Amar Shah, MD, is a cataract, refractive, and cornea surgeon at Mid-Ohio Eye.

Rates of Hyperosmolar Tear Film After Cataract Surgery, With Amar Shah, MD

2025 American Society of Cataract and Refractive Surgery (ASCRS) Annual Meeting

 highlighted a significant gap in ocular surface recovery following 

, with more than a third of patients showing elevated tear film osmolarity one month after surgery despite standard postoperative care.

The study at the Cincinnati Eye Institute enrolled 71 patients scheduled for cataract surgery. Tear osmolarity was measured using the ScoutPro Osmolarity System before surgery and again at the 30-day postoperative visit. Hyperosmolarity was defined as ≥ 315 mOsm/L, following ASCRS guidelines for ocular surface disease (OSD).

At baseline, 44% of patients (31 of 71) were found to have hyperosmolar tear film. Among the 59 patients who returned for the 30-day follow-up, 31% of those with normal osmolarity preoperatively developed hyperosmolarity. Meanwhile, only 50% of those who started with elevated osmolarity saw normalization by day 30, despite treatment with antibiotics, corticosteroids, NSAIDs, and artificial tears.

, presenting investigator Amar Shah, MD, a cataract, refractive, and cornea surgeon at Mid-Ohio Eye, noted that a central feature of dry eye disease is hyperosmolarity of the tear film. He indicated the value of obtaining information on whether a tear osmolarity is elevated or abnormal, suggesting its presence can lead to light scatter comparable to a grade two or three cataract.

“While in a cataract, the amount of light scatter is pretty constant, because the cataract is either there or not,” Shah told 

. “In hyperosmolar tear film, the light scatter is more fluctuating between blinks or throughout the course of the day. This can be a little bit harder to identify, because we can't see alterations in osmolarity at the slit lamp.”

Shah emphasized that the persistence of hyperosmolarity despite a conventional drop regimen suggests the need for more targeted interventions. He pointed to options ranging from preservative-free artificial tears to prescription therapies like cyclosporine, lifitegrast, or punctal occlusion.

“This suggests that despite what we consider routine post-operative drops, there certainly could be an opportunity to add additional treatment to address these alterations in tear osmolarity,” Shah told 

. “This can range from as simple as over-the-counter interventions like high-quality, preservative-free artificial lubrication or ointments, or it could be escalated up to any number of our bevy of available prescription treatment options.”

With increasing use of premium intraocular lenses and rising patient expectations, Shah stressed that managing the ocular surface is critical to visual outcomes.

“There’s an opportunity to be a little bit more aggressive in our management of ocular surface disease, pre- and post-operatively, especially in our modern era where patients' expectations are higher,” Shah told 

. “The utilization of advanced technology interactive lenses is increasing, and the bar that we need to meet and exceed is growing higher and higher.”

Shah AP, Barfell AD. The Prevalence of Hyperosmolar Tear Film in Patients Pre- and 30-Days-Post Cataract Surgery. Paper presented at the 2025 American Society of Cataract and Refractive Surgery (ASCRS) Annual Meeting. April 25-28, 2025. Los Angeles, CA.

Shah explores the impact of hyperosmolarity on tear film post-cataract surgery, emphasizing the need for enhanced dry eye management strategies.

Rate of Hyperosmolar Tear Film After Cataract Surgery, With Amar Shah, MD

Amar Shah, MD

) is the third leading cause of cancer-related death despite only accounting for 3% of all new cancer diagnoses.

 Obesity is a well-known risk factor for multiple types of cancer, including PDAC. In fact, there exists a relative risk of PDAC of 1.10 for every 5-unit increment increase in body mass index (BMI).

 While bariatric surgery has been demonstrated to reduce overall cancer incidence and mortality, conflicting data exist regarding the effects of bariatric surgery on PDAC.

We performed a retrospective case-control study utilizing the National Inpatient Sample (NIS) database from October 2015 to December 2020. All adult subjects (age ≥18 years) with a BMI >40 kg/m2 or >35 kg/m2 with ≥1 metabolic comorbidity were identified and stratified into those with and without a history of bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy).

