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Minali Prasad,1,&ast; Deniz Goodman,1,&ast; Jia Xu,2 Sanhit Gutta,2 Daniella Zubieta,2 Sreevardhan Alluri,2 Nicole H Siegel,1,2 Crandall E Peeler,1,2 Hyunjoo J Lee,1,2 Howard J Cabral,3 Manju L Subramanian1,2 1Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; 2Department of Ophthalmology, Boston Medical Center, Boston, MA, USA; 3Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA&ast;These authors contributed equally to this workCorrespondence: Manju L Subramanian, Department of Ophthalmology, Boston Medical Center, 85 East Concord Street, &num;8813, Boston, MA, 02118, USA, Tel +1 (617) 638 – 4555, Fax +1 (617) 414 – 2929, Email Manju.Subramanian@bmc.orgPurpose: Long-term patient satisfaction may influence patients’ perspectives of the quality of care and their relationship with their providers. This is a follow up to a comparative effectiveness study investigating oral to intravenous sedation (OIV study). The OIV study found that oral sedation was noninferior in patient satisfaction to standard intravenous (IV) sedation for anterior segment and vitreoretinal surgeries. This study aims to determine if patient satisfaction with oral sedation remained noninferior long term.Patients and Methods: Patients were re-interviewed using the same satisfaction survey given during the OIV study. Statistical analysis involved t-tests for noninferiority of the long-term mean satisfaction score of oral and IV sedation. We also compared the original mean satisfaction score and the follow-up mean satisfaction score for each type of sedation and for both groups combined.Results: Participants were interviewed at a median of 1225.5 days (range 754– 1675 days) from their surgery. The original mean satisfaction score was 5.26 ± 0.79 for the oral treatment group (n = 52) and 5.27 ± 0.64 for the intravenous treatment group (n = 46), demonstrating noninferiority with a difference in mean satisfaction score of 0.015 (p < 0.0001). The follow-up mean satisfaction score was 5.23 ± 0.90 for oral sedation and 5.60 ± 0.61 for IV sedation, with a difference in the mean satisfaction score of 0.371 (p = 0.2071). Satisfaction scores did not differ between the original mean satisfaction score and the follow-up mean satisfaction score for the oral treatment group alone (p = 0.8367), but scores in the intravenous treatment group increased longitudinally (p = 0.0004).Conclusion: In this study, long-term patient satisfaction with oral sedation was not noninferior to satisfaction with IV sedation, unlike our findings with short-term patient satisfaction in our original study. Patient satisfaction also remained unchanged over time for the oral treatment group, but patients in the intravenous treatment group reported higher long-term satisfaction with their anesthesia experience compared to the immediate post-operative period.Keywords: longitudinal, ocular surgery, anesthesia, oral triazolam, intravenous midazolam, noninferiority

Introduction Maternal mortality rates have been increasing in the United States for decades. For several years, opioid overdoses have been a leading cause of maternal mortality in several states. New Hampshire (NH) is a particularly severe case, with 50% of all maternal deaths being caused by drug-related overdoses from 2016 to 2017. We report on the implementation of a point-of-care naloxone distribution program for an Ob/Gyn clinic in NH. Methods Naloxone distribution was tracked to measure program implementation. Proportion of patients screened for naloxone need was calculated monthly. Proportion of patients with which discussions about naloxone took place was calculated quarterly. Patient and provider perspectives on the program were captured periodically. Statistical process control charts monitored change over time and evaluated for special-cause variation. Results The clinic has distributed 12 doses of naloxone since program implementation in April 2020. Despite the challenges posed by the COVID-19 pandemic, screening for naloxone need has remained at pre-pandemic rates (moving average: 73%), except for a decrease in April-May 2020. Patient-provider discussions about naloxone have also remained at pre-pandemic rates (moving average: 51%). Qualitative feedback from patients and providers has indicated that the program has been well-received by both groups. Discussion The purpose of this description is to provide a framework for other Ob/Gyn clinics to use in implementing similar naloxone distribution programs. Although too early to determine whether this intervention will result in a significant decrease in maternal mortality due to opioid overdose in our patients, this measure will continue to be tracked annually. Implementation of a naloxone program in the obstetrical context provides an important way to improve outcomes for a vulnerable perinatal population., Author(s): M. Duska [sup.1] , D. Goodman [sup.1] [sup.2] Author Affiliations: (1) grid.414049.c, 0000 0004 7648 6828, The Dartmouth Institute for Health Policy and Clinical Practice, , 74 College St, [...]

