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OCS Ophthalmic Coding Specialist

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OCS exam Dumps Source : Ophthalmic Coding Specialist

Test Code : OCS
Test Name : Ophthalmic Coding Specialist
Vendor Name : Medical
: 45 Real Questions

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Medical Ophthalmic Coding Specialist

Jobs that pay with no B.A.: essentially the most profitable fields in Washington state | killexams.com Real Questions and Pass4sure dumps

are looking to make good funds without incomes a 4-12 months faculty degree? agree with becoming a dental hygienist, diagnostic ultrasound technician, registered nurse or respiratory-therapy technician.

these are a few of the roles with salaries that hit $50,000 or extra a 12 months just a 12 months out of a training software at a community or technical school.

These numbers — produced by way of the State Board for community and Technical colleges (SBCTC) — dovetail with the findings from a fresh report via the Georgetown middle on education and the workforce, which concludes that blue-collar jobs that pay an outstanding wage proceed to be on the decline throughout the nation, however skilled-services jobs that pay smartly are on the upward push.

And while those professional-service jobs don’t require a four-year school diploma, applicants customarily need some training past excessive college, reminiscent of an affiliate or technical degree or certificate from a community faculty.

In its document, “respectable Jobs that Pay with out a BA,” Georgetown calculates that there are 30 million jobs within the u.s. today that supply median salary of $fifty five,000 annually for people with out a bachelor’s degree. (For the intention of this file, Georgetown defines a “good job” as one which pays a median revenue of $55,000 a yr, and at the very least $35,000 a year.)

The record additionally estimates that 62 % of Washington people don’t have a bachelor’s diploma. Of these worker's, best forty two percent have a job that will pay an excellent wage.

Georgetown recognized 5 industries in Washington which have had the most reliable boom in “respectable jobs” considering the fact that 1991: enjoyment and hospitality and personal functions, fitness-care features, monetary consulting/company features, schooling features and government services.

but let’s get extra specific.

The state community-faculty board collects facts on what its college students are paid a yr after they graduate from one in every of its colleges’ skilled and technical programs and certificates. (professional and technical courses put together students for the body of workers, and don't seem to be the equal as tutorial transfer programs, which get college students ready to transfer to a 4-year faculty and earn a bachelor’s degree.)

The document has some obstacles; for example, the board knows its graduates’ fields of study and their year-after-graduation pay, but it surely doesn’t know if the graduate really took a job in the certain box through which they studied. nevertheless, the document is a stunning first rate indicator, and the numbers align neatly with the Georgetown school look at. It’s also current, measuring how a good deal students who graduated in 2013-14 have been making in 2015-sixteen.

Graduates who go into health care earn one of the appropriate salaries. The highest-paid container of examine in Washington is dental hygienist. The median income in that field is $42 an hour. Nursing — no surprise here — is a exact box, too, with the state’s 1,533 nursing graduates from 2013-14 making a median wage of $31.sixty six an hour. The midpoint income for specialists in diagnostic clinical ultrasound is $34.32 an hour.

Some classes that graduate fewer than 50 students a 12 months — including cardiovascular expertise, hearth science and water high-quality/wastewater administration — additionally pay very excessive wages.

One caveat: one of the most optimum-paying fields of look at are also elaborate to get into as a result of there’s so a lot competition among students. as an example, a student making use of to get right into a neighborhood-faculty nursing application will need correct grades in prerequisite courses, referred to Darby Kaikkonen, coverage-analysis director for the neighborhood and technical faculty board.

Early childhood schooling is the lowest-paying box in Washington, providing a median salary of simply $13.sixty one an hour, or median annual earnings of $21,940 for the 525 students who graduated with that degree.

That’s a mirrored image of how little value is positioned on educating young little ones, observed Laura McDowell, spokeswoman for the schools. but since it’s also a favored field, the faculties are designing “stackable” certificates — certificates that build on each and every different and lead to an affiliate degree, which then can cause an utilized bachelor’s diploma, which can result in a stronger revenue. Highline college offers this type of program.

Between 1991 and 2015, the number of blue-collars jobs did go up in Washington state — little question a few of them in the construction business, one of the most profitable fields for americans and not using a bachelor’s in quick-starting to be Seattle.

but the state brought much more decent jobs for americans who worked in professional capabilities — 93,000 jobs in all, based on the Georgetown analysis.