, Tenth Edition Clinical Modification (ICD-10-CM) codes were used to define variables of interest. Baseline characteristics and comorbidities among the 2 groups were compared using chi-squared and Wilcoxon rank-sum tests and logistic regression analysis was performed to assess the risk of PDAC after adjusting for multiple risk factors, including tobacco use, acute and chronic pancreatitis, diabetes mellitus and various stages of obesity.

Over 19 million subjects were included, 1,656,329 of whom had a history of bariatric surgery. Patients with a history of bariatric surgery were significantly younger, more frequently female (75% vs 58%), had higher rates of class 3 obesity (69% vs 52%) and lower prevalence of hypertension, hyperlipidemia, chronic kidney disease, Charlson Comorbidity Index (CCI) ≥3, tobacco use, acute and chronic pancreatitis and pancreatic cancer (0.1% vs 0.2%) while having a higher prevalence of OSA (

 <.001). Additionally, in-hospital mortality (0.5% vs 1.8%), total hospital charges and overall length of stay were lower in the bariatric surgery cohort compared to the nonsurgical cohort (

 <.001). After adjusting for multiple comorbidities and risk factors, history of bariatric surgery was demonstrated to significantly reduce the risk of PDAC on both univariable (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.44 - 0.56) and multivariable analysis (OR, 0.68; 95% CI, 0.61 - 0.77).

This is the largest analysis to date investigating the effects of bariatric surgery on pancreatic cancer risk reduction and serves to clarify previously inconclusive data. We have shown bariatric surgery to exhibit an independently protective effect against PDAC oncogenesis. It is reasonable to suggest that patients at increased risk of PDAC as well as other obesity-related malignancies may be recommended for surgically-assisted weight loss earlier and more frequently.

With advancements in minimally invasive bariatric procedures, expanding patient eligibility and indications for surgery, increasing utilization of bariatric surgery and endoscopic bariatric and metabolic therapies may help alleviate the growing burden of pancreatic cancer.

Surveillance, Epidemiology and End Result (SEER) Program. Surveillance Research Program, National Cancer Institute. 2023 Apr 25. https://seer.cancer.gov.

Aune D, Greenwood DC, Chan DS, et al. Body mass index, abdominal fatness and pancreatic cancer risk: a systematic review and non-linear dose-response meta-analysis of prospective studies. Ann Oncol. Apr 2012;23(4):843-52. doi:10.1093/annonc/mdr398

Schauer DP, Feigelson HS, Koebnick C, et al. Bariatric Surgery and the Risk of Cancer in a Large Multisite Cohort. Ann Surg. Jan 2019;269(1):95-101. doi:10.1097/SLA.0000000000002525

Adams TD, Stroup AM, Gress RE, et al. Cancer incidence and mortality after gastric bypass surgery. Obesity (Silver Spring). Apr 2009;17(4):796-802. doi:10.1038/oby.2008.610

Sjöström L, Gummesson A, Sjöström CD, et al. Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial. Lancet Oncol. Jul 2009;10(7):653-62. doi:10.1016/S1470-2045(09)70159-7

Tee MC, Cao Y, Warnock GL, Hu FB, Chavarro JE. Effect of bariatric surgery on oncologic outcomes: a systematic review and meta-analysis. Surg Endosc. Dec 2013;27(12):4449-56. doi:10.1007/s00464-013-3127-9

Bulsei J, Chierici A, Alifano M, et al. Bariatric surgery reduces the risk of pancreatic cancer in individuals with obesity before the age of 50 years: A nationwide administrative data study in France. Eur J Surg Oncol. Apr 2023;49(4):788-793. doi:10.1016/j.ejso.2022.11.013

Fan H, Mao Q, Zhang W, Fang Q, Zou Q, Gong J. The Impact of Bariatric Surgery on Pancreatic Cancer Risk: a Systematic Review and Meta-Analysis. Obes Surg. Apr 05 2023;doi:10.1007/s11695-023-06570-x

Wilson RB, Lathigara D, Kaushal D. Systematic Review and Meta-Analysis of the Impact of Bariatric Surgery on Future Cancer Risk. Int J Mol Sci. Mar 24 2023;24(7)doi:10.3390/ijms24076192

A history of bariatric surgery was associated with up to 50% reduced risk of PDAC among a national cohort.

