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Asher Khan,1,2 Kamran M Riaz,2 Neal Rangu,1,2 Vinay A Shah,2 Zain S Hussain,2,3 Mahmoud A Khaimi2 1College of Medicine, University of Oklahoma, Oklahoma City, OK, USA; 2Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, OK, USA; 3University of Medicine and Health Sciences, Basseterre, Saint Kitts and NevisCorrespondence: Kamran M Riaz, Dean McGee Eye Institute, University of Oklahoma, 608 Stanton L. Young Blvd, Oklahoma City, OK, 73104, USA, Tel +1 405-271-1095, Fax +1 405-271-3680, Email Kamran-Riaz@dmei.orgIntroduction: Postoperative endophthalmitis (POE) is a rare but devastating complication of ophthalmic surgeries. Microinvasive glaucoma surgery (MIGS) procedures have become increasingly utilized for the surgical reduction of intraocular pressure (IOP). Ab-interno canaloplasty (ABiC) is a popular MIGS procedure, but POE rates and clinical effects following ABiC have not been studied.Methods: This study conducted a retrospective review of all consecutive cases of either standalone ABiC or combined ABiC with phacoemulsification performed at a tertiary care academic referral center from 2015 to 2021. Exclusion criteria included a history of incisional glaucoma surgery, retinal surgery, or additional concurrent microinvasive glaucoma surgery (MIGS) at the time of ABiC. The rates of POE after ABiC were calculated with 95% confidence intervals (CI) based on the Clopper-Pearson exact method.Results: Of 3256 cases of ABiC, one case (0.03%, 1/3256, 95% CI: 0.00– 0.17%) of post-ABiC endophthalmitis was identified. The rate of POE in standalone ABiC was 0.00% (0/1332 cases, 95% CI: 0.00– 0.28%), whereas the rate in combined ABiC with phacoemulsification was 0.05% (1/1924 cases, 95% CI: 0.00– 0.29%). Additionally, the rate of POE following stand-alone cataract surgery, 0.10%, 11/11,470 cases, 95% CI: 0.05– 0.17%), total cataract surgeries, 0.06% (17/28,013 cases, 95% CI: 0.04– 0.10%), total MIGs, excluding ABiC, surgeries, 0.08%, (3/3845 cases, 95% CI: 0.02– 0.23%) portray non-inferiority of ABiC in the risk of POE. The case of ABiC-POE presented four days after surgery and required a vitreous tap with intraocular injection of antibiotics and pars plana vitrectomy. No causative organism was identified. A final 1-year follow-up revealed a corrected distance visual acuity of 20/40 and stable glaucoma.Conclusion: The rate of POE after ABiC (1 per 3256 cases) is statistically non-inferior to the reported incidence of POE after other MIGS and incisional glaucoma surgeries.Keywords: ab-interno canaloplasty, canaloplasty, endophthalmitis, post-operative infections

Farzad Jamshidi, Vinay A Shah, Kamran M Riaz Dean McGee Eye Institute, University of Oklahoma Department of Ophthalmology, Oklahoma City, OK, USACorrespondence: Kamran M RiazDean McGee Eye Institute, University of Oklahoma Department of Ophthalmology, 608 Stanton L Young Blvd, Oklahoma City, 73104, OK, USATel +1 405-271-6060Email Kamran-Riaz@dmei.orgPurpose: To report a case of posterior to anterior migration of a dexamethasone (Ozurdex) implant in a case of scleral-fixated intraocular lens (SFIOL) via Yamane technique.Methods/Patients: Single case report.Results: Dexamethasone implant was successfully removed in the operating room. The patient had improved confrontational visual field and did not develop corneal edema nor intraocular pressure elevation.Conclusion: In the presence of a stable SFIOL via Yamane technique, posterior chamber implants may migrate to the anterior chamber. Clinicians may wish to exercise additional caution in injecting posterior chamber steroid implants in this patient population.Keywords: dexamethasone implant, intra-scleral haptic fixation, scleral fixated IOL, uveitis, Yamane, ISHF

Accurate and efficient detection of ships from aerial images is an intriguing and difficult task of extreme societal importance due to their implication and association with maritime infractions, and other suspicious actions. Having an automated system with the required capabilities indicates a substantial reduction in the related man-hours of characterization and the overall underlying processes. With the advent of various image processing techniques and advancements in the field of machine learning and deep learning, specialized methodologies can be created for the said task. An intuition for the enhancement of existing methodologies would be a study on attention-based cognition and the development of improved neural architectures with the available attention modules. This paper offers a novel study and empirical analysis of the utility of various attention modules with U-Net and other subsidiary architectures as a backbone for the task of computationally efficient and accurate ship detection. The best performing models are depicted and explained thoroughly, while considering their temporal performance.

Background. After COVID-19 emergence, medical education witnessed a shift from face-to-face education to digital education, which inevitably affected medical students. Globally, due to the closure of schools and universities, medical education was shifted to electronic learning (E-learning). This paper aimed to assess the effects of the COVID-19 pandemic on medical education and determine medical students’ knowledge, attitude, and practices towards E-learning in the Kurdistan Region of Iraq. Materials and Methods. An online cross-sectional study was conducted among 500 undergraduate students of seven medical colleges in the Kurdistan Region, Iraq, in November 2021, to assess their state during the COVID-19 pandemic and how this affected their education. Results. There were 50.6% of males and 49.4% of females. The mean age was 20.6 (± 1.5 SD) years. Approximately 17% of participants mentioned having financial issues, while 19.2% of students experienced health-related problems. As many as 67% of participants reported that the Internet quality was good or very good, whereas 46.8% of students disagreed that E-learning was a possible substitute for traditional learning. About two-thirds of participants agreed or were neutral that downloadable content was better than live content; however, only 19.2% of students agreed that E-learning could be used in the clinical aspect. A total of 52.2% of participants disagreed that E-testing could replace traditional learning methods. Surprisingly, 86.4% of students stated that they regularly used the Internet in their study. Conclusions. E-learning was the main adjustment made in the educational system, including medical education. The study concluded with insights into how different circumstances could have different consequences on the efficacy of medical education. E-learning showed effective results in continuing learning until the educational system switched to a blended system. Training programs for medical education personnel are vital in effective E-learning opportunities.

