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PurposeTo report five cases of ocular scedosporiosis with associated predisposing factors, treatment courses, and clinical outcomes.ObservationThis case series consists of 5 patients diagnosed with ocular scedosporiosis. Two patients were female and 3 were male. The average age was 68.4 years (range 53-85). Four of the 5 had a clear history of ocular surgery or ocular trauma with organic foreign material. Two developed sclero-keratitis. Two had cornea-only involvement. There was 1 scleritis-only case. Patients with scleritis required topical and systemic treatment. Patients with only keratitis were treated topically. The two patients with sclero-keratitis ultimately progressed to eye removal despite maximal therapy.Conclusion and importanceOcular scedosporiosis is exceedingly rare, especially in the Unites States. We highlight similarities and differences of five ocular scedosporiosis cases. Most cases involved either ocular surgery or contamination with ground or plant matter. This case series highlights the challenge of the diagnosis and the aggressivity of this disease.

Background: Limited information is available on factors that affect the burden tinnitus. The aim of this study is to investigate the association between tinnitus burden and demographic, patient-specific and tinnitus characteristics. Secondly, it was examined which variables could predict a change in tinnitus burden after 12 months. Method: In a prospective Dutch cohort of 383 tinnitus patients seeking medical help, tinnitus complaints, demographics, tinnitus characteristics, psychological wellbeing and quality of life were assessed using an online self-report survey at three timepoints (start, 6 months, 12 months). The main outcome variables for tinnitus burden are the Tinnitus Questionnaire (TQ) and Visual Analog Scale (VAS) for tinnitus burden and loudness. Results: Several variables (time, sex, education level, life events, anxiety and depression, sleep issues, tinnitus loudness, hearing impairment and treatment) were significantly associated with tinnitus burden. Additionally, tinnitus burden after 12 months was associated with anxiety, following treatment, sleep issues, negative life events and hearing impairment (increase) and anxiety, total of life events and environmental quality of life (decrease) predicted the tinnitus burden after 12 months. Conclusions: Several factors, such as education level, life events, psychological factors and sleep quality, are related to tinnitus burden and can predict tinnitus burden over time.

ObjectiveTo describe the characteristics, management, and functional outcomes of patients with synchronous urethral stricture disease (SUSD) utilizing a multi-institutional cohort.MethodsData were collected and assessed from a prospectively maintained, multi-institutional database. Patients who underwent anterior urethroplasty for urethral stricture disease (USD) were included and stratified by the presence or absence of SUSD. USD location and etiology were classified according to the Trauma and Urologic Reconstruction Network of Surgeons Length, Segment and Etiology Anterior Urethral Stricture Classification System. Anterior urethroplasty techniques were recorded for both strictures. Functional failure was compared between groups.ResultsOne thousand nine hundred eighty-three patients were identified, of whom, 137/1983 (6.9%) had SUSD. The mean primary stricture length for patients with SUSD was 3.5 and 2.6 cm for the secondary stricture. Twelve anterior urethroplasty technique combinations were utilized in treating the 27 different combinations of SUSD. Functional failure was noted in 18/137 (13.1%) patients with SUSD vs 192/1846 (10.4%) patients with solitary USD, P = .3. SUSD was not associated with increased odds of functional failure. S classifications: S1b, P = .003, S2a, P = .001, S2b, P = .01 and S2c, P = .02 and E classifications: E3a, P = .004 and E6, P = .03, were associated with increased odds of functional failure.ConclusionRepair of SUSD in a single setting does not increase the risk of functional failure compared to patients with solitary USD. Increasing S classification, S1b through S2c and E classifications E3a and E6 were associated with increased functional failure. This reinforces the importance of the Trauma and Urologic Reconstruction Network of Surgeons Length, Segment and Etiology Anterior Urethral Stricture Classification System as a necessary tool in large-scale multi-institutional analysis when assessing highly heterogenous patient populations.

