bluuebunny/crossref_metadata_2025 huggingface dataset:
Context-sensitive evaluation: Determining the context surrounding the implementation of a government policy
Authors: Alderman Lyn
Published: January 2018

This article explains the essence of the context-sensitive parameters and dimensions in play at the time of an intervention, through the application of Rog's (2012) model of contextual parameters. Rog's model offers evaluators a structured approach to examine an intervention. The initial study provided a systematic way to clarify the scope, variables, timing, and appropriate evaluation methodology to evaluate the implementation of a government policy. Given that the government implementation of an educational intervention under study did not follow the experimental research approach, nor the double cycle of action research approach, the application of Rog's model provided an in-depth understanding of the context-sensitive environment; it is from this clear purpose that the broader evaluation was conducted. Overall, when governments or institutions implement policy to invoke educational change (and this intervention is not guided by an appropriate evaluation approach), then program evaluation is achievable post-implementation. In this situation, Rog's (2012) model of contextual parameters is a useful way to achieve clarity of purpose to guide the program evaluation.
Reflexive monitoring in New Zealand: Evaluation lessons in supporting transformative change
Authors: Rijswijk Kelly , Bewsell Denise , Small Bruce , Blackett Paula
Published: January 2018

An Agricultural Innovation System (AIS) approach is currently being used to determine whether the adoption of agricultural innovations in New Zealand can be enhanced. Important elements of the innovation systems approach include the participatory application of a co-innovation process, for example inclusiveness and a focus on transformative change, to remove barriers in the creation and uptake of sustainable innovations. Alongside AIS, novel evaluation approaches are being used, namely reflexive monitoring. Thus, the role of a reflexive monitor has been trialled to help understand and guide the co-innovation process. A reflexive monitor helps innovation networks challenge and change assumptions, practices, and underlying institutions in the design or management of a project, through an on-going process of evaluation in an action research setting. In this article, experiences of reflexive monitoring conducted within a research programme in New Zealand are shared. Information was gathered from workshops, meetings and interviews with reflexive monitors. Insights include the need to understand that there is no recipe for the role of a reflexive monitor, that is the role is context-dependent. However, focussing on developing solutions to a problem and taking a flexible, adaptive approach are essential elements in ensuring that monitoring and evaluation are effective.
Project evaluation in higher education: A study of contextual issues
Authors: Huber Elaine , Harvey Marina
Published: January 2018

This paper reports on the second phase of a wider study on evaluation of locally funded learning and teaching projects in higher education. A review of the extant literature in this area shows that there is little evidence of the extent to which the alignment between theory and practice, or praxis, of such evaluation is achieved. The first phase established that the project leader's perception and conceptualisation of evaluation can inhibit achieving praxis. Consequently, the aim of the second phase was to investigate in detail the contextual factors impacting on project evaluation. Three case examples of internally funded learning and teaching projects provide the data for analysis using an explanatory approach. The projects share a focus on curriculum design in arts and humanities disciplines at an Australian university.

A case study approach enabled the in-depth investigation of this contemporary phenomenon, within its real-life context. Data collection included interviews with each project manager and with the project lead; this was triangulated with the data of grant applications, final reports and meeting minutes. A thematic approach to coding the research data was adopted. One key finding indicates a disjunct of how evaluation is conceptualised between the project lead and the project manager. In addition, factors that influence the praxis of evaluation were also identified including timeframe; previous experience of leading a project; and the requirement (or lack thereof) from the projects’ grant funding body. Informed by the research findings, four strategies to enhance the adoption of systematic evaluation in small learning and teaching projects are presented; these strategies offer the potential to reach across disciplinary and sector boundaries in their application.
Bridging the Gap Both-Ways: Enhancing Evaluation Quality and Utilisation in a Study of Remote Community Safety and Wellbeing with Indigenous Australians
Authors: Grey Kim , Putt Judy , Baxter Nathalie , Sutton Sue
Published: January 2018

This paper demonstrates how the voices of people affected by a policy can contribute to evaluation quality and utilisation. In this participatory mixed-methods approach, Indigenous Australians in remote parts of the Northern Territory of Australia were involved in evaluation of an intervention that significantly affected their daily lives. The evaluation was inspired by the ideas and values demonstrated in a both-ways learning model. This mixed-methods approach combines a people-centered participatory methodology with a more standardised policy-focused application of survey methods to contribute to policy development and local planning.