Grads from these 10 group-faculty classes make the maximum salaries This chart suggests the median salaries college students are making a year after they graduate from some of the expert or technical courses listed below. The report has some obstacles – as an example, researchers don’t recognize if graduates in reality took a job in the specific container wherein they studied. when you are viewing this interactive on a cell, rotate your equipment to landscape mode. Job/box of study,complete students completing software,Median wages,Median profits Accounting technician & bookkeeping,552,$sixteen.13 ,"$28,342 " Administrative assistant & secretary sciences,seventy one,$14.fifty two ,"$26,306 " Agriculture business & management,eleven,$16.06 ,"$29,948 " Air traffic manage,23,$15.89 ,"$29,360 " aircraft/frame/powerplant mechanic,148,$18.30 ,"$39,670 " Airframe mechanical & aircraft,236,$sixteen.34 ,"$34,094 " Airline/business/knowledgeable pilot,27,$18.59 ,"$26,852 " Anesthesiologist assistant,10,$22.19 ,"$47,837 " Architectural drafting & architectural CAD,sixteen,$21.06 ,"$29,314 " Auto mechanics,378,$14.64 ,"$28,727 " Auto provider middle professional,12,$13.sixty seven ,"$22,815 " Auto body/collision & restore,sixty nine,$14.forty five ,"$29,081 " Biomedical technician,33,$23.sixty seven ,"$49,364 " building development technician,26,$15.59 ,"$24,826 " building/construction management,31,$22.62 ,"$48,885 " constructing/domestic/construction expert,12,$25.forty ,"$30,446 " business administrative & administration,313,$15.35 ,"$26,961 " Cabinetmaking & millwork,29,$sixteen.sixty three ,"$29,913 " CAD draft/design technician,44,$19.fifty one ,"$38,416 " Cardiovascular technologist,eleven,$forty one.seventy one ,"$76,718 " Carpentry,forty,$17.forty one ,"$29,026 " newborn-care provider/assistant,17,$14.05 ,"$27,000 " Civil draft/engineer CAD,23,$21.62 ,"$forty one,399 " Civil engineering technician,19,$20.51 ,"$35,008 " scientific/scientific lab technician (certificates),fifty two,$18.94 ,"$35,766 " laptop numerical manage machinist technician,25,$17.14 ,"$32,320 " commercial photography,24,$14.seventy nine ,"$17,one hundred sixty " desktop & assistance methods protection,one hundred and five,$20.19 ,"$forty,493 " desktop graphics,66,$14.50 ,"$19,480 " "computer program, product",10,$17.01 ,"$33,113 " computer programming,115,$21.14 ,"$40,308 " laptop guide expert,seventy seven,$14.44 ,"$27,924 " desktop programs community/telecommunication,372,$18.23 ,"$35,031 " laptop technician/desktop device,12,$21.15 ,"$44,464 " development engineer technician,13,$15.eighty one ,"$30,464 " building management,31,$28.29 ,"$55,876 " building/heavy machine operators,13,$sixteen.04 ,"$19,791 " crook justice/legislations enforcement,one hundred thirty,$14.53 ,"$25,522 " statistics warehouse & database administration,fifty eight,$26.eleven ,"$fifty three,225 " Dental assistant,243,$15.78 ,"$26,167 " Dental hygienist,163,$42.00 ,"$60,629 " Diagnostic ultrasound technician,68,$34.32 ,"$fifty seven,829 " Diesel mechanics technician,172,$16.73 ,"$34,315 " Digital media: net/multi,ninety five,$17.00 ,"$24,989 " "Draft & design technician, typical",94,$18.fifty four ,"$35,012 " Early childhood educator & teacher,525,$13.sixty one ,"$21,940 " Electrical/digital & communications technician,78,$21.47 ,"$39,637 " Electrical/energy transmission installer,39,$20.ninety four ,"$41,121 " Electrician,forty nine,$15.95 ,"$29,428 " Electro-mechanical technician,33,$19.69 ,"$41,944 " Electrocardiograph technician,15,$13.ninety one ,"$23,608 " EMT (ambulance),262,$15.04 ,"$29,536 " EMT (paramedic),101,$21.07 ,"$forty four,448 " "Engineering technician, conventional",145,$17.05 ,"$35,a hundred and forty " Environmental engineer technician,11,$15.30 ,"$31,592 " Environmental technology,10,$15.07 ,"$28,221 " Esthetician & skincare,35,$17.14 ,"$18,334 " govt assistant/secretary,29,$15.ninety one ,"$29,707 " style/attire design,24,$15.78 ,"$26,533 " Firefighting,147,$17.01 ,"$31,423 " hearth science/administration,12,$34.forty eight ,"$ninety,427 " fire methods technician,sixteen,$18.seventy nine ,"$37,146 " Fishing & fisheries,14,$14.forty nine ,"$27,591 " international language for place of work,14,$sixteen.27 ,"$30,667 " woodland technician,15,$17.33 ,"$32,785 " Funeral director/service,20,$19.65 ,"$38,271 " photo design,57,$26.09 ,"$41,000 " image assistance programs & cartography,14,$23.83 ,"$39,862 " fitness tips/medical information,133,$17.00 ,"$33,556 " fitness unit coordinator/ward clerk,39,$15.59 ,"$25,180 " hearing instrument specialist,12,$sixteen.50 ,"$27,391 " warmth/AC/vent/refrigeration upkeep,one zero one,$19.fifty five ,"$36,942 " Hemodialysis technician,36,$16.86 ,"$33,951 " Histologic technician,10,$18.seventy five ,"$42,371 " home health aide,20,$15.76 ,"$30,214 " "Horticulture operations, conventional",44,$14.60 ,"$22,908 " health facility imperative carrier technician,21,$18.01 ,"$34,078 " Human supplies management/personnel,30,$sixteen.eighty one ,"$29,885 " Human functions practising,118,$14.93 ,"$27,058 " Industrial electronics technician,18,$15.30 ,"$23,229 " Industrial plant functions,eleven,$22.13 ,"$forty six,122 " tips processing,56,$17.00 ,"$33,290 " Instrumentation technician,20,$20.23 ,"$forty six,955 " interior design,54,$15.87 ,"$22,653 " Job advantage for constuction trade,19,$14.fifty five ,"$23,896 " Landscaping & groundskeeping,13,$17.04 ,"$32,812 " prison administrative assistant/secretary,39,$14.00 ,"$25,084 " criminal assistant/paralegal,212,$17.21 ,"$31,608 " Liberal arts & sciences,192,$14.14 ,"$20,194 " Library assisting,12,$13.65 ,"$22,694 " Licensed useful nursing,280,$21.fifty one ,"$forty,024 " Logistics & materials administration,13,$22.forty seven ,"$47,057 " computing device tool technician,187,$17.seventy three ,"$35,897 " Manufacturing technician,eighty three,$17.44 ,"$34,944 " marketing management,a hundred and one,$17.45 ,"$31,628 " therapeutic massage remedy,fifty three,$20.90 ,"$16,637 " Mechanical drafting/CAD,11,$17.33 ,"$41,960 " Mechanical technician,sixteen,$17.85 ,"$33,133 " clinical coverage coding specialist,112,$15.04 ,"$26,893 " scientific coverage expert,36,$sixteen.11 ,"$28,187 " medical laboratory technician,16,$22.forty four ,"$forty four,724 " medical workplace assistant,fifty five,$14.02 ,"$25,832 " medical workplace management,10,$14.sixty seven ,"$23,396 " clinical receptionist,37,$14.29 ,"$19,804 " clinical/clinical assistant,654,$15.sixty five ,"$30,046 " assembly & experience planning,eleven,$13.ninety three ,"$31,211 " mental health provider technician,16,$13.74 ,"$23,126 " "Microcomputer apps, normal",129,$sixteen.00 ,"$24,853 " bike protection & fix,sixteen,$14.50 ,"$28,203 " Multi-expert health care,26,$15.forty five ,"$23,374 " Musical instrument digital interface know-how,27,$14.05 ,"$19,769 " natural aid legislations enforcement,12,$20.58 ,"$34,408 " Occupational remedy assistant,seventy eight,$24.60 ,"$37,739 " office administration & supervision,174,$14.58 ,"$24,888 " Operations administration & supervisor,12,$22.fifty eight ,"$48,753 " Ophthalmic technician,5,$17.04 ,"$34,286 " Opticianry/ophthalmic doling out,15,$17.89 ,"$31,310 " Pharmacy technician/assistant,174,$16.09 ,"$27,500 " Phlebotomy,290,$15.forty three ,"$27,007 " actual therapy assistant,one hundred ten,$23.fifty nine ,"$41,332 " Plastics engineer technician,27,$13.64 ,"$28,551 " manner computing device preservation & restore,34,$22.59 ,"$50,393 " challenge management,32,$25.52 ,"$50,936 " Radiation & imaging,11,$28.51 ,"$54,198 " Radiologic technologist *,71,$29.64 ,"$47,809 " Radiologic technologist *,89,$27.sixty five ,"$46,477 " Registered nursing,1533,$31.66 ,"$fifty eight,445 " Rehabilitation counseling,11,$14.85 ,"$19,340 " Respiratory remedy technician,sixty three,$30.65 ,"$51,116 " Restaurant/culinary/catering management,10,$23.ninety two ,"$forty nine,274 " Retail administration,25,$19.04 ,"$38,661 " sign language interpretation & translation,14,$sixteen.87 ,"$21,622 " Social/human capabilities casework,eighty two,$14.31 ,"$26,772 " sports & fitness management,forty three,$15.36 ,"$21,287 " Stationary engineer,23,$20.62 ,"$43,303 " Substance abuse/dependancy,188,$14.88 ,"$28,598 " Surgical technician,104,$22.01 ,"$39,306 " Surveying technician,16,$22.37 ,"$46,222 " device administration,28,$15.eighty ,"$24,733 " system/network & LAN/WAN,18,$15.78 ,"$29,995 " Telecommunication technician,12,$21.14 ,"$forty six,060 " device & die technician,ninety one,$21.sixty three ,"$46,297 " Truck & bus driver,137,$18.34 ,"$37,627 " Veterinary assistant/technician,53,$13.sixty two ,"$26,258 " visual communications,29,$15.89 ,"$24,216 " Viticulture & enology,32,$15.22 ,"$32,426 " Water exceptional/wastewater management,17,$33.21 ,"$67,620 " web/multimedia administration/webmaster,35,$18.73 ,"$27,915 " Welding technician,489,$17.33 ,"$32,581 "

*Radiologic technology seems on the listing twice because diverse faculties coded the container differently, which led to two slightly different hourly and every year wage figures.


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Adverum Biotechnologies announces long-term Preclinical Efficacy records on ADVM-022 Gene therapy in wet AMD | killexams.com Real Questions and Pass4sure dumps

may additionally 01, 2018 09:00 ET | supply: Adverum Biotechnologies, Inc.