Although evidence has suggested that social skills interventions yield social and symptom benefits for autistic children, significant variability in outcomes between studies has raised important questions regarding efficacy and moderators of intervention outcomes (i.e., which interventions yield positive effects and which autistic children are most likely to benefit). The efficacy of a comprehensive psychosocial program for autistic children, ages 7-12 years (N = 88) was tested in a prior randomized controlled trial (RCT). Significant effects favoring the program group (versus waitlist controls) were found at posttest on measures of autism-feature severity, social/social-communication skills, social-cognitive understanding (nonliteral language), and global social skills, and these were maintained at 4-6 week follow-up. In this exploratory study, demographic and clinical variables were tested as potential moderators of outcomes from the prior RCT. Moderation effects were not evident for demographics, or child IQ, expressive language, autistic diagnostic symptoms, or baseline co-occurring externalizing or internalizing symptoms. Child receptive language appeared to moderate the outcome of nonliteral language only. Overall, program effects were, with one exception, unrelated to third variables.

Purpose: To report five cases of ocular scedosporiosis with associated predisposing factors, treatment courses, and clinical outcomes. Observation: This case series consists of 5 patients diagnosed with ocular scedosporiosis. Two patients were female and 3 were male. The average age was 68.4 years (range 53–85). Four of the 5 had a clear history of ocular surgery or ocular trauma with organic foreign material. Two developed sclero-keratitis. Two had cornea-only involvement. There was 1 scleritis-only case. Patients with scleritis required topical and systemic treatment. Patients with only keratitis were treated topically. The two patients with sclero-keratitis ultimately progressed to eye removal despite maximal therapy. Conclusion and importance: Ocular scedosporiosis is exceedingly rare, especially in the Unites States. We highlight similarities and differences of five ocular scedosporiosis cases. Most cases involved either ocular surgery or contamination with ground or plant matter. This case series highlights the challenge of the diagnosis and the aggressivity of this disease.

Children with ASD are more likely to be involved in bullying compared to typically developing peers; however, studies rarely examine bullying perpetration and the contributing factors among this population. The primary aim of this study was to examine the extent to which parent-reported ASD symptoms, social skills, and comorbid externalizing and internalizing symptoms predicted bullying perpetration in a sample of 390 children with ASD without intellectual disability. Findings from hierarchical regression analyses indicated that social skill deficits, externalizing symptoms (i.e., hyperactivity, aggression, and conduct problems), and depressive symptoms were associated with higher likelihood of bullying perpetration, while severity of ASD symptoms and anxiety were not significant predictors. Further research is needed to better understand bullying perpetration among children with ASD.

PurposeWe evaluated the noninferiority of 10.4 μl of eye drops eluted with a commercially available eye drop adapter, the Nanodropper (Nanodropper, Inc), on pupillary dilation and cycloplegia in children compared with the standard of care (SOC), 50 μl of eye drops.DesignProspective randomized trial.ParticipantsPediatric patients scheduled for routine pupillary dilation at the University of California, San Francisco, at the Pediatric Ophthalmology Clinic were enrolled. Each participant provided 1 eye for the intervention group (Nanodropper) and 1 eye for the control group (SOC).MethodsParticipants were randomized to receive small-volume dilating drops in 1 eye (Nanodropper) and SOC dilating drops in the other eye. Dilation was performed using 1 drop each of 1% cyclopentolate, 1% tropicamide, and 2.5% phenylephrine. Refraction and pupillometry were obtained before and 30 minutes after dilation. A noninferiority analysis was performed to assess change from before to after dilation in spherical equivalent and in pupil constriction percentage and maximum pupil diameter after dilation.Main outcome measuresSpherical equivalent, maximum pupil diameter, and pupil constriction percentage.ResultsOne hundred eyes of 50 patients were included, with a mean ± standard deviation age of 9 ± 3 years. After controlling for baseline measurements, the spherical equivalent after dilation was 0.05 diopter (D) more (95% confidence interval [CI], -0.28 to 0.37 D) in the Nanodropper arm, which did not achieve noninferiority. Maximum pupil diameter after dilation was lower in the Nanodropper group (mean, -0.01 mm; 95% CI, -0.20 to -0.03), which did achieve noninferiority. Constriction percentage after dilation was 0.57 percentage points more (95% CI, -1.38 to 2.51 percentage points) in the Nanodropper group, which did not achieve noninferiority.ConclusionsAdministration of eye drops using a small-volume adapter demonstrated similar efficacy to SOC in a pediatric population. Strict noninferiority was met only for pupillary dilation and not for cycloplegia or constriction percentage; however, the small differences in the effect of the Nanodropper versus SOC on all primary outcomes were not clinically significant. We conclude that small-volume eye drops have the potential to decrease unnecessary medical waste and medication toxicity while maintaining therapeutic effect.Financial disclosure(s)Proprietary or commercial disclosure may be found after the references.