We have carried out joint theoretical and experimental investigations of three Heusler compounds CoMoFeAl, CoMo0.5Fe1.5Al, and Co1.5Mo0.5FeAl. Our first-principle calculations show that all three compounds show either ferro- or ferrimagnetic order with CoMoFeAl and CoMo0.5Fe1.5Al exhibiting high spin polarization of almost 80%. The investigated samples were prepared using arc melting and high vacuum annealing. All the samples show cubic crystal structure with disorder. The parent compound CoMoFeAl shows a small saturation magnetization of 12 emu/g, and a Curie temperature of 440 K. The other two compounds, namely, Co1.5Mo0.5FeAl and CoMo0.5Fe1.5Al, show much higher saturation magnetizations of 62 emu/g and 59 emu/g, and substantially higher Curie temperatures of 950 K and 780 K, respectively.

Background and aimsHealthcare staff are at high risk of occupational exposure to Hepatitis B and other blood-borne diseases. Lack of education about the knowledge of Hepatitis B virus contributes to an increase in cases. This study aims to determine the knowledge of the Hepatitis B virus among the medical professionals in Duhok province, Kurdistan Region of Iraq, and to determine their knowledge of the importance of vaccination.Materials and methodsThis cross-sectional study was conducted in Duhok province, Kurdistan Region of Iraq, among medical science students from November 2022 to February 2023 and a total of 511 students participated in the study. A Self-administered questionnaire comprising 22 items categorized into five sections was distributed to the students either electronically or by paper and pen method. The survey utilized a Five-point Likert scale when assessing respondents' opinions on knowledge, attitude, and practice (KAP). Microsoft Excel and GraphPad Prism 9 were used for statistical analysis.ResultsA total of 511 responses were collected from medical, dental, pharmacy, and laboratory students. The average age of the participants was 20.74 ±1.43 years. Among the respondents, only 96 (18.8%) were fully vaccinated against the Hepatitis B virus (received 3 or more doses of the vaccine), while 294 (57.5%) were not vaccinated. Lack of vaccination programs was the major reason for not receiving a vaccination (n = 182, 62%). About 286 (55.96%) of the participants had good knowledge, attitude, and practice on Hepatitis B, manifesting median scores of 26, 18, and 20, respectively.ConclusionIn our study, half of the students were found to be unvaccinated, mainly due to the absence of vaccination programs. Vaccinated students exhibited better knowledge, attitude, and practice toward the infection than non-vaccinated students. Therefore, we recommend the implementation of a vaccination program as well as training on infection prevention guidelines to increase awareness and encourage vaccination.

We have carried out a combined theoretical and experimental investigation of both stoichiometric and nonstoichiometric CoFeVGe alloys. In particular, we have investigated CoFeVGe, Co1.25Fe0.75VGe, Co0.75Fe1.25VGe, and CoFe0.75VGe bulk alloys. Our first principles calculations suggest that all four alloys show ferromagnetic order, where CoFeVGe, Co1.25Fe0.75VGe, and Co0.75Fe1.25VGe are highly spin polarized with spin polarization values of over 80%. However, the spin polarization value of CoFe0.75VGe is only about 60%. We have synthesized all four samples using arc melting and high-vacuum annealing at 600 °C for 48 hours. The room temperature x-ray diffraction of these samples exhibits a cubic crystal structure with disorder. All the samples show single magnetic transitions at their Curie temperatures, where the Curie temperature and high field (3T) magnetization are 288 K and 42 emu/g; 305 K and 1.5 emu/g; 238 K and 39 emu/g; and 306 K and 35 emu/g for CoFeVGe, Co1.25Fe0.75VGe, Co0.75Fe1.25VGe, and CoFe0.75VGe, respectively.

Half-metallic Heusler alloys have attracted significant attention due to their potential application in spin-transport-based devices. We have synthesized one such alloy, CoFeV0.5Mn0.5Si, using arc melting and high-vacuum annealing at 600 °C for 24 hours. First principles calculation indicates that CoFeV0.5Mn0.5Si shows a nearly half-metallic band structure with a degree of spin polarization of about 93%. In addition, this value can be enhanced by the application of tensile strain. The room temperature x-ray diffraction patterns are indexed with the cubic crystal structure without secondary phases. The annealed sample shows ferromagnetic order with the Curie temperature well above room temperature (Tc = 657 K) and a saturation magnetization of about 92 emu/g. Our results indicate that CoFeV0.5Mn0.5Si has a potential for room temperature spin-transport-based devices.

Cyber-physical systems are often misunderstood to be just any embedded systems. The real cyber-physical system should have both physical and digital (computational-communication-control) parts inter-connected in each part and process, and the system itself should have the capacity to change its own behaviour to adapt to changing requirements. This paper presents an architecture of an intelligent cyber-physical system where a reconfigurable manufacturing system is supported by a machine learning algorithm to provide enhanced decision-making to the manufacturing control system. Experiment results are presented showing the machine learning module can help the control system adjust itself with changing requirements provided externally (by a user) in the form of training examples. The result is an architecture of an intelligent cyber-physical system, with physical and digital parts always working in synchronization, enabling change in the system's behaviour in terms of manufacturing process-flow in order to adapt to any change in the production planning.

