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Vivian L Qin,1,* Amy Yimin Chen,2,* Hasan Bashir,3 David Hsu,4 Lily Wushanley,3 Vivian Lee1 1University of Pennsylvania, Scheie Eye Institute, Philadelphia, PA, USA; 2University of Pennsylvania, Vagelos Program in Life Sciences & Management, Philadelphia, PA, USA; 3Rutgers University, Robert Wood Johnson Medical School, New Brunswick, NJ, USA; 4University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA*These authors contributed equally to this workCorrespondence: Vivian Lee, University of Pennsylvania, 51N 39th Street, Philadelphia, PA, 19104, USA, Tel +1 215-662-8125, Email Vivian.lee@pennmedicine.upenn.eduPurpose: The aim of this research is to describe the use of the social media platform, Instagram, by academic ophthalmology residency programs in the United States over time and consider the impact of the COVID-19 pandemic on ophthalmology’s social media presence.Methods and Subjects: This cross-sectional study was conducted online by reviewing the publicly accessible Instagram accounts of all accredited US academic ophthalmology residency programs.Main Outcomes and Measures: Number of US ophthalmology residency programs with an affiliated Instagram account were analyzed by year of creation. The content of the top six accounts with the most followers was analyzed by evaluating amount of engagement within defined post categories.Results: Of the 124 ophthalmology residency programs, 78 (62.9%) were identified as having an affiliated Instagram account, 60 accounts (48.4%) were created during the years 2020 or 2021, and 62 (50.0%) accounts focused specifically on promoting the residency training program. Of the top six accounts with the most followers, post categories that received the most engagement were “Medical” and “Group Photo”, while those that received the least engagement were “Department Bulletin” and “Miscellaneous.” User engagement on posts as measured by likes and comments increased across multiple post categories after January 2020.Conclusion: Social media presence of ophthalmology residency programs on Instagram increased substantially in 2020 and 2021. As a result of the COVID-19 pandemic restricting in-person interactions, residency programs have used alternative platforms to reach applicants. Given the increasing use of such applications, social media will likely continue to become an important aspect of professional engagement in ophthalmology.Keywords: social media, medical education, ophthalmology, ophthalmology residency

Angela V Bedenbaugh,1 Machaon Bonafede,2 Elizabeth H Marchlewicz,3 Vinson Lee,4 Jeyanesh Tambiah1 1Biosplice Therapeutics, Inc., San Diego, CA, USA; 2Veradigm Life Sciences, Chicago, IL, USA; 3IBM Watson Health, Cambridge, MA, USA; 4The Kinetix Group, New York, NY, USACorrespondence: Angela V BedenbaughBiosplice Therapeutics, Inc., San Diego, CA, USATel +1 404 272 8139Email angela.bedenbaugh@biosplice.comPurpose: To determine the prevalence, healthcare resource utilization and costs (HCRU&C) of knee osteoarthritis (OA) patients versus controls.Patients and Methods: Retrospective, matched-cohort administrative claims analysis using IBM MarketScan databases (2011– 2017). Newly diagnosed, adult (18+ yrs) knee OA patients identified by ICD9/10 code were matched 1:1 to controls by age, sex, payer, and geography; alpha level set to 0.05. Prevalence was estimated for 2017. All-cause and knee OA-related HCRU&C reported per-patient-per-year (PPPY) over follow-up period up to 4 years.Results: Overall 2017 knee OA prevalence was 4% (615,514 knee OA/15.4M adults). A total of 510,605 patients meeting inclusion criteria were matched 1:1 with controls. The knee OA cohort had mean age 60 years and was 58% female. Versus controls, knee OA patients had significantly more PPPY outpatient (84.5 versus 45.0) and pharmacy (29.8 versus 19.8) claims, and significantly higher PPPY outpatient costs ($12,571 versus $6,465), and pharmacy costs ($3,655 versus $2,038). Knee OA patients incurred $7,707 more PPPY total healthcare costs than controls, of which $4,674 (60.6%) were knee OA-related medical claims and $1,926 (25%) were knee OA-related medications of interest. PPPY costs for nonselective NSAIDs, cyclooxygenase-2 (COX-2) inhibitors, intraarticular hyaluronic acid, non-acute opioids, and knee replacement were higher for knee OA patients than controls. Using median and mean all-cause total cost ($9,330 and $24,550, respectively), the estimated sum cost of knee OA patients in MarketScan ranged from $5.7B to $15B annually.Conclusion: This retrospective analysis demonstrated an annual 2017 prevalence of 4.0% (≥ 18 years) and 13.2% (≥ 65 years) for newly diagnosed knee OA patients. Compared with controls, all-cause costs were significantly higher for knee OA patients, nearly double that of matched controls, attributable to increased medical and treatment costs and comorbidity treatment burden. Additionally, the estimated annual cost of knee OA treatment was substantial, ranging between $5.7 billion and $15 billion.Keywords: administrative claims, economic burden, arthritis, pharmacy costs

