Optometrists' attitudes toward using OCT angiography lag behind other retinal imaging types

Purpose: While optometrists' attitudes toward established retinal imaging types are generally positive, they are unknown for optical coherence tomography angiography (OCTA). We performed a cross-sectional survey to estimate attitudes toward OCTA and identify clinician and/or practice characteristics that influence them. Methods: A paper-based survey was mailed to 252 randomly selected optometrists in Australia. Five-point Likert-scale items from a previous survey assessing attitudes toward new technology were included to probe respondent characteristics and attitudes toward retinal imaging. Performance expectancy attitudes toward OCTA were elicited by the statement ‘I believe OCTA is useful in daily practice’. Mean scores out of five (mean [SD]) were rounded and mapped to appropriate descriptive statements. Results: The response rate was 47% (118/252). The mean (SD) age of respondents was 44.0 (13.8) years and 50.8% (60/118) were female. Optometrists had 19.9 (14.0) years of clinical experience and 66.9% (79/118) worked at independent practices. In total, 8.5% (10/118) of respondents used OCTA to provide clinical care. Optometrists agreed that optical coherence tomography (OCT), colour fundus imaging, ultra-wide field imaging and fundus autofluorescence (mean scores 3.6–4.7 out of 5) were useful in daily practice but felt neutral about whether OCTA was useful (3.4 [0.8]). Optometrists believed that OCTA was less enjoyable to use (p < 0.0001), less endorsed by peers (p < 0.0001) and felt less confident that they had the knowledge to interpret OCTA (p < 0.0001) compared to other retinal imaging types. Conclusions: Optometrists are undecided on whether OCTA is useful in daily practice and had lower expectations that using OCTA would confer job performance benefits compared to other retinal imaging types. Further work is needed to advocate the benefits of using OCTA across the profession

Attitudes of optometrists towards artificial intelligence for the diagnosis of retinal disease: A cross-sectional mail-out survey

Purpose: Artificial intelligence (AI)-based systems have demonstrated great potential in improving the diagnostic accuracy of retinal disease but are yet to achieve widespread acceptance in routine clinical practice. Clinician attitudes are known to influence implementation. Therefore, this study aimed to identify optometrists' attitudes towards the use of AI to assist in diagnosing retinal disease. Methods: A paper-based survey was designed to assess general attitudes towards AI in diagnosing retinal disease and motivators/barriers for future use. Two clinical scenarios for using AI were evaluated: (1) at the point of care to obtain a diagnostic recommendation, versus (2) after the consultation to provide a second opinion. Relationships between participant characteristics and attitudes towards AI were explored. The survey was mailed to 252 randomly selected practising optometrists across Australia, with repeat mail-outs to non-respondents. Results: The response rate was 53% (133/252). Respondents' mean (SD) age was 42.7 (13.3) years, and 44.4% (59/133) identified as female, whilst 1.5% (2/133) identified as gender diverse. The mean number of years practising in primary eye care was 18.8 (13.2) years with 64.7% (86/133) working in an independently owned practice. On average, responding optometrists reported positive attitudes (mean score 4.0 out of 5, SD 0.8) towards using AI as a tool to aid the diagnosis of retinal disease, and would be more likely to use AI if it is proven to increase patient access to healthcare (mean score 4.4 out of 5, SD 0.6). Furthermore, optometrists expressed a statistically significant preference for using AI after the consultation to provide a second opinion rather than during the consultation, at the point-of-care (+0.12, p = 0.01). Conclusions: Optometrists have positive attitudes towards the future use of AI as an aid to diagnose retinal disease. Understanding clinician attitudes and preferences for using AI may help maximise its clinical potential and ensure its successful translation into practice

A survey of chronic rhinitis in Hong Kong

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Population-based incidence of community-acquired pneumonia hospitalization in Hong Kong children younger than 5 years before universal conjugate pneumococcal immunization