The aim of the study was to hear from local people in communities and encourage them to share their views about changes in community safety. It provided a voice for Indigenous Australians affected by the Northern Territory Emergency Response (NTER), which sought to protect children in 73 Indigenous communities across the Northern Territory. The aim of the NTER was to create safer communities and to improve health, nutrition, educational outcomes, service delivery and engagement with Indigenous people. Regardless of views about the NTER, a clear gap in the evidence base for evaluation was to understand if people felt safer after the intervention. Increased police, safe houses, night patrols, health services, family support services and management of income support payments were introduced, but what did Indigenous people living in remote communities think? What was their experience and what will happen to the information they may choose to share?

Adopting a mixed-methods approach that included a large-scale survey and qualitative research conducted with local Indigenous residents of remote communities strengthened evaluative findings, particularly for policy makers and community residents. A participatory research cycle was used to engage local people and return results in an ethical feedback process that aimed to build capacity on the ground and link into future planning. We sought to promote the role of evaluation in remote Northern Territory communities as a worthwhile way for local people to share their voice, stories and experiences with the policy makers whose decisions can so significantly affect their lives.
Challenges in Evaluating Aboriginal Healing Programs: Definitions, Diversity and Data
Authors: Blignault Ilse , Williams Megan
Published: January 2018

Indigenous people around the world have long healing traditions. Contemporary Aboriginal and Torres Strait Islander healing projects are designed to empower individuals, families and communities; strengthen connections to culture; and reduce the damaging effects of colonisation and government policies such as the forcible removal of children (the Stolen Generations). Evidence on the conditions necessary for healing to occur, and how healing works for different people and in different contexts, is limited. Evaluations that will help identify good practice and document the full range of outcomes are sorely needed.

This paper is based largely on experiences and learnings from Stolen Generations projects around Australia funded by the Aboriginal and Torres Strait Islander Healing Foundation, and the reflections of experienced scholar-practitioners. It argues that evaluations that are responsive to, and ultimately owned and led by, Aboriginal and Torres Strait Islander communities need to be designed and implemented differently to mainstream evaluations. Timeframes, methods, relationships between evaluators and stakeholders, and the identification and measurement of outcomes all need to be carefully considered. Challenges include definitions of healing, diversity of landscapes and programs, and data collection. Qualitative methods that preference and support Indigenous cultural frameworks and ways of creating and sharing knowledge work well. In addition to ensuring culturally sensitive methodologies and tools, working ethically and effectively in the Indigenous healing space means emphasising and enabling safety for participants, workers and organisations.
Interactive Logic Models: Using Design and Technology to Explore the Effects of Dynamic Situations on Program Logic
Authors: Snow M. Elizabeth , Snow Nancy
Published: January 2018

Logic models are commonly used by evaluators to illustrate relationships among a program's inputs, activities, outputs, and outcomes. They are useful in helping intended users develop programs, communicate a program's theory of change, and design evaluations. However, as static documents, logic models can be challenging to build, work with, and present to stakeholders, especially for large and complex programs. Challenged by this inadequacy of static logic models, a program evaluator turned to a graphic designer and a software developer for help. Together, this interdisciplinary group developed web-based software (Dylomo) that allows evaluators to create logic models that better communicate the logic within the model. In this paper, we describe the process by which this interdisciplinary group created this new technology—including a user-testing experience at the Canadian Evaluation Society Conference in Canada in June 2016—to build and present logic models that use interactivity and allow program evaluators to more easily demonstrate the logic within a complex program and to visually explore the potential effects of changes within the program's landscape. This software is freely available on the web, so readers can apply it to their own evaluation practice.
Evaluating Women's Empowerment: Experimenting with a Creative Participatory Self-evaluation Methodology in Papua New Guinea
Authors: Waffi Joy Marie
Published: January 2018

This article introduces a participatory evaluation methodology that can be used with very low literacy groups of women to capture change experienced in their voice, participation, and decision-making abilities at the household and community levels. Central to this methodology is the process utilised to enable a personal determination of the level of change that has taken place according to individual baselines and circumstances, and using this information to present a more accurate picture of how much change has occurred for some women versus others and use percentage break-ups to show the different change-level-groups of women in a community. Whereas one can easily make the mistake of generalising change levels for all the women based on the responses of a few outspoken ones, this evaluation methodology captures the richness and diversity that exists even among a small group of women. Utilising such an evaluation approach makes one recognise the complexities that come with measuring change in women's voice, participation and decision-making in very low literacy settings.

