W.K. Kellogg Foundation

Human T-lymphotropic virus (HTLV), cytomegalovirus (CMV), and Epstein-Barr virus (EBV) each have the propensity for infection as well as the development of latency in humans. As many ocular tissue report forms provided by Eye Bank Association of America (EBAA) member eye banks list serological testing results for these viruses, the EBAA Policy and Position Review Subcommittee (PPRS) sought to investigate and clarify the implications of these results. Current EBAA policies regarding HTLV, CMV, and EBV were reviewed. Additionally, a search of articles written in or translated into the English language regarding the aforementioned viruses with a focus on ocular infection and ocular tissue transplantation was performed on PubMed. Current EBAA policies indicate that ocular tissues from donors with seropositivity to HTLV, CMV, and/or EBV can be used for transplantation. The risk of transmission of HTLV was felt to be the most consequential, given its low seroprevalence and its association with adult T-cell lymphoma/leukemia. However, as corneal and limbal tissue are not leukocyte-rich, the risk of transmitting HTLV is low. Despite reports of the isolation of all 3 viruses in ocular tissues, a literature review did not reveal any reported cases of viral transmission through ocular tissue transplantation. Ocular tissues from donors with seropositivity to HTLV, CMV, and/or EBV can be used for transplantation per current EBAA guidelines. Despite the potential for ocular infection by these viruses, there are no reported cases of viral transmission from ocular tissue transplantation, affirming the validity of the current EBAA guidelines.

ABSTRACT Purpose A knowledge gap persists regarding the utilization of corneal transplant surgery among enrollees in Affordable Care Act (ACA) plans and the factors influencing associated costs and complications post-ACA implementation. This study investigates the demographics, costs, and complications of cornea transplant for patients insured under the ACA from 2015 to 2019. Methods A novel claims dataset of Affordable Care Act (ACA) marketplace plan subscribers was utilized. Multivariable logistic and linear regression models were used to assess demographics, cost, and complication rates of corneal transplant using demographic/clinical data and insurance plan type. Results Among 26,997,610 enrollees, 0.005% (n = 1266) underwent cornea transplant. About 32.9% (n = 416) of patients experienced a postoperative complication, the most common being corneal transplant failure (15.6%) and infectious keratitis (11.5%). Insurance plan type was not associated with rate of postoperative complications (p = 0.87). Patients with different plan types incurred significantly different out-of-pocket (OOP) cost (p < 0.001), with patients on Silver cost-sharing reduction plans paying the lowest ($4). Conclusion This study is the first to assess the demographics, costs, and complications of corneal transplant patients within the ACA population. Our findings suggest that patients with higher cost-sharing subsidies experience lower OOP costs and may be more inclined to pursue corneal transplant than those on lower actuarial value plans.

ABSTRACT Gravity‐equation estimates of the elasticity of trade with respect to bilateral trade costs – or of coefficient estimates of binary variables for the presence or absence of economic integration agreements (EIAs) – are central to determining quantitatively economic welfare impacts of trade‐policy liberalizations. Despite decades of study, trade economists have largely focused on conditional mean estimates of a (constant) trade elasticity or of an EIA dummy variable's (common) effect in a “gravity‐equation” specification. In this paper, we provide a novel panel‐data quantile regression approach to estimating EIAs' partial effects across (conditional) quantiles that avoids Jensen's Inequality, avoids the incidental parameters problem associated with three‐way fixed effects, and allows zeros. To motivate the potential economic usefulness of our approach, we examine two distinct “cases.” First, using quantile regressions across a broad swath of country‐pairs and EIAs at the disaggregated trade‐flow level, we provide systematic evidence that supports the Arkolakis (2010) proposition; trade‐flow growth effects of any type of EIA are larger for goods with lower initial sales. Second, we show that the partial effects of EIAs on trade flows are considerably larger for developing countries' exporters across quantiles.

A next-generation medium-energy gamma-ray telescope targeting the MeV range would address open questions in astrophysics regarding how extreme conditions accelerate cosmic-ray particles, produce relativistic jet outflows, and more. One concept, AMEGO-X, relies upon the mission-enabling CMOS Monolithic Active Pixel Sensor silicon chip AstroPix. AstroPix is designed for space-based use, featuring low noise, low power consumption, and high scalability. Desired performance of the device include an energy resolution of 5 keV (or 10% FWHM) at 122 keV and a dynamic range per-pixel of 25-700 keV, enabled by the addition of a high-voltage bias to each pixel which supports a depletion depth of 500 um. This work reports on the status of the AstroPix development process with emphasis on the current version under test, version three (v3), and highlights of version two (v2). Version 3 achieves energy resolution of 10.4 +/- 3.2% at 59.5 keV and 94 +/- 6 um depletion in a low-resistivity test silicon substrate.

Anthropogenic climate warming affects plant communities by changing community structure and function. Studies on climate warming have primarily focused on individual effects of warming, but the interactive effects of warming with biotic factors could be at least as important in community responses to climate change. In addition, climate change experiments spanning multiple years are necessary to capture interannual variability and detect the influence of these effects within ecological communities. Our study explores the individual and interactive effects of warming and insect herbivory on plant traits and community responses within a 7-year warming and herbivory manipulation experiment in two early successional plant communities in Michigan, USA. We find stronger support for the individual effects of both warming and herbivory on multiple plant morphological and phenological traits; only the timing of plant green-up and seed set demonstrated an interactive effect between warming and herbivory. With herbivory, warming advanced green-up, but with reduced herbivory, there was no significant effect of warming. In contrast, warming increased plant biomass, but the effect of warming on biomass did not depend upon the level of insect herbivores. We found that these treatments had stronger effects in some years than others, highlighting the need for multiyear experiments. This study demonstrates that warming and herbivory can have strong direct effects on plant communities, but that their interactive effects are limited in these early successional systems. Because the strength and direction of these effects can vary by ecological context, it is still advisable to include levels of biotic interactions, multiple traits and years, and community type when studying climate change effects on plants and their communities.

About one-fourth of survey respondents from an ASCRS database initiate treatment for primary open angle glaucoma (POAG) with laser trabeculoplasty. Factors impacting physicians' choice of laser versus topical treatment for POAG were explored. To characterize primary treatment preferences (topical medication versus laser trabeculoplasty or intracameral sustained release implants) in primary open angle glaucoma (POAG) patients and determine factors related to primary intervention selection. A 33-question survey was distributed to an American Society of Cataract and Refractive Surgery database on treatment choices made by ophthalmologists for POAG. Data collected included country of practice, years of practice, completion of glaucoma fellowship training, type of practice, and preference for the first line of treatment for POAG. Multiple logit regression was used to compare the effect of covariates on physicians' choice of either topical medication or laser trabeculoplasty for POAG. A total of 252 of 19,246 (1.3%) surveys were returned. Almost three-quarters of respondents used topical medication as the first line of treatment for POAG (73.6%), whereas 26.4% preferred to start with laser treatment. Significant variables associated with the selection of laser (vs. drops) are practicing in the United States (odds ratio [OR] 2.85; 95% CI, 1.33-6.10), the more recent completion of ophthalmology residency (OR 1.95; 95% CI, 1.00-3.77), the greater volume of minimally invasive glaucoma surgeries (MIGS) (OR 1.68; 95% CI, 1.18-2.40), and a glaucoma patient base greater than 25% (OR 2.21; 95% CI, 1.09-4.48). For the first-line treatment of POAG, laser trabeculoplasty is more likely to be preferred, over topical drops, by U.S. physicians who are relatively new in practice, who have a larger glaucoma patient base, and who perform more MIGS.