Abstract Background Childhood mortality has remained a major challenge to public health amongst families in Nigeria and other developing countries. The menace of incessant childhood mortality has been a major concern and this calls for studies to generate new scientific evidence to determine its prevalence and explore predisposing factors associated with it in Nigeria. Method Data was obtained from Nigeria DHS, 2013. The study outcome variable was the total number of children lost by male partners and female partners respectively who were married. The difference between the numbers of child births and the number of living children was used to determine the number of children lost. Study variables were obtained for 8658 couples captured in the data set. Descriptive statistics were computed to examine the presence of over-dispersion and zero occurrences. Data were analysed using STATA Software version 12.0. Zero-inflated negative binomial (ZINB) regression analysis was carried out to determine the factors associated with childhood mortality. Results of ZINB were reported in terms of IRR and 95% confidence interval (CI). Results The age (mean ± std.) of male and female participants were 36.88 ± 7.37 and 28.59 ± 7.30 respectively. The data showed that 30.8% women reported loss of children and 37.3% men reported the same problem. The study revealed age (years), region, residence, education, wealth index, age at first birth and religion of father and mother as factors associated with childhood mortality. In terms of education, secondary and tertiary educated fathers exhibited 3.8% and 12.1% lower risk of childhood mortality respectively than non-educated fathers. The results showed that the risk of childhood mortality are 26.7%, 39.7 and 45.9% lower among the mothers having primary, secondary and tertiary education respectively than those with no formal education. The mothers living in rural areas experienced 28.3% increase in childhood mortality than those in urban areas, while the fathers in rural areas experienced 33.5% increase in childhood mortality than the urban areas. The risk of childhood mortality was significantly lower in middle, richer and richest (11.1%, 37.5 and 49%) economic quintiles respectively when compared to the risk of childhood mortality with female spouse who are poorest. Similar results were obtained for the fathers, with reduction in the incidence-rate ratio of 3.3%, 20.2 and 28.7% for middle, richer and richest economic quintiles respectively, compared to the poorest status. Furthermore, region and religion were found to be significant factors associated with childhood mortality in Nigeria. Conclusion The findings suggested that age, region, residence, education, wealth index, age at first birth and religion of fathers and mothers are key determinants associated with childhood mortality. The correlation between childhood mortality and fathers’ and mothers’ ages were found to increase the incidence of the outcome for every unit increase in age. The converse was however, true for age at first birth which was also statistically significant. The implication of this study is that policy makers and stakeholders in health care should provide for improved living standards to achieve good life expectancy meeting SDG3.

The structural, magnetic and magnetocaloric properties of Fe deficient Pr2-xNdxFe17 (x = 0.5, 0.7) alloys prepared by arc-melting and melt-spinning have been investigated. The room temperature x-ray diffraction patterns show that the samples are nearly single-phase and crystallize in the rhombohedral Th2Zn17-type crystal structure. The Curie temperatures determined from the thermomagnetic curves are 302 K and 307 K for Pr1.5Nd0.5Fe17 and Pr1.3Nd0.7Fe17, respectively. The peak magnetic entropy change and the relative cooling power at field change of 50 kOe are 3.01 J/kgK and 345 J/kg for Pr1.5Nd0.5Fe17, and 4.31 J/kgK and 487 J/kg for Pr1.3Nd0.7Fe17, respectively. The absence of magnetic and thermal hysteresis with relatively high cooling efficiency suggests that the alloys have potential for magnetic refrigeration.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Software demonstrators are effective tools to show and understand scientific and engineering concepts in function, and they also allow rapid experiments. In the field of grammatical inference, there is a lack of 'ready-to-use' grammar synthesis tools, with simple interfaces showing intermediate stages of the grammar inference process, and the presented work addresses this issue by giving tools for experimentation with regular grammar and finite-state automata, to help students and researchers understand their properties, underlying concepts and applications.

The effect of Y addition and magnetic field on texture and magnetic properties of arc-melted alnico 9 magnets has been investigated. Small additions of Y (1.5 wt.%) develop a (200) texture for the arc-melted alnico 9 magnet. Such a texture is hard to form in cast samples. To achieve this goal, we set up a high-field annealing system with a maximum operation temperature of 1250 °C. This system enabled annealing in a field of 45 kOe with subsequent draw annealing for the solutionized buttons; we have been able to substantially increase remanence ratio and coercivity, from 0.70 and 1200 Oe for the Y-free alnico 9 to 0.90 and 1400 Oe for the Y-doped alnico 9, respectively. A high energy product of 7.3 MGOe has been achieved for the fully heat-treated Y-doped alnico 9. The enhancement of coercivity is believed to arise from the introduction of magnetocrystalline anisotropy from 80 nm Y2Co17-type grains, which are exchange-coupled to the main-phase alnico rods.

Bulk alloys and thin films of Fe-substituted Ti3Co5B2 have been investigated by first-principle density-functional calculations. The series, which is of interest in the context of alnico magnetism and spin electronics, has been experimentally realized in nanostructures but not in the bulk. Our bulk calculations predict paramagnetism for Ti3Co5B2, Ti3Co4FeB2 and Ti3CoFe4B2, whereas Ti3Fe5B2 is predicted to be ferromagnetic. The thin films are all ferromagnetic, indicating that moment formation may be facilitated at nanostructural grain boundaries. One member of the thin-film series, namely Ti3CoFe4B2, is half-metallic and exhibits perpendicular easy-axis magnetic anisotropy. The half-metallicity reflects the hybridization of the Ti, Fe and Co 3d orbitals, which causes a band gap in minority spin channel, and the limited equilibrium solubility of Fe in bulk Ti3Co5B2 may be linked to the emerging half-metallicity due to Fe substitution.

Students today lack the real experiences needed to make sense of complex technical concepts although industry is one of the primary customers that constantly challenges academia to make curricula more relevant to professional practice. Our response to these influences was to create and test idea of Distributed and Remote Lab dedicated to active learning. In this survey, the experiments on representational fidelity measures are performed on two types of 'client' user interface (Wall and Window) in two modes of presentation (Desktop and Video beam) of the distributed manufacturing system. The proposed remote system has allowed students from Belgrade, Serbia to dynamically interact with a real manufacturing process held in Minho's Lab, Portugal, to carry out a remote experimental practice. This survey gives advantage to Wall interface, in the fields of smooth display of view changes and object motion and consistency of object behaviour. There are also weaker correlations between representational fidelity measures when Wall interface is used and certain advantage on desktop presentation mode.

