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Perspectives20 May 2003Medical Professionalism in the New Millennium: A Physician Charter 15 Months LaterFREELinda Blank, Harry Kimball, MD, Walter McDonald, MD, and Jaime Merino, MD, for the ABIM Foundation, ACP Foundation, and European Federation of Internal Medicine (EFIM)*Linda BlankFrom ABIM Foundation and ACP Foundation, Philadelphia, Pennsylvania; and European Federation of Internal Medicine, Maastricht, the Netherlands., Harry Kimball, MDFrom ABIM Foundation and ACP Foundation, Philadelphia, Pennsylvania; and European Federation of Internal Medicine, Maastricht, the Netherlands., Walter McDonald, MDFrom ABIM Foundation and ACP Foundation, Philadelphia, Pennsylvania; and European Federation of Internal Medicine, Maastricht, the Netherlands., and Jaime Merino, MDFrom ABIM Foundation and ACP Foundation, Philadelphia, Pennsylvania; and European Federation of Internal Medicine, Maastricht, the Netherlands., for the ABIM Foundation, ACP Foundation, and European Federation of Internal Medicine (EFIM)*Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-138-10-200305200-00012 SectionsAboutVisual AbstractAbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail AbstractFor a list of members of these organizations, see the Appendix.As we mark the 15-month anniversary of the physician charter that was published simultaneously in Annals of Internal Medicine and The Lancet in 2002 (1, 2), the members of the Medical Professionalism Project are pleased by the level of interest and activity the charter has engendered. Several hundred U.S. and international newspapers cited the charter in related stories; more than 70 radio, television, and online interviews have been conducted with individual project members; over 65 000 reprints have been requested from around the world; and, collectively, the Annals, Medical Professionalism Project and European Federation of Internal Medicine (EFIM) Web sites have logged more than 70 000 related visits. In addition, this issue of Annals features a collection of provocative Letters about the charter. Building on this level of responsiveness, the ABIM (American Board of Internal Medicine) Foundation and the ACP (American College of Physicians) Foundation will sponsor phase II of the Project, planned as a 2-year initiative. Phase II will encompass reviewing the charter's initial impact and, within that context, explore the opportunity to define the health rights and responsibilities of patients, physicians, and society.Background and RationaleThe Medical Professionalism Project, jointly sponsored by the ABIM Foundation and the ACP Foundation, began in November 1999 as a collaborative effort designed to raise the concept of professionalism within the consciousness of internal medicine, both in the United States and Europe. The two foundations, in partnership with the European Federation of Internal Medicine, are well positioned to influence the ethical and professional standards of medicine and encourage the profession to reaffirm its civic commitment.Impetus for the Project stemmed from the following question: Why is raising awareness about the core values of medical professionalism important? As the pace of change in health care accelerated and the future of medical practice became increasingly uncertain, the ABIM and ACP Foundations and European Federation of Internal Medicine saw the need to convene this collaborative project because medical professionalism is universally endangered. Physician unionization, waning ability to self-regulate, medical errors, bioterrorism, compromised access and health care delivery, conflicts of interest precipitated by managed care and for-profit medicine, and the pharmaceutical industry's role in patient care and medical education reflect the range of issues that challenge the medical profession globally. At this crossroads, the medical profession urgently needs a united front to influence and inform the culture and context of both clinical practice and medical training. The charter's three fundamental principles and set of professional responsibilities are intended to encourage such dedication and debate (Table).Table. Charter on Medical Professionalism: Fundamental Principles and Professional Responsibilities PublicationsTo date, in addition to Annals of Internal Medicine and The Lancet, the charter has been published in the following journals: Clinical Medicine (formerly Journal of the Royal College of Physicians), European Journal of Internal Medicine, American Journal of Obstetrics and Gynecology, The American Journal of Surgery, Journal of the American College of Dentists, Annals of the Royal College of Physicians and Surgeons of Canada, Canadian Medical Association Journal, The Medical Journal of Australia, Bollettino Ordine Provinciale Medici Chirurghi e Odontoiatri-Milano, La Revue de Mdecine Interne, and La Radiologia Medica. The charter has been translated into Italian, French, Spanish, Portuguese, German, and Polish. The Health Ministry of Italy also published the charter and distributed it to every medical student and faculty member throughout the country. Translations into Dutch, Swedish, Japanese, and Turkish should lead to future publication in journals written in these languages.PresentationsSince the charter's publication, project members and others have collectively given more than 100 related presentations in a variety of formats: named lectures, grand rounds, medical school graduation addresses, plenary sessions at national and international meetings, workshops, and seminars. National meetings have included those of the Association of American Medical Colleges, ACP, American College of Obstetricians and Gynecologists, American Medical Association, Arnold P. Gold Foundation, Council of Medical Specialty Societies, Accreditation Council for Graduate Medical Education, American Board of Medical Specialties, American College of Surgeons, Association for Hospital Medical Education, and Federation of State Medical Boards. International meetings have included those of the Association for Medical Education in Europe and the European School of Internal Medicine; the European Federation of Internal Medicine Congresses in Edinburgh and Berlin; the International Society of Internal Medicine Congress in Kyoto; and the Association of Canadian Medical Colleges, Ottowa Conference, and Royal College of Physicians and Surgeons of Canada.EndorsementsTo date, the following 90 professional associations, colleges, societies, and certifying boards have endorsed the charter: Accreditation Council for Graduate Medical Education; American Academy of Allergy, Asthma & Immunology; American Academy of Dermatology; American Academy of Family Physicians; American Academy of Neurology; American