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Ian Gerard Brennan,1,* Stephen R Kelly,1,* Edel McBride,2 Darragh Garrahy,1 Robert Acheson,2 Joanne Harmon,2 Shane McMahon,2 David J Keegan,1 Helen Kavanagh,1 Louise O’Toole2 1Diabetic RetinaScreen, National Screening Service, Health Service Executive, Dublin, Ireland; 2Diabetic Retinal Screening Service, NEC Care, Cork City, Co. Cork, Ireland*These authors contributed equally to this workCorrespondence: Louise O’Toole, NEC Care, Matthew House-3rd Floor, Fr Matthew Street, Cork City, Co. Cork, T12 TN56, Ireland, Email lotoole@materprivate.iePurpose: Diabetic retinopathy (DR) is a preventable cause of blindness detectable through screening using retinal digital photography. The Irish National Diabetic Retina Screening (DRS) programme, Diabetic RetinaScreen, provides free screening services to patients with diabetes from aged 12 years and older. A technical failure (TF) occurs when digital retinal imaging is ungradable, resulting in delays in the diagnosis and treatment of sight-threatening disease. Despite their impact, the causes of TFs, and indeed the utility of interventions to prevent them, have not been extensively examined.Aim: Primary analysis aimed to identify factors associated with TF. Secondary analysis examined a subset of cases, assessing patient data from five time points between 2019 and 2021 to identify photographer/patient factors associated with TF.Methods: Patient data from the DRS database for one provider were extracted for analysis between 2018 and 2022. Information on patient demographics, screening results, and other factors previously associated with TF were analyzed. Primary analysis involved using mixed-effects logistic regression models with nested patient-eye random effects. Secondary analysis reviewed a subset of cases in detail, checking for causes of TF.Results: The primary analysis included a total of 366,528 appointments from 104,407 patients over 5 years. Most patients had Type 2 diabetes (89.2%), and the overall TF rate was 4.9%. Diabetes type and duration, dilate pupil status, and the presence of lens artefacts on the camera were significantly associated with TF. The Secondary analysis identified the primary cause of TF was found to be optically dense cataracts, accounting for over half of the TFs.Conclusion: This study provides insight into the causes of TF within the Irish DRS program, highlighting cataracts as the primary contributing factor. The identification of patient-level factors associated with TF facilitates appropriate interventions that can be put in place to improve patient outcomes and minimize delays in treatment and diagnosis.Keywords: ungradable image, cataract, screen failure, camera, retinal photography

Joanne Harmon,1 Stephen Kelly,2 Robert Acheson,1 David Keegan,2 Shane McMahon,1 Helen Kavanagh,2 Louise O’Toole1 1NEC Care, Cork, Ireland; 2Diabetic RetinaScreen, Heath Service Executive, Dublin, IrelandCorrespondence: Louise O’Toole, NEC Care, 55 South Mall (2nd Floor), Cork, T12 RR44, Ireland, Tel +35318858656, Fax +35318858658, Email lotoole@materprivate.ieBackground: Patient non-attendance following referral to hospital is a significant challenge, in particular, for persons with diabetes.Aim: We sought to determine the impact on both visual acuity and the subsequent follow-up retinopathy grade of patients when they fail to attend Diabetic Retinopathy Treatment (DRT) Centers following referral from Diabetic RetinaScreen (DRS).Methods: A retrospective analysis of patients discharged from DRT due to multiple consecutive missed appointments between January 2016 and June 2021. Patients discharged for non-attendance were compared with patients discharged from completed treatment.Results: Of the 24,945 NEC patients referred to DRT, 5900 (24%) and 9345 (37%) were discharged back to DRS due to non-attendance and completed treatment, respectively. Those discharged for non-attendance were younger (60.7 v 63.4, p < 0.001) and had higher proportions of males (67% v 63%, p < 0.001) and people with type 1 diabetes (27% v 18%, p < 0.001). After attending rescreening after discharge, those discharged for non-attendance were significantly more likely to have a worsening of DR grade (26% v 8%, p < 0.001).Conclusion: Despite being notified that further investigation (with possible treatment) was required post DRS, many diabetic patients failed to attend for further management of their eye care in DRT. These patients had worse visual outcomes compared to those that attended. Improved patient education and communication are required to mitigate against the consequences of non-attendance.Keywords: maculopathy, follow up, HES, DNA, compliance

Melanie A Jordan, Jonathan HarmonCollege of Pharmacy – Glendale, Midwestern University, Glendale, AZ, USAAbstract: Obesity is currently a worldwide pandemic, with overweight (body mass index [BMI] ≥25 kg/m2) and obesity (BMI ≥30 kg/m2) estimated at 35% and 12% of the global adult population, respectively. According to data collected from the United States National Health and Nutrition Examination Survey, approximately 68.8% of US adults are overweight or obese. Additionally, a large burden of health care costs can be attributed directly to obesity as well as multiple, potentially preventable, comorbidities such as cancer, cardiovascular disease, and diabetes. As a result, national and international organizations, such as the US Centers for Disease Control and World Health Organization, have made halting the rise of the obesity epidemic a top priority. Pharmacists, commonly considered one of the most trustworthy and accessible health care professionals, are ideally situated to provide counseling for weight and lifestyle management. This review presents examples of pharmacist-led as well as collaborative practices that have been somewhat successful in educating and monitoring patient progress in attaining weight-loss goals. Common barriers and potential solutions to administration of lifestyle counseling and monitoring programs, such as limited pharmacist time and resources, lack of expertise and/or confidence in program administration, and patient perception and awareness, are also discussed.Keywords: pharmacy, obesity, counseling, weight loss, lifestyle management

PREdiction of NOn-LINear soil behavior (PRENOLIN) is an international benchmark aiming to test multiple numerical simulation codes that are capable of predicting nonlinear seismic site response with various constitutive models. One of the objectives of this project is the assessment of the uncertainties associated with nonlinear simulation of 1D site effects. A first verification phase (i.e., comparison between numerical codes on simple idealistic cases) will be followed by a validation phase, comparing the predictions of such numerical estimations with actual strongmotion recordings obtained at well-known sites. The benchmark presently involves 21 teams and 23 different computational codes. We present here the main results of the verification phase dealing with simple cases. Three different idealized soil profiles were tested over a wide range of shear strains with different input motions and different boundary conditions at the sediment/bedrock interface. A first iteration focusing on the elastic and viscoelastic cases was proved to be useful to ensure a common understanding and to identify numerical issues before pursuing the nonlinear modeling. Besides minor mistakes in the implementation of input parameters and output units, the initial discrepancies between the numerical results can be attributed to (1) different understanding of the expression “input motion” in different communities, and (2) different implementations of material damping and possible numerical energy dissipation. The second round of computations thus allowed a convergence of all teams to the Haskell–Thomson analytical solution in elastic and viscoelastic cases. For nonlinear computations, we investigate the epistemic uncertainties related only to wave propagation modeling using different nonlinear constitutive models. Such epistemic uncertainties are shown to increase with the strain level and to reach values around 0.2 (log10 scale) for a peak ground acceleration of 5 m=s2 at the base of the soil column, which may be reduced by almost 50% when the various constitutive models used the same shear strength and damping implementation.