The Diagnostic Accuracy of First-Year Ophthalmology Residents on Call: Considerations for Postgraduate Year 2 (PGY-2) Standardizations of Call Structure.

Background Ophthalmology is a unique specialty with limited exposure during medical school. To improve the transition to ophthalmology residency, the Accreditation Council for Graduate Medical Education (ACGME) announced in 2017 that all ophthalmology residency programs would move to a combined post-graduate year (PGY) 1 year with mandatory integration by 2023. Currently, there are no standardized guidelines from the American Board of Ophthalmology (ABO) or the Accreditation Council for Graduate Medical Education (ACGME) to address ophthalmology resident competence prior to becoming the primary contact for inpatient and emergency room (ER) consultations as a PGY-2. Novice residents may not be equipped to accurately diagnose vision or life-threatening ocular conditions. A balance between resident autonomy and supervision is required for proper training without increasing patient morbidity and mortality. Objective This study's objective is to examine the diagnostic accuracy of PGY-2 ophthalmology non-integrated residents on call to standardize supervision requirements (through buddy-call) prior to initiating indirectly supervised calls. Methods All inpatient and ER ophthalmology consults for the first seven weeks of the year evaluated by PGY-2 (junior) residents were supervised and graded as "correct" or "incorrect" by PGY-4 (senior) residents. Results One hundred forty-eight consults were seen over 30 call days over a period of seven weeks (4.93 consults per call). The percentage of correct diagnoses increased with each successive week (R2 = 0.9581; correlation = 0.979). The greatest percent increase of correctly diagnosed encounters was between weeks 2 and 3 (19.14%) correlating to call numbers 10-16 and 45-68 patient encounters. The mean percent accuracy surpassed 70% during weeks 3-4, and improvement continued to week 7. High-acuity diagnoses were identified consistently 100% of the time from week 5 onward. Conclusion Our analysis indicated that diagnostic accuracy was greater than 70% between weeks 3 and 4 with high-acuity diagnostic accuracy reaching 100% at week 5. It can be postulated that optimal direct senior resident supervision is needed for at least 3-5 weeks before transitioning to indirectly supervised calls by PGY-2 residents. This standardization would allow junior residents to acquire sufficient clinical experience to accurately make a diagnosis and prevent patient morbidity. Further research nationally is necessary prior to creating a standardized call structure for PGY-2 residents especially with the newly mandatory integrated ophthalmology residency programs.

High-performance superconducting quantum processors via laser annealing of transmon qubits.

Scaling the number of qubits while maintaining high-fidelity quantum gates remains a key challenge for quantum computing. Presently, superconducting quantum processors with >50 qubits are actively available. For these systems, fixed-frequency transmons are attractive because of their long coherence and noise immunity. However, scaling fixed-frequency architectures proves challenging because of precise relative frequency requirements. Here, we use laser annealing to selectively tune transmon qubits into desired frequency patterns. Statistics over hundreds of annealed qubits demonstrate an empirical tuning precision of 18.5 MHz, with no measurable impact on qubit coherence. We quantify gate error statistics on a tuned 65-qubit processor, with median two-qubit gate fidelity of 98.7%. Baseline tuning statistics yield a frequency-equivalent resistance precision of 4.7 MHz, sufficient for high-yield scaling beyond 103 qubit levels. Moving forward, we anticipate selective laser annealing to play a central role in scaling fixed-frequency architectures.

Time-resolved HO2 detection with Faraday rotation spectroscopy in a photolysis reactor.

Faraday rotation spectroscopy (FRS) employs the Faraday effect to detect Zeeman splitting in the presence of a magnetic field. In this article, we present system design and implementation of radical sensing in a photolysis reactor using FRS. High sensitivity (100 ppb) and time resolved in situ HO2 detection is enabled with a digitally balanced acquisition scheme. Specific advantages of employing FRS for sensing in such dynamic environments are examined and rigorously compared to the more established conventional laser absorption spectroscopy (LAS). Experimental results show that FRS enables HO2 detection when LAS is deficient, and FRS compares favorably in terms of precision when LAS is applicable. The immunity of FRS to spectral interferences such as absorption of hydrocarbons and other diamagnetic species absorption and optical fringing are highlighted in comparison to LAS.

Dynamic computational optical fringe mitigation in tunable laser absorption spectroscopy.

In optical spectroscopic systems where unwanted optical scattering cannot be eliminated, Fabry-Pérot etalons cause unpredictable changes in the spectral background. Frequent system calibration is then required to maintain the desired measurement accuracy, which presents a major limitation to the spectrometer. We introduce a computational approach to mitigate the adverse effects of optical fringing without hardware modifications. Motivated by experimental observations of complicated fringe behaviors, we simplify the problem by decomposing the fringe background into component etalons that can be addressed according to their individual characteristics. The effectiveness of the proposed method is demonstrated on a silicon photonic methane sensor, where accurate measurements of methane concentration are obtained from spectral data strongly affected by optical fringes.

