bluuebunny/crossref_metadata_2025_split huggingface dataset:
Peningkatkan Kemampuan Guru Dalam Membuat Rpp Abad 21 Melalui Pembinaan Guru Dengan Menggunakan Metode CLCK
Authors: Rodiyah Siti 
Published: July 2023

Penelitian Tindakan Kepengawasan ini memiliki beberapa tujuan, diantaranya mengetahui pembinaan guru dengan menggunakan metode CLCK (Contoh, Latih, Coba dan Kembangkan) dapat meningkatkan kemampuan guru dalam membuat RPP Abad 21 di MI Diniyah Islamiyah, MI Istiqlal dan MI Karisma Tahun Pelajaran 2021/2022. Prosedur yang dilakukan oleh penulis dalam PTKp ini menggunakan siklus dengan pelaksanaan dua siklus. Tiap siklus terdiri darai empat tahapan yaitu perencanaan, pelaksanaan tindakan, observasi atau pengamatan dan refleksi. Variabel yang menjadi sasaran perubahan dalam Penelitian Tindakan Kepengawasan ini adalah Kemampuan Guru Dalam Membuat RPP K-13 dan variabel tindakan yang digunakan adalah G Metode CLCK. Subjek yang dijadikan penelitian ini adalah guru kelas MI wilayah binaan Jakarta Pusat 1 yang berjumlah 18 orang pada semester ganjil tahun pelajaran 2022/2020. Sedangkan teknik pengumpulan data yang digunakan adalah observasi dan dokumentasi. Dari data hasil siklus 1 tentang observasi guru kelas pembuatan RPP Abad 21 dengan menggunakan metode CLCK (Contoh, Latih, Coba dan Kembangkan), dapat terlihat bahwa dari 18 orang guru kelas, 11 orang guru atau 61 % memperoleh nilai kelengkapan RPP Cukup, 7 orang guru atau 39 % memperoleh nilai kelengkapan RPP baik dan belum ada guru kelas yang memperoleh nilai Sangat Baik dengan rata-rata 2.4 kategori Cukup (C). Pada perbaikan Siklus 2 diperoleh nilai hasil observasi diatas KKM yaitu mencapai 3.6 dengan predikat A/4 (Sangat Baik) dan ketuntasan mencapai 100 % berdasarkan KKM B/3 (baik) dan penulis tidak melanjutkan ke siklus 3. Dengan melakukan pembinaan guru menggunakan Metode CLCK (Contoh, Latih, Coba dan Kembangkan) di MI Diniyah Islamiyah, MI Istiqlal dan MI Karisma Tahun Pelajaran 2021/2022, dapat meningkatkan kemampuan guru kelas dalam membuat RPP Abad 21.
Addressing NAFLD as a type 2 diabetes complication using the emerging paradigms in diagnostic and management techniques
Authors: Bajaj Harpreet Singh 
Published: July 2023

Several critical epidemiological facts underscore the urgent need to address non-alcoholic fatty liver disease (NAFLD) in type 2 diabetes (T2D):

NAFLD is the most common liver disease in Canada, affecting approximately one in four Canadians;
NAFLD is projected to become the number one leading indication for liver transplant by 2025;
Individuals with T2D are at the greatest risk of liver disease progression in NAFLD; T2D is the main predictor of NAFLD-related liver fibrosis and mortality.

To put this into clinical perspective, consider the following fictitious case: A 45-year-old teetotaler, Caucasian woman with T2D and a body mass index (BMI) of 32 kg/m2, with no microvascular or macrovascular complications, was incidentally found to have “fatty liver” on abdominal ultrasound. ALT and AST were both within normal range. She was recommended to lose weight and control A1C. Twelve years later, she developed hematemesis and liver biopsy confirmed end-stage liver cirrhosis, with hepatocellular carcinoma. She was scheduled to undergo a liver transplant at age 59.
Despite the three established facts presented above and an abundance of cases similar to the one presented here, currently NAFLD is not being addressed during routine diabetes care as a complication of T2D.
Endocrinopathies Associated with Immune Checkpoint Inhibitors
Authors: Druce Irena 
Published: July 2023