Developed in haste and used for an internal CARE International end-of-project evaluation in early 2014, the author shares her original experience of utilising this new self-developed participatory evaluation methodology. The article is sequenced so that the reader is presented with the circumstances out of which this evaluation methodology was developed, the benefits discovered from utilising it, shortfalls of the original methodology, and improvements that will be made to further develop and strengthen the methodology.
Social Structure of Regional Entrepreneurship: The Impacts of Collective Action of Incumbents on De Novo Entrants
Authors: Wang Liang , Tan Justin
Published: January 2018

The literature has posited that agglomeration economies and the formation of social relationships resulting from the geographic concentration of incumbents constitute the forces that “pull” new entrants into industry clusters. However, this proposition overlooks how the collective action of incumbents in pursuit of their own benefits affects new entrants. This study examines how business associations as collective action organizations established by incumbents to promote and safeguard group-wide interests contribute to de novo entrants. The empirical evidence from Canada’s telecommunication equipment manufacturing industry between 1995 and 2005 reveals that the prevalence of local business associations encourages de novo entrants. However, the impact is curvilinear such that excessive collective action on the part of local fellow incumbents can create a clubby environment and “push” new entrants away.
A Lack of Systemic Absorption Following the Repeated Application of Topical Quetiapine in Healthy Adults
Authors: Kayhart Bryce , Lapid Maria I. , Nelson Sarah , Cunningham Julie L. , Thompson Virginia H. , Leung Jonathan G.
Published: January 2018

In the absence of suitable oral or intravenous access for medication administration and when the intramuscular medications are undesirable, alternative routes for drug delivery may be considered. Antipsychotics administered via an inhaled, intranasal, rectal, or topical route have been described in the literature. Topically administered antipsychotics have been previously reported to produce negligible systemic absorption despite being used in clinical practice for nausea and behavioral symptoms associated with dementia. Additionally, the American Academy of Hospice and Palliative Medicine recommends against the use of topical medications that lack supporting literature. Three studies have assessed the systemic absorption of different antipsychotics after administration of only a single, topically applied dose. To evaluate whether the repeated administration of a topically applied antipsychotic may result in detectable serum levels in an accumulating fashion, a pharmacokinetic study was conducted. Five healthy, adult participants consented to receive extemporaneously prepared topical quetiapine in Lipoderm every 4 hours for a total of 5 doses. Blood samples were drawn at baseline and hours 2, 4, 8, 12, 16, and 24, and serum quetiapine concentrations were measured using high-performance liquid chromatography. Quetiapine was undetectable in every sample from 3 participants. Two participants had minimally detectable serum quetiapine levels no sooner than hour 12 of the study period. Extemporaneously prepared quetiapine in Lipoderm resulted in nonexistent or minimal serum level following repeated topical administration. The use of topically applied quetiapine should still be questioned.
Factors Associated With Adherence to Nasoalveolar Molding (NAM) by Caregivers of Infants Born With Cleft Lip and Palate
Authors: Esmonde Nick O. , Garfinkle Judah S. , Chen Yiyi , Lambert William E. , Kuang Anna A.
Published: January 2018

Objective:

Identify factors associated with adherence to nasoalveolar molding (NAM) therapy.

Design:

Retrospective case-control study.

Setting:

Tertiary referral center.

Patients, Participants:

Infants with cleft lip, with or without cleft palate, referred for NAM. One hundred thirty-five patients met criteria.

Main Outcome Measure(s):

Adherence to NAM therapy, defined as continuous use of the appliance and attendance of NAM adjustment visits.

Results:

Female sex (OR = 2.85, 95% CI 1.21-6.74), bilateral cleft (OR = 2.88, 95% CI 1.29-6.46), and travel distance (OR = 1.01, 95% CI 1.00-1.01) were independent predictors of nonadherence. Bilateral clefts (OR = 8.35, 95% CI 2.72-25.64) and public-payer insurance (OR = 3.67, 95% CI 1.13-11.91) for male patients were significantly associated with nonadherence, in our sex-stratified multivariate model. The majority of the families (58%) had public health insurance. Males comprised 77.0% of the cohort.