Nicole Quah Qin Xian,1 Ahmed Alnahrawy,2 Rashmi Akshikar,2 Vickie Lee2,3 1Department of Stroke Medicine, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; 2Department of Ophthalmology, Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK; 3Department of Surgery & Cancer, General Surgery, Faculty of Medicine,Imperial College London, London, UKCorrespondence: Vickie LeeDepartment of Ophthalmology, Western Eye Hospital, Imperial College Healthcare NHS Trust, 153– 173 Marylebone Road, Marylebone, London, NW1 5QH, UKTel +44 20 3312 6666Email vickie.lee@nhs.netPurpose: There is no universal consensus on second-line agents for the treatment of moderate/severe to sight-threatening thyroid eye disease (TED) to maintain remission after first-line intravenous methylprednisolone (IVMP). This study investigates the efficacy and safety of mycophenolate mofetil (MMF) in TED patients in a real-world setting and over a longer period than previous randomized controlled trials.Methods: A retrospective cohort study of TED patients with active moderate/severe to sight-threatening TED seen over a 4-year period. Data collected were visual acuity (VA), Clinical Activity Score (CAS), Gorman Diplopia scores, MMF dosing and side effects at 24, 52 and 78 weeks. Clinical efficacy was defined as an absence of relapse: no decline in best corrected LogMAR VA, no need for further steroids, no increase in CAS of ≥ 2.Results: Out of 23 patients, 20 patients were included in this study. 10% (2/20) stopped MMF before 24 weeks. Median duration of MMF treatment was 76 weeks (1– 140 weeks). 55% (11/20) had dysthyroid optic neuropathy (DON). In those with active moderate-severe TED without DON, clinical efficacy was seen in 100% (8/8) at 24 weeks, 87.5% (7/8) at 52 weeks, and 83.3% (5/6) at 78 weeks, with CAS decreasing from a baseline of 2.78± 1.99 to 0.50± 0.58 at 24 weeks, 0.50± 0.82 at 52 weeks and 1.00± 1.30 at 78 weeks. In DON, improvements were seen in 90% (9/10) at 24 weeks, 100% (7/7) at 52 weeks and 100% (4/4) at 78 weeks, with significantly reduced CAS scores from 2.55± 1.54 to 0.83± 1.27, 1.00± 1.17 and 0.63± 0.95 at 24, 52 and 78 weeks, respectively. Gorman score, VA and soft tissue inflammation parameters also improved throughout. There were two significant side effects over the treatment period.Conclusion: MMF appears to be an effective and safe second-line immunosuppressive agent. Further studies aimed at elucidating optimal dosing regimens and ideal treatment duration will prove helpful.Keywords: Graves orbitopathy, dysthyroid optic neuropathy, CellCept

We have conducted a search for strong gravitational lensing systems in the Dark Energy Spectroscopic Instrument (DESI) Legacy Imaging Surveys Data Release 9. This is the third paper in a series. These surveys together cover ∼19,000 deg2 visible from the Northern Hemisphere, reaching a z-band AB magnitude of ∼22.5. We use a deep residual neural network, trained on a compilation of known lensing systems and high-grade candidates as well as nonlenses in the same footprint. After applying our trained neural network to the survey data, we visually inspect and rank images with probabilities above a threshold which has been chosen to balance precision and recall. We have found 1895 lens candidates, of which 1512 are identified for the first time. Combining the discoveries from this work with those from Papers I (335) and II (1210), we have discovered a total of 3057 new candidates in the Legacy Surveys.

