bluuebunny/crossref_metadata_2025 huggingface dataset:
Orthopedic Surgery Resident Debt Load and Its Effect on Career Choice
Authors: Johnson Joey P. , Cassidy Dale B. , Tofte Josef N. , Bariteau Jason T. , Daniels Alan H.
Published: April 2016

Student loan debt has become a topic of discussion and debate among physicians and legislators. This study seeks to assess the level of debt of orthopedic surgery residents and to determine whether debt burden affects the career choice of orthopedic trainees. A 26-question, anonymous survey was distributed via email to resident trainees enrolled in different medical and surgical specialty training programs across the United States. Orthopedic trainees were compared with trainees in other specialties using comparative statistics. Of the approximately 13,503 residents who were sent the survey, a total of 3076 responded, including 167 of an estimated 580 orthopedic residents, for approximate response rates of 22.8% and 28.8%, respectively. On average, orthopedic surgery residents were at a later post-graduate year than overall respondents (
P
<.025). When asked if student loan debt would influence the next step in their career, nonorthopedic residents were statistically more likely to respond “yes” compared with orthopedic surgery residents (57.21% vs 49.08%, respectively;
P
=.041). More than 50% of all respondents agreed that student loan debt would affect their type or location of practice. The majority of orthopedic residents take student loan debt into consideration when determining their final location and type of practice, although less so for orthopedic trainees compared with other specialties. As medical education continues to become more expensive and the threat of dropping physician reimbursement looms on the horizon, student debt may become a primary driving factor for young American physicians' career plans. [
Orthopedics.
2016; 39(3):e438–e443.]
Idiopathic Spinal Epidural Lipomatosis in the Lumbar Spine
Authors: Al-Omari Ali A. , Phukan Rishabh D. , Leonard Dana A. , Herzog Tyler L. , Wood Kirkham B. , Bono Christopher M.
Published: April 2016

Overgrowth of epidural fat, known as spinal epidural lipomatosis (SEL), can cause symptomatic compression of the spinal cord, conus medullaris, or cauda equina. Suggested predisposing factors such as obesity, steroid use, and diabetes mellitus have been based on a few reported cases, many of which were not surgically confirmed. There is a paucity of epidemiological data in surgically confirmed cases for this disorder. The purpose of this independently reviewed, retrospective, matched cohort analysis was to compare the demographics and incidence of comorbidities of patients who underwent lumbar decompression for SEL vs degenerative stenosis without SEL. Two surgeons' databases were reviewed to identify patients older than 18 years who underwent decompression surgery for magnetic resonance imaging–verified, symptomatic lumbar SEL. A matched control group comprised an equal number of patients with degenerative stenosis (n=14). Demographic data, body mass index, symptom type/duration, comorbidities, complications, treatment history, and associated pathology were collected from medical records. Previously suggested risk factors, such as obesity, endocrinopathy, and epidural steroid injections, were not significantly different between the SEL and control groups. Furthermore, there were no differences in operative times, complications, or blood loss. The only noted difference between the 2 groups was the preoperative duration of symptoms, on average double in patients with SEL. This series represents the largest of its kind reported to date. Because symptom duration was the only difference noted, it is postulated to be the result of lack of awareness of SEL. Future prospective study in a larger group of patients is warranted. [
Orthopedics.
2016; 39(3):163–168.]
Two-Stage Revision Anterior Cruciate Ligament Reconstruction
Authors: Erickson Brandon J. , Cvetanovich Gregory , Waliullah Khalid , Khair Michael , Smith Patrick , Bach Bernard , Sherman Seth
Published: April 2016

The number of primary anterior cruciate ligament (ACL) tears is rapidly increasing. In patients who wish to return to their preoperative level of function, specifically as it pertains to participation in sports, the gold standard of treatment following an ACL tear remains an anterior cruciate ligament (ACL) reconstruction. Despite a majority of good/excellent results following primary ACL reconstruction, there is a growing subset of patients with persistent or recurrent functional instability who require revision ACL reconstruction. Preoperative planning for revision ACL reconstruction requires a careful understanding of the root cause of ACL failure, including possible technical causes of primary ACL failure and the presence of combined knee pathology that was not addressed at the index ACL reconstruction. The decision to perform 2-stage revision ACL reconstruction is multifactorial and is reached by technical considerations that may make a 1-stage revision less optimal, including tunnel widening, arthrofibrosis, active infection, and others. Concomitant knee pathology such as meniscal deficiency, malalignment (including an increase in posterior tibial slope), chondral lesions, and other ligamentous laxity may also require a staged approach to treatment. This evidence-based review covers the indications for 2-stage revision ACL reconstruction, surgical techniques, evidence for and technique of bone grafting prior ACL tunnels, and outcomes of 2-stage revision stratified by initial cause of ACL reconstruction failure. With proper preoperative planning and an understanding of the cause of failure following the primary ACL reconstruction, revision ACL reconstruction can offer excellent outcomes in the motivated patient. [
Orthopedics.
2016; 39(3):e456–e464.]
Bilateral Total Knee Arthroplasty in a 15 Year Old With Skeletal Dysplasia and Open Physes
Authors: Ho Jason C. , Siqueira Marcelo B. P. , Jacob Paul , Goodwin Ryan C. , Barsoum Wael K.
Published: April 2016

