Prediction of Visual Field Progression with Baseline and Longitudinal Structural Measurements Using Deep Learning.

PURPOSE: Identifying glaucoma patients at high risk of progression based on widely available structural data is an unmet task in clinical practice. We test the hypothesis that baseline or serial structural measures can predict visual field (VF) progression with deep learning (DL). DESIGN: Development of a DL algorithm to predict VF progression. METHODS: 3,079 eyes (1,765 patients) with various types of glaucoma and ≥5 VFs, and ≥3 years of follow-up from a tertiary academic center were included. Serial VF mean deviation (MD) rates of change were estimated with linear-regression. VF progression was defined as negative MD slope with p<0.05. A Siamese Neural Network with ResNet-152 backbone pre-trained on ImageNet was designed to predict VF progression using serial optic-disc photographs (ODP), and baseline retinal nerve fiber layer (RNFL) thickness. We tested the model on a separate dataset (427 eyes) with RNFL data from different OCT. The Main Outcome Measure was Area under ROC curve (AUC). RESULTS: Baseline average (SD) MD was 3.4 (4.9)dB. VF progression was detected in 900 eyes (29%). AUC (95% CI) for model incorporating baseline ODP and RNFL thickness was 0.813 (0.757-0.869). After adding the second and third ODPs, AUC increased to 0.860 and 0.894, respectively (p<0.027). This model also had highest AUC (0.911) for predicting fast progression (MD rate <1.0 dB/year). Model's performance was similar when applied to second dataset using RNFL data from another OCT device (AUC=0.893; 0.837-0.948). CONCLUSIONS: DL model predicted VF progression with clinically relevant accuracy using baseline RNFL thickness and serial ODPs and can be implemented as a clinical tool after further validation.

Hypotony Failure Criteria in Glaucoma Surgical Studies and Their Influence on Surgery Success.

PURPOSE: Review hypotony failure criteria used in glaucoma surgical outcome studies and evaluate their impact on success rates. DESIGN: Systematic literature review and application of hypotony failure criteria to 2 retrospective cohorts. PARTICIPANTS: A total of 934 eyes and 1765 eyes undergoing trabeculectomy and deep sclerectomy (DS) with a median follow-up of 41.4 and 45.4 months, respectively. METHODS: Literature-based hypotony failure criteria were applied to patient cohorts. Intraocular pressure (IOP)-related success was defined as follows: (A) IOP ≤ 21 mmHg with ≥ 20% IOP reduction; (B) IOP ≤ 18 mmHg with ≥ 20% reduction; (C) IOP ≤ 15 mmHg with ≥ 25% reduction; and (D) IOP ≤ 12 mmHg with ≥ 30% reduction. Failure was defined as IOP exceeding these criteria in 2 consecutive visits > 3 months after surgery, loss of light perception, additional IOP-lowering surgery, or hypotony. Cox regression estimated failure risk for different hypotony criteria, using no hypotony as a reference. Analyses were conducted for each criterion and hypotony type (i.e., numerical [IOP threshold], clinical [clinical manifestations], and mixed [combination of numerical or clinical criteria]). MAIN OUTCOME MEASURES: Hazard ratio (HR) for failure risk. RESULTS: Of 2503 studies found, 278 were eligible, with 99 studies (35.6%) lacking hypotony failure criteria. Numerical hypotony was predominant (157 studies [56.5%]). Few studies used clinical hypotony (3 isolated [1.1%]; 19 combined with low IOP [6.8%]). Forty-nine different criteria were found, with IOP < 6 mmHg, IOP < 6 mmHg on ≥ 2 consecutive visits after 3 months, and IOP < 5 mmHg being the most common (41 [14.7%], 38 [13.7%], and 13 [4.7%] studies, respectively). In both cohorts, numerical hypotony posed the highest risk of failure (HR, 1.51-1.21 for criteria A to D; P < 0.001), followed by mixed hypotony (HR, 1.41-1.20 for criteria A to D; P < 0.001), and clinical hypotony (HR, 1.12-1.04; P < 0.001). Failure risk varied greatly with various hypotony definitions, with the HR ranging from 1.02 to 10.79 for trabeculectomy and 1.00 to 8.36 for DS. CONCLUSIONS: Hypotony failure criteria are highly heterogenous in the glaucoma literature, with few studies focusing on clinical manifestations. Numerical hypotony yields higher failure rates than clinical hypotony and can underestimate glaucoma surgery success rates. Standardizing failure criteria with an emphasis on clinically relevant hypotony manifestations is needed. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Efficacy of Smoothing Algorithms to Enhance Detection of Visual Field Progression in Glaucoma.