Academy of Ophthalmology; American Academy of Orthopaedic Surgeons; American Academy of OtolaryngologyHead and Neck Surgery; American Academy of Pediatrics; American Academy of Physical Medicine and Rehabilitation; American Board of Medical Specialties; American Board of Allergy and Immunology; American Board of Anesthesiology; American Board of Colon and Rectal Surgery; American Board of Dermatology; American Board of Emergency Medicine; American Board of Family Practice; American Board of Internal Medicine; American Board of Medical Genetics; American Board of Neurological Surgery; American Board of Nuclear Medicine; American Board of Obstetrics and Gynecology; American Board of Ophthalmology; American Board of Orthopedic Surgery; American Board of Otolaryngology; American Board of Pathology; American Board of Pediatrics; American Board of Physical Medicine and Rehabilitation; American Board of Plastic Surgery; American Board of Preventive Medicine; American Board of Psychiatry and Neurology; American Board of Radiology; American Board of Surgery; American Board of Thoracic Surgery; American Board of Urology; ABIM Foundation; American College of Dentists; American College of Medical Genetics; American College of Obstetricians and Gynecologists; ACP; American College of Radiology; American College of Surgeons; ACP Foundation; American Psychiatric Association; American Society of Anesthesiologists; American Society of Clinical Pathologists; American Society of Plastic Surgeons; American Urological Association; Association of Academic Physiatrists; Association of Physicians of Ireland; Association of Physicians of Malta; Austrian Society of Internal Medicine; Belgian Society of Internal Medicine; College of Physicians and Surgeons of British Columbia; Council of Deans, Association of Canadian Medical Colleges; Council of Medical Specialty Societies; Czech Society of Internal Medicine; Danish Society of Internal Medicine; Estonian Society of Internal Medicine; European Federation of Internal Medicine; Federation of Royal Colleges of Physicians of United Kingdom; Federation of State Medical Boards; Finnish Society of Internal Medicine; French Society of Internal Medicine; German Society of Internal Medicine; Hellenic Society of Internal Medicine; Hungarian Society of Internal Medicine; Israeli Society of Internal Medicine; Italian Society of Internal Medicine; Latvian Society of Internal Medicine; Lithuanian Society of Internal Medicine; Luxembourg Society of Internal Medicine; Ministero della Salute; Netherlands Society of Internal Medicine; Polish Society of Internal Medicine; Portuguese Society of Internal Medicine; Royal Australasian College of Physicians and Surgeons; Royal College of Physicians of Edinburgh; Royal College of Physicians of Ireland; Royal College of Physicians of London; Royal College of Physicians and Surgeons of Canada; Slovak Society of Internal Medicine; Slovenian Society of Internal Medicine; Society of Neurological Surgeons; Society of Nuclear Medicine; Society of Thoracic Surgeons; Spanish Society of Internal Medicine; Swedish Society of Internal Medicine; Swiss Society of Internal Medicine; and Turkish Society of Internal Medicine. During the remainder of the year, additional endorsements will be sought from state medical societies, educational organizations, and other national and international medical associations.Future ActivitiesThe ABIM Foundation has launched a series of targeted activities to promote the charter: 1) an attractive charter publication for distribution at medical school and residency orientation, white coat ceremonies, and graduation; 2) a charter wall poster suitable for framing; 3) Putting the Charter into Practice [small seed grants for implementation were awarded to McGill University; New York University School of Medicine; University of California, San Francisco; University of Michigan Medical School; and University of Texas Medical Branch, Galveston]; 4) Medical Professionalism Project colloquia and conferences; 5) professionalism portfolios designed to promote self-reflection and use of self-assessment tools; 6) inclusion of the charter with each ABIM diplomate's Board certificate; 7) a proposed charter series in peer-reviewed journals; and 8) a proposed award recognition program. The past, present, and future activities stimulated by the charter are being chronicled and will be essential in determining its short- and long-term impact toward promoting and empowering an action agenda for the profession of medicine that is universal in scope and purpose.Appendix: Project MembersABIM Foundation: Troyen Brennan, MD, JD (Project Chair); Linda Blank (Project Staff); Jordan Cohen, MD; Harry Kimball, MD; and Neil Smelser, PhD.ACP Foundation: Robert Copeland, MD; Risa Lavizzo-Mourey, MD, MBA; and Walter McDonald, MD.European Federation of Internal Medicine: Gunilla Brenning, MD; Chris Davidson, MA, MB, FRCP; Philippe Jaeger, MB, MD; Alberto Malliani, MD; Hein Muller, MD, PhD; Daniel Sereni, MD; and Eugene Sutorius, JD.Special Consultants: Richard Cruess, MD; Sylvia Cruess, MD; and Jaime Merino, MD.References1. Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002;136:243-6. [PMID: 11827500] LinkGoogle Scholar2. Medical professionalism in the new millennium: a physicians' charter. Lancet. 2002;359:520-2. [PMID: 11853819] CrossrefMedlineGoogle Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From ABIM Foundation and ACP Foundation, Philadelphia, Pennsylvania; and European Federation of Internal Medicine, Maastricht, the Netherlands.Disclosures: None disclosed.Corresponding Author: Linda Blank, ABIM Foundation, 510 Walnut Street, Suite 1700, Philadelphia, PA 19106; e-mail, [email protected]org.Current Author Addresses: Ms. Blank and Dr. Kimball: ABIM Foundation, 510 Walnut Street, Suite 1700, Philadelphia, PA 19106.Dr. McDonald: ACP Foundation, 190 N. Independence Mall West, Philadelphia, PA 19106.Dr. Merino: Depart. Medicina y Psiquiatria, Universidad Miguel Hernandez, Campus de San Juan, Cta. 332 Alicante-Valencia Km. 87, 03550 San Juan de Alicante, Spain. 