bluuebunny/crossref_metadata_2025 huggingface dataset:
Rural and Urban Suicide in South Korea
Authors: Park B. C. Ben , Lester David
Published: October 2012

Suicide rates in 2005 in South Korea were higher in rural areas than in urban areas. Those in rural areas more often used pesticides and chemicals as a method for suicide, and there was a greater proportion of men and the elderly, both groups at higher risk for suicide in South Korea. These three factors may account for the high rural suicide rate in South Korea.
The Mini—IPIP Scale: Psychometric Features and Relations with PTSD Symptoms of Chinese Earthquake Survivors
Authors: Li Zhongquan , Sang Zhiqin , Wang Li , Shi Zhanbiao
Published: October 2012

The present purpose was to validate the Mini—IPIP scale, a short measure of the five-factor model personality traits, with a sample of Chinese earthquake survivors. A total of 1,563 participants, ages 16 to 85 years, completed the Mini—IPIP scale and a measure of posttraumatic stress disorder (PTSD) symptoms. Confirmatory factor analysis supported the five-factor structure of the Mini—IPIP with adequate values of various fit indices. This scale also showed values of internal consistency, Cronbach's alphas ranged from .79 to .84, and McDonald's omega ranged from .73 to .82 for scores on each subscale. Moreover, the five personality traits measured by the Mini—IPIP and those assessed by other big five measures had comparable patterns of relations with PTSD symptoms. Findings indicated that the Mini—IPIP is an adequate short-form of the Big-Five factors of personality, which is applicable with natural disaster survivors.
Subjective Experiences in First-Degree Relatives of Schizophrenic Subjects
Authors: Loas Gwenolé , Dimassi Hajer , Yon Valérie , Monestes Jean Louis
Published: October 2012

First-degree relatives of patients with schizophrenia may score higher on the Frankfurt Complaint Questionnaire (FCQ) than controls. The present study was designed to provide evidence of validity for the French version of the 24-item subscale of the Frankfurt Complaint Questionnaire (FCQ—24). In 27 first-degree relatives of patients with schizophrenia (high-risk group) and 30 controls, the high-risk group scored significantly higher on the FCQ, as expected.
Mortality Salience Increases Personal Relevance of the Norm of Reciprocity
Authors: Schindler Simon , Reinhard Marc-André , Stahlberg Dagmar
Published: October 2012

Research on terror management theory found evidence that people under mortality salience strive to live up to salient cultural norms and values, like egalitarianism, pacifism, or helpfulness. A basic, strongly internalized norm in most human societies is the norm of reciprocity: people should support those who supported them (i.e., positive reciprocity), and people should injure those who injured them (i.e., negative reciprocity), respectively. In an experiment ( N = 98; 47 women, 51 men), mortality salience overall significantly increased personal relevance of the norm of reciprocity ( M = 4.45, SD = 0.65) compared to a control condition ( M = 4.19, SD = 0.59). Specifically, under mortality salience there was higher motivation to punish those who treated them unfavourably (negative norm of reciprocity). Unexpectedly, relevance of the norm of positive reciprocity remained unaffected by mortality salience. Implications and limitations are discussed.
When will Energy Sector be serious about appalling condition?
Authors: Thanju Jeewan P.
Published: October 2012

DOI: http://dx.doi.org/10.3126/hn.v8i0.4899 Hydro Nepal Issue No. 8, 2011 January Page:  5-6 Uploaded date: 16 June, 2011
Effects of Soil Conditions on Cost of Low Head SHP Schemes
Authors: Singal Sunil K. , Saini R. P. , Raghuvanshi C. S.
Published: October 2012

Energy is the engine of growth of any developing economy. Consumption of electrical energy is universally accepted indicator of progress in the agricultural, industrial and commercial sectors, as also of the well being of the people of the nation. India is blessed with many rivers, natural streams, canal networks and mountains offering tremendous small hydropower potential which is clean and technically proven source of energy. Under this study, an attempt has been made to discuss the cost sensitive parameters of small hydropower schemes. Based on the cost sensitive parameters, the methodology for estimation of cost of low head small hydropower scheme has been evolved and the effect of soil conditions on cost of SHP schemes discussed. DOI: http://dx.doi.org/10.3126/hn.v8i0.4904Hydro Nepal: Journal of Water, Energy and Environment Issue No. 8, 2011 JanuaryPage: 24-28Uploaded date: 16 June, 2011
Application of HBV Model in Hydrological Studies of Nepali River Basins: A Case Study
Authors: Shrestha Subarna , Alfredsen Knut
Published: October 2012

Ungauged basins are challenges for hydrological study, the key discipline to analyse for planning and the operation of water resources projects. Several river basins have no hydrologic measurements where there is feasibility of promising water resources schemes. This study deals with use of the Hydrologiska Byråns avdeling for Vattenbalans (HBV) hydrological model to generate stream flow time series and other hydrological variables. The model was calibrated successfully in the Sanghutar catchment of the Likhu River of Nepal, and then used to simulate runoff series at the proposed intake site of Likhu HEP, where the gauging station has not been installed. The model can be used to generate runoff of other ungauged catchments which have similar catchment characteristics.DOI: http://dx.doi.org/10.3126/hn.v8i0.4910 Hydro Nepal: Journal of Water, Energy and Environment Issue No. 8, 2011 JanuaryPage: 38-43Uploaded date: 17 June, 2011
Promoting Capacity Building: Discussion Essay
Authors: Rosenlund Carole
Published: October 2012

