bluuebunny/crossref_metadata_2025 huggingface dataset:
Precision, Reliability, and Responsiveness of a Novel Automated Quantification Tool for Cartilage Thickness: Data from the Osteoarthritis Initiative
Authors: Bowes Michael Antony , Guillard Gwenael Alain , Vincent Graham Richard , Brett Alan Donald , Wolstenholme Christopher Brian Hartley , Conaghan Philip Gerard
Published: August 2019

Objective.

Accurate automated segmentation of cartilage should provide rapid reliable outcomes for both epidemiological studies and clinical trials. We aimed to assess the precision and responsiveness of cartilage thickness measured with careful manual segmentation or a novel automated technique.

Methods.

Agreement of automated segmentation was assessed against 2 manual segmentation datasets: 379 magnetic resonance images manually segmented in-house (training set), and 582 from the Osteoarthritis Initiative with data available at 0, 1, and 2 years (biomarkers set). Agreement of mean thickness was assessed using Bland-Altman plots, and change with pairwise Student t test in the central medial femur (cMF) and tibia regions (cMT). Repeatability was assessed on a set of 19 knees imaged twice on the same day. Responsiveness was assessed using standardized response means (SRM).

Results.

Agreement of manual versus automated methods was excellent with no meaningful systematic bias (training set: cMF bias 0.1 mm, 95% CI ± 0.35; biomarkers set: bias 0.1 mm ± 0.4). The smallest detectable difference for cMF was 0.13 mm (coefficient of variation 3.1%), and for cMT 0.16 mm(2.65%). Reported change using manual segmentations in the cMF region at 1 year was −0.031 mm (95% CI −0.022, −0.039), p < 10−4, SRM −0.31 (−0.23, −0.38); and at 2 years was −0.071 (−0.058, −0.085), p < 10−4, SRM −0.43 (−0.36, −0.49). Reported change using automated segmentations in the cMF at 1 year was −0.059 (−0.047, −0.071), p < 10−4, SRM −0.41 (−0.34, −0.48); and at 2 years was −0.14 (−0.123, −0.157, p < 10−4, SRM −0.67 (−0.6, −0.72).

Conclusion.

A novel cartilage segmentation method provides highly accurate and repeatable measures with cartilage thickness measurements comparable to those of careful manual segmentation, but with improved responsiveness.
Evaluation of the Economic Burden of Psoriatic Arthritis and the Relationship Between Functional Status and Healthcare Costs
Authors: McHugh Neil , Maguire Áine , Handel Ian , Tillett William , Morris James , Hawkins Neil , Cavill Charlotte , Korendowych Eleanor , Mughal Farhan
Published: August 2019

Objective.

This analysis aimed to evaluate the economic burden of patients with psoriatic arthritis (PsA) on the UK healthcare system and estimate the relationship between functional status and direct healthcare costs.

Methods.

Functional status [measured using the Health Assessment Questionnaire–Disability Index (HAQ-DI)], demographics, disease history, and healthcare resource use data were extracted from a cohort of patients at the Royal National Hospital for Rheumatic Diseases, Bath, UK. Each resource use item per patient was then allocated a unit cost. Linear regression models were used to predict costs as a function of HAQ-DI. Medication costs were not included in the primary analysis, which was carried out from the UK National Health Service perspective.

Results.

Data were available for 101 patients. Mean HAQ-DI score was 0.84 (SD 0.75) and mean age at HAQ-DI measurement was 57.8 (SD 10.7). Total annual healthcare costs per patient, excluding medication costs, ranged between £174 and £8854, with a mean of £1586 (SD £1639). A 1-point increase in HAQ-DI score was associated with an increase in total costs of £547.49 (standard error £224), with secondary care consultations appearing to be the primary factor. Subgroup analyses suggested higher cost increases in patients with HAQ-DI scores of 2–3 and with a disease duration > 10 years.

Conclusion.

Patients with PsA place a significant economic burden on the healthcare system. Functional status is highly correlated with costs and appears to be driven mainly by the cost of secondary care consultations. Results were similar to previous studies in rheumatoid arthritis populations.
Predictive Utility of Cardiovascular Risk Prediction Algorithms in Inflammatory Rheumatic Diseases: A Systematic Review
Authors: Colaco Keith , Ocampo Vanessa , Ayala Ana Patricia , Harvey Paula , Gladman Dafna D. , Piguet Vincent , Eder Lihi
Published: August 2019

Objective.

We performed a systematic review of the literature to describe current knowledge of cardiovascular (CV) risk prediction algorithms in rheumatic diseases.

Methods.

A systematic search of MEDLINE, EMBASE, and Cochrane Central databases was performed. The search was restricted to original publications in English, had to include clinical CV events as study outcomes, assess the predictive properties of at least 1 CV risk prediction algorithm, and include patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), psoriatic arthritis (PsA), or psoriasis. By design, only cohort studies that followed participants for CV events were selected.

Results.