Purpose: To evaluate and compare the effectiveness of nearest neighbor (NN)- and variational autoencoder (VAE)-smoothing algorithms to reduce variability and enhance the performance of glaucoma visual field (VF) progression models. Design: Longitudinal cohort study. Subjects: 7150 eyes (4232 patients), with ≥ 5 years of follow-up and ≥ 6 visits. Methods: Vsual field thresholds were smoothed with the NN and VAE algorithms. The mean total deviation (mTD) and VF index rates, pointwise linear regression (PLR), permutation of PLR (PoPLR), and the glaucoma rate index were applied to the unsmoothed and smoothed data. Main Outcome Measures: The proportion of progressing eyes and the conversion to progression were compared between the smoothed and unsmoothed data. A simulation series of noiseless VFs with various patterns of glaucoma damage was used to evaluate the specificity of the smoothing models. Results: The mean values of age and follow-up time were 62.8 (standard deviation: 12.6) years and 10.4 (standard deviation: 4.7) years, respectively. The proportion of progression was significantly higher for the NN and VAE smoothed data compared with the unsmoothed data. VF progression occurred significantly earlier with both smoothed data compared with unsmoothed data based on mTD rates, PLR, and PoPLR methods. The ability to detect the progressing eyes was similar for the unsmoothed and smoothed data in the simulation data. Conclusions: Smoothing VF data with NN and VAE algorithms improves the signal-to-noise ratio for detection of change, results in earlier detection of VF progression, and could help monitor glaucoma progression more effectively in the clinical setting. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Predictors of Glaucomatous Progression in Individuals with Small and Large Optic Discs.

PURPOSE: To identify factors associated with glaucomatous progression in individuals with small and large optic discs. DESIGN: Retrospective review. SUBJECTS: 4505 individuals with glaucoma at UCLA; 233 (59.7%) with small discs, 157 (40.3%) with large discs. METHODS: Small and large disc sizes were defined by OCT or Heidelberg Retinal Tomography as disc area ≤ 5% (≤ 1.3 mm2) and ≥ 95% (≥ 2.9 mm2), respectively. Medical records were reviewed for demographics, systemic comorbidities, glaucoma type, ocular comorbidities, and ocular surgery. Logistic regression was used to identify predictors of visual field (VF) progression in individuals with small and large discs and predictors of large versus small discs. MAIN OUTCOME MEASURES: The VF deterioration with mean deviation, pointwise linear regression, and glaucoma rate index (GRI); large vs. small disc. RESULTS: In individuals with small discs, Asian versus non-Hispanic White ethnicity was associated with increased progression (adjusted odds ratio [aOR] = 4.05; 95% confidence interval [CI] = 1.12-14.59 for GRI). Higher intraocular pressure (IOP) range and peak were associated with increased progression in individuals with both small discs (aOR = 1.12; 95% CI = 1.00-1.27 and aOR = 1.05; 95% CI = 1.00-1.10 per 1 mmHg for range and peak with GRI) and large discs (aOR = 1.35; 95% CI = 1.12-1.66 and aOR = 1.11; 95% CI = 1.03-1.20 per 1 mmHg for range and peak with GRI). Multivariable predictors of having large vs. small discs included vasospastic phenotype (aOR = 2.58; 95% CI = 1.35-5.19) and Black (aOR = 20.46; 95% CI = 8.33-61.84), Hispanic/Latino (aOR = 9.65; 95% CI = 4.14-25.39), Asian (aOR = 4.87; 95% CI = 2.96-8.1), and other (aOR = 2.79; 95% CI = 1.69-4.63) versus non-Hispanic White ethnicity. CONCLUSIONS: Increased odds of glaucomatous progression were associated with Asian vs. non-Hispanic White ethnicity in glaucoma patients with small optic discs, as well as with increased IOP range and peak in those with small and large discs. Individuals with a vasospastic phenotype and those from racial and ethnic minority backgrounds had increased odds of having large vs. small optic discs. Further characterization of discernible phenotypes would improve disease prognostication and help individualize glaucoma treatment. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

¿qué investigamos cuando estudiamos la violencia en redes sociales en colombia? una revisión sistemática de la literatura

Con el incremento en el acceso y uso de las redes sociales en Colombia, es de esperar que prácticas y discursos violentos se trasladen a estos espacios digitales. Sin duda, hoy en día las redes sociales son parte de los ecosistemas de información y comunicación de los colombianos en los que las culturas de violencia y paz se expanden y transforman. En este contexto, es esencial explorar las formas en las que investigamos la violencia en redes sociales, ya que entender este fenómeno permite responder mejor a las necesidades y experiencias de las comunidades del país. Este artículo busca explorar cómo se ha estudiado la violencia en las redes sociales en Colombia mediante una revisión sistemática de la literatura. Resultados muestran un complejo trayecto de investigación en el país que comprende variados objetivos, como entender las diferentes formas en las que la violencia es ejercida a través de redes sociales o sobre cómo nos permite conocer más contextos de violencia. Igualmente, los resultados muestran que las investigaciones están principalmente enfocadas en dos plataformas: Facebook y Twitter. Finalmente, se encontró que los artículos están principalmente orientados a investigar tres tipos de violencias: violencia de género, violencia relacionada con conflicto armado y violencia escolar. Los hallazgos de esta revisión sistemática de la literatura permiten, por un lado, valorar previos estudios que han demostrado el complejo panorama de la violencia mediática en el país y, por otro lado, descubrir posibles vacíos en la literatura que podrían ser respondidos por investigadoras e investigadores en el futuro.