Not available.DOI: http://dx.doi.org/10.3126/hn.v8i0.4926 Hydro Nepal: Journal of Water, Energy and Environment Issue No. 8, 2011 January Page:  57-60 Uploaded date: 23 June, 2011
Dams in India-Nepal Border By Buddhi Narayan Shrestha
Authors: Thanju Jeewan P
Published: October 2012

By Buddhi Narayan ShresthaKathmandu, Nepal: Bhumichitra; 1st Edition 2008; 408 pp.; NRs 440 (US $15)DOI: http://dx.doi.org/10.3126/hn.v8i0.4930 Hydro Nepal: Journal of Water, Energy and Environment Issue No. 8, 2011 January Page:  71-72 Uploaded date: 23 June, 2011
Interview with Odd Hoftun
Authors: Thanju Jeewan P.
Published: October 2012

Mr. Odd Hoftun toiled more than 50 years in various development activities in Nepal mainly in development of Mission Hospital, Tansen, Palpa, Butwal Technical Institute (BTI) in Butwal; and later in the hydropower development in Butwal and neighbouring Districts of Nepal. He has been instrumental in training several hundreds of skilled technical manpower and establising high value companies such as Butwal Power Company, BTI, Nepal Hydro & Electric Ltd. (NHE), Himal Hydro and General Construction etc. He talked with Jeewan P. Thanju, Editor-in-Chief of HYDRO Nepal.DOI: http://dx.doi.org/10.3126/hn.v8i0.4932 Hydro Nepal: Journal of Water, Energy and Environment Issue No. 8, 2011 January Page:  81-83 Uploaded date: 23 June, 2011
National News Vol.8 2011
Authors: Editor The
Published: October 2012

DOI: http://dx.doi.org/10.3126/hn.v8i0.4933 Hydro Nepal: Journal of Water, Energy and Environment Issue No. 8, 2011 January Page: 75-80 Uploaded date: 23 June, 2011
Solar Power
Authors: Thanju Jeewan P.
Published: October 2012

DOI: http://dx.doi.org/10.3126/hn.v8i0.4934 Hydro Nepal: Journal of Water, Energy and Environment Issue No. 8, 2011 January Page:  84-85 Uploaded date: 23 June, 2011
Electoral Fairness and the Law of Democracy: A Structural Rights Approach to Judicial Review
Authors: Dawood Yasmin
Published: October 2012

Partisan self-dealing in the design of election laws is a central challenge for democratic governance. This article develops a new conceptual framework, which I call a structural rights approach, that would enable the Supreme Court of Canada to respond effectively to this problem. A structural rights approach uses the language and logic of individual rights to regulate the structure of democratic institutions. In particular, I argue that courts should design democratic rights to remedy the structural deficiencies of the political system. To this end, I claim that the Supreme Court should interpret the right to vote as encompassing a new democratic right – the right to a fair and legitimate democratic process. In addition, I argue that the right to a fair and legitimate democratic process is best understood as a ‘structural right.’ I define ‘structural rights’ as individual rights that take into account the broader institutional framework within which rights are defined, held, and exercised. This article focuses on two cases studies – electoral redistricting and campaign finance – to show how the Court could use the right to a fair and legitimate democratic process to remedy the problem of partisan self-dealing. In addition, this article canvasses a wide array of structural approaches in the Canadian and American law of democracy literatures, and it locates the structural rights approach within this body of scholarship. The article also considers the structural rights approach with reference to theories of dialogue and deference. The structural rights approach not only provides a new paradigm for the Supreme Court’s oversight of the democratic process; it also offers an alternative way to conceptualize democratic rights.
Sexual History Evidence in Cases of Sexual Assault: A Critical Re-evaluation
Authors: Levanon Liat
Published: October 2012

Modern legal regimes have narrowed the scope of the sexual history evidence that is admissible for purposes of proving or refuting claims of consent in cases of sexual assault. Yet, under most modern regimes, similar-sexual-history evidence is still admissible. The article critically analyses the epistemic foundations of these regimes by laying down two arguments. The main argument is that, in the vast majority of cases, similar sexual history is simply irrelevant to questions of consent. First, a simple statistical analysis demonstrates that, in the class of complainants on sexual assault, similar-sexual-history evidence is not indicative of consent. Bayesian insights are then introduced in order to reinforce the analysis and refine it by identifying one narrow exception. Next, it is demonstrated that, in light of the proposed analysis, current evidential regimes can only make sense under some highly controversial normative or factual assumptions. The secondary argument contends that some of the modern evidential regimes reflect the idea that claims of power inequalities between men and women should be at the heart of sexual assault law, rather than claims of consent or lack of it.
Surgery for convexity meningioma: Simpson Grade I resection as the goal
Authors: Hasseleid Bernt Filip , Meling Torstein R. , Rønning Pål , Scheie David , Helseth Eirik
Published: October 2012

Object

Recently the relevance of Simpson resection grade as a prognostic factor for recurrence of WHO Grade I meningiomas was challenged, contradicting many previous scientific reports and traditional neurosurgical teaching. The objective of this study was to determine whether the predictive value of Simpson resection grade is outdated or remains valid with respect to meningioma recurrence and overall survival.

Methods

All patients at least 16 years old who underwent primary craniotomies for convexity meningiomas at Oslo University–affiliated hospitals (Rikshospitalet and Ullevål University Hospitals) in the period between January 1, 1990, and January 27, 2011, were included. Overall survival and retreatment-free survival rates were correlated with patient- and surgery-specific factors.

