bluuebunny/crossref_metadata_2025 huggingface dataset:
The Benefits and Challenges of Mobile Technologies in Education
Authors: Sonko Julius
Published: October 2015

As the world gradually becomes universally networked with digital cellular systems and wireless high-speed Internet connectivity, mobile technologies are increasingly also becoming more ubiquitous, with enhanced capabilities ideal for supporting learning. There can be no doubt that mobile technologies are already playing a major role in education, especially since such technologies are more in tune with this fast-paced information age. This chapter examines the benefits and challenges of mobile technologies in education from the perspective of Sub-Saharan Africa. Because of the benefits that are exclusive to mobile technologies, the educational sector is gradually legitimizing the dissemination of education via such technologies. However, critics have not yet bought into the idea of disseminating education via mobile technologies because of the challenges related to such technologies. Nonetheless, the benefits seem to outweigh the challenges, and it is certain that mobile technologies are poised to be the future means for increasing education access in Sub-Saharan Africa.
Medical Education
Authors: Sturmberg Joachim
Published: October 2015

The notion that the medical professions are grounded in sound social and philosophical commitments to human well-being and advancement is the very foundation of medicine since time in memoriam. Caring is the essential work of all health professionals, since most patients have no medical condition explainable by the mechanistic biomedical model. Health, illness, and disease, and biomedically defined disease distributions in the community follow a Pareto distribution (aka the 80/20 split) (i.e. only a minor percentage require tertiary hospital interventions). This chapter unravels important failures inherent in current medical education approaches – the misconceptions about science, the limitations inherent in the prevailing worldviews, the shaping of attitudes and behaviors resulting from social interactions in health professional institutions, and the impact of the lack of flexibility within health professional institutions. Positing that health is a personal dynamic balanced state, represented through a somato-psycho-socio-semiotic model, is the basis on which principles for a patient-centered educational approach are developed. Such a new curriculum would embrace the complex adaptive systems principle – focusing on the interdependencies between teachers and learners, allowing the curriculum to emerge over the course based on learners' clinical exposures and experiences, fostering a critical engagement with the multifaceted knowledge base of the disciplines, and most importantly, building the necessary resilience for handling, individually and collectively, the emotional demands of caring.
Security in Digital Images
Authors: Otair Mohammed A.
Published: October 2015

Due to the swift growth of the using of the digital multimedia in the internet these days, the security in digital images has become a very important issue. Lately, significant attentions are given by many researchers in the field of the security for digital images, and several image encryption techniques have been developed to improve the security levels of these images. Different techniques can be applied to protect intellectual property rights for digital images and prohibit illegal copying. The aim of this chapter is to introduce the most important techniques that have been developed to implement the security in digital images such as digital watermarking and image steganography.
Mobile Learning in the Arab World
Authors: Al-Shehri Saleh
Published: October 2015

Most Arab countries started their own e-learning and mobile learning initiatives in order to cope with global integration of latest educational technologies. The high mobile phone penetration among Arabs as well as availability of good mobile infrastructure are all important factors that can enhance the shift to mobile learning. Moreover, several studies indicate positive attitudes and perceptions toward mobile learning at different Arab learning institutions. However, specific challenges may act as barriers to mobile learning in the Arab world. This chapter reviews some of the current mobile learning practices in the Arab world and provides an overview of challenges faced by Arab students, educators, and probably researchers. A description of future mobile learning in the Arab countries is then provided.
Envisioning Mobile Learning as the Future of Teaching and Learning via Technology
Authors: Imtinan Umera , Chang Vanessa , Issa Tomayess
Published: October 2015

Technology has played a key role in reshaping the way education is being delivered in university environments. Mobile technologies are one of the latest technologies to enter the higher education arenas around the world, offering great potential for teaching and learning. Students and teachers have been using mobile devices for formal and informal collaboration, communication, and connectivity within learning environments for a couple of decades without recognizing it as mobile learning. Mobile learning needs to be researched and theorized in order to be included in formal educational Information and Communication Technologies and its full potential harnessed for the future generations. A number of mobile learning researchers borrowed traditional learning models as theoretical foundations for mobile learning research. However, theories from a diverse range of subject areas such as Education, Information Systems, Human-Computer Interaction, and Telecommunication Engineering have also been used as the basis for mobile learning projects around the world. This incorporation of a diversity of disciplines and subjects has made mobile learning a multidisciplinary research field. This chapter aims to review the current mobile learning theories, models, and frameworks with the lens of mobile learning characteristics and challenges pointed out by prominent mobile learning researchers across the world in order to present the case of mobile learning as the future of teaching and learning.
Juvenile Idiopathic Arthritis (JIA) and Education in Primary School Children
Authors: Gibbon Michele , Duffy Ciarán M. , Taylor Gillian , Laniel Sophie
Published: October 2015

This chapter per the authors describes the impact that juvenile idiopathic arthritis (JIA) has on the functioning of children within elementary school settings. Suggestions for teachers, educators and administrators regarding the ways in which they may assist children in adapting to obstacles encountered at school (academic and social), as they relate to the disease. Exploration of the partnership between a child with JIA, his/her family and members of the health care and educational teams is examined.
Challenges for Children with Special Health Needs at the Time of Transition to School
Authors: Janus Magdalena , Siddiqua Ayesha
Published: October 2015