With the increase in the access and use of social media platforms in Colombia, it is expected that violent practices and discourses transfer to these digital spaces. Certainly, today's social media are part of the information and communication ecosystems of Colombians, where cultures of violence expand and transform. In this context, it is essential to explore the ways in which we examine and research social media violence, since understanding this phenomenon allows us to strengthen a culture of peace that better responds to the needs and experiences of the country's communities. Thus, this article seeks to explore how social media violence has been studied in Colombia, through a systematic literature review. Results show a complex trajectory of research in the country that includes various objectives, such as understanding the different ways in which violence is exercised through social media, or how it allows us to learn more about contexts of violence. Likewise, the results show that research is mainly focused on two platforms: Facebook and Twitter. Finally, the articles were found to be mainly focused on three types of violence: gender-based violence, violence related to armed conflict, and school violence. Overall, findings of this systematic literature review allow, on the one hand, to assess previous studies that have demonstrated the complex landscape of social media violence in the country, and, on the other hand, to discover possible gaps in the literature that could be addressed by researchers in the future.

Prediction of visual field progression with serial optic disc photographs using deep learning.

AIM: We tested the hypothesis that visual field (VF) progression can be predicted with a deep learning model based on longitudinal pairs of optic disc photographs (ODP) acquired at earlier time points during follow-up. METHODS: 3919 eyes (2259 patients) with ≥2 ODPs at least 2 years apart, and ≥5 24-2 VF exams spanning ≥3 years of follow-up were included. Serial VF mean deviation (MD) rates of change were estimated starting at the fifth visit and subsequently by adding visits until final visit. VF progression was defined as a statistically significant negative slope at two consecutive visits and final visit. We built a twin-neural network with ResNet50-backbone. A pair of ODPs acquired up to a year before the VF progression date or the last VF in non-progressing eyes were included as input. Primary outcome measures were area under the receiver operating characteristic curve (AUC) and model accuracy. RESULTS: The average (SD) follow-up time and baseline VF MD were 8.1 (4.8) years and -3.3 (4.9) dB, respectively. VF progression was identified in 761 eyes (19%). The median (IQR) time to progression in progressing eyes was 7.3 (4.5-11.1) years. The AUC and accuracy for predicting VF progression were 0.862 (0.812-0.913) and 80.0% (73.9%-84.6%). When only fast-progressing eyes were considered (MD rate < -1.0 dB/year), AUC increased to 0.926 (0.857-0.994). CONCLUSIONS: A deep learning model can predict subsequent glaucoma progression from longitudinal ODPs with clinically relevant accuracy. This model may be implemented, after validation, for predicting glaucoma progression in the clinical setting.

Tic-Tac: A Translational Approach in Mechanisms Associated with Irregular Heartbeat and Sinus Rhythm Restoration in Atrial Fibrillation Patients.

Atrial fibrillation (AF) is a prevalent cardiac condition predominantly affecting older adults, characterized by irregular heartbeat rhythm. The condition often leads to significant disability and increased mortality rates. Traditionally, two therapeutic strategies have been employed for its treatment: heart rate control and rhythm control. Recent clinical studies have emphasized the critical role of early restoration of sinus rhythm in improving patient outcomes. The persistence of the irregular rhythm allows for the progression and structural remodeling of the atria, eventually leading to irreversible stages, as observed clinically when AF becomes permanent. Cardioversion to sinus rhythm alters this progression pattern through mechanisms that are still being studied. In this review, we provide an in-depth analysis of the pathophysiological mechanisms responsible for maintaining AF and how they are modified during sinus rhythm restoration using existing therapeutic strategies at different stages of clinical investigation. Moreover, we explore potential future therapeutic approaches, including the promising prospect of gene therapy.

Phenotypic expressions of the optic disc in primary open-angle glaucoma.