Results

Three hundred ninety-one consecutive patients were included in the study. The median patient age was 60.1 years (range 19–92 years). The female-to-male ratio was 2.1:1. The WHO grades were Grade I in 353 (90.3%), Grade II in 22 (5.6%), and Grade III in 16 (4.1%). The follow-up rate was 100%. Median follow-up time was 7.1 years (range 0.0–20.9 years) and total observation time was 3147 patient-years. The 1-, 5-, and 10-year overall survival rates were 96%, 89%, and 78%, respectively. Age, sex, WHO grade, and Simpson grade were significantly associated with overall survival. The 1-, 5-, and 10-year retreatment-free survival rates were 99%, 94%, and 90%, respectively. Simpson resection grade and WHO grade were significantly associated with retreatment-free survival. The hazard ratios for retreatment after combined Simpson resection Grades II+III and IV+V were 4.9- and 13.2-times higher than after Simpson Grade I resection, respectively.

Conclusions

Simpson Grade I resection should continue to be the goal for convexity meningiomas.
Overheated and melted intracranial pressure transducer as cause of thermal brain injury during magnetic resonance imaging
Authors: Tanaka Reiichiro , Yumoto Tetsuya , Shiba Naoki , Okawa Motohisa , Yasuhara Takao , Ichikawa Tomotsugu , Tokunaga Koji , Date Isao , Ujike Yoshihito
Published: October 2012

Magnetic resonance imaging is used with increasing frequency to provide accurate clinical information in cases of acute brain injury, and it is important to ensure that intracranial pressure (ICP) monitoring devices are both safe and accurate inside the MRI suite. A rare case of thermal brain injury during MRI associated with an overheated ICP transducer is reported.

This 20-year-old man had sustained a severe contusion of the right temporal and parietal lobes during a motor vehicle accident. An MR-compatible ICP transducer was placed in the left frontal lobe. The patient was treated with therapeutic hypothermia, barbiturate therapy, partial right temporal lobectomy, and decompressive craniectomy. Immediately after MRI examination on hospital Day 6, the ICP monitor was found to have stopped working, and the transducer was subsequently removed. The patient developed meningitis after this event, and repeat MRI revealed additional brain injury deep in the white matter on the left side, at the location of the ICP transducer. It is suspected that this new injury was caused by heating due to the radiofrequency radiation used in MRI because it was ascertained that the tip of the transducer had been melted and scorched. Scanning conditions—including configuration of the transducer, MRI parameters such as the type of radiofrequency coil, and the specific absorption rate limit—deviated from the manufacturer's recommendations. In cooperation with the manufacturer, the authors developed a precautionary tag describing guidelines for safe MR scanning to attach to the display unit of the product.

Strict adherence to the manufacturer's guidelines is very important for preventing serious complications in patients with ICP monitors undergoing MRI examinations.
Inflammasome proteins in cerebrospinal fluid of brain-injured patients as biomarkers of functional outcome
Authors: Adamczak Stephanie , Dale Gordon , de Rivero Vaccari Juan Pablo , Bullock M. Ross , Dietrich W. Dalton , Keane Robert W.
Published: October 2012

Object

Traumatic brain injury (TBI), the third most common CNS pathology, plagues 5.3 million Americans with permanent TBI-related disabilities. To evaluate injury severity and prognosis, physicians rely on clinical variables. Here, the authors seek objective, biochemical markers reflecting molecular injury mechanisms specific to the CNS as more accurate measurements of injury severity and outcome. One such secondary injury mechanism, the innate immune response, is regulated by the inflammasome, a molecular platform that activates caspase-1 and interleukin-1β.

Methods

The authors investigated whether inflammasome components were present in the CSF of 23 patients with TBI and whether levels of inflammasome components correlate with outcome. The authors performed an immunoblot analysis of CSF samples from patients who suffered TBI and nontrauma controls and assessed the outcomes 5 months postinjury by using the Glasgow Outcome Scale. Data were analyzed using Mann-Whitney U-tests and linear regression analysis.

Results

Patients with severe or moderate cranial trauma exhibited significantly higher CSF levels of the inflammasome proteins ASC, caspase-1, and NALP-1 than nontrauma controls (p < 0.0001, p = 0.0029, and p = 0.0202, respectively). Expression of each protein correlated significantly with the Glasgow Outcome Scale score at 5 months postinjury (p < 0.05). ASC, caspase-1, and NALP-1 were significantly higher in the CSF of patients with unfavorable outcomes, including death and severe disability (p < 0.0001).

Conclusions

NALP-1 inflammasome proteins are potential biomarkers to assess TBI severity, outcome, and the secondary injury mechanisms impeding recovery, serving as adjuncts to clinical predictors.
Gamma Knife surgery of pediatric gliomas
Authors: Weintraub David , Yen Chun-Po , Xu Zhiyuan , Savage Jesse , Williams Brian , Sheehan Jason
Published: October 2012

Object

While some low-grade pediatric gliomas may be cured with resection, many patients harbor tumors that cannot be completely resected safely, are difficult to access via an open surgical approach, or recur. Gamma Knife surgery may be beneficial in the treatment of these tumors.

Methods

The authors reviewed a consecutive series of 24 pediatric patients treated at the authors' institution between 1989 and 2011. All patients harbored tumors that were either surgically inaccessible or had evidence of residual or recurrent growth after resection. Progression-free survival was evaluated and correlated with clinical variables. Additional outcomes evaluated were clinical outcome, imaging response, and overall survival.

