’ quality of life. Less appreciated is the fact that loss of accommodative ability and its current treatments methods may present safety concerns, for example, increasing the risk of falls. Therefore, a more complete understanding of treatment options with respect to how they relate to the natural ability of the eye is needed to improve decision making and to aid clinicians in individualizing treatment options. This article reviews the options for expanding functional through focus—a term coined to describe the ability of the eye to see at all distances with minimal latency—by how they vary the refractive power over time, across the visual field, between eyes, or across a range of distances.Keywords: accommodation, presbyopia, functional through focus