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To write what is worth publishing, to find honest people to publish it, and get sensible people to read it, are the three great difficulties in being an author. Charles Caleb Colton Each year, the annual Journal Impact Factors (JIFs) published by the Institute for Scientific Information (ISI) are awaited with almost equal amounts of trepidation and anticipation by editors of peer-reviewed journals. Since the JIF is widely acknowledged as 1 key indicator of a journal's quality,1–4 a significant rise or fall on the JIF-ranked table can affect journal prestige and may influence a variety of quality measurements such as subscription figures or the number and quality of submitted manuscripts. The ISI JIF is calculated for each year by establishing the number of citations in that year to articles published in the preceding 2 years and dividing this figure by the total number of substantive articles published in the same 2-year period. The 2004 JIF value for the Journal of Cataract & Refractive Surgery (JCRS) is 1.937.5 In a year in which many ophthalmic journals experienced a reduction in their JIF, this is an improvement on the 2003 JIF (1.877) and cements a high-ranking mean JIF of 2.013 for the journal during the period 1999 to 2004. As highlighted in a contemporary review of journal citation by Cartwright and McGhee in this issue,6 of more than 100 periodicals in the ophthalmology and vision-science arena, two thirds might be considered peer reviewed but only 42 have the appropriate scientific qualities that enable the Science Citation Index to calculate a journal impact factor.5 For several years, a debate has flourished around whether the JIF is truly a definitive measure of quality that readers, researchers, and editors should consider when evaluating scientific journals.7–10 Although many would agree that it is the only readily available quantitative value with which to gauge relative journal quality, there are many limitations and potential misuses of the JIF.6 Unfortunately, other possible measures of journal quality or influence such as circulation or electronic access of articles are less readily available and may be influenced by factors other than journal quality per se. Nonetheless, the most frequently electronically accessed articles may be representative of the interest of the general readership7 and therefore an indicator of journal quality and influence. Perneger11 has noted that the papers receiving the most "electronic hits" on the British Medical Journal web site were subsequently cited more frequently than less accessed papers. Frank12 evaluated the criteria used by authors in selecting journals, and the top 3 factors that influenced the author's choice of submission journal were, in descending order, journal's prestige, makeup of the journal's readership, and whether the journal usually published articles on the topic. While prestige and quality are ultimately judgments that can be made only by careful peer review, to a large extent we live in a number-biased electronic age in which some form of citation analysis, be that JIF or other citation parameters, will be used as a surrogate measure of journal quality. The Journal of Cataract & Refractive Surgery publishes quality peer-reviewed articles relating to its 2 main topic areas of cataract and refractive surgery. The 2004 ISI Journal Citation Reports,5 which include the JIF, were published in June 2005. Subsequent to the release of these data, an analysis via the ISI Web of Science (July 2005)13 revealed more than 6500 articles falling under the broad heading "cataract surgery." If one considers the top 500 most-cited articles in this field, it is notable that more than 70% of these were published in only 5 journals: 117 (23.4%) were in JCRS, 21.8% in Ophthalmology, 12.2% in Archives of Ophthalmology, and 6.6% each in the British Journal of Ophthalmology and the American Journal of Ophthalmology (AJO). No other journal published more than 4.0% of the 500 top-cited articles. In relation to refractive surgery, laser in situ keratomileusis (LASIK) has become an outstandingly successful procedure over the past decade and a major research topic in the field of refractive surgery. A similar search of the ISI Web of Science demonstrates that LASIK has been the subject of more than 2040 articles. Once more we can use these data to examine journal influence both in relation to the number of articles published in specific journals and, perhaps more importantly, the relative number of the 500 most-cited articles published in each journal. In respect to the top 500 most commonly cited articles, almost one third (31.2%) were published in JCRS and the majority of the others were published in the Journal of Refractive Surgery (26.8%), Ophthalmology (18.6%), Cornea (6.4%), AJO (4.0%), and Investigative Ophthalmology and Visual Science (IOVS) (1.8%). The JIF is a measure of journal quality, not a measure of individual articles, and a relatively small number of heavily cited articles can contribute to the JIF, whereas many articles in the same journal may be cited rarely or not at all.14 In 2004, the top 3 JIF-ranked ophthalmology journals were Progress in Retinal and Eye Research (Progress), IOVS, and Survey of Ophthalmology (Survey), respectively. Two of these 3 journals, Progress and Survey, primarily publish review articles, which are typically referenced more frequently than original research.14 In the 2004 JIF analysis period, although Progress was the top-ranked journal, with a JIF of 5.345, it published only 29 articles in 2003 compared with 702 published by the second-ranked, but arguably much more influential original research journal, IOVS (JIF 3.577). Ultimately, a journal is only as good as the quality of the scientific papers it publishes. The Journal of Cataract & Refractive Surgery serves an international readership with a focus on the twin domains of cataract surgery and refractive surgery. Although the United States is the source of around 50% of the world's ophthalmic and vision science literature,15 it behooves any international journal to provide a suitable platform for quality research from around the world. To this end, JCRS publishes original clinical and scientific studies for an international readership from a diverse and representative international authorship originating from more than 50 countries including the U.S. (23.4%), Japan (5.9%), England (5.7%), Germany (5.7%), Austria (3.5%), India (3.2%), Spain (3.1%), Italy (2.8%), Turkey (2.3%), and Canada (2.1%). The 2004 JIF continues a strong trend that has maintained JCRS' position in the top 12 JIF-ranked ophthalmology journals over the past 5 years. However, while the JIF is 1 useful indicator of journal quality, it does not comprehensively define the relative quality of a journal. Indeed, the preceding analysis of the ISI Web of Science citation data demonstrates that JCRS publishes a greater number of top-cited articles in the fields of cataract surgery and refractive surgery (LASIK) than any other journal. The journal also readily fulfils Frank's criteria12 of prestige, appropriate readership, and publication in key areas for researchers in the related areas of cataract and refractive surgery. Both authorship and readership are broad and international and, with the publication of the 2004 citation indices, the editorial board should be heartily congratulated on maintaining JCRS as the premier journal in this field.