PurposeThe purpose of this study was to investigate the social determinants of health for keratoconus.MethodsIn this retrospective cohort study of patients with keratoconus, the electronic health record was reviewed for keratometry, treatments received, clinical comorbidities, and social characteristics. Outcomes included severe keratoconus at presentation (steep keratometry ≥52 diopters), disease progression (≥0.75 diopters increase from the first to the most recent clinical visit), and corneal transplantation. Logistic regression was used to evaluate factors associated with severity at presentation and corneal transplantation. Cox proportional hazards modeling was used to evaluate progression.ResultsA total of 1038 patients with keratoconus were identified, 725 (70%) of whom had baseline imaging. Compared with commercially insured patients, Medicaid recipients were more likely to have severe keratoconus, independent of social and clinical confounders [odds ratio (OR) 1.94, 95% confidence interval (CI), 1.12-3.35, P = 0.017]. Male sex was independently associated with progression (hazard ratio = 1.38, 95% CI, 1.03-1.84, P = 0.030). Medicare and Medicaid recipients were more likely to require transplantation compared with commercially insured patients (OR 2.71, 95% CI, 1.65-4.46, P < 0.001 and OR 1.74, 95% CI, 1.08-2.80, P = 0.022, respectively). Other social determinants of health, including non-White race/ethnicity, limited English proficiency, and unemployment, were associated with the outcomes only in univariate analysis. Obstructive sleep apnea, atopy, body mass index, and tobacco use were not associated with any outcome.ConclusionsSocioeconomic factors were more consistent predictors of keratoconus severity and corneal transplantation compared with clinical factors that have received relatively greater attention in the keratoconus literature.

This study reports on two pilot studies developing a telemedicine parent-delivered social skills intervention (PDSSI) for school-aged children with ASD. Pilot study 1 involved initial development, training, and feasibility testing for six parent-child pairs using in-person training and fidelity monitoring. Findings from study 1 supported the intervention procedures through high satisfaction and parent implementation fidelity. Pilot study 2 tested the intervention with 11 parent-child pairs using telemedicine for parent training, fidelity monitoring, and child outcome testing. Findings from study 2 supported feasibility using telemedicine. Study 2 also provided initial data indicating improvements in child social skills knowledge (d = 1.15), social skills (d = 1.75), and ASD characteristics (d = 0.92). Parents reported improvements in their own empowerment (d = 1.09) and stress (d = 0.44). Some outcomes were assessed and maintained at a 16-week follow-up. Overall, results support ongoing testing of this telemedicine PDSSI.

Sensor calibration for dissolved gas is a critical and necessary step to ensure consistent sensor response over time and under different conditions. In this work, we describe a 3D printed device that facilitates the calibration of gas sensors. The device effectively maintained gas concentration in the solution for at least 2 h. Analytical curves were constructed in the pH range of 2 to 12, yielding determination coefficients surpassing 0.98. The chosen method proved suitable for the calibration of the sensors. Furthermore, using accurate and reliable reference sensors contributed to obtaining precise and trustworthy measurements.

PurposeTo report a case of congenital ciliary body cysts causing microspherophakia, ectopia lentis, and secondary angle closure glaucoma in an infant.ObservationsA 16-month-old male was found to have bilateral ciliary body cysts associated with zonular laxity or absence causing microspherophakia and ectopia lentis as demonstrated on multimodal imaging. Additionally, the patient had secondary angle closure glaucoma which was likely multi-factorial related to both lens abnormalities and anterior displacement of the iris from the cysts themselves. The patient underwent lensectomy and cyst removal which resulted in intraocular pressure stabilization and visual rehabilitation.Conclusions and importanceCongenital ciliary body cysts are a rare cause of lens abnormalities and secondary angle closure glaucoma in children. Information regarding genetic underpinnings or systemic associations is limited.

