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The objective of this study was to compare the sensitivity and specificity of handheld fundus cameras in detecting diabetic retinopathy (DR), diabetic macular edema (DME), and macular degeneration. Participants in the study, conducted at Maharaj Nakorn Hospital in Northern Thailand between September 2018 and May 2019, underwent an ophthalmologist examination as well as mydriatic fundus photography with three handheld fundus cameras (iNview, Peek Retina, Pictor Plus). Photographs were graded and adjudicated by masked ophthalmologists. Outcome measures included the sensitivity and specificity of each fundus camera for detecting DR, DME, and macular degeneration, relative to ophthalmologist examination. Fundus photographs of 355 eyes from 185 participants were captured with each of the three retinal cameras. Of the 355 eyes, 102 had DR, 71 had DME, and 89 had macular degeneration on ophthalmologist examination. The Pictor Plus was the most sensitive camera for each of the diseases (73-77%) and also achieved relatively high specificity (77-91%). The Peek Retina was the most specific (96-99%), although in part due to its low sensitivity (6-18%). The iNview had slightly lower estimates of sensitivity (55-72%) and specificity (86-90%) compared to the Pictor Plus. These findings demonstrated that the handheld cameras achieved high specificity but variable sensitivities in detecting DR, DME, and macular degeneration. The Pictor Plus, iNview, and Peek Retina would have distinct advantages and disadvantages when applied for utilization in tele-ophthalmology retinal screening programs.

Importance  Several jurisdictions in the United States have secured hotels to temporarily house people experiencing homelessness who require isolation or quarantine for confirmed or suspected coronavirus disease 2019 (COVID-19). To our knowledge, little is known about how these programs serve this vulnerable population outside the hospital setting.Objective  To assess the safety of a hotel-based isolation and quarantine (I/Q) care system and its association with inpatient hospital capacity.Design, Setting, and Participants  This retrospective cohort study of a hotel-based I/Q care system for homeless and unstably housed individuals in San Francisco, California, was conducted from March 19 to May 31, 2020. Individuals unable to safely isolate or quarantine at home with mild to moderate COVID-19, persons under investigation, or close contacts were referred from hospitals, outpatient settings, and public health surveillance to 5 I/Q hotels. Of 1009 I/Q hotel guests, 346 were transferred from a large county public hospital serving patients experiencing homelessness.Exposure  A physician-supervised team of nurses and health workers provided around-the-clock support, including symptom monitoring, wellness checks, meals, harm-reduction services, and medications for opioid use disorder.Main Outcomes and Measures  Characteristics of I/Q hotel guests, program retention, county hospital readmissions, and mean length of stay.Results  Overall, the 1009 I/Q hotel guests had a median age of 44 years (interquartile range, 33-55 years), 756 (75%) were men, 454 (45%) were Latinx, and 501 (50%) were persons experiencing sheltered (n = 295) or unsheltered (n = 206) homelessness. Overall, 463 (46%) received a diagnosis of COVID-19; 303 of 907 (33%) had comorbid medical disorders, 225 of 907 (25%) had comorbid mental health disorders, and 236 of 907 (26%) had comorbid substance use disorders. A total of 776 of 955 guests (81%) completed their I/Q hotel stay; factors most strongly associated with premature discontinuation were unsheltered homelessness (adjusted odds ratio, 4.5; 95% CI, 2.3-8.6; P

