High dives and parallel plans: Relationships between medical student elective strategies and residency match outcomes

Background: Medical students are anxious about not getting a preferred residency position.  We described elective patterns of two recent cohorts and examined associated match outcomes. Methods: We conducted a retrospective review of the final-year electives of all students who participated in the residency match (first iteration) at one school for 2017 and 2018.  We categorized elective patterns and associated them with aggregated match outcomes. We examined high-demand/low-supply (HDLS) disciplines separately. Results: We described three elective patterns: High Dive, Parallel Plan(s), and No Clear Pattern. Many students had High Dive and Parallel Plans patterns; only a few showed No Clear Pattern. Match rates for High Dive and Parallel Plan patterns were high but many students matched to Family and Internal Medicine.  When we separated out HDLS predominance, the match rate remained high but a significant number matched to disciplines in which they did not have a majority of electives. Most High Dive and Parallel Plan students who went unmatched did so with HDLS discipline electives.  Conclusion: Many students chose High Dive and Parallel Plan strategies to both high-capacity and HDLS disciplines. Match rates were high for both patterns but students also matched to non-primary disciplines.  Back-up planning may reside in the entire application, and not just electives selection

Hypertensive eye disease

Hypertensive eye disease includes a spectrum of pathological changes, the most well known being hypertensive retinopathy. Other commonly involved parts of the eye in hypertension include the choroid and optic nerve, sometimes referred to as hypertensive choroidopathy and hypertensive optic neuropathy. Together, hypertensive eye disease develops in response to acute and/or chronic elevation of blood pressure. Major advances in research over the past three decades have greatly enhanced our understanding of the epidemiology, systemic associations and clinical implications of hypertensive eye disease, particularly hypertensive retinopathy. Traditionally diagnosed via a clinical funduscopic examination, but increasingly documented on digital retinal fundus photographs, hypertensive retinopathy has long been considered a marker of systemic target organ damage (for example, kidney disease) elsewhere in the body. Epidemiological studies indicate that hypertensive retinopathy signs are commonly seen in the general adult population, are associated with subclinical measures of vascular disease and predict risk of incident clinical cardiovascular events. New technologies, including development of non-invasive optical coherence tomography angiography, artificial intelligence and mobile ocular imaging instruments, have allowed further assessment and understanding of the ocular manifestations of hypertension and increase the potential that ocular imaging could be used for hypertension management and cardiovascular risk stratification

Reliability and Determinants of Retinal Vessel Oximetry Measurements in Healthy Eyes

METHODS. Subjects older than 40 years without a history of stroke and heart disease were recruited from a community-based clinic. Subjects underwent standardized systemic and ocular examinations. Normal eyes were defined as eyes without major eye diseases such as age-related macular degeneration, glaucoma, or retinopathy. Retinal vessel oximetry levels were measured by using the Oxymap T1 Retinal Oximeter. Intra-and intergrader reliability of retinal vessel oximetry measurements were assessed by using 50 images. Intravisit repeatability of retinal vessel oximetry measurements was assessed by using 20 paired images. Univariable linear regression was performed to examine the associations between retinal vessel oximetry measurements and systemic determinants. CONCLUSIONS. The Oxymap Retinal Oximeter allows reliable and repeatable retinal vessel oximetry measurements. Age is the main factor that influences retinal venular oximetry levels and should be taken into account when retinal oximetry measurements are interpreted

Classification of SD-OCT Volumes using Local Binary Patterns: Experimental Validation for DME Detection

International audienceThis paper addresses the problem of automatic classification of Spectral Domain OCT (SD-OCT) data for automatic identification of patients with Diabetic Macular Edema (DME) versus normal subjects. Optical Coherence Tomography (OCT) has been a valuable diagnostic tool for DME, which is among the most common causes of irreversible vision loss in individuals with diabetes. Here, a classification framework with five distinctive steps is proposed and we present an extensive study of each step. Our method considers combination of various pre-processings in conjunction with Local Binary Patterns (LBP) features and different mapping strategies. Using linear and non-linear classifiers, we tested the developed framework on a balanced cohort of 32 patients. Experimental results show that the proposed method outperforms the previous studies by achieving a Sensitivity (SE) and Specificity (SP) of 81.2% and 93.7%, respectively. Our study concludes that the 3D features and high-level representation of 2D features using patches achieve the best results. However, the effects of pre-processing is inconsistent with respect to different classifiers and feature configurations

Classification of SD-OCT volumes with multi pyramids, LBP and HOG descriptors: application to DME detections

International audienceThis paper deals with the automated detection of DME on OCT volumes.Our method considers a generic classification pipeline with preprocessing for noise removal and flattening of each B-Scan.Features such as HoG and LBP are extracted and combined to create a set of different feature vectors which are fed to a linear-SVM classifier.Experimental results show a promising sensitivity/specificity of 0.75/0.87 on a challenging dataset

Concordance between SIVA, IVAN, and VAMPIRE software tools for semi-automated analysis of retinal vessel caliber