Immune checkpoint receptors are expressed by cells of the immune system and lead to reduced or absent function, which physiologically limits autoimmunity. These receptors are also exploited by malignant cells to maintain immune tolerance and evade destruction. Monoclonal antibodies targeting immune checkpoints have revolutionized oncology, with potential long-lasting clinical response, even in the setting of metastatic solid tumors. For example, in the past, metastatic melanoma signalled certain death; now, remission is possible.
The primary targets of current pharmacotherapy are cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and the programmed cell death protein 1 (PD-1) and its ligand (PD-L1). Today, half of all patients with metastatic disease are eligible to receive immune checkpoint inhibitor (ICI) therapy. As of December 2021, there were eight approved agents available for 17 malignancies, and more than 1,000 clinical trials have been conducted to explore these agents in adjuvant and maintenance settings.
The immune activation that underlies ICI therapy and the persistence of clinical response beyond the pharmacologic half-life also explain the toxicities that have been observed. Immune-related adverse events (irAEs) from ICI therapy have been shown to occur in virtually every organ system. They manifest at varying times during treatment, sometimes occurring after its discontinuation. Interestingly, the presence of these adverse events (AEs) is related to the immune system’s degree of self-tolerance and predicts patient response to this treatment modality.
Endocrinopathies are some of the most common irAEs, occurring in 15–40% of patients; however, they have posed challenges for clinicians as they are difficult to diagnose due to diverse and non-specific manifestations. In contrast to other irAEs, endocrinopathies do not respond to high-dose glucocorticoids and they are permanent. Steroid treatment has been shown to have no effect on the disease severity or the likelihood of resolution. Fortunately, when diagnosed appropriately, ICI-associated endocrinopathies are easy to treat, do not necessitate treatment discontinuation, and have an excellent prognosis.
Future Role of Non-Insulin Antihyperglycemic Agents in the Management of Type 1 Diabetes Mellitus
Authors: Senior Peter A. 
Published: July 2023

In contrast to current approaches to Type 2 diabetes (T2DM), the management of Type 1 diabetes (T1DM) continues to be glucocentric. This is understandable considering the substantial lifetime risk of potentially devastating microvascular complications associated with the disease. Consequently, advances in the management of T1DM have largely focused on enhanced insulin preparations, technologies for insulin delivery and blood glucose monitoring. However, despite the use of these therapeutic approaches, only 21% of adults (and fewer children) reach glycemic targets associated with a lower risk of microvascular complications and life expectancy in patients with T1DM is 12 years shorter than that of the general population. Cardiovascular and kidney disease, together with hypoglycemia, are the major causes of mortality in patients with T1DM.
Significant morbidity and mortality are associated with T1DM, but also with its treatment. The adverse effects of insulin, causing hypoglycemia (which is often a key barrier to achieving glycemic targets) and body weight gain are well known to clinicians. Insufficient attention has been paid to the burden of diabetes self-management and the negative impact of the disease and its treatment on patients’ quality of life.
Should practitioners consider a broader perspective on T1DM management with the objective of reducing microvascular and macrovascular risk, while simultaneously reducing the burden of T1DM and the adverse effects of therapy? Could using non-insulin antihyperglycemic agents (NIAHAs) as adjuncts to insulin assist practitioners in achieving this objective? The potential utility of NIAHAs in the management of T1DM is discussed in this paper.
Management of Pediatric Type 2 Diabetes
Authors: Basak Sanjukta 
Published: July 2023