There are limited reports of total knee arthroplasty (TKA) in the pediatric population. The use of constrained, stemmed components is particularly unusual in the setting of open physes due to concerns with growth arrest and implant survivorship. The current authors describe a 15-year-old boy with open growth plates and an epiphyseal dysplasia-like condition affecting the knees bilaterally. He had no other significant medical or orthopedic conditions and his genetic workup was negative. He had severe knee pain and a bilateral 40° valgus with severe lateral compartment arthritis. Conservative treatment provided no symptom relief, and the patient had been wheelchair bound for 18 months prior to presentation. Treatment with simultaneous bilateral TKA using cemented, stemmed, and constrained components was undertaken. There were no intraoperative complications, and his final follow-up was at 5.6 years postoperatively. Radiographic evaluation at follow-up showed that components were well placed with no loosening. The patient had pain-free motion and a perfect Knee injury and Osteoarthritis Outcome Score. Based on the review of the literature and the outcomes of this case, the authors believe simultaneous bilateral TKA using cemented, stemmed, and constrained components is a reasonable option for joint reconstruction in the pediatric patient with open physes who also has significant arthritis and deformity not of oncologic origin. [
Orthopedics.
2016; 39(3):e549–e552.]
Adult Native Septic Arthritis in an Inner City Hospital: Effects on Length of Stay
Authors: Daynes Jacob , Roth Matthew F. , Zekaj Mark , Hudson Ian , Pearson Claire , Vaidya Rahul
Published: April 2016

The objective of this retrospective study was to assess what factors affected length of stay (LOS) in 183 adult patients with native septic arthritis. Diagnosis was based on a representative physical examination, fluid cell count/Gram stain, and organisms isolated from joint fluid culture. Data included demographics, comorbidities, laboratory results, treatment, and discharge times. Joint fluid cultures were positive in 55% (100 of 183) of the patients, and these patients were the subjects of this study. Blood cultures were taken for 65 patients and were positive in 54%; when positive, they were found to be the same as isolates from joint fluid analysis 91% of the time. Pathogens found in joint fluid analysis were as follows: methicillin-susceptible
Staphylococcus aureus
(MSSA), 44%; methicillin-resistant
S aureus
(MRSA), 21%;
Streptococcus
species, 14%;
Pseudomonas
, 10%; and other organisms, 11%. Surgical washout less than 24 hours from diagnosis affected LOS (12.25 vs 16.96 days for >24 hours;
P
<.05), but pathogen type and comorbid conditions did not. Average time for culture sensitivities was 4±1 days. Almost half of the patients had MSSA. Delays that could be controlled were getting an early diagnosis and expedient surgical washout of the joint. A lack of insurance and a requirement of intravenous antibiotics prolonged stay, whereas age, sex, and ethnicity did not. Waiting for bacterial sensitivities was a factor that could not be controlled. The authors believe that polymerase chain reaction or other technologies could lead to early diagnosis and expedient surgery. Effective oral antibiotics against resistant organisms would help the patients leave the hospital earlier. [
Orthopedics.
2016; 39(4):e674–e679.]
Reduced Anterior Cruciate Ligament Vascularization Is Associated With Chondral Knee Lesions
Authors: Hetsroni Iftach , Manor Amir , Finsterbush Alex , Lowe Joseph , Mann Gideon , Palmanovich Ezequiel
Published: April 2016

This study tested the association between periligamentous vascularization of the anterior cruciate ligament (ACL) and the presence of chondral knee lesions via retrospective analysis of prospectively collected data from 702 consecutive knee arthroscopic procedures. In each case, the ACL periligamentous envelope was documented as follows: (1) vascular, where the ACL was covered with blood vessels along its entire length; (2) centrally avascular, where the central third of the ACL was not covered but peripheral vascularized coverage was present; and (3) avascular, where there was no blood vessel coverage of the ACL. Inclusion criteria for the study were as follows: (1) age older than 18 years and (2) normal knee ligament laxity. Univariate analysis and multiple logistic regression were used to test the association between chondral lesions and each of the variables: sex, age, meniscus tear, decreased ACL vascularity, and concomitant chondral lesion in another knee compartment. The cohort included 516 knees. In the univariate analysis, all variables were associated with a chondral lesion, but only older age and decreased ACL vascularity were associated with chondral lesions in each knee compartment. In the regression model, only decreased ACL vascularity was associated with chondral lesions in each knee compartment. For avascular knees, the odds ratio was 2.84 for medial femoral condyle lesions (95% confidence interval, 1.73–4.68;
P
=.000), 2.44 for lateral femoral condyle lesions (95% confidence interval, 1.19–5.03;
P
=.015), and 2.48 for patellofemoral lesions (95% confidence interval, 1.55–3.97;
P
=.000). The findings showed that decreased ACL periligamentous vascularization is associated with chondral lesions of the femoral condyles in knees with preserved ACL laxity. [
Orthopedics.
2016; 39(4):e737–e743.]
Intraoperative Manipulation for Flexion Contracture During Total Knee Arthroplasty
Authors: Matsui Yoshio , Minoda Yukihide , Fumiaki Inori , Nakagawa Sigeru , Okajima Yoshiaki , Kobayashi Akio
Published: April 2016