-- 13-Month data show Efficacy and sturdiness of Protein Expression following a Single Intravitreal Administration of ADVM-022 --

-- statistics to be introduced in a Poster Session on may also 17, 2018 at the ASGCT twenty first Annual convention --

MENLO PARK, Calif., may additionally 01, 2018 (GLOBE NEWSWIRE) -- Adverum Biotechnologies, Inc. (Nasdaq:ADVM), a clinical-stage gene remedy company targeting unmet clinical wants in serious rare and ocular ailments, announced lengthy-time period preclinical efficacy statistics on ADVM-022 in a non-human primate mannequin of moist age-linked macular degeneration (wAMD). in this preclinical examine, the efficacy of ADVM-022 at 13 months submit-administration become in step with earlier mentioned data, demonstrating that a single intravitreal injection of ADVM-022 turned into found to be protected and statistically huge (p<0.0001) in fighting the development of Grade IV lesions in comparison to the car control community. ADVM-022 prompted long-term efficacy that become corresponding to aflibercept, an anti-Vascular Endothelial increase factor (VEGF) standard-of-care therapy. ADVM-022 changed into well tolerated, with no severe adverse events.

The facts will be presented in a poster presentation on may also 17, 2018 at the ASGCT twenty first Annual meeting in Chicago, IL.

“We continue to be inspired by the efficacy and sustained protein tiers they are seeing a year put up a single intravitreal injection of ADVM-022,” noted Mehdi Gasmi, Ph.D, chief science and technology officer of Adverum Biotechnologies. “These long lasting efficacy facts support their plans to boost ADVM-022 into the health center and they remain on course to publish an Investigational New Drug (IND) software for ADVM-022 in the 2d half of this 12 months. they are excited to be working on a gene remedy candidate that has tested the expertise to alleviate the medicine burden of established injections for sufferers residing with moist AMD.”

“ADVM-022 represents a novel method to treating wAMD with a gene remedy administered as a single intravitreal injection,” said Szilard Kiss, M.D., director of clinical research within the department of Ophthalmology at Weill Cornell scientific college. “Intravitreal injections of aflibercept are a activities office practice for retinal consultants, and a single-administration medication with long lasting efficacy would tremendously improve the way this degenerative disease is handled.”

about the ADVM-022 Preclinical StudyThe long-term efficacy of ADVM-022 was evaluated in the business-commonplace laser-precipitated choroidal neovascularization (CNV) mannequin in non-human primates (NHPs). NHPs obtained a single intravitreal injection of both ADVM-022 (n=four, a hundred µL, ~2x1012 vg/eye, bilaterally) or car (n=four, a hundredµL, bilaterally) 12.5 months just before lasering of the macular region of the retina to set off VEGF upregulation and CNV. As a positive control, a separate community of animals got bilateral intravitreal injections of aflibercept recombinant protein (n=4, 30 µL, 1.2 mg/eye), an anti-VEGF ordinary-of-care therapy, on the time of lasering.  Clinically-imperative Grade IV lesions have been evaluated at two and four weeks publish lesioning and consequences were as follows:

  Efficacy DataIncidence of Grade IV Lesion   ADVM-022(13 Months)(n=4) Aflibercept(at Lasering)(n=4) car control(13 months)(n=four) 2 Weeks post Lesioning 0p.c1,2 2.eight%1,2 forty two.eightpercent1 four Weeks publish Lesioning 6.3p.c1,2 4.5percent1,2 forty.threepercent1 1p<0.0001 vs car 2p=0.4 and nil.7 between ADVM-022 and aflibercept corporations at 2 and 4 weeks, respectively

Three further animals that did not endure laser remedy and that bought the same intravitreal ADVM-022 injection confirmed solid vitreous levels of aflibercept at approximately three µg/mL 13 months publish vector administration.   

ASGCT Poster SessionPoster Title: AAV.7m8-aflibercept gives lengthy-term coverage in a Non-human Primate model of wet Macular Degeneration Over 365 days post Intravitreal Vector Administration (#554)Session Title: Neurologic diseases (including Ophthalmic and Auditory ailments) IITime: Thursday, might also 17, 2018, 5:15-7:15 pm CTLocation: Hilton Chicago, Stevens Salon C & D

About ADVM-022 Gene remedy for wAMDAdverum’s gene remedy candidate ADVM-022 makes use of a proprietary vector capsid (AAV.7m8) carrying an aflibercept coding sequence under the handle of a proprietary expression cassette and is run as a single intravitreal injection. VEGF overexpression can lead to wAMD development and vision loss.  remedy with ADVM-022 is designed to reduce the burden of everyday anti-VEGF injections, the current common-of-care medicine for wAMD.

About Adverum Biotechnologies, Inc.Adverum is a medical-stage gene therapy company concentrated on unmet scientific needs in critical rare and ocular illnesses. Adverum has a robust pipeline that includes product candidates designed to treat rare illnesses alpha-1 antitrypsin (A1AT) deficiency and hereditary angioedema (HAE) in addition to moist age-connected macular degeneration (wAMD). Leveraging a subsequent-era adeno-associated virus (AAV)-based mostly directed evolution platform, Adverum generates product candidates designed to deliver long lasting efficacy by inducing sustained expression of a therapeutic protein. Adverum has collaboration agreements with Regeneron prescription drugs to research, improve, and commercialize gene therapy items for ophthalmic ailments and Editas medication to discover the start of genome editing drug treatments for the treatment of inherited retinal illnesses. Adverum’s core capabilities consist of scientific construction and in-apartment manufacturing advantage, chiefly in process development and assay development. For extra assistance please discuss with www.adverum.com.

Adverum’s ahead-looking StatementsStatements contained in this press unencumber concerning Adverum’s intention to file an IND utility for ADVM-022 in the 2nd half of 2018 and skills for extra building of ADVM-022 are “ahead-looking statements” inside the that means of the deepest Securities Litigation Reform Act of 1995. precise outcomes and the timing of routine might range materially from these expected in such ahead-searching statements on account of a variety of risks and uncertainties described in Adverum’s periodic reports filed with the SEC. All ahead-searching statements contained in this press unlock speak handiest as of the date on which they had been made. Adverum undertakes no duty to update such statements to mirror routine that take place or cases that exist after the date on which they were made.

Contact for Adverum:Leone PattersonChief monetary Officer650-665-7222lpatterson@adverum.com


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Gyroscope's gene therapy given to first dry AMD patient | killexams.com real questions and Pass4sure dumps

Gyroscope

UK biotech Gyroscope Therapeutics could have a mass market product on its hands if its new gene therapy for one of the most common form of blindness proves effective.

The company has just dosed the first patient in a phase 1/2 trial of its gene therapy for dry age-related macular degeneration (AMD), one of the leading causes of blindness worldwide.

In 2020 it is estimated that 196m people globally will have the disease while 11m will already have significant vision loss. In the UK it affects around 600,000 people.

While other gene therapy pioneer companies have targeted rare eye diseases first, Gyroscope could open up a huge global market if the drug proves its worth in trials.

Its GT005 candidate has been injected into the back of one of the patient’s eyes in a bid to prevent further degeneration of photoreceptor cells in the retina. The patient, an 80-year-old woman from Oxford named Janet Osborne, has geographic atrophy (GA) associated with dry AMD, which causes blurring in the central vision of her left eye.

There are no approved therapies for the dry form of AMD, although antibodies can be used to treat the wet form of the eye disease, which is caused by abnormal blood vessel growth in the retina. Dry AMD is caused by the gradual death of retinal cells that can occur over many months or years and is far more common.

GT005 was administered under a local anaesthetic by Robert MacLaren, an ophthalmology specialist at Oxford Eye Hospital. It takes the form of a targeted, one-off injection into the macula of the retina that is designed to locally modulate the activity of complement, part of the innate immune system.