Type 2 Diabetes Mellitus (T2DM) can no longer be considered an adult chronic disease. The diagnosis of pediatric T2DM is based on the laboratory criteria of fasting plasma glucose ≥7.0 mmol/L; 2-hour plasma glucose on a 75 g oral glucose tolerance test (OGTT) ≥11.1 mmol/L; random plasma glucose ≥11.1 mmol/L; or A1c ≥6.5% per Diabetes Canada. It is important to note that these criteria are based on extrapolations from adult data, and have not been specifically validated in youth. The International Society for Pediatric and Adolescent Diabetes (ISPAD) adds that the diagnosis should not be made on these laboratory criteria alone, but should include symptoms of hyperglycemia and negative islet auto-antibodies.
A Canadian national surveillance study of pediatric T2DM completed in 2010, has demonstrated a minimum incidence of youth-onset T2DM of 1.54 per 100,000 children per year with significant regional variation; the highest incidence was 12.45 per 100,000 children per year in Manitoba. Youth-onset T2DM disproportionately affected Canadian children from high-risk ethnic groups, with 44% of new diagnoses occurring in the Indigenous, Asian, African and Caribbean populations.
Over the past twenty years, youth-onset diabetes has been rising. In the United States, according to the SEARCH for Diabetes in Youth Study, there has been an annual increase of 7.1% observed across all age, sex, race and ethnic groups. The COVID-19 pandemic has added further escalation in the incidence of youth-onset worsening disease severity at presentation. New cases in the United States rose by 77.3% in the initial year following the COVID-19 pandemic, vs in the two years pre-pandemic. Furthermore, 21% of youth presented with diabetic ketoacidosis or hyperosmolar hyperglycemic syndrome vs previous estimates of 9% pre-pandemic. The SEARCH for Diabetes in Youth Group projects that the number of youths with T2DM will increase from 28,000 to 48,000 youth today, to 220,000 youth by 2060, with widening racial and ethnic disparities among youth with T2DM
Improving Access to Endocrinologists through Provider-to-Provider eConsultations
Authors: Keely Erin , Liddy Clare 
Published: July 2023

Access to specialty healthcare care remains a major issue for many Canadians. Not only are wait times long, but other barriers contribute to inequitable access. These include the patient’s ability to attend appointments (e.g. related to transportation difficulties and/or cost), and the ability of some patients to participate in an appointment (e.g. due to cognitive impairment, mobility challenges, loss of wages, or degree of comfort with a new provider).
Informal consultations between healthcare providers have always played a role in healthcare access. The “call a colleague” approach works well when a practitioner is able to contact a colleague by telephone and an established network of specialists exists; however, it is inefficient, does not facilitate record-keeping for medico-legal purposes and follow-up, and is not remunerated. One way to help address these obstacles is through inter-provider electronic consultations (eConsults).
The evolving role of OCT in pathologic myopia
Authors: Greve Mark , Seamone Mark , Shen Carl 
Published: July 2023

The global burden of myopia represents a significant public health concern that is expected to continue to increase in the near future. It is estimated that 50% of the world’s population will be affected by myopia by 2050, with a disproportionately high prevalence in Asia. High myopia, where the spherical equivalent refractive error is equal to or higher than 6.00 diopters, is expected to increase in prevalence from 2.7% to 10% during this period. The severity of myopia is of paramount concern to clinicians as higher levels are associated with pathologic myopia (PM) and increased risk of vision loss. Pathologic myopia, as recently defined by the International Myopia Institute, is an excessive axial elongation associated with myopia that leads to structural changes in the posterior segment of the eye that can lead to loss of best-corrected visual acuity. These structural changes and their complications include posterior staphyloma, myopic choroidal neovascularization, myopic maculopathy, myopic traction maculopathy, dome shaped maculopathy, optic disc changes and glaucoma associated with myopia, and retinal detachments.
The advent of optical coherence tomography (OCT) has facilitated the characterization, diagnosis, and management of several of these complications associated with PM and will be the focus of this article. Imaging the highly myopic eye represents a crucial step in the identification of these complications and poses its own unique challenges. Researchers have demonstrated the advantage of 3D cube scans in the detection of pathology compared to 1- and 5-line rasters. Using vertical scanning patterns aligning where the radius of curvature is larger relative to the horizontal plane of the myopic eye can minimize associated artifacts. Wide scans, facilitated by emerging technologies such as swept- source OCT and ultra wide-field OCT, are useful in cases of PM where the pathology can initiate peripherally.
Methods to treat myopia progression in pediatric patients
Authors: Wan Michael J. 
Published: July 2023