Takayasu arteritis (TAK) is a vasculitis mainly affecting the aorta and its large branches.1 TAK predominantly affects young women and 90% of TAK patients are females. While many patients with TAK have been found in Asian countries, this disease is reported from all over the world. TAK is, however, seen more commonly in Indian subcontinent, Japan, China, Korea and southeast Asian countries amongst the APLAR nations as well as in Turkey, Brazil, Mexico and south Africa. Reports from western world including Iceland and USA also do exist in literature. Much about Dr. Mikito Takayasu, who was the first to report a patient with TAK, is not widely known. In this essay, Chikashi Terao from Kyoto would like to introduce the history of TAK and Dr. Takayasu. In April 1908, Dr. Mikito Takayasu (Fig. 1), a professor of ophthalmology at the current Kanazawa University, at the 12th Annual Meeting of Japanese Ophthalmology Society held in Fukuoka, reported a case of a 22-year-old woman. He described ‘a case of peculiar changes in the central retinal vessels’.2 He saw the female patient for the first time in May 1905. She had felt lowering and blurring of her vision since September 1904. She sometimes developed redness of conjuctiva. While the symptoms transiently improved by medication, they recurred in March 1905 and she visited Dr. Takayasu. She did not have a history of severe medical or gynecological diseases. While he described that she looked as if she suffered from tuberculosis (TB), he and his colleagues in the Department of Internal Medicine did not find any evidence of infection, including TB or syphilis. Her pupils were slightly dilated and the light reflex was damaged. He found eminent abnormalities in retinal vessels. Retinal vessels branched 2–3 mm away from the optic disc and the branches formed anastomosis with one another to create circularity around the disc. The branches branched further radially and the peripheral portions were narrow. The distal parts of the branches made aneurysms, anastomosis with other branches to form circularity, or terminated in a blind end. The optic disc was severely congested and hemorrhage was found around the disc. While these abnormalities were mainly found in arteries, veins anastomosed with arteries and venous blood flowed into the lesions. While he found these abnormalities in the oculus dexter, similar findings were reported in the oculus sinister. She was admitted and took medications. During the first admission, she was found to have cataracts and underwent an operation. However, her vision did not improve. She stopped visiting the hospital for several years after discharge. She revisited Dr. Takayasu's clinic in February 1908. She developed retinal detachment and her left pupil was remarkably dilated. Dr. Takayasu had no choice but to tell her that there was no effective treatment. He described that the anastomosis and aneurysmal changes should be the primary findings and that the others should be the secondary findings. After his presentation at the Congress, Dr. Yoshiakira Ohnishi, a professor at Kyushu University, mentioned another female case resembling the case presented by Dr. Takayasu. He described that he could not sense her pulse at the bilateral radial arteries. This case report by Dr. Takayasu was published in June in the same year in the Journal of the Juzen Medical Society in Kanazawa University (Fig. 2). In this manuscript, he presented an image of the arteries that he beautifully hand-sketched himself (Fig. 3). While it is often regarded that it was Dr. Takayasu who first reported a patient with TAK, there are other prior potential case reports of patients with TAK. Giovanni Battista Morgagni, an Italian anatomist, described a 40-year-old woman suffering from pulseless disease.3 In 1830, Rokushu Yamamoto described a 45-year-old man suffering from fever.4 After 1 year, the patient became pulseless in the right radial artery and had a very weak pulse in the left radial artery. The patient developed pulseless disease in both carotid arteries and died 11 years after the first visit. He described two other cases reported by another doctor. In 1856, Savory5 reported a 22-year-old woman presenting with pulseless disease in both upper extremities and left neck. The patient lost her vision. However, whether these cases truly suffered from TAK is uncertain. Numano4 suspected the case reported by Savory should be explained by other diseases since the patient had a corneal ulcer leading to invasion of scalp and brain. Dr. Minoru Nakajima in 1921 compared his cases with previous reports and proposed that they should be regarded as one disease. He characterized this disease by the following four criteria: (i) affecting bilateral eyes in young women; (ii) arteriovenous anastomosis around the optic disc and microaneurysm formation in retinal vessels; (iii) lowering of vision complicated with cataract; and (iv) unpalpable radial artery. He proposed to call this disease ‘Takayasu disease’. After his proposal, Japanese ophtalmologists paid attention to this disease and many cases were reported. In 1946, Frövig6 proposed that the diseases presenting pulselessness should be called ‘aortic arch syndrome’. In 1948, Drs Kentaro Shimizu and Keiji Sano, brain surgeons at the University of Tokyo, proposed to give an alias name of ‘pulseless disease’. In 1951, this disease was reported by these doctors outside of Japan for the first time, by reviewing a total of 25 cases.7 Since 1951, there have been case reports from a number of foreign countries. In 1952, Caccamise and Whitman8 reported the primary occidental case report. In 1962, Judge et al.9 described ‘Takayasu's arteritis’. In Japan, many doctors proposed acronyms of TAK. Drs Maekawa and Kakei called it ‘occlusive coagulant aortic syndrome’.10 Dr. Nasu11 called it ‘obstructive productive arteritis’. In 1965, Riehl et al.12 analyzed this disease from pathological and immunological aspects and proposed the concept that this disease is an autoimmune disease. Since 1990 when the American College of Rheumatology published a classification criteria of TAK13 and described ‘Takayasu arteritis’, the name of TAK prevailed worldwide. Although both ‘Takayasu arteritis’ and ‘Takayasu's arteritis’ are used, in the Online Mendelian Inheritance in Man (OMIM) it is registered as ‘Takayasu arteritis’ and this expression is more commonly used. The case report by Dr. Takayasu is quite suggestive. His report tells us that we should carefully examine and observe patients to find characteristics of the patients. Even if we saw just one case, there is a possibility that many patients exist with the same symptoms. It is impressive that Dr. Takayasu described the first patient as being similar to patients with TB. In fact, there are studies pointing out the overlapping of TB and TAK.14, 15 Geographical prevalence of TAK is similar to that of TB. Although there are many conflicting studies in terms of epidemiology and immunology,16 there is a possibility that exposure to TB triggers the immune reaction to TAK. In fact, my group showed that the susceptibility variant is located in the IL12B region17 and this variant has previously been reported in relation to mycobacterium infection. Dr. Mikito Takayasu was born on 19 July, 1860 in Saga prefecture in Japan as the fourth son of a priest. He graduated from Tokyo foreign language school and entered Tokyo University. He graduated from Tokyo University in 1887 and soon moved to Kanazawa prefecture as a lecturer. He went to Germany for 2 years, where he performed research in Berlin City Hospital, Berlin Charité University Hospital and Leipzig University. He studied under Dr. von Graphe. He showed by means of Sudan dyes that arcus senilis occurs due to fat deposition.18 Until his findings, little was known about the nature of arcus senilis in spite of the high frequency of this phenomenon. He returned to Kanazawa and obtained his PhD degree in 1903 for this research. He then went on to become a professor and principal of the Medical School. In 1923, the Medical School was reorganized as the Medical University and he was appointed Dean. He retired from the University in 1924. After retirement, he opened his own clinic near the University Hospital. To prevent the lowering in numbers of patients in surrounding ophthalmologist clinics, he set a very expensive doctor's fee. Despite the expensive fees, his clinic was very popular because patients highly appreciated his sound character and respected his medical skills, experience and knowledge. It is said that many people believed that water from the small river running by his house was effective for eye diseases. In 1933, he suffered from stroke and moved to Beppu in Kyushu for recovery. He died of rectal cancer in Beppu when he was 78 years old on 20 November, 1938. His bones were transferred to Kanazawa soon after his death and his funeral was conducted at Kanazawa University. His grave has been kept in the Hoenji Temple near Kanazawa University (Fig. 4). His statue was built in Kanazawa University in 2002 (Fig. 5). He had three sons and five daughters. Dr. Akira Takayasu, his second son, was a professor of ophthalmology at Kagoshima University. Dr. Tatsuo Hirose, his great-grandson, is a clinical professor of ophthalmology at Harvard Medical School. Dr. Hirose is a grandson of Ms. Miyako Takayasu Hirose, one of Dr. Takayasu's daughters. According to Dr. Hirose, he had seen a couple of young women with TAK during his 4-year stay in the Ophthalmology Clinic in Kanazawa University. However, he has not seen a single patient with TAK in Boston during his career over 40 years in a tertiary referral retina clinic in Boston. This can be explained by different prevalences of TAK among different populations. I would like to thank Dr. Tatsuo Hirose in the Ophthalmology Department of Harvard Medical School and Dr. Kazuki Kuniyoshi in the Department of Ophthalmology, Kinki University Faculty of Medicine, for allowing me to include information from Dr. Hirose in this essay and for their kind help to obtain information about Dr. Mikito Takayasu. I would like to thank Dr. Kazuhisa Sugiyama in the Ophthalmology Department of Kanazawa University for allowing me to use their photos for this essay.