Objectives: We sought to document the incidence of pediatric hospitalization for bacterial pneumonia before universal childhood conjugate pneumococcal vaccination using two different methods of diagnosis. Methods: By following the World Health Organization (WHO) chest radiography (CXR) protocol, two radiologists independently read the CXRs of a cohort of systematically recruited children younger than 5 years. The children had acute respiratory infections and were admitted to one of two hospitals that care for 72.5% of all pediatric admissions on Hong Kong Island. Medical records were reviewed for clinical manifestation and to identify bacterial pneumonia diagnosed by pediatricians. Results: In children younger than 5 years, the incidences of bacterial pneumonia, as diagnosed by pediatricians and by the WHO CXR standard, were 775.7 per 100,000 population [95% confidence interval (CI, 591.8-998.3)] and 439.5 per 100,000 population (95% CI, 304.6-614.5), respectively. The study period was from 2002 to 2004. Conclusion: This study provided a reliable baseline estimate of the hospitalization burden of pneumococcal pneumonia in Hong Kong children before the advent of universal conjugate pneumococcal vaccination. © 2014

Behavioral characteristics of chinese adolescents with dyslexia: The use of teachers' behavior checklist in Hong Kong

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Population-based hospitalization incidence of respiratory viruses in community-acquired pneumonia in children younger than 5 years of age

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Drusen-aware model for age-related macular degeneration recognition

Introduction: The purpose of this study was to build an automated age-related macular degeneration (AMD) colour fundus photography (CFP) recognition method that incorporates confounders (other ocular diseases) and normal age-related changes by using drusen masks for spatial feature supervision. Methods: A range of clinical sources were used to acquire 7588 CFPs. Contrast limited adaptive histogram equalisation was used for pre-processing. ResNet50 was used as the backbone network, and a spatial attention block was added to integrate prior knowledge of drusen features into the backbone. The evaluation metrics used were sensitivity, specificity and F1 score, which is the harmonic mean of precision and recall (sensitivity) and area under the receiver-operating characteristic (AUC). Fivefold cross-validation was performed, and the results compared with four other methods. Results: Excellent discrimination results were obtained with the algorithm. On the public dataset (n = 6565), the proposed method achieved a mean (SD) sensitivity of 0.54 (0.09), specificity of 0.99 (0.00), F1 score of 0.62 (0.06) and AUC of 0.92 (0.02). On the private dataset (n = 1023), the proposed method achieved a sensitivity of 0.92 (0.02), specificity of 0.98 (0.01), F1 score of 0.92 (0.01) and AUC of 0.98 (0.01). Conclusion: The proposed drusen-aware model outperformed baseline and other vessel feature-based methods in F1 and AUC on the AMD/normal CFP classification task and achieved comparable results on datasets that included other diseases that often confound classification. The method also improved results when a five-category grading protocol was used, thereby reflecting discriminative ability of the algorithm within a real-life clinical setting