Abstract: Background: WISDOM is a 100,000 healthy women preference-tolerant, pragmatic study comparing annual to personalized risk-based breast screening. The novelty of WISDOM personalized screening is the integration of previously validated genetic and clinical risk factors (age, family history, breast biopsy results, ethnicity, mammographic density) into a single risk assessment model that directs the starting age, timing, and frequency of screening. The goal of WISDOM is to determine if personalized screening, compared to annual screening, is as safe, less morbid, enables prevention, and is preferred by women. The study is registered on ClinicalTrials.gov, NCT02620852. Methods: Women aged 40-74 years with no history of breast cancer or DCIS, and no previous double mastectomy can join the study online at wisdomstudy.org. Participants can elect randomization or self-select a study arm, and provide electronic consent and Release for Medical Information using DocuSign. For all participants, 5-year risk of developing breast cancer is calculated according to the Breast Cancer Screening Consortium (BCSC) model. Participants in the personalized arm undergo panel-based mutation testing, and their 5-year risk is calculated using the BCSC score combined with a Polygenic Risk Score (BCSC-PRS) that includes 75 single nucleotide polymorphisms (SNPs, increase to 229) known to increase breast cancer risk. SNPs and mutations (BRCA1, BRCA2, TP53, PTEN, STK11, CDH1, ATM, PALB2, and CHEK2) are assessed by saliva-based testing through Color Genomics. 5-year risk level thresholds are used to stratify for low-, moderate- and high risk. Risk stratification determines age to start, stop, and frequency of screening. Enrollment: As of July 2018, the WISDOM study is open to all eligible women in California, North Dakota, South Dakota, Minnesota and Iowa. To date, 23,329 eligible women have registered and 14,393 women have consented to participate in the trial. We analyzed 3,255 participants who have completed risk assessment in the personalized arm. The median age was 56 years. 82% were Caucasian, 1% African-American, and 6% Asian. 9% self-reported as Hispanic. We are partnering with health insurers and self-insured companies using coverage with evidence progression. To strengthen generalizability, we are expanding to other states. WISDOM enrollment will continue past 2019. Feasibility: To evaluate the addition of PRS, we used paired statistical tests (McNemar) to compare the distributions of BCSC, and BCSC-PRS risk estimates around low-risk (6%) thresholds, the latter corresponding to 5-year risk of a BRCA mutation carrier. The median 5-year risk was 1.5% (IQR 1.0-2.1%) using the BCSC model, and 1.4% (IQR 0.8-2.5%) using the BCSC-PRS model. The BCSC-PRS model classified more women into the low (

An electric motor converts electrical energy into mechanical work and an electric generator converts mechanical work into electrical energy. The symmetry between the motor and generator naturally leads to questions about creating a perpetual motion machine. The allure of this question has inspired textbook problems, physics education articles, and award-winning physics demonstrations. It is commonly taught that spinning a generator faster produces a larger electromotive force (EMF), because the generator's instantaneous EMF is proportional to the angular rate of rotation. When making this point in class, students will often ask about an interesting thought experiment, which is depicted in Fig. 1. The student question is as follows: "If an electric motor is connected via a system of gears to an electric generator, so that the generator spins faster than the motor, then does the generator's output power P[subscript G] exceed the motor's input power P[subscript M]?"

A three-dimensional Tomographic Reconstruction Algorithm (3D TRA) has been developed and implemented on a parallel machine at the Maui High Performance Computing Center (MHPCC). Given a time sequence of infrared images, this algorithm provides information to determine the location, physical dimensions, and initial space-dependent temperature increase of laser heated blood vessels. In this approach the serial computation of a 3D TRA is decomposed into multiple tasks which can be executed in parallel to reduce the computation time.