Bariatric Surgery is Associated with Reduced Risk of Pancreatic Cancer: Analysis of a US National Database

Bailey Flora, MS, RD, ND

I think we've gone through a litany of different ideas about the drugs and how we use them. One of the concerns that many people have when anything new comes out is, is it reliable? I know, certainly, when drugs come out, is it effective, is it safe, and then can my patients get it? We ask the same questions with laboratory tests. Is it effective? Is it reliable? Can my patients get it for free or covered through insurance? With that, I think I'd like to get the last part. I'm going to hear from both of you. What advice do you have for your colleagues treating rheumatoid arthritis in the community setting? Joy?

I think we've come a long way. I think rheumatologists need to commend themselves. First of all, rheumatologists are still the subspecialty that still listens to patients. We still examine our patients. We use all of our clinical tools, we don't rely just on testing alone. However, we are probably the group of subspecialists that question and ask those questions on how this test is going to benefit our patients. And so I think that we do look at science, and the fact that we are getting these studies that are showing us consistently that looking at the signaling and whether a patient is going to have a response or not have a response to certain medications, and as we get into more precision medicine, and we see that these tools are going to help us to get our patients into low disease activity quicker and get to that treat to target quicker, I think we're going to rely on them more. Like Bob has said, it's going to take us a few years. There's going to be our early adopters that are going to look at this and look at that science and study it and say, ‘This is a tool in my toolbox, I’m going to use it with my clinical exam. I’m going to use it with all my laboratory testing, and I’m going to move into that direction quicker, and I’m going to see the response probably in my patients a little bit quicker.’ Then there are going to be the early adopters. There are going to be our colleagues that are going to take a little bit more time. But I think over the next few years you're going to see a big change in how we approach our patients. We're going to be commended for how quickly we take care of the patient journey and get these patients in low disease activity, and maybe at some point, rheumatoid arthritis will not have the stigma that it has had over the last several years, at least in my career, that this is a "crippling" disease process. Thank you.

Joy said it very nicely, and I would like to add that this technology has great potential. We're only scratching the surface based on the data on looking at the signal of nonresponse to TNFs [tumor necrosis factor], and hopefully getting more patients involved and more data collected will strengthen the argument that this is a reliable piece of information that will really help us guide therapy. Second, I look forward to the day that the adoption by CMS [Centers for Medicare & Medicaid Services] and adoption by the commercial insurance carriers will help us guide therapy and allow us to have this be an affordable option for us to use and not have the worry of large out-of-pocket expenses and concerns about that. Then, I just think that this really has the opportunity to help guide our patients to get to those treat to target goals, low disease activity, remission. That would ultimately lead to getting our patients to our goals as providers, as doctors, and also to the patient goals of improving those quality-of-life and patient-reported outcome things that we measure.

I think both of you hit the nail right on the head. We need more tools. We need more information. We need more accessibility to these tools because although we've had a tremendous explosion of therapeutic options, we haven't had any real guidance. To have a test that may guide our hand in therapy, even for just the first decision or even beyond that, because as we both and all know here, the therapy selection right now comes down to what are we most comfortable with? What came first? Maybe comorbid conditions, but mainly insurance mandates. Use this, then that, then this because that's our formulary. That's our sequence. I think many of us are feeling choked by this because as scientists, as rheumatologists, we are data-driven. We know better, and we know that as this science evolves in the 21st century, precision medicine is the way we can learn from our oncology colleagues. With that, I'd like to give a thanks to all of you for this rich and informative discussion. Before we conclude, I'd like to get final thoughts from each of you. Joy?

I wholeheartedly agree with everything that has been said here today. We're in a very rich environment that we have a lot of potential, a lot of hope, down the line by having a good collaboration with the science, with the testing, to give our patients that precision medicine that we want to achieve and to get these patients into the remittive state that they should be able to get into. By using good science and showing insurance companies that we are scientists, that we use evidence-based medicine to make some of our decisions. I hope through the work of the CRSO [Clinical Research Support Office], Bob, and my other colleagues, and I know myself I've tried to work in that area as well, that we'll be able to convince our insurance payers that this is the way to go for our patients and to get them into low disease activity in remission as quickly as possible.

