BACKGROUND:As the digital age progresses, individuals are increasingly seeking online websites for the dissemination of information. YouTube, the most popular free video streaming platform worldwide, garners over 2 billion users. Plastic surgery information is widely available on YouTube and acts as a common interface for the distribution of plastic surgery-related information. This investigation aimed to identify trends in YouTube videos describing common plastic surgery search terms based on narrator gender, channel type, and language patterns. METHODS:Top-ranking videos for six common plastic surgery search terms were queried. Video characteristics and transcripts for each video were extracted. Transcripts were subsequently analyzed using the Linguistic Inquiry and Word Count software. Comparisons were performed using various statistical analysis methods. RESULTS:Significant differences in audience engagement were noted by search topic (p < 0.05). Speakers in plastic surgery videos were predominantly male only (108 [60%]), with notable variation observed across channel type and search topic. Significant differences were found for videos on medical professional channels (p = 0.004) and videos regarding gynecomastia (p < 0.05). Linguistic pattern analysis revealed that female speakers used more authentic (p = 0.01) and emotional (p = 0.012) language than male speakers. CONCLUSION:With YouTube being the most visited online video platform website worldwide, plastic surgeons must understand trends to appropriately tailor their content and maximize their social media reach. Also, while plastic surgery is making strides in the right direction, continued work should be done in promoting adequate representation among online material. NO LEVEL ASSIGNED:This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background:Given the dialogistic properties of ChatGPT, we hypothesized that this artificial intelligence (AI) function can be used as a self-service tool where clinical questions can be directly answered by AI. Our objective was to assess the content, accuracy, and accessibility of AI-generated content regarding common perioperative questions for reduction mammaplasty.Methods:ChatGPT (OpenAI, February Version, San Francisco, Calif.) was used to query 20 common patient concerns that arise in the perioperative period of a reduction mammaplasty. Searches were performed in duplicate for both a general term and a specific clinical question. Query outputs were analyzed both objectively and subjectively. Descriptive statistics, t tests, and chi-square tests were performed where appropriate with a predetermined level of significance of P less than 0.05.Results:From a total of 40 AI-generated outputs, mean word length was 191.8 words. Readability was at the thirteenth grade level. Regarding content, of all query outputs, 97.5% were on the appropriate topic. Medical advice was deemed to be reasonable in 100% of cases. General queries more frequently reported overarching background information, whereas specific queries more frequently reported prescriptive information (P < 0.0001). AI outputs specifically recommended following surgeon provided postoperative instructions in 82.5% of instances.Conclusions:Currently available AI tools, in their nascent form, can provide recommendations for common perioperative questions and concerns for reduction mammaplasty. With further calibration, AI interfaces may serve as a tool for fielding patient queries in the future; however, patients must always retain the ability to bypass technology and be able to contact their surgeon.

Artificial intelligence (AI) language models, like ChatGPT, have gained tremendous popularity and hold immense potential in becoming educational and clinical decision making tools. ChatGPT has successfully passed numerous standardized exams including the United States Medical Licensing Examination Step Examination and the Plastic Surgery Inservice Training Exam (PSITE), demonstrating promise as a flagship educational tool in AI. Since ChatGPT's emergence, other AI models such as Microsoft Bing and Google Bard have materialized. This study aimed to assess and compare the performance of these three AI models on the PSITE.

PurposeTo examine trends in ophthalmic trauma secondary to five major sports (baseball, soccer, tennis, football, basketball) and identify differences between patient characteristics and time period (pre-COVID vs COVID) of injury.MethodsThe National Electronic Injury Surveillance System was queried to extract cases related to the sports of interest from 2011-2020. Entries were analyzed by age, sex, diagnosis, location, and disposition, with narrative descriptions assessed to characterize the mechanism of injury and visual sequelae. National incidence was extrapolated and Pearson's ?2 and Fisher's exact tests were performed.ResultsAmong 98,995 presentations, most involved male (83.5%) and pediatric patients (59.2%). Contusion/abrasion (57.3%) was the predominant diagnosis, with injuries primarily precipitated by contact with a ball (44.9%) and occurring in the recreational setting (49.0%). Visual sequelae were documented in 6.4% of injuries. Patients were commonly treated/examined and released (95.6%). Between sports, significant differences in diagnosis (p < .001), mechanism of injury (p < .001), location (p < .001), visual sequelae (p < .001), and disposition (p = .005) were observed. Stratification by age indicated significant differences in diagnosis, mechanism of injury, and location (all p < .001). Stratification by sex indicated significant differences in the mechanism of injury (p < .001) and visual sequelae (p = .04). Stratification by time period indicated significant differences in diagnosis (p = .002) and mechanism of injury (p = .001).ConclusionThere are notable differences in sports-related ocular injuries by patient characteristic, revealing important considerations for their clinical evaluation and the development of safety guidelines.