In this chapter, the transition from pre-school to kindergarten for children who need assistance with developmental/physical disabilities or chronic illnesses (children with “special health needs”) will be discussed. Services available during this transition are often inadequate to facilitate a successful school entry among children with special health needs. Administrative challenges involving multiple services agencies and differences in philosophy of pre-school and kindergarten service providers reduce the continuity of services during transition. While there are numerous strategies in place to facilitate the transition process, parents have reported many barriers to a smooth transition. These include lack of communication with staff at school, lack of preparation of education professionals, late and inadequate levels of service provision. Several service recommendations have been proposed to address these barriers, whose effectiveness remains largely understudied. Additional studies are needed to examine the role of diverse strategies in achieving successful transition.
Micro-ribonucleic acid and carcinogenesis: breast cancer as an example
Authors: Al-Khanbashi Manal , Al-Moundhri Mansour
Published: October 2015

MicroRNAs (miRNAs) are a class of small non-coding RNAs that have unique functions at post-transcriptional level (epigenetics). MiRNAs play a pivotal role in controlling gene expression at various levels including differentiation, cell-cycle regulation, apoptosis and many others in mammals as well as in many organisms. Recently, there has been greater understanding of the contribution of dysregulation of miRNA into disease status in particular carcinogenesis. In this review, we will discuss miRNA discovery, nomenclature, function, contribution of their dysregulation into disease status in particular carcinogenesis and their potential role as biomarkers.
Special edition of African Evaluation Journal on the national evaluation system
Authors: Goldman Ian , Rabie Babette , Abrahams Mark
Published: October 2015

No abstract available.
Clinician perceptions and patient experiences of antiretroviral treatment integration in primary health care clinics, Tshwane, South Africa
Authors: Mathibe Maphuthego D. , Hendricks Stephen J.H. , Bergh Anne-Marie
Published: October 2015

Background: Primary Health Care (PHC) clinicians and patients are major role players in the South African antiretroviral treatment programme. Understanding their perceptions and experiences of integrated care and the management of people living with HIV and AIDS in PHC facilities is necessary for successful implementation and sustainability of integration.Objective: This study explored clinician perceptions and patient experiences of integration of antiretroviral treatment in PHC clinics.Method: An exploratory, qualitative study was conducted in four city of Tshwane PHC facilities. Two urban and two rural facilities following different models of integration were included. A self-administered questionnaire with open-ended items was completed by 35 clinicians and four focus group interviews were conducted with HIV-positive patients. The data were coded and categories were grouped into sub-themes and themes.Results: Workload, staff development and support for integration affected clinicians’ performance and viewpoints. They perceived promotion of privacy, reduced discrimination and increased access to comprehensive care as benefits of service integration. Delays, poor patient care and patient dissatisfaction were viewed as negative aspects of integration. In three facilities patients were satisfied with integration or semi-integration and felt common queues prevented stigma and discrimination, whilst the reverse was true in the facility with separate services. Single-month issuance of antiretroviral drugs and clinic schedule organisation was viewed negatively, as well as poor staff attitudes, poor communication and long waiting times.Conclusion: Although a fully integrated service model is preferable, aspects that need further attention are management support from health authorities for health facilities, improved working conditions and appropriate staff development opportunities.
Характеризация почти совершенно нелинейных функций через подфункции
Authors: Gorodilova Anastasiya Aleksandrovna
Published: October 2015

Исследуются вопросы комбинаторного описания почти совершенно нелинейных функций (APN-функций). Получена полная характеризация APN-функций от $n$ переменных через подфункции от $n-1$ переменных: доказано, что векторная функция от $n$ переменных - APN-функция тогда и только тогда, когда каждая из ее подфункций от $n-1$ переменных является либо APN-функцией, либо имеет порядок дифференциальной равномерности $4$, и при этом выполнены условия допустимости. Приведена подробная характеризация APN-функций от $2$, $3$ и $4$ переменных. Исследование выполнено при поддержке гранта РФФИ 15-07-01328 и гранта НШ-1939.2014.1 Президента России для ведущих научных школ.
Цепь Маркова с теоретико-числовым предельным распределением
Authors: Zubkov Andrei Mikhailovich , Kolesnikova Kseniya Alekseevna
Published: October 2015

Пусть в урне находятся шары белого и черного цветов. За 1 шаг с вероятностями, равными $\frac12$ , либо число белых шаров увеличивается на число черных шаров, либо число черных шаров увеличивается на число белых шаров. Получены формулы для первых двух моментов общего числа шаров в урне, доказано, что предел функции распределения доли числа белых шаров в урне совпадает с теоретико-числовой функцией Минковского. Исследование выполнено за счет гранта Российского научного фонда (проект 14-50-00005).
Об элементарных словарных функциях, получаемых на основе ограниченной префиксной конкатенации
Authors: Marchenkov Sergey Seraphimovich
Published: October 2015

На множестве словарных функций в алфавите $\{1,2\}$ вводится операция ограниченной префиксной конкатенации. На основе этой операций и операции суперпозиции определяется класс BPC полиномиально вычислимых функций. Устанавливается принадлежность классу BPC ряда словарных функций, а также замкнутость класса BPC относительно некоторых известных операций. Вводится некоторый тип двуленточных нестирающих машин Тьюринга и доказывается, что функции из класса BPC можно вычислить на машинах этого типа за полиномиальное время. Работа выполнена при поддержке Российского фонда фундаментальных исследований, проект 13-01-00958.
Среднее и дисперсия числа подфункций случайной булевой функции, близких к множеству аффинных функций
Authors: Serov Aleksandr Aleksandrovich
Published: October 2015