Purpose: Low- to middle-income nations contain more than 80% of the world's population; however, only 4% of articles in ophthalmology journals belong to these countries. We aim to analyze the global diversity of the editorial boards of ophthalmology journals. Methods: Cross-sectional study, including all journals in the Ophthalmology section of the SCImago Journal & Country Rank (SJR). Journals were classified according to the country of origin, SJR interquartile range (Q1-Q4), impact factor, and open-access policy. Global diversity among journals was determined by the country of affiliation of editors-in-chief and editorial board members. Nations were classified by income according to the World Bank's 2022 system. The association between editorial diversity and the journal's metrics and country of origin was analyzed using the χ2 test and the Mann-Whitney U test. Results: A total of 116 journals were included and 83.6% belonged to high-income nations. Only 18 (13.3%) editors-in-chief and 582 (13.5%) board members were affiliated with middle-income nations. The most prevalent middle-income countries in editorial boards were Brazil (n = 184, 4.26%), India (n = 150, 3.47%), Turkey (n = 42, 0.97%), and Iran (n = 36, 0.83%). Only 40 (1.07%) editorial board members of Q1 journals were affiliated with non-high-income nations, most belonging to India (n = 28, 70%). Journals from middle-income nations had a statistically significant lower prevalence in the first- and second-quartile ranking (P < 0.001) and a higher proportion of open-access policies (P = 0.019). Conclusions: A clear underrepresentation of low- to middle-income nations was observed in ophthalmology journals. Promoting editorial diversity and minimizing the possibility of editorial bias could lead to greater exposure to real-world data from resource-constrained settings. Translational Relevance: The documented underrepresentation of low- to middle-income nations in ophthalmology journals highlights the importance of promoting diversity and inclusion.