The Facial Plastic and Reconstructive Surgery (FPRS) fellowship is a highly competitive post-graduate program for graduates of accredited otolaryngology-head and neck surgery (OHNS) or plastic surgery programs. Since its establishment in 1969, the FPRS fellowship program has trained over 1200 physicians, offering approximately 40 positions annually. 1 Solutions TKISG. Fellowship program description handbook. American Academy of Facial Plastic and Reconstructive Surgery. 〈https://www.aafprs.org/Professionals/Development/Fellowship_Programs/ERF/Fellowship_Programs.aspx〉. Google Scholar Despite its prominence, limited information is available regarding the characteristics of FPRS fellowship program directors (PDs). This report aims to analyze the demographic, educational, and scholarly attributes of FPRS PDs and establish a foundation for future comparative studies in the field.

Renal angiomyolipomas, common benign tumors, can exhibit slow growth in sporadic cases or have aggressive tendencies when linked to genetic conditions like tuberous sclerosis. This case report focuses on the exceptionally rare angiomyolipoma with epithelial cysts (AMLEC) variant, particularly challenging to diagnose due to its scarcity. Describing a 41-year-old woman's case, initially suspected to be renal cell carcinoma during an infertility evaluation, subsequent partial nephrectomy revealed a tumor comprising smooth muscle, blood vessels, and fat, with cystic regions featuring cuboidal linings and a layer devoid of abnormal cell activity. Immunohistochemistry confirmed specific markers within different tumor components, highlighting the diagnostic complexities of AMLEC and emphasizing the crucial role of histopathological examinations in accurate characterizations.

Most cases of optic neuritis (ON) occur in women and in patients between the ages of 15 and 45 years, which represents a key demographic of individuals who seek health information using the internet. As clinical providers strive to ensure patients have accessible information to understand their condition, assessing the standard of online resources is essential. To assess the quality, content, accountability, and readability of online information for optic neuritis. This cross-sectional study analyzed 11 freely available medical sites with information on optic neuritis and used PubMed as a gold standard for comparison. Twelve questions were composed to include the information most relevant to patients, and each website was independently examined by four neuro-ophthalmologists. Readability was analyzed using an online readability tool. Journal of the American Medical Association (JAMA) benchmarks, four criteria designed to assess the quality of health information further were used to evaluate the accountability of each website. Freely available online information. On average, websites scored 27.98 (SD +/- 9.93, 95% CI 24.96-31.00) of 48 potential points (58.3%) for the twelve questions. There were significant differences in the comprehensiveness and accuracy of content across websites (p < .001). The mean reading grade level of websites was 11.90 (SD +/- 2.52, 95% CI 8.83-15.25). Zero websites achieved all four JAMA benchmarks. Interobserver reliability was robust between three of four neuro-ophthalmologist (NO) reviewers (rho = 0.77 between NO3 and NO2, rho = 0.91 between NO3 and NO1, rho = 0.74 between NO2 and NO1; all p < .05). The quality of freely available online information detailing optic neuritis varies by source, with significant room for improvement. The material presented is difficult to interpret and exceeds the recommended reading level for health information. Most websites reviewed did not provide comprehensive information regarding non-therapeutic aspects of the disease. Ophthalmology organizations should be encouraged to create content that is more accessible to the general public.

Purpose: To evaluate the demographic, educational, and scholarly characteristics of Association of University Professors of Ophthalmology–accredited vitreoretinal surgery fellowship program directors in the United States and Canada. Methods: Demographic, educational, and scholarly profiles of identified program directors were collated from online public resources. Characteristics were compared by sex, program size, ranking, and affiliation. Results: Eighty-one program directors (mean age [±SD] 54.7 ± 11.0 years) from 78 fellowship programs were identified. The minority were women (14.8%), who were on average 6 years younger than their male counterparts ( P = .07). The majority of program directors had an academic affiliation (90.1%), most commonly professor (54.8%). The mean h-index, 5-year h-index, and m-quotient were 20.9 ± 14.9, 5.9 ± 4.4, and 0.82 ± 0.42, respectively. Compared with their counterparts, program directors of both “top 10” and large programs published more manuscripts ( P < .05), accrued more citations ( P < .05), and had a higher h-index ( P < .05). Fellowship programs with female program directors had a significantly larger proportion of female retina faculty ( P = .002). Conclusions: The backgrounds of vitreoretinal surgery program directors are diverse. However, women remain underrepresented in this position, highlighting an area with the potential for greater equity in ophthalmology.