Complement consists of a series of soluble proteins intended to fight off foreign invaders in the body by activating a cell-killing factor called the membrane attack complex (MAC), but in dry AMD seems to run amok, damaging healthy retinal cells. GT005 uses a virus to deliver a gene sequence coding for a protein that prevents complement from attacking the cells. it is the first of Gyroscope’s gene therapies to progress into the clinic.

The initial trial is designed to check that the procedure is safe and provide some evidence that it can slow down photoreceptor cell degeneration, and if early signs are positive testing will be expanded to include patients with less advanced AMD.

“A genetically defined treatment administered early on to preserve vision in patients who would otherwise lose their sight would be a tremendous breakthrough and certainly something I hope to see in the near future,” said MacLaren.

Eye diseases have been an early target for gene therapies because delivery into the eye is relatively simple. The first approved gene therapy in the US was Spark Therapeutics’ Luxturna (voretigene neparvovec) for inherited retinal dystrophy (IRD) caused by RPE65 gene mutations, which was also cleared in Europe towards the end of last year.

Meanwhile, researchers at the US National Institutes of Health are also preparing for human trials of a stem cell-based implant for AMD that is designed to replace the photoreceptor cells lost in the disease.

Based at the biotech cluster Bio-Catalyst Science park in Stevenage in southern England, Gyroscope is one of several cell and gene therapy companies being funded by life sciences investment firm Syncona.

Chris Hollowood, chief investment officer of Syncona and chairman of Gyroscope, said: “The evolution of Gyroscope into a clinical stage company is a great milestone and an example of Syncona’s expertise in harnessing ‘Third Wave’ technologies to develop therapies for serious diseases. Gene therapies are at the forefront of a new generation of treatments for retinal diseases and they are excited by the potential of Gyroscope’s novel approach to address one of the world’s biggest causes of blindness.”

Soraya Bekkali

Dr Soraya Bekkali

Dr Soraya Bekkali, chief executive of Gyroscope Therapeutics, commented: “Our goal at Gyroscope is to advance new therapies for the treatment of debilitating eye diseases such as age-related macular degeneration. Building on the research of Gyroscope’s scientific founders, they have been working relentlessly over the last two years to advance their first drug development programme into the clinic.

We are delighted to have dosed the first patient in the FOCUS study. They believe this is a great step forward in developing a therapy to treat dry AMD, while they continue their efforts on expanding their clinical programmes internationally.”


Loss to Follow-Up in Patients With Retinal Vein Occlusion Undergoing Intravitreal Anti-VEGF Injections | killexams.com real questions and Pass4sure dumps

Introduction

Retinal vein occlusion (RVO) is a fairly common cause of vision loss, with an estimated prevalence between 0.3%1 and 1.6%.2 More recently, a pooled analysis from 11 studies estimated that 16.4 million adults were affected by RVO worldwide.3 Macular edema resulting from RVO is often the primary cause of impaired vision, with vascular endothelial growth factor (VEGF) playing a critical role in the pathogenesis. Multiple studies have demonstrated that intravitreal anti-VEGF injections improve visual outcomes.4–6 In the CRYSTAL study for macular edema due to central retinal vein occlusion (CRVO), ranibizumab (Lucentis; Genentech, South San Francisco, CA) therapy resulted in significant visual acuity (VA) gains at 12 months with a mean of 8.1 injections.7 Similarly, in the BRAVO and CRUISE trials, patients with RVO with monthly ranibizumab injections achieved improved vision-related function compared with patients who received sham through 6 months.8 Regular follow-up is imperative for many of these cases in order to optimize outcomes. However, to date, few studies have investigated the frequency of loss to follow-up (LTFU) in patients with RVO receiving intravitreal injections, as well as the associated demographics and risk factors. In this study, they sought to determine the proportion of patients who were LTFU in a large retina practice and identify potential associated factors.

Patients and MethodsSubjects

A retrospective cohort study based on billing codes was initiated among all patients with macular edema secondary to RVO who received at least one intravitreal anti-VEGF injection at Wills Eye Hospital and the offices of Mid-Atlantic Retina, a large retina practice with multiple offices in Pennsylvania, New Jersey, and Delaware, from January 1, 2012, to January 1, 2017. A flowchart with the description of included and excluded patients is shown in Figure 1. This study was approved by the institutional review board at Wills Eye Hospital.

Flowchart for inclusion of patients with retinal vein occlusion (RVO) in final analysis. A total of 3,400 patients with macular edema due to RVO receiving intravitreal anti-vascular endothelial growth factor injections were eligible for final analysis after the application of the inclusion and exclusion criteria.

Figure 1.

Flowchart for inclusion of patients with retinal vein occlusion (RVO) in final analysis. A total of 3,400 patients with macular edema due to RVO receiving intravitreal anti-vascular endothelial growth factor injections were eligible for final analysis after the application of the inclusion and exclusion criteria.

Study Population

Medical diagnoses for RVO were based on International Classification of Disease, 9th or 10th Revision Clinical Modification (ICD-9/ICD-10). Current Procedural Terminology 4 (CPT4) codes were used for identifying intravitreal injections. Bevacizumab (Avastin; Genentech, South San Francisco, CA), ranibizumab, and aflibercept (Eylea; Regeneron, Tarrytown, NY) were identified using the medication-specific Healthcare Common Procedure Coding System codes. Only those initiating intravitreal anti-VEGF injections between January 1, 2012, to January 1, 2016, were included. Patients who were found to be deceased during follow-up or received corticosteroid injections were excluded. Repeated intravitreal injections were performed on a treat-and-extend or pro re nata basis at the discretion of the injecting physician.

Data Collection

Information from patient records, including race / ethnicity, age, gender, address, VA, date of each office visit, and date of each injection, was entered into an electronic database. Best available Snellen VA measurements were collected using distance spectacle correction or best pinhole correction when available. Only a subgroup of their patient cohort had recorded VA that could be utilized in the final analysis due to the fact that, during the study period, patient charts were transitioned to an electronic health record system. As a result, some of the older clinical data were no longer accessible. The interval between each injection and the next subsequent visit was calculated. The longest interval was used for assessment of follow-up. Regional average adjusted gross income (AGI) was calculated using the Internal Revenue Service's AGI database, which provides the average AGI per zip code across the United States.9 Patients' addresses were translated into a coordinate format using the Bing maps application program interface (Microsoft, Redmond, WA). Spherical distance from patient residence to the retina clinic was calculated using a Haversine formula.10,11

Definition of LTFU

Follow-up intervals for each patient were measured from the date of each intravitreal anti-VEGF treatment to the next subsequent visit. LTFU was defined as a subsequent visit occurring more than 12 months after an intravitreal injection or no further visits after the last intravitreal injection with this last injection occurring at least 12 months prior and no records of death before the end of the study period. The analysis was closed 12 months before database closure, and the period from January 1, 2016, to January 1, 2017, was used as a window for observation.12,13 Any patients who initiated intravitreal injections during that period were excluded.

Statistical Analysis

The following factors were evaluated for possible associations with LTFU: age (< 65 years, 65 years to 80 years, > 80 years), gender (male, female), race (white, black, Asian, Hispanic, other, unknown), AGI (< $50,000, $50,000 to $100,000, > $100,000), RVO types (CRVO, branch retinal vein occlusion [BRVO]), distance of residence from clinic (<10 miles, 10 miles to 20 miles, > 20 miles). The continuous variables of age, distance from clinic, and regional average AGI were converted to categorical variables based on the data distributions and biological factors. In the category of race, “Other” included American Indian, Pacific Islander, and multiple races. Patients who had no listed race in the practice database or who declined to be identified were classified as “Unknown.” Subgroup analysis was conducted based on a subset of patients with VA data at the baseline visit. It was converted to categorical variables based on the data distribution and classified as VA better than 20/50, 20/50 to 20/100, and worse than 20/100.