BACKGROUND: Which phenotypes are we able to recognize in the optic nerve of patients with primary open angle glaucoma? METHODS: Retrospective interventional case series. 885 eyes from 885 patients at an outpatient tertiary care centre who met specified criteria for POAG were included. Disc photographs were classified by three glaucoma specialists into the following phenotypes according to their predominant characteristics: (1) concentric rim thinning, (2) focal rim thinning, (3) acquired pit of the optic nerve (APON), (4) tilted, (5) extensive peripapillary atrophy (PPA), and (6) broad rim thinning. Demographic, medical, and ocular data were collected. Kruskal-Wallis was used as a non-parametric test and pairwise comparison was performed by using Wilcoxon rank sum test corrected. RESULTS: Phenotypic distribution was as follows: 398(45%) focal thinning, 153(18%) concentric thinning, 153(17%) broad thinning, 109(12%) tilted, 47(5%) extensive PPA and 25(3%) APON. Phenotypic traits of interest included a higher proportion of female patients with the focal thinning phenotype (p = 0.015); myopia (p = 0.000), Asian race (OR: 8.8, p = 0.000), and younger age (p = 0.000) were associated with the tilted phenotype; the concentric thinning patients had thicker RNFL (p = 0.000), higher MD (p = 0.008) and lower PSD (p = 0.043) than broad thinning, despite no difference in disc sizes (p = 0.849). The focal thinning group had a localized VF pattern with high PSD compared to concentric thinning (p = 0.005). CONCLUSION: We report six phenotypic classifications of POAG patients with demographic and ocular differences between phenotypes. Future refinement of phenotypes should allow enhanced identification of genetic associations and improved individualization of patient care.

Long-Term Visual Field Outcomes After Ahmed Glaucoma Valve Implantation.

PURPOSE: To measure visual field (VF) rates of change after Ahmed Glaucoma Valve (AGV) implantation and to investigate risk factors for progression. DESIGN: Retrospective, clinical cohort study. METHODS: Patients who underwent AGV implantation with at least 4 eligible postoperative VFs and 2 years of follow-up were included. Baseline, intraoperative, and postoperative data were collected. VF progression was explored with 3 methods: mean deviation (MD) rate; glaucoma rate index (GRI); and pointwise linear regression (PLR). For a subset of eyes with sufficient preoperative and postoperative VFs, rates were compared between the 2 periods. RESULTS: A total of 173 eyes were included. The intraocular pressure (IOP) and number of glaucoma medications were significantly reduced from a median (interquartile range [IQR]) of 23.5 (12.1) mm Hg at baseline to 12.8 (4.0) mm Hg at final follow-up, and from (mean ± SD) 3.3 ± 1.2 to 2.2 ± 1.4, respectively. A total of 38 eyes (22%) showed VF progression, and 101 eyes (58%) were stable as assessed by all 3 methods, which accounted for 80% of all eyes. The rate of VF decline by MD and GRI was a median (IQR) of -0.30 (0.8) dB/y and -2.30 (10.6) (of -100), respectively. When comparing progression before and after surgery, the reduction was not statistically significant with any of the methods. The peak IOP (after 3 postoperative months) was associated with VF deterioration, with a 7% increase in risk per each additional millimeter of mercury (mm Hg). CONCLUSIONS: To our knowledge, this is the largest published series reporting long-term VF outcomes after glaucoma drainage device implantation. There is a continued, significant rate of VF decline after AGV surgery.

A Neural Network for Automated Image Quality Assessment of Optic Disc Photographs.

This study describes the development of a convolutional neural network (CNN) for automated assessment of optic disc photograph quality. Using a code-free deep learning platform, a total of 2377 optic disc photographs were used to develop a deep CNN capable of determining optic disc photograph quality. Of these, 1002 were good-quality images, 609 were acceptable-quality, and 766 were poor-quality images. The dataset was split 80/10/10 into training, validation, and test sets and balanced for quality. A ternary classification model (good, acceptable, and poor quality) and a binary model (usable, unusable) were developed. In the ternary classification system, the model had an overall accuracy of 91% and an AUC of 0.98. The model had higher predictive accuracy for images of good (93%) and poor quality (96%) than for images of acceptable quality (91%). The binary model performed with an overall accuracy of 98% and an AUC of 0.99. When validated on 292 images not included in the original training/validation/test dataset, the model's accuracy was 85% on the three-class classification task and 97% on the binary classification task. The proposed system for automated image-quality assessment for optic disc photographs achieves high accuracy in both ternary and binary classification systems, and highlights the success achievable with a code-free platform. There is wide clinical and research potential for such a model, with potential applications ranging from integration into fundus camera software to provide immediate feedback to ophthalmic photographers, to prescreening large databases before their use in research.

DDLSNet: A Novel Deep Learning-Based System for Grading Funduscopic Images for Glaucomatous Damage.

