bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.]
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.
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

ABSTRACT

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

ABSTRACT

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

ABSTRACT

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

ABSTRACTBackgroundAttributes 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.ObjectiveOur 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.MethodsBetween 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.ResultsOf 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.ConclusionsOur 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.
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.