We compare the network of aggregated journal-journal citation relations provided by the Journal Citation Reports (JCR) 2012 of the Science and Social Science Citation Indexes (SCI and SSCI) with similar data based on Scopus 2012. First, global maps were developed for the two sets separately; sets of documents can then be compared using overlays to both maps. Using fuzzy-string matching and ISSN numbers, we were able to match 10,524 journal names between the two sets; that is, 96.4% of the 10,936 journals contained in JCR or 51.2% of the 20,554 journals covered by Scopus. Network analysis was then pursued on the set of journals shared between the two databases and the two sets of unique journals. Citations among the shared journals are more comprehensively covered in JCR than Scopus, so the network in JCR is denser and more connected than in Scopus. The ranking of shared journals in terms of indegree (that is, numbers of citing journals) or total citations is similar in both databases overall (Spearman's \r{ho} &gt; 0.97), but some individual journals rank very differently. Journals that are unique to Scopus seem to be less important--they are citing shared journals rather than bein

Rankings of scholarly journals based on citation data are often met with skepticism by the scientific community. Part of the skepticism is due to disparity between the common perception of journals' prestige and their ranking based on citation counts. A more serious concern is the inappropriate use of journal rankings to evaluate the scientific influence of authors. This paper focuses on analysis of the table of cross-citations among a selection of Statistics journals. Data are collected from the Web of Science database published by Thomson Reuters. Our results suggest that modelling the exchange of citations between journals is useful to highlight the most prestigious journals, but also that journal citation data are characterized by considerable heterogeneity, which needs to be properly summarized. Inferential conclusions require care in order to avoid potential over-interpretation of insignificant differences between journal ratings. Comparison with published ratings of institutions from the UK's Research Assessment Exercise shows strong correlation at aggregate level between assessed research quality and journal citation `export scores' within the discipline of Statistics.