Swine producers are encouraged to practice antibiotic stewardship by reducing their use of antibiotics belonging to classes of medical importance to humans. We conducted a scoping review of non-antibiotic approaches in the form of products or management practices that might prevent or control disease and thus reduce the need for antibiotics in nursery pigs. Our objectives were to systematically describe the research on this broad topic for the North American context, identify specific topics that could feasibly support systematic reviews, and identify knowledge gaps. A search of multiple databases identified 11,316 articles and proceedings for relevance screening. From these, 441 eligible clinical trials and observational studies were charted. The majority were clinical trials (94%). Study results from EU countries were mostly communicated through journal articles, whereas study results from the USA were mostly communicated through conference proceedings. Interventions and health outcomes were diverse. The two most frequent intervention categories were feed additives and piglet vaccines. The three most frequent outcomes reported were diarrhea, mortality, and indices of vaccine immunity. There were 13 specific topics comprising various feed additives and vaccines that might feasibly support systematic reviews. There were relatively few studies in which interventions were compared with antibiotic comparison groups and relatively few studies evaluating management practices.

Impedance pump is a simple valve-less pumping mechanism, where an elastic tube is joined to a more rigid tube, at both ends. By inducing a periodic asymmetrical compression on the elastic tube will produce a unidirectional flow within the system. This pumping concept offers a low energy, low noise alternative, which makes it an effective driving mechanism, especially for micro-fluidic systems. In addition, the wave-based mechanism through which pumping occurs infers many benefits in terms of simplicity of design and manufacturing. Adjustment of simple parameters such as the excitation frequencies or compression locations will reverse the direction of flow, providing a very versatile range of flow outputs. This paper describes the experimental analysis of such impedance-driven flow with emphasis on the dynamical study of the reverse flow in open-loop environment. In this study, tapered section with converging steps is introduced at both ends of the elastic tube to amplify the magnitude of reverse flow. Study conducted shows that the reverse peak flow is rather significant with estimate of 23% lower than the forward peak flow. The flow dynamics on the other hand has shown to exhibit different characteristics as per the forward peak flow. The flow characteristics is then studied and showed that the tapered sections altered the impedance within the system and hence induce a higher flow in the reverse direction.

Although advanced thermostat technologies offer energy efficiency potential, these devices alone do not guarantee savings. Household occupants often deviate from thermostat programs, perhaps due to differing thermal comfort preferences, which are strong drivers of residential energy use and vary across genders. This study aims to develop an initial typology of interpersonal interactions around thermal comfort, explore the role of gender in such interactions, and examine the impacts of interactions on thermostat adjustments. Using n = 1568 diary observations collected from 112 participants, we identify three interaction types: conflicts, compromises, and agreements. Fixed effects analyses find that women are marginally more likely to report engaging in conflicts, whereas men are significantly more likely to report engaging in agreements and compromises, both of which are associated with greater likelihood of adjusting thermostats within a given day. This work represents an early step in investigating the multiply determined nature of household energy decisions.

Inconel 718 is widely used in various high end industries such as aerospace, nuclear plant, petrochemical plants etc. Inconel 718 is used for these applications due to unique mechanical properties such as high mechanical strength at elevated temperatures, high resistance to corrosion, and high strength to weight ratio. The unique properties of Inconel 718 made it difficult to be machined due to rapid work hardening and high cutting temperature. In addition, chatter vibration further increases the difficulty in machining of Inconel 718. In this paper, an experimental study on the effects of tool edge radius to the chatter behaviour was investigated. The dynamic responses of the milling process were recorded and analysed in both time domain and frequency domain. The results showed the variable helix and pitch end mill tool with larger tool edge radius able to mitigate chatter vibration at lower cutting speeds. Variable helix and pitch end mill with specific tool edge radius able to mitigate chatter vibration under the same cutting parameters. Experiments shows proper selection of tool edge radius improves the stability of end milling machining process.

A methacrylic-acrylic polymer was synthesised for use as a non-plasticised membrane for hydrogen ion-selective sensor incorporating tridodecylamine as an ionophore. The copolymer consisted of methyl methacrylate and n-butyl acrylate monomers in a ratio of 2:8. Characterisation of the copolymer using FTNMR demonstrated that the amount of each monomer incorporated during solution polymerisation was found to be similar to the amount used in the feed before polymerisation. The glass transition temperature of the copolymer determined by differential scanning calorimetry was -30.9 ºC. Potentiometric measurements conducted showed a linear pH response range of 4.3 – 9.6 with the response slope of 56.7 mV/decade. The selectivity of the sensors towards hydrogen ions was similar to other plasticiser based membrane electrodes and the logarithmic selectivity coefficients for discrimination against interference cations is close to –9.7. However, the incorporation of a lipophilic anion as membrane additive is essential in ensuring optimum performance of the hydrogen ion sensor.