This paper refers to the new direction for enhancement in traditional remote controlling functionality in manufacturing systems. Employing a diversity of tools such as videoconferencing, computer supported cooperative work tools, immersive virtual reality, virtual environment tools, such as "Metaverse" tools, and Internet through Pragmatic Web, is necessary for overcoming the "space barrier". Therefore, further analysis of human-machine user interface is crucial for user interaction with manufacturing systems through remote control. That is the motivation for investigation on evaluation of the user interfaces for remote control of manufacturing systems within the above-mentioned framework. Preliminary results of the evaluation of two types of interfaces are presented in this paper. These two interfaces are distinctive in one particular presentational aspect, while all the remote controlling functionalities are equal for both. The results show that one user interface type clearly fares better than the other over a number of factors as graded by users.

Mn2CrGa in the disordered cubic structure has been synthesized using rapid quenching and subsequent annealing. The cubic phase transforms to a stable tetragonal phase when a fraction of Cr or Ga is replaced by Pt or Al, respectively. All samples are ferrimagnetic with high Curie temperatures (Tc); Mn2CrGa exhibits the highest Tc of about 813 K. The tetragonal samples have appreciable values of magnetocrystalline anisotropy energy, which leads to an increase in coercivity (Hc) that approaches about 10 kOe in the Pt-doped sample. The Hc linearly increases with a decrease of temperature, concomitant with the anisotropy change with temperature. All samples are metallic and show negative magnetoresistance with room-temperature resistivities on the order of 1 mΩcm. The magnetic properties including high Tc and low magnetic moment suggest that these tetragonal materials have potential for spin-transfer-torque-based devices.

Abstract Background The peptidyl-proline isomerase, Protein Never in Mitosis Gene A Interacting-1 (PIN1), regulates turnover of inducible nitric oxide synthase (iNOS) in murine aortic endothelial cells (MAEC) stimulated with E. coli endotoxin (LPS) and interferon-γ (IFN). Degradation of iNOS was reduced by a calpain inhibitor, suggesting that PIN1 may affect induction of other calpain-sensitive inflammatory proteins, such as cyclooxygenase (COX)-2, in MAEC. Methods MAEC, transduced with lentivirus encoding an inactive control short hairpin (sh) RNA or one targeting PIN1 that reduced PIN1 by 85%, were used. Cells were treated with LPS/IFN, calpain inhibitors (carbobenzoxy-valinyl-phenylalaninal (zVF), PD150606), cycloheximide and COX inhibitors to determine the effect of PIN1 depletion on COX-2 and calpain. Results LPS or IFN alone did not induce COX-2. However, treatment with 10 μg LPS plus 20 ng IFN per ml induced COX-2 protein 10-fold in Control shRNA MAEC. Induction was significantly greater (47-fold) in PIN1 shRNA cells. COX-2-dependent prostaglandin E2 production increased 3-fold in KD MAEC, but did not increase in Control cells. The additional increase in COX-2 protein due to PIN1 depletion was post-transcriptional, as induction of COX-2 mRNA by LPS/IFN was the same in cells containing or lacking PIN1. Instead, the loss of COX-2 protein, after treatment with cycloheximide to block protein synthesis, was reduced in cells lacking PIN1 in comparison with Control cells, indicating that degradation of the enzyme was reduced. zVF and PD150606 each enhanced the induction of COX-2 by LPS/IFN. zVF also slowed the loss of COX-2 after treatment with cycloheximide, and COX-2 was degraded by exogenous μ-calpain in vitro. In contrast to iNOS, physical interaction between COX-2 and PIN1 was not detected, suggesting that effects of PIN1 on calpain, rather than COX-2 itself, affect COX-2 degradation. While cathepsin activity was unaltered, depletion of PIN1 reduced calpain activity by 55% in comparison with Control shRNA cells. Conclusion PIN1 reduced calpain activity and slowed the degradation of COX-2 in MAEC, an effect recapitulated by an inhibitor of calpain. Given the sensitivity of COX-2 and iNOS to calpain, PIN1 may normally limit induction of these and other calpain substrates by maintaining calpain activity in endothelial cells.

Aim: To investigate the validity of WINROP use in multi-ethnic population in a tertiary centre in Singapore., Methods: Birth weight, gestational age, and weekly weight measurements of four hundred two preterm infants (<32 weeks gestation) born between year 2011 and 2019 were entered into WINROP algorithm. Based on their weekly weight gain, WINROP algorithm would signal an alarm if the infant is at risk for type 1 ROP requiring treatment. The WINROP result is then compared with the ophthalmological findings. All the infants were screened based on the hospital ROP screening protocol. The negative predictive value, positive predictive value, sensitivity and specificity were calculated., Results: Among all the infants enrolled, 31 infants developed type 1 ROP. WINROP successfully signalled 23 out of 31 correctly. The calculated sensitivity was 74.2 % and specificity was 48.0 %. The positive predictive value was 10.6% and negative predictive value was 95.7%., Conclusions: Our study showed that when WINROP is applied to our multi-ethnic population, it has a moderate sensitivity of 74.2% and a high predictive negative value of 95.7%. We would not recommend it to be used a solitary screening method but it can be used to better risk stratify preterm infants at risk of type 1 ROP, particularly in resource limited settings., (© 2024 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Background: Impaired cerebral autoregulation (CA) is one of several proposed mechanisms of acute brain injury in patients supported by extracorporeal membrane oxygenation (ECMO). The primary aim of this study was to determine the feasibility of continuous CA monitoring in adult ECMO patients. Our secondary aims were to describe changes in cerebral oximetry index (COx) and other metrics of CA over time and in relation to functional neurologic outcomes., Methods: This is a single-center prospective observational study. We measured COx, a surrogate measurement of cerebral blood flow measured by near-infrared spectroscopy, which is an index of CA derived from the moving correlation between mean arterial pressure (MAP) and slow waves of regional cerebral oxygen saturation. A COx value that approaches 1 indicates impaired CA. Using COx, we determined the optimal MAP (MAP OPT ) and lower and upper limits of autoregulation for individual patients. These measurements were examined in relation to modified Rankin Scale (mRS) scores., Results: Fifteen patients (median age 57 years [interquartile range 47-69]) with 150 autoregulation measurements were included for analysis. Eleven were on veno-arterial ECMO (VA-ECMO), and four were on veno-venous ECMO (VV-ECMO). Mean COx was higher on postcannulation day 1 than on day 2 (0.2 vs. 0.09, p < 0.01), indicating improved CA over time. COx was higher in VA-ECMO patients than in VV-ECMO patients (0.12 vs. 0.06, p = 0.04). Median MAP OPT for the entire cohort was highly variable, ranging from 55 to 110 mm Hg. Patients with mRS scores 0-3 (good outcome) at 3 and 6 months spent less time outside MAP OPT compared with patients with mRS scores 4-6 (poor outcome) (74% vs. 82%, p = 0.01). The percentage of time when observed MAP was outside the limits of autoregulation was higher on postcannulation day 1 than on day 2 (18.2% vs. 3.3%, p < 0.01)., Conclusions: In ECMO patients, it is feasible to monitor CA continuously at the bedside. CA improved over time, most significantly between postcannulation days 1 and 2. CA was more impaired in VA-ECMO patients than in VV-ECMO patients. Spending less time outside MAP OPT may be associated with achieving a good neurologic outcome., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.)