Для случайных равновероятных булевых функций изучается распределение количеств подфункций от заданного числа переменных, близких к множеству аффинных булевых функций. Показано, например, что для булевых функции от $n$ переменных математическое ожидание числа подфункций от $s\geqslant 3+\log_2 n$ переменных, расстояние Хэмминга от которых до множества аффинных функций меньше $2^{s-2}$, стремится к $0$ при $n\rightarrow\infty$.
Ozone and NOx chemistry in the eastern US: evaluation of CMAQ/CB05 with satellite (OMI) data
Authors: Canty T. P. , Hembeck L. , Vinciguerra T. P. , Anderson D. C. , Goldberg D. L. , Carpenter S. F. , Allen D. J. , Loughner C. P. , Salawitch R. J. , Dickerson R. R.
Published: October 2015

Abstract. Regulatory air quality models, such as the Community Multiscale Air Quality model (CMAQ), are used by federal and state agencies to guide policy decisions that determine how to best achieve adherence with National Ambient Air Quality Standards for surface ozone. We use observations of ozone and its important precursor NO2 to test the representation of the photochemistry and emission of ozone precursors within CMAQ. Observations of tropospheric column NO2 from the Ozone Monitoring Instrument (OMI), retrieved by two independent groups, show that the model overestimates urban NO2 and underestimates rural NO2 under all conditions examined for July and August 2011 in the US Northeast. The overestimate of the urban to rural ratio of tropospheric column NO2 for this baseline run of CMAQ (CB05 mechanism, mobile NOx emissions from the National Emissions Inventory; isoprene emissions from MEGAN v2.04) suggests this model may underestimate the importance of interstate transport of NOx. This CMAQ simulation leads to a considerable overestimate of the 2-month average of 8 h daily maximum surface ozone in the US Northeast, as well as an overestimate of 8 h ozone at AQS sites during days when the state of Maryland experienced NAAQS exceedances. We have implemented three changes within CMAQ motivated by OMI NO2 as well as aircraft observations obtained in July 2011 during the NASA DISCOVER-AQ campaign: (a) the modeled lifetime of organic nitrates within CB05 has been reduced by a factor of 10, (b) emissions of NOx from mobile sources has been reduced by a factor of 2, and (c) isoprene emissions have been reduced by using MEGAN v2.10 rather than v2.04. Compared to the baseline simulation, the CMAQ run using all three of these changes leads to considerably better simulation of column NO2 in both urban and rural areas, better agreement with the 2-month average of daily 8 h maximum ozone in the US Northeast, fewer number of false positives of an ozone exceedance throughout the domain, as well as an unbiased simulation of surface ozone at ground-based AQS sites in Maryland that experienced an ozone exceedance during July and August 2007. These modifications to CMAQ may provide a framework for use in studies focused on achieving future adherence to specific air quality standards for surface ozone by reducing emission of NOx from various anthropogenic sectors.
Predicting ambient aerosol thermal–optical reflectance measurements from infrared spectra: elemental carbon
Authors: Dillner A. M. , Takahama S.
Published: October 2015

Abstract. Elemental carbon (EC) is an important constituent of atmospheric particulate matter because it absorbs solar radiation influencing climate and visibility and it adversely affects human health. The EC measured by thermal methods such as thermal–optical reflectance (TOR) is operationally defined as the carbon that volatilizes from quartz filter samples at elevated temperatures in the presence of oxygen. Here, methods are presented to accurately predict TOR EC using Fourier transform infrared (FT-IR) absorbance spectra from atmospheric particulate matter collected on polytetrafluoroethylene (PTFE or Teflon) filters. This method is similar to the procedure developed for OC in prior work (Dillner and Takahama, 2015). Transmittance FT-IR analysis is rapid, inexpensive and nondestructive to the PTFE filter samples which are routinely collected for mass and elemental analysis in monitoring networks. FT-IR absorbance spectra are obtained from 794 filter samples from seven Interagency Monitoring of PROtected Visual Environment (IMPROVE) sites collected during 2011. Partial least squares regression is used to calibrate sample FT-IR absorbance spectra to collocated TOR EC measurements. The FT-IR spectra are divided into calibration and test sets. Two calibrations are developed: one developed from uniform distribution of samples across the EC mass range (Uniform EC) and one developed from a uniform distribution of Low EC mass samples (EC < 2.4 μg, Low Uniform EC). A hybrid approach which applies the Low EC calibration to Low EC samples and the Uniform EC calibration to all other samples is used to produce predictions for Low EC samples that have mean error on par with parallel TOR EC samples in the same mass range and an estimate of the minimum detection limit (MDL) that is on par with TOR EC MDL. For all samples, this hybrid approach leads to precise and accurate TOR EC predictions by FT-IR as indicated by high coefficient of determination (R2; 0.96), no bias (0.00 μg m−3, a concentration value based on the nominal IMPROVE sample volume of 32.8 m3), low error (0.03 μg m−3) and reasonable normalized error (21 %). These performance metrics can be achieved with various degrees of spectral pretreatment (e.g., including or excluding substrate contributions to the absorbances) and are comparable in precision and accuracy to collocated TOR measurements. Only the normalized error is higher for the FT-IR EC measurements than for collocated TOR. FT-IR spectra are also divided into calibration and test sets by the ratios OC/EC and ammonium/EC to determine the impact of OC and ammonium on EC prediction. We conclude that FT-IR analysis with partial least squares regression is a robust method for accurately predicting TOR EC in IMPROVE network samples, providing complementary information to TOR OC predictions (Dillner and Takahama, 2015) and the organic functional group composition and organic matter estimated previously from the same set of sample spectra (Ruthenburg et al., 2014).
A new algorithm for detecting cloud height using OMPS/LP measurements
Authors: Chen Z. , DeLand M. , Bhartia P. K.
Published: October 2015