This study examines the social media uptake of scientific journals on two different platforms - X and WeChat - by comparing the adoption of X among journals indexed in the Science Citation Index-Expanded (SCIE) with the adoption of WeChat among journals indexed in the Chinese Science Citation Database (CSCD). The findings reveal substantial differences in platform adoption and user engagement, shaped by local contexts. While only 22.7% of SCIE journals maintain an X account, 84.4% of CSCD journals have a WeChat official account. Journals in Life Sciences &amp; Biomedicine lead in uptake on both platforms, whereas those in Technology and Physical Sciences show high WeChat uptake but comparatively lower presence on X. User engagement on both platforms is dominated by low-effort interactions rather than more conversational behaviors. Correlation analyses indicate weak-to-moderate relationships between bibliometric indicators and social media metrics, confirming that online engagement reflects a distinct dimension of journal impact, whether on an international or a local platform. These findings underscore the need for broader social media metric frameworks that incorporate locally dom

An exploratory, descriptive analysis is presented of the national orientation of scientific, scholarly journals as reflected in the affiliations of publishing or citing authors. It calculates for journals covered in Scopus an Index of National Orientation (INO), and analyses the distribution of INO values across disciplines and countries, and the correlation between INO values and journal impact factors. The study did not find solid evidence that journal impact factors are good measures of journal internationality in terms of the geographical distribution of publishing or citing authors, as the relationship between a journal's national orientation and its citation impact is found to be inverse U-shaped. In addition, journals publishing in English are not necessarily internationally oriented in terms of the affiliations of publishing or citing authors; in social sciences and humanities also USA has their nationally oriented literatures. The paper examines the extent to which nationally oriented journals entering Scopus in earlier years, have become in recent years more international. It is found that in the study set about 40 per cent of such journals does reveal traces of internati

Transformer models have revolutionized NLP, yet many morphologically rich languages remain underrepresented in large-scale pre-training efforts. With SindBERT, we set out to chart the seas of Turkish NLP, providing the first large-scale RoBERTa-based encoder for Turkish. Trained from scratch on 312~GB of Turkish text (mC4, OSCAR23, Wikipedia), SindBERT is released in both base and large configurations, representing the first large-scale encoder-only language model available for Turkish. We evaluate SindBERT on part-of-speech tagging, named entity recognition, offensive language detection, and the TurBLiMP linguistic acceptability benchmark. Our results show that SindBERT performs competitively with existing Turkish and multilingual models, with the large variant achieving the best scores in two of four tasks but showing no consistent scaling advantage overall. This flat scaling trend, also observed for XLM-R and EuroBERT, suggests that current Turkish benchmarks may already be saturated. At the same time, comparisons with smaller but more curated models such as BERTurk highlight that corpus quality and diversity can outweigh sheer data volume. Taken together, SindBERT contributes b

In recent years, sentiment analysis has gained increasing significance, prompting researchers to explore datasets in various languages, including Turkish. However, the limited availability of Turkish datasets has led to their multifaceted usage in different studies, yielding diverse outcomes. To overcome this challenge, a rigorous review was conducted of research articles published between 2012 and 2022. 31 studies were listed, and 23 Turkish datasets obtained from publicly available sources and email requests used in these studies were collected. We labeled these 31 studies using a taxonomy. We provide a map of sentiment analysis datasets according to this taxonomy in Turkish over 10 years. Moreover, we run state-of-the-art sentiment analysis tools on these datasets and analyzed performance across popular Turkish sentiment datasets. We observed that the performance of the sentiment analysis tools significantly depends on the characteristics of the target text. Our study fosters a more nuanced understanding of sentiment analysis in the Turkish language.

Overlay journals are characterised by their articles being published on open access repositories, often already starting in their initial preprint form as a prerequisite for submission to the journal prior to initiating the peer-review process. In this study we aimed to identify currently active overlay journals and examine their characteristics. We utilised an explorative web search and contacted key service providers for additional information. The final sample consisted of 34 overlay journals. While the results show that new overlay journals have been actively established within recent years, the current presence of overlay journals remains diminutive compared to the overall number of open access journals. Most overlay journals publish articles in natural sciences, mathematics or computer sciences, and are commonly published by groups of academics rather than formal organisations. They may also rank highly within the traditional journal citation metrics. None of the investigated journals required fees from authors, which is likely related to the cost-effective aspects of the overlay publishing model. Both the growth in adoption of open access preprint repositories and researcher

Using the Scopus dataset (1996-2007) a grand matrix of aggregated journal-journal citations was constructed. This matrix can be compared in terms of the network structures with the matrix contained in the Journal Citation Reports (JCR) of the Institute of Scientific Information (ISI). Since the Scopus database contains a larger number of journals and covers also the humanities, one would expect richer maps. However, the matrix is in this case sparser than in the case of the ISI data. This is due to (i) the larger number of journals covered by Scopus and (ii) the historical record of citations older than ten years contained in the ISI database. When the data is highly structured, as in the case of large journals, the maps are comparable, although one may have to vary a threshold (because of the differences in densities). In the case of interdisciplinary journals and journals in the social sciences and humanities, the new database does not add a lot to what is possible with the ISI databases.

Using three years of the Journal Citation Reports (2011, 2012, and 2013), indicators of transitions in 2012 (between 2011 and 2013) are studied using methodologies based on entropy statistics. Changes can be indicated at the level of journals using the margin totals of entropy production along the row or column vectors, but also at the level of links among journals by importing the transition matrices into network analysis and visualization programs (and using community-finding algorithms). Seventy-four journals are flagged in terms of discontinuous changes in their citations; but 3,114 journals are involved in "hot" links. Most of these links are embedded in a main component; 78 clusters (containing 172 journals) are flagged as potential "hot spots" emerging at the network level. An additional finding is that PLoS ONE introduced a new communication dynamics into the database. The limitations of the methodology are elaborated using an example. The results of the study indicate where developments in the citation dynamics can be considered as significantly unexpected. This can be used as heuristic information; but what a "hot spot" in terms of the entropy statistics of aggregated cit