Eleven of 146 identified manuscripts were included. Studies evaluated the predictive performance of the Framingham Risk Score, QRISK2, Systematic Coronary Risk Evaluation (SCORE), Reynolds Risk Score, American College of Cardiology/American Heart Association Pooled Cohort Equations (PCE), Expanded Cardiovascular Risk Prediction Score for Rheumatoid Arthritis (ERS-RA), and the Italian Progetto CUORE score. Approaches to improve predictive performance of general risk algorithms in patients with RA included the use of multipliers, biomarkers, disease-specific variables, or a combination of these to modify or develop an algorithm. In both SLE and PsA patients, multipliers were applied to general risk algorithms. In studies of RA and SLE patients, efforts to include nontraditional risk factors, disease-related variables, multipliers, and biomarkers largely failed to substantially improve risk estimates.

Conclusion.

Our study confirmed that general risk algorithms mostly underestimate and at times overestimate CV risk in rheumatic patients. We did not find studies that evaluated models for psoriasis or AS, which further demonstrates a need for research in these populations.
Nailfold Videocapillaroscopy in Systemic Sclerosis–related Pulmonary Arterial Hypertension: A Systematic Literature Review
Authors: Smith Vanessa , Vanhaecke Amber , Vandecasteele Els , Guerra Miguel , Paolino Sabrina , Melsens Karin , Cutolo Maurizio
Published: August 2019

Objective.

Pulmonary arterial hypertension (PAH) is one of the leading causes of death in systemic sclerosis (SSc). Current screening algorithms are hampered by low positive predictive values. Outcome measures that could add to performance characteristics would be welcome. We aim to evaluate the role of nailfold videocapillaroscopy (NVC) using standardized definitions, in SSc-related PAH (SSc-PAH).

Methods.

A systematic review to identify original research papers documenting an association between NVC and right heart catheterization-defined SSc-PAH was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Subsequently, NVC characteristics were subdivided into quantitative (capillary density, dimension, morphology, and hemorrhages), semiquantitative, and qualitative assessment (NVC pattern), according to the definitions of the European League Against Rheumatism Study Group on Microcirculation in Rheumatic Diseases.

Results.

The systematic search identified 316 unique search results, of which 5 were included in the final qualitative analysis. The occurrence of incident SSc-PAH unequivocally associated in 2 longitudinal studies with progressive capillary loss (p = 0.04 and p = 0.033) and the progression to a severe (active/late) NVC pattern (p = 0.05/0.01 and HR = 5.12, 95% CI 1.23–21.27). In 3 cross-sectional studies, SSc-PAH was found to be unequivocally inversely associated with capillary density (p = 0.001 and p < 0.05) and associated with the presence of a severe NVC pattern (p = 0.03 and p < 0.05).

Conclusion.

This is the first systematic literature review investigating the role of NVC in SSc-PAH using standardized description, to our knowledge. Unequivocal associations were found between (incident) SSc-PAH and capillary density and NVC pattern. Integration of NVC into current screening algorithms to boost their performance may be a future step.
Distal Femoral Osteotomy for Lateral Compartment Osteoarthritis of the Knee
Authors: Mathews James , Cobb Andrew G , Richardson Simon , Bentley George
Published: August 2019

ABSTRACT

Twenty-one patients with lateral compartment osteoarthritis and valgus deformity of the knee underwent distal femoral supracondylar osteotomy (medial closing wedge) between 1 983 and 1 993 with followup ranging from 1 to 8 years. Ten knees had plastercast immobilization, 5 had fixation with 2 staples supplemented with a plaster cast, and 6 knees had rigid internai fixation with an AO blade plate.

Thirty-three percent of patients had a satisfactory result using the HSS score, and 57% had a satisfactory result using the Knee Society Clinical Rating. Fifty-seven percent had a significant complication, including severe knee stiffness requiring manipulation under anesthesia (48%), nonunion/delayed union (19%), infection (1 0%), and fixation failure (5%). Five (1 9%) knees required total knee replacement within 5 years of surgery.

Satisfactory results were obtained only in those patients who had less severe degrees of osteoarthritis confined to the lateral compartment (grades I to III), adequate correction of valgus deformity (the anatomical axis within 2° from zero), and rigid internal fixation to permit postoperative early mobilization. These results indicate that distal femoral osteotomy is a satisfactory procedure in the young, active patient with osteoarthritis of the lateral compartment of the knee, but requires precise surgical technique and rigid internal fixation.
Multimodal Analysis of Hyperautofluorescent Ring Size in Retinitis Pigmentosa
Authors: Jiang Shangjun , Choudhry Netan
Published: August 2019

BACKGROUND AND OBJECTIVE:

To determine if a correlation exists between hyperautofluorescent ring size with visual acuity (VA), foveal avascular zone (FAZ) size, and retinal capillary perfusion density (CPD) in retinitis pigmentosa (RP).

PATIENTS AND METHODS:

Eighteen eyes from nine patients with RP were imaged using fundus autofluorescence (AF) to identify autofluorescence defects, and hyperautofluorescent ring size was measured with an image-processing program. Spectral-domain optical coherence tomography angiography was used to measure FAZ area and calculate parafoveal CPD in the superficial capillary plexus (SCP) and the deep capillary plexus (DCP) using both a 3 mm × 3 mm and 6 mm × 6 mm strategy.

RESULTS:

The area of hyperautofluorescence was not strongly correlated with SCP perfusion density (
P
= .74), DCP perfusion density (
P
= .25), FAZ area (
P
= .14), or VA (
P
= .33).

CONCLUSION:

The area of the hyperautofluorescent ring does not correlate with VA, retinal CPD, or FAZ area.