Impedance pump is a simple valve-less pumping mechanism, which transport fluid through the mismatch of impedance in the system. A typical open-loop impedance pump consists of an elastic tube, connected to rigid tubing, where the rigid section is connected to a reservoir. Mismatch in impedance occurs when an asymmetrical periodic excitation is exerted on the elastic tube. Studies showed that sequential excitations on the elastic tube infers higher volumetric efficiency than a single excitation. This work studies the effects of an intermediary reservoir between two excitation points on an elastic tube. This study aims to shed some light on the steady state response and fluid motion within the intermediary reservoir; in which increased volumetric efficiency is demonstrated.

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 (

In April 2019, educators from around Aotearoa (New Zealand) and Australia came together to share their experiences of teaching Indigenous public health. The inaugural International Indigenous Public Health Education Leadership Symposium provided an opportunity to (i) discuss the range of challenges of this work, and (ii) to affirm a collective aspiration to strengthen the contribution of public health education to improved Indigenous outcomes. Talking across the borders of individual institutions, distinct cultures and nations enabled a rich conversation about the interface of health and Indigenous education. We explored the twin agendas of decolonisation and indigenisation, meeting the respective needs of Indigenous and non-Indigenous students, and how to best mobilise Indigenous public health leadership. This article will outline the discussion that unfolded and that led to the establishment of an inclusive Australia/Aotearoa/South Pacific Indigenous public health education entity and network.

Introduction: Globally, persons with disabilities (PWD) face structural and social barriers to inclusive healthcare. Medical schools, as crucibles of medical professional identity formation, have the responsibility to foster person-centredness toward all patients, including PWD, among her graduates. We co-designed with PWD a "Communications with Persons with Disabilities" workshop and evaluated its impact. Methods: The workshop enlisted PWD as patient educators, occurred within the third-year undergraduate Family Medicine posting, and was designed to positively impact communications skills and attitudes toward PWD. Students (n=135) were surveyed pre- and post- workshop following a mixed-methods approach (demographic data, Attitude Towards Disabled Persons (ATDP)- O scale, feedback questions, and post-workshop free reflections). Descriptive analysis was used for demographic and feedback questions, and thematic analysis for reflections. Paired t-test was used to evaluate change in ATDP-O scores. Results: There were 69 survey respondents (51.11%). Most students agreed that communications training with PWD could be strengthened in medical school, and that the workshop was relevant to their future medical career (n=68, 98.55%). Attitudes towards PWD significantly improved after the workshop (ATDP-O change: +9.29 points (12.7%), p <0.001). Student reflections included attitudes, such as the importance of seeing the person beyond the disability, and a call for action towards inclusivity and accessibility of care for PWD. Conclusion: Students' attitudes were positively affected by involving PWD in the curriculum. Further research is needed for assessing the impact of how a longitudinal PWD curriculum could affect medical trainees and improve social inclusiveness in healthcare practice. [ABSTRACT FROM AUTHOR]

