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Background and Objective: Proliferative vitreoretinopathy (PVR) has been mitigated by intravitreal methotrexate (MTX) 400 μg/0.1 mL in several studies. Here, we evaluate the results from a lower dose of MTX, 200 μg/0.05 mL. Materials and Methods: We identified and reviewed records of patients with grade ≥C1 PVR who were treated with 200 μg/0.05 mL MTX injections: during PVR surgery and every 2 weeks thereafter. Results: Twenty-four eyes met inclusion criteria with a mean of 5.6 injections and follow-up ranging 6 to 56 months. The retina was reattached in 19 of 24 eyes (79%) after a single surgery and in 5 of 24 eyes (21%) after one additional PVR surgery. Visual acuity improved from baseline logMAR 1.63 to 0.97 at 12 months ( P < .001), with 5 of 20 achieving 20/60 or better and 16 of 20 achieving 20/200 or better. One eye developed a transient corneal abrasion that resolved within 1 week. Conclusion: Low-dose MTX (200 μg/0.05 mL) during and after PVR surgery resulted in good rates of retinal reattachment and visual acuity recovery. [ Ophthalmic Surg Lasers Imaging Retina 2023;54(3):139–146.]

IntroductionThe Accreditation Council for Graduate Medical Education (ACGME) offers descriptions of competencies and milestones but does not provide standardized assessments to track trainee competency. Entrustable professional activities (EPAs) and special assessments (SAs) are emerging methods to assess the level of competency obtained by regional anesthesiology and acute pain medicine (RAAPM) fellows.MethodsA panel of RAAPM physicians with experience in education and competency assessment and one medical student were recruited to participate in a modified Delphi method with iterative rounds to reach consensus on: a list of EPAs, SAs, and procedural skills; detailed definitions for each EPA and SA; a mapping of the EPAs and SAs to the ACGME milestones; and a target level of entrustment for graduating US RAAPM fellows for each EPA and procedural skill. A gap analysis was performed and a heat map was created to cross-check the EPAs and SAs to the ACGME milestones.ResultsParticipants in EPA and SA development included 19 physicians and 1 medical student from 18 different programs. The Delphi rounds yielded a final list of 23 EPAs, a defined entrustment scale, mapping of the EPAs to ACGME milestones, and graduation targets. A list of 73 procedural skills and 7 SAs were similarly developed.DiscussionA list of 23 RAAPM EPAs, 73 procedural skills, and 7 SAs were created using a rigorous methodology to reach consensus. This framework can be utilized to help assess RAAPM fellows in the USA for competency and allow for meaningful performance feedback.

Background Pulse oximetry is ubiquitous in anesthesia and is generally a reliable noninvasive measure of arterial oxygen saturation. Concerns regarding the impact of skin pigmentation and race/ethnicity on the accuracy of pulse oximeter accuracy exist. The authors hypothesized a greater prevalence of occult hypoxemia (arterial oxygen saturation [Sao2] less than 88% despite oxygen saturation measured by pulse oximetry [Spo2] greater than 92%) in patients undergoing anesthesia who self-reported a race/ethnicity other than White. Methods Demographic and physiologic data, including self-reported race/ethnicity, were extracted from a departmental data warehouse for patients receiving an anesthetic that included at least one arterial blood gas between January 2008 and December 2019. Calculated Sao2 values were paired with concurrent Spo2 values for each patient. Analysis to determine whether Black, Hispanic, Asian, or Other race/ethnicities were associated with occult hypoxemia relative to White race/ethnicity within the Spo2 range of 92 to 100% was completed. Results In total, 151,070 paired Sao2–Spo2 readings (70,722 White; 16,011 Black; 21,223 Hispanic; 8,121 Asian; 34,993 Other) from 46,253 unique patients were analyzed. The prevalence of occult hypoxemia was significantly higher in Black (339 of 16,011 [2.1%]) and Hispanic (383 of 21,223 [1.8%]) versus White (791 of 70,722 [1.1%]) paired Sao2–Spo2 readings (P < 0.001 for both). In the multivariable analysis, Black (odds ratio, 1.44 [95% CI, 1.11 to 1.87]; P = 0.006) and Hispanic (odds ratio, 1.31 [95% CI, 1.03 to 1.68]; P = 0.031) race/ethnicity were associated with occult hypoxemia. Asian and Other race/ethnicity were not associated with occult hypoxemia. Conclusions Self-reported Black and Hispanic race/ethnicity are associated with a greater prevalence of intraoperative occult hypoxemia in the Spo2 range of 92 to 100% when compared with self-reported White race/ethnicity. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