We aimed to compare measurements from three of the most widely used software packages in the literature and to generate conversion algorithms for measurement of the central retinal artery equivalent (CRAE) and central retinal vein equivalent (CRVE) between SIVA and IVAN and between SIVA and VAMPIRE. We analyzed 223 retinal photographs from 133 human participants using both SIVA, VAMPIRE and IVAN independently for computing CRAE and CRVE. Agreement between measurements was assessed using Bland–Altman plots and intra-class correlation coefficients. A conversion algorithm between measurements was carried out using linear regression, and validated using bootstrapping and root-mean-square error. The agreement between VAMPIRE and IVAN was poor to moderate: The mean difference was 20.2 µm (95% limits of agreement, LOA, −12.2–52.6 µm) for CRAE and 21.0 µm (95% LOA, −17.5–59.5 µm) for CRVE. The agreement between VAMPIRE and SIVA was also poor to moderate: the mean difference was 36.6 µm (95% LOA, −12.8–60.4 µm) for CRAE, and 40.3 µm (95% LOA, 5.6–75.0 µm) for CRVE. The agreement between IVAN and SIVA was good to excellent: the mean difference was 16.4 µm (95% LOA, −4.25–37.0 µm) for CRAE, and 19.3 µm (95% LOA, 0.09–38.6 µm) for CRVE. We propose an algorithm converting IVAN and VAMPIRE measurements into SIVA-estimated measurements, which could be used to homogenize sets of vessel measurements obtained with different software packages

Retinal microvascular network attenuation in Alzheimer's disease

AbstractIntroductionCerebral small-vessel disease has been implicated in the development of Alzheimer's disease (AD). The retinal microvasculature enables the noninvasive visualization and evaluation of the systemic microcirculation. We evaluated retinal microvascular parameters in a case-control study of AD patients and cognitively normal controls.MethodsRetinal images were computationally analyzed and quantitative retinal parameters (caliber, fractal dimension, tortuosity, and bifurcation) measured. Regression models were used to compute odds ratios (OR) and confidence intervals (CI) for AD with adjustment for confounders.ResultsRetinal images were available in 213 AD participants and 294 cognitively normal controls. Persons with lower venular fractal dimension (OR per standard deviation [SD] increase, 0.77 [CI: 0.62–0.97]) and lower arteriolar tortuosity (OR per SD increase, 0.78 [CI: 0.63–0.97]) were more likely to have AD after appropriate adjustment.DiscussionPatients with AD have a sparser retinal microvascular network and retinal microvascular variation may represent similar pathophysiological events within the cerebral microvasculature of patients with AD

The KCNJ11 E23K Polymorphism and Progression of Glycaemia in Southern Chinese: A Long-Term Prospective Study

Context: The KCNJ11 E23K variant is associated with type 2 diabetes mellitus (T2DM) in cross-sectional studies, but conflicting findings have been reported from prospective studies. Objective: This study aimed to evaluate whether the E23K variant could predict glycaemic progression in a Southern Chinese population. Methods/Principal Findings: We performed a long-term prospective study on 1912 subjects from the Hong Kong Cardiovascular Risk Factors Prevalence Study (CRISPS). The KCNJ11 E23K variant was associated with the progression to prediabetes after a median interval of 12 years on multinomial logistic regression analysis, even after adjustment for traditional risk factors (OR 1.29, P age, sex, BMI and fasting plasma glucose [FPG] adjusted = 0.02). Based on Cox proportional hazard regression analysis, the E23K variant also predicted incident prediabetes (HR 1.18, P age, sex, BMI and FPG adjusted = 0.021). However, E23K was not associated with the progression to T2DM in either multinomial or Cox regression analysis, and the association of E23K with glycaemic progression to either prediabetes or T2DM was significant only in unadjusted Cox regression analysis (P = 0.039). In a meta-analysis of eight prospective studies including our own, involving 15680 subjects, the E23K variant was associated with incident T2DM (fixed effect: OR 1.10, P = 4×10 -3; random effect: OR 1.11, P = 0.035). Conclusions: Our study has provided supporting evidence for the role of the E23K variant in glycaemic progression in Chinese, with its effect being more evident in the early stage of T2DM, as the subjects progressed from normal glucose tolerance to prediabetes. © 2011 Cheung et al.published_or_final_versio

Ophthalmol Ther

The healthcare burden of cardiovascular diseases remains a major issue worldwide. Understanding the underlying mechanisms and improving identification of people with a higher risk profile of systemic vascular disease through noninvasive examinations is crucial. In ophthalmology, retinal vascular network imaging is simple and noninvasive and can provide in vivo information of the microstructure and vascular health. For more than 10 years, different research teams have been working on developing software to enable automatic analysis of the retinal vascular network from different imaging techniques (retinal fundus photographs, OCT angiography, adaptive optics, etc.) and to provide a description of the geometric characteristics of its arterial and venous components. Thus, the structure of retinal vessels could be considered a witness of the systemic vascular status. A new approach called "oculomics" using retinal image datasets and artificial intelligence algorithms recently increased the interest in retinal microvascular biomarkers. Despite the large volume of associated research, the role of retinal biomarkers in the screening, monitoring, or prediction of systemic vascular disease remains uncertain. A PubMed search was conducted until August 2022 and yielded relevant peer-reviewed articles based on a set of inclusion criteria. This literature review is intended to summarize the state of the art in oculomics and cardiovascular disease research