Cannabinoid use, particularly for recreational purposes, is increasing exponentially across all age groups, especially in younger populations, due to its perceived low risk and legalization. While cannabinoids may be largely considered as safe, there is mounting evidence of increased risk of systemic and neurological complications through their interaction with the poorly understood endocannabinoid receptor network within the central nervous system and other organ systems. Acute cannabinoid exposure can cause neuropsychiatric symptoms in addition to altering cerebral blood flow, leading to cerebrovascular complications such as ischemic stroke, subarachnoid hemorrhage, and reversible cerebral vasoconstriction syndrome (RCVS). Chronic use, particularly among adolescents, may be associated with increased risk of long-term cognitive deficits, schizophrenia, and other neuropsychiatric effects. Synthetic cannabinoids have increased potency, with reports of causing profound neurological complications including coma, seizures, posterior reversible encephalopathy syndrome, and RCVS. Despite increasing evidence, the quality of literature describing neurologic complications with cannabinoids remains limited to case series and retrospective cohort studies, with significant confounding factors such as concomitant use of other illicit drugs, limiting interpretation. In this review, we summarize the effect of cannabinoids on the neurologic system and associated neurological complications., Competing Interests: None declared., (Thieme. All rights reserved.)

Spontaneous intracerebral hemorrhage (ICH) is the most morbid of all stroke types with a high early mortality and significant early disability burden. Traditionally, outcome assessments after ICH have mirrored those of acute ischemic stroke, with 3 months post-ICH being considered a standard time point in most clinical trials, observational studies, and clinical practice. At this time point, the majority of ICH survivors remain with moderate to severe functional disability. However, emerging data suggest that recovery after ICH occurs over a more protracted course and requires longer periods of follow-up, with more than 40% of ICH survivors with initial severe disability improving to partial or complete functional independence over 1 year. Multiple other domains of recovery impact ICH survivors including cognition, mood, and health-related quality of life, all of which remain under studied in ICH. To further complicate the picture, the most important driver of mortality after ICH is early withdrawal of life-sustaining therapies, before initiation of treatment and evaluating effects of prolonged supportive care, influenced by early pessimistic prognostication based on baseline severity factors and prognostication biases. Thus, our understanding of the true natural history of ICH recovery remains limited. This review summarizes the existing literature on outcome trajectories in functional and nonfunctional domains, describes limitations in current prognostication practices, and highlights areas of uncertainty that warrant further research., Competing Interests: None declared., (Thieme. All rights reserved.)

We demonstrate the growth of 3C-SiC with reduced planar defects on a micro-scale compliant substrate. Heteroepitaxial growth of 3C-SiC on trenches with a width and separation of 2 µm, etched into a Si(001) substrate, is found to suppress defect propagation through the epilayer. Stacking faults and other planar defects are channeled away from the center of the patterned structures, which are rounded through the use of H 2 annealing at 1100 °C. Void formation between the columns of 3C-SiC growth acts as a termination point for defects, and coalescence of these columns into a continuous epilayer is promoted through the addition of HCl in the growth phase. The process of fabricating these compliant substrates utilizes standard processing techniques found within the semiconductor industry and is independent of the substrate orientation and offcut.

Background: In patients with disorders of consciousness (DoC), laboratory and molecular biomarkers may help define endotypes, identify therapeutic targets, prognosticate outcomes, and guide patient selection in clinical trials. We performed a systematic review to identify common data elements (CDEs) and key design elements (KDEs) for future coma and DoC research., Methods: The Curing Coma Campaign Biospecimens and Biomarkers work group, composed of seven invited members, reviewed existing biomarker and biospecimens CDEs and conducted a systematic literature review for laboratory and molecular biomarkers using predetermined search words and standardized methodology. Identified CDEs and KDEs were adjudicated into core, basic, supplemental, or experimental CDEs per National Institutes of Health classification based on level of evidence, reproducibility, and generalizability across different diseases through a consensus process., Results: Among existing National Institutes of Health CDEs, those developed for ischemic stroke, traumatic brain injury, and subarachnoid hemorrhage were most relevant to DoC and included. KDEs were common to all disease states and included biospecimen collection time points, baseline indicator, biological source, anatomical location of collection, collection method, and processing and storage methodology. Additionally, two disease core, nine basic, 24 supplemental, and 59 exploratory biomarker CDEs were identified. Results were summarized and generated into a Laboratory Data and Biospecimens Case Report Form (CRF) and underwent public review. A final CRF version 1.0 is reported here., Conclusions: Exponential growth in biomarkers development has generated a growing number of potential experimental biomarkers associated with DoC, but few meet the quality, reproducibility, and generalizability criteria to be classified as core and basic biomarker and biospecimen CDEs. Identification and adaptation of KDEs, however, contribute to standardizing methodology to promote harmonization of future biomarker and biospecimens studies in DoC. Development of this CRF serves as a basic building block for future DoC studies., (© 2023. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.)