BACKGROUND Virtual reality is emerging as an important component of medical education. Although the benefits of virtual reality are apparent, the optimal strategy to orient to or differentiate learners in the virtual space have not been delineated. OBJECTIVE The purpose of this study was to investigate the relationships between demographic variables, social variables, and self-perceived comfort with technology to performance on a standardized non-medical virtual reality experience. METHODS This prospective observational study was performed at the International Meeting on Simulation in Healthcare in January 2022. This conference includes medical and non-medical attendees. Participants provided demographic information and participated in a scored non-medical VR experience. Participants then completed a System Usability Index and NASA Task Load Index form. RESULTS 95 participants were included in final analysis. 55 (57.9%) of participants had prior virtual reality experience. Higher scores were associated with younger age (11.09, p CONCLUSIONS An immersive virtual reality experience was well tolerated and enjoyed by our study population. Performance was most closely related to age and gender. Self-perceived comfort with virtual reality was more predictive of score than prior virtual reality experience. CLINICALTRIAL Not applicable

This communication presents a partial historical summary of some of Iowa State University’s Chemistry Department teaching response to the shift to online course delivery caused by the COVID-19 pandemic. The observations reflect discussions between and informal surveys of an instructor cohort that impacted roughly 1200 undergraduate students. These students were enrolled in general chemistry I, organic chemistry II, inorganic chemistry, quantum mechanics, and chemistry for non-physical-science majors. The paper highlights the challenges faced and describes how faculty and students met them.

Evapotranspiration (ET) from tropical forests serves as a critical moisture source for regional and global climate cycles. However, the magnitude, seasonality, and interannual variability of ET in the Congo Basin remain poorly constrained due to a scarcity of direct observations, despite the Congo being the second-largest river basin in the world and containing a vast region of tropical forest. In this study, we applied a water balance model to an array of remotely sensed and in situ datasets to produce monthly, basin-wide ET estimates spanning April 2002 to November 2016. Data sources include water storage changes estimated from the Gravity Recovery and Climate Experiment (GRACE) satellites, in situ measurements of river discharge, and precipitation from several remotely sensed and gauge-based sources. An optimal precipitation dataset was determined as a weighted average of interpolated data by Nicholson et al. (2018), Climate Hazards InfraRed Precipitation with Station data version 2 (CHIRPS2) , and the Precipitation Estimation from Remotely Sensed Information using Artificial Neural Networks–Climate Data Record product (PERSIANN-CDR), with the relative weights based on the error magnitudes of each dataset as determined by triple collocation. The resulting water-balance-derived ET (ETwb) features a long-term average that is consistent with previous studies (117.2±3.5 cm yr−1) but displays greater seasonal and interannual variability than seven global ET products. The seasonal cycle of ETwb generally tracks that of precipitation over the basin, with the exception that ETwb is greater in March–April–May (MAM) than in the relatively wetter September–October–November (SON) periods. This pattern appears to be driven by seasonal variations in the diffuse photosynthetically active radiation (PAR) fraction, net radiation (Rn), and soil water availability. From 2002 to 2016, Rn, PAR, and vapor-pressure deficit (VPD) all increased significantly within the Congo Basin; however, no corresponding trend occurred in ETwb. We hypothesize that the stability of ETwb over the study period despite sunnier and less humid conditions may be due to increasing atmospheric CO2 concentrations that offset the impacts of rising VPD and irradiance on stomatal water use efficiency (WUE).

The current COVID-19 pandemic has produced numerous innovations in personal protective equipment, barrier devices, and infection mitigation strategies, which have not been validated. During high-risk procedures such as airway manipulation, coughs are common and discrete events that may expose healthcare workers to large amounts of viral particles. A simulated cough under controlled circumstances can rapidly test novel devices and protocols and thus aid in their evaluation and the development of implementation guidelines. Physiologic cough simulators exist but require significant expertise and specialized equipment not available to most clinicians.Using components commonly found in healthcare settings, a cough simulator was designed for clinicians to easily assemble and use. Both droplet and aerosol particle generators were incorporated into a bimodal experimental system. High-speed flash photography was used for data collection.Using a gas flow analyzer, video recordings, and high-speed digital photography, the cough and particle simulators were quantitatively and qualitatively compared with known physiologic cough parameters and in vivo Schlieren imaging of human coughs.Based on our validation studies, this cough and particle simulator model approximates a physiologic, human cough in the context of testing personal protective equipment, barrier devices, and infection prevention measures.