With the increasing prevalence of diabetic retinopathy (DR), screening is of the utmost importance to prevent vision loss for patients and reduce financial costs for the healthcare system. Unfortunately, it appears that the capacity of optometrists and ophthalmologists to adequately perform in-person screenings of DR will be insufficient within the coming years. Telemedicine offers the opportunity to expand access to screening while reducing the economic and temporal burden associated with current in-person protocols. The present literature review summarizes the latest developments in telemedicine for DR screening, considerations for stakeholders, barriers to implementation, and future directions in this area. As the role of telemedicine in DR screening continues to expand, further work will be necessary to continually optimize practices and improve long-term patient outcomes.

To the Editor: Artificial intelligence (AI) has become an increasingly important topic in ophthalmology due to its potentially indispensable role in the rapid and efficient detection of ocular pathology.1–3 Indeed, a bibliometric analysis of the most cited ophthalmology articles in Asia identified AI as an emerging area of investigation within the region.4 However, citation count captures scientific, not social, dissemination. Here, we provide a perspective distinct from traditional bibliometric analyses by evaluating the social impact of literature concerning AI in ophthalmology. The Web of Science database was queried by “Topic” on October 9, 2022, using search terms and Boolean operators: Ophthalmol* OR Optometry AND “Artificial Intelligence” OR “Deep Learning” OR “Machine Learning.”5 Exclusion of duplicates yielded 2927 articles. Altmetric Attention Score (AAS), a measure of the online dissemination of an article,6–8 was obtained using Altmetric Explorer, and articles were ranked. Each article was reviewed by 2 investigators (T.B. and P.A.P.), and only the top 100 discussing the application of AI primarily in ophthalmology were included in this analysis (Supplementary Digital Content, Table 1, https://links.lww.com/APJO/A207). Pertinent article, author, and journal characteristics of the top 100 articles were extracted. Pearson correlation coefficient, Mann-Whitney U test, Kruskal-Wallis test, and Fisher exact test were calculated where appropriate using GraphPad Prism 9 (San Diego, CA). P<0.05 was considered statistically significant. The median AAS of selected articles was 36.5 (range: 20–1231), predominantly driven by mentions on Twitter (median: 33.5; range: 0–796). Robust positive correlations were observed between AAS and citation count (r=0.58; P<0.001) and citations per year (r=0.54; P<0.001). Ninety-nine percent of articles were published within the past 7 years, with the majority (54%) published between 2020 and 2022 (Fig. 1), highlighting the relative recency of social interest in the area. Eighty-three percent of articles were open-access, a significant difference from the 35.1% of open-access articles identified in our initial search (P<0.001).FIGURE 1: Trends in the 100 most mentioned articles examining artificial intelligence and ophthalmology. The bar graph, measured against the left axis, indicates the number of most mentioned articles published in a particular year, and the line graph, measured against the right axis, indicates their median Altmetric Attention Score (AAS).Ophthalmology-specific journals were the source of 54% of articles (Supplementary Digital Content Table 2, https://links.lww.com/APJO/A208), and those published in JAMA Ophthalmology (16%) and Ophthalmology (13%) collectively garnered higher median AAS relative to counterparts in other ophthalmology-specific journals (P=0.023). As depicted in, Supplementary Digital Content, Table 3, https://links.lww.com/APJO/A209, most articles examined the application of AI for pathologies principally relevant to medical and/or surgical retina (52%). Across articles, there were significant differences in median AAS by subspecialty (P=0.039). Females comprised 21% of first authors and 16% of senior authors. While no significant differences in median AAS were observed by senior author gender (P=0.24), articles by male first authors trended toward having a higher median AAS (P=0.077). Senior authors were from 19 countries (Supplementary Digital Content, Table 4, https://links.lww.com/APJO/A210). Aggregated by region, they primarily originated from North America (43%), Europe (29%), and Asia (24%). There were no disparities in median AAS of articles by region (P=0.77). The authors with the most articles in the top 100 were D.S.W. Ting (14%) and T.Y. Wong (12%). Eighty-four percent and 58% of articles were the product of multi-institutional and multinational collaborations, respectively. Despite limitations associated with AAS,6–8 measuring the social impact of research offers complementary insights to traditional bibliometrics. The present investigation demonstrates that literature regarding AI in ophthalmology is widely discussed on online platforms. Of particular social interest is the utility of AI for the detection of retinal pathologies such as diabetic retinopathy and age-related macular degeneration. As evidenced here, authors from Asian countries have adopted a significant role in the production of socially impactful scientific literature concerning this topic. By increasing engagement with social media, investigators exploring AI in ophthalmology have the potential to disseminate research to a substantially broader audience.