Purpose: To report an image analysis pipeline, DDLSNet, consisting of a rim segmentation (RimNet) branch and a disc size classification (DiscNet) branch to automate estimation of the disc damage likelihood scale (DDLS). Design: Retrospective observational. Participants: RimNet and DiscNet were developed with 1208 and 11 536 optic disc photographs (ODPs), respectively. DDLSNet performance was evaluated on 120 ODPs from the RimNet test set, for which the DDLS scores were graded by clinicians. Reproducibility was evaluated on a group of 781 eyes, each with 2 ODPs taken within 4 years apart. Methods: Disc damage likelihood scale calculation requires estimation of optic disc size, provided by DiscNet (VGG19 network), and the minimum rim-to-disc ratio (mRDR) or absent rim width (ARW), provided by RimNet (InceptionV3/LinkNet segmentation model). To build RimNet's dataset, glaucoma specialists marked optic disc rim and cup boundaries on ODPs. The "ground truth" mRDR or ARW was calculated. For DiscNet's dataset, corresponding OCT images provided "ground truth" disc size. Optic disc photographs were split into 80/10/10 for training, validation, and testing, respectively, for RimNet and DiscNet. DDLSNet estimation was tested against manual grading of DDLS by clinicians with the average score used as "ground truth." Reproducibility of DDLSNet grading was evaluated by repeating DDLS estimation on a dataset of nonprogressing paired ODPs taken at separate times. Main Outcome Measures: The main outcome measure was a weighted kappa score between clinicians and the DDLSNet pipeline with agreement defined as ± 1 DDLS score difference. Results: RimNet achieved an mRDR mean absolute error (MAE) of 0.04 (± 0.03) and an ARW MAE of 48.9 (± 35.9) degrees when compared to clinician segmentations. DiscNet achieved 73% (95% confidence interval [CI]: 70%, 75%) classification accuracy. DDLSNet achieved an average weighted kappa agreement of 0.54 (95% CI: 0.40, 0.68) compared to clinicians. Average interclinician agreement was 0.52 (95% CI: 0.49, 0.56). Reproducibility testing demonstrated that 96% of ODP pairs had a difference of ≤ 1 DDLS score. Conclusions: DDLSNet achieved moderate agreement with clinicians for DDLS grading. This novel approach illustrates the feasibility of automated ODP grading for assessing glaucoma severity. Further improvements may be achieved by increasing the number of incomplete rims sample size, expanding the hyperparameter search, and increasing the agreement of clinicians grading ODPs.

Computational Simulation of Colorectal Cancer Biomarker Particle Mobility in a 3D Model.

Even though some methods for the detection of colorectal cancer have been used clinically, most of the techniques used do not consider the in situ detection of colorectal cancer (CRC) biomarkers, which would favor in vivo real-time monitoring of the carcinogenesis process and consequent studies of the disease. In order to give a scientific and computational framework ideal for the evaluation of diagnosis techniques based on the early detection of biomarker molecules modeled as spherical particles from the computational point of view, a computational representation of the rectum, stool and biomarker particles was developed. As consequence of the transport of stool, there was a displacement of CRC biomarker particles that entered the system as a result of the cellular apoptosis processes in polyps with a length lower than 1 cm, reaching a maximum velocity of 3.47×10-3 m/s. The biomarkers studied showed trajectories distant to regions of the polyp of origin in 1 min of simulation. The research results show that the biomarker particles for CRC respond to the variations in the movements of the stool with trajectories and speeds that depend on the location of the injury, which will allow locating the regions with the highest possibilities of catching particles through in situ measurement instruments in the future.

RimNet: A Deep Neural Network Pipeline for Automated Identification of the Optic Disc Rim.

Purpose: Accurate neural rim measurement based on optic disc imaging is important to glaucoma severity grading and often performed by trained glaucoma specialists. We aim to improve upon existing automated tools by building a fully automated system (RimNet) for direct rim identification in glaucomatous eyes and measurement of the minimum rim-to-disc ratio (mRDR) in intact rims, the angle of absent rim width (ARW) in incomplete rims, and the rim-to-disc-area ratio (RDAR) with the goal of optic disc damage grading. Design: Retrospective cross sectional study. Participants: One thousand and twenty-eight optic disc photographs with evidence of glaucomatous optic nerve damage from 1021 eyes of 903 patients with any form of primary glaucoma were included. The mean age was 63.7 (± 14.9) yrs. The average mean deviation of visual fields was -8.03 (± 8.59). Methods: The images were required to be of adequate quality, have signs of glaucomatous damage, and be free of significant concurrent pathology as independently determined by glaucoma specialists. Rim and optic cup masks for each image were manually delineated by glaucoma specialists. The database was randomly split into 80/10/10 for training, validation, and testing, respectively. RimNet consists of a deep learning rim and cup segmentation model, a computer vision mRDR measurement tool for intact rims, and an ARW measurement tool for incomplete rims. The mRDR is calculated at the thinnest rim section while ARW is calculated in regions of total rim loss. The RDAR was also calculated. Evaluation on the Drishti-GS dataset provided external validation (Sivaswamy 2015). Main Outcome Measures: Median Absolute Error (MAE) between glaucoma specialists and RimNet for mRDR and ARW. Results: On the test set, RimNet achieved a mRDR MAE of 0.03 (0.05), ARW MAE of 31 (89)°, and an RDAR MAE of 0.09 (0.10). On the Drishti-GS dataset, an mRDR MAE of 0.03 (0.04) and an mRDAR MAE of 0.09 (0.10) was observed. Conclusions: RimNet demonstrated acceptably accurate rim segmentation and mRDR and ARW measurements. The fully automated algorithm presented here would be a valuable component in an automated mRDR-based glaucoma grading system. Further improvements could be made by improving identification and segmentation performance on incomplete rims and expanding the number and variety of glaucomatous training images.