Myopia is an enormous, and growing, public health issue across the globe. The prevalence of myopia has doubled in just the past 50 years and it is estimated that approximately half of the world’s population (4.8 billion people) will be affected by 2050. The increase has been especially pronounced in individuals of East Asian descent, where 80-90% of young adults are now myopic. Myopia is now the most common cause of visual impairment and the second most common cause of blindness worldwide.
While often considered a “correctable” cause of vision loss, people with myopia have an increased lifetime risk of complications, such as macular degeneration and retinal detachment, which can cause long-term visual impairment or even blindness. Although all levels of myopia are associated with an increased risk of complications, the risk is substantially greater in people with high myopia (defined by the World Health Organization as a refractive error of ≤-5 diopters ). In addition to a large burden of visual impairment, myopia also has a significant global economic cost, estimated to be $250 billion per year in lost productivity, which is almost certain to rise.
With these factors in mind, preventing the progression of myopia is a global public health priority. The purpose of this article is to review the currently available methods to treat myopia progression in children.
Cataract surgery in the myope: What you should know
Authors: Teichman Joshua 
Published: July 2023

Improvements in technology have led to an increased safety profile in cataract surgery. Accordingly, in recent decades there has been an increasing clinical focus on providing improved refractive outcomes.
Initially using manual keratometers and ultrasound biometry, advances in intraocular lens (IOL) formulae lead to increased precision and accuracy of IOL calculations. This manifested in the form of decreased requirement for spectacle correction, usually at a distance target.
Later, optical biometry supplanted ultrasound as a more accurate method for the measurement of axial length and anterior chamber depth; it may also be useful in the measurement of lens thickness and white-to-white limbal distance. Newer biometers have built-in topographers with accurate keratometry.
It is beneficial to have an experienced ultrasonographer to perform testing in myopes, but it should be noted that posterior staphyloma can cause issues for the most experienced technicians. Some of the newer optical biometers capture a small OCT image at the time of testing to be used to test for foveal alignment, which is especially important in staphylomatous eyes.
More accurate testing, combined with newer-generation IOL formulae, has resulted in further improvement in the accuracy and precision of IOL calculation and increased spectacle independence for patients, commonly at distance. Moreover, newer intraocular lenses including multifocal and trifocal IOLs have increased the probability of spectacle independence at both distance and near. Furthermore, extended range of vision IOLs can provide distance and intermediate vision, with less dysphotopsia than current multifocal lenses.
Despite these advances, there are patient populations in which special attention is required to achieve improved refractive outcomes. Patients with increased axial length (myopes) have suffered from systematic errors in IOL calculation. Initially, modifications to previously developed IOL formulae were developed to compensate for this. The Wang-Koch correction (including its newer-generation correction) to various formulae would be an example of this.
Currently, the newest generation of IOL formulae perform better, without correction, than the previous generation of formulae, with or without correction.
Strategies for the Management of Ocular Surface Disease in Glaucoma
Authors: Trask William , Muzychuk Adam 
Published: July 2023

Ocular surface disease (OSD) is a common ophthalmological concern, with a prevalence in the Canadian population estimated at 25%. Amongst glaucoma patients, up to 60% report symptoms of OSD and up to 78% have clinical signs. Surface symptoms significantly reduce glaucoma-related quality-of-life (QOL), and there is emerging evidence to suggest that treatment of OSD may in fact improve intraocular-pressure (IOP) control and contribute to disease stabilization. The treatment of OSD in glaucoma has been receiving increasing attention, however specific recommendations remain sparse.
Ocular surface disease is known to represent a complex milieu of genetic predisposition, adnexal and periorbital status, environmental factors, systemic diseases, and medications (topical and systemic), amongst other predisposing factors. Effective management of this condition therefore demands that treatment be targeted to the specific clinical context. A 2020 study of Canadian glaucoma specialists found that, although 97% identified optimization of ocular surface disease as important for improving patient QOL, only 22.2% felt this was currently being managed adequately in the subspecialty clinic setting. Moreover, although all participants felt comfortable modifying topical hypotensive regimens to improve surface disease, only 61.1% were confident identifying patients who would benefit from topical steroids, and just 30.5% felt knowledgeable regarding the use and dispensation of autologous serum tears, which are increasingly deployed for treatment-resistant OSD in dry-eye practices. There is, therefore, an unmet need for clarity in the treatment algorithm to optimize OSD in glaucoma patients. Here, we discuss the therapeutic approach to these patients and present a suggested algorithm to guide management.
Genetics of retinal degeneration in 2023
Authors: Héon Elise , Vincent Ajoy , Tayyib Alaa 
Published: July 2023