Data were analyzed using SPSS version 17.0 (SPSS, Chicago, IL). The chi-square test was used to compare the differences based on characteristics between patients with follow-up and LTFU. Variables with a P value of .2 or less in the univariate analysis were evaluated in the logistic regression model using a stepwise backward strategy to evaluate the independent association between variables and LTFU. Associations were estimated using odds ratio with 95% confidence intervals (CI). A P value of less than .05 was considered statistically significant.

Results

A total of 4,462 patients with RVO undergoing intravitreal injections from January 1, 2012, to January 1, 2017, were identified (Figure 1). Since January 1, 2016, to January 1, 2017, was set as a window of observation for patients who had injections prior to that time period, 799 (17.9%) participants receiving injections for the first time during this period were excluded. An additional 134 (3.0%) patients receiving intravitreal corticosteroid injections were also excluded. 129 (2.9%) patients were excluded due to death. As a result, 3,400 patients who had 37,664 clinical visits were eligible. Mean (± standard deviation, [SD]) age of the study population was 75.3 years (± 13.2 years), with 72.8 years (± 13.6 years) for males and 77.5 years (± 12.5 years) for females. A total of 26,026 intravitreal injections were performed, with an average of 7.66 injections for each patient.

Following an injection, 863 (25.4%) patients were LTFU. Of those, the majority (789, 91.4%) had no further visits for more than 12 months after the last intravitreal injection and only 74 (8.6%) returned more than 1 year after an injection. Of the 789 patients, 271 (34.3%) only received one injection and never returned. Characteristics of the RVO subjects is shown in table 1. Among the three age groups, LTFU rate was lowest in patients between 65 and 80 years old (22.1% [298 of 1,347]), increasing to 25.5% (347 of 1,359) in those older than 80 years of age and 31.4% (218 of 694) in those younger than 65 years old (P < .001). Based on race / ethnicity, LTFU was observed in 22.3% (574 of 2,576) of white patients, 28.2% (97 of 344) of black patients, 16.7% (12 of 72) of Asian patients, 41.1% (51 of 124) of Hispanic patients, and 44.2% (119 of 269) in unknown races (P < .001). Four hundred seventy-four of 1,632 (29.0%) patients with CRVO and 389 of 1,768 (22.0%) patients BRVO were LTFU (P < .001). The highest proportion of LTFU in each group was found to be patients living more than 20 miles away from clinic (30.9%), those with AGI <$50,000 (29.2%), and those with no health insurance (50.0%) (P < .05 within each group).

Baseline Characteristics of Patients With RVO Follow-Up and Loss to Follow-Up After Intravitreal Anti-VEGF Injections

Table 1:

Baseline Characteristics of Patients With RVO Follow-Up and Loss to Follow-Up After Intravitreal Anti-VEGF Injections

Table 2 shows the univariate and multivariate results for the predictive factors for LTFU. Based on the univariate analysis, age group, race / ethnicity, RVO type, distance of residence from clinic, insurance status, and regional average AGI were all associated with LTFU and were considered in the multivariate model. After adjusting for covariates, gender and AGI did not significantly predict LTFU or interact with the other predictors. Compared with white patients, patients who were black (odds ratio [OR]: 1.37; 95% confidence interval [CI], 1.06–1.78; P = .02), Hispanic (OR: 2.37; 95% CI, 1.62–3.47; P < .001), other (OR: 8.04; 95% CI, 2.71–23.67; P < .001), and unknown (OR: 2.81; 95% CI, 2.17–3.65; P < .001) were associated with a higher risk of LTFU. Those living more than 20 miles away from the clinic were also more likely to be LTFU (OR: 1.47; 95% CI, 1.17–1.86) when compared with patients living fewer than 10 miles away (P = .001). Patients with no insurance were at approximately two-fold increased odds of LTFU compared to those with government coverage for insurance (P = .05). In contrast, patients between the ages of 65 and 80 years had a 29% lower risk of LTFU compared to those younger than 65 years (P = .007). Compared to patients with CRVO, the BRVO group was less likely to be LTFU (OR: 0.70; 95% CI, 0.60–0.82; P < .001).

Potential Risk Factors for Loss to Follow-Up in Patients With Macular Edema Due to RVO Following Intravitreal Anti-VEGF Injections

Table 2:

Potential Risk Factors for Loss to Follow-Up in Patients With Macular Edema Due to RVO Following Intravitreal Anti-VEGF Injections

Subgroup analysis was performed on 1,957 patients with RVO with available VA data. The lowest rate of LTFU (14.1%) was found in patients with a baseline VA better than 20/50, whereas the highest rate (20.1%) occurred in those with VA between 20/50 and 20/100. A statistically significant difference was detected between these three groups (P = .006). Multivariate analysis showed that patients with baseline VA 20/50 to 20/100 or worse than 20/100 were approximately 1.5-times more likely to be LTFU compared to those with VA better than 20/50.

Discussion

Our study investigated LTFU immediately after an intravitreal anti-VEGF injection for macular edema due to RVO in a real-world setting. They found that approximately one in four patients did not return for a subsequent visit for at least 1 year, which is of potential concern given the importance of ongoing therapy to optimize visual outcomes. They also found that LTFU was significantly associated with race/ethnicity, age, RVO type, and distance from clinic.

The 25.4% rate of LTFU found in their study was higher than expected. Among those patients classified as LTFU, the vast majority (91.4%) never returned, whereas the remaining 8.6% returned for a visit sometime beyond 1 year. Moreover, approximately one in three patients who were LTFU only had one injection and never returned. Since these patients are likely at greatest risk for vision loss without appropriate therapy, it is concerning to see such a high rate. Although no prior published studies appear to have explored LTFU rates in RVO, one study has looked at this issue in patients with neovascular age-related macular degeneration (AMD) receiving intravitreal ranibizumab injections. In this study, 19.9% were noncompliant with follow-up. However, they only investigated 95 patients undergoing intravitreal ranibizumab on a pro re nata regimen with monthly follow-up and defined nonadherence as missing a scheduled visit. A questionnaire found that lack of motivation was the primary reason for the LTFU.14 Differences in the definition of LTFU, method of data analysis, and underlying diagnosis distinguishes their study from ours, limiting direct comparisons.

We also examined potential factors associated with LTFU. Patients with a diagnosis of CRVO were more likely to be LTFU than those with BRVO. One possible explanation is that patients with more severe ischemia and, therefore, poorer visual outcomes despite anti-VEGF injections may be less motivated to adhere to further therapy. Prior studies have demonstrated that patients with severe ocular disease and poor VA were less likely to follow-up.15,16 Since CRVO patients are more likely than BRVO to have severe macular ischemia and poorer vision,17,18 this may explain the greater rate of LTFU. Their subgroup analysis of patients with available baseline VA data appear to support this hypothesis, as those with VA of 20/50 or worse were more likely to be LTFU.

Another factor that appeared to impact LTFU was race / ethnicity. Compared with white patients, those who were black and Hispanic were at higher risk of LTFU. In previous diabetic retinopathy screening studies, African-Americans were found to be less likely to receive eye care.19,20 Another study also found that black patients with diabetes were only 70% as likely to have eye care visits compared with white patients.21 Similarly, the Los Angeles Latino Eye Study analyzed 821 adult Latinos with type 2 diabetes mellitus and discovered that only about 35% of Latinos followed the American Diabetes Association guidelines for eye care.22 Their study differed by looking at patients who had already started a treatment plan but failed to return in a timely fashion whereas the prior studies explored the likelihood of patients to initiate a care visit. Nevertheless, the fact that 28.2% of black patients and 41.1% of Hispanic patients compared to 22.3% of white patients were LTFU suggests that there may exist societal and / or cultural barriers to proper care.23 Of note, a high rate of LTFU (44.2%) was detected in patients who chose not to self-report their race in their study. The sociodemographic distribution in this population is not well understood due to the lack of supporting literature.