Joint gap balancing during total knee arthroplasty (TKA) is important for ensuring postoperative joint stability and range of motion. Although the joint gap should be balanced to ensure joint stability, it is not easy to achieve perfect balancing during TKA. In particular, relative extension gap shortening can induce flexion contracture. Intraoperative manipulation is often empirically performed. This study evaluated the tension required for this manipulation and investigated the influence of intraoperative manipulation on the joint gap in cadaveric knees. Total knee arthroplasty was performed in 6 cadaveric knees from whole body cadavers. Flexion contracture was induced using an insert that was 4 mm thicker than the extension gap, and intraoperative manipulation was performed. Study measurements included the changes in the joint gap after manipulation at 6 positions, with the knee bending from extension to 120° flexion, and the manipulation tension that was required to create a 4-mm increase in the gap. The manipulation tension needed to create a 4-mm increase in the extension gap was 303±17 N. The changes in the joint gap after manipulation were 0.4 mm, 0.6 mm, 0.2 mm, −0.2 mm, −0.4 mm, and −0.6 mm at 0°, 30°, 45°, 60°, 90°, and 120° flexion, respectively. Therefore, the joint gap was not significantly changed by the manipulation. Intraoperative manipulation does not resolve flexion contracture. Therefore, if flexion contracture occurs during TKA, treatment with additional bone cutting and soft tissue release is likely more appropriate than manipulation. [
Orthopedics.
2016; 39(6):e1070–e1074.]
The Relationship Between the California Critical Thinking Disposition Inventory and Student Learning Outcomes in Baccalaureate Nursing Students
Authors: Searing Lisabeth Meade , Kooken Wendy Carter
Published: April 2016

Background:

Critical thinking is the foundation for nurses' decision making. One school of nursing used the California Critical Thinking Disposition Inventory (CCTDI) to document improvement in critical thinking dispositions.

Method:

A retrospective study of 96 nursing students' records examined the relationships between the CCTDI and learning outcomes. Correlational statistics assessed relationships between CCTDI scores and cumulative grade point averages (GPA) and scores on two Health Education Systems Incorporated (HESI) examinations. Ordinal regression assessed predictive relationships between CCTDI scores and science course grades and NCLEX-RN success.

Results:

First-year CCTDI scores did not predict first-year science grades. Senior-year CCTDI scores did not correlate with cumulative GPA or HESI RN Exit Exam scores, but were weakly correlated with HESI Pharmacology Exam scores. CCTDI scores did not predict NCLEX-RN success.

Conclusion:

This study did not identify meaningful relationships between critical thinking dispositions, as measured by the CCTDI, and important learning outcomes. The results do not support the efficacy of using the CCTDI in nursing education. [
J Nurs Educ.
2016;55(4):224–226.]
If You Teach It, They Will Screen: Advanced Practice Nursing Students' Use of Screening and Brief Intervention in the Clinical Setting
Authors: Agley Jon , McNelis Angela M. , Carlson Joan M. , Schwindt Rhonda , Clark Carol A. , Kent Kathleen A. , Lay Kathy , Gassman Ruth A. , Crabb David W.
Published: April 2016

Background:

In the United States, approximately 30% of adults drink at risky levels or meet the criteria for harmful or dependent alcohol use. Screening, brief intervention, and referral to treatment (SBIRT) in primary care settings is indicated. This study assessed whether knowledge, attitudes, and beliefs about SBIRT, evaluated after a three-part, mixed-methods training, predicted whether 21 family nurse practitioner (FNP) students screened for alcohol use during clinical patient encounters.

Method:

After training, students completed a survey and documented implementation of SBIRT during their clinical practice-specific management courses.

Results:

FNP students who reported higher levels of perceived competence in their posttraining surveys were more likely to screen for alcohol in the clinical setting.

Conclusion:

Screening for alcohol misuse and identifying patients engaged in hazardous drinking meet important nurse practitioner competencies. Further research is needed to explore training programs that specifically emphasize activities to increase perceived competence, knowledge, and comfort regarding SBIRT. [
J Nurs Educ
. 2016;55(4):231–235.]
Graded Marginal Recession: A Surgical Technique to Correct Small Angle Vertical Deviations
Authors: Brooks Steven E. , Habib Larissa
Published: April 2016

Purpose:

To describe a novel muscle recession technique to surgically correct small angle vertical deviations in symptomatic adults with fusion potential.

Methods:

A novel technique involving a graded recession of the medial and lateral poles of a vertical rectus muscle, combined with graded medial and lateral tenotomy of the muscle, was used to treat small vertical deviations. A surgical nomogram was developed based on the configuration of the procedure and its predicted effects. Four patients with small angle hypertropia ranging from 1 to 5 prism diopters (PD) underwent the graded marginal recession procedure and were observed for up to 3 years.

Results:

Three of the four patients had successful correction of their strabismus and resolution of diplopia, with no complications or induced incomitance. One patient was initially orthotropic but showed a 2 PD regression 1 month postoperatively, eventually requiring additional surgery to achieve stable orthotropia.

Conclusions:

The graded marginal recession can be safely and effectively used to correct very small vertical deviations in adults with fusion potential. A surgical nomogram can be created to guide predicted corrections in increments of less than 0.5 PD.

[
J Pediatr Ophthalmol Strabismus
. 2016;53(2):85–89.]
Cytopathological Evaluation of Ocular Surface and Needle Washings Following Intravitreal Melphalan Injections for Retinoblastoma
Authors: Francis Jasmine H. , Mondesire-Crump Ijah , Marr Brian P. , Brodie Scott E. , Abramson David H.
Published: April 2016

Purpose:

There is concern that injections into eyes with retinoblastoma are dangerous and allow tumor escapement. This study attempted to determine this risk by investigating the presence of malignant cells in ocular surface and needle washings of eyes with retinoblastoma receiving intravitreal injections.

Methods:

Two hundred ocular surface and 202 needle washings were obtained from 280 injections into eyes with retinoblastoma. Each specimen underwent cytopathlogical assessment for the presence of malignant cells.