Inherited retinal degenerations (IRDs) are of great interest with the development of novel therapies, thereby allowing this group of conditions to be “actionable” for the first time.
A molecular diagnosis can be obtained in nearly 70% of cases of IRD, with over 300 IRD-linked genes having been identified to date. Numerous animal models of different genetic subtypes of IRDs replicated the human phenotypes enough to develop and test novel therapies to improve outcomes for IRD patients. The first gene replacement therapy indicated for IRD, Luxturna (voretigene neparvovec-rzyl), was approved by Health Canada in October 2020 and is now available to patients with vision loss due to inherited retinal dystrophy caused by confirmed biallelic RPE65 mutations. Clinicians from Ontario, Quebec and Alberta can now access this treatment through their province’s public health plan.
This article aims to review some basic information and present new knowledge about IRDs to allow clinicians to better understand diagnosis and disease management.
Keratoconus Management: Navigating Patient Options
Authors: Vosoughi Amir R. , Rocha Guillermo 
Published: July 2023

Keratoconus (KC) is a condition which results in progressive corneal thinning. It was first discovered by Dr. John Nottingham in 1854 who described it as “conical cornea” due to the outward bowing appearance caused by the condition. The prevalence of KC is between 0.2 and 4,790 per 100,000 people. KC does not have a gender predilection. It is believed to appear more commonly in South Asian and Middle Eastern populations.
Keratoconus typically begins in the second and third decades of life although it can develop at any time. The clinical symptoms of the condition include blurred and distorted vision. Patients may present with higher-order aberrations (HOA) ̶ the most characteristic of which is coma ̶ resulting in blurred and double vision. The common signs of KC include corneal protrusion and thinning, prominent corneal nerves, Fleischer ring, Vogt’s striae, and scissors reflex on retinoscopy. The most frequently encountered phenotype is oval cones in the central cornea. The primary diagnostic tool for KC is corneal topography, although pachymetry, including epithelial mapping and corneal tomography, are often performed in conjunction with each other as they aid with early detection and the monitoring of KC progression.
Advancements in clinicians’ knowledge of KC and expertise in its treatment, have led to novel therapies. Stopping disease progression is now possible and improving patients’ quality of vision is feasible in many cases.
Preventive measures halting progression and management of mild and moderate forms of KC are reviewed. Treatment of severe KC will also be briefly reviewed.
Approach to management of inflammatory bowel disease-related arthritis
Authors: Choi May Y. , Mosher Dianne 
Published: July 2023

The most common extraintestinal manifestation of inflammatory bowel disease (IBD) is arthropathy. These conditions have been reported in up to 50% of patients with IBD and are more common in Crohn’s’ disease (CD), particularly colonic disease, and in females.
IBD-associated arthritis is classified as a type of spondyloarthritis (SpA). The treatment is dependent on the type of SpA involvement, which can be subdivided into peripheral and/or axial disease. The treatment approach consists of a combination of non-pharmacological and pharmacological therapies managed by a multidisciplinary team and is based on collaborative decisions between gastroenterology and rheumatology. In light of rapidly expanding therapeutic armamentaria for both immune-mediated arthritis and IBD, this paper will provide an overview of an approach to the treatment of arthritis associated with IBD, considering recommendations by recent guidelines and novel therapies.