Risk factors for microcystic macular oedema in glaucoma.

BACKGROUND/AIMS: To identify clinical characteristics and factors associated with microcystic macular edema (MME) in patients with primary open-angle glaucoma (POAG). METHODS: We included 315 POAG eyes between 2010 and 2019 with good-quality macular volume scans that had reliable visual fields (VF) available within 6 months in this observational retrospective cohort study. Eyes with retinal pathologies except for epiretinal membrane (ERM) were excluded. The inner nuclear layer was qualitatively assessed for the presence of MME. Global mean deviation (MD) and Visual Field Index (VFI) decay rates, superior and inferior MD rates and pointwise total deviation rates of change were estimated with linear regression. Logistic regression was performed to identify baseline factors associated with the presence of MME and to determine whether MME is associated with progressive VF loss. RESULTS: 25 out of 315 eyes (7.9%) demonstrated MME. The average (±SD) age and MD in eyes with and without MME was 57.2 (±8.7) versus 62.0 (±9.9) years (p=0.02) and -9.8 (±5.7) versus -4.9 (±5.3) dB (p<0.001), respectively. Worse global MD at baseline (p=0.001) and younger age (p=0.02) were associated with presence of MME. ERM was not associated with the presence of MME (p=0.84) in this cohort. MME was not associated with MD and VFI decay rates (p>0.49). CONCLUSIONS: More severe glaucoma and younger age were associated with MME. MME was not associated with faster global VF decay in this cohort. MME may confound monitoring of glaucoma with full macular thickness.

A Metascore of Multiple Imaging Methods to Measure Long-Term Glaucoma Structural Progression.

Purpose: To develop a structural metascore (SMS) that combines measurements from different devices and expresses them on a single scale to facilitate their long-term analysis. Methods: Three structural measurements (Heidelberg Retina Tomograph II [HRT] rim area, HD-Cirrus optical coherence tomography [OCT] average retinal nerve fiber layer [RNFL] thickness, Spectralis OCT RNFL global thickness) were normalized on a scale of 0 to 100 and converted to a reference value. The resultant metascores were plotted against time. SMS performance was evaluated to predict future values (internal validation), and correlations between the average grades assigned by three clinicians were compared with the SMS slopes (external validation). Results: The linear regression fit with the variance approach, and adjustment to a Spectralis equivalent was the best-performing approach; this was denominated metascore. Plots were created for 3416 eyes of 1824 patients. The average baseline age (± standard deviation) was 69.8 (±13.9), mean follow-up was 11.6 (±4.7) years, and mean number of structural scans per eye was 10.0 (±4.7). The mean numbers of scans per device were 3.8 (±2.5), 5.0 (±2.9), and 1.3 (±3.0) for HRT, Cirrus, and Spectralis, respectively. The metascore slopes' median was -0.3 (interquartile range 1.1). Correlations between the average grades assigned by the three clinicians and the metascore slopes were -0.51, -0.49, and -0.69 for the first (structural measurement printouts alone), second (metascore plots alone), and third (printouts + metascore plots) series of gradings, respectively. The average absolute predictive ability was 7.63/100 (whereas 100 = entire normalized scale). Conclusions: We report a method that converts Cirrus global RNFL and HRT global rim area normalized measurements to Spectralis global RNFL equivalent values to facilitate long-term structural follow-up. Translational Relevance: Because glaucoma changes usually occur slowly, patients are often examined with different instruments during their follow-up, a method that "unifies" structural measurements provided by different devices, which could assist patients' longitudinal structural follow-up.

The role of collegiality in academic review, promotion, and tenure.