Purpose: To characterize prevalence estimates by race, age, sex, and comorbidity (diabetes and hypertension) within the Medicare beneficiary demographic., Methods: In this US population-based retrospective cohort analysis, the Vision and Eye Health Surveillance System was analyzed for a 100% sample of Medicare Fee-For-Service beneficiary populations of Asians and non-Hispanic Whites between 2014 and 2018. Exclusionary criteria included beneficiaries younger than 40 years. Prevalence rate ratios, defined as prevalence rate for Asians divided by prevalence rate for non-Hispanic Whites, were calculated using multivariate negative binomial regression or Pearson-scaled Poisson regression, stratified by age, sex, and comorbidity., Results: A total of 21,892,200 Medicare beneficiaries fulfilled the inclusionary criteria in 2018. Of the entire cohort, 3.2% of the beneficiaries (N = 714,500) were Asian. For beneficiaries aged 40 to 64 years, Asian male (prevalence rate ratios 1.73, 95% confidence interval 1.64-1.83, P < 0.0001) and female (prevalence rate ratios 1.34, 95% confidence interval 1.28-1.41, P < 0.0001) beneficiaries had an increased prevalence rate of all age-related macular degeneration relative to non-Hispanic Whites. Significant time-wise increases in prevalence rate ratios were observed within several age groups, sexes, and comorbidities (race-time interaction coefficients P < 0.05 )., Conclusion: This analysis highlights increased age-related macular degeneration prevalence estimates within the Asian American demographic relative to non-Hispanic Whites. Furthermore, specific Asian subpopulations are experiencing accelerated prevalence rates over time.

Purpose: To evaluate whether the volume of wash out rinse after povidone iodine (PI) application for intravitreal injections (IVI) affects patients' ocular surface irritation., Methods: This was a prospective, single-masked, randomized-controlled trial consisting of 142 subjects. A total of 51, 45, and 46 patients received 3-mL, 10-mL, and 15-mL of ocular rinse respectively. Reductions in the Ocular Surface Disease Index (OSDI) and the Standardized Patient Evaluation of Eye Dryness II (SPEED II) surveys, conducted before and at 24-72 h post-injection, were analyzed., Results: There was no statistical difference in objective dry eye findings of Schirmer test (p-value = 0.788), tear break-up time (p-value = 0.403), Oxford fluorescein grade (p-value = 0.424) between the study groups prior to injections. Dry eye symptoms as measured by reductions in the OSDI and SPEEDII scores were not different between the study groups (p-value = 0.0690 and 0.6227, respectively)., Conclusion: There is no difference in patients' ocular surface irritation between 3-mL, 10-mL, and 15-mL post injection rinse. Given the large number of IVIs performed, modification of practice patterns based on these findings could lead to significant reduction in global cost burden for IVIs., (© 2023. Brazilian Retina and Vitreous Society.)

Delayed cerebral ischemia (DCI) is one of the most important complications of subarachnoid hemorrhage. Despite lack of prospective evidence, medical rescue interventions for DCI include hemodynamic augmentation using vasopressors or inotropes, with limited guidance on specific blood pressure and hemodynamic parameters. For DCI refractory to medical interventions, endovascular rescue therapies (ERTs), including intraarterial (IA) vasodilators and percutaneous transluminal balloon angioplasty, are the cornerstone of management. Although there are no randomized controlled trials assessing the efficacy of ERTs for DCI and their impact on subarachnoid hemorrhage outcomes, survey studies suggest that they are widely used in clinical practice with significant variability worldwide. IA vasodilators are first line ERTs, with better safety profiles and access to distal vasculature. The most commonly used IA vasodilators include calcium channel blockers, with milrinone gaining popularity in more recent publications. Balloon angioplasty achieves better vasodilation compared with IA vasodilators but is associated with higher risk of life-threatening vascular complications and is reserved for proximal severe refractory vasospasm. The existing literature on DCI rescue therapies is limited by small sample sizes, significant variability in patient populations, lack of standardized methodology, variable definitions of DCI, poorly reported outcomes, lack of long-term functional, cognitive, and patient-centered outcomes, and lack of control groups. Therefore, our current ability to interpret clinical results and make reliable recommendations regarding the use of rescue therapies is limited. This review summarizes existing literature on rescue therapies for DCI, provides practical guidance, and identifies future research needs., (© 2023. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.)