Results

Between 1989 and 2011, 13 male and 11 female patients (median age 11 years, range 4–18 years) with gliomas were treated. Tumor pathology was pilocytic astrocytoma (WHO Grade I) in 15 patients (63%), WHO Grade II in 4 (17%), and WHO Grade III in 1 (4%). The tumor pathology was not confirmed in 4 patients (17%). The mean tumor volume at the time of treatment was 2.4 cm3. Lesions were treated with a median maximum dose of 36 Gy, median of 3 isocenters, and median marginal dose of 15 Gy.

The median duration of imaging follow-up was 74 months, and the median duration of clinical follow-up was 144 months. The tumors responded with a median decrease in volume of 71%. At last follow up, a decrease in tumor size of at least 50% was demonstrated in 18 patients (75%) and complete tumor resolution was achieved in 5 (21%). Progression-free survival at last follow-up was achieved in 20 patients (83%). Progression was documented in 4 patients (17%), with 3 patients requiring repeat resection and 1 patient dying. The initial tumor volume was significantly greater in patients with disease progression (mean volume 4.25 vs 2.0 cm3, p < 0.001). Age, tumor pathology, tumor location, previous radiation, Karnofsky Performance Scale score, symptom duration, and target dosage did not differ significantly between the 2 groups.

Conclusions

Gamma Knife surgery can provide good clinical control of residual or recurrent gliomas in pediatric patients. Worse outcomes in the present series were associated with larger tumor volumes at the time of treatment.
Trends in the diagnosis and treatment of pediatric primary spinal cord tumors
Authors: Hayden Gephart Melanie G. , Lober Robert M. , Arrigo Robert T. , Zygourakis Corinna C. , Guzman Raphael , Boakye Maxwell , Edwards Michael S. B. , Fisher Paul G.
Published: October 2012

Object

Pediatric primary spinal cord tumors (PSCTs) are rare, with limited comprehensive data regarding incidence and patterns of diagnosis and treatment. The authors evaluated trends in the diagnosis and treatment of PSCTs using a nationwide database.

Methods

The Surveillance, Epidemiology, and End Results (SEER) registry was queried for the years 1975–2007, evaluating clinical patterns in 330 patients 19 years of age or younger in whom a pediatric PSCT had been diagnosed. Histological diagnoses were grouped into pilocytic astrocytoma, other low-grade astrocytoma, ependymoma, and high-grade glioma. Patient demographics, tumor pathology, use of external beam radiation (EBR), and overall survival were analyzed.

Results

The incidence of pediatric PSCT was 0.09 case per 100,000 person-years and did not change over time. Males were more commonly affected than females (58% vs 42%, respectively; p < 0.006). Over the last 3 decades, the specific diagnoses of pilocytic astrocytoma and ependymoma increased, whereas the use of EBR decreased (60.6% from 1975 to 1989 vs 31.3% from 1990 to 2007; p < 0.0001). The 5- and 10-year survival rates did not differ between these time periods.

Conclusions

While the incidence of pediatric PSCT has not changed over time, the pattern of pathological diagnoses has shifted, and pilocytic astrocytoma and ependymoma have been increasingly diagnosed. The use of EBR over time has declined. Relative survival of patients with low-grade PSCT has remained high regardless of the pathological diagnosis.
Dorsal myelopathy secondary to epidural fibrous scar tissue around a spinal cord stimulation electrode
Authors: Cicuendez Marta , Munarriz Pablo M. , Castaño-Leon Ana M. , Paredes Igor
Published: October 2012

The authors describe a patient with delayed thoracic spinal cord compression due to fibrous scar tissue around an epidural electrode used in spinal cord stimulation (SCS). One year after implantation of the system the stimulation became ineffective, and 1 year later the patient developed progressive paraparesis. There was no evidence of device-related complications on plain radiographs and CT scans, so the system was removed to perform MRI studies. These studies showed a dorsal myelopathy secondary to scar tissue around the electrode. At surgery thick scar tissue was resected, and the patient's neurological symptoms improved. The histological examination confirmed fibrosis, and microbiological studies excluded chronic infection. As far as the authors are aware, this complication has never been reported before at the thoracic level. Scarring around SCS electrodes should be considered as a late complication and as a possible cause of the tolerance phenomenon.
Does ossification of the posterior longitudinal ligament progress after laminoplasty? Radiographic and clinical evidence of ossification of the posterior longitudinal ligament lesion growth and the risk factors for late neurologic deterioration
Authors: Fargen Kyle M. , Cox J. Bridger , Hoh Daniel J.
Published: October 2012

Ossification of the posterior longitudinal ligament (OPLL) is a disease process characterized by progressive growth and calcification resulting in spinal canal compromise and serious neurological sequelae in advanced cases. Historically, OPLL has most commonly been treated with posterior surgical decompression. Although this procedure indirectly decompresses the spinal cord, it does not address the offending pathological entity, and further growth of the lesion may result in delayed neurological deterioration. This fact is particularly relevant because a number of long-term studies have revealed both longitudinal and transverse disease progression in individuals treated both surgically and conservatively. Despite these high rates of radiographically documented progression, however, the rate of neurological decline in patients undergoing posterior surgery with laminoplasty is low. In this article, the authors review the pathophysiology of OPLL, evidence of disease progression, and outcome data addressing conservative and surgical treatments.
The Mamaindê Tense/Evidentiality System
Authors: Eberhard David M.
Published: October 2012

This paper describes the extensive tense/evidentiality system of Mamaindê, a northern Nambikwara language of Brazil. This morphological system performs a dual function in Mamaindê, that of marking tense as well as indicating information source. First, each of the six evidentials are discussed in detail, followed by a section on the use of evidentials as ‘extensions’ with secondary semantic properties. After comments regarding the possible origins of this particular morphological category, a comparative section highlights the similarities and differences between the various evidential systems discovered thus far in the Nambikwara family, as well as some parallels with evidentiality within other Amazonian languages. The systems most similar to Mamaindê are those found in Lakondê, a northern Nambikwara language ( Telles & Wetzels 2006 ), Tariana, an Arawak language ( Aikhenvald 2004 : 60) and Tuyuca, East Tucanoan ( Payne 1997 : 256–7). The paper closes with a short commentary on the possible connections between Mamaindê evidentials and Mamaindê culture.