Results:

Cytopathological results revealed no malignant cells in all 200 ocular surface and 202 needle washing specimens. In the ocular surface washings, squamous cells, red blood cells, and inflammatory cells were found in 15, 2, and 2 specimens, respectively. In the needle washings, 4 specimens contained squamous cells but no red blood cells or inflammatory cells were found in any specimen.

Conclusion:

With this injection and evaluation technique, no malignant cells were recovered, highlighting the low risk of the procedure.

[J Pediatr Opthalmol Strabismus. 2016;53(2):96–98.]
Sensory Modulation Treatment on a Psychiatric Inpatient Unit: Results of a Pilot Program
Authors: Gardner Jennifer
Published: April 2016

The purpose of the current pilot program was to measure efficacy of sensory modulation treatment for adults (
N
= 20) admitted to an inpatient, involuntary psychiatric unit. Efficacy of 1-hour group (
n
= 10) and 1-hour individual (
n
= 9) sensory modulation treatment was measured via pre- and postintervention self-rating scales (visual analog scale from 0 to 10, with 0 =
low arousal
and 10 =
high arousal
) and post-survey. Results indicated treatment elicited an average self-perceived change in arousal of 1.93. Group treatment elicited an average self-rating change of 1.79, whereas individual treatment elicited an average change of 2.67. For participants who initially rated their arousal level ≥6, group treatment elicited a change of 4.5, whereas individual treatment elicited a change of 7.5. Participants sought materials and activities that were primarily categorized into the olfactory, gustatory, and auditory sensory systems. [
Journal of Psychosocial Nursing and Mental Health Services, 54
(4), 44–51.]
Repeatability of Keratometry Measurements Obtained With Three Topographers in Keratoconic and Normal Corneas
Authors: Guilbert Emmanuel , Saad Alain , Elluard Maud , Grise-Dulac Alice , Rouger Hélène , Gatinel Damien
Published: April 2016

PURPOSE:

To assess the repeatability of the corneal topography functions of Orbscan II (Bausch & Lomb, Rochester, NY), OPD-Scan III (Nidek, Gamagori, Japan), and iTrace (Tracey Technologies, Houston, TX) in keratoconic eyes and in a control group of normal patients.

METHODS:

In this prospective cohort study, patients were recruited between November 2011 and May 2012. Measurements were performed with a combined Placido-scanning slit system (Orbscan II) and two combined Placido-aberrometer systems (OPD-Scan III and iTrace). Repeatability limit and intraclass correlation coefficients (ICCs) of keratometric readings were calculated.

RESULTS:

Fifty-nine keratoconic eyes of 34 patients and 54 normal eyes of 27 patients were included. Three groups were evaluated: all stage I–IV keratoconic eyes (59 eyes), a subgroup consisting of stage I–II keratoconic eyes (41 eyes), and normal eyes (54 eyes). For almost all parameters studied, the repeatability limit was higher in the two groups of keratoconic eyes compared to normal eyes with all three topographers, indicating lower repeatability. For the maximum keratometry measurement, repeatability limit was 1.73, 1.49, and 1.41 diopters (D) in the stage I–IV keratoconic eyes group, 1.11, 1.02, and 0.98 D in the stage I–II keratoconic eyes group, and 0.61, 0.37, and 1.02 D in the normal eyes group with Orbscan II, OPD-Scan III, and iTrace, respectively.

CONCLUSIONS:

Topographies performed in keratoconic eyes are less repeatable than those performed in normal eyes. Threshold values of keratometric changes used to ascertain keratoconus progression should be carefully considered. Caution should be taken when interpreting the topographies of such patients. The higher variability should be taken into account before performing any treatment.

[
J Refract Surg.
2016;32(3):187–192.]
Prospective Clinical Comparison of Patient Outcomes Following Implantation of Trifocal or Bifocal Intraocular Lenses
Authors: Cochener Béatrice
Published: April 2016

PURPOSE:

To compare the visual results and patient satisfaction after bilateral implantation between a bifocal and a trifocal intraocular lens (IOL).

METHODS:

This study is a prospective, randomized, controlled study involving bilateral implantation of one of two multifocal IOLs. Patients were assessed for uncorrected and distance-corrected near (33 cm), intermediate (66 cm), and distance visual acuity. Distance contrast sensitivity under photopic (85 cd/m
2
) conditions with and without glare was also measured. Using a subjective questionnaire, patient satisfaction, spectacle independence, and the perception of glare and halo phenomena were evaluated at the final follow-up; a defocus curve analysis was conducted.

RESULTS:

Fifteen patients (30 eyes) were implanted with the FineVision IOL (PhysIOL, Liége, Belgium) and 12 patients (24 eyes) received the Tecnis ZMB00 IOL (Abbott Medical Optics, Santa Ana, CA). The average follow-up was 6 months. The mean binocular uncorrected visual acuity was 0.02 ± 0.04 logMAR in the FineVision group and 0.04 ± 0.05 logMAR in the Tecnis group and the mean binocular uncorrected near visual acuity was 0.01 ± 0.00 logMAR in both groups. In the intermediate range of the defocus curve, there was a statistically significant difference between the two IOLs (
P
< .05). Contrast sensitivity was within normal limits under photopic conditions in both groups.

CONCLUSIONS:

Both the Tecnis and FineVision IOLs provide a satisfactory range of vision, including a high level of uncorrected distance, intermediate, and near acuity and improved contrast sensitivity under photopic conditions.

