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Karen B Fernandez, Seth P Epstein, Geoffrey S Raynor, Alan T Sheyman, Morgan L Massingale, Peter G Dentone, Lukas D Landegger, Penny A Asbell Department of Ophthalmology, Mount Sinai School of Medicine, New York, NY, USA Purpose: To determine the changes in dry eye disease (DED) severity and the percentage of cells expressing HLA-DR on the ocular surface following treatment with lubricant eyedrops containing polyethylene glycol and propylene glycol (PEG/PG) and the gelling agent hydroxypropyl guar (HP-Guar).Patients and methods: Nineteen patients with DED used PEG/PG + HP-Guar eyedrops four times per day for 30 days. Assessments included DED severity (Ocular Surface Disease Index [OSDI], corneal staining, conjunctival staining, tear film break-up time [TFBUT], and Schirmer testing) and impression cytology of the conjunctiva with masked flow cytometry at baseline and at 30 days.Results: There was a significant decrease in corneal staining (P

Neurologists are commonly consulted for patients with a functional neurologic disorder. Best practices as to their diagnosis and treatment have been established, and multiple academic centers have programs in place for their treatment. However, given the number of patients suffering from this condition, a comprehensive model of care that can be broadly implemented needs to be developed and applied beyond specialized academic programs., (© 2020 American Academy of Neurology.)

Background: There are over 165,000 mHealth apps currently available to patients, but few have undergone an external quality review. Furthermore, no standardized review method exists, and little has been done to examine the consistency of the evaluation systems themselves., Objective: We sought to determine which measures for evaluating the quality of mHealth apps have the greatest interrater reliability., Methods: We identified 22 measures for evaluating the quality of apps from the literature. A panel of 6 reviewers reviewed the top 10 depression apps and 10 smoking cessation apps from the Apple iTunes App Store on these measures. Krippendorff's alpha was calculated for each of the measures and reported by app category and in aggregate., Results: The measure for interactiveness and feedback was found to have the greatest overall interrater reliability (alpha=.69). Presence of password protection (alpha=.65), whether the app was uploaded by a health care agency (alpha=.63), the number of consumer ratings (alpha=.59), and several other measures had moderate interrater reliability (alphas>.5). There was the least agreement over whether apps had errors or performance issues (alpha=.15), stated advertising policies (alpha=.16), and were easy to use (alpha=.18). There were substantial differences in the interrater reliabilities of a number of measures when they were applied to depression versus smoking apps., Conclusions: We found wide variation in the interrater reliability of measures used to evaluate apps, and some measures are more robust across categories of apps than others. The measures with the highest degree of interrater reliability tended to be those that involved the least rater discretion. Clinical quality measures such as effectiveness, ease of use, and performance had relatively poor interrater reliability. Subsequent research is needed to determine consistent means for evaluating the performance of apps. Patients and clinicians should consider conducting their own assessments of apps, in conjunction with evaluating information from reviews.

Aerosol production from sprays of four irrigation systems used for upland application of wastewater was studied over a range of operating and meteorological conditions by sampling particles from evaporated tracer droplets. Most aerosol-forming droplets were less than 100 mum in diameter with median number diameters from 1 to 3 mum and median mass diameters appreciably larger. More than 10(10) respirable sized particles were produced per minute by single nozzles. Actual wastewater sprays were similar. Diffusion calculations indicate decreases in concentration of 1 to 2 orders of magnitude in 1 km.

Tests were conducted to determine the relationship between airborne pollen concentrations and distance. Simultaneous samples were taken in 171 tests with sets of eight rotoslide samplers spaced from one to 486 M. apart in straight lines. Use of all possible pairs gave 28 separation distances. Tests were conducted over a 2-year period in urban and rural locations distant from major pollen sources during both tree and ragweed pollen seasons. Samples were taken at a height of 1.5 M. during 5-to 20-minute periods. Tests were grouped by pollen type, location, year, and direction of the wind relative to the line. Data were analyzed to evaluate variability without regard to sampler spacing and variability as a function of separation distance. The mean, standard deviation, coefficient of variation, ratio of maximum to the mean, and ratio of minimum to the mean were calculated for each test, each group of tests, and all cases. The average coefficient of variation is 0.21, the maximum over the mean, 1.39 and the minimum over the mean, 0.69. No relationship was found with experimental conditions. Samples taken at the minimum separation distance had a mean difference of 18 per cent. Differences between pairs of samples increased with distance in 10 of 13 groups. These results suggest that airborne pollens are not always well mixed in the lower atmosphere and that a sample becomes less representative with increasing distance from the sampling location.

Tests were conducted to determine the relationship between concentrations of airborne pollens and sampling time, using sequential rotoslide samplers at urban and rural locations. Short-period data showed an increase in variability with time between samples. Two-hour data showed a stronger trend for the first 12 hours but better agreement as the time between samples approached one day.