BackgroundTo determine if there is a difference in the quantity of microbial flora of the conjunctiva in individuals practicing head submersion ("dunk") versus no head submersion ("no-dunk") during hot tub use.MethodsIn this double-blind randomized clinical trial, healthy volunteers aged ≥ 18 years were recruited. Participants were randomized to head submersion versus no head submersion during a 15-minute hot tub soak. Study personnel, masked to the dunk or no-dunk group assignment, obtained conjunctival cultures before and immediately after hot tub use. De-identified specimens were submitted to the clinical microbiology laboratory for culture and analysis. The main outcome measure was the difference in the quantity of organisms cultured from the conjunctiva before and after hot tub exposure, as determined using a defined ordinal scale. A two-tailed Student's t-test was performed to compare the total microbial colony counts between the two arms. Simpson's diversity was used to measure the changes in organism diversity between the arms.ResultsOf 36 enrolled subjects, 19 were randomly assigned to the dunk and 17 were assigned to the no-dunk groups. Water samples obtained from all hot tubs were culture negative. Eleven of 19 eyes (58%) from the dunk group and eight of 17 eyes (47%) from the no-dunk group had negative conjunctival bacterial cultures before and after hot tub exposure. However, six of 19 eyes (32%) and four of 17 eyes (24%) of the dunk and no-dunk groups, respectively, were culture-positive after, but not before hot tub exposure. The quantity of organisms before and after hot tub exposure was not significantly different between the two arms (P = 0.12). However, the dunk group only showed a small increase in the quantity of organisms after as compared to before hot tub use (P = 0.03). None of the samples from subjects or hot tubs were culture-positive for Acanthamoeba.ConclusionsHead submersion in a public hot tubs during a 15-minute soak does not appear to change conjunctival flora, as determined by culture plate yield, this does not eliminate the association between hot tub use and devastating and painful corneal blindness. Therefore, our recommendation is to remove contact lenses prior to hot tub use, avoid head submersion in a hot tub, and urgently seek ophthalmological help if any eye pain and/or decrease in vision is experienced after hot tub use.

PurposeTo determine factors that influence patient satisfaction scores in individuals who have recently had cataract surgery.SettingByers Eye Institute, Palo Alto, California, USA.DesignProspective case series.MethodsSelected questions from the Press Ganey survey and the National Eye Institute Visual Function Questionnaire-25 were administered to each patient immediately after completion of a clinic visit. The correlation between patient-specific variables and the answer to the survey question "likelihood of recommending our practice to others," a surrogate for overall patient satisfaction, was assessed using the Student t test. A logistical regression model was used to adjust for potentially confounding variables.ResultsOne hundred forty-three patients were recruited from 4 providers; 57 (39.8%) were men, and the mean age was 70.0 years ± 11.6 (SD). The main outcome was the proportion of scores less than 5, or "very good," for the likelihood of recommending the practice to others. There was a statistically significant association between a non-5 patient satisfaction score and self-reported ethnicity of Asian or Pacific Islander compared with other ethnicities (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.0-5.1; P = .049); other possible correlates were not statistically significant. The relationship persisted after adjustment for potential confounding variables (OR, 2.6; 95% CI, 1.1-6.3; P = .027).ConclusionIn postoperative cataract patients, Asian or Pacific Islander ethnicity, a factor out of the control of the provider and clinic staff, was associated with a lower overall Press Ganey patient satisfaction score compared with patients of all other ethnicities.

Purpose To compare the quality of optic nerve photographs from three different handheld fundus cameras and to assess the reproducibility and agreement of vertical cup-to-disk ratio (VCDR) measurements from each camera. Methods Adult patients from a comprehensive ophthalmology clinic and an intravitreous injection clinic in northern Thailand were recruited for this cross-sectional study. Each participant had optic nerve photography performed with each of 3 handheld cameras: the Volk iNview, Volk Pictor Plus, and Peek Retina. Images were graded for VCDR in a masked fashion by two photo-graders and images with > 0.2 discrepancy in VCDR were assessed by a third photo-grader. Results A total of 355 eyes underwent imaging with three different handheld fundus cameras. Optic nerve images were judged ungradable in 130 (37%) eyes imaged with Peek Retina, compared to 36 (10%) and 55 (15%) eyes imaged with the iNview and Pictor Plus, respectively. For 193 eyes with gradable images from all 3 cameras, inter-rater reliability for VCDR measurements was poor or moderate for each of the cameras, with intraclass correlation coefficients ranging from 0.41 to 0.52. A VCDR ≥ 0.6 was found in 6 eyes on iNview images, 9 eyes on Pictor Plus images, and 3 eyes on Peek images, with poor agreement between cameras (e.g., no eyes graded as VCDR ≥ 0.6 on images from both the iNview and Pictor Plus). Conclusions Inter-rater reliability of VCDR grades from 3 handheld cameras was poor. Cameras did not agree on which eyes had large VCDRs. [ABSTRACT FROM AUTHOR]