Human brucellosis can be caused by different Brucella spp. When conducting operations in a country with high rates of brucellosis, extra precautions should be taken. Appropriate personal protective measures should be used in situations when close contact with animal carcasses cannot be avoided. Clinical diagnosis, treatment, and prevention are discussed.

Leishmaniasis is a parasitic infection that can involve the skin, mucosal membranes, and internal organs. Soldiers are at highrisk of leishmaniasis when conducting operations in endemic regions. Medical providers should have a low threshold to consider Leishmaniasis as the cause of persisting skin lesions.

Leptospirosis is caused by an infection with bacteria of the Leptospira species. These spirochetes are carried by a variety of wild and domestic animals. Humans can become infected with these bacteria; leptospirosis most commonly occurs in the tropics and subtropics. Military personnel are at risk of infection through deployment in the field.

Recent studies from the Hawaiian Islands showed that pedogenic thresholds demarcate domains in which rock-derived nutrient dynamics remain similar across wide variations in rainfall. These thresholds appear related to certain aspects of N cycling, but the degree to which they correspond to patterns of biological N fixation (BNF)-the dominant input of N into less-managed ecosystems-remains unclear. We measured aboveground plant biomass, foliar nutrient concentrations, and foliar δ

Native forests on islands throughout the global tropics face increasing pressure from the human-driven expansion of coconut palm (Cocos nucifera) planted for the purposes of coconut oil harvest. Co...

Measles is a significant concern with approximately 10 million people infected annually causing over 100,000 deaths worldwide. In the US before use of the measles vaccine, there were estimated to be 3 to 4 million people infected with measles annually, causing 400 to 500 deaths. Complications of measles include otitis media, diarrhea, pneumonia, and acute encephalitis. Measles is a leading cause of blindness in the developing world, especially in those who are vitamin A deficient. Malnourished children with measles are also at higher risk of developing noma (or cancrum oris), a rapidly progressive gangrenous infection of the mouth and face. Most deaths due to measles are caused by pneumonia, diarrhea, or neurological complications in young children, severely malnourished or immunocompromised individuals, and pregnant women. A rare sequela of measles is subacute sclerosing panencephalitis.

Evapotranspiration (ET) from tropical forests serves as a critical moisture source for regional and global climate cycles. However, the magnitude, seasonality, and interannual variability of ET in the Congo Basin remain poorly constrained due to a scarcity of direct observations, despite it being the second-largest river basin the world and containing a vast region of tropical forest. In this study, we applied a water balance model to an array of remotely-sensed and in-situ datasets to produce monthly, basin-wide ET estimates spanning April 2002 to November 2016. Data sources include water storage changes estimated from the Gravity Recover and Climate Experiment (GRACE) satellites, in-situ measurements of river discharge, and precipitation from several remotely sensed sources. An optimal precipitation dataset was determined as a weighted average of interpolated data by Nicholson et al. (2018), Climate Hazards Infrared Precipitation with Station Version 2 (CHIRPS2) data, and the Precipitation Estimation from Remotely Sensed Information using Artificial Neural Networks−Climate Data Record product (PERSIANN−CDR), with the relative weights based on the error magnitudes in each dataset as determined by triple collocation. The resulting water balance-derived ET (ETwb) features a long-term average that is consistent with previous studies (117.2 ± 3.5 cm/year), but displays greater seasonal and interannual variability than six global ET products. The seasonal cycle of ETwb generally tracks that of precipitation over the basin, with the exception that ETwb is greater in March–April–May (MAM) than in the relatively wetter September–October–November (SON) periods. This pattern appears to be driven by seasonal variations in diffuse photosynthetically-active radiation (PAR) fraction, net radiation (Rn), and soil water availability. From 2002–2016, Rn, PAR, and vapor-pressure deficit (VPD) all increase significantly within the Congo Basin; however, no corresponding trend occurred in ETwb. We hypothesize that the stability of ETwb over the study period despite sunnier and less humid conditions is likely due to increasing atmospheric CO2 concentrations that offset the impacts of rising VPD and irradiance on stomatal water use efficiency (WUE).