Age was another important factor associated with LTFU. Patients who were between 65 and 80 years old were less likely to be LTFU. The Diabetic Retinopathy Awareness Program found that younger age was one of the factors associated with diabetic vision care noncompliance.24 One explanation may be that most patients younger than 65 years are still working, making it more challenging to take time off for clinic visits. Another possible explanation may be related to medical insurance coverage. Since patients in the U.S. are covered under Medicare starting at age 65, these older patients would have at least 80% of medical expenses covered. Younger patients may be more likely to be uninsured or have high deductible plans, which may be another barrier to receiving appropriate care. Based on their findings, patients older than 80 years of age were also more likely to be LTFU. Although these older patients should have less problems with insurance coverage due to Medicare, they may need to rely more on others to transport them to office visits. In addition, with advancing age they likely have more comorbidities and therefore need to prioritize their care.

Distance also appeared to influence LTFU, with patients living more than 20 miles away being at highest risk. Some of these patients from more distant locations may have been coming for a one-time second opinion or were visiting the area when the RVO occurred. The longer driving time as well as higher expense for gas and possibly tolls may have also contributed. Moreover, approximately 40% of the patients in their study were older than 80 years of age. Many of these patients may not feel comfortable driving longer distances and may have to rely on others to bring them to the office, which is a greater burden to the caregiver if the office is farther away.

This study has several limitations. It was retrospective and relied on accurate demographic and billing data from a practice database. Their analysis did not include all of the potential factors that might explain the LTFU. Since they only had access to their practice database rather than all practice databases in their geographic area, it is possible that some patients may have followed up with another eye care specialist for ongoing care. Finally, the definition for LTFU focused on the time interval between an injection and next follow-up visit. They chose a period of 12 months for that interval, as it would be extremely unlikely that a patient would have been given an injection and then instructed to return a year or more later. Despite these limitations, this was a fairly large study that included 3,400 patients receiving 26,026 intravitreal injections over 37,664 visits during a 4-year period. In addition, they were able to perform a systematic analysis of these patients that highlights a real-world potentially alarming rate of LTFU in patients with RVO receiving intravitreal anti-VEGF injections.

In summary, their findings highlight the need for more effective interventions to encourage better follow-up in patients with RVO receiving intravitreal anti-VEGF injections. Patients who are younger than 65 years of age, black or Hispanic, diagnosed with CRVO, living in more distant locations, or have worse baseline VA may require special attention. Future studies looking at larger numbers of patients with varying demographic backgrounds and geographic locations will be helpful to confirm these results. Identifying additional risk factors will also be necessary in order to design risk prediction models that allow clinicians to focus interventions on those at highest risk of LTFU.

References
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  • Paz SH, Varma R, Klein R, et al. Noncompliance with vision care guidelines in Latinos with type 2 diabetes mellitus: The Los Angeles Latino Eye Study. Ophthalmology. 2006;113(8):1372–1377. doi:10.1016/j.ophtha.2006.04.018 [CrossRef]
  • Nsiah-Kumi P, Ortmeier SR, Brown AE. Disparities in diabetic retinopathy screening and disease for racial and ethnic minority populations — a literature review. J Natl Med Assoc. 2009;101(5):430–437. doi:10.1016/S0027-9684(15)30929-9 [CrossRef]
  • Schoenfeld ER, Greene JM, Wu SY, Leske MC. Patterns of adherence to diabetes vision care guidelines: Baseline findings from the Diabetic Retinopathy Awareness Program. Ophthalmology. 2001;108(3):563–571. doi:10.1016/S0161-6420(00)00600-X [CrossRef]
  • Table 1

    Baseline Characteristics of Patients With RVO Follow-Up and Loss to Follow-Up After Intravitreal Anti-VEGF Injections

    VariableFollow-Up (N = 2,537)Loss to Follow-Up (N = 863)P ValueGender, n (%).06  Male1,167 (46.0%)429 (49.7%)  Female1,370 (54.0%)434 (50.3%)Age (Years), n (%)< .001  < 65476 (18.8%)218 (25.3%)  65–801,049 (41.3%)298 (34.5%)  > 801,012 (39.9%)347 (40.2%)Race, n (%)< .001  White2,002 (78.9%)574 (66.5%)  Black247 (9.7%)97 (11.2%)  Asian60 (2.4%)12 (1.4%)  Hispanic73 (2.9%)51 (5.9%)  Othera5 (0.2%)10 (1.2%)  Unknown150 (5.9%)119 (13.8%)RVO Type, n (%)< .001  CRVO1,158 (45.6%)474 (54.9%)  BRVO1,379 (54.4%)389 (45.1%)Distance From Clinics (Miles), n (%).02  < 101,751 (69.0%)570 (66.1%)  10–20488 (19.2%)160 (18.5%)  > 20298 (11.8%)133 (15.4%)Regional Average AGI, n (%).006  < $50,000621 (24.5%)256 (29.7%)  $50,000–100,0001,415 (55.8%)462 (53.5%)  > $100,000501 (19.7%)145 (16.8%)Health Insurance Status, n (%)< .001  Government coverageb1,776 (70.0%)557 (64.5%)  Private744 (29.3%)289 (33.5%)  No insurance17 (0.7%)17 (2.0%)Table 2

    Potential Risk Factors for Loss to Follow-Up in Patients With Macular Edema Due to RVO Following Intravitreal Anti-VEGF Injections

    Univariate AnalysisMultivariate AnalysisVariableLoss to Follow-Up, n (%)OR (95% CI)P ValueOR (95% CI)P ValueGender  Male429 (26.9%)1.00 [Ref]1.00 [Ref]  Female434 (24.1%)0.86 (0.74–1.01).060.89 (0.76–1.05).17Age (Years)  < 65218 (31.4%)1.00 [Ref]1.00 [Ref]  65–80298 (22.1%)0.62 (0.51–0.76)< .0010.71 (0.55–0.91).007  > 80347 (25.5%)0.75 (0.61–0.92).0050.91 (0.71–1.18).49Race  White574 (22.3%)1.00 [Ref]1.00 [Ref]  Black97 (28.2%)1.37 (1.06–1.76).021.37 (1.06–1.78).02  Asian12 (16.7%)0.70 (0.37–1.31).260.65 (0.35–1.23).19  Hispanic51 (41.1%)2.44 (1.68–3.53)< .0012.37 (1.62–3.47)< .001  Othera10 (66.7%)6.98 (2.38–20.49)< .0018.04 (2.71–23.67)< .001  Unknown119 (44.2%)2.77 (2.14–3.58)< .0012.81 (2.17–3.65)< .001RVO Type  CRVO474 (29.0%)1.00 [Ref]1.00 [Ref]  BRVO389 (22.0%)0.69 (0.59–0.81)< .0010.70 (0.60–0.82)< .001Distance From Clinics (Miles)  < 10570 (24.6%)1.00 [Ref]1.00 [Ref]  10–20160 (24.7%)1.01 (0.82–1.23).951.03 (0.84–1.27).80  > 20133 (30.9%)1.37 (1.10–1.72).0061.47 (1.17–1.86).001Regional Average AGI  < $50,000256 (29.2%)1.00 [Ref]1.00 [Ref]  $50,000–100,000462 (24.6%)0.79 (0.66–0.95).010.90 (0.74–1.10).31  > $100,000145 (22.4%)0.70 (0.56–0.89).0030.86 (0.67–1.12).25Health Insurance Status  Government coverageb557 (23.9%)1.00 [Ref]1.00 [Ref]  Private289 (28.0%)1.24 (1.05–1.46).011.16 (0.94–1.43).17  No insurance17 (50.0%)3.19 (1.62–6.29).0012.06 (1.00–4.26).05Baseline Snellen VAc  > 20/5091 (14.1%)1.00 [Ref]1.00 [Ref]  20/50–20/100129 (20.1%)1.525 (1.137–2.046).0051.526 (1.129–2.063).006  < 20/100134 (20.0%)1.519 (1.135–2.033).0051.401 (1.027–1.911).033

    Jobs that pay without a B.A.: the most lucrative fields in Washington state | killexams.com real questions and Pass4sure dumps

    Want to make good money without earning a four-year college degree? Consider becoming a dental hygienist, diagnostic ultrasound technician, registered nurse or respiratory-therapy technician.