[
J Refract Surg.
2016;32(3):146–151.]
Analysis of the Optical Quality of Spherical and Aspheric Intraocular Lenses in Simulated Nanophthalmic Eyes
Authors: Trindade Bruno Lovaglio Cançado , Amaral Felipe Tayer , de Lima Monteiro Davies William
Published: April 2016

PURPOSE:

To analyze the optical performance of different implant strategies in simulated nanophthalmic eyes.

METHODS:

An optical design software was used. Analysis included eye models that required 30.00, 45.00, and 60.00 diopters (D) intraocular lenses (IOLs) to achieve emmetropia. Spherical and aspheric IOLs were designed. They were tested either with a single implant setting S or by splitting the power into two lenses. Setting P1 had an even split of the power between the lenses and setting P2 had an uneven power split with one-third of the power in the anterior lens and two-thirds in the posterior IOL. The area under the modulation transfer function (MTF) curve was calculated and spherical aberration was recorded in each setting.

RESULTS:

Setting S had the worst optical performance in the spherical group and the best performance in the aspheric group. A statistically significant difference was found between setting S and the piggyback options (settings P1 and P2) in all analyzed variables for the spherical and aspheric groups for the 45.00 and 60.00 D IOL requirement. No statistically significant difference was found between the piggyback settings.

CONCLUSIONS:

Single aspheric IOLs had better optical performance than piggybacking lower-power aspheric IOLs. In the spherical lenses group, the results were the opposite, with the piggyback options having higher optical quality than the single IOL. MTF shows that single aspheric lenses provide the highest contrast sensitivity among all of the analyzed settings.

[
J Refract Surg.
2016;32(3):193–200.]
Corneal Stromal Demarcation Line Depth Following Standard and a Modified High Intensity Corneal Cross-linking Protocol
Authors: Kymionis George D. , Tsoulnaras Konstantinos I. , Liakopoulos Dimitrios A. , Skatharoudi Christina A. , Grentzelos Michael A. , Tsakalis Nikolaos G.
Published: April 2016

PURPOSE:

To compare the corneal stromal demarcation line depth using anterior segment optical coherence tomography (AS-OCT) after corneal cross-linking (CXL) using two different treatment protocols: the standard Dresden protocol (30 minutes with 3 mW/cm
2
) and a modified high intensity protocol (7 minutes with 18 mW/cm
2
), corresponding to a total surface dose of 5.4 and 7.5 J/cm
2
, respectively.

METHODS:

This prospective, comparative, interventional case series included 29 keratoconic patients (32 eyes). All patients underwent CXL using the same high intensity ultraviolet-A (UV-A) irradiation device (CCL-365; Peschke Meditrade GmbH, Huenenberg, Switzerland). Sixteen eyes were treated for 30 minutes with 3 mW/cm
2
according to the standard Dresden protocol, whereas 16 eyes were treated with a novel modified high intensity CXL protocol for 7 minutes with 18 mW/cm
2
of UV-A irradiation intensity. One month postoperatively, corneal stromal demarcation line depth was measured by two independent observers using AS-OCT.

RESULTS:

There was no significant difference in corneal stromal demarcation line depth between observer measurements for both groups (
P
= .645, Dresden protocol group;
P
= .715, high intensity group). Mean corneal stromal demarcation line depth was 341.81 ± 47.02
µ
m for the Dresden protocol group and 313.37 ± 48.85
µ
m for the high intensity protocol group. There was no statistically significant difference (
P
= .104) in the corneal stromal demarcation line depth between the two groups. Mean endothelial cell density did not change significantly in either group (
P
= .090, Dresden protocol group;
P
= .103, high intensity group). No intraoperative or postoperative complications were noted.

CONCLUSIONS:

Corneal stromal demarcation line depth using UV-A irradiance with 3 mW/cm
2
for 30 minutes and 18 mW/cm
2
for 7 minutes was similar. It seems that the current modified accelerated CXL protocol provided the same treatment depth as the standard Dresden protocol.

[
J Refract Surg.
2016;32(4):218–222.]
Predictors of Macular Atrophy Detected by Fundus Autofluorescence in Patients With Neovascular Age-Related Macular Degeneration After Long-Term Ranibizumab Treatment
Authors: Kuehlewein Laura , Dustin Laurie , Sagong Min , Hariri Amirhossein , Mendes Thais S. , Rofagha Soraya , Bhisitkul Robert B. , Sadda SriniVas R.
Published: April 2016

BACKGROUND AND OBJECTIVE:

To study the relationship between baseline morphologic characteristics of the choroidal neovascular (CNV) lesion and long-term development of macular atrophy in eyes with neovascular age-related macular degeneration (AMD) treated with ranibizumab (Lucentis; Genentech, South San Francisco, CA).

PATIENTS AND METHODS:

Certified graders evaluated baseline and 7-year follow-up (SEVEN-UP study) images of 41 eyes from the MARINA/ANCHOR and HORIZON trials. Using GRADOR software and stepwise linear regression, graders correlated lesion characteristics on fluorescein angiography (FA) at both visits with areas of definite decreased autofluorescence (DDAF) on fundus autofluorescence (FAF) imaging at the SEVEN-UP visit.

RESULTS:

Three of 41 eyes (7.3%) had macular atrophy on FA at baseline (mean ± standard deviation [SD] size: 0.29 mm
2
± 1.50 mm
2
), 29 (70.7%) at SEVEN-UP (mean ± standard deviation [SD] area: 7.42 mm
2
± 7.97 mm
2
). On FAF imaging at the SEVEN-UP visit, all 41 eyes (100%) had DDAF (mean ± SD size: 10.29 mm
2
± 8.07 mm
2
). Variables significantly associated with area of DDAF at the SEVEN-UP visit were the area of leaking CNV lesion components (coefficient: 0.953;
P
< .001), the area of other lesion components (coefficient: 1.094;
P
= .038), and the area of retinal pigment epithelial (RPE) atrophy (coefficient: 1.334;
P
= .040) on baseline FA imaging.