The overall result of this research is a comprehensive presentation of the Mamaindê evidential system, and an assessment of how it fits into a cross-linguistic picture of evidentiality.
Reduction and maintenance of overabundance. A case study on Italian verb paradigms
Authors: Thornton Anna M.
Published: October 2012

Overabundance occurs when two or more forms are available to realize the same cell in an inflectional paradigm, as in It. devo/debbo ‘must.1sg.prs.ind’. Such multiple forms, called cell-mates, abound in Italian. This paper presents a case study of the diachronic evolution of the cell-mates realizing the 1sg and 3pl cells of the Present Indicative of the verbs dovere ‘must’, vedere ‘see’, chiedere ‘ask’, sedere ‘sit’, possedere ‘possess’. Analysis of corpora of Italian texts dating from the 13thto the 20thcentury shows that some cases of overabundance were reduced over time, while others have been maintained till the present. This paper explores the factors responsible for these different outcomes. Previous observations that overabundance tends to be better preserved in low-frequency items and in forms learned relatively late appear confirmed by the Italian data; in addition, conscious normative interventions have been found to play a great role in the Italian situation. In conclusion, this study shows that overabundance is a genuine type of non-canonical phenomenon that can occur in paradigms; the idea often put forward in the literature, that overabundance will eventually inevitably be eliminated in all cases, is not fully supported by the data.
Integrating Informatics in Undergraduate Nursing Curricula: Using the QSEN Framework as a Guide
Authors: Spencer Julie A.
Published: October 2012

Informatics education must prepare today’s nurses to manage a deluge of information and use technology effectively. In addition, U.S. health care is being redesigned with technology that improves patient safety and quality of care. The Institute of Medicine’s recommendations for health care safety and professional education prompted initiatives by the National League for Nursing, the American Association of Colleges of Nursing, and others to make informatics a fundamental part of nursing education. The Quality and Safety Education for Nurses (QSEN) project outlines specific competency goals for informatics knowledge, skills, and attitudes. However, progress toward integration of informatics in nursing curricula has been slow, and additional strategies need further exploration and discussion in the nursing literature. This article uses the QSEN framework to present strategies for teaching multiple facets of informatics in the classroom, simulation laboratory, and clinical settings in a baccalaureate nursing curriculum.
Creating Innovative Models of Clinical Nursing Education
Authors: Niederhauser Victoria , Schoessler Mary , Gubrud-Howe Paula Marie , Magnussen Lois , Codier Estelle
Published: October 2012

Although nursing care has changed significantly over the past 30 years, methods to clinically train nursing students have not. The traditional model of clinical nursing education, where a faculty member oversees a group of six to eight students on an acute care unit for a 4- to 8-hour shift, provides a haphazard approach to learning. A need exists to find innovative ways to effectively train more nursing students to better prepare them for today’s health care environment. Using a change framework, seven approaches to clinical nursing education were created through academic–practice partnerships. These approaches may increase the effectiveness and efficiency of the clinical nursing education system.
Comparison of the Ratio of Keratometric Change to Refractive Change Induced by Myopic Ablation
Authors: Moshirfar Majid , Christiansen Steven M. , Kim Gene
Published: October 2012

PURPOSE:

To compare the ratio of keratometric change (ΔK) to refractive change (ΔSE) induced by refractive laser ablation.

METHODS:

The charts of 3337 eyes that underwent LASIK or photorefractive keratectomy (PRK) from 2002 to 2011 were retrospectively reviewed, and the ratio ΔK/ΔSE measured at 3 months postoperatively was compared between eyes with low ΔSE (0.00 to 2.99 diopters [D]), moderate ΔSE (3.00 to 5.99 D), and high ΔSE (6.00 to 8.99 D). Eyes were further stratified by LASIK vs PRK; custom vs conventional treatments; microkeratome vs IntraLase (Abbott Medical Optics Inc) femtosecond laser–created flaps; and flat (38.00 to 41.99 D) vs moderate (42.00 to 45.99 D) vs steep (46.00 to 49.99 D) preoperative keratometry, and the ratio ΔK/ΔSE was similarly compared.

RESULTS:

Significant differences were found in the ratio ΔK/ΔSE among eyes with low ΔSE (1.00±0.50 D), moderate ΔSE (0.83±0.19 D), and steep ΔSE (0.80±0.15 D) (
P
<.001), and between eyes with moderate and high ΔSE in LASIK vs PRK, custom vs conventional treatments, and microkeratome vs IntraLase flaps. Significant differences in the ratio ΔK/ΔSE were also found in eyes with low, moderate, and high ΔSE regardless of preoperative keratometry. The ratio ΔK/ΔSE compared with ΔSE follows a nonlinear pattern and tended to be higher and more variable at lower amounts of correction.