Prior studies have shown that the accuracy and efficiency of reaching can be improved using novel sensory interfaces to apply task-specific vibrotactile feedback (VTF) during movement. However, those studies have typically evaluated performance after less than 1 h of training using VTF. Here, we tested the effects of extended training using a specific form of vibrotactile cues-supplemental kinesthetic VTF-on the accuracy and temporal efficiency of goal-directed reaching. Healthy young adults performed planar reaching with VTF encoding of the moving hand's instantaneous position, applied to the non-moving arm. We compared target capture errors and movement times before, during, and after approximately 10 h (20 sessions) of training on the VTF-guided reaching task. Initial performance of VTF-guided reaching showed that people were able to use supplemental VTF to improve reaching accuracy. Performance improvements were retained from one training session to the next. After 20 sessions of training, the accuracy and temporal efficiency of VTF-guided reaching were equivalent to or better than reaches performed with only proprioception. However, hand paths during VTF-guided reaching exhibited a persistent strategy where movements were decomposed into discrete sub-movements along the cardinal axes of the VTF display. We also used a dual-task condition to assess the extent to which performance gains in VTF-guided reaching resist dual-task interference. Dual-tasking capability improved over the 20 sessions, such that the primary VTF-guided reaching and a secondary choice reaction time task were performed with increasing concurrency. Thus, VTF-guided reaching is a learnable skill in young adults, who can achieve levels of accuracy and temporal efficiency equaling or exceeding those observed during movements guided only by proprioception. Future studies are warranted to explore learnability in older adults and patients with proprioceptive deficits, who might benefit from using wearable sensory augmentation technologies to enhance control of arm movements., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Accuracy of electroencephalography (EEG) source localization relies on the volume conduction head model. A previous analysis of young adults has shown that simplified head models have larger source localization errors when compared with head models based on magnetic resonance images (MRIs). As obtaining individual MRIs may not always be feasible, researchers often use generic head models based on template MRIs. It is unclear how much error would be introduced using template MRI head models in older adults that likely have differences in brain structure compared to young adults. The primary goal of this study was to determine the error caused by using simplified head models without individual-specific MRIs in both younger and older adults. We collected high-density EEG during uneven terrain walking and motor imagery for 15 younger (22±3 years) and 21 older adults (74±5 years) and obtained [Formula: see text]-weighted MRI for each individual. We performed equivalent dipole fitting after independent component analysis to obtain brain source locations using four forward modeling pipelines with increasing complexity. These pipelines included: 1) a generic head model with template electrode positions or 2) digitized electrode positions, 3) individual-specific head models with digitized electrode positions using simplified tissue segmentation, or 4) anatomically accurate segmentation. We found that when compared to the anatomically accurate individual-specific head models, performing dipole fitting with generic head models led to similar source localization discrepancies (up to 2 cm) for younger and older adults. Co-registering digitized electrode locations to the generic head models reduced source localization discrepancies by  ∼  6 mm. Additionally, we found that source depths generally increased with skull conductivity for the representative young adult but not as much for the older adult. Our results can help inform a more accurate interpretation of brain areas in EEG studies when individual MRIs are unavailable.

Importance: Patients who survive severe intracerebral hemorrhage (ICH) and intraventricular hemorrhage (IVH) typically have poor functional outcome in the short term and understanding of future recovery is limited., Objective: To describe 1-year recovery trajectories among ICH and IVH survivors with initial severe disability and assess the association of hospital events with long-term recovery., Design, Setting, and Participants: This post hoc analysis pooled all individual patient data from the Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage phase 3 trial (CLEAR-III) and the Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation (MISTIE-III) phase 3 trial in multiple centers across the US, Canada, Europe, and Asia. Patients were enrolled from August 1, 2010, to September 30, 2018, with a follow-up duration of 1 year. Of 999 enrolled patients, 724 survived with a day 30 modified Rankin Scale score (mRS) of 4 to 5 after excluding 13 participants with missing day 30 mRS. An additional 9 patients were excluded because of missing 1-year mRS. The final pooled cohort included 715 patients (71.6%) with day 30 mRS 4 to 5. Data were analyzed from July 2019 to January 2022., Exposures: CLEAR-III participants randomized to intraventricular alteplase vs placebo. MISTIE-III participants randomized to stereotactic thrombolysis of hematoma vs standard medical care., Main Outcomes and Measures: Primary outcome was 1-year mRS. Patients were dichotomized into good outcome at 1 year (mRS 0 to 3) vs poor outcome at 1 year (mRS 4 to 6). Multivariable logistic regression models assessed associations between prospectively adjudicated hospital events and 1-year good outcome after adjusting for demographic characteristics, ICH and IVH severity, and trial cohort., Results: Of 715 survivors, 417 (58%) were male, and the overall mean (SD) age was 60.3 (11.7) years. Overall, 174 participants (24.3%) were Black, 491 (68.6%) were White, and 49 (6.9%) were of other races (including Asian, Native American, and Pacific Islander, consolidated owing to small numbers); 98 (13.7%) were of Hispanic ethnicity. By 1 year, 129 participants (18%) had died and 308 (43%) had achieved mRS 0 to 3. In adjusted models for the combined cohort, diabetes (adjusted odds ratio [aOR], 0.50; 95% CI, 0.26-0.96), National Institutes of Health Stroke Scale (aOR, 0.93; 95% CI, 0.90-0.96), severe leukoaraiosis (aOR, 0.30; 95% CI, 0.16-0.54), pineal gland shift (aOR, 0.87; 95% CI, 0.76-0.99]), acute ischemic stroke (aOR, 0.44; 95% CI, 0.21-0.94), gastrostomy (aOR, 0.30; 95% CI, 0.17-0.50), and persistent hydrocephalus by day 30 (aOR, 0.37; 95% CI, 0.14-0.98) were associated with lack of recovery. Resolution of ICH (aOR, 1.82; 95% CI, 1.08-3.04) and IVH (aOR, 2.19; 95% CI, 1.02-4.68) by day 30 were associated with recovery to good outcome. In the CLEAR-III model, cerebral perfusion pressure less than 60 mm Hg (aOR, 0.30; 95% CI, 0.13-0.71), sepsis (aOR, 0.05; 95% CI, 0.00-0.80), and prolonged mechanical ventilation (aOR, 0.96; 95% CI, 0.92-1.00 per day), and in MISTIE-III, need for intracranial pressure monitoring (aOR, 0.35; 95% CI, 0.12-0.98), were additional factors associated with poor outcome. Thirty-day event-based models strongly predicted 1-year outcome (area under the receiver operating characteristic curve [AUC], 0.87; 95% CI, 0.83-0.90), with significantly improved discrimination over models using baseline severity factors alone (AUC, 0.76; 95% CI, 0.71-0.80; P < .001)., Conclusions and Relevance: Among survivors of severe ICH and IVH with initial poor functional outcome, more than 40% recovered to good outcome by 1 year. Hospital events were strongly associated with long-term functional recovery and may be potential targets for intervention. Avoiding early pessimistic prognostication and delaying prognostication until after treatment may improve ability to predict future recovery.