Structural and biochemical analysis of phosphoethanolamine methyltransferase from the pine wilt nematode Bursaphelenchus xylophilus.

In free-living and parasitic nematodes, the methylation of phosphoethanolamine to phosphocholine provides a key metabolite to sustain phospholipid biosynthesis for growth and development. Because the phosphoethanolamine methyltransferases (PMT) of nematodes are essential for normal growth and development, these enzymes are potential targets of inhibitor design. The pine wilt nematode (Bursaphelenchus xylophilus) causes extensive damage to trees used for lumber and paper in Asia. As a first step toward testing BxPMT1 as a potential nematicide target, we determined the 2.05 Å resolution x-ray crystal structure of the enzyme as a dead-end complex with phosphoethanolamine and S-adenosylhomocysteine. The three-dimensional structure of BxPMT1 served as a template for site-directed mutagenesis to probe the contribution of active site residues to catalysis and phosphoethanolamine binding using steady-state kinetic analysis. Biochemical analysis of the mutants identifies key residues on the ß1d-α6 loop (W123F, M126I, and Y127F) and ß1e-α7 loop (S155A, S160A, H170A, T178V, and Y180F) that form the phosphobase binding site and suggest that Tyr127 facilitates the methylation reaction in BxPMT1.

Adaptive thermal stabilization of an integrated photonic spectrometer using parasitic interference fringes.

Parasitic fringe drift from unwanted scatterings limits the long-term stability of waveguide-based optical spectrometers. Yet their spectral features provide relevant information that can be used to improve performance of the spectrometer. We show that fringe drift can be extracted and utilized to perform accurate thermal stabilization, especially in the case of integrated waveguide sensors. In this Letter, effective stabilization of a methane silicon photonic sensor is demonstrated, and significant reduction in fringe noise is clearly observed.

Field Deployment of a Portable Optical Spectrometer for Methane Fugitive Emissions Monitoring on Oil and Gas Well Pads.

We present field deployment results of a portable optical absorption spectrometer for localization and quantification of fugitive methane (CH4) emissions. Our near-infrared sensor targets the 2ν3 R(4) CH4 transition at 6057.1 cm-1 (1651 nm) via line-scanned tunable diode-laser absorption spectroscopy (TDLAS), with Allan deviation analysis yielding a normalized 2.0 ppmv∙Hz-1/2 sensitivity (4.5 × 10-6 Hz-1/2 noise-equivalent absorption) over 5 cm open-path length. Controlled CH4 leak experiments are performed at the METEC CSU engineering facility, where concurrent deployment of our TDLAS and a customized volatile organic compound (VOC) sensor demonstrates good linear correlation (R2 = 0.74) over high-flow (>60 SCFH) CH4 releases spanning 4.4 h. In conjunction with simultaneous wind velocity measurements, the leak angle-of-arrival (AOA) is ascertained via correlation of CH4 concentration and wind angle, demonstrating the efficacy of single-sensor line-of-sight (LOS) determination of leak sources. Source magnitude estimation based on a Gaussian plume model is demonstrated, with good correspondence (R2 = 0.74) between calculated and measured release rates.

Hybrid Faraday rotation spectrometer for sub-ppm detection of atmospheric O2.

Faraday rotation spectroscopy (FRS) of O(2) is performed at atmospheric conditions using a DFB diode laser and permanent rare-earth magnets. Polarization rotation is detected with a hybrid-FRS detection method that combines the advantages of two conventional approaches: balanced optical-detection and conventional FRS with an optimized analyzer offset angle for maximum sensitivity enhancement. A measurement precision of 0.6 ppmv·Hz(-1/2) for atmospheric O(2) has been achieved. The theoretical model of hybrid detection is described, and the calculated detection limits are in excellent agreement with experimental values.

Hydrofluoric acid flow etching of low-loss subwavelength-diameter biconical fiber tapers.

An etch method based on surface tension driven flows of hydrofluoric acid microdroplets for the fabrication of low-loss, subwavelength-diameter biconical fiber tapers is presented. Tapers with losses less than 0.1 dB/mm are demonstrated, corresponding to an order of magnitude increase in the optical transmission over previous acid-etch techniques. The etch method produces adiabatic taper transitions with minimal surface corrugations. A biconical fiber taper fabricated using this method is used to demonstrate an erbium doped silica microsphere laser.

High-speed laser modulation beyond the relaxation resonance frequency limit.

We propose and show that for coupling modulated lasers (CMLs), in which the output coupler is modulated rather than the pump rate, the conventional relaxation resonance frequency limit to the laser modulation bandwidth can be circumvented. The modulation response is limited only by the coupler. Although CMLs are best suited to microcavities, as a proof-of-principle, a coupling-modulated erbium-doped fiber laser is modulated at 1 Gb/s, over 10000 times its relaxation resonance frequency.