CONCLUSIONS:

The change in simulated keratometry required to achieve 1.00 D of myopic refractive correction decreased as the amount of refractive change increased, was more variable with lower amounts of correction, and followed a nonlinear relationship. Many variables, such as LASIK vs PRK, custom vs conventional, and microkeratome vs IntraLase flaps, affected the ratio of ΔK/ΔSE for moderate and high myopic corrections.
Flap-off Epi-LASIK Versus Automated Epithelial Brush in PRK: A Prospective Comparison Study of Pain and Reepithelialization Times
Authors: Magone M. Teresa , Engle Andrew T. , Easter Thu-Ha , Stanley Philip F. , Howells James , Pasternak Joseph F.
Published: October 2012

PURPOSE:

To compare the effect of flap-off epi-LASIK versus automated brush epithelial removal on pain and wound healing in low myopic photorefractive keratectomy (PRK).

METHODS:

In this prospective intraindividual study 60 patients received surface ablation in each eye. Epithelial removal was performed by an automated brush technique in one eye (brush group) and epi-LASIK with flap removal (flap-off group) in the fellow eye. The epithelial defect size was measured daily after surgery until both eyes were reepithelialized. Postoperative pain on a scale from 0 to 6 and topical and oral analgesic medication use was recorded until the bandage contact lens was removed.

RESULTS:

The flap-off group had significantly less postoperative pain on days 1 (
P
=.0003), 2 (
P
=.0001), 3 (
P
<.0001), and 4 (
P
<.0001) compared to the brush group. However, the average difference in pain scores between groups was only 0.33 points out of 6. No difference was noted in the normalized overall percentage rate of healing over the first 4 days in the flap-off group (5.41±1.39%/hour) compared to the brush group (5.42±1.94%/hour) (
P
=.97).

CONCLUSIONS:

The flap-off group showed a statistically but not clinically significant advantage over the brush group in pain scores. However, no difference was noted in the percentage rate of epithelial healing time between the two groups.
Rotational Stability and Visual Quality in Eyes With Rayner Toric Intraocular Lens Implantation
Authors: Alberdi Txomin , Macías-Murelaga Beatriz , Bascarán Lucía , Goñi Nahia , de Arregui Sandra Sáez , Mendicute Javier
Published: October 2012

PURPOSE:

To assess astigmatic reduction and rotational stability of Rayner T-flex toric intraocular lenses (IOL) (573T and 623T; Rayner Intraocular Lenses Ltd) in a series of cataract surgery patients with corneal astigmatism >1.50 diopters (D).

METHODS:

This prospective, observational study included 27 eyes from 22 consecutive patients with pre-operative regular corneal astigmatism ⩾1.50 D in which Rayner T-flex toric IOL implantation was performed after phacoemulsification. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), residual refractive sphere, residual keratometric and refractive cylinder, and deviation from attempted toric IOL axis were measured.

RESULTS:

Mean UDVA 3 months after surgery was 0.1042±0.1290 with 20/40 or better in 96% of eyes and 20/25 or better in 52% of eyes. Mean refractive postoperative sphere was 0.25±0.37 D and mean refractive postoperative cylinder was 0.52±0.63 D. Vector analysis of attempted versus achieved visual correction showed that 100% of eyes were within ⩾1.00 D and 87% of eyes were within ⩾0.50 D. Mean change in keratometric astigmatism was 0.54±1.33 for J
0
and −0.24±1.17 for J
45
(
P
>.05). Twenty-five (92.6%) eyes had IOL rotation <10°.

CONCLUSIONS:

Rayner T-flex toric IOL implantation is an effective and reliable option to correct preexisting astigmatism in cataract surgery.
Intrastromal Corneal Ring Segment SK for Moderate to Severe Keratoconus: A Case Series
Authors: Fahd Daoud C. , Jabbur Nada S. , Awwad Shady T.
Published: October 2012

PURPOSE:

To report clinical results and safety profiles of symmetrical intrastromal corneal ring segment (ICRS; Intacs SK, Addition Technology Inc) implantation in eyes with moderate to severe keratoconus.

METHODS:

Interventional case series of 24 eyes from 22 patients implanted with Intacs SK using the femtosecond laser. Evaluation included uncorrected (UDVA) and corrected distance visual acuity (CDVA), manifest refraction, and Placido-based Scheimpflug imaging. Postoperative follow-up was 1 day, 1 week, and 1, 3, and 6 months.

RESULTS:

Mean patient age was 28±7 years (range: 16 to 41 years). All eyes had keratoconus. Twenty-one of 24 eyes had 2, 450-μm symmetrical segments inserted. Mean UDVA and CDVA were significantly better at 1, 3, and 6 months postoperatively (UDVA: 20/340 preoperatively vs 20/70 at 6 months [
P
<.001]; CDVA: 20/70 preoperatively vs 20/40 at 6 months [
P
<.001]; UDVA analysis of variance [ANOVA]: F=6.46,
P
=.0057; CDVA ANOVA: F=5.24,
P
=.0138). Pre- and 6-months postoperative clinical results were: mean spherical equivalent refractive error −9.60±4.86 diopters (D) and −3.05±2.05 D (
P
<.001), respectively; mean refractive cylinder, −3.20±1.50 D and −1.55±1.10 D, respectively (
P
<.001); and mean average total corneal power 52.03±4.49 D and 46.95±4.61 D, respectively (
P
<.001). No complications occurred, and no patients were lost to follow-up. Eyes with steeper preoperative corneal keratometry readings had the greatest flattening in corneal curvature and thus the greatest decrease in myopic refraction (r=−0.4,
P
<.001). No correlation was found between preoperative thinnest corneal pachymetry and postoperative curvature flattening.