CONCLUSION:

The area of DDAF at more than 7 years after initiation of ranibizumab therapy was 35% larger than the original CNV lesion. The baseline area of leaking CNV and other components of the CNV lesion and the baseline area of RPE atrophy were important predictors of the area of definite decreased autofluorescence, presumably corresponding to areas of photoreceptor and RPE loss. The findings from this study may guide hypothesis generation for future AMD trials.

[
Ophthalmic Surg Lasers Imaging Retina
. 2016;47:224–231.]
Diabetic Macular Edema Diagnosis and Treatment in the Real World: An Analysis of Medicare Claims Data (2008 to 2010)
Authors: Dugel Pravin U. , Layton Andrew , Varma Rohit
Published: April 2016

BACKGROUND AND OBJECTIVE:

To characterize vascular endothelial growth factor (VEGF) inhibitor treatment patterns in patients with diabetic macular edema (DME) using a Medicare Standard Analytic Files Part B or Outpatient Claims database to understand treatment frequency and DME persistence.

PATIENTS AND METHODS:

A retrospective analysis of treatment patterns for patients diagnosed with DME receiving their first anti-VEGF injection was performed.

RESULTS:

The average number of anti-VEGF injection claims for DME per patient rose from 3.1 to 4.6 per year (mean: 4.2). Within 1 year of diagnosis, 46% of patients received their final DME diagnosis (mean: 1.9 anti-VEGF claims), and 65% of patients received their final anti-VEGF treatment for DME. Patients who received treatment for DME through years 2 and 3 submitted a mean of four and 7.2 anti-VEGF claims, respectively.

CONCLUSION:

VEGF inhibitor treatment was less frequent than in landmark trials, but did resolve DME in a proportion of patients.

[
Ophthalmic Surg Lasers Imaging Retina.
2016;47:258–267.]
En Face Spectral-Domain Optical Coherence Tomography Imaging of Outer Retinal Hard Exudates in Diabetic Macular Edema Based on Optical Coherence Tomography Patterns
Authors: Kim Yonguk , Yu Seung-Young , Kwak Hyung Woo
Published: April 2016

BACKGROUND AND OBJECTIVE:

To evaluate en face spectral-domain optical coherence tomography (SD-OCT) findings of the outer retinal hard exudates in diabetic macular edema (DME).

PATIENTS AND METHODS:

Exploratory analyses of prospective and consecutive case series. Fifty-five eyes treated with intravitreal ranibizumab (IVR) (Lucentis; Genentech, South San Francisco, CA) for 12 months were classified according to OCT features of DME: diffuse retinal thickening (DRT), cystoid macular edema (CME), and serous retinal detachment (SRD). Area fraction of outer nuclear layer (ONL) hard exudates (HEs) was assessed from en face OCT images.

RESULTS:

Area fraction of ONL HEs increased from 1.45% ± 1.22% to 2.24% ± 1.31% in DRT and from 2.24% ± 1.85% to 3.25% ± 1.52% in CME. HE gain was greatest during first 3 months (DRT = 0.83%; CME = 1.25%). SRD showed no difference in HEs (
P
= .462).

CONCLUSIONS:

ONL HEs increased in DRT and CME at month 12 following IVR. Rapid gain of HEs was found during the initial loading phase of IVR.

[
Ophthalmic Surg Lasers Imaging Retina
. 2016;47:313–321.]
OCT Angiography Findings in Acute Central Serous Chorioretinopathy
Authors: Feucht Nikolaus , Maier Matthias , Lohmann Chris P. , Reznicek Lukas
Published: April 2016

BACKGROUND AND OBJECTIVE:

To describe optical coherence tomography angiography (OCTA) findings in patients with acute central serous chorioretinopathy (CSC) compared to conventional imaging methods.

PATIENTS AND METHODS:

A consecutive series of 11 eyes from 10 healthy patients with acute CSC were included and underwent fluorescein angiography (FA), indocyanine green angiography (ICGA), OCT, fundus autofluorescence (FAF), and OCTA. Obtained OCTA images were evaluated for the presence of serous detachments of the neurosensory retina, leakage points, or other altered findings and compared to conventional imaging devices.

RESULTS:

In four out of 11 eyes, it was possible to detect detached retina adjacent to the leakage point in OCTA images, compared with four of 11 eyes using FA, five of 11 eyes using ICGA, 11 of 11 eyes using SD-OCT, and four of 11 eyes using FAF. In five out of 11 eyes, irregular flow patterns were observed on OCTA images through the choriocapillaris. OCTA images could not identify leakage points in any of the included eyes, compared with 11 out of 11 eyes on FA, five out of 11 eyes on ICGA, eight out of 11 eyes on SD-OCT, and zero out of 11 eyes on FAF.

CONCLUSION:

OCTA images of the superficial and deep retinal plexus, outer retina, and choriocapillaris did not reveal altered flow patterns directly associated with the leakage point in acute CSC. However, OCTA was able to visualize altered choroidal flow in some of the included eyes.