Review, promotion, and tenure (RPT) processes at universities typically assess candidates along three dimensions: research, teaching, and service. In recent years, some have argued for the inclusion of a controversial fourth criterion: collegiality. While collegiality plays a role in the morale and effectiveness of academic departments, it is amorphic and difficult to assess, and could be misused to stifle dissent or enforce homogeneity. Despite this, some institutions have opted to include this additional element in their RPT documents and processes, but it is unknown the extent of this practice and how it varies across institution type and disciplinary units. This study is based on two sets of data: survey data collected as part of a project that explored the publishing decisions of faculty and how these related to perceived importance in RPT processes, and 864 RPT documents collected from 129 universities from the United States and Canada. We analysed these RPT documents to determine the degree to which collegiality and related terms are mentioned, if they are defined, and if and how they may be assessed during the RPT process. Results show that when collegiality and related terms appear in these documents they are most often just briefly mentioned. It is less common for collegiality and related terms to be defined or assessed in RPT documents. Although the terms are mentioned across all types of institutions, there is a statistically significant difference in how prevalent they are at each. Collegiality is more commonly mentioned in the documents of doctoral research-focused universities (60%), than of master's universities and colleges (31%) or baccalaureate colleges (15%). Results from the accompanying survey of faculty also support this finding: individuals from R-Types were more likely to perceive collegiality to be a factor in their RPT processes. We conclude that collegiality likely plays an important role in RPT processes, whether it is explicitly acknowledged in policies and guidelines or not, and point to several strategies in how it might be best incorporated in the assessment of academic careers.

Using social annotation to construct knowledge with others: A case study across undergraduate courses.

Background: Social annotation (SA) is a genre of learning technology that enables the addition of digital notes to shared texts and affords contextualized peer-to-peer online discussion. A small body of literature examines how SA, as asynchronous online discussion, can contribute to students' knowledge construction (KC)-or a process whereby learners collaborate through shared socio-cognitive practices. This case study analyzed how SA enabled student participation in seven KC activities, such as interpretation and elaboration. Methods: We analyzed 2,121 annotations written by 59 students in three undergraduate courses at a Canadian University in the first months of 2019. Using a method of open coding and constant comparison, we coded each annotation for evidence of KC activities. Results: Results showed a range of KC activities in students' SA. Across courses, interpretation was the most common KC activity (40%), followed by elaboration (20%). Annotations that were part of peer-to-peer discussion included all seven types of KC activities, but some activities, such as consensus building, support, and conflict, were almost exclusively found in replies to others. Conclusions: This study suggests that SA is a productive form of online learning through which undergraduate students in multiple disciplinary contexts can interact with peers, make sense of academic content, and construct knowledge by reading and writing together.

Structural-Functional Glaucoma Progression Trajectory in 2-Dimensional Space.

PRCIS: We describe a method that provides rapid visualization of glaucomatous change in a 2-dimensional (2D) structural and functional (S/F) space. PURPOSE: To describe a method to visualize glaucomatous change in a 2D S/F space. DESIGN: This was a retrospective longitudinal observational study. SUBJECTS: Group I included 64 normal and 64 glaucomatous eyes used to develop the structural score. Group II included 957 glaucomatous eyes used to plot the structural-functional progression vectors. METHODS: Subjects were arranged in 2 groups. Group I was a cross-sectional group used to develop a structural score which were applied to longitudinal measurements of patients in group II for vectoral analysis. Visual field index was used as a functional score. Vectors were created for each eye to define structural (x) and functional (y) progression. The structural and functional components were calculated with linear models of optical coherence tomography scores and visual field index. The resultant vector and its confidence interval were plotted in 2D S/F space. MAIN OUTCOME MEASURES: Combined structural-functional glaucomatous progression. RESULTS: Group I included 64 normal and 64 glaucomatous eyes. We calculated 957 vectors (957 eyes of 582 OAG patients) in group II. The mean (±SD) follow-up period was 6.9 (±1.5) years and mean baseline mean deviation (MD) was -4.3 (±5.4). Preperimetric, mild, moderate, and severe groups included 159, 288, 299, and 211 eyes, respectively. Mean baseline MDs in these groups were 0.8, -1.0, -3.7, and -11.2 dB, and mean vector slopes were 0.88, 1.00, 1.98, and 2.69. CONCLUSION: We present a method that presents glaucoma progression in a 2D S/F space. This approach integrates a large amount of longitudinal numerical data and provides the clinician with a rapid and intuitive summary of the patient's glaucoma trajectory.

Página web para el estudio del modelo celular de la coagulación en la carrera de medicina y residencia de especialidades clínicas / Website For The Study Of The Cellular Model Of Coagulation In Medicine Major And The Residency Of Clinical Specialties

Introducción: El modelo de la coagulación ha experimentado cambios para alcanzar un consenso con relación a los trastornos hemorrágicos que se aprecian en la práctica médica. El modelo celular de la coagulación es el más aceptado con el que se cuenta dentro de esta área del conocimiento, sin embargo, es poco conocido e integrado en los planes de estudio en Cuba. Objetivo: Confeccionar una página web que integre los elementos actuales acerca del modelo celular de la coagulación. Materiales y métodos: Se realizó un estudio de tipo innovación tecnológica entre los meses de enero de 2017 y enero de 2018 en Ciego de Ávila. Se desarrolló en tres etapas: confección, validación por expertos y comprobación de efectividad por usuarios. Para el diseño se empleó el software Drupal, y el lenguaje HTML. Para la comprobación se contó con dos grupos de expertos que valorara desde el punto de vista de pertinencia educativa e informática. Se comprobó la efectividad mediante un posprueba aplicada a 106 estudiantes de medicina y 16 residentes. Resultados: Se obtuvieron valoraciones de adecuado y muy adecuado por consenso de expertos, siendo la originalidad (7,13 ± 1,24) y la pertinencia (7,20 ± 1,74) los aspectos mejor valorados. Más del 90 % de los usuarios valoraron igualmente la página web como muy satisfactorias según los contenidos tratados y la originalidad. Durante la posprueba el 84,91 por ciento de los estudiantes y 66,67 por ciento de los residentes se suscriben a la calificación de excelente. Conclusiones: Se confeccionó una página con la capacidad de integrar los elementos actuales acerca del modelo celular de la coagulación(AU)

