bluuebunny/crossref_metadata_2025 huggingface dataset:
Reformen zur Entlastung geringer Einkommen und ihre Auswirkungen auf die Beschäftigung
Authors: Krebs Tom , Scheffel Martin , Barišić Manuela , Consiglio Valentina Sara
Published: October 2021

Die Corona-Krise hat die Wirtschaft zwar belastet, doch bietet sie auch die Chance, durch Reformen des Sozialversicherungssystems den Aufbau guter Beschäftigung zu fördern. Auf Basis eines makroökonomischen Modells untersucht der Beitrag zwei Reformvarianten, die den sozialrechtlichen Sonderstatus des Minijobs abschaffen und zudem Erwerbspersonen mit niedrigem Einkommen entlasten. Die Ergebnisse der Simulationsanalyse zeigen, dass eine Reform zur Abschaffung der Minijob-Regelung bei gleichzeitiger Entlastung der unteren Einkommensgruppen (bis 1.800 Euro brutto im Monat) viele Gewinner:innen hat. Die Reform hätte positive Effekte für Wirtschaft, Gesellschaft und öffentliche Finanzen.
Die prekäre alte Normalität der EU und die Notwendigkeit zur Reform
Authors: Gabrisch Hubert
Published: October 2021

Die EU befindet sich seit 2008 im Krisenmodus. Die Sehnsucht nach der alten Normalität ist das große politische Ziel, aber eine Rückkehr zum Status quo ante wäre nicht wirklich wünschenswert. Leider besitzt die europäische Politik kein Konzept für die Zukunft der EU nach der COVID-19-Pandemie. Das könnte sich als existenzielles Problem für die EU in ihrer derzeitigen Gestalt erweisen. Der Artikel analysiert den inneren Zusammenhang der verschiedenen Krisen seit 2008, zeigt Möglichkeiten für eine Reform der Architektur der EU in den zentralen Feldern Fiskal- und Geldpolitik auf, warnt vor weiteren Krisen und vor einer Marginalisierung der EU im globalen Maßstab.
Unleashing JupyterHub: Exploiting Resources Without Inbound Network Connectivity Using HTCondor
Authors: Freyermuth Oliver , Kohl Katrin , Wienemann Peter
Published: October 2021

In recent years Jupyter notebooks have conquered class rooms and some scientists also enjoy their convenience to quickly evaluate ideas and check whether a more detailed study is justified. To lower the threshold for getting started with Jupyter notebooks and to ease sharing and collaborative use, offering a JupyterHub service is tempting. However, offering such a service for a larger science class also requires a compute backend with sufficient resources such that hundreds of notebooks can be run simultaneously. Since resource usage for teaching activities typically fluctuates significantly over the year, dedicated compute resources seem inefficient. In this paper we present an alternative by exploiting an existing high throughput computing cluster (BAF2) at the University of Bonn, which comes with the additional advantage that scientific users may use the very same software and data environment they also select for their batch jobs. To implement this, we used a novel approach which allowed us to integrate BAF2 execute nodes although they do not have inbound network connectivity. Therefore, it does not touch the security concept of the cluster. The very same technique can be used to integrate any compute resources without inbound network connectivity and thus allows one to overcome usual firewall restrictions. This design also simplifies exploiting remote resources e.g. offered by resource federations or cloud providers.
Deep Palmprint Recognition with Alignment and Augmentation of Limited Training Samples
Authors: Brown Dane , Bradshaw Karen
Published: October 2021

This paper builds upon a previously proposed automatic palmprint alignment and classification system. The proposed system was geared towards palmprints acquired from either contact or contactless sensors. It was robust to finger location and fist shape changes—accurately extracting the palmprints in images without fingers. An extension to this previous work includes comparisons of traditional and deep learning models, both with hyperparameter tuning. The proposed methods are compared with related verification systems and a detailed evaluation of open-set identification. The best results were yielded by a proposed Convolutional Neural Network, based on VGG-16, and outperforming tuned VGG-16 and Xception architectures. All deep learning algorithms are provided with augmented data, included in the tuning process, enabling significant accuracy gains. Highlights include near-zero and zero EER on IITD-Palmprint verification using one training sample and leave-one-out strategy, respectively. Therefore, the proposed palmprint system is practical as it is effective on data containing many and few training examples.
TRANSITION DENSITIES OF SUBORDINATORS OF POSITIVE ORDER
Authors: Grzywny Tomasz , Leżaj Łukasz , Trojan Bartosz
Published: October 2021

We prove the existence and asymptotic behaviour of the transition density for a large class of subordinators whose Laplace exponents satisfy lower scaling condition at infinity. Furthermore, we present lower and upper bounds for the density. Sharp estimates are provided if an additional upper scaling condition on the Laplace exponent is imposed. In particular, we cover the case when the (minus) second derivative of the Laplace exponent is a function regularly varying at infinity with regularity index bigger than
$-2$
.
Convolutional Neural Network, Res‐Unet++, ‐Based Dispersion Curve Picking From Noise Cross‐Correlations
Authors: Song Weibin , Feng Xuping , Wu Gaoxiong , Zhang Gongheng , Liu Ying , Chen Xiaofei
Published: October 2021