[
Ophthalmic Surg Lasers Imaging Retina
. 2016;47:322–327.]
Bilateral Proliferative Retinopathy Associated With Hoyeraal-Hreidarsson Syndrome, a Severe Form of Dyskeratosis Congenita
Authors: Allingham Michael J.
Published: April 2016

Dyskeratosis congenita (DC) is the prototypical member of a family of diseases caused by defective telomere maintenance. These “telomeropathies” also include Hoyeraal-Hreidarsson syndrome (HH) and Revesz syndrome, which are severe forms of dyskeratosis congenita, as well as a subset of idiopathic pulmonary fibrosis, aplastic anemia, and Coats' plus syndrome. Retinopathy has only rarely been reported in DC and HH, but is universally present in Coats' plus and Revesz syndromes. The care of these patients is typically a multidisciplinary effort, and this should include monitoring by an ophthalmologist.

[
Ophthalmic Surg Lasers Imaging Retina
. 2016;47:366–368.]
OCT Angiography Features of a Case of Bilateral Full-Thickness Macular Hole at Different Stages
Authors: Pierro Luisa , Iuliano Lorenzo , Bandello Francesco
Published: April 2016

The authors present the optical coherence tomography angiography features of the deep vascular plexus in a case of bilateral full-thickness macular hole. The right eye is a newly diagnosed, small, full-thickness macular hole, and the left eye is a longstanding, large macular hole.

[
Ophthalmic Surg Lasers Imaging Retina
. 2016;47:388–389.]
Historical Overview of Adult Gifted Education in the United States
Authors: Bazler Judith , Graybill Letitia , Van Sickle Meta
Published: April 2016

Giftedness is not present only in childhood. It persists for a lifetime. However, even though most colleges/universities provide special needs services for appropriate students, most if not all college faculty might not believe it necessary to provide any accommodations for gifted/talented students either at undergraduate or at the graduate level. In order to accommodate one or more gifted/talented students in a class, faculty need to rethink their pedagogy and assessment strategies. At the college/university level accommodations are usually absent because faculty do not perceive a need to do so in their courses. In courses for pre-service teachers, some instructors provide practices in courses including how to teach gifted and talented students in basic education settings for K-12 grades. This chapter presents a brief overview of gifted and talented education in the United States focusing more specifically on gifted and talented at the university (or adult) level.
Using Bronfenbrenner's Ecological Framework to Design Support Systems for Education and Special Education
Authors: Walker Gabriela , Pattison Elizabeth
Published: April 2016

Principles of Bronfenbrenner's Ecological Theory were reviewed to examine potential uses for classroom teachers and re-imagine Bronfenbrenner's System's Theory into a series of novel frameworks that could be practically applied to students' lives and experiences outside of the classroom environment. This interpretive review offers educators and families novel conceptual frameworks intended to foster deep understanding of individual students and to provide practical tools to visualize and navigate the unique web of human relationships and support available outside of the classroom. Fourteen newly created “systems theories” are briefly presented here.
Selecting Computer-Mediated Interventions to Support the Social and Emotional Development of Individuals with Autism Spectrum Disorder
Authors: Gillespie-Lynch Kristen , Brooks Patricia J. , Shane-Simpson Christina , Gaggi Naomi Love , Sturm Deborah , Ploog Bertram O.
Published: April 2016

This chapter is designed to provide parents, professionals, and individuals with Autism Spectrum Disorder (ASD) with tools to help them evaluate the effectiveness of computer-mediated interventions to support the social and emotional development of individuals with ASD. Starting with guidelines for selecting computer-mediated interventions, we highlight the importance of identifying target skills for intervention that match an individual's needs and interests. We describe how readers can assess the degree to which an intervention is evidence-based, and include an overview of different types of experiments and statistical methods. We examine a variety of computer-mediated interventions and the evidence base for each: computer-delivered instruction (including games), iPad-type apps, virtual environments, and robots. We describe websites that provide additional resources for finding educational games and apps. We conclude by emphasizing the uniqueness of each individual with ASD and the importance of selecting interventions that are well-matched to the specific needs of each individual.
The SOAR Strategies for Online Academic Research
Authors: Knox Carolyn Harper , Anderson-Inman Lynne , Terrazas-Arellanes Fatima E. , Walden Emily Deanne , Hildreth Bridget
Published: April 2016

Students often struggle when conducting research online, an essential skill for meeting the Common Core State Standards and for success in the real world. To meet this instructional challenge, researchers at the University of Oregon's Center for Advanced Technology in Education (CATE) developed, tested, and refined nine SOAR Strategies for Online Academic Research. These strategies are aligned with well-established, research-based principles for teaching all students, with particular attention to the instructional needs of students with learning disabilities. To support effective instruction of the SOAR Strategies, researchers at CATE developed a multimedia website of instructional modules called the SOAR Toolkit. This chapter highlights the real world importance of teaching middle school students to conduct effective online research. In addition, it describes the theoretical and historical foundations of the SOAR Strategies, instructional features of the SOAR Toolkit, and research results from classroom implementations at the middle school level.
Imagining Social Equity
Authors: Farrell Helen J.
Published: April 2016

In my view, work in special and inclusive education, and early childhood special education intervention is challenging and exciting. The children and young people (and adults) with complex special needs have become the shared responsibility of both educators and many other allied health professionals in recent years. The unique patterns of special education service delivery to these children and young people require work in interdisciplinary teams. The mission and concern of the chapter offers the interdisciplinary community in the education sector including teachers, academics, graduate students, policy makers, researchers, non-governmental organisations, government officials, school boards, medical and paramedical professionals, and advocacy groups the opportunity to work together to explore what notions of social equity mean, and to investigate ways of ameliorating disadvantage in special and inclusive education, and early childhood special education intervention sectors.
iPods and iPads as AAC Devices for Children with Developmental Disorders
Authors: van der Meer Larah
Published: April 2016