Determinants of corporate leverage adjustments: A cross-country analysis

Capital structure literature suggests that firms are very likely to consider target leverage ratios when they issue new capital (Graham & Harvey, 2001). Albeit the dynamic trade-off theory predicts that firms have incentives to move toward target debt ratios by reducing any deviation from those targets (Frank & Goyal, 2009), due to substantial financing frictions, i.e. issuance costs or intermediation costs, firms may decide to temporarily deviate from their target levels. A recent strand of research has investigated significant factors that affect such adjustment costs or firms’ leverage SOA. This thesis consists of three essays that investigate crucial determinants of corporate leverage adjustments: equity liquidity, corporate sustainability performance (CSP), and employment protection laws (EPL). Chapter 1 examines the impact of liquidity on the speed of adjustment (SOA) of corporate leverage at the individual company level. Using a sample of UK firms and data from 35 countries, respectively, over the period from 1996 to 2016, the chapter finds that high-liquidity firms have a significantly faster SOA than less liquid firms. This result survives a series of robustness checks and holds after addressing the endogeneity concern using exogenous shocks and additional control variables. Further analyses imply that the positive effect of liquidity on the SOA exists only for over-levered firms, and this impact is moderated in countries with bankruptcy codes. In the cross-section, the chapter suggests that the positive relationship between liquidity and SOA is more pronounced for firms whose current position is relatively close to its target leverage ratio and whose target ratio is relatively stable. The chapter further shows that the positive equity liquidity-SOA association is less (more) pronounced for firms in strong (weak) institutional environments. The results provide new insights into the role of liquidity in firms’ capital structure decisions and the determinants of capital structure dynamics. Chapter 2 investigates the impact of corporate sustainability performance (CSP) on the speed at which firms adjust their leverage to the target ratios. Using a large sample of 31 countries from 2002 to 2018 with two proxies of CSP, the chapter suggests that firms that invest more in CSP move faster toward their target leverage. In exploring the potential underlying economic mechanisms through which CSP affects leverage adjustments, the chapter shows that superior CSP plays an important role in easing information asymmetry, enhancing stakeholder engagements, pushing up stock prices in the stock market, and improving competitive advantages in the product market of firms. In further analyses, the positive association between CSP and leverage SOA is shown to be less pronounced in countries with high-quality institutions. The results remain statistically and quantitatively unchanged from numerous robustness tests and IV estimates. Overall, this chapter enlightens the crucial role of CSP in shaping the firm’s decisions on dynamic capital structure and provides implications for strategic planning of firms on the optimal choices of CSP investments. Finally, chapter 3 highlights the impact of employment protection laws (EPLs) on the speed of corporate leverage adjustments. By exploiting within-country changes in EPLs across 19 OECD countries, the chapter suggests that firms operating in countries with more stringent EPLs have significantly low leverage adjustment speeds. This association is consistent with the view that stringent EPLs raise firms’ costs of adjustment on target leverage. The result survives several tests addressing the endogeneity concern by instrument variable approach, Rajan and Zingales (1998)’s method, and additional control variables and is robust to a battery of robustness checks. The chapter further demonstrates that the response of leverage adjustment to changes in EPLs is more pronounced in countries with effective legal enforcement. Generally, results of the chapter are consistent with the dynamic trade-off theory of capital structure

Diagnostic accuracy of OCTA and OCT for myopic choroidal neovascularisation: a systematic review and meta-analysis

Background/Objectives: The purpose of this project was to systematically review and meta-analyse studies assessing the diagnostic accuracy of optical coherence tomography angiography (OCTA) and optical coherence tomography (OCT) for myopic choroidal neovascularisation (mCNV). Fluorescein angiography (FA) was accepted as the reference standard. Methods: PUBMED and EMBASE were searched from inception to March 2021 for studies evaluating the test accuracy of OCTA and/or OCT for diagnosing mCNV. The Preferred Reporting Items for Systematic Reviews and Meta-analyses of Diagnostic Test Accuracy Studies guideline was followed, and the Grading of Recommendations, Assessment, Development and Evaluation approach was used to frame clinical recommendations. Pooled estimates of test accuracy were obtained using a bivariate model. Results: Of 410 studies assessed for eligibility, 3 studies were identified that compared OCTA to FA and 3 studies were identified that compared spectral domain (SD) OCT to FA. All studies had at least one major methodological flaw leading to an overall high risk of bias. On meta-analysis, the pooled sensitivity of OCTA was 0.89 (95% CI 0.78–0.94) and pooled specificity was 0.93 (95% CI 0.79–0.98). The pooled sensitivity of SD-OCT was 0.99 (95% CI 0.91–1.00). Due to uncertainty in individual studies, the pooled specificity of SD-OCT could not be estimated. Conclusions: OCTA can reliably diagnose mCNV in clinically suspected patients, however, SD-OCT may not reliably establish a positive diagnosis of mCNV. Future large, prospective studies with improvements in conduct and reporting are needed to strengthen these clinical recommendations

Severe macrolide-resistant Mycoplasma pneumoniae pneumonia associated with macrolide failure

We investigated differences in outcomes between 68 children hospitalized with macrolide-sensitive Mycoplasma pneumoniae pneumonia (MSMP group) and 25 children hospitalized with macrolide-resistant M. pneumoniae pneumonia (MRMP group). In the MRMP group, 19 children received macrolides and clinical failure occurred in six of which five had pneumonia progression during therapy.published_or_final_versio