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On 24 April 2023, a Coronal Mass Ejection event caused the solar wind to become sub‐Alfvénic, leading to the development of an Alfvén Wing configuration in the Earth's magnetosphere. Alfvén Wings have previously been observed as cavities of low flow around moons in Jupiter's and Saturn's magnetospheres, but the observing spacecraft did not have the ability to directly measure the Alfvén Wings' current structures. Through in situ measurements made by the Magnetospheric Multiscale spacecraft, the 24 April event provides us with the first direct measurements of current structures during an Alfvén Wing configuration. These structures are observed to be significantly more anti‐field‐aligned and electron‐driven than the typical diamagnetic magnetopause current, indicating the disruption caused to the magnetosphere current system by the Alfvén Wing formation. The magnetopause current is then observed to recover more of its typical, perpendicular structure during the magnetosphere's recovery from the Alfvén Wing formation. Plain Language Summary: The solar wind applies pressure on the Earth's magnetic field, distorting it from a dipole into its compressed dayside and stretched tail configuration. However, this typical structure can be disrupted by eruptive solar events such as Coronal Mass Ejections (CMEs), which may cause the solar wind's pressure to drop low enough that it is no longer able to push the magnetosphere back to form a single unified tail. When this occurs, the tail splits into two separate structures, called Alfvén Wings. While this configuration is rare at Earth, it is common from interactions of the outer planets' magnetosphere's with their moons, where Alfvén Wing configurations have been studied and modeled. However, because the observing spacecraft lacked the necessary instrumentation, we have not yet directly observed the Alfvén Wing current structures. On 24 April 2023, a CME event led to the creation of an Alfvén Wing formation in the Earth's magnetosphere. We observed this event using the Magnetospheric Multiscale spacecraft, which enabled us to make the first direct observations of Alfvén Wing current structures. These currents were found to be mainly parallel to the local magnetic field, in contrast to typical magnetopause currents. Key Points: On 24 April 2023, the Magnetospheric Multiscale (MMS) spacecraft observed an Alfvén Wing formation along the dawn‐flank of Earth's magnetosphereMMS's observations represent the first in situ measurements of Alfvén Wing current structuresThe current structures are found to be primarily anti‐field‐aligned, electron‐driven, and filamentary [ABSTRACT FROM AUTHOR]

This article presents a statistical analysis of overlapping double ion-energy dispersion events in the northern cusp ("double dispersion"). Double dispersion in either cusp is a phenomenon associated with multiple reconnections occurring on the dayside magnetosphere as a result of its constant interaction with the variable solar wind. Using observations from a low Earth orbiting (LEO) Defense Meteorological Satellite Program (DMSP) satellite, we analyze 138 dayside events selected by the automatic algorithm extended from our previous work. We conducted a correlation study between the number of detected double dispersion events and 1) the month of the year to analyze the seasonal response of the cusp, and 2) solar wind interplanetary magnetic field (IMF) components and clock/cone angles to investigate its relationship with magnetic reconnection. We found that dispersion events occur more frequently during the northern summer months (i.e., when the dipole is tilted Sunward) and when the By component of IMF is positive. In addition, we provide a machine-readable list of the events and the code used to automatically detect the events. [ABSTRACT FROM AUTHOR]

Aim: To describe the effectiveness and side-effect profile of adding difluprednate therapy to patients with anterior scleritis being treated systemically., Methods: Retrospective chart review. Charts from all patients with anterior scleritis who were treated with topical difluprednate in addition to systemic therapy from 1 January 2018 to 1 January 2020 were reviewed. Data collected included: demographics, scleritis type, systemic diagnosis, presence of nodules or necrosis, changes in scleritis activity, intraocular pressure (IOP), number of difluprednate drops used, type of systemic treatment used, best-corrected visual acuity (BCVA) and lens status. The primary outcome was clinical resolution of scleritis. Secondary outcomes included BCVA loss ≥2 lines, change in lens status or cataract surgery and IOP ≥24 mm Hg., Results: Thirty-two patients (44 eyes) were analysed. The median age was 57 years (IQR 52, 72); 59% were female; 72% were Caucasian. An associated systemic disease was present in 59%. Systemic therapies used when difluprednate was added were: 65% immunosuppressive agents, 43% prednisone and 25% non-steroidal anti-inflammatory drugs. The addition of difluprednate resulted in clinical resolution in 79.6% of the treated eyes. Median time to inactivity was 9 weeks (IQR 5, 20). Eyes initially using 2-4 drops per day had a higher response rate (89%, p=0.005). Over a median follow-up of 34 weeks (IQR 21, 74), 11 eyes had IOP elevation; 6 eyes lost ≥2 lines of BCVA, 5 eyes had cataract progression., Conclusion: Most eyes treated with difluprednate achieved inactivity. The addition of difluprednate to systemic therapies provides an alternative to achieve control of inflammation., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To assess the accuracy and completeness of ChatGPT-generated answers regarding uveitis description, prevention, treatment, and prognosis., Methods: Thirty-two uveitis-related questions were generated by a uveitis specialist and inputted into ChatGPT 3.5. Answers were compiled into a survey and were reviewed by five uveitis specialists using standardized Likert scales of accuracy and completeness., Results: In total, the median accuracy score for all the uveitis questions ( n  = 32) was 4.00 (between "more correct than incorrect" and "nearly all correct"), and the median completeness score was 2.00 ("adequate, addresses all aspects of the question and provides the minimum amount of information required to be considered complete"). The interrater variability assessment had a total kappa value of 0.0278 for accuracy and 0.0847 for completeness., Conclusion: ChatGPT can provide relatively high accuracy responses for various questions related to uveitis; however, the answers it provides are incomplete, with some inaccuracies. Its utility in providing medical information requires further validation and development prior to serving as a source of uveitis information for patients.