Ambient seismic noise cross‐correlation has been widely applied in surface wave tomography at regional to global scales, including for seismic exploration of near‐surface structures. Reliable seismic imaging requires the accurate selection of dispersion curves. However, manual picking has become cumbersome work with the increase in available correlation traces; it is even more difficult when the number of dispersion curves increases by using frequency‐Bessel (F‐J) transform. Here, we show that the neural network Res‐Unet++ can automatically and accurately extract both fundamental dispersion curves and overtones from the F‐J dispersion spectra after training the network. Results show that selected dispersion curves had high accuracies in the synthetic data (greater than 95%). The network could effectively extract both the fundamental and higher modes in real data, and transfer learning improved the adaptability of neural networks for different geological areas. The obtained dispersion curves from the real data agreed well with those acquired manually and were advantageous for generating more effective dispersion points.
Kinematics and Evolution of the Southern Eastern California Shear Zone, Based on Analysis of Fault Strike, Distribution, Activity, Roughness, and Secondary Deformation
Authors: Spotila James A. , Garvue Max M.
Published: October 2021

The Eastern California shear zone is a complex set of dextral faults that accommodates significant plate motion and has produced large earthquakes. The evolution of this system and why it consists of closely spaced, irregular faults that fail in multi‐fault ruptures are not well understood. Here we analyze the geometry, spatial distribution, and Quaternary slip activity of right‐lateral faults in the southern Mojave block. We find these faults are oriented favorably for accommodating regional dextral plate motion and do not show evidence of replacement following counterclockwise rotation to unfavorable positions, although activity may be migrating westward as previously proposed. We also confirm that the shear zone is transpressive, with widespread restraining bends, distributed convergent deformation, and significant impact on near‐fault topography. Observations also show that faults are geometrically complex, as represented by along‐strike variability in fault strike. We document a correlation between strike variability and fault activity (slip rate or net slip), which is evident within the shear zone as well as for a control group of other faults. We suggest that strike variability represents a form of geometric roughness, which may inhibit fault slip and result in complex ruptures, slip‐strengthening behavior, and a prevalence of off‐fault deformation. Other factors, including preexisting crustal fabric, edge effects, and changes in the stress field, may further complicate kinematics. These results suggest that faults of the shear zone are still juvenile and somewhat unique, yet offer an important window into how broadly distributed shear may evolve into a through‐going continental transform system.
The Dominant Control of Relief on Soil Water Content Distribution During Wet‐Dry Transitions in Headwaters
Authors: Han Xiaole , Liu Jintao , Srivastava Puneet , Liu Hu , Li Xiaopeng , Shen Xuhui , Tan Hongbing
Published: October 2021

The redistribution of hillslope soil water during and after rainstorms is affected by soil properties and topography. Therefore, understanding how soil‐terrain attributes affect the soil volumetric water content (VWC) distribution under various catchment storages is a prerequisite for accurate hydrological modeling. Herein, the relationships between soil‐terrain attributes and soil VWC were examined in a steep (average slope = 60%), forested, zero‐order catchment. Detailed topography, soil properties, and runoff, and high frequency (6‐min) soil moisture data observed from July 2016 to November 2017 were employed along with resampled VWC data in three time‐steps (daily, hourly, and 6‐min intervals) for correlation analysis between soil‐terrain attributes and measured VWC. The results showed that daily aggregated data overlooked the highly heterogeneous flow conditions under dry‐wet transitions, leading to a constantly high correlation between VWC and the topographic wetness index (TWI). In comparison, the 6‐min data captured short‐lived flow processes, highlighting that, in reality, VWC‐TWI correlations fluctuated frequently as a function of catchment storages and precipitation characteristics, with four wetting patterns identified. Under wet‐dry transitions, the VWC‐TWI correlations increased significantly (from 0.3 to 0.6) as the hillslope gradually drained of lateral subsurface water. Soil water behavior consists of diurnal oscillations superimposed on a declining trend, which demonstrates the existence of unsaturated flow and which contributed to the increase in the strength of the correlations. Finally, through correlation analysis of all drying (n = 4) and wetting (n = 45) periods, we found that soil‐terrain attributes and VWC correlations can be used to identify the dominant soil water processes in various catchment storages.
Fortilin inhibits p53, halts cardiomyocyte apoptosis, and protects the heart against heart failure
Authors: Chunhacha Preedakorn , Pinkaew Decha , Sinthujaroen Patuma , Bowles Dawn E. , Fujise Ken
Published: October 2021

Heart failure (HF) has reached epidemic proportions in developed countries, affecting over 20 million people worldwide. Despite modern medical and device therapies, 60–70% of HF patients still die within 5 years of diagnosis as it relentlessly progresses through pervasive apoptotic loss of cardiomyocytes. Although fortilin, a 172-amino-acid anti-p53 molecule, is one of the most expressed proteins in the heart, its precise role there has remained unknown. Also unclear is how cardiomyocytes are protected against apoptosis. Here, we report that failing human hearts express less fortilin than do non-failing hearts. We also found that mice lacking fortilin in the heart (fortilinKO-heart) die by 9 weeks of age due to extensive cardiomyocyte apoptosis and severe HF, which suggests that fortilin sustains cardiomyocyte viability. The lack of fortilin is also associated with drastic upregulation of p53 target genes in the hearts. The heart-specific deletion of p53 in fortilinKO-heart mice extends their life spans from 9 to 18 weeks by mitigating cardiomyocyte apoptosis. Our data suggest that fortilin is a novel cardiac p53 inhibitor and that its inadequate expression in failing hearts and subsequent overactivation of the p53 apoptosis pathway in cardiomyocytes exacerbates HF.
Luminescence and photoionization of X-ray generated Sm2+ in coprecipitated CaF2 nanocrystals
Authors: Rozaila Z. Siti , Riesen Nicolas , Riesen Hans
Published: October 2021