Over recent decades, social media has become increasingly interwoven into the digital network that connects global society. This trend has broadly impacted medicine, with health care providers employing social media for teaching, learning, and promotion. As a particularly visual specialty, ophthalmology has the potential to benefit immensely from expanded clinician (and trainee) engagement with these platforms.

Objective To evaluate the quality and readability of online health content regarding the ocular health effects of blue light. Methods Five commercial and five non-commercial websites with content regarding the ocular effect of blue light were examined. Quality evaluations were conducted using a 14-question assessment composed by the authors and the 16-question DISCERN instrument. Website accountability was evaluated via the Journal of the American Medical Association (JAMA) benchmarks. Readability was determined using an online tool (Readable). Correlational and comparative analyses were conducted where appropriate. Results The average questionnaire score was 84 (standard deviation [SD] ± 17.89, 95% confidence interval [CI] 77.32-90.68) out of 136 points (61.8%). Significant differences in quality were identified between websites (p = 0.02), with Healthline achieving the highest score. Compared to commercial websites, non-commercial websites trended toward having significantly higher median questionnaire scores (p = 0.06). Zero websites achieved all four JAMA benchmarks. The average reading grade level of content was 10.43 (SD ± 1.15, 95% CI 9.60 - 11.25), with differences between websites trending toward significance (p = 0.09). There was no correlation between resource readability and quality (ρ = 0.28; p = 0.43) or accountability (ρ = 0.47; p = 0.17). Conclusions There remain substantial deficiencies in the quality, accountability, and readability of online content concerning the effect of blue light on ocular health. Clinicians and patients must recognize such issues when recommending and consuming these resources.

Purpose: Physician turnover is costly to health care systems and affects patient experience due to discontinuity of care. This study aimed to assess the frequency of turnover by ophthalmologists and identify physician and practice characteristics associated with turnover.Design: Retrospective cross-sectional study.Participants: Actively practicing United States ophthalmologists included in the Centers for Medicare and Medicaid Services Physician Compare and Physician and Other Supplier Public Use File between 2014 and 2021.Methods: We collected data for each ophthalmologist that was associated with practice/institution and then calculated the rate of turnover both annually in each year window and cumulatively as the total proportion from 2014 to 2021. Multivariable logistic regression analysis was used to identify physician and practice characteristics associated with turnover. We also evaluated turnover characteristics surrounding the Coronavirus disease 2019 (COVID-19) pandemic. Main Outcome Measures: Ophthalmologist turnover, defined as a change of an ophthalmologist's National Provider Identifier practice affiliation from one year to the next.Results: Of 13 264 ophthalmologists affiliated with 3306 unique practices, 34.1% separated from at least 1 practice between 2014 and 2021. Annual turnover ranged from 3.7% (2017) to 19.4% (2018), with an average rate of 9.4%. Factors associated with increased turnover included solo practice (adjusted odds ratio [aOR], 9.59), university affiliation (aOR, 1.55), practice location in the Northeast (aOR, 1.39), and practice size of 2 to 4 members (aOR, 1.21; P < 0.05 for all). Factors associated with decreased turnover included male gender (aOR, 0.87) and more than 5 years of practice: 6 to 10 years (aOR, 0.63), 11 to 19 years (aOR, 0.54), 20 to 29 years (aOR, 0.36), and = 30 years (aOR, 0.18; P < 0.05 for all). In the initial year (2020) of the COVID-19 pandemic, annual turnover increased from 7.8% to 11.0%, then decreased to 8.7% in the postvaccine period (2021).Conclusions: One-third of United States ophthalmologists separated from at least 1 practice from 2014 through 2021. Turnover patterns differed by various physician and practice characteristics, which may be used to develop future strategies for workforce stability. Because administrative data cannot solely determine reasons for turnover, further investigation is warranted given the potential clinical and financial implications.

