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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

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

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

Novel metal oxide films and new metal gates are currently being developed for future generations of Si based field-effect transistors as the SiO2 gate dielectric and polycrystalline Si gate electrode are reaching scaling limits. These gate stacks are often comprised of sub-nanometer layers. Device properties are increasingly controlled by the complex structure and chemistry of interfaces between the layers. Electron energy-loss spectroscopy (EELS) in scanning transmission electron microscopy (STEM) is capable of providing insights into interfacial chemistry and local atomic structure with a spatial resolution unmatched by any other technique. Using gate stacks with Hf-silicate dielectrics as examples, we demonstrate the capabilities of STEM/EELS for analyzing the interfacial chemistry of novel gate stacks. We show that a priori unknown reaction layers of a few A thickness can be detected and identified even in the presence of substantial interfacial roughness that may obscure such layers in a high-resolution image. We discuss some experimental aspects of STEM/EELS chemical profiling applied to gate stacks and the factors affecting the interpretation. In particular, the effects of interfacial roughness, beam spreading, elemental analysis in a heavily scattering matrix, and the interpretation of the EELS core-loss fine-structures from ultrathin layers are discussed. (c) 2004 Elsevier B.V. All rights reserved.

Alessandra N Bazzano,1 Lauren Cenac,1 Amelia J Brandt,1 Josephine Barnett,2 Shelley Thibeau,3 Katherine P Theall1 1Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 2City University of New York, CUNY Graduate Center, New York, NY, 3Ochsner Clinic Foundation, New Orleans, LA, USA Abstract: An increase in the marketing and use of herbal galactagogues among breastfeeding mothers in the US has raised the issue of how best to provide support and information on the use of these products, particularly in light of limited availability of certified lactation counselors and continued suboptimal rates of breastfeeding globally. Currently, no cross-sectional data are available on the experiences and attitudes of mothers regarding the use of herbal and pharmaceutical galactagogues for lactation in the US. The findings of an online survey of 188 breastfeeding mothers on experiences with and sources of information on galactagogues are presented. Most mothers (76%) reported that while breastfeeding, they felt as though they were not making enough milk to meet the needs of their child, and yet 54% also indicated that they had not supplemented with formula. A large proportion of respondents reported utilizing galactagogues to increase lactation and finding them useful. The results indicated that most women learned about galactagogues from the Internet or by word of mouth through friends. Lactation consultants were the third-most reported sources of information on these products. While many respondents reported perceiving galactagogues as innocuous, more evidence on safety and efficacy is needed to support women properly who seek out and use them. Large-scale studies of the prevalence of galactagogue use in the US and rigorous evaluation of use globally are needed to ensure that mothers who choose to breastfeed may safely avail themselves of all options when counseling support is insufficient. Keywords: galactagogue, breastfeeding, lactation, lactation support