Abstract. The Ozone Mapping and Profiler Suite Limb Profiler (OMPS/LP) ozone product requires the determination of cloud height for each event to establish the lower boundary of the profile for the retrieval algorithm. We have created a revised cloud detection algorithm for LP measurements that uses the spectral dependence of the vertical gradient in radiance between two wavelengths in the visible and near-IR spectral regions. This approach provides better discrimination between clouds and aerosols than results obtained using a single wavelength. Observed LP cloud height values show good agreement with coincident Cloud-Aerosol Lidar and Infrared Pathfinder Satellite Observation (CALIPSO) measurements.
Cosmic ray transport and anisotropies to high energies
Authors: Biermann P. L. , Caramete L. I. , Meli A. , Nath B. N. , Seo E.-S. , de Souza V. , Becker Tjus J.
Published: October 2015

Abstract. A model is introduced, in which the irregularity spectrum of the Galactic magnetic field beyond the dissipation length scale is first a Kolmogorov spectrum k-5/3 at small scales λ = 2 π/k with k the wave-number, then a saturation spectrum k-1, and finally a shock-dominated spectrum k-2 mostly in the halo/wind outside the Cosmic Ray disk. In an isotropic approximation such a model is consistent with the Interstellar Medium (ISM) data. With this model we discuss the Galactic Cosmic Ray (GCR) spectrum, as well as the extragalactic Ultra High Energy Cosmic Rays (UHECRs), their chemical abundances and anisotropies. UHECRs may include a proton component from many radio galaxies integrated over vast distances, visible already below 3 EeV.
Patterns of landscape form in the upper Rhône basin, Central Swiss Alps, predominantly show lithologic controls despite multiple glaciations and variations in rock uplift rates
Authors: Stutenbecker L. A. , Costa A. , Schlunegger F.
Published: October 2015

Abstract. The development of topography is mainly dependent on the interplay of uplift and erosion, which are in term controlled by various factors including climate, glaciers, lithology, seismic activity and short-term variables such as anthropogenic impact. While most studies have focused on the role of tectonics and climate on the landscape form and underlying processes, less attention has been paid on exploring the controls of lithology on erosion. The Central European Alps are characterized by a large spatial variability in exposed lithologies and as such offer an ideal laboratory to investigate the lithological controls on erosion and landscape form. Here, we focus on the ca. 5400 km2-large upper Rhône basin situated in the Central Swiss Alps to explore how the lithological architecture of the bedrock conditions the Alpine landscape. To this extent, we extract geomorphological parameters along the channels of ca. 50 tributary basins, whose catchments are located in either granitic basement rocks (External massifs), oceanic meta-sedimentary and ophiolitic rocks (Penninic nappes) or fine-grained continental-margin sediments (Helvetic nappes). The analysis of longitudinal river profiles show that all tributary rivers within the Rhône basin are in topographic transient state as testified by mainly convex or concave-convex longitudinal stream channel profiles with several knickpoints of either tectonic or glacial origin. In addition, although the entire Rhône basin shows a strong glacial inheritance (and is still partly glaciated) and some of the highest uplift rates recently measured in the Alps, the river network has responded differently to those perturbations as revealed by the morphometric data. In particular, tributary basins in the Helvetic nappes are the most equilibrated (concave river profiles, overall lower elevations, less steep slope gradients and lowest hypsometric integrals), while the tributaries located in the External massifs are least equilibrated, where streams yield strong convex long profiles, and where the tributary basins have the highest hypsometric integral and reveal the steepest hillslopes. We interpret this pattern to reflect differences in response times of the fluvial erosion in tributary streams towards glacial and tectonic perturbations, where the corresponding lengths strongly depend on the lithology and therefore on the bedrock erodibility.
Using satellite-based estimates of evapotranspiration and groundwater changes to determine anthropogenic water fluxes in land surface models
Authors: Anderson R. G. , Lo M.-H. , Swenson S. , Famiglietti J. S. , Tang Q. , Skaggs T. H. , Lin Y.-H. , Wu R.-J.
Published: October 2015