[
Ophthalmic Surg Lasers Imaging Retina
. 2019;50:492–496.]
Comparison of Residual Subfoveal Fluid by Intraoperative OCT After Macula-Involving RRD Repair Using Direct Drainage, Drainage Retinotomy, or Perfluoro-n-Octane
Authors: Obeid Anthony , Ehmann David , Adam Murtaza , Kasi Sundeep , Shahlaee Abtin , Klufas Michael A. , Hsu Jason , Mehta Sonia , Chiang Allen , Garg Sunir , Ho Allen C. , Gupta Omesh P.
Published: August 2019

BACKGROUND AND OBJECTIVE:

This study evaluated the residual subfoveal fluid (SFF) immediately after rhegmatogenous retinal detachment (RRD) repair using intraoperative optical coherence tomography (iOCT).

PATIENTS AND METHODS:

This retrospective cohort study assessed fovea-involving RRD repaired by pars plana vitrectomy (PPV) using different drainage techniques. iOCT images were acquired through the fovea at the start of the case prior to initiating vitrectomy and then again immediately prior to introduction of tamponade.

RESULTS:

Ten eyes (32.3%) received perfluoro-n-octane (PFO), 12 (38.7%) underwent a posterior drainage retinotomy, and nine (29.0%) had drainage through the retinal break. There was no significant difference in the mean SFF thickness between eyes in either group (
P
= .85). There was no significant association between SFF thickness on iOCT and functional or anatomic outcomes (
P
> .05).

CONCLUSION:

There is no difference in the amount of residual SFF as measured on iOCT during RRD repair with pars plana vitrectomy using either direct drainage, drainage retinotomy, or PFO.

[
Ophthalmic Surg Lasers Imaging Retina
. 2019;50:497–503.]
Intraoperative Drainage of a Bullous Serous Pigment Epithelial Detachment
Authors: Sisk Robert A.
Published: August 2019

BACKGROUND AND OBJECTIVE:

To describe a novel, simple technique for surgically draining a bullous serous pigment epithelial detachment (PED).

PATIENTS AND METHODS:

Pars plana vitrectomy was performed with confirmed elevation of the hyaloid face. Proportional diathermy allowed stepwise entry into the PED superotemporally through an initially small, needle-point focus while providing control of any potential bleeding. Thick fluid was aspirated with a soft-tipped cannula, fluid-air exchange was performed, and intravitreal bevacizumab was injected before removing the cannulas.

RESULTS:

The PED was successfully completely drained intraoperatively and remained flat at 1 week postoperatively. However, the draining site ultimately closed, and continued exudation from choroidal neovascularization led to recurrent PED and eventual nonhemorrhagic retinal pigment epithelial tear despite aggressive treatment with aflibercept and photodynamic therapy. The early visual acuity benefit may relate to resolution of hyperopic shift.

CONCLUSION:

Serous PED can be surgically reduced without hemorrhagic complications, but long-term success depends upon control of the underlying choroidal neovascularization.

[
Ophthalmic Surg Lasers Imaging Retina
. 2019;50:510–513.]
Multimodal Retinal Imaging Findings in Williams-Beuren Syndrome
Authors: Erşan Hatice Bilge Araz , Güven Dilek , Demir Atilla Gökçe , Dirim Ayşe Burcu , Kaçar Hakan , Arslan Doğukan
Published: August 2019

A 17-year-old male patient diagnosed with Williams-Beuren syndrome presented with a gradual decline in vision in both eyes during a 3-year period. The ophthalmologic examination was notable for numerous loop-shaped tortuous vessels accompanying normal appearing retinal vessels and cystoid macular edema (CME). Mild foveal hypoplasia with a persistence of inner retinal layers was noted on spectral-domain optical coherence tomography (OCT). OCT angiography showed that the abnormal vessels were not retinal vessels but were compatible with prepapillary vascular loops. The CME persisted despite repeated intravitreal bevacizumab treatment. The resolution was observed following an intravitreal triamcinolone acetonide injection.

[
Ophthalmic Surg Lasers Imaging Retina
. 2019;50:514–518.]
Inner Nuclear Layer Cystic Changes in Phakic Fellow Eyes of Patients With Acute Pseudophakic Cystoid Macular Edema
Authors: Pannullo Nicole A. , Chu Rachel L. , Sigler Eric J.
Published: August 2019

Improvements in retinal imaging have recently elucidated structural patterns in the development of macular edema, particularly involving the inner nuclear layer. Here, the authors describe two cases of isolated inner nuclear layer cystic changes in the phakic fellow eye of patients with pseudophakic cystoid macular edema. Both cases improved with treatment of their fellow eye and resolution of contralateral macular edema. The authors hypothesize potential pathomechanisms for this likely common but under-recognized phenomenon.

[
Ophthalmic Surg Lasers Imaging Retina
. 2019;50:522–524.]
Bilateral Diffuse Uveal Melanocytic Proliferation Associated With Bladder Cancer: A Novel Imaging Finding
Authors: O'Day Roderick , Michalova Kira , Campbell William G.
Published: August 2019

The authors report a case of bilateral diffuse uveal melanocytic proliferation associated with transitional cell carcinoma of the bladder. A novel imaging finding on indocyanine green angiography of a “string of sausages” pattern in the large choroidal vessels is described. This occurs in areas of alternating retinal pigment epithelial hypertrophy and destruction, which is likely to be its cause. To the authors' knowledge, it has not been previously described.