Railway Locomotive Management Systems (RLMS) represent a pioneering innovation in the railway industry, providing a comprehensive approach to locomotive and operational management. This abstract provides a succinct overview of RLMS, emphasizing its importance and core functions. RLMS is a sophisticated amalgamation of software and hardware solutions aimed at modernizing locomotive management within contemporary railway networks. It addresses essential aspects such as locomotive tracking, maintenance scheduling, fuel management, crew management, inventory control, and performance monitoring. Furthermore, it enhances safety with advanced safety systems, efficient communication protocols, and real-time decision-making capabilities. The primary goal of RLMS is to elevate efficiency and safety in railway operations. This is achieved through the optimization of locomotive performance, predictive maintenance to minimize downtime, and reduction in fuel consumption. It also plays a pivotal role in crew management, ensuring well-trained staff and efficient scheduling

Kavian, Joseph Abraham BA; Patel, Parth A. BS; Jiao, Cheng BS; Patel, Kajol K. BS; Boyd, Carter J MD, MBA Author Information

OBJECTIVE: To examine the effect of cost of living on general surgery resident salaries and identify factors asso-ciated with greater incomes and availability of housing stipends. DESIGN: Retrospective cross-sectional analysis of Fel-lowship and Residency Electronic Interactive Database (FREIDA), institutional websites, and Doximity. Program characteristics were compared through Kruskal-Wallis tests, ANOVA, and x2 tests. Multivariable linear mixed modeling and multivariable logistic regression were uti-lized to determine factors associated with higher salary and availability of housing stipend, respectively. SETTING: Three-hundred fifty-one general surgery resi-dency programs in the United States. PARTICIPANTS: Three-hundred-seven general surgery residency programs with available salary data for the 2022 to 2023 academic year. RESULTS: The average postgraduate year 1 resident annual salary was $59,906.00 (standard deviation [SD] +/- $5051.97). After adjustment for the cost of living, the average annual income surplus was $22,428.42 (SD +/- $4848.64). Cost of living and resident remuneration var-ied substantially across regions (p < 0.001). Annual income surplus was the highest for programs in the Northeast when compared to other regions (p < 0.001). Resident annual income increased by $510 (95% confi-dence interval [CI] $430-$590) for each $1000 increase in the cost of living and $150 (95% CI $80-$210) for each 10-rank increase in Doximity general surgery program reputation ranking. An increased cost of living was associated with a higher likelihood of housing stipend availability (odds ratio 1.17, 95% CI 1.07-1.28). CONCLUSIONS: General surgery residents are inade-quately compensated for the cost of living, indicating the potential for increased compensation to alleviate economic strain of surgical trainees. As financial stress can have implications for mental and physical well-being, further discussion of current resident salaries and benefits is warranted. ( J Surg Ed 80:639-645. (c) 2023 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.) ABBREVIATIONS: DGME, Direct Graduate Medical Edu-cation RAI, required annual income RHI, required hourly income ACGME, Accreditation Council for Graduate Medical Education MIT, Massachusetts Institute of Tech-nology AMA, American Medical Association PGY post-graduate year

ABSTRACT Purpose To describe the magnitude, party affiliation, temporal trend, and geographic distribution of political contributions made by ophthalmologists in the United States. Methods This cross-sectional study used public finance data from the Federal Election Commission website to identify political donations from ophthalmologists between 2003–2019. Contributions were filtered for occupation lines matching either ”ophthalmologist,” or ”eye surgeon,” and each contribution was cross-referenced to catalogue donations as ”Republican,” ”Democratic,” or ”Independent.” Results From 2003–2019, a total of 31,855 political donations were made by self-identified ophthalmologists, totaling $11,603,672. Of all dollars, 10.7%, 19.5%, and 69.8% went to Democratic, Republican, and Independent committees, respectively. Political contributions directed towards the American Academy of Ophthalmology Political Action Committee (OPHTHPAC) constituted the majority (59.8%) of overall contributions. From 2003 to 2019, the total number of unique contributions increased significantly from 1135 to 3208 (? = 0.63; P < .01). In dollars, this translated to an increase from $482,300 donated in 2003 to $640,695 donated in 2019, although this trend was non-significant (? = 0.18; P = .48). Conversely, the average amount of each contribution significantly declined from $425 to $203 (? = -0.35; P < .001). As expected, larger states such as California, Texas, Florida, Illinois, Michigan, and New York had the highest contribution dollars, in that order. Conclusions Political contributions from ophthalmologists have significantly risen since 2003, however there remain opportunities for growth in engagement with OPHTHPAC. Future analysis of how this involvement translates to representative health policy is warranted.