Abstract. Irrigation is a widely used water management practice that is often poorly parameterized in land surface and climate models. Previous studies have addressed this issue via use of irrigation area, applied water inventory data, or soil moisture content. These approaches have a variety of drawbacks including data latency, accurately prescribing irrigation intensity, and a lack of conservation of water volume for models using a prescribed soil moisture approach. In this study, we parameterize irrigation fluxes using satellite observations of evapotranspiration (ET) compared to ET from a suite of land surface models without irrigation. We then incorporate the irrigation flux into the Community Land Model (CLM) and use a systematic trial-and-error procedure to determine the ground- and surface-water withdrawals that are necessary to balance the new irrigation flux. The resulting CLM simulation with irrigation produces ET that matches the magnitude and seasonality of observed satellite ET well, with a mean difference of 6.3 mm month−1 and a correlation of 0.95. Differences between the new CLM ET values and satellite-observed ET values are always less than 30 mm month−1 and the differences show no pattern with respect to seasonality. The results reinforce the importance of accurately parameterizing anthropogenic hydrologic fluxes into land surface and climate models to assess environmental change under current and future climates and land management regimes.
Setting up the critical rainfall line for debris flows via support vector machines
Authors: Tsai Y. F. , Chan C. H. , Chang C. H.
Published: October 2015

Abstract. The Chi-Chi earthquake in 1999 caused tremendous landslides which triggered many debris flows and resulted in significant loss of public lives and property. To prevent the disaster of debris flow, setting a critical rainfall line for each debris-flow stream is necessary. Firstly, 8 predisposing factors of debris flow were used to cluster 377 streams which have similar rainfall lines into 7 groups via the genetic algorithm. Then, support vector machines (SVM) were applied to setup the critical rainfall line for debris flows. SVM is a machine learning approach proposed based on statistical learning theory and has been widely used on pattern recognition and regression. This theory raises the generalized ability of learning mechanisms according to the minimum structural risk. Therefore, the advantage of using SVM can obtain results of minimized error rates without many training samples. Finally, the experimental results confirm that SVM method performs well in setting a critical rainfall line for each group of debris-flow streams.
Clinical Experience with the WIOL-CF Accommodative Bioanalogic Intraocular Lens: Czech National Observational Registry
Authors: Studeny Pavel , Krizova Deli , Urminsky Juraj
Published: October 2015

Purpose

To assess efficacy and patient satisfaction after cataract surgery and implantation of a new accommodative bioanalogic intraocular lens (IOL).

Methods

We evaluated the collected data of 48 patients with bilateral cataract surgery and Wichterle IOL (WIOL) implantation included in the Czech national observational registry. Monocular and binocular uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity, uncorrected near visual acuity (UNVA), best spectacle-corrected visual acuity for distance (CDVA), best spectacle-corrected visual acuity for near (CNVA), distance-corrected near visual acuity (DCNVA), and distance-corrected intermediate visual acuity were evaluated 6 months after surgery. Subjective patient satisfaction was assessed at 3 months postoperatively.

Results

The mean monocular UDVA was 0.074 ± 0.108 logMAR, the mean monocular CDVA was 0.047 ± 0.125 logMAR, the mean monocular UNVA was 0.328 ± 0.146 logMAR, the mean monocular DCNVA was 0.339 ± 0.131 logMAR, and the mean monocular CNVA was 0.139 ± 0.107 logMAR. A total of 24 patients (50%) had no problems with any light phenomena. A total of 18 patients were very satisfied (37.5%), 11 were satisfied (22.9%), 15 (31.2%) were rather satisfied, 4 (8.3%) were rather dissatisfied, and 0 were dissatisfied.

Conclusions

The WIOL–continuous focus polyfocal lens offers very good vision at far and intermediate distance comparable with other types of multifocal IOLs, and relatively good near vision, while the incidence of adverse side phenomena is relatively low.
Intravitreal Anti-VEGF Therapy for Macular Radiation Retinopathy: A 10-Year Study
Authors: Finger Paul T. , Chin Kimberly J. , Semenova Ekaterina A.
Published: October 2015

Purpose

To report long-term experience with intravitreal anti–vascular endothelial growth factor treatment for radiation maculopathy.

Methods

From 2005-2015, 120 consecutive patients underwent intravitreal anti-VEGF therapy for radiation maculopathy. Inclusion criteria included a diagnosis of uveal melanoma treated with plaque radiotherapy and subsequent macular radiation vasculopathy (exudate, retinal hemorrhage, intraretinal microangiopathy, neovascularization, edema). Anti-VEGF therapy involved continuous injections in 4- to 12-week intervals with doses of 1.25 mg/0.05 mL, 2.0 mg/0.08 mL, 2.5 mg/0.1 mL, or 3.0 mg/0.12 mL of bevacizumab as well as 0.5 mg/0.05 mL or 2.0 mg/0.05 mL of ranibizumab. Goals were maintenance of visual acuity and normative macular anatomy. Safety and tolerability (retinal detachment, hemorrhage, infection), visual acuity, central foveal thickness on optical coherence tomography imaging, and clinical features of radiation maculopathy were analyzed.

Results

Progressive reductions in macular edema, hemorrhages, exudates, cotton-wool spots, and microangiopathy were noted. At last follow-up, 80% remained within 2 lines of their initial visual acuity or better, with a mean treatment interval of 38 months (range 6-108 months). Kaplan-Meier analysis of the probability of remaining within 2 lines of initial visual acuity was 69% at 5 years and 38% at 8 years of anti-VEGF therapy. Discontinuation of therapy was rare. Relatively few acute or long-term side effects were noted, allowing for good long-term patient accrual.