The learning cycle has been embraced as a teaching approach that is consistent with the goals of the "National Science Education Standards" (National Research Council, 1996). Science teacher educators may be disappointed to find, however, that preservice teachers may fail to grasp this model, even after extensive instruction (e.g., Settlage, 2000). Our own preservice teachers often express the belief that teaching multiple activities related to a single concept is redundant. In this manner, they fail to grasp the importance of carefully sequencing learning activities to promote conceptual development. In this paper, we describe an approach in which we use the learning cycle as a model for our own instruction to assist preservice elementary teachers in developing "conceptual storylines" through carefully sequenced activities that follow the learning cycle. (Contains 3 figures.)

Informal learning settings are valuable environments for students to learn beyond the classroom. This article describes the preliminary findings from a systematic review that explored programmatic elements associated with science, technology, engineering, and mathematics (STEM) learning, knowledge, identity, and self-efficacy for neurodiverse youth in informal STEM learning environments. [ABSTRACT FROM AUTHOR]

Although teacher educators have achieved some success in improving teachers' understanding of the nature of science (NOS), helping teachers teach NOS has proved a much greater challenge. Currently, there are few examples in the literature of teachers who effectively teach NOS, and fewer still that rely on student outcomes as a measure of teachers' effectiveness. Much remains to be understood regarding the sources, nature, and development of teachers' pedagogical content knowledge (PCK) in regard to NOS. Using S. Magnusson, J. Krajcik, and H. Borko's (1999) framework, we examined the PCK for NOS of three elementary teachers who have been successful in improving their students' understanding of NOS. We relied on interviews, questionnaires, classroom observations, and classroom artifacts collected over a 3-year period to characterize their PCK for NOS. Although each had robust knowledge of instructional strategies for teaching NOS, teachers lacked the requisite knowledge of assessment that would provide a feedback loop to support continued development of their knowledge of learners and lead to improvement in their teaching of NOS. Our findings highlight a need for professional development that focuses on developing aspects of PCK for NOS such as teachers' knowledge of assessment as well as educative curriculum materials to support continued development of teachers' PCK for NOS in practice. (Contains 2 tables, 4 figures, and 2 footnotes.)

How can a teacher simultaneously teach science concepts through inquiry while helping students learn about the nature of science? After pondering this question in their own teaching, the authors developed a 5E learning cycle lesson (Bybee et al. 2006) that concurrently embeds opportunities for fourth-grade students to (a) learn a science concept, (b) develop an inquiry skill, and (c) learn about scientific inquiry (an aspect of the nature of science). This approach has been found to be particularly useful to help students think like scientists. (Contains 1 figure.)

Convening professionals--physically or virtually--is necessary but certainly not sufficient for meaningful collaboration and networking to occur. Professional development (PD) must be designed and carried out in ways that encourage a culture of sustained collegiality (Loucks-Horsley et al. 2003). This article presents seven principles for creating and implementing collaborative PD. It summarizes lessons learned from a long-term evaluation of federally-funded science and mathematics teacher PD projects across the state of Missouri. (Contains 3 online resources.)

How can a science teacher find professional development (PD) opportunities that are meaningful, coherent, and sustained that will foster teacher and student learning? The authors believe that science teachers can and should be savvy consumers of PD--seeking out learning experiences that are designed with a few key features in mind. The purpose of this article is to articulate those key features by presenting a consumer guide that includes two parts--a shoppers's guide and a user's guide to PD. (Contains 2 figures.)