Abstract Jade and greenstone objects have been held in high regard by many cultures stemming from their limited geological availability and their unique optical and mechanical properties. Jade and greenstone objects symbolized life, fertility, and eternity to early Mesoamerican people. In recent years, scientific studies on jade and greenstone objects have been performed to establish provenance and usage, identify composition, and verify the presence of a particular material. These studies of jade and greenstone objects are generally divided geographically, with considerable interest in China and Central America. Most studies are focused on objects from one particular archaeological site; however, a few studies have focused on collections from a range of sites. The use of multiple complimentary analytical techniques has been shown to be the most effective method for characterizing and understanding the technical information obtained from cultural heritage objects. In our study, we examine a set of Mesoamerican jade and greenstone objects from the collection at the Dallas Museum of Art using multiple non-destructive techniques, including scanning electron microscopy with energy dispersive spectroscopy, Raman spectroscopy, X-ray diffraction, and handheld X-ray fluorescence spectroscopy. We briefly discuss the advantages and disadvantages of each technique. Lastly, we present the results from our study and discuss them in their archaeological and historical context.

Abstract Objectives The aim of this study is to evaluate the impact of radiologist and urologist variability on detection of prostate cancer (PCa) and clinically significant prostate cancer (csPCa) with magnetic resonance imaging (MRI)‐transrectal ultrasound (TRUS) fusion prostate biopsies. Patients and methods The Prospective Loyola University MRI (PLUM) Prostate Biopsy Cohort (January 2015 to December 2020) was used to identify men receiving their first MRI and MRI/TRUS fusion biopsy for suspected PCa. Clinical, MRI and biopsy data were stratified by radiologist and urologist to evaluate variation in Prostate Imaging‐Reporting and Data System (PI‐RADS) grading, lesion number and cancer detection. Multivariable logistic regression (MVR) models and area under the curve (AUC) comparisons assessed the relative impact of individual radiologists and urologists. Results A total of 865 patients (469 biopsy‐naïve) were included across 5 urologists and 10 radiologists. Radiologists varied with grading 15.4% to 44.8% of patients with MRI lesions as PI‐RADS 3. PCa detection varied significantly by radiologist, from 34.5% to 66.7% (p = 0.003) for PCa and 17.2% to 50% (p = 0.001) for csPCa. Urologists' PCa diagnosis rates varied between 29.2% and 55.8% (p = 0.013) and between 24.6% and 39.8% (p = 0.36) for csPCa. After adjustment for case‐mix on MVR, a fourfold to fivefold difference in PCa detection was observed between the highest‐performing and lowest‐performing radiologist (OR 0.22, 95%CI 0.10–0.47, p

This study assessed the reliability and criterion-related validity of teacher ratings on the Adapted Skillstreaming Checklist for a sample of 133 children, aged 6-11 years, with autism spectrum disorder (without intellectual disability). Internal consistency for the total sample was 0.93. For a subsample, test-retest reliability was very good (r = 0.74; intraclass correlation coefficient = 0.85) at a 9-month interval. Child age, intelligence quotient, language abilities, and sex were not associated with the Adapted Skillstreaming Checklist total score. The Adapted Skillstreaming Checklist total score was inversely and strongly related to teacher ratings of autism spectrum disorder symptom severity. Significant positive correlations (moderate-to-high) were found between the Adapted Skillstreaming Checklist and prosocial skills scales and significant negative correlations (low-to-moderate) with problem behavior scales on a broad measure of child functioning. Implications and suggestions for future study are discussed.

The Adapted Skillstreaming Checklist measures social/social-communication skills and behavioral flexibility/regulation of children with autism spectrum disorder without intellectual disability. Prior studies provided support for the reliability and criterion-related validity of the Adapted Skillstreaming Checklist total score for these children; however, no studies have examined the Adapted Skillstreaming Checklist factor structure. This exploratory factor analysis examined the factor structure and internal consistency of parent ratings on the Adapted Skillstreaming Checklist for a sample of 331 children, ages 6-12 years, with autism spectrum disorder without intellectual disability. Results yielded a correlated three-factor solution. The individual factors and total score demonstrated very good internal consistency reliability. Findings supported the presence and interpretability of three subscales, as well as derivation of a total composite reflecting overall prosocial and adaptive skills and behaviors. Implications for assessment and research are discussed.