[
Ophthalmic Surg Lasers Imaging Retina
. 2019;50:525–528.]
Late-Stage Sorsby Fundus Dystrophy Manifesting Severe Vision Loss in the Absence of Choroidal Neovascularization
Authors: Hanif Adam M. , Jain Nieraj
Published: August 2019

A patient with a family history of molecularly confirmed Sorsby fundus dystrophy (SFD) presented with 9 years of progressive, bilateral central vision loss. Specific mutation analysis of the
TIMP3
gene confirmed SFD, identifying a pathogenic mutation of p.Ser204Cys:c.610A>T. Optical coherence tomography imaging revealed diffuse retinal, retinal pigment epithelium, and choroidal atrophy without evidence for choroidal neovascularization (CNV). Although SFD is classically associated with CNV and subretinal fibrosis, some cases follow an atrophic course in the absence of CNV formation. This case highlights the extent to which extensive atrophic degeneration can lead to visual disability without choroidal neovascularization in late-stage SFD.

[
Ophthalmic Surg Lasers Imaging Retina
. 2019;50:e215–e217.]
Comparision of the knee joint alignment in sportsmen and controls
Authors: Amaratunga H. A. , Ileperuma M. R. , Rathnaweera W. , Adikari S. B. , Suraweera H. J.
Published: August 2019

The alignment of the knee joint described as the angle formed by the femoral shaft and the tibial shaft at the knee. It is of significance due to its association with different disease conditions affecting the knee. Muscle strength affects alignment of the knee, therefore we measured the knee alignment of Peradeniya University rugby team and compared with a control. All 27 individuals in the university rugby pool, all of them being male, were included in the study. Their weight and height were measured in kilograms and meters using standard measuring scales and the BMI was calculated using the Quetelets index. Anterior plane knee alignment was measured using a handheld metal goniometer. The other group consisted of 25 male student volunteers that do not engage in sporting activities. The rugby players had a mean knee alignment angle of 181.96° (± 3.4) and the control sample had a mean of 183.67° (±3.75). The difference observed in the means was statistically significant (p=0.45) with the rugby players' having more varus oriented knee joints. The rugby players in our study showed a more varus oriented knee joint alignment than the controls. The varus orientation seen in these ruby players at this early age could be a cause for development of knee joint OA in the future due to the excessive strain placed on the medial compartment of the knee joint.
An audit on medical students' exposures to occupational hazards during cadaveric dissections
Authors: Mathangasinghe Y. , Samaranayake U. M. J. E. , Perera M. H. S. , Maddumaarachchi H. S. T. M. , Anthony D. J. , Malalasekera A. P.
Published: August 2019

IntroductionWe intended to study the prevalence of occupational hazards in the anatomy laboratory and the safety measures taken by students. Methodology An audit was conducted among two batches of medical students, soon after the completion of the anatomy curriculum. Exposures, practices, health conditions of the students, their suggestions to improve safety measures and self-reported engagement in dissections in each session (in a ten-point Likert scale) were assessed using a validted self – administered questionnaire. ResultsOf 196 respondents, 50%(n=98) were males. Mean age was 21.8±1.1 years. During their first-year dissections, 1 5.8% (n = 31) had cut injuries, 86.7%(n=170) had skin contact with cadaver fluids while 5.6%(n=11) had eye splashes. Of those with skin contact, 43.5%(n=74) washed immediately. Of those who had eye splashes, only 18.2%(n=2) washed immediately for 20 minutes as recommended. Nine students reported new nail infections, seven developed allergies to cadaver fluids and 15 developed skin rashes during the period of dissections. Self-reported engagement in dissections positively correlated with the frequency of skin contact with cadaver fluids (r=.161, p=0.035), but not with the frequency of cut injuries (p>.05) or eye splashes (p>.05). Students suggested the following safety measures : 63.3%(n=72)-lab coats, 55.6%(n=109)- masks, 16.8% (n = 3 3) - goggles , 43.9% (n=86)-a lecture on lab safety, 44.4% (n = 87) – a workshop and 40.3% (n=79)-a formal safety protocol. ConclusionsStudents are exposed to numerous occupational hazards in the anatomy laboratory. Inadequate adherence to internationally recommended laboratory safety measures may increase the risk of occupational hazards.
Anatomy of thoracoscopic thymectomy; case report
Authors: Jayathilake Anuradha B. , Madushanka U. D. P. , Pinto V. , Galketiya K. B.
Published: August 2019

Thymectomy is performed for myasthenia gravis with or without thymoma. Performing by thoracoscopy reduces the surgical morbidity. Anatomical landmarks play a key role to perform a safe surgery. We present the anatomical highlights of a patient who underwent the procedure.
Case report; An adult presenting with bilateral hip joint dysplasia
Authors: Gunasekara K. S. , Chinthaka R. G. , Dissanayake S.
Published: August 2019

No abstract available
Editorial
Authors: Beenhakker J. C.
Published: August 2019

No abstract available
The effect of controlled warm-up exercises on the crawl swimming performance of under-15 male waterpolo players
Authors: Sabor David , Moll Catherine
Published: August 2019