Conclusions

Continuous intravitreal anti-VEGF therapy in patients with radiation maculopathy was well-tolerated and preserved vision. In most cases, reductions or resolution of retinal hemorrhages, cotton-wool spots, and retinal edema were noted for up to 10 years.
Combined use of Doppler OCT and en Face OCT Functions for Discrimination of an Aneurysm in the Lamina Cribrosa from a Disc Hemorrhage
Authors: Holló Gábor
Published: October 2015

Purpose

In addition to retinal nerve fiber layer thickness measurements, the recently introduced AngioVue optical coherence tomography (OCT) offers corresponding layer-by-layer Doppler OCT and en face OCT functions, for simultaneous evaluation of perfusion and structure of the optic nerve head. We investigated the clinical usefulness of combined use of Doppler and en face Fourier-domain OCT functions of the AngioVue Fourier-domain OCT for discrimination of a disc hemorrhage and a disc hemorrhage–like atypical vessel structure located deep in the lamina cribrosa.

Case report

We present our findings with AngioVue OCT on a disc hemorrhage and a spatially related retinal nerve fiber layer bundle defect in a glaucomatous eye (case 1). Both alterations were detected on en face OCT images without any Doppler OCT signal. We also report on an aneurysm suggestive for a disc hemorrhage on clinical examination and disc photography in a treated ocular hypertensive eye (case 2). The aneurysm was within the lamina cribrosa tissue at the border of the cup and the neuroretinal rim. This vascular structure produced strong Doppler signals but no structurally detectable signs on the en face OCT images.

Conclusions

Combined evaluation of corresponding Doppler OCT and en face OCT images enables ophthalmologists to easily separate true disc hemorrhages from disc hemorrhage–like deep vascular structures. This is of clinical significance in preventing unnecessary intensification of pressure-lowering treatment in glaucoma.
Lamotrigine-Induced Tubulointerstitial Nephritis and Uveitis-Atypical Cogan Syndrome
Authors: Kolomeyer Anton M. , Kodati Shyam
Published: October 2015

Purpose

To report a case of lamotrigine-induced tubulointerstitial nephritis and uveitis (TINU)-atypical Cogan syndrome.

Methods

Case report.

Results

A 16-year-old boy with traumatic brain injury and seizures presented to the emergency department with facial swelling, rash, and back pain several days after increasing lamotrigine dose secondary to a breakthrough seizure. Creatinine, urine β2 microglobulin, and eosinophils were elevated. Antinuclear antibodies, antineutrophil cytoplasmic antibodies, angiotensin-converting enzyme, and complement were normal. Renal biopsy showed acute granulomatous tubulointerstitial nephritis. Lamotrigine was discontinued, intravenous steroids were initiated, and the patient was discharged on Ativan and prednisone. Subsequently, he was diagnosed with bilateral anterior uveitis (vision 20/30 bilaterally) and started on prednisolone and cyclopentolate. Two months later, he developed a branch retinal artery occlusion in the right eye (vision 20/70) and bilateral ocular hypertension for which timolol-brimonidine and dorzolamide were added. Neuroimaging and hypercoagulability workup was unremarkable. Vision and intraocular pressure improved, while uveitis remained recalcitrant. Several months later, the patient developed central serous retinopathy in the right eye (vision 20/30). Prednisone was stopped but restarted due to methotrexate intolerance. A month later, he reported dizziness and was diagnosed with severe bilateral sensorineural hearing loss. Brain magnetic resonance imaging showed foci of perivascular, subcortical, and cochlear enhancement. Transtympanic Decadron injections and infliximab infusions were initiated. At the final visit, vision remained at 20/30 with trace anterior chamber reaction bilaterally while on timolol-brimonidine, dorzolamide, and prednisolone.

Conclusions

An idiosyncratic drug reaction should be considered in the differential diagnosis of TINU-atypical Cogan syndrome.
Choroidal Thickness in Diabetic Retinopathy in Relation to Long-Term Systemic Treatments for Diabetes Mellitus
Authors: Kase Satoru , Endo Hiroaki , Yokoi Masahiko , Kotani Masako , Katsuta Satoshi , Takahashi Mitsuo , Kase Manabu
Published: October 2015

Purpose

To measure central choroidal thickness (CCT) in patients with diabetic retinopathy (DR) and analyze the correlation with clinical backgrounds regarding medications for diabetes mellitus (DM).

Methods

We retrospectively identified 86 patients with DR (172 eyes) and 43 healthy subjects (57 eyes) who underwent spectral-domain optical coherence tomography. Among the 86 patients with DM who had received no intraocular treatments, 61 were diabetic patients who had continuously received systemic treatments for DM (under treatment group). Twenty-five were patients who had discontinued the treatments or had not received any treatment for DM until this study started (no treatment group).

Results

The results of CCT acquired by 2 masked raters showed a significant correlation coefficient (r = 0.98), indicating high reproducibility in this study. No correlation of CCT was noted between normal (272 ± 71 µm) and DM eyes (264 ± 77 µm), the presence of diabetic macular edema, or CCT and the severity of DR in the patients examined. Interestingly, there was a significant decrease in CCT (175 ± 42 µm) in eyes with mild/moderate nonproliferative DR (NPDR) in the no treatment group (p<0.05), whereas CCT was prominently thicker in eyes with severe NPDR (354 ± 76 µm) and proliferative DR (286 ± 74 µm) than in eyes without DR.