CONCLUSIONS:

Implantation of Intacs SK for moderate to severe keratoconus is safe and effective, leading to significant decrease in myopia and appreciable decrease in astigmatism with improvement in CDVA.
Intraocular Lens Power Calculations for Cataract Surgery After Phototherapeutic Keratectomy in Granular Corneal Dystrophy Type 2
Authors: Jung Se Hwan , Han Kyung Eun , Sgrignoli Bradford , Kim Tae-im , Lee Hyung Keun , Kim Eung Kweon
Published: October 2012

PURPOSE:

To investigate the predictability of various intraocular lens (IOL) power calculation methods in granular corneal dystrophy type 2 (GCD2) with prior phototherapeutic keratectomy (PTK) and to suggest the more predictable IOL power calculation method.

METHODS:

Medical records of 20 eyes from 16 patients with GCD2, all having undergone cataract surgery after PTK, were retrospectively evaluated. Postoperative cataract refractive errors were compared with target diopters (D) using IOL power calculation methods as follows: 1) myopic and 2) hyperopic Haigis-L formula in IOLMaster (Carl Zeiss Meditec); 3) SRK/T formula using 4.5-mm zone Holladay equivalent keratometry readings (EKRs) (single-K Holladay EKRs method); 4) central keratometry power of true net power map in the Pentacam system (Oculus Optikgeräte GmbH); and 5) clinical history, Aramberri double-K, and double-K Holladay EKRs methods. Topographic status of corneal curvature after PTK was evaluated.

RESULTS:

Fourteen (70%) of 20 eyes showed central island formation after PTK. When central island was present, the mean absolute error (MAE) using the hyperopic Haigis-L formula was 0.25±0.15 D. When central island was not present, the myopic Haigis-L formula showed MAE of 0.33±0.16 D. When central island formation and IOLMaster keratometry underestimation were present, the hyperopic Haigis-L formula showed the least MAE of 0.26±0.08 D when switching the IOL-Master keratometry values equal to 4.5-mm zone Holladay EKRs.

CONCLUSIONS:

In planning for cataract surgery after PTK in GCD2, topographic analysis for central island formation is necessary. With or without central island formation, the hyperopic or myopic Haigis-L formula can be applied. When IOLMaster keratometry shows underestimation, the Haigis-L formula using 4.5-mm zone Holladay EKRs can be considered.
A Systematic Comparison of Free and Bound Antibodies Reveals Binding-Related Conformational Changes
Authors: Sela-Culang Inbal , Alon Shahar , Ofran Yanay
Published: October 2012

To study structural changes that occur in Abs upon Ag binding, we systematically compared free and bound structures of all 141 crystal structures of the 49 Abs that were solved in these two forms. We found that many structural changes occur far from the Ag binding site. Some of them may constitute a mechanism for the recently suggested allosteric effects in Abs. Within the binding site itself, CDR-H3 is the only element that shows significant binding-related conformational changes; however, this occurs in only one third of the Abs. Beyond the binding site, Ag binding is associated with changes in the relative orientation of the H and L chains in both the variable and constant domains. An even larger change occurs in the elbow angle between the variable and the constant domains, and it is significantly larger for binding of big Ags than for binding of small ones. The most consistent and substantial conformational changes occur in a loop in the H chain constant domain. This loop is implicated in the interaction between the H and L chains, is often intrinsically disordered, and is involved in complement binding. Hence, we suggest that it may have a role in Ab function. These findings provide structural insight into the recently proposed allosteric effects in Abs.
Semen Promotes the Differentiation of Tolerogenic Dendritic Cells
Authors: Remes Lenicov Federico , Rodriguez Rodrigues Christian , Sabatté Juan , Cabrini Mercedes , Jancic Carolina , Ostrowski Matías , Merlotti Antonela , Gonzalez Heidi , Alonso Andrea , Pasqualini Rodolfo A. , Davio Carlos , Geffner Jorge , Ceballos Ana
Published: October 2012

Seminal plasma is not just a carrier for spermatozoa. It contains high concentrations of cytokines, chemokines, and other biological compounds that are able to exert potent effects on the immune system of the receptive partner. Previous studies have shown that semen induces an acute inflammatory response at the female genital mucosa after coitus. Moreover, it induces regulatory mechanisms that allow the fetus (a semiallograft) to grow and develop in the uterus. The mechanisms underlying these regulatory mechanisms, however, are poorly understood. In this study, we show that seminal plasma redirects the differentiation of human dendritic cells (DCs) toward a regulatory profile. DCs differentiated from human monocytes in the presence of high dilutions of seminal plasma did not express CD1a but showed high levels of CD14. They were unable to develop a fully mature phenotype in response to LPS, TNF-α, CD40L, Pam2CSK4 (TLR2/6 agonist), or Pam3CSK4 (TLR1/2 agonist). Upon activation, they produced low amounts of the inflammatory cytokines IL-12p70, IL-1β, TNF-α, and IL-6, but expressed a high ability to produce IL-10 and TGF-β. Inhibition of the PG receptors E-prostanoid receptors 2 and 4 prevented the tolerogenic effect induced by seminal plasma on the phenotype and function of DCs, suggesting that E-series PGs play a major role. By promoting a tolerogenic profile in DCs, seminal plasma might favor fertility, but might also compromise the capacity of the receptive partner to mount an effective immune response against sexually transmitted pathogens.
Anti-HIV B Cell Lines as Candidate Vaccine Biosensors
Authors: Ota Takayuki , Doyle-Cooper Colleen , Cooper Anthony B. , Huber Michael , Falkowska Emilia , Doores Katherine J. , Hangartner Lars , Le Khoa , Sok Devin , Jardine Joseph , Lifson Jeffrey , Wu Xueling , Mascola John R. , Poignard Pascal , Binley James M. , Chakrabarti Bimal K. , Schief William R. , Wyatt Richard T. , Burton Dennis R. , Nemazee David
Published: October 2012