X-ray generation and photobleaching of Sm2+ in CaF2:Sm3+ nanocrystals prepared by co-precipitation.
Visible-light-induced sulfonylation of Baylis–Hillman acetates under metal- and oxidant-free conditions
Authors: Yang Cai-Yun , Zhang De-Run , Hu Lin-Ping , Li Xia , Yang Shi-Chen , Liu Bo , Huang Guo-Li
Published: October 2021

A visible-light-driven metal- and oxidant-free procedure for the sulfonylation of Baylis–Hillman acetates with sulfonyl hydrazides under open-air conditions at room temperature is reported. The methods provide a green and facile synthetic route to access allylic sulfones.
Untersuchung zur indikationsgerechten Empfehlung einer Protonenpumpeninhibitor (PPI)-Medikation in Entlassungsbriefen einer gastroenterologischen Klinik
Authors: Fischbach Wolfgang , Hünger Beate , Hünger Matthias
Published: October 2021

Hintergrund und Ziel Protonenpumpeninhibitoren (PPI) zählen zu den weltweit am häufigsten verordneten Arzneimitteln. Sie galten lange Zeit als unbedenklich, ehe in den letzten Jahren unerwünschte Nebenwirkungen bei einer Dauermedikation diskutiert wurden. Zweifelsohne ist ein indikationsgerechter Einsatz der PPI zu fordern. In dieser retrospektiven Analyse untersuchten wir, wie viele Patienten einer gastroenterologischen Klinik mit einer PPI-Medikation entlassen wurden, und wie häufig die Empfehlung indikations-, dosis- und zeitgerecht war.

Methode 1612 Entlassungsbriefe von stationären Patienten aus dem Zeitraum 1.1.2011 bis 30.6.2011 wurden ausgewertet. Die Patienten mit einer PPI-Empfehlung wurden in vier Gruppen eingeteilt: (1) PPI-Empfehlung leitliniengerecht, korrekte Dosis und Therapiedauer; (2) leitliniengerechte Indikation, aber falsche Dosis oder fehlende/falsche Angabe zur Therapiedauer; (3) PPI-Empfehlung sinnvoll, aber nicht durch Leitlinien abgesichert; (4) fehlende Indikation, falsche Empfehlung. Zur weiteren Differenzierung wurden in den vier Gruppen jeweils mehrere Untergruppen gebildet, die Komorbiditäten und Begleitmedikation berücksichtigten.

Ergebnisse 808 der 1612 Entlassungsbriefe (50,1%) enthielten eine PPI-Empfehlung. Die Zuordnung zu den vier Hauptgruppen war wie folgt: (1) n=344 (42,6%); (2) n=115 (14,2%); (3) n=159 (19,7%); (4) n=190 (23,5%).

Schlussfolgerung PPI werden bei Entlassung (zu) häufig und teilweise unkritisch empfohlen. Daraus ergibt sich die Forderung nach einer besseren Schulung der Weiterbildungsassistenten und einer kritischen Durchsicht der Arztbriefe durch Ober- und Chefärzte. Selbst bei optimaler Umsetzung verbleiben noch in ca. 20% diskutable, nicht durch aktuelle Leitlinien abgesicherte Empfehlungen.
Nachhaltigkeit im Kreißsaal
Authors: Wacker Jürgen
Published: October 2021

Die Medizin in Deutschland verlässt sich auf Strom. Ein Ansatz, den es zu überdenken gilt. Katastrophen und der Klimawandel erfordern es, einen Notfallplan zu entwerfen, wie Geburtshilfe auch ohne Strom und Stecker funktioniert. Es gibt eine Reihe von Instrumenten und Methoden, mit denen sich bereits heute mehr Nachhaltigkeit im Kreißsaal umsetzen lässt.
Rare Findings in Cleidocranial Dysplasia Caused by RUNX Mutation
Authors: Kalayci Yigin Aysel , Duz Mehmet Bugrahan , Seven Mehmet
Published: October 2021

Background Cleidocranial dysplasia (CCD, #MIM119600) is an autosomal-dominant skeletal dysplasia characterized by delayed closure of the cranial sutures, aplasia, or hypoplasia of the clavicles and dental abnormalities. These findings were accompanied by mobile and drooping shoulders, frontal and parietal bossing, hypertelorism, brachycephaly, short stature, supernumerary, and late erupting teeth. Radiographic studies can reveal involvement of multiple bones including skull, chest, pelvis, and limbs. CCD can be diagnosed with clinical and radiological evaluation and validated by molecular studies. Heterozygous loss of function RUNX2 gene, which plays an important role in osteogenesis and differentiation of precursor cells, causes CCD phenotype.

Methods In this article, we reported five cases from three unrelated families with CCD phenotype. All exons and exonic–intronic boundary regions of RUNX2 gene from five patients were analyzed by polymerase chain reaction amplification and direct Sanger-sequencing.