The effect of controlled warm-up exercises on crawl swimming performance was determined in 31 under-15 male water polo players. The study employed a two-group crossover design in which the subjects were randomly assigned to one of two groups. One group swam a 50m crawl sprint with no preliminary warm-up, followed two days later by a 50m crawl sprint with a preliminary controlled warm-up. The other group did the two swims in reverse order. The controlled warm-up programme consisted of approximately 4 minutes of dynamic exercise and 8 minutes of passive stretching. Results showed a decrease in performance times of 71% of the subjects after exposure to a controlled warm-up programme. This positive effect was attributed to the increase in muscle temperature, leading to an increase in the speed of muscle contraction, smoother muscle contraction and improved strength of muscle contraction. Thus it was concluded that controlled warm-up exercises have a positive effect on the crawl swimming performance of under 15 male water polo players.
Overall health and drinking behavior among pregnant and breastfeeding women in Korea
Authors: Kim Eun Gyeong
Published: August 2019

OBJECTIVES: The study was to conduct a comparative assessment of drinking behaviors and overall health among pregnant and breastfeeding women.METHODS: This study used data collected from the Korean Community Health Survey in 2015. Data obtained from 2,156 pregnant or breastfeeding women were analyzed using descriptive statistics, the t-test, the chi-square test, and the Pearson correlation coefficient.RESULTS: Current drinking and alcohol consumption were higher among pregnant women than among breastfeeding women. Depression was twice as common among breastfeeding women than among pregnant women, and stress was much higher among breastfeeding women as well. Breastfeeding women also had lower subjective dental health and more unmet medical needs than pregnant women.CONCLUSIONS: Although pregnant women were in better overall health than breastfeeding women, many of them were unable to stop drinking, which is a risky and adverse health behavior that negatively affects maternal and fetal health. In order to reduce drinking among pregnant and breastfeeding women, it is necessary to develop a tailored, standardized educational program and national guidelines.
Learning Abroad: Residents' Narratives of Clinical Experiences From a Global Health Elective
Authors: Lauden Stephanie M. , Gladding Sophia , Slusher Tina , Howard Cynthia , Pitt Michael B.
Published: August 2019

Background

While resident participation in global health (GH) rotations has grown, little is known about trainee perceptions of the personal value of these international clinical experiences and their importance to the objectives of GH training.

Objective

We sought to better understand the clinical scenarios experienced during international rotations that residents perceived as most meaningful and the frequency of these experiences across scenarios and participating residents.

Methods

Using the conceptual framework of Schön's reflection on action, we asked University of Minnesota GH track pediatric and internal medicine–pediatric residents to describe 10 clinical scenarios they found interesting or impactful during their 2016–2017 GH elective. We conducted a qualitative analysis of the deidentified resident narratives and mapped themes to the Accreditation Council for Graduate Medical Education (ACGME) competencies.

Results

All eligible residents (n = 13) participated, yielding 129 unique clinical scenarios from 7 countries. We identified 5 thematic groups: (1) addressing challenges in making diagnoses in resource-limited settings; (2) dealing with patient outcomes different from those expected in the United States; (3) encountering and managing diseases in a different clinical context; (4) encountering and managing diseases in a different cultural context; and (5) reflecting on learning and self-growth. Of the 129 unique clinical scenarios, 30% (n = 39) had not been previously experienced by participants. Across the 5 themes, all ACGME core competencies were addressed.

Conclusions

Residents identified meaningful scenarios of their GH experiences that are relevant to the educational and clinical objectives of GH training.
Educational Curricula and Programs in Adolescent Medicine for Health Workers in Low- and Middle-Income Countries: A Scoping Review
Authors: Miller Kathleen K. , Brown Sarah Jane , Pfeffer Betsy , Olupot-Olupot Peter , Kitaka Sabrina
Published: August 2019

Background

Adolescent medicine (AM) has been increasingly recognized as critically important to the health of individuals during their transition to adulthood. On a global scale, AM is often underprioritized and underfunded. In low- and middle-income countries (LMICs), education and AM training is developing, and AM physicians often are from general medicine backgrounds.

Objective

The objective of our scoping review was to identify existing training curricula and educational tools designed to teach AM skills to health care workers in LMICs.

Methods

We followed PRISMA guidelines for scoping reviews for article identification and inclusion. Online databases, including MEDLINE, Embase, CINAHL, and Scopus, were used to identify papers. We included studies that took place in a LMIC, were available in English, and described any of the following: published educational curricula in AM, education-based intervention for HCWs that focused on AM, or a training opportunity in AM located in a LMIC.

Results

Our review includes 14 publications: 5 published curricula and 9 articles describing educational interventions or training opportunities in AM in LMICs. Curricula were relatively consistent in the topics included, although they varied in implementation and teaching strategies. The scholarly articles described educational materials and identified a number of innovative strategies for training programs.

Conclusions

Our review found existing high-quality AM curricula designed for LMICs. However, there is limited published data on their implementation and utilization. There is a continued need for funding and implementation of education in AM in resource-constrained settings.
USMLE Step 2 CK: Best Predictor of Multimodal Performance in an Internal Medicine Residency
Authors: Sharma Akshita , Schauer Daniel P. , Kelleher Matthew , Kinnear Benjamin , Sall Dana , Warm Eric
Published: August 2019

Background

Internal medicine (IM) residency programs receive information about applicants via academic transcripts, but studies demonstrate wide variability in satisfaction with and usefulness of this information. In addition, many studies compare application materials to only 1 or 2 assessment metrics, usually standardized test scores and work-based observational faculty assessments.