Challenge studies following passive immunization with neutralizing Abs suggest that an HIV vaccine could be efficacious were it able to elicit broadly neutralizing Abs (bNAbs). To better understand the requirements for activation of B cells producing bNAbs, we generated cell lines expressing bNAbs or their germline-reverted versions (gl-bNAbs) as BCRs. We then tested the abilities of the bNAb-expressing cells to recognize HIV pseudovirions and vaccine candidate proteins by binding and activation assays. The results suggest that HIV envelope (Env) Ag-expressing, infection-competent virions are poorly recognized by high-affinity bNAb-expressing cells, as measured by the inability of Ags to induce rapid increases in intracellular calcium levels. Other Ag forms appear to be highly stimulatory, in particular, soluble gp140 trimers and a multimerized, scaffolded epitope protein. Virions failed to efficiently activate bNAb-expressing B cells owing to delayed or inefficient BCR recognition, most likely caused by the low density of Env spikes. Importantly, B cells carrying gl-bNAb BCRs were not stimulated by any of the tested vaccine candidates. These data provide insight into why many HIV immunogens, as well as natural HIV infections, fail to rapidly stimulate bNAb responses and suggest that bNAb-expressing cell lines might be useful tools in evaluation of vaccine Ags for infectious diseases. Because soluble Env trimers or multimerized scaffolded epitopes are best at activating B cell-expressing bNAbs, these antigenic forms should be considered as preferred vaccine components, although they should be modified to better target naive gl-bNAb B cells.
Pseudotumoral Autoimmune Pancreatitis Mimicking a Pancreatic Cancer: A Very Difficult Disease to Diagnose
Authors: Ben Abid Sadreddine , Hefaiedh Rania , Zghab Sameh , Miloudi Nizar , Gharbi Lassad , Khalfallah Mohamed Taher
Published: October 2012

Autoimmune pancreatitis (AIP) is a rare disorder, although the exact prevalence is still unkown. It is a type of pancreatitis that is presumed to have an autoimmune aetiology, and is currently diagnosed based on a combination of 5 criteria. However, in this day and age, some patients with AIP are likely to be resected for the suspicion of malignancy. The authors report a case of pseudotumoral autoimmune pancreatitis, reviewing some literature about it and underlining the difficulty in the diagnosis. A 56-year-old patient was referred to our unit for upper abdominal pain. In his past medical history we note mellitus diabetes. The clinical examination was unremarkable. Laboratory data showed no abnormal values. Upper endoscopy showed antral gastritis. Transabdominal ultrasonography showed a hepatic steatosis and 5 angiomas. No computed tomography scan was made. Magnetic resonance imaging (MRI) showed 5 angiomas and a lesion of 20x20 mm of the pancreatic tail with decreased signal intensity on T1-weighted MR images, increased signal intensity on T2-weighted MR images. Due to concerns of pancreatic malignancy, the patient underwent open distal spleno-pancreatectomy. Histolo gical analysis of the resected specimen revealed no malignancy. Postoperatively, immunoglobulin G fraction 4 was slightly above of the upper limit of the normal range. After corticotherapy the patient is getting better. This case underlines the difficulties still encountered in the diagnosis of AIP. It has been frequently misdiagnosed as pancreatic cancer and caused unnecessary resection. In order to avoid unnecessary resections for an otherwise benign and easily treatable condition, it is urgent to refine diagnostic criteria and to reach an international consensus.
Perceptions of pregnant teenagers with regard to the antenatal care clinic environment
Authors: James Sindiwe , Rall Nadine , Strümpher Juanita
Published: October 2012

Pregnancy in teenagers seems to be a challenge that might contribute to a struggle to fulfil the objectives of the Millennium Development Goals directly related to women’s reproductive health and neonatal care. The challenge becomes worse as midwives and nurses find it difficult to fully supervise all these pregnancies, because teenagers stay away or default from clinic attendance. The purpose of the study was to explore and describe the perceptions of pregnant teenagers of the antenatal care (ANC) clinic environment and to recommend guidelines to midwifery operational managers for strategies to create teenager-friendly ANC clinic environments. The study applied a qualitative research design with explorative, descriptive and contextual research approaches. The ethical principles that guided this study were respect for the person, beneficence and justice. Semi-structured interviews utilising a predetermined interview schedule with a central open-ended question to address the study objectives were used. Data were collected from pregnant teenagers attending ANC clinics in Nelson Mandela Metropolitan Municipality. Participants were unanimous in that they perceived the clinic environment as causing discomfort to them. Different reasons attributed to this experience were related to their young age. The age difference between themselves and other women attending the clinic made participants perceive themselves as inferior and as being treated as such at the clinic. They found this embarrassing and recommended having their own waiting area and additional midwives at the clinic so that they would not be subjected to humiliating scrutiny and disapproval from older pregnant women. Pregnant teenagers’ recall of their experiences of the ANC clinic environment suggests that they perceive themselves as not being adequately cared for, as judged, and as forced to be in an environment that is insensitive to their needs. As a result some of their peers stayed away from the clinic and at times they contemplated the same action. A well-managed ANC clinic environment which has midwives who are empowered with the necessary skills in terms of dealing with the needs of youth has been requested by the pregnant teenagers.