Clinical Features and Treatment Outcomes of Carbapenem-Resistant Pseudomonas aeruginosa Keratitis.

Importance: Evaluation of the microbiological diagnostic profile of multidrug-resistant Pseudomonas aeruginosa keratitis and potential management with rose bengal-photodynamic antimicrobial therapy (RB-PDAT) is important. Objective: To document the disease progression of carbapenemase-resistant P aeruginosa keratitis after an artificial tear contamination outbreak. Design, Setting, and Participants: This retrospective observation case series included 9 patients 40 years or older who presented at Bascom Palmer Eye Institute and had positive test results for multidrug-resistant P aeruginosa keratitis between January 1, 2022, and October 31, 2023. Main Outcomes and Measures: Evaluation of type III secretion phenotype, carbapenemase-resistance genes blaGES and blaVIM susceptibility to antibiotics, and in vitro and in vivo outcomes of RB-PDAT against multidrug-resistant P aeruginosa keratitis. Results: Among the 9 patients included in the analysis (5 women and 4 men; mean [SD] age, 73.4 [14.0] years), all samples tested positive for exoU and carbapenemase-resistant blaVIM and blaGES genes. Additionally, isolates were resistant to carbapenems as indicated by minimum inhibitory concentration testing. In vitro efficacy of RB-PDAT indicated its potential application for treating recalcitrant cases. These cases highlight the rapid progression and challenging management of multidrug-resistant P aeruginosa. Two patients were treated with RB-PDAT as an adjuvant to antibiotic therapy and had improved visual outcomes. Conclusions and Relevance: This case series highlights the concerning progression in resistance and virulence of P aeruginosa and emphasizes the need to explore alternative therapies like RB-PDAT that have broad coverage and no known antibiotic resistance. The findings support further investigation into the potential effects of RB-PDAT for other multidrug-resistant microbes.

Review and analysis of history and utilization of pneumatic retinopexy after pneumatic retinopexy versus vitrectomy for the management of primary rhegmatogenous retinal detachment outcomes randomized trial (PIVOT).

PURPOSE OF REVIEW: We describe the history and series results of pneumatic retinopexy (PnR)and provide an analysis of PnR utilization after publication of results of pneumatic retinopexy versus vitrectomy for the management of primary rhegmatogenous retinal detachment outcomes randomized trial (PIVOT). RECENT FINDINGS: No significant trends were found for average number of services ( P  = 0.153) of PnR after the publication of PIVOT results. SUMMARY: PnR is a rhegmatogenous retinal detachment (RRD) repair technique that was first described in the early 1900 s and has evolved over time to become a modern-day, minimally invasive, underutilized treatment option. Other repair techniques for RRD include scleral buckling and pars plana vitrectomy (PPV), which has been compared to the use of PnR in PIVOT. Results of PIVOT concluded that PnR offered superior visual acuity and noninferiority. PnR is underutilized in the United States even after publication of results of PIVOT deemed it a noninferior treatment. Lack of a significant increase in national utilization of PnR could be associated with multifactorial clinician, systems, and financial reasons in the real-world setting.

Prevalence of Visual Impairment and Availability of Eye Care Providers in Florida.

PURPOSE: To determine the association between prevalence of visual impairment (VI) and density of eye care providers in Florida counties. DESIGN: Cross-sectional study. METHODS: Population-based study included ophthalmologist members of the American Academy of Ophthalmology, licensed optometrists, and respondents of the 2015-2020 American Community Survey (ACS) administered by the US Census Bureau. The number of ophthalmologists collected from the American Academy of Ophthalmology member directory and the number of optometrists collected from the Florida Department of Health License registry were compared with prevalence of VI in each county as reported by ACS 2020 5-year estimates. Median age, mean income, race, and percent uninsured of each county were collected from ACS 2020 5-year estimates. Main outcome measures included the number of eye care providers and prevalence of VI per Florida county. RESULTS: Eye care provider density and mean income of each county were negatively correlated with VI prevalence. Counties with zero eye care providers had significantly higher prevalence of VI per 100 000 residents than those with at least 1 eye care provider. While adjusting for mean income, for every increase in 1 eye care provider per 100 000 people, there was an expected decrease in VI prevalence by 31.15 ± 14.58 people per 100 000 residents. For every increase in mean county income by $1000, there was an expected mean ± SE decrease in prevalence of VI by 24.02 ± 9.90 people per 100 000 people. CONCLUSIONS: Increased eye care provider density and mean county income are associated with lower prevalence of VI in Florida counties. Further studies may elucidate the cause for this relationship and solutions to decrease VI prevalence.

A Contemporary Review of Barriers and Methods to Fostering Academic Urologists.

Urology has shown a gradual decrease in the number of graduating residents who plan to pursue a career in academic medicine. Our objective was to identify barriers to academic urology, present options to mitigate those barriers, and explore strategic ways to encourage trainees to seek careers in academic urology. The authors performed a contemporary review of relevant articles through PubMed assessing prior survey studies, editorials, and expert opinion articles that evaluated academic urology, perceptions of academic medicine, physician burnout, and barriers that have been identified to pursuing careers in academic medicine. Selected articles were then independently reviewed by three authors for relevance and application of factors mitigating perceived barriers to pursuing a career in academic medicine, specifically academic urology. Barriers at the academic levels of medical school and residency were found to consist of the following: lack of exposure to research early in their medical careers, inadequate mentorship, all-specialty leading levels of burnout, current average levels of medical school indebtedness contrasted to perceptions of pay disparity when compared to private practice urologists' income, and perceptions of difficulty in maintaining the academic "triple threat." More acutely, the decision to make Step 1 a pass/fail exam, with the addition of historically low match rates in urology, have resulted in additional complications and concerns for aspiring academic urologists. There are clear barriers that graduating urology residents encounter when considering a career in academic medicine. In this review, we present possible mitigating factors that may be instituted at the individual, medical school, and postgraduate levels to increase the number of practicing academics.

Identification of urban drinking water supply patterns across 627 cities in China based on supervised and unsupervised statistical learning.

Urbanization, one of the predominant trends of the 21st century, places great stress on urban water supply networks. This paper aimed to identify the most important variables driving urban water supply patterns in China, a region which has seen rapid urban growth in the last few decades. In addition, a principal component analysis-informed urban water sustainability index was developed in order to benchmark cities. The research involved applying statistical learning and other analytical methods to 12 years of urban water supply data for 627 cities across China. The findings were as follows: (1) PCA showed that approximately 46.8% of variability in the data could be explained by two principal components. Component 1 (37.26%) was more closely associated with variables related to water supply and sale, supply pipelines, and water supply finance. C2 (9.51%) was clearly related to urban water prices and average per capita water use. (2) Random forest and XGBoost algorithms were effective in classifying cities according to their region, with model testing accuracies of 87.69% and 88.32% respectively. (3) Chinese cities have consistently suffered water loss/leakage rates above 20% since 2001, and water prices are closely associated with leakage. (4) China's urban water sustainability has increased by just 3.56% between 2001 and 2013; Southwest China saw the highest growth rate in urban water supply sustainability. The implications of our research effort will be useful for decision makers in water-stressed urban areas around the world who are seeking novel insights in how to leverage statistical learning techniques to gain insights into urban drinking water supply patterns.