    Those are a few of the jobs with salaries that hit $50,000 or more a year just a year out of a training program at a community or technical college.

    These numbers — produced by the State Board for Community and Technical Colleges (SBCTC) — dovetail with the findings from a recent report by the Georgetown Center on Education and the Workforce, which concludes that blue-collar jobs that pay a good wage continue to be on the decline across the country, but skilled-services jobs that pay well are on the rise.

    And while those skilled-service jobs don’t require a four-year college degree, applicants typically need some education beyond high school, such as an associate or technical degree or certificate from a community college.

    In its report, “Good Jobs that Pay without a BA,” Georgetown calculates that there are 30 million jobs in the United States today that provide median earnings of $55,000 annually for people without a bachelor’s degree. (For the purpose of this report, Georgetown defines a “good job” as one that pays a median earnings of $55,000 a year, and a minimum of $35,000 a year.)

    The report also estimates that 62 percent of Washington workers don’t have a bachelor’s degree. Of those workers, only 42 percent have a job that pays a good wage.

    Georgetown identified five industries in Washington that have had the greatest growth in “good jobs” since 1991: leisure and hospitality and personal services, health-care services, financial consulting/business services, education services and government services.

    But let’s get more specific.

    The state community-college board collects data on what its students are paid a year after they graduate from one of its colleges’ professional and technical programs and certificates. (Professional and technical programs prepare students for the workforce, and are not the same as academic transfer programs, which get students ready to transfer to a four-year college and earn a bachelor’s degree.)

    The report has some limitations; for example, the board knows its graduates’ fields of study and their year-after-graduation pay, but it doesn’t know if the graduate actually took a job in the specific field in which they studied. Still, the report is a pretty good indicator, and the numbers align well with the Georgetown University study. It’s also current, measuring how much students who graduated in 2013-14 were making in 2015-16.

    Graduates who go into health care earn some of the top salaries. The highest-paid field of study in Washington is dental hygienist. The median salary in that field is $42 an hour. Nursing — no surprise here — is a top field, too, with the state’s 1,533 nursing graduates from 2013-14 making a median wage of $31.66 an hour. The midpoint salary for professionals in diagnostic medical ultrasound is $34.32 an hour.

    Some programs that graduate fewer than 50 students a year — including cardiovascular technology, fire science and water quality/wastewater management — also pay very high wages.

    One caveat: Some of the highest-paying fields of study are also difficult to get into because there’s so much competition among students. For example, a student applying to get into a community-college nursing program will need top grades in prerequisite courses, said Darby Kaikkonen, policy-research director for the community and technical college board.

    Early childhood education is the lowest-paying field in Washington, offering a median salary of just $13.61 an hour, or median annual salary of $21,940 for the 525 students who graduated with that degree.

    That’s a reflection of how little value is placed on teaching young children, said Laura McDowell, spokeswoman for the colleges. But because it’s also a popular field, the colleges are designing “stackable” certificates — certificates that build on each other and lead to an associate degree, which then can lead to an applied bachelor’s degree, which can lead to a higher salary. Highline College offers such a program.

    Between 1991 and 2015, the number of blue-collars jobs did go up in Washington state — no doubt some of them in the construction industry, one of the most lucrative fields for people without a bachelor’s in fast-growing Seattle.

    But the state added even more good jobs for people who worked in skilled services — 93,000 jobs in all, according to the Georgetown analysis.

