Dupilumab-associated ocular surface disease : an interdisciplinary decision framework for prescribers in the Australian setting

Background/Objectives: Dupilumab-associated ocular surface disease (DAOSD) is of particular relevance in patients with atopic dermatitis (AD). Guidance on DAOSD assessment and management in the Australian setting is needed to reduce its impact and minimise disruption to treatment. Methods: A systematic review of the literature was undertaken to identify data pertaining to the incidence, pathophysiology, risk factors and management of DAOSD. A critical review of this literature was used to inform a decision framework for dupilumab-prescribers and develop a graded severity scoring tool to guide appropriate management options. Results: DAOSD typically emerges within 4 months of commencing dupilumab and the occurrence of new events diminishes over time. The reported incidence varies widely depending on the nature and source of the data: 8.6–22.1% (clinical trials programme), 0.5–70% (real-world data; differences in study size, duration of follow-up, ophthalmologist intervention, use of prophylaxis). Occurrence increases with AD severity and in patients with prior history of ocular disease; pathophysiology is still to be fully characterised. Management options have evolved over time and include lubricants/artificial tears, corticosteroids, calcineurin inhibitors, antihistamines, anti-inflammatory agents and antimicrobial agents. Current therapies aim to resolve symptoms or reduce severity to levels sufficiently tolerable to enable continuation of dupilumab therapy. Conclusions: Recommendations for DAOSD assessment and management include identification of high-risk patients, vigilance for red flags (keratoconus, herpetic and bacterial keratitis), regular assessment of symptom severity (before and during dupilumab therapy), conservative management of mild DAOSD by the prescribing physician and ophthalmologist referral for collaborative care of moderate–severe DAOSD and high-risk patients

The manifold advantages of articulatory representations, Including microphone and speaker normalization

I'm going to be making two broad points during my talk. The first is that we should do a transformation from speech acoustics to articulator positions as part of our speech processing. The second point I will try to make is that we can do a transformation from speech sounds to articulator positions

Comparison of RFI Mitigation Strategies for Dispersed Pulse Detection

Impulsive radio-frequency signals from astronomical sources are dispersed by the frequency dependent index of refraction of the interstellar media and so appear as chirped signals when they reach earth. Searches for dispersed impulses have been limited by false detections due to radio frequency interference (RFI) and, in some cases, artifacts of the instrumentation. Many authors have discussed techniques to excise or mitigate RFI in searches for fast transients, but comparisons between different approaches are lacking. This work develops RFI mitigation techniques for use in searches for dispersed pulses, employing data recorded in a "Fly's Eye" mode of the Allen Telescope Array as a test case. We gauge the performance of several RFI mitigation techniques by adding dispersed signals to data containing RFI and comparing false alarm rates at the observed signal-to-noise ratios of the added signals. We find that Huber filtering is most effective at removing broadband interferers, while frequency centering is most effective at removing narrow frequency interferers. Neither of these methods is effective over a broad range of interferers. A method that combines Huber filtering and adaptive interference cancellation provides the lowest number of false positives over the interferers considered here. The methods developed here have application to other searches for dispersed pulses in incoherent spectra, especially those involving multiple beam systems.Comment: Accepted for publication in Ap

DAOSD Activity Assessment Questionnaire & Scoring Sheet

Questionnaire and scoring algorithm to aid in the assessment of eye symptom severity and appropriate management of dupilumab-associated ocular surface disease (DAOSD) in patients with moderate-severe atopic dermatitis before and during treatment

Relational autonomy in breast diseases care: a qualitative study of contextual and social conditions of patients’ capacity for decision-making

Abstract Background A relational approach to autonomy refers to the way in which social conditions and relationships shape a person’s self-identity and capacity in decision-making. This article provides an empirical account of how treatment choices for women undergoing breast diseases care are fostered within the dynamics of their relationships with clinicians, family members, and other aspects of their social environment. Methods This qualitative study recruited ten women undergoing treatment at a breast programme, and eight clinicians supporting their care, in a private teaching hospital in New South Wales, Australia. Fourteen patient-clinician consultation observations and 17 semi-structured interviews were conducted. Schema analysis of interview transcripts were undertaken by a team of researchers and corroborated by observational fieldnotes. Results Relational identities of patients influenced the rationale for treatment decision-making. Patients drew on supportive resources from family and medical advice from clinicians to progress with treatment goals. While clinicians held much social power over patients as the medical experts, patients highlighted the need for clinicians to earn their trust through demonstrated professionalism. Information exchange created a communicative space for clinicians and patients to negotiate shared values, promoting greater patient ownership of treatment decisions. As treatment progressed, patients’ personal experiences of illness and treatment became a source of self-reflection, with a transformative impact on self-confidence and assertiveness. Conclusion Patients’ confidence and self-trust can be fostered by opportunities for communicative engagement and self-reflection over the course of treatment in breast disease, and better integration of their self-identity and social values in treatment decisions

Perspectives of people with inherited retinal diseases on ocular gene therapy in Australia: protocol for a national survey

Introduction Voretigene neparvovec-rzyl (Luxturna) was approved by the Australian Therapeutic Goods Administration on 4 August 2020 for the treatment of biallelic mutations in the RPE65 gene, a rare cause of congenital and adult-onset retinal dystrophy (predominantly Leber congenital amaurosis). Previous studies have shown that individuals who might participate in gene therapy trials overestimate clinical effect and underestimate risks. However, little is known about the perspectives of patients who may be offered approved gene therapy treatment for ocular conditions (as distinct from participating in clinical trials of gene therapy). The main objective of this study is to develop a tool to assess knowledge, attitudes and perceptions of approved and future genetic therapies among potential recipients of ocular gene therapy. In addition, we aim to assess the quality of life, attitudes towards clinical trials and vision-related quality of life among this cohort.Methods and analysis A new ‘Attitudes to Gene Therapy for the Eye’ tool will be developed following consultation with people with inherited retinal disease (IRD) and content matter experts. Australians with IRD or their guardians will be asked to complete an internet-based survey comprising existing quality of life and visual function instruments and items for the newly proposed tool. We expect to recruit 500 survey participants from patient support groups, the practices of Australian ophthalmologists who are specialists in IRD and Australian ophthalmic research institutions. Launch is anticipated early 2021. Responses will be analysed using item response theory methodology.Ethics and dissemination This study has received ethics approval from the University of Melbourne (#2057534). The results of the study will be published in a peer-reviewed journal and will be presented at relevant conferences. Organisations involved in recruitment, and the Patient Engagement Advisory committee will assist the research team with dissemination of the study outcomes