Objective

We sought to determine which application materials best predict performance across a broad array of residency assessment outcomes generated by standardized testing and a yearlong IM residency ambulatory long block.

Methods

In 2019, we analyzed available Electronic Residency Application Service data for 167 categorical IM residents, including advanced degree status, research experience, failures during medical school, undergraduate medical education award status, and United States Medical Licensing Examination (USMLE) scores. We compared these with post-match residency multimodal performance, including standardized test scores and faculty member, peer, allied health professional, and patient-level assessment measures.

Results

In multivariate analyses, USMLE Step 2 Clinical Knowledge (CK) scores were most predictive of performance across all residency performance domains measured. Having an advanced degree was associated with higher patient-level assessments (eg, physician listens, physician explains, etc). USMLE Step 1 scores were associated with in-training examination scores only. None of the other measured application materials predicted performance.

Conclusions

USMLE Step 2 CK scores were the highest predictors of residency performance across a broad array of performance measurements generated by standardized testing and an IM residency ambulatory long block.
Using the Postgraduate Hospital Educational Environment Measure to Identify Areas for Improvement in a Singaporean Residency Program
Authors: Ong Andrew Ming-Liang , Fong Warren Weng-Seng , Chan Adrian Kwok-Wai , Phua Ghee-Chee , Tham Chee-Kian
Published: August 2019

Background

Attributes of the clinical learning environment (CLE) are a measure of quality in postgraduate medical education, and assessing the CLE is a component of the New Accreditation System being introduced in Singapore by the Accreditation Council for Graduate Medical Education International. There is a dearth of published studies of CLE quality in Singapore.

Objective

Our study had 3 aims: (1) to measure the CLE in 1 Singaporean residency program; (2) to compare trainee perceptions by sex, training level, and experience; and (3) to identify areas for improvement.

Methods

Between October and December 2017, we conducted a mixed assessment of the CLE in an internal medicine program in Singapore, using the Postgraduate Hospital Educational Environment Measure (PHEEM) and qualitative exploration using a focus group.

Results

Of 153 IM residents, 136 (89%) provided PHEEM responses and 8 participated in the focus group. Total PHEEM scores and scores for the 3 subscales were higher than published data on the use of the PHEEM in international settings. Exploration of selected PHEEM responses via a focus group identified attributes associated with negative perceptions of the CLE: excessive workload, inadequate faculty presence in the CLE, and unmet trainee needs. It also suggested senior residents' clinical workloads, greater responsibilities, and pending examinations may contribute to their less positive perceptions of the CLE.

Conclusions

Our analysis using the PHEEM showed overall positive perceptions of the CLE, along with areas for improvement amenable to interventions. Our approach has relevance to an accreditation model with ongoing evaluation of the CLE.
Semantic prosody of the verb root -gbú ‘kill’ in Ìgbò
Authors: Egenti Martha Chidimma , Ikegwuonu Christiana Ngozi
Published: August 2019

Semantic prosody (SP) involves the typical behaviour of words in lexical patterning and its tendency to line up with either positive or negative words. This work seeks to investigate the SP of the Igbo verb root gbú ‘kill’ in a bid to ascertain its propensity towards its collocates. Using the AntConc software to extract the data from the Igbo version of Things Fall Apart by Chinua Achebe translated by Izuu Nwankwo, as well as adopting the Sinclarian approach/extended unit of meaning-oriented approach, the concordance result for the verb root gbú ‘kill’ reveals that there is preponderance of the collocates of the verb root co-occurring mostly with proper, common noun and abstract nouns with similar semantic features having negative aura of meaning such as war and suicide and things referring to related unfavourable-sounding state of affairs. The sense of negativity is retained in the compound construction that involves the verb, while the lexical environment of the verb depicts unfavourable events of fear, revenge, war, suicide, great depression. It can be concluded that, in spite of the strong negative SP of the verb gbú, it also has some positive meanings which are used in the idiomatic sense.Keywords: Semantic Prosody, Collocation, Concordance, Lexical Semantics, Phraseology
The linguistic situation in Orkesumet, an urban area in Simanjiro District of Tanzania
Authors: Lusekelo Amani
Published: August 2019

An investigation of the linguistic landscape in urban Africa is a welcome contribution to make in that multilingualism presents fascinating results. To satisfy this demand, the current paper investigates the patterns of language use in billboards in a small township of Orkesumet in northern Tanzania. Data demonstrates that the state of Kiswahili and English bilingualism is apparently open for religiously, privately and publicly owned institutions such as schools, churches, public offices, and accommodation facilities. Such bilingual billboards do not make use of hybrid language because there were no tokens of Kiswahili-English, Maasai-English and Kiswahili-Maasai recorded in the area. The main mechanism used to attract customers is through the selection of font-colour and font-size. The large font in black colour is preferred for names of firms, while red colour is opted for items sold and/or services rendered.Keywords: Bilingualism, Billboards, Language Use, Simanjiro, Tanzania
The expression of property concepts in Etulo
Authors: Ezenwafor Chikelu Ihunanya , Adams Inyani
Published: August 2019