Results Our patients had classical CCD phenotype and we detected three different previously described mutations including c.1171C > T, IVS4 + 4delAAGT and c.676G > A. However, nail dysplasia has never been associated with these mutations. Our patients had varying degrees of nail dysplasia. Two of three mutations are related with Runt DNA-binding domain of RUNX2 protein in Wnt signaling and c.1171C > T had effect on proline/serine/threonine-rich (PST) domain. Recently, Wnt signaling pathway was presented as a key regulator of digit and nail differentiation. Our data suggest that RUNX2 gene may have an essential role on embryogenesis of nails, probably by protecting their integrity.
Modelling and reviewing the reliability and multi-objective optimization of wind-turbine system and photovoltaic panel with intelligent algorithms
Authors: Alayi Reza , Jahangiri Mehdi , Guerrero John William Grimaldo , Akhmadeev Ravil , Shichiyakh Rustem Adamovich , Zanghaneh Sara Abbasi
Published: October 2021

One of the options for non-dependence on fossil fuels is the use of renewable energy, which has not grown significantly due to the variable nature of this type of energy. The combined use of wind and solar energy as energy sources can be a good solution to the problem of variable energy output. Therefore, the purpose of this research is to model a combination of the wind-turbine system and photovoltaic cell, which is needed to investigate their ability to supply electrical energy. To determine this important power production, real data of solar-radiation intensity and wind are used and, in modelling photovoltaic cells, the effects of ambient temperature are also considered. In order to generalize the studied system in all dimensions, different scenarios have been considered. According to the amount of electrical power generated, during the evaluation of these scenarios, two economic parameters, namely the selected scenario of a wind/solar system with diesel-generator support, was determined.
Percutaneous mitral valve edge-to-edge repair for late systolic anterior motion after surgical mitral valve repair: a case report
Authors: Ishizu Kenichi , Isotani Akihiro , Shirai Shinichi , Ando Kenji
Published: October 2021

Background

Late post-operative systolic anterior motion (SAM) is a rare but challenging issue. The feasibility of percutaneous mitral valve edge-to-edge repair (PMVR) using the MitraClip to treat late refractory SAM after surgical mitral valve repair has rarely been reported in the literature.

Case summary

An 88-year-old woman with a history of mitral valve repair for a P2 prolapse 14 years before, presented with signs of congestive heart failure. Transoesophageal echocardiogram (TOE) demonstrated significant SAM of the anterior mitral leaflet, resulting in the detachment from the posterior mitral leaflet in mid-to-late systole and severe mitral regurgitation (MR). The heart team decided to perform PMVR using the MitraClip to simultaneously address the issues of SAM and MR, considering the patient’s high surgical risk. TOE after the clip deployment at the medial edge of the mitral valve, where the most severe SAM was detected, confirmed resolution of SAM with marked reduction of MR. The patient was discharged home with good haemodynamic compensation.

Discussion

Post-operative SAM typically occurs immediately after the reparative surgery and resolves with conservative treatment; however, persistent SAM requiring repeat surgery remains a serious concern. As an alternative strategy, the MitraClip has some advantages, including low procedural risk, immediately observable results, and the ability to relocate the clip. Meanwhile, the greater risk of post-procedural mitral stenosis, particularly in patients undergoing mitral repair, should be taken into account. In our case, the clip deployment at the medial edge of the valve could minimize the progression of mitral stenosis with a satisfactory reduction of MR.
Tissue factor cytoplasmic domain exacerbates post-infarct left ventricular remodeling via orchestrating cardiac inflammation and angiogenesis
Authors: Wang J W , Chong S Y , Zharkova O , Yatim S M J M , Wang X , Lim X C , Huang C , Tan C Y , Jiang J , Versteeg H H , Dewerchin M , Carmeliet P , Lam C S P , Chan M Y
Published: October 2021

Introduction

The coagulation protein tissue factor (TF) regulates inflammation and angiogenesis via its cytoplasmic domain in infection, cancer and diabetes. While TF is highly abundant in the heart and implicated in cardiac injuries and dysfunction, the contribution of its cytoplasmic domain in cardiac pathology remains unclear.

Purpose

We aimed to investigate the contribution of the cytoplasmic domain of TF to post-infarct myocardial injury and adverse left ventricular (LV) remodeling.

Methods and results

Myocardial infarction was induced by permanent occlusion of the left anterior descending coronary artery. Male mice with C57BL/Jax background were used for the study. Compared with wild-type mice, mice lacking the TF cytoplasmic domain (TFΔCT) had a higher survival rate (90.5% versus 70%, p=0.0298) during a 28-day follow-up after myocardial infarction. Among surviving mice, TFΔCT mice had better cardiac function and less LV remodeling (ESV: 114.5±13.1mL for WT, 67.06±10.8mL for TFΔCT, p<0.001; EDV: 146.6±12.4mL for WT, 99.97±11.71mL for TFΔCT, p<0.001) than wild-type mice. Bone marrow chimerism indicated that deletion of the TF cytoplasmic domain in either bone marrow-derived cells or cardiac resident cells could alleviate post-infarct cardiac dysfunction. Speckle-tracking strain analysis revealed that the overall improvement of post-infarct cardiac performance in TFΔCT mice was attributed to reduced myocardial deformation in the peri-infarct region (strain-%: 11.14±0.97 for WT, 15.34±1.10 for TFΔCT, p=0.007; strain rate-/s: 3.89±0.26 for WT, 5.18±0.21 for TFΔCT, p=0.0005). Histological analysis demonstrated that TFΔCT hearts had in the infarct area greater proliferation of endothelial cells and myofibroblasts accompanied with better scar formation. Compared with wild-type hearts, infarcted TFΔCT hearts showed less infiltration of proinflammatory cells with concomitant lower expression of protease-activated receptor-1 (PAR1)-Rac1 axis. Furthermore, infarcted TFΔCT hearts presented markedly higher peri-infarct vessel density associated with enhanced endothelial cell proliferation and higher expression of PAR2 and PAR2-associated pro-angiogenic pathway factors.