Sensory augmentation technologies are being developed to convey useful supplemental sensory cues to people in comfortable, unobtrusive ways for the purpose of improving the ongoing control of volitional movement. Low-cost vibration motors are strong contenders for providing supplemental cues intended to enhance or augment closed-loop feedback control of limb movements in patients with proprioceptive deficits, but who still retain the ability to generate movement. However, it remains unclear what form such cues should take and where on the body they may be applied to enhance the perception-cognition-action cycle implicit in closed-loop feedback control. As a step toward addressing this knowledge gap, we used low-cost, wearable technology to examine the perceptual acuity of vibrotactile stimulus intensity discrimination at several candidate sites on the body in a sample of participants spanning a wide age range. We also sought to determine the extent to which the acuity of vibrotactile discrimination can improve over several days of discrimination training. Healthy adults performed a series of 2-alternative forced choice experiments that quantified capability to perceive small differences in the intensity of stimuli provided by low-cost eccentric rotating mass vibration motors fixed at various body locations. In one set of experiments, we found that the acuity of intensity discrimination was poorer in older participants than in middle-aged and younger participants, and that stimuli applied to the torso were systematically harder to discriminate than stimuli applied to the forearm, knee, or shoulders, which all had similar acuities. In another set of experiments, we found that older adults could improve intensity discrimination over the course of 3 days of practice on that task such that their final performance did not differ significantly from that of younger adults. These findings may be useful for future development of wearable technologies intended to improve the control of movements through the application of supplemental vibrotactile cues., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Pomplun, Thomas, Corrigan, Shah, Mrotek and Scheidt.)

Background and Objectives: Regional variability in subarachnoid hemorrhage (SAH) care is reported in physician surveys. We aimed to describe variability in SAH care using patient-level data and identify factors impacting hospital outcomes and regional variability in outcomes., Methods: A retrospective multi-center cross-sectional cohort study of consecutive non-traumatic SAH patients in the Vizient Clinical Data Base, between January 1st, 2009 and December 30th, 2018 was performed. Participating hospitals were divided into US regions: Northeast, Midwest, South, West. Regional demographics, co-morbidities, severity-of-illness, complications, interventions and discharge outcomes were compared. Multivariable logistic regression was performed to identify factors independently associated with primary outcomes: hospital mortality and poor discharge outcome. Poor discharge outcome was defined by the Nationwide Inpatient Sample-SAH Outcome Measure, an externally-validated outcome measure combining death, discharge disposition, tracheostomy and/or gastrostomy. Regional variability in the associations between care and outcomes were assessed by introducing an interaction term for US region into the models., Results: Of 109,034 patients included, 24.3% were from Northeast, 24.9% Midwest, 34.9% South, 15.9% West. Mean (SD) age was 58.6 (15.6) years and 64,245 (58.9%) were female. In-hospital mortality occurred in 21,991 (20.2%) and 44,159 (40.5%) had poor discharge outcome. There was significant variability in severity-of-illness, co-morbidities, complications and interventions across US regions. Notable findings were higher prevalence of surgical clipping (18.8 vs. 11.6%), delayed cerebral ischemia (4.3 vs. 3.1%), seizures (16.5 vs. 14.8%), infections (18 vs. 14.7%), length of stay (mean [SD] days; 15.7 [19.2] vs. 14.1 [16.7]) and health-care direct costs (mean [SD] USD; 80,379 [98,999]. vs. 58,264 [74,430]) in the West when compared to other regions (all p < 0.0001). Variability in care was also associated with modest variability in hospital mortality and discharge outcome. Aneurysm repair, nimodipine use, later admission-year, endovascular rescue therapies reduced the odds for poor outcome. Age, severity-of-illness, co-morbidities, hospital complications, and vasopressor use increased those odds (c-statistic; mortality: 0.77; discharge outcome: 0.81). Regional interaction effect was significant for admission severity-of-illness, aneurysm-repair and nimodipine-use., Discussion: Multiple hospital-care factors impact SAH outcomes and significant variability in hospital-care and modest variability in discharge-outcomes exists across the US. Variability in SAH-severity, nimodipine-use and aneurysm-repair may drive variability in outcomes., Competing Interests: AH and SH are employed by Center for Advanced Analytics and Informatics, Vizient, Inc. None of the authors had any financial relationships except JS, who is the Chair of the DSMB for the INTREPID Study funded by BARD, member of the CEC for the REACT Study funded by Idorsia, member of the Editorial Board of Stroke, and an ex-officio member of the Board of Directors of the Neurocritical Care Society. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Shah, Kazmi, Damani, Harris, Hohmann, Calvillo and Suarez.)

Purpose: To evaluate the utility of dissolvable collagen punctal plugs (CPP) in reducing ocular surface irritation after intravitreal injections (IVI)., Methods: Sixty-four subjects in the experimental group received CPP after intravitreal injections. Sixty-two controls did not receive CPP. Reductions in the Ocular Surface Disease Index © (OSDI) and Standardized Patient Evaluation of Eye Dryness II (SPEED II) scores were analysed., Results: Dry eye symptoms, as measured by reductions from the pre- to post-injection OSDI (p = 0.137) and SPEED II (p = 0.381) scores, did not significantly differ between the two groups. In sub-group analysis, patients with objective findings of dry eyes had significant improvement in their symptoms (p = 0.046) with CPP. The effect of CPP is not significant in those without dry eyes (p = 0.27)., Conclusion: CPPs were not effective in reducing post-injection ocular irritation in patients with no or only mild dry eye symptoms. CPPs improved patients' post-injection comfort levels in those who had moderate-to-severe symptoms and objective findings of dry eye. Though costly CPP could be considered in selective patients. A standardized eye rinse could be a simple, efficacious, and cost-effective way to reduce post-injection ocular irritation; however, more studies are needed., (© 2021. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)