Property concepts refer to properties, qualities or characteristics of referents (Thompson 1988). In many languages, there seems to be a correspondence between the expression of property concepts and the adjective category. There are however languages that express property concepts via means other than the adjective category. This paper examines the means by which property concepts are expressed in Etulo. It is observed that property concepts in Etulo are expressed by qualificatives. Etulo qualificatives subsume a small class of adjectives, a subset of verbs and nouns, and a class of ideophones. We adopt Dixon’s (2004) typological framework in establishing a distinct category of adjectives in Etulo.
Cows fed hydroponic fodder and conventional diet: effects on milk quality
Authors: Agius Alan , Pastorelli Grazia , Attard Everaldo
Published: August 2019

Abstract. The technology of green fodder production is especially important in arid and semiarid regions. Hydroponics improves on average the amount of crops in the same space, as traditional soil-based farming and can reduce water consumption compared to traditional farming methods. Limited research has been carried out on the use of hydroponic fodder and milk quality. A comparative study of traditional (Malta farm) and hydroponic fodder (Gozo farm) was conducted in Malta with 20 cows of the Holstein–Friesian breed from two farms. Individual and bulk-tank milk samples were collected once a week for a period of 1 month in order to evaluate physical (pH, conductivity, density, freezing point) and chemical (fat, protein, ash, lactose, solid nonfat) parameters as well as mineral (Zn, Cu, Pb, Ba) content. Milk proximate and physical data were processed by analysis of variance (ANOVA) for repeated measures and an ANOVA procedure with farm and time as effects for minerals. The results indicated differences in fat content and pH, showing higher values (P<0.05) in milk samples of cows fed with the hydroponic rather than the traditional fodder; a significant time effect (P<0.001) was found in all qualitative analyses except for lactose and salts. Minerals were in the range as reported elsewhere; Cu and Pb content was significantly higher (P<0.001) in the Gozo farm than the one in Malta, whereas Zn content showed higher values in Malta (P<0.001) than Gozo. Although the proximate results were similar for both farms, except for the higher fat content for the Gozo farm, principal component analysis (PCA) revealed that milk quality for the Gozo farm was superior to that of the Malta farm. However, further studies are needed to determine the effects of different hydroponic fodder using a large herd size.
Deposition of ionic species and black carbon to the Arctic snowpack: combining snow pit observations with modeling
Authors: Jacobi Hans-Werner , Obleitner Friedrich , Da Costa Sophie , Ginot Patrick , Eleftheriadis Konstantinos , Aas Wenche , Zanatta Marco
Published: August 2019

Abstract. Although aerosols in the Arctic have multiple and complex
impacts on the regional climate, their removal due to deposition is still
not well quantified. We combined meteorological, aerosol, precipitation, and
snowpack observations with simulations to derive information about the
deposition of sea salt components and black carbon (BC) from November 2011
to April 2012 to the Arctic snowpack at two locations close to
Ny-Ålesund, Svalbard. The dominating role of sea salt and the
contribution of dust for the composition of atmospheric aerosols were
reflected in the seasonal composition of the snowpack. The strong alignment
of the concentrations of the major sea salt components in the aerosols, the
precipitation, and the snowpack is linked to the importance of wet
deposition for transfer from the atmosphere to the snowpack. This
agreement was less strong for monthly snow budgets and deposition, indicating
important relocation of the impurities inside the snowpack after
deposition. Wet deposition was less important for the transfer of nitrate,
non-sea-salt sulfate, and BC to the snow during the winter period. The
average BC concentration in the snowpack remains small, with a limited
impact on snow albedo and melting. Nevertheless, the observations also
indicate an important redistribution of BC in the snowpack, leading to layers
with enhanced concentrations. The complex behavior of bromide due to
modifications during sea salt aerosol formation and remobilization in
the atmosphere and in the snow were not resolved because of the lack of
bromide measurements in aerosols and precipitation.
Revisiting the Agung 1963 volcanic forcing – impact of one or two eruptions
Authors: Niemeier Ulrike , Timmreck Claudia , Krüger Kirstin
Published: August 2019

Abstract. In 1963 a series of eruptions of Mt. Agung, Indonesia, resulted in
the third largest eruption of the 20th century and claimed about 1900 lives. Two eruptions of this series injected SO2 into the
stratosphere, which can create a long-lasting stratospheric
sulfate layer. The estimated mass flux of the
first eruption was about twice as large as the mass flux of the
second eruption. We followed the estimated emission profiles and
assumed for the first eruption on 17 March an injection rate of 4.7 Tg SO2 and 2.3 Tg SO2 for the
second eruption on 16 May. The injected sulfur forms a
sulfate layer in the stratosphere. The evolution of sulfur is
nonlinear and depends on the injection rate and aerosol background
conditions. We performed ensembles of two model experiments, one
with a single eruption and a second one with two eruptions. The two smaller
eruptions result in a lower sulfur burden, smaller aerosol particles, and 0.1 to 0.3 Wm−2 (10 %–20 %) lower radiative forcing in monthly mean
global average compared to the individual eruption experiment. The
differences are the consequence of slightly stronger meridional
transport due to different seasons of the eruptions, lower injection
height of the second eruption, and the resulting different aerosol
evolution. Overall, the evolution of the volcanic clouds is different in case
of two eruptions than with a single eruption only. The differences
between the two experiments are significant. We conclude that there
is no justification to use one eruption only and both climatic
eruptions should be taken into account in future emission datasets.
Alkyl nitrates in the boreal forest: formation via the NO3-, OH- and O3-induced oxidation of biogenic volatile organic compounds and ambient lifetimes
Authors: Liebmann Jonathan , Sobanski Nicolas , Schuladen Jan , Karu Einar , Hellén Heidi , Hakola Hannele , Zha Qiaozhi , Ehn Mikael , Riva Matthieu , Heikkinen Liine , Williams Jonathan , Fischer Horst , Lelieveld Jos , Crowley John N.
Published: August 2019