Conclusions

Our findings demonstrate that the TF cytoplasmic domain exacerbates post-infarct cardiac injury and adverse LV remodeling via differential regulation of inflammation and angiogenesis. Targeted inhibition of the TF cytoplasmic domain-mediated intracellular signaling may ameliorate post-infarct LV remodeling without perturbing coagulation.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): National University Health System of Singapore
Epidemiology of Burn-Related Morbidity and Mortality in Patients Over 80 Years of Age
Authors: Secanho Murilo Sagrbi , Rajesh Aashish , Menezes Neto Balduino Ferreira , Maciel Ana Beatriz Pedroso de Oliveira , Chequim Merimar Maria , Rocha Cristiane , Palhares Neto Aristides Augusto
Published: October 2021

Burns cause greater morbidity and mortality in older patients owing to the physiological changes and functional status declines with age. We sought to characterize the epidemiology of burn injuries in the patient population aged over 80 years. A retrospective analysis of all patients aged >80 years admitted to a tertiary burn center in Brazil over a 10-year period was conducted. Multiple parameters including comorbidities, BSA burned, intensive care unit (ICU) admissions, inhalation injury, and revised Baux score were analyzed to assess association with mortality. Twenty-six patients were identified. The overall mortality rate was 42.3%. The mortality rate increased with the TBSA, with 100% mortality at >20% total BSA involvement (P < .001). Inhalation injury occurred in 3 (11.5%) patients, all of whom suffered mortality (P < .001). ICU admission was necessary for 14 (53.8%) patients, out of which 11 (78.6%) did not survive (P < .001). The revised Baux score had a significant impact on the mortality, with higher values among patients who did not survive (89.2 ± 6.2 vs 110.7 ± 17.9, P < .001). Burns cause high mortality in the octogenarian and nonagenarian populations. It is important to stratify patients at high risk, institute prompt treatment and discuss goals of care early on for optimal patient outcomes.
Risk and Impact of Severe Acute Respiratory Syndrome Coronavirus 2 Infection on Corneal Transplantation: A Case–Control Study
Authors: Levine Harry , Sepulveda-Beltran Paula A. , Altamirano Diego S. , Sabater Alfonso L. , Dubovy Sander R. , Flynn Harry W. , Amescua Guillermo
Published: October 2021

Purpose:

The purpose of this study was to evaluate the risk of symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection after corneal transplantation surgery, with cataract surgeries as controls, and the impact of the novel coronavirus disease pandemic in the clinical and surgical complications of corneal transplantation and cataract surgeries.

Methods:

A retrospective matched case–control study of 480 consecutive individuals who underwent surgery at the Bascom Palmer Eye Institute between May 2020 and November 2020. A total of 240 patients who underwent corneal transplantation with tissue obtained from the Florida Lions Eye Bank were age, race, ethnicity, and sex matched with 240 patients who underwent cataract surgery during the same day and by the same surgical team. Only the first corneal transplant or cataract surgery during this period was considered for each individual. All donors and recipients were deemed SARS-CoV-2 negative by a nasopharyngeal polymerase chain reaction test before surgery. Postoperative SARS-CoV-2 infections were defined as previously SARS-CoV-2(−) individuals who developed symptoms or had a positive SARS-CoV-2 polymerase chain reaction test during the first postoperative month.

Results:

Mean age, sex, race, and ethnicity were similar between groups. There were no differences between the corneal transplant and cataract groups in the rates of SARS-CoV-2 infection before (5.8% vs. 7.5%, P= 0.6) or after surgery (2.9% vs. 2.9%, P = 1). The rates of postoperative complications did not increase during the pandemic, compared with previously reported ranges.

Conclusions:

In this study, postoperative SARS-CoV-2 infection was similar for individuals undergoing corneal transplantation or cataract surgery. Further research is required to evaluate the transmission of SARS-CoV-2 through corneal tissue.
Impact of Acanthamoeba Keratitis on the Vision-Related Quality of Life of Contact Lens Wearers
Authors: Carnt Nicole A. , Man Ryan E. K. , Fenwick Eva K. , Lamoureux Ecosse L. , Keay Lisa J.
Published: October 2021

Purpose:

The aim of this study was to determine the impact of Acanthamoeba keratitis (AK) caused by contact lens (CL) use on vision-related quality of life (VRQOL) and the sociodemographic factors and disease outcome associated with VRQOL.

Methods:

Sixty-one CL-associated AK cases and 59 asymptomatic CL wearers (mean age ±SD 39.4 ± 16.5 vs. 45.5 ± 15.2 yrs, P = 0.04) were recruited from Moorfields Eye Hospital and Institute for Optometry, London. AK cases were surveyed during active disease and were stratified into “poor” and “good” outcomes based on clinical features. VRQOL was measured using Rasch-transformed scores from the Emotional, Mobility, and Reading domains of the 32-item Impact of Visual Impairment questionnaire. AK cases were compared with controls and “poor” outcomes compared with “good” with multivariable linear regression. Multivariable linear regression models were also used to identify the sociodemographic factors and disease outcome associated with VRQOL.

Results:

AK was associated with significant and substantial reductions in all 3 evaluated domains of VRQOL (Reading −59.6%, Mobility −59.8%, and Emotional −66.2%) compared with controls, independent of sociodemographic factors. Patients with AK who experienced poor outcomes, those who were of British White race (compared with all other races) and female, had lower VRQOL scores across all domains. Patients with AK with lower incomes scored worse on Reading and Mobility domains, whereas those with lower education had poorer Emotional scores.