I'm going to throw one out there. I'll put on my advocacy hat for a minute and just say that we've been really trying to improve formulary construction based on efficacy and safety. That flies in the face of the payers and the PBMs [pharmacy benefit managers] who basically construct formularies based on what's most profitable to them and not at all what's related to safety or effectiveness. I see this being a real tool that we can use from the advocacy standpoint in fighting the PBMs, in other words, being a PBM buster. That it could blow up their whole paradigm. I'm doubly excited, not only based on the science and how patient outcomes can be affected by utilizing this, but also utilizing it as maybe a cajole against the payers and against the PBMs who are unfortunately in control of what we prescribe and getting in the way of the doctor-patient relationship.

Well, Bob and Joy, thanks to you and our audience for this rich and informative discussion. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming peer exchanges and other great content right in your inbox.

Nehad Soloman, MD; Joy Schechtman, DO; and Robert Levin, MD, share final thoughts and takeaways on the treatment of rheumatoid arthritis in the community setting.

Clinical Pearls for RA Management

Joy Schechtman, DO

Andrea Nguyen, PA, shares her clinical pearls on taking care of patients with AD.

Clinical Pearls on AD Management

This is a video synopsis/summary of a panel discussion involving Melodie Young, NP, and Andrea Nguyen, PA.

In this segment, the discussion centers on providing advice and encouragement for healthcare professionals, particularly those entering the field or adjusting their approach to adhere to newer guidelines for managing atopic dermatitis (AD). The speakers acknowledge the increasing prevalence of AD, emphasizing the substantial number of patients with significant body involvement who may require more than just topical therapies.

The advice includes a systematic approach to learning about the various therapeutic categories, such as monoclonal antibodies, biologics, oral Jack inhibitors, and topicals. The recommendation is to start with a focused exploration of one category to build confidence before expanding knowledge across all therapy options. Anticipating continuous development in the next 5 to 10 years, there is emphasis on creating an efficient workflow and clinic template to streamline the prescription process for these complex therapies.

The conversation concludes with the suggestion of possible future discussions on using telemedicine for AD management, highlighting its effectiveness in treating chronic diseases like AD.

Video synopsis is AI-generated and reviewed by HCPLive editorial staff.

Clinical Pearls on AD Management 

Melodie Young, NP

The panel discusses the mechanism of treatment-emergent hypophosphatemia that occurs following the administration of certain intravenous iron formulations.

Treatment-Emergent Hypophosphatemia Following Administration of Intravenous Iron

Video content above is prompted by the following:

Treatment-emergent hypophosphatemia is now widely recognized as a phenomenon that can occur following administration of certain IV iron formulations and within the first 2 weeks after administration. Can you discuss the mechanism of treatment-emergent hypophosphatemia?

Michael Auerbach, MD

Michelle Guan, MD, is an internal medicine resident at the University of California Los Angeles.

Leveraging Wearable Devices for IBS Self Management, with Michelle Guan, MD

Wearable devices may serve as valuable self-management tools encouraging greater levels of physical activity and improved sleep among patients with 

, according to findings from a recent study.

The data were presented at Digestive Disease Week (DDW) 2025 by Michelle Guan, MD, an internal medicine resident at the University of California Los Angeles, and highlight a significant association between increased daily step count and median hours of sleep as measured by a Fitbit device with reduced IBS symptom severity.

“Wearable devices like the Fitbit really offer a unique and objective way to track factors that are deeply connected to IBS symptom management, especially sleep,” Guan explained to 

, describing how although patients frequently self-report sleep issues, wearables can provide a more accurate picture of sleep quality, including metrics like REM and deep sleep, to uncover some of the physiological patterns tied to symptom flares and offer actionable insights for self management.

She and colleagues note that monitoring step count and sleep data using wearable devices may be cost-effective and easily accessible for patients but cite a lack of data using commercially available wearable devices such as the Fitbit. Seeking to address this gap in research, they recruited IBS and healthy participants to wear a Fitbit device for 14 days to capture their daily step count and sleep data. Participants also completed questionnaires to assess IBS symptoms using NIH GI PROMIS, self-reported sleep (Pittsburgh Sleep Quality Index, PROMIS Sleep), and current anxiety and depression symptoms (Hospital Anxiety and Depression Scale).

In total, the study enrolled 20 patients with IBS and 20 controls. Predominant IBS subtypes included diarrhea (45%), constipation (30%), and mixed (25%).