Abstract. The formation of alkyl nitrates in various oxidation processes
taking place throughout the diel cycle can represent an important sink of
reactive nitrogen and mechanism for chain termination in atmospheric
photo-oxidation cycles. The low-volatility alkyl nitrates (ANs) formed from
biogenic volatile organic compounds (BVOCs), especially terpenoids, enhance
rates of production and growth of secondary organic aerosol. Measurements of
the NO3 reactivity and the mixing ratio of total alkyl nitrates
(ΣANs) in the Finnish boreal forest enabled assessment of the
relative importance of NO3-, O3- and OH-initiated formation of
alkyl nitrates from BVOCs in this environment. The high reactivity of the
forest air towards NO3 resulted in reactions of the nitrate radical,
with terpenes contributing substantially to formation of ANs not only during
the night but also during daytime. Overall, night-time reactions of NO3
accounted for 49 % of the local production rate of ANs, with contributions
of 21 %, 18 % and 12 % for NO3, OH and O3 during the day.
The lifetimes of the gas-phase ANs formed in this environment were on the
order of 2 h due to efficient uptake to aerosol (and dry deposition),
resulting in the transfer of reactive nitrogen from anthropogenic sources to
the forest ecosystem.
Variability in vertical structure of precipitation with sea surface temperature over the Arabian Sea and the Bay of Bengal as inferred by Tropical Rainfall Measuring Mission precipitation radar measurements
Authors: Saikranthi Kadiri , Radhakrishna Basivi , Narayana Rao Thota , Satheesh Sreedharan Krishnakumari
Published: August 2019

Abstract. Tropical Rainfall Measuring Mission (TRMM) precipitation radar measurements are
used to examine the variation in vertical structure of precipitation with
sea surface temperature (SST) over the Arabian Sea (AS) and Bay of Bengal
(BOB). The variation in reflectivity and precipitation echo top with SST is
remarkable over the AS but small over the BOB. The reflectivity increases
with SST (from 26 to 31 ∘C) by ∼1
and 4 dBZ above and below 6 km, respectively, over the AS, while its
variation is <0.5 dBZ over the BOB. The transition from shallow
storms at lower SSTs (≤27 ∘C) to deeper storms at higher
SSTs is strongly associated with the decrease in stability and
mid-tropospheric wind shear over the AS. In contrary, the storms are deeper at
all SSTs over the BOB due to weaker stability and mid-tropospheric wind
shear. At lower SSTs, the observed high aerosol optical depth (AOD) and low
total column water (TCW) over AS results in the small cloud effective radius
(CER) and weaker reflectivity. As SST increases, AOD decreases and TCW
increases, leading to a large CER and high reflectivity. The changes in these
parameters with SST are marginal over the BOB and hence the CER and
reflectivity. The predominance of collision–coalescence process below the
bright band is responsible for the observed negative slopes in the
reflectivity over both the seas. The observed variations in reflectivity originate at the cloud formation stage over both the seas, and these
variations are magnified during the descent of hydrometeors to the
ground.
Organic coating on sulfate and soot particles during late summer in the Svalbard Archipelago
Authors: Yu Hua , Li Weijun , Zhang Yangmei , Tunved Peter , Dall'Osto Manuel , Shen Xiaojing , Sun Junying , Zhang Xiaoye , Zhang Jianchao , Shi Zongbo
Published: August 2019

Abstract. Interaction of anthropogenic particles with radiation and clouds plays an
important role in Arctic climate change. The mixing state of aerosols is a key
parameter to influence aerosol radiation and aerosol–cloud interactions.
However, little is known of this parameter in the Arctic, preventing an
accurate representation of this information in global models. Here we used
transmission electron microscopy with energy-dispersive X-ray spectrometry,
scanning electron microscopy, nanoscale secondary ion mass spectrometry, and
atomic forces microscopy to determine the size and mixing state of
individual sulfate and carbonaceous particles at 100 nm to 2 µm
collected in the Svalbard Archipelago in summer. We found that 74 % by
number of non-sea-salt sulfate particles were coated with organic matter
(OM); 20 % of sulfate particles also had soot inclusions which only
appeared in the OM coating. The OM coating is estimated to contribute
63 % of the particle volume on average. To understand how OM coating
influences optical properties of sulfate particles, a Mie core–shell model
was applied to calculate optical properties of individual sulfate particles.
Our result shows that the absorption cross section of individual OM-coated
particles significantly increased when assuming the OM coating as
light-absorbing brown carbon. Microscopic observations here suggest that OM
modulates the mixing structure of fine Arctic sulfate particles, which may
determine their hygroscopicity and optical properties.