The Apple iPod Touch™ and iPad™ are increasingly used as augmentative and alternative communication (AAC) devices. This chapter discusses the use of iPods™/iPads™ loaded with software applications that enable speech output and thereby transform them into speech-generating devices (SGD). While a popular mode of communication for children with developmental disorders (DD) who have little or no spoken language, assessment of the effectiveness of such new technology to enhance communicative functioning is necessary. Research on the use of iPods™/iPads™ was evaluated to assess whether they are (a) effective as AAC devices, (b) at least as effective as other AAC interventions, and (c) effective at the individual level of implementation. Findings suggested that the use of iPods™/iPads™ as AAC devices is promising, also in comparison to other AAC systems. Children typically preferred using iPods™/iPads™. Selection of an AAC system based on the child's preference coupled with appropriate instructional strategies may lead to the enhancement of communicative functioning for children with DD.
Video Use in Teacher Education
Authors: Hodge Ashley , Carbonara David D.
Published: April 2016

Video is a valuable technology used for teaching and learning and specifically, video plays a significant part in effectively preparing pre-service teachers (PSTs) for the profession. Video is now being used as a form of PST assessment, which raises concern as to whether PSTs are being properly supported in this process. Therefore, this chapter turns to years of research on video use in teacher education to 1.) Identify ways that video has effectively been utilized in teacher education 2.) Understand the most operative aspects of video with respect to both the developer and the observer 3.) Explain the concern surrounding video as a means for assessment in teacher education and 4.) Suggest ways to support PSTs in recording and creating their own video segments of teaching. In doing so, this chapter aims to contribute to improving teacher education programs in terms of video-based assessment.
A Collective Case Study on Two Speech and Language Impaired Learners with Autism
Authors: Sabale Jacqueline R.
Published: April 2016

Various treatment methodologies have been demonstrated to be efficacious in instructing learners with autism; however, there is no universal method of treatment, since no single treatment method has been proven to ameliorate the multifaceted symptoms of autism entirely (Lovaas, 1987). This chapter discusses the results of a qualitative study that investigated the functional validity and instructional implications of the implementation of a potential hybrid Applied Behavior Analysis (ABA)/Applied Verbal Behavior (AVB) and Apple tablet technology-infused model of instructional intervention targeting the initial language development of two speech- and language-impaired learners with autism. Research was conducted in an attempt to determine whether the hybrid model was operational and effective in teaching verbal behavior skills. Data collection results and observational anecdotal notes indicate that the Apple iPad-infused hybrid model of instruction was operational and more effective in teaching verbal behavior skills than the traditional paper-based instructional method. Furthermore, participants of the study were able to successfully generalize the hybrid model's Discrete Trial Training (DTT) discriminative stimulus targets in diverse natural settings.
Mobile Games Individualise and Motivate Rehabilitation in Different User Groups
Authors: Koivisto Antti , Merilampi Sari , Sirkka Andrew
Published: April 2016

Trials on Mobile Games are presenting a huge potential in cognitive, physical and mental rehabilitation. This paper is to discuss user viewpoints of trials with mobile games combining cognitive stimulation and physical exercise in rehabilitation: Game#1 controlled by tilting the mobile phone embedded in a balance board; Game#2 controlled by tilting the tablet pc; and Game#3 a modified game version of Trail Making A -memory test played by tapping figures on the tablet pc touch screen. The total amount of participants was 89 of which 74% were older adults (women=24; men=33; average age 85.9 years) and 26% people with learning disabilities (n=23; a 38.9 years). The gameplay setting was similar for all target groups, although the game graphics (Game#1) were slightly modified based on each user group. Mobile devices were used as the game platform to create easily approachable games of low costs and suitable for the majority of people.
Implementing a Problem-Based Technology Learning Environment to Foster Cultural Literacy and Responsiveness Instructional Skills
Authors: Glimps Blanche Jackson , Ford Theron
Published: April 2016

Technology is part of our daily lives; we can observe the use of technology in our cell phones and portable computers and, most notably, within classrooms. If used within the proper pedagogical context, computer-aided technology can be quite advantageous to teacher educators whose pedagogical belief is also centered on teaching and learning that is responsive to students' needs and cultures. When technology is combined with Problem-Based Learning (PBL), it can be a powerful aid to help pre-service teachers build cultural literacy and the skills needed to be responsive to students' needs. This chapter presents a single case study of the highly successful academic outcomes through the wedding of PBL and technology.
Nonverbal Learning Disabilities and Asperger Syndrome in Young Adults
Authors: Stothers M. E. , Cardy J. Oram
Published: April 2016

The purpose of this chapter is to explore data-driven hypotheses concerning linguistic similarities and differences in adults with nonverbal learning disabilities (NLD) and autism spectrum disorder (ASD). The focus of the chapter is on profiling linguistic, cognitive, and neuropsychological strengths and weaknesses seen in both clinical groups. A research sample of adults from 19 to 44 years of age is described. Findings include strengths in the breadth of vocabulary and weaknesses in semantic precision and integration. A secondary finding, in which responses to adult autism screening surveys distinguish both clinical groups from controls, and the clinical groups from one another, is presented. Patterns and trends in this data point to difficulties with verbal and nonverbal gestalt formation that are amenable to intervention. Clinical examples of interventions suggested by the data are provided, as they apply to post-secondary students of the same age as the sample.