Conclusions:

AK has a considerable detrimental impact on VRQOL. Clinicians should consider the importance of referring patients with AK for rehabilitative support and counseling as part of active disease management.
Substance Use Disorder Treatment Through Telemedicine in the Age of CoVID-19
Authors: Onderdonk Mary , Goldstein Nancy
Published: October 2021

Telemedicine has been effective at bridging the gap between patients, providers, and health systems. As part of a large, academic medical center in Baltimore, MD, it has been found that using digital tools, particularly when access to care is otherwise limited, is beneficial to supporting recovery. However, there are barriers to telemedicine surrounding patient privacy and increased tendency of patients to avoid treatment. Maintaining personalized, evidence-based clinical care while limiting the spread of CoVID-19 has required swift adaptation from healthcare providers. The intent of this article is to discuss provider perspectives of benefits and barriers to telemedicine for substance use disorder treatment during the CoVID-19 pandemic.
“Pulsating proptosis and heavy eye syndrome precipitated by neurofibromatosis type 1
Authors: Lai Yi-Fen , Lee Lung-Chi , Chen Yi-Hao , Chien Ke-Hung
Published: October 2021

Rationale:

Neurofibromatosis type 1 (NF1) is a hereditary disease characterized by café-au-lait spots, peripheral neurofibromas, Lisch nodules, optic nerve glioma, and sphenoid wing dysplasia. Pulsating proptosis is associated with a sphenoid bony defect. Heavy eye syndrome is characterized by acquired esohypotropia in patients with high myopia. This study aimed to describe the presentation of pulsating proptosis and heavy eye syndrome precipitated by NF1 and its management.

Patient concerns:

A 41-year-old woman presented with progressive pulsating proptosis and hypodeviation of the right eye over the past 2 years. The axial length of the right eye was 36.81 mm. The right eye presented with esohypotropia and hypoglobus. The ocular motility examination showed limitations in all directions, especially in supraduction. Brain computed tomography revealed sphenoid wing dysplasia of the right orbit. The meningocele protruded through the orbital defect, lifting the globe. Brain magnetic resonance imaging demonstrated superior rectus muscle (SR) medial displacement and lateral rectus muscle inferior displacement. Physical examination revealed café-au-lait macules and neurofibromas on the trunk.

Diagnosis:

NF1 with pulsating proptosis and heavy eye syndrome.

Interventions:

The patient declined neurosurgery due to risk and economic reasons. To manage her main concern regarding cosmetics, we performed orbital floor decompression, SR resection with advancement, maximal hang-back recession of the inferior rectus muscle, and a partial Jensen's procedure.

Outcomes:

Proptosis was reduced. The eye position became more symmetrical. The range of eye movements was also increased.

Lessons:

This case describes a rare synchronous presentation of pulsating proptosis and heavy eye syndrome precipitated by NF1. Adult-onset presentation implied a progressive process in NF1. The case also showed a different etiology from that of typical heavy eye syndrome. It reminds ophthalmologists that orbital imaging should be performed in high myopia patients with strabismus to evaluate the extraocular muscle pathway. Furthermore, the case demonstrated a management that avoided the risk and expensive cost of neurosurgery, which has not been reported.
Licensure and Driving Status among Visually Impaired Persons
Authors: Robinson Joshua L. , Liu Yuhan , Chen Qingxia
Published: October 2021

SIGNIFICANCE

Many drivers with vision loss maintain licensure and continue to drive despite their vision falling short of legal criteria.

PURPOSE

This study aimed to determine what proportion of visually impaired patients continue driving despite falling short of the legal cutoffs described in state licensure laws.

METHODS

We created a driving habits survey and administered it to 335 consecutive adult low vision patients presenting for their initial evaluation at the Vanderbilt Eye Institute. We measured visual acuity and contrast sensitivity as part of the clinical evaluation and accounted for historic visual field results where indicated. We compared self-reported licensure and driving status against the vision criteria for licensure in each subject's home state.

RESULTS

Two hundred fifty-seven subjects (76.7%) possessed an unexpired license. One hundred forty-one (54.9%) of these demonstrated vision, which would meet their home state's licensure criteria. Ninety-five of 134 current drivers (70.9%) met their home state's licensure criteria. Thirty-nine current drivers (29.1%) were driving outside the bounds of licensure criteria in their state. Among licensed subjects, being a current driver was associated with younger age (P < .001), better visual acuity (P < .001), and better contrast sensitivity (P < .001).

CONCLUSIONS

Many drivers do not possess adequate vision for licensure based on their home state's current standards. Changes to licensure qualification and renewal procedures may be advisable.
Objective Assessment of Corneal and Lens Clarity in Patients with COVID-19
Authors: Aydemir Emre , Aksoy Aydemir Gozde , Atesoglu Halil İbrahim , Goker Yasin Sakir , Kiziltoprak Hasan , Ozcelik Kazim Caglar
Published: October 2021

SIGNIFICANCE

The severe acute respiratory syndrome coronavirus 2 virus, which causes the coronavirus disease 2019 (COVID-19) pandemic, can bind to epithelial cells in the human cornea and conjunctiva, which may result in changes of corneal and lenticular densitometry.

PURPOSE

We aimed to report the corneal and lenticular clarity of patients who had been diagnosed previously with confirmed infection of COVID-19.

METHODS

This was a prospective, cross-sectional study. Fifty-three patients who had recovered from COVID-19 and 51 healthy individuals who had not had COVID-19 (control) were included in this study. Measurement of the corneal (at a corneal diameter of 12 mm) and lens densitometry of participants was performed using a Pentacam HR Scheimpflug imaging system. Three different optimal depths as anterior, central, and posterior layers and four concentric zones, consisting of diameters of 0 to 2, 2 to 6, 6 to 10, and 10 to 12 mm, were chosen to perform the corneal densitometric measurements. The mean lenticular densitometric values were calculated in zone 1 at 2.0 mm, zone 2 at 4.0 mm, and zone 3 at 6.0 mm by taking the central part of the pupil as reference point.