The genus Scolopendra includes large centipedes that inhabit tropical regions of Southeast Asia and the Pacific Islands as well as South America and the Southwestern US. They are capable of inflicting a clinically significant venomous bite. These multilegged arthropods may enter tents or buildings at night in search of prey and tend to hide in bedding and clothing. Presentation and management are discussed.

Hawaii has one of the highest incidences of Campylobacteriosis in the United States, but there remains little published data on circulating strains or antimicrobial resistance. We characterized 110 clinical Campylobacter isolates (106 C. jejuni, 4 C. coli) processed at Tripler Army Medical Center in Honolulu, HI from 2012–2016. Twenty-five percent of C. jejuni isolates exhibited fluoroquinolone (FQ) resistance, compared with 16% for tetracycline (TET), and 0% for macrolides. Two of the four C. coli isolates were resistant to FQ, TET, and macrolides. C. jejuni isolates further underwent multilocus sequence typing, pulsed-field gel electrophoresis, and molecular capsular typing. Nineteen capsule types were observed, with two capsule types (HS2 and HS9) being associated with FQ resistance (p

The development of location-aware technologies, such as smartphones, raises serious questions regarding locational privacy and the ethical use of geographic data. The degree to which these concepts are taught in undergraduate geographic information science (GISci) courses is unknown. A survey of GISci educators shows that issues of privacy and ethics are important in a GISci education. However, a large proportion of GISci educators are not concerned about the loss of locational privacy and many do not devote classes to the subject. Those not teaching the subject cite lack of course time and the need for more information.

Scrub typhus, also known as tsutsugamushi disease, is caused by Orientia sp. and approximately 1 million new cases are reported annually. This article discusses the importance of scrub typhus and its clinical presentation, diagnosis, treatment, and prevention.

Eleven new compounds, R Ni2Cd20 (R=Y, La–Nd, Sm, Gd, Tb) and R Pd2Cd20 (R=Ce, Pr, Sm), were grown as single crystals in high temperature cadmium-rich solutions. They crystallize in the cubic CeCr2Al20-type structure ( Fd 3 ¯ m , Z=8) as characterized by measurements of powder X-ray diffraction. Electrical resistivity, magnetization, and specific heat measurements were performed on R Ni2Cd20 (R=Y, La–Nd, Sm, Gd, Tb) single crystals. Whereas YNi2Cd20 and LaNi2Cd20 exhibit unremarkable metallic behavior, when magnetic moments from localized 4f electron states (Gd3+–Tb3+) are embedded into this host, they exhibit ferromagnetic order with values of the Curie temperature TC for R Ni2Cd20 (R=Gd, and Tb) which scale with the de Gennes factor.

Electrical resistivity, specific heat, and magnetization measurements on the URuOsSi system suggest a phase transition from the ‘hidden order’ phase to another unidentified phase that is likely to be a large moment antiferromagnetic phase. It is noteworthy that the hidden order/large moment antiferromagnetic phase boundary is enhanced from 17.5 K at = 0 to 50 K at = 1. However, as increases, the gap opening in the Fermi surface due to the hidden order phase transition, deduced from electrical resistivity and specific heat measurements, decreases. This study reveals that both Fe and Os isoelectronic substitutions for Ru in URuSi yield an enhancement of . In contrast to the URuFeSi system, where the unit cell volume decreases with , in the URuOsSi system, the unit cell volume increases with . Thus the enhancement of the hidden order/large moment antiferromagnetic transition temperature cannot be solely due to an increase in chemical pressure.

The Geneva Conventions stipulate that an occupying power must ensure adequate health care delivery to noncombatants. Special emphasis is given to children, who are among the most vulnerable in a conflict zone. Whether short-term pediatric care should be provided by Military Treatment Facilities to local nationals for conditions other than combat-related injury is controversial. A review of 1,197 children without traumatic injury cared for during 10 years in Iraq and Afghanistan was conducted. Mortality rates were less than 1% among patients with surgical conditions and resource utilization was not excessive. In view of international humanitarian law and these outcomes, children with nontraumatic conditions can and should be considered for treatment at Military Treatment Facilities. The ability to correct the condition and availability of resources necessary to do so should be taken into account.