Estudios serológicos en la población de la Costa del Pacífico de Colombia, cuya actividad ofrece contacto permanente con artrópodos hematófagos, demostraron anticuerpos para varios virus transmitidos por artrópodos, Para investigar los diferentes factores de este hallazgo, se elige una zona de bosque pluvial tropical como representativa de la costa. Se discuten y analizan los caracteres geográficos, físicos y climatológicosde la región, que cuenta con abundancia de reservorios potenciales de arbovirus: aves y mamíferos. Se describen tres situaciones ecológicas distintas: manglar, pantanos de agua salobre-agua dulce y bosque pluvial tropical; en todas hay numerosos artrópodos: mosquitos, tabanos, etc. Al considerar los criaderos de mosquitos se encuentra que el agua acumulada en recipientes vegetales altos produce mayoría de especies, Los insectos adultos se capturan con cebos humano o animal, a nivel del suelo o en plataformas bajo el dosel del bosque, durante el día y en la noche. Tambien se utilizan diversos modelos de trampas de luz. Así se obtienen,además de especies ya conocidas en Colombia, otras no registradas previamente y algunas nuevas. En relación con arbovirus se logran varios aislamientos positivos en mosquitos y flebótomos.Serological studies of the population having continuous contact with blood-sucking arthropods on the Pacific Coast of Colombia, showed antibodies against a variety of arthropod-borne viruses. In order to investigate some factors related to this finding, a tropical rain forest area representative of this portion of the coast was selected. We have discussed and analyzed the geographical, physical and climatological characteristics of this region that has an abundance of potential arbovirus reservoirs, i. e., birds and mammals. There are three distinct ecological patterns: mangrove swamps, brackish water swamps and tropical rain forest. There is a variety of arthropods (mosquitoes, tabanids, etc.) in each of these areas. The breeding sites producing the widest variety of mosquito species and numbers of mosquitoes are found in tree holes and bromeliads of the tallest trees. Adult insects were capturedduring the day and night with human and animal bait at ground level and on platforms at varying heights above the ground. We also used a variety of light traps. Apart from wellknown species, we found some new species and others that had not been recorded previously in Colombia. Several types of arbovirus were isolated from mosquitoes and sandflies.

Durante los estudios de artrópodos hematófagos y arbovirus de la Costa del Pacífico de Colombia, particularmente en la región del Río Raposo, para los dipteros de la familia Tabanidae se registraron 44 especies, de las cuales 39 son conocidas; las 5 restantes, todavía innominadas, pueden ser nuevas. En la familia hay representantes de las tribus Pangoniini, Scionini, Chrysopini, Diachlorini y Tabanini. La tribu Diachlorini es lamás rica, con 12 géneros y 23 especies, mientras que Tabanini tiene solamente 1 género, con 12 especies. Por primera vez se informa en Colombia la presencia de 13 especies. De los 44 representantes en la lista, 36 son conocidos en Panamá y 16 en Ecuador. La inoculacion en ratones de 3.090 ejemplares, repartidos en 370 grupos, que corresponden a 11 especies conocidas y a 3 sin identificar, es negativa para aislamiento de virus. Se hacen algunos comentarios sobre la ocurrencia y distribución de las especies colectadas.Thirty-nine known and 5 as yet undetermined or new species of the Family Tabanidae are recorded from the Río Raposo on the Pacific coastal plain of Colombia. The tribes Pangoniini, Scionini, Chrysopini, Diachlorini and Tabanini are represented in the collections. Diachlorini is the most common tribe with 12 genera and 23 species, whereas Tabanini is represented by only 1 genus with 12 species. Thirteen species are reported from Colombia for the first time. Of the 44 representatives listed, 36 are known from Panamá and 16 from Ecuador. A total of 3.090 individuals in 370 pools of 14 species were inoculated into mice with no virus isolations made. Comments are made on the distribution and occurrence of the species collected.

Se presenta una lista anotada de los mosquitos verdaderos, familia Culicidae, encontrados desde 1962 hasta 1966 en la zona del Río Raposo, en la Costa del Pacífico de Colombia, durante estudios sobre virus transmitidos por artrópodos. La familia está representada por 16 géneros conocidos previamente y otro nuevo para la ciencia. Estos géneros comprenden 87 especies con nombre. Para cada una se ofrece breve información sobre su método de captura, abundancia relativa y otros datos pertinentes. Las larvas o pupas de 41 especies conocidas se obtuvieron en diferentes tipos de criaderos. Por primera vez se registra en el país la presencia de 26 especies. De 4.727 grupos de mosquitos inoculados en ratones para buscar virus hay 116 aislamientos positivos que se diseutir an en próximos trabajos.We present here an annotated list of mosquitoes of the family Culicidae collected from 1962 to 1966 in the Río Raposo region of the Pacific coast of Colombia, in the course of studies of arthropod-borne viruses. There are included 86 named species of 16 previously known genera and one new genus and species being described in another paper. Forty-one species were reared from larvae and pupae collected in a variety of breeding places. Twenty-six species are recorded for the first time from Colombia. For each species, notes on the method of collection, relative abundance and other pertaining data are given. Viruses were isolated from 116 of 4,727 mosquito pools processed. These agents will be the subject of other papers to he published.