Conclusions

This study demonstrated that CCT was significantly decreased in the presence of mild/moderate NPDR in the no treatment group, suggesting that a continuously high blood sugar state caused by insufficient treatments for DM may facilitate vascular damage in the choroid in the early stage of DR.
Intraocular Surgery with Melphalan Irrigation for Vitreous Hemorrhage in an Only Eye with Retinoblastoma
Authors: Yarovoy Andrey A. , Ushakova Tatyana L. , Gorshkov Ilya M. , Polyakov Vladimir G. , Golubeva Olesya V. , Gorovtsova Olga V. , Krivovyaz Olga S.
Published: October 2015

Purpose

To illustrate the successful outcome of pars plana vitrectomy (PPV) with melphalan irrigation for vitreous hemorrhage (VH) with suspected viable retinoblastoma. Despite the high risk of intraocular surgery, it was performed to preserve the only potentially seeing eye with treated retinoblastoma.

Methods

Vitreous hemorrhage occurred in the only eye of a 4-year-old boy after treatment for recurrent multifocal group C retinoblastoma with systemic chemotherapy (carboplatin, etoposide, and cyclophosphamide; and vincristine, cyclophosphamide, and doxorubicin), ruthenium brachytherapy with plaque repositioning, cryotherapy, and external radiotherapy. The VH developed 8 months after repeated brachytherapy with subsequent intravitreal melphalan chemotherapy. The patient's parents refused to remove the eye. The fellow eye was enucleated earlier because of VH and secondary glaucoma, without histologic signs of a viable tumor. Pars plana lensectomy, 25-G vitrectomy with melphalan irrigation (5 μg/mL), and silicone oil tamponade were performed.

Results

No ophthalmoscopic or morphologic signs of a viable tumor were detected. Four months later, the silicone oil was removed. Visual acuity was 20/200 with aphakic correction. Follow-up for 34 months revealed no signs of tumor recurrence or dissemination.

Conclusions

Despite the high risk of intraocular surgery, the need to preserve the only potentially seeing eye with treated retinoblastoma may require PPV. Thus, in unclear cases of VH with suspected viable tumor, PPV with intraocular melphalan irrigation, with caution, may be a reasonable procedure.
Enhanced Depth Imaging Optical Coherence Tomography in Adult-Onset Foveomacular Vitelliform Dystrophy
Authors: Grenga Pier Luigi , Fragiotta Serena , Cutini Alessandro , Meduri Alessandro , Vingolo Enzo Maria
Published: October 2015

Purpose

To compare mean choroidal thickness in patients with adult-onset foveomacular vitelliform dystrophy (AOFVD) and healthy subjects, to analyze patients with AOFVD in order to evaluate choroidal thickness disease-related changes, also in relation to the different stages of AOFVD disease and to the retinal pigment epithelium (RPE) features, and to correlate mean choroidal thickness with age in both groups.

Methods

In this prospective observational cross-sectional study, a total of 63 eyes of 51 consecutive subjects were examined, consisting of a control group (n = 28 eyes) and the AOFVD group (n = 35 eyes). A complete ophthalmologic examination, fundus autofluorescence, and spectral-domain optical coherence tomography were performed in all patients.

Results

Mean subfoveal choroidal thickness was 214.78 ± 62.35 µm in healthy subjects and 222.31 ± 73.29 µm in the AOFVD group (p = 0.33). In the vitelliruptive group, the mean choroidal thickness was significantly thicker than in the control group at each choroidal location. Mean choroidal thickness was significantly increased in the pseudohypopyon stage when compared to the vitelliform one (+66.34 µm, p = 0.02). Eyes with subretinal fluid (SRF) showed significantly thicker choroid when compared with those without SRF. No significant correlations were found between age and choroidal thickness in the study group.

Conclusions

The study of the choroid in patients with AOFVD suggested a possible role in the pathologic changes during the different stages of disease, and could help us to evaluate progression of the disease. Greater choroidal thickness associated with SRF and RPE bumps are signs of RPE alterations and could be related to evolution of the AOFVD lesion to a different stage.
Conversion Arthroplasty of the Hip: Mid-Term Results are Good
Authors: Zahar Akos , Cross Michael B. , Lakatos Tamas , Lakatos Jozsef , Major Balint , Kendoff Daniel , Szendröi Miklos
Published: October 2015

The historical mid-term results of conversion total hip arthroplasty (THA) are acceptable; however, the complication rates are high. In total, 39 patients (45 hips) from 2 institutions underwent conversion THA from 1993-2006 and were retrospectively evaluated. The mean age was 48.3 years, the mean follow-up time was 8.7 years, and the mean duration arthrodesis prior to conversion THA was 18.2 years. The outcomes included operative time, blood loss, leg-length discrepancy (LLD), thigh circumference, Harris Hip Score (HHS), complications, and radiographic evaluation. A total of 34 THAs were cemented, and 11 were uncemented. The mean operative time was 102 minutes, and the mean blood loss was 1019 ml. The mean HHS improved from 32.4 to 82.5 (p<0.01). The mean LLD decreased from 4.2 to 1.1 cm, while the thigh circumference increased by a mean of 1.6 cm. Complications included: a positive Trendelenburg gait (6), early haematoma that required surgical evacuation (5), dislocation (2), deep infection (1), and early aseptic loosening of the components (2). In conclusion, the functional results of the conversion THA using predominantly cemented components are good at mid-term follow-up; although the complication rates remain higher than a standard primary THA, aseptic loosening rates of the cemented components is low at mid-term follow-up.
Alendronate Stimulates Osteoprotegerin Expression in Fibroblasts from Periprosthetic Membrane
Authors: Qian Yebin , Zhang Xian-long , Jiang Yao , Zeng Bing-Fang , Wang Qi , Chen Yunsu , Shen Hao , Wang Qiaojie
Published: October 2015