RESULTS

When compared with the individuals in the control group, the corneal densitometry measurements in the patients in the COVID-19 group were considerably higher in anterior 0 to 2 mm, 2 to 6 mm, 6 to 10 mm zones and total diameter; center 0 to 2 and 2 to 6 mm zones and total diameter; posterior 0 to 2 mm zone; and total corneal 0 to 2 and 2 to 6 mm zones and total diameter (P < .05, for each). When compared with the individuals in the control group, all of the lens densitometry measurements, except for those located in zone 1, were determined to be significantly higher among the patients in the COVID-19 group (P < .05, for each).

CONCLUSIONS

Significant alterations were found in corneal and lenticular densitometric values in patients who had had COVID-19. The virus could adversely affect cornea and lens transparency.
Case Report: Anisometropic Astigmatism Secondary to Unilateral Coronal Synostosis
Authors: Qayum Jennifer V.
Published: October 2021

SIGNIFICANCE

This case highlights the importance of performing a cycloplegic examination, including retinoscopy, on infants with the diagnosis of craniosynostosis because of the risk of refractive amblyopia.

PURPOSE

This report presents the unique case of an infant with amblyogenic anisometropic astigmatism secondary to unilateral coronal synostosis, which resolved after fronto-orbital advancement.

CASE REPORT

A 4-month, 14-day-old male infant with right unilateral coronal synostosis associated with Pfeiffer syndrome presented to the clinic with anisometropic astigmatism (right eye, +2.00 diopter sphere; left eye, +4.00 –4.75 ×170). Because of his young age, this refractive error was initially monitored. Upon follow-up examination at 6 months of age, he showed stability in his refractive error and early signs of amblyopia. Glasses were prescribed and amblyopia resolved. After cranial surgery, the patient's orbits were symmetric, and his amblyogenic astigmatism resolved.

CONCLUSIONS

Patients who present to the clinic with craniosynostosis should undergo cycloplegic examinations, including retinoscopy, early in their care with the knowledge that these patients can require interventions such as glasses and amblyopia treatment.
Accuracy and Repeatability of Internet-ordered Spectacle Lenses
Authors: Gordon Adam , Twa Michael D. , Cutter Gary , Kleinstein Robert N.
Published: October 2021

SIGNIFICANCE

Both consumers and eye care practitioners need to know how well online optical vendors conform with the accepted standards for quality and safety. We found that almost 1 in 10 prescriptions failed to meet national standards, which is a significant improvement over previous studies.

PURPOSE

The purpose of this study was to assess the accuracy and repeatability of spectacle lens prescriptions ordered from a sample of online vendors.

METHODS

Spectacle lens prescriptions were ordered by paid participants with no optical training who were masked to the study objectives. The prescription powers ordered (sphere, cylinder, and axis) were statistically sampled from 1000 previously filled prescriptions. A total of 100 orders were placed with each of three online vendors that included a range of high- and low-powered single vision lenses and progressive addition lenses, and duplicate orders to assess repeatability. An independent certified testing laboratory was contracted to assess conformance with voluntary consensus standards (ANSI Z80.1-2015) and Food and Drug Administration drop-ball safety testing. Lenses not meeting these standards were counted as failures.

RESULTS

The overall failure rates for the three vendors were 11.2 ± 3.2% (vendor A), 8.0 ± 2.7% (vendor B), and 8.2 ± 2.8% (vendor C). The repeatability for 20 prescriptions ordered five times from each vendor was high, with correlation coefficients greater than 90%. There were no observed lens impact failures.

CONCLUSIONS

Almost 1 in 10 spectacle lens prescriptions ordered from three online vendors failed to meet national standards for optical quality. Additional studies are needed to assess eyewear ordered online for other important patient-specific variables that can influence visual performance and ultimate acceptability of prescription eyewear, such as lens placement relative to the visual axis, frame fit, and cosmetic acceptability.
Evaluation of Average Retinal Nerve Fiber Layer Measurement in Eyes with Refractive Errors
Authors: Shpak Alexander A. , Korobkova Maria V.
Published: October 2021

SIGNIFICANCE

Optical coherence tomography (OCT) measurements of peripapillary retinal nerve fiber layer (pRNFL) play an important role in the diagnosis of glaucoma and optic atrophy. However, the interpretation of these measurements in patients with refractive errors, especially of a high degree, presents great difficulties. Optical coherence tomography instruments from most manufacturers do not take into account the effect of refractive errors, especially of a high degree, on quantitative measurements of pRNFL.

PURPOSE

The aim of this study was to develop a simple and easy method for evaluation of average pRNFL in eyes with refractive errors.

METHODS

Average pRNFL was measured by Cirrus HD-OCT (Carl Zeiss Meditec Inc., Dublin, CA) in 183 healthy White subjects (183 eyes) older than 40 years, with an axial length of the eye from 22.5 to 24.5 mm and spherical equivalent of refraction from −1.63 to 2.0 D.

RESULTS

For an average pRNFL, normative database of eyes with refraction close to emmetropia was constructed. The calculated first and fifth percentiles for age groups 41 to 50, 51 to 60, 61 to 70, and 71 to 85 years were 81 and 83, 79 and 81, 78 and 80, and 76 and 79 μm, respectively. Littmann-Bennett formula was modified to calculate a table containing first and fifth percentiles for eyes with axial lengths of 19 to 30 mm in the same age groups.