Introduction: The coagulation model has undergone changes to reach a consensus regarding the bleeding disorders that are seen in medical practice. The cellular model of coagulation is the most accepted that is available within this area of knowledge; however, it is little known and integrated into the curricula in Cuba. Objective: Create a web page that integrates the current elements about the cellular model of coagulation. Materials and methods: A technological innovation study was carried out between January 2017 and January 2018 in Ciego de Ávila province. It was developed in three stages: preparation, validation by experts and verification of effectiveness by users. For the design was used Drupal software, and HTML language. For the verification, there were two groups of experts to assess from the point of view of educational and computer relevance. Effectiveness was tested by a post-test applied to 106 medical students and 16 residents. Results: Adequate and very adequate assessments were obtained by consensus of experts, with originality (7.13 ± 1.24) and relevance (7.20 ± 1.74) being the best valued aspects. More than 90 percent of users also rated the website as very satisfactory according to the contents treated and originality. During the post-test, 84.91 percent of students and 66.67 percent of residents confirmed the excellent rating. Conclusions: A web page was made with the ability to integrate the current elements about the cellular model of coagulation(AU)

Página web para el estudio del modelo celular de la coagulación en la carrera de medicina y residencia de especialidades clínicas / Website For The Study Of The Cellular Model Of Coagulation In Medicine Major And The Residency Of Clinical Specialties

Introducción: El modelo de la coagulación ha experimentado cambios para alcanzar un consenso con relación a los trastornos hemorrágicos que se aprecian en la práctica médica. El modelo celular de la coagulación es el más aceptado con el que se cuenta dentro de esta área del conocimiento, sin embargo, es poco conocido e integrado en los planes de estudio en Cuba. Objetivo: Confeccionar una página web que integre los elementos actuales acerca del modelo celular de la coagulación. Materiales y métodos: Se realizó un estudio de tipo innovación tecnológica entre los meses de enero de 2017 y enero de 2018 en Ciego de Ávila. Se desarrolló en tres etapas: confección, validación por expertos y comprobación de efectividad por usuarios. Para el diseño se empleó el software Drupal, y el lenguaje HTML. Para la comprobación se contó con dos grupos de expertos que valorara desde el punto de vista de pertinencia educativa e informática. Se comprobó la efectividad mediante un posprueba aplicada a 106 estudiantes de medicina y 16 residentes. Resultados: Se obtuvieron valoraciones de adecuado y muy adecuado por consenso de expertos, siendo la originalidad (7,13 ± 1,24) y la pertinencia (7,20 ± 1,74) los aspectos mejor valorados. Más del 90 por ciento de los usuarios valoraron igualmente la página web como muy satisfactorias según los contenidos tratados y la originalidad. Durante la posprueba el 84,91 por ciento de los estudiantes y 66,67 por ciento de los residentes se suscriben a la calificación de excelente. Conclusiones: Se confeccionó una página con la capacidad de integrar los elementos actuales acerca del modelo celular de la coagulación(AU)

Introduction: The coagulation model has undergone changes to reach a consensus regarding the bleeding disorders that are seen in medical practice. The cellular model of coagulation is the most accepted that is available within this area of knowledge; however, it is little known and integrated into the curricula in Cuba. Objective: Create a web page that integrates the current elements about the cellular model of coagulation. Materials and methods: A technological innovation study was carried out between January 2017 and January 2018 in Ciego de Ávila province. It was developed in three stages: preparation, validation by experts and verification of effectiveness by users. For the design was used Drupal software, and HTML language. For the verification, there were two groups of experts to assess from the point of view of educational and computer relevance. Effectiveness was tested by a post-test applied to 106 medical students and 16 residents. Results: Adequate and very adequate assessments were obtained by consensus of experts, with originality (7.13 ± 1.24) and relevance (7.20 ± 1.74) being the best valued aspects. More than 90 percent of users also rated the website as very satisfactory according to the contents treated and originality. During the post-test, 84.91 percent of students and 66.67 percent of residents confirmed the excellent rating. Conclusions: A web page was made with the ability to integrate the current elements about the cellular model of coagulation(AU)