nt.
 There was considerable variability in what IM clerkships assessed and how those assessments were translated into grades. The NBME MSE was a major contributor to the final grade despite concerns about the impact on patient care learning. These findings underscore the difficulty in comparing learners across institutions and serve to advance discussions for how to improve accuracy and comparability of grading in the clinical environment.
  To investigate students' experience (over time) with meta-reflection writing exercises, called Signature Reflections. These exercises were used to strengthen reflective capacity, as part of a 4-year reflective writing portfolio curriculum that builds on a recognized strategy for reflection (narrative medicine) and employs longitudinal faculty-mentors.
 
  In 2018, the authors conducted 5 focus groups with 18 third-year students from the Columbia University Vagelos College of Physicians and Surgeons class of 2019 to examine students' experience with Signature Reflections. Using an iterative, thematic approach, they developed codes to reflect common patterns in the transcripts, distilled conceptually similar codes, and assembled the code categories into themes.
 
  Three core themes (safe space, narrative experience, mirror of self) and one overarching theme (moving through time) were identified. Students frequently experienced relief at having a safe reflective space that promoted grappling with their fears or v their development.
 A longitudinal narrative medicine-based portfolio curriculum with pauses for meta-reflection allowed students, with faculty support, to observe their trajectory through medical school, explore fears and vulnerabilities, and narrate their own growth. Findings suggest that narrative medicine curricula should be required and sufficiently longitudinal to facilitate opportunities to practice the skill of writing for insight, foster relationships with faculty, and strengthen students' temporal perspectives of their development.A 58-year-old highly myopic woman had suffered a windscreen trauma to her left eye during a car accident 40 years earlier.  https://www.selleckchem.com/products/vvd-214.html  Reportedly, iris tissue was removed in emergency surgery. Her right eye has very poor vision with only hand motion perception due to myopic maculopathy. The myopia of -12 diopters (D) in her left eye is corrected with a hard contact lens, which is well tolerated. With the contact lens and an additional spectacle correction of -1.5 D, visual acuity is 0.5 Jg1. Slitlamp biomicroscopy reveals a lacerated iris with iridodialysis extending along the superior circumference from 830 to 430 o'clock and a superior-temporal pupil coloboma. The disinserted and contracted iris tissue resides on the anterior lens surface (Figure 1). The residual pupil is slightly decentered inferiorly and still reactive to light. The lens zonular fibers are intact along the full and particularly the superior circumference. Slitlamp illumination reveals grade 2 cataract formation in nucleus center. Intraocular pressure is 12 mm Hg. The central retina shows myopic tabulation with intact macula.During the past 6 months, the patient has been experiencing increasing shortsightedness and light sensitivity, especially outdoors, and desires cataract surgery. Given this is the only eye with reading capacity, which would be your surgical options and preferred approach to treat the cataract and remedy the traumatized iris?
  To determine the impact of corneal crosslinking (CXL) performed over the laser in situ keratomileusis (LASIK) flap using the Standard CXL (S-CXL) protocol or under the flap after flap lift (flap-CXL) on regional corneal stiffness using Brillouin microscopy.
 
  University of Southern California Keck School of Medicine, Los Angeles, California, and Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA.
 
  Laboratory ex vivo experiment.
 
  After epithelium debridement, LASIK flaps were created on intact fresh porcine eyes with a mechanical microkeratome. Then, S-CXL (riboflavin applied to the corneal surface followed by 3 mW/cm ultraviolet exposure with the flap in place for 30 minutes) or flap-CXL (riboflavin applied to the stromal bed after reflecting the flap followed by the same ultraviolet A exposure with the flap replaced) was performed. Depth profile of stiffness variation and averaged elastic modulus of anterior, middle, and posterior stroma were determined by analyzing Brillouin maps. Each eye servel stiffening occurred in the middle or posterior cornea with either protocol.
  To assess the accuracy of the Kane formula for intraocualr lens (IOL) power calculation in comparison with established formulas in the elderly population.
 
  Shiley Eye Institute, University of California San Diego, USA.
 
  Retrospective cohort.
 
  Retrospective data from 90 patients (90 eyes) aged 75 years or older who underwent uneventful cataract surgery with SN60WF intraocular lens (IOL) implantation were evaluated. The first operated eyes of patients with final corrected distance visual acuity 20/40 or better and axial length 22 to 26 mm were included. Prediction errors were calculated for Barrett Universal (BU) II, Haigis, Hoffer Q, Holladay 1, Kane, and SRK/T formulas. A subgroup analysis based on age (75-84 and ≥85 years old) was performed.
 
  Use of both BUII and Kane formulas resulted in the highest percentage of eyes with prediction errors within ±0.50 diopters (D) (72% each) and significantly higher than Hoffer Q, Holladay 1, and SRK/T (P = .001). Rates of predictability within ±0.25 D and ±1.00 D were 31% to 38% and 87% to 92%, respectively, with no significant differences between formulas. No statistically significant difference was seen between formulas in the median absolute error. These tendencies remained consistent in both age groups when analyzed separately. Subgroup analysis showed better predictability of all formulas in the younger age group.
 
  To the authors' knowledge, this is the first study evaluating the Kane formula exclusively in the elderly population. The Kane formula was found to be of equal accuracy to the BUII and superior to the Hoffer Q, Holladay 1, and SRK/T formulas. Very elderly patients might have reduced refractive precision using all formulas.
 To the authors' knowledge, this is the first study evaluating the Kane formula exclusively in the elderly population. The Kane formula was found to be of equal accuracy to the BUII and superior to the Hoffer Q, Holladay 1, and SRK/T formulas. Very elderly patients might have reduced refractive precision using all formulas.