Purpose

Aseptic loosening of an implant after total joint arthroplasty is still a major complication that results from periprosthetic osteolysis. Fibroblasts in the interface membrane express receptor activator of nuclear factor kappa B ligand (RANKL) and stimulate osteoclast formation. Studies demonstrate that through the control of osteoclastic bone loss bisphosphonates inhibit wear particle-induced bone resorption around total hip arthroplasty. The majority of bisphosphonates studies have focused on their effects on osteoblasts and osteoclasts. Little attention has been paid to their action on fibroblasts.

Methods

We isolated fibroblasts from the interface membrane that was obtained when revision hip arthroplasty was performed because of aseptic loosening. Fibroblasts were stimulated with alendronate. RANKL and osteoprotegerin (OPG) assays were performed using enzyme-linked immunosorbent assay kit and real time Reverse Transcription- Polymerase Chain Reaction (RT-PCR).

Results

We found that alendronate stimulated OPG mRNA and protein expression in a time and dose dependent manner. By contrast, alendronate did not affect RANKL expression.

Conclusions

The results indicate that alendronate modulated OPG production by fibroblasts from periprosthetic membrane, which may prove helpful for the inhibition of bone loss during aseptic loosening following total joint arthroplasty.
Frontal Plane Pelvic Motion during Gait Captures Hip Osteoarthritis Related Disability
Authors: Bolink Stijn A.A.N. , Brunton Luke R. , van Laarhoven Simon , Lipperts Matthijs , Heyligers Ide C. , Blom Ashley W. , Grimm Bernd
Published: October 2015

Gait analysis has widely been accepted as an objective measure of function and clinical outcome. Ambulatory accelerometer-based gait analysis has emerged as a clinically more feasible alternative to optical motion capture systems but does not provide kinematic characterisation to identify disease dependent mechanisms causing walking disability. This study investigated the potential of a single inertial sensor to derive frontal plane motion of the pelvis (i.e. pelvic obliquity) and help identify hip osteoarthritis (OA) related gait alterations. Patients with advanced unilateral hip OA (n = 20) were compared to patients with advanced unilateral knee OA (n = 20) and to a healthy control group (n = 20). Kinematic characterisation of frontal plane pelvic motion during gait demonstrated decreased range of motion and increased asymmetry for hip OA patients specifically.
Factors Associated with Restricted Hip Extension during Gait in Women after Total Hip Arthroplasty
Authors: Tsukagoshi Rui , Tateuchi Hiroshige , Fukumoto Yoshihiro , Akiyama Haruhiko , So Kazutaka , Kuroda Yutaka , Okumura Hideo , Ichihashi Noriaki
Published: October 2015

Purpose

A decreased peak hip extension angle in the late stance phase is a major gait abnormality in patients with THA. The purpose of this study was to determine the relationship between peak hip extension angle during gait and functional impairments such as muscle weakness and the limitation in joint range of motion and to identify the clinical factors influencing peak hip extension angle during gait.

Methods

67 female volunteers with THA were examined. Biomechanical gait analysis was performed to measure peak hip extension angle during gait. Maximal isometric strength of the hip and knee, passive hip extension range of motion, leg length discrepancy, and hip pain were assessed.

Results

Peak hip extension angle during gait significantly correlated with passive hip extension range of motion (r = 0.259), hip pain (r = −0.264), isometric strengths of the hip musculature (r = 0.278-0.491), and knee extensor (r = 0.386). Stepwise multiple regression analysis revealed that hip abductor torque (β = 0.355, P = 0.001), hip pain (β = −0.353, P = 0.001), and passive hip extension range of motion (β = 0.258, P = 0.011) were significant contributors to peak hip extension angle during gait (R2 = 0.408).

Conclusions

Our findings suggest that THA rehabilitation aimed at improving gait ability should focus on strengthening the hip abductors, controlling hip pain and increasing range of motion of hip extension.
Precision of Acetabular Cup Placement in Robotic Integrated Total Hip Arthroplasty
Authors: Elson Leah , Dounchis Jon , Illgen Richard , Marchand Robert C. , Padgett Douglas E. , Bragdon Charles R. , Malchau Henrik
Published: October 2015

Aims

The aim of this study was to assess the efficacy of stereotactic-arm assisted acetabular component placement during total hip arthroplasty (THA).

Methods

120 patients underwent primary THA at 4 different medical centres. A preoperative pelvic CT protocol was used to plan socket placement followed by robotic-arm assisted acetabular preparation and cup insertion. Intraoperative cup position was recorded and postoperative placement measured using Martell suite analysis software.

Results

Using a 95% predictive intervals, robotic-arm cup placement was within +/-4 degrees of planned position in 95% of cases. Applying these data to the so-called safe zone, 96% of sockets were within the defined safe zone. Our data confirms that intraoperative robotic assistance improves the precision of preparation and position of the acetabular cup during total hip arthroplasty.