In addition to affecting individual health the COVID-19 pandemic has disrupted efforts to deliver essential health services around the world. In this article we present an overview of the immediate programmatic and epidemiologic impact of the pandemic on polio eradication as well as the adaptive strategic and operational measures taken by the Global Polio Eradication Initiative (GPEI) from March through September 2020. Shortly after the World Health Organization (WHO) declared a global pandemic on 11 March 2020, the GPEI initially redirected the programme's assets to tackle COVID-19 and suspended house-to-house supplementary immunization activities (SIAs) while also striving to continue essential poliovirus surveillance functions. From March to May 2020, 28 countries suspended a total of 62 polio vaccine SIAs. In spite of efforts to continue poliovirus surveillance, global acute flaccid paralysis (AFP) cases reported from January-July 2020 declined by 34% compared with the same period in 2019 along with decreases in the mean number of environment samples collected per active site in the critical areas of the African and Eastern Mediterranean regions. The GPEI recommended countries should resume planning and implementation of SIAs starting in July 2020 and released guidelines to ensure these could be done safely for front line workers and communities. By the end of September 2020, a total of 14 countries had implemented circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreak response vaccination campaigns and Afghanistan and Pakistan restarted SIAs to stop ongoing wild poliovirus type 1 (WPV1) transmission. The longer-term impacts of disruptions to eradication efforts remain to be determined, especially in terms of the effect on poliovirus epidemiology. Adapting to the pandemic situation has imposed new considerations on program implementation and demonstrated not only GPEI's contribution to global health security, but also identified potential opportunities for coordinated approaches across immunization and health services., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021. Published by Elsevier Ltd.)

Objective: Survivors of Ebola virus disease (EVD) experience decreased intraocular pressure (IOP) relative to unaffected close contacts during the first year of convalescence. Whether this effect persists over time and its relationship to intraocular pathology are unclear. We sought to determine whether IOP remained lower in survivors of EVD over 4 years of follow-up and to identify associated risk factors., Design: Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL) III is a 5-year, longitudinal cohort study of survivors of EVD and their close contacts and is a collaboration between the Liberian Ministry of Health and the United States National Institutes of Health., Participants: Participants who enrolled in PREVAIL III at John F. Kennedy Medical Center in Liberia, West Africa from June 2015 to March 2016 who underwent comprehensive ophthalmic evaluation annually for 5 consecutive visits., Methods: Intraocular pressure was measured at each visit by a handheld rebound tonometer using sterile tips. Comparisons are made between antibody-positive survivors and antibody-negative close contacts., Main Outcome Measures: Intraocular pressure, measured in mmHg, at each study visit., Results: Of 565 antibody-positive survivors and 644 antibody-negative close contacts enrolled in the study at baseline, the majority of participants returned annually, with 383 (67.8%) and 407 (63.2%) participants, respectively, presenting for the final study visit at a median of 60 months after symptom onset. A sustained, relative decrease in IOP was observed in survivors relative to close contacts, with mean difference of -0.72 mmHg (95% confidence interval [CI] -1.18 to -0.27) at the final study visit. This difference remained constant throughout the study period ( P  = 0.4 for interaction over time). Among survivors, physical examination findings of vitreous cell and OCT findings of vitreous opacities both demonstrated a significant association with decreased IOP at baseline ( P < 0.05 for both). After adjusting for such factors, the difference throughout the follow-up (-0.93 mmHg, 95% CI, -1.23 to -0.63) remained significant., Conclusions: Survivors of EVD experienced a sustained decrease in IOP relative to close contacts over a 5-year period after EVD. The results highlight the importance of considering long-term sequelae of emerging infectious diseases within a population., Financial Disclosures: Proprietary or commercial disclosure may be found after the references., (© 2022 by the American Academy of Ophthalmology. Published by Elsevier Inc.)