Although there were no significant differences in Fitbit step count between the IBS and control groups, within the IBS group, investigators noted increased 7-day median step count was significantly associated with decreased median abdominal pain (

=.004) scores. Additionally, while there were no differences in the duration of sleep stages and number of nightly awakenings between IBS and controls, in participants with IBS, increased median of hours slept across 7 days detected by Fitbit was associated with less abdominal pain (

Of note, when comparing self-reported versus Fitbit-measured mean hours slept for all participants, individuals significantly overestimated the total hours of sleep by Fitbit (

“This research suggests that enhancing REM sleep may be a valuable target in IBS management strategies and wearable devices offer a real-time objective data capturing ability that both patients and clinicians can then use to monitor sleep quality and then correlate it with symptom changes,” Guan explained.

Looking ahead, she expresses interest in studies using larger and more diverse patient populations to validate her findings and potentially explore causality. Guan also points to the value of assessing interventions that directly aim to increase REM sleep and longitudinal studies looking at the impact of sleep improvement on sustained symptom relief.

Editors’ note: Guan does not have any relevant disclosures.

Guan M, LeBrett WG, Cortessis R, et al. STEP COUNT AND SLEEP MEASURED BY WEARABLE DEVICE ARE ASSOCIATED WITH IMPROVED SYMPTOMS IN PATIENTS WITH IRRITABLE BOWEL SYNDROME. Abstract presented at Digestive Disease Week 2025 in San Diego, CA, from May 3 - May 6, 2025.

Guan describes the potential value of using wearable devices to enhance IBS management by tracking sleep and exercise.

Michelle Guan, MD

Vice Chief of Education, Fellowship Program Director

Division of Gastroenterology and Hepatology at UNC Health Care

Experts discuss the recent use of biosimilars like inolimomab as treatment for ulcerative colitis (UC).

Biosimilar Treatment Options for Patients With UC

Millie Long, MD, MPH

Nathaniel Marchetti, DO, is a professor of thoracic medicine and surgery at Lewis Katz School of Medicine at Temple University and medical director of the respiratory intensive care unit at Temple University Hospital.

Using RV/TLC to Determine Lung Reduction Procedure Efficacy, with Nathaniel Marchetti, DO

New research is shedding light on the potential utility of assessing changes in residual volume (RV)/total lung capacity (TLC) to determine the efficacy of lung reduction procedures in patients with emphysema and hyperinflation.

the American Thoracic Society (ATS) International Conference 2025

 by Nathaniel Marchetti, DO, a professor of thoracic medicine and surgery at Lewis Katz School of Medicine at Temple University and medical director of the respiratory intensive care unit at Temple University Hospital, and suggest examining changes in RV/TLC may serve as a better physiological marker of improvement in patient outcomes than absolute RV following bronchoscopic lung volume reduction (BLVR).

“Currently, [RV] is the gold standard, so it's a good marker of improvement following lung reduction, no matter what the method is. In this case, we're looking at bronchoscopic lung volume reduction,” Marchetti explained to 

. “However, it doesn't really account for what occurs. Because the residual volume decreases more than the total lung capacity, there's a resizing of the lung in relation to the chest wall.”

Patients with emphysema and hyperinflation have improved outcomes following lung reduction due to decreases in air-trapping that negatively impact lung, chest wall, respiratory muscle and cardiac function. While absolute reductions in RV are frequently used to evaluate the efficacy of these lung reduction procedures, changes in RV/TLC have been suggested to be a superior metric to indicate the adequacy of lung reduction in hyperinflated emphysematous patients.

In the present study, investigators reviewed data for 97 patients who underwent BLVR at Temple University Hospital from August 2018 to December 2023. Physiologic respiratory measures at baseline pre-BLVR were compared to data collected 6 months post-BLVR.

Among the cohort, 41% of patients were female and the mean age was 67.8±5.8 years. Investigators noted patients were severely obstructed (FEV1 0.82 ± 0.27L, 31.0±8.3% pred), hyperinflated (TLC, 7.2±1.3L, 121.8±16.3% pred), and air trapped (RV, 4.5±1.1L, 203.5±45.4% pred), and received one-way endobronchial valves for BLVR.