    Grads from these 10 community-college programs make the highest salaries This chart shows the median salaries students are making a year after they graduate from one of the professional or technical programs listed below. The report has some limitations – for example, researchers don’t know if graduates actually took a job in the specific field in which they studied. If you're viewing this interactive on a mobile, rotate your device to landscape mode. Job/field of study,Total students completing program,Median wages,Median earnings Accounting technician & bookkeeping,552,$16.13 ,"$28,342 " Administrative assistant & secretary sciences,71,$14.52 ,"$26,306 " Agriculture business & management,11,$16.06 ,"$29,948 " Air traffic control,23,$15.89 ,"$29,360 " Aircraft/frame/powerplant mechanic,148,$18.30 ,"$39,670 " Airframe mechanical & aircraft,236,$16.34 ,"$34,094 " Airline/commercial/professional pilot,27,$18.59 ,"$26,852 " Anesthesiologist assistant,10,$22.19 ,"$47,837 " Architectural drafting & architectural CAD,16,$21.06 ,"$29,314 " Auto mechanics,378,$14.64 ,"$28,727 " Auto service center specialist,12,$13.67 ,"$22,815 " Auto body/collision & repair,69,$14.45 ,"$29,081 " Biomedical technician,33,$23.67 ,"$49,364 " Building construction technician,26,$15.59 ,"$24,826 " Building/construction management,31,$22.62 ,"$48,885 " Building/home/construction specialist,12,$25.40 ,"$30,446 " Business administrative & management,313,$15.35 ,"$26,961 " Cabinetmaking & millwork,29,$16.63 ,"$29,913 " CAD draft/design technician,44,$19.51 ,"$38,416 " Cardiovascular technologist,11,$41.71 ,"$76,718 " Carpentry,40,$17.41 ,"$29,026 " Child-care provider/assistant,17,$14.05 ,"$27,000 " Civil draft/engineer CAD,23,$21.62 ,"$41,399 " Civil engineering technician,19,$20.51 ,"$35,008 " Clinical/medical lab technician (certificate),52,$18.94 ,"$35,766 " Computer numerical control machinist technician,25,$17.14 ,"$32,320 " Commercial photography,24,$14.79 ,"$17,160 " Computer & information systems security,105,$20.19 ,"$40,493 " Computer graphics,66,$14.50 ,"$19,480 " "Computer program, product",10,$17.01 ,"$33,113 " Computer programming,115,$21.14 ,"$40,308 " Computer support specialist,77,$14.44 ,"$27,924 " Computer systems network/telecommunication,372,$18.23 ,"$35,031 " Computer technician/computer system,12,$21.15 ,"$44,464 " Construction engineer technician,13,$15.81 ,"$30,464 " Construction management,31,$28.29 ,"$55,876 " Construction/heavy equipment operators,13,$16.04 ,"$19,791 " Criminal justice/law enforcement,130,$14.53 ,"$25,522 " Data warehouse & database administration,58,$26.11 ,"$53,225 " Dental assistant,243,$15.78 ,"$26,167 " Dental hygienist,163,$42.00 ,"$60,629 " Diagnostic ultrasound technician,68,$34.32 ,"$57,829 " Diesel mechanics technician,172,$16.73 ,"$34,315 " Digital media: web/multi,95,$17.00 ,"$24,989 " "Draft & design technician, general",94,$18.54 ,"$35,012 " Early childhood educator & teacher,525,$13.61 ,"$21,940 " Electrical/electronic & communications technician,78,$21.47 ,"$39,637 " Electrical/power transmission installer,39,$20.94 ,"$41,121 " Electrician,49,$15.95 ,"$29,428 " Electro-mechanical technician,33,$19.69 ,"$41,944 " Electrocardiograph technician,15,$13.91 ,"$23,608 " EMT (ambulance),262,$15.04 ,"$29,536 " EMT (paramedic),101,$21.07 ,"$44,448 " "Engineering technician, general",145,$17.05 ,"$35,140 " Environmental engineer technician,11,$15.30 ,"$31,592 " Environmental technology,10,$15.07 ,"$28,221 " Esthetician & skin care,35,$17.14 ,"$18,334 " Executive assistant/secretary,29,$15.91 ,"$29,707 " Fashion/apparel design,24,$15.78 ,"$26,533 " Firefighting,147,$17.01 ,"$31,423 " Fire science/administration,12,$34.48 ,"$90,427 " Fire systems technician,16,$18.79 ,"$37,146 " Fishing & fisheries,14,$14.49 ,"$27,591 " Foreign language for workplace,14,$16.27 ,"$30,667 " Forest technician,15,$17.33 ,"$32,785 " Funeral director/service,20,$19.65 ,"$38,271 " Graphic design,57,$26.09 ,"$41,000 " Graphic information systems & cartography,14,$23.83 ,"$39,862 " Health information/medical records,133,$17.00 ,"$33,556 " Health unit coordinator/ward clerk,39,$15.59 ,"$25,180 " Hearing instrument specialist,12,$16.50 ,"$27,391 " Heat/AC/vent/refrigeration maintenance,101,$19.55 ,"$36,942 " Hemodialysis technician,36,$16.86 ,"$33,951 " Histologic technician,10,$18.75 ,"$42,371 " Home health aide,20,$15.76 ,"$30,214 " "Horticulture operations, general",44,$14.60 ,"$22,908 " Hospital central service technician,21,$18.01 ,"$34,078 " Human resources management/personnel,30,$16.81 ,"$29,885 " Human services training,118,$14.93 ,"$27,058 " Industrial electronics technician,18,$15.30 ,"$23,229 " Industrial plant services,11,$22.13 ,"$46,122 " Information processing,56,$17.00 ,"$33,290 " Instrumentation technician,20,$20.23 ,"$46,955 " Interior design,54,$15.87 ,"$22,653 " Job skills for constuction trade,19,$14.55 ,"$23,896 " Landscaping & groundskeeping,13,$17.04 ,"$32,812 " Legal administrative assistant/secretary,39,$14.00 ,"$25,084 " Legal assistant/paralegal,212,$17.21 ,"$31,608 " Liberal arts & sciences,192,$14.14 ,"$20,194 " Library assisting,12,$13.65 ,"$22,694 " Licensed practical nursing,280,$21.51 ,"$40,024 " Logistics & materials management,13,$22.47 ,"$47,057 " Machine tool technician,187,$17.73 ,"$35,897 " Manufacturing technician,83,$17.44 ,"$34,944 " Marketing management,101,$17.45 ,"$31,628 " Massage therapy,53,$20.90 ,"$16,637 " Mechanical drafting/CAD,11,$17.33 ,"$41,960 " Mechanical technician,16,$17.85 ,"$33,133 " Medical insurance coding specialist,112,$15.04 ,"$26,893 " Medical insurance specialist,36,$16.11 ,"$28,187 " Medical laboratory technician,16,$22.44 ,"$44,724 " Medical office assistant,55,$14.02 ,"$25,832 " Medical office management,10,$14.67 ,"$23,396 " Medical receptionist,37,$14.29 ,"$19,804 " Medical/clinical assistant,654,$15.65 ,"$30,046 " Meeting & event planning,11,$13.93 ,"$31,211 " Mental health service technician,16,$13.74 ,"$23,126 " "Microcomputer apps, general",129,$16.00 ,"$24,853 " Motorcycle maintenance & repair,16,$14.50 ,"$28,203 " Multi-skilled health care,26,$15.45 ,"$23,374 " Musical instrument digital interface technology,27,$14.05 ,"$19,769 " Natural resource law enforcement,12,$20.58 ,"$34,408 " Occupational therapy assistant,78,$24.60 ,"$37,739 " Office management & supervision,174,$14.58 ,"$24,888 " Operations management & supervisor,12,$22.58 ,"$48,753 " Ophthalmic technician,5,$17.04 ,"$34,286 " Opticianry/ophthalmic dispensing,15,$17.89 ,"$31,310 " Pharmacy technician/assistant,174,$16.09 ,"$27,500 " Phlebotomy,290,$15.43 ,"$27,007 " Physical therapy assistant,110,$23.59 ,"$41,332 " Plastics engineer technician,27,$13.64 ,"$28,551 " Process machine maintenance & repair,34,$22.59 ,"$50,393 " Project management,32,$25.52 ,"$50,936 " Radiation & imaging,11,$28.51 ,"$54,198 " Radiologic technologist *,71,$29.64 ,"$47,809 " Radiologic technologist *,89,$27.65 ,"$46,477 " Registered nursing,1533,$31.66 ,"$58,445 " Rehabilitation counseling,11,$14.85 ,"$19,340 " Respiratory therapy technician,63,$30.65 ,"$51,116 " Restaurant/culinary/catering management,10,$23.92 ,"$49,274 " Retail management,25,$19.04 ,"$38,661 " Sign language interpretation & translation,14,$16.87 ,"$21,622 " Social/human services casework,82,$14.31 ,"$26,772 " Sports & fitness management,43,$15.36 ,"$21,287 " Stationary engineer,23,$20.62 ,"$43,303 " Substance abuse/addiction,188,$14.88 ,"$28,598 " Surgical technician,104,$22.01 ,"$39,306 " Surveying technician,16,$22.37 ,"$46,222 " System administration,28,$15.80 ,"$24,733 " System/network & LAN/WAN,18,$15.78 ,"$29,995 " Telecommunication technician,12,$21.14 ,"$46,060 " Tool & die technician,91,$21.63 ,"$46,297 " Truck & bus driver,137,$18.34 ,"$37,627 " Veterinary assistant/technician,53,$13.62 ,"$26,258 " Visual communications,29,$15.89 ,"$24,216 " Viticulture & enology,32,$15.22 ,"$32,426 " Water quality/wastewater management,17,$33.21 ,"$67,620 " Web/multimedia management/webmaster,35,$18.73 ,"$27,915 " Welding technician,489,$17.33 ,"$32,581 "

    *Radiologic technology appears on the list twice because different schools coded the field differently, which led to two slightly different hourly and yearly wage figures.



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    Siemens [1 Certification Exam(s) ]
    Snia [7 Certification Exam(s) ]
    SOA [15 Certification Exam(s) ]
    Social-Work-Board [4 Certification Exam(s) ]
    SpringSource [1 Certification Exam(s) ]
    SUN [63 Certification Exam(s) ]
    SUSE [1 Certification Exam(s) ]
    Sybase [17 Certification Exam(s) ]
    Symantec [135 Certification Exam(s) ]
    Teacher-Certification [4 Certification Exam(s) ]
    The-Open-Group [8 Certification Exam(s) ]
    TIA [3 Certification Exam(s) ]
    Tibco [18 Certification Exam(s) ]
    Trainers [3 Certification Exam(s) ]
    Trend [1 Certification Exam(s) ]
    TruSecure [1 Certification Exam(s) ]
    USMLE [1 Certification Exam(s) ]
    VCE [6 Certification Exam(s) ]
    Veeam [2 Certification Exam(s) ]
    Veritas [33 Certification Exam(s) ]
    Vmware [58 Certification Exam(s) ]
    Wonderlic [2 Certification Exam(s) ]
    Worldatwork [2 Certification Exam(s) ]
    XML-Master [3 Certification Exam(s) ]
    Zend [6 Certification Exam(s) ]





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