Purpose: In survivors of Ebola virus disease (EVD), intraocular viral persistence raises questions about the timing and safety of cataract surgery. To the best of our knowledge, this is the first controlled study evaluating Ebola virus persistence and cataract surgery safety and outcomes in EVD survivors., Methods: Seropositive EVD survivors and seronegative controls with vision worse than 20/40 from cataract and without active intraocular inflammation were enrolled. Aqueous humor from survivors was tested with reverse transcription-polymerase chain reaction for Ebola viral RNA. Participants underwent manual small-incision cataract surgery and 1 year of follow-up examinations., Results: Twenty-two eyes of 22 survivors and 12 eyes of eight controls underwent cataract surgery. All of the aqueous samples tested negative for Ebola viral RNA. Median visual acuity improved from 20/200 at baseline to 20/25 at 1 year in survivors and from count fingers to 20/50 in controls (overall, P < 0.001; between groups, P = 0.07). After a 1-month course of topical corticosteroids, 55% of survivors and 67% of controls demonstrated at least 1+ anterior chamber cell. Twelve months after surgery, optical coherence tomography revealed a median increase in macular central subfield thickness of 42 µm compared with baseline (overall, P = 0.029; between groups, P = 0.995)., Conclusions: EVD survivors and controls demonstrated significant visual improvement from cataract surgery. The persistence of intraocular inflammation highlights the importance of follow-up. The absence of detectable intraocular Ebola viral RNA provides guidance regarding the safety of eye surgery in Ebola survivors., Translational Relevance: These findings demonstrate the safety and efficacy of cataract surgery in Ebola survivors and will inform ocular surgery guidelines in this population., Competing Interests: Disclosure: A.O. Eghrari, None; J.G. Shantha, None; R.D. Ross, None; C. Van Ryn, None; I. Crozier, None; B. Hayek, None; D. Gradin, None; B. Roberts, None; S.G. Prakalapakorn, None; F. Amegashie, None; K. Nishant, None; G. Singh, None; R. Dolo, None; J. Fankhauser, None; B. Burkholder, None; J. Pettitt, None; R. Gross, None; T. Brady, None; B. Dighero-Kemp, None; C. Reilly, None; L. Hensley, None; E. Higgs, None; S. Yeh, None; R.J. Bishop, None, (Copyright 2021 The Authors.)

Importance: Survivors of Ebola virus disease (EVD) may experience ocular sequelae. Comparison with antibody-negative individuals from the local population is required to characterize the disease., Objective: To assess features of ophthalmic disease specific to EVD., Design, Setting, and Participants: This baseline cross-sectional analysis of survivors of EVD and their close contacts was conducted within PREVAIL III, a 5-year, longitudinal cohort study. Participants who enrolled at John F. Kennedy Medical Center in Liberia, West Africa from June 2015 to March 2016 were included in this analysis. Close contacts were defined as household members or sex partners of survivors of EVD. Data were analyzed from July 2016 to July 2020., Exposures: All participants, both survivors and close contacts, underwent testing of IgG antibody levels against Ebola virus surface glycoprotein., Main Outcomes and Measures: Ocular symptoms, anterior and posterior ophthalmologic examination findings, and optical coherence tomography images were compared between antibody-positive survivors and antibody-negative close contacts., Results: A total of 564 antibody-positive survivors (320 [56.7%] female; mean [SD] age, 30.3 [14.0] years) and 635 antibody-negative close contacts (347 [54.6%] female; mean [SD] age, 25.8 [15.5] years) were enrolled in this study. Survivors were more likely to demonstrate color vision deficit (28.9% vs 19.0%, odds ratio [OR], 1.6; 95% CI, 1.2-2.1) and lower intraocular pressure (12.4 vs 13.5 mm Hg; mean difference, -1.2 mm Hg; 95% CI, -1.6 to -0.8 mm Hg) compared with close contacts. Dilated fundus examination revealed a higher percentage of vitreous cells (7.8% vs 0.5%; OR, 16.6; 95% CI, 5.0-55.2) and macular scars (4.6% vs 1.6%; OR, 2.8; 95% CI, 1.4-5.5) in survivors than in close contacts. Uveitis was present in 26.4% of survivors and 12.1% of close contacts (OR, 2.4; 95% CI, 1.8-3.2). Among all participants with uveitis, survivors were more likely than close contacts to have intermediate uveitis (34.2% vs 6.5% of all cases; OR, 7.8; 95% CI, 3.1-19.7) and had thicker mean central subfield thickness on optical coherence tomography (222 vs 212 μm; mean difference, 14.4 μm; 95% CI, 1.9-26.9 μm)., Conclusions and Relevance: In this cross-sectional study, survivors of EVD had a distinct spectrum of ocular and neuro-ophthalmologic findings compared with close contacts that potentially require medical and surgical treatment.