A number of journal classification systems have been developed in bibliometrics since the launch of the Citation Indices by the Institute of Scientific Information (ISI) in the 1960s. These systems are used to normalize citation counts with respect to field-specific citation patterns. The best known system is the so-called "Web-of-Science Subject Categories" (WCs). In other systems papers are classified by algorithmic solutions. Using the Journal Citation Reports 2014 of the Science Citation Index and the Social Science Citation Index (n of journals = 11,149), we examine options for developing a new system based on journal classifications into subject categories using aggregated journal-journal citation data. Combining routines in VOSviewer and Pajek, a tree-like classification is developed. At each level one can generate a map of science for all the journals subsumed under a category. Nine major fields are distinguished at the top level. Further decomposition of the social sciences is pursued for the sake of example with a focus on journals in information science (LIS) and science studies (STS). The new classification system improves on alternative options by avoiding the problem

The evolution of Turkish Journal of Chemistry (Turk J. Chem) Hirsch index (h-index) over the period 1995-2005 is studied and determined in the case of the self and without self-citations. It is seen that the effect of Hirsch index of Turk J. Chem has a highly positive trend during the last five years. It proves that Turk J. Chem is improving itself both in quantity and quality since h-index reflects peer review, and peer review reflects research quality of a journal.

Using "Analyze Results" at the Web of Science, one can directly generate overlays onto global journal maps of science. The maps are based on the 10,000+ journals contained in the Journal Citation Reports (JCR) of the Science and Social Science Citation Indices (2011). The disciplinary diversity of the retrieval is measured in terms of Rao-Stirling's "quadratic entropy." Since this indicator of interdisciplinarity is normalized between zero and one, the interdisciplinarity can be compared among document sets and across years, cited or citing. The colors used for the overlays are based on Blondel et al.'s (2008) community-finding algorithms operating on the relations journals included in JCRs. The results can be exported from VOSViewer with different options such as proportional labels, heat maps, or cluster density maps. The maps can also be web-started and/or animated (e.g., using PowerPoint). The "citing" dimension of the aggregated journal-journal citation matrix was found to provide a more comprehensive description than the matrix based on the cited archive. The relations between local and global maps and their different functions in studying the sciences in terms of journal lit

To investigate the frequency of converting a residency dissertation to a journal article in Turkey. To compare the different residency programs and their publications rates; to sub classify of dissertations according to sub-specialties. Ophthalmologists who graduated before 2010 conducted surveys. The surveys questions included graduation year, residency program, topic of the dissertations, type of the study (prospective, retrospective, or experimental), publication rate from the dissertations, and type of journal for published dissertations. Three-hundred-eight ophthalmologists conducted surveys. Fifty seven (18.5%) dissertations were published in SCI-Expanded Indexed journals (39 of them (23%) from the university hospital programs and 17 of them (13%) from state hospital programs (p=0.036)) and 97 of dissertations were published in national journals. 92 of 170 (54%) dissertations from the university based residency programs and 59 of 131 (45%) dissertations from the state hospital based residency programs were published in national journals or international journals indexed in the SCI-Expanded Index (p=0.17). A publication rate from dissertations was similar between big city university programs and small city university programs (23.3%; 22.6%). The most frequently studied topics of dissertations were cataract-refractive surgery (21.5%), followed by retina (21%), glaucoma (21%), cornea-anterior segment (19%), and strabismus (7%). Of the study design, 57% of them were prospective, 32% were retrospective, and 10.5% were experimental study. In this study, it seems to be that lesser than one fifth of Ophthalmology Residency dissertations in Turkey converted to journal articles in SCI-Expanded journals. It is obvious that the overall quality of the dissertations was inadequate to be published in indexed journals and it is necessary to take some measures to increase the scientific quality.

The developments that language models have provided in fulfilling almost all kinds of tasks have attracted the attention of not only researchers but also the society and have enabled them to become products. There are commercially successful language models available. However, users may prefer open-source language models due to cost, data privacy, or regulations. Yet, despite the increasing number of these models, there is no comprehensive comparison of their performance for Turkish. This study aims to fill this gap in the literature. A comparison is made among seven selected language models based on their contextual learning and question-answering abilities. Turkish datasets for contextual learning and question-answering were prepared, and both automatic and human evaluations were conducted. The results show that for question-answering, continuing pretraining before fine-tuning with instructional datasets is more successful in adapting multilingual models to Turkish and that in-context learning performances do not much related to question-answering performances.

BACKGROUND: Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older. METHODS: Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health. FINDINGS: Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2·2% (95% uncertainty interval [UI] 1·5-3·0) of age-standardised female deaths and 6·8% (5·8-8·0) of age-standardised male deaths. Among the population aged 15-49 years, alcohol use was the leading risk factor globally in 2016, with 3·8% (95% UI 3·2-4·3) of female deaths and 12·2% (10·8-13·6) of male deaths attributable to alcohol use. For the population aged 15-49 years, female attributable DALYs were 2·3% (95% UI 2·0-2·6) and male attributable DALYs were 8·9% (7·8-9·9). The three leading causes of attributable deaths in this age group were tuberculosis (1·4% [95% UI 1·0-1·7] of total deaths), road injuries (1·2% [0·7-1·9]), and self-harm (1·1% [0·6-1·5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27·1% (95% UI 21·2-33·3) of total alcohol-attributable female deaths and 18·9% (15·3-22·6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0·0-0·8) standard drinks per week. INTERPRETATION: Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption. FUNDING: Bill & Melinda Gates Foundation.