Post-BLVR, RV decreased by 310 mL in 74.2% of participants and RV/TLC decreased by 4% in 68.0% of participants. Investigators called attention to improvements in FEV1 (+0.19 ± 0.19), RV (-0.89 ± 0.93), RV/TLC (-8.4 ± 9.7), SGRQ (-24.5 ± 13.0), mMRC (-1.4 ± 0.83) and 6MWD (15.3 ± 74.8) 6 months following BLVR.

“For me, one thing that was very rewarding with this project and research was that this was a theory that was proposed by investigators 25 years ago and was very physiologically based, and it still holds true today,” Marchetti said. “I think that the take home message is that a reduction in RV/TLC is the most important parameter when you're looking at any therapy that's goal is to reduce lung volumes, and it should track best with what patients care about, which is symptoms.”

Editors’ note: Marchetti has relevant disclosures with the American Lung Association, NIH, AstraZeneca, and Sanofi.

Marchetti N, Thomas J, Patlakh N, et al. Reductions in RV vs. RV/TLC as a Measure of Success Following BLVR [abstract]. 

https://doi.org/10.1164/ajrccm.2025.211.Abstracts.A1017

Marchetti explains the benefits of assessing RV/TLC rather than absolute RV to determine the efficacy of BLVR in patients with emphysema and hyperinflation.

Nathaniel Marchetti, DO

Research Needs and the Future of COPD Treatment

Future research in COPD management is expected to focus on expanding the evidence base for newly approved therapies, with an emphasis on long-term outcomes and precision targeting. While current phase 3 trials have demonstrated efficacy in reducing exacerbations and improving lung function, additional data are needed to evaluate their impact on disease progression, hospital readmissions, and mortality. There is growing interest in understanding whether these treatments can stabilize or even alter the natural trajectory of COPD, particularly in high-risk patients or those with severe exacerbations.

Another area of focus involves identifying more refined biomarkers to guide treatment selection. Presently, blood eosinophil levels are the most widely used biomarker, but their variability limits predictive accuracy. Emerging tools such as FeNO (fractional exhaled nitric oxide) show promise, especially in identifying patients with type 2 inflammation who may benefit from specific biologics. Imaging biomarkers and advanced diagnostic technologies are also being explored to assess airway remodeling, mucus plugging, and gas trapping, which could lead to more tailored interventions. However, these approaches are still in the developmental phase and not yet ready for widespread clinical use.

There is also increasing discussion around the potential for earlier intervention with biologic therapies, possibly even in pre-COPD stages, to prevent irreversible lung damage. While conceptually appealing, cost and lack of supporting data remain barriers to adopting this strategy. To justify earlier use, robust trials are needed to demonstrate disease-modifying effects. Overall, the future of COPD care lies in a shift toward personalized medicine, supported by real-world data, advanced biomarkers, and continued innovation in clinical research.

Panelists discuss the future of chronic obstructive pulmonary disease (COPD) management, emphasizing the need for long-term data on newly approved therapies, the development of refined biomarkers like FeNO and imaging tools to guide precision treatment, and the potential for earlier intervention with biologics—all aimed at advancing personalized care and altering the disease trajectory in high-risk patients.

Nicola Hanania, MD, MS

Dr Linda Stein Gold, Dr Mona Shahriari and Dr Seemal Desai share advice for improving psoriasis care for patients with skin of color.

Advice for Dermatologists in Treating Psoriasis in Patients With Skin of Color

This is a video synopsis/summary of a panel discussion involving Linda Stein Gold, MD; Mona Shahriari, MD, FAAD; and Seemal Desai, MD.

The discussion focuses on the implications of research findings for patients with skin of color in psoriasis treatment. The speakers emphasize the importance of utilizing data-driven approaches to guide treatment decisions and advocate for increased diversity in clinical trial participation to ensure representative study populations.

They discuss the significance of cultural sensitivity in patient interactions and highlight the need for continued investment in research and development to generate data that can inform clinical practice effectively. The transcript concludes with a call to action for dermatologists to play a critical role in improving outcomes for all patients with psoriasis, underscoring the value of sharing knowledge and fostering collaboration within the medical community.

Overall, the conversation emphasizes the importance of evidence-based approaches, cultural competence, and ongoing research efforts in addressing the needs of diverse patient populations with psoriasis.

Authors