CONCLUSIONS

For the correct interpretation of the measurements of pRNFL in patients with refractive errors, an original table was proposed, which provides a quick assessment of the results obtained on the Cirrus HD-OCT device. The proposed new formulas make it easy to calculate a similar table for any optical coherence tomography device using existing databases or after collecting a normative database of eyes with refraction close to emmetropia.
Case Series: Small Full-thickness Macular Hole Treated with Topical Dorzolamide and Bevacizumab Intravitreal Injections
Authors: Feria Anzaldo Estephania , El Hamichi Sophia , Gold Aaron , Latiff Azeema , Berrocal Audina M. , Murray Timothy
Published: October 2021

SIGNIFICANCE

This article reports two cases reported of combined treatment with topical dorzolamide and intravitreal bevacizumab injections, successfully treating small full-thickness macular hole without the need for traditional macular hole surgery.

PURPOSE

This study aimed to report the potential effectiveness of combination treatment with topical dorzolamide and bevacizumab intravitreal injection therapy for small macular holes.

CASE REPORTS

Case 1 was a 68-year-old woman presented with distorted and decreased vision in her right eye for 9 months. Fundus examination showed a full-thickness macular hole, which was confirmed with spectral domain optical coherence tomography measuring 96 μm. Treatment with topical dorzolamide and intravitreal bevacizumab 1.25 mg/0.05 mL injections was initiated. Spectral domain optical coherence tomography showed gradual improvement of the full-thickness macular hole with complete hole closure and visual improvement in just 1 month. Case 2 was a 73-year-old woman who presented with distorted and decreased vision in her right eye for 8 months. Fundus examination showed a full-thickness macular hole in the right eye, confirmed with spectral domain optical coherence tomography, measuring 76 μm. Treatment with topical dorzolamide and intravitreal bevacizumab 1.25 mg/0.05 mL injections was initiated. Spectral domain optical coherence tomography showed gradual improvement of the full-thickness macular hole with complete closure at 2 months and improvement in visual acuity.

CONCLUSIONS

The combination of topical dorzolamide and bevacizumab intravitreal injection is a reasonable consideration for small macular holes with vascular components before considering surgery. Both cases had early macular closure in less than 3 months.
Effects of Robot-Assisted Gait Training in Patients With Multiple Sclerosis
Authors: Ozsoy-Unubol Tugba , Ata Emre , Cavlak Muyesser , Demir Serkan , Candan Zeynep , Yilmaz Figen
Published: October 2021

Objective

This study aims to evaluate and compare the effects of conventional and robot-assisted gait training (RAGT) programs on fatigue, mood, and quality of life in patients with multiple sclerosis who have fatigue.

Methods

In this single-blinded, randomized controlled study, 37 patients with multiple sclerosis were randomized into two groups: RAGT (n = 18) and conventional gait training (n = 19). The RAGT group had gait training with RoboGait, whereas the conventional gait training group received conventional physiotherapist-assisted gait training. Outcome measures were the Fatigue Severity Scale, Hospital Anxiety Depression Scale, Multiple Sclerosis Quality of Life-54, Extended Disability Status Scale, Functional Ambulation Category, Berg Balance Test, and 6-min walk test.

Results

Baseline demographic, clinic, and functional data were similar. Both groups showed improvements in the Fatigue Severity Scale, Hospital Anxiety Depression Scale–Depression, Multiple Sclerosis Quality of Life, Berg Balance Test, and 6-min walk test scores after treatment. Only the RAGT group showed an improvement in Hospital Anxiety Depression Scale–Anxiety score. The RAGT group had better Fatigue Severity Scale, and Hospital Anxiety Depression Scale scores.

Conclusion

In combination with the standard rehabilitation program, both RAGT and conventional gait training are effective for multiple sclerosis. However, RAGT has superior effects in terms of fatigue, depression, and anxiety. Therefore, it may be preferred in multiple sclerosis patients who exhibit prominent symptoms of fatigue, depression, or anxiety.
Quality healthcare services under National Health Insurance Scheme in Ghana: perspectives from health policy implementers and beneficiaries
Authors: Kipo-Sunyehzi Daniel Dramani
Published: October 2021

Purpose

This paper aims to examine the factors that affect the quality of healthcare services in the implementation of the National Health Insurance Scheme (NHIS) at the local level in Ghana from the perspectives of health policy implementers and beneficiaries in public-private organisations.

Design/methodology/approach

This paper has adopted a mixed research method with both qualitative and quantitative data, with in-depth interviews, document analysis and focus groups discussions. A total of 107 participants took part in the interviews and the questionnaire survey.

Findings

The study found that these factors greatly affect the quality of healthcare services from the implementers’ perspectives — referrals, effectiveness in monitoring, timeliness, efficiency, reimbursement, compliance with standard guidelines of Ghana Health Service (GHS) and accreditation process. For the beneficiaries, three healthcare services factors are important, including medical consultations, diagnostic services and the supply of drugs and medicines. Some other factors are found to be the least prioritized healthcare services, namely the issuance of prescription forms, verification of identification (ID) cards and staff attitude. However, the study found that implementers and beneficiaries exhibited a mixed reaction (perspectives) on accessing some healthcare services. In some healthcare services where the implementers perceived that beneficiaries have more access to such services, the beneficiaries think otherwise, an irony in the perspectives of the two actors.

Originality/value

This paper adds to the extant literature on the perspectives of policy implementers and beneficiaries on factors that affect the quality of healthcare services in general and specifically on the implementation of NHIS in Ghana with the public-private dimension.