Conclusions:

NAM treatment adherence is impaired by bilateral clefts, female sex, increased travel distance, and public insurance. Further studies are warranted to investigate how these factors affect adherence, and to develop interventions to improve adherence in families at risk due to economic or psychosocial barriers.
Respiratory Polysomnographic Findings in Patients Treated Primarily for Unilateral Cleft Lip and Palate
Authors: Sobral Davi Sandes , Faller Gustavo Juliane , Collares Marcus Vinícius Martins
Published: January 2018

Cleft lip and palate (CLP) is the most common congenital craniofacial abnormality. Obstructive sleep apnea syndrome (OSAS) is a highly prevalent but underdiagnosed disease and is frequently associated with craniofacial anomalies. There are few studies describing the sleep breathing pattern of children with CLP. This study sought to characterize the respiratory profile of 23 children with unilateral cleft lip and palate, aged 7-12 years, who had undergone cleft lip and nasal repair at age 3-4 months and palatoplasty at 12-15 months, with a particular focus on evaluating the presence of OSAS in children with CLP. Polysomnography was performed and findings were analyzed descriptively. We found a mean and median for apnea/hypopnea index (AHI) of 1.11/h (SD = 0.78) and 0.9/h, respectively. The mean obstructive apnea index (OAI) was 0.27/h (SD = 0.38) and the median, 0.1/h. Nearly 30% of patients had an AHI above 1.4 events/h. There was no significant oxyhemoglobin desaturation in the study group. In this group, the prevalence of OSAS was higher than in noncleft populations when compared to the normality values adopted. This sample of patients with unilateral cleft lip and palate exhibited an increased prevalence of OSAS during the mixed dentition stage. Although the results showed that OSAS was mild, we advise closer observation of these patients. Polysomnography is recommended for the assessment of children with airway abnormalities, to individualize the extent of treatment.
Female and Male Differences in Academic Achievement in Individuals With Cleft
Authors: Persson Martin , Becker Magnus , Conrad Amy L. , Svensson Henry
Published: January 2018

Objective:

The focus of this study was to determine if there is any significant difference in academic achievement for girls and boys with a cleft compared to the general population of Swedish students at graduation from compulsory school.

Design:

A retrospective population-based study using data obtained from the Swedish Medical Birth Register that was linked to the Swedish School–Grade Register.

Participants:

Two hundred seventy girls and 241 boys with cleft palate (CP), 222 girls and 429 boys with cleft lip (CL), and 299 girls and 531 boys with cleft lip and palate (CLP) were compared with the compulsory school population comprising 609,397 girls and 640,007 boys.

Main Outcome Measures:

(1) Odds of receiving the lowest grade and reduced odds in receiving high grades in Mathematics, English, and Swedish. (2) grade point average (GPA).

Results:

In all 3 subject grades, for boys with cleft there was no difference when compared to the male population. Girls with cleft were similar to their peers with a few exceptions. Girls with CLP had lower Math grades, and girls with CP had lower Math, English, and Swedish grades. Girls with CP and CLP achieved a significantly lower GPA in comparison to the female population and boys with CP and CL achieved lower GPAs in comparison to the male population.

Conclusions:

This study indicates that educational outcomes for girls with cleft are more negatively affected than for boys with cleft.
Does Unilateral Cleft Lip and Palate Affect the Maxillary Sinus Volume?
Authors: Demirtas Omer , Kalabalik Fahrettin , Dane Asim , Aktan Ali Murat , Ciftci Ertugrul , Tarim Elif
Published: January 2018

Objective:

The purposes of this study were to evaluate and compare the maxillary sinus volume (MSV) of patients with a unilateral cleft lip and palate (UCLP) between the cleft side and noncleft side and between adolescent patients with UCLP and a control (noncleft) group using cone beam computed tomography (CBCT).

Methods:

CBCT images of 44 UCLP patients (29 males and 15 females, with a mean [SD] age of 13.5 [5.0] years) and 44 (22 males and 22 females, with a mean [SD] age 14.9 [4.2] years) age- and sex-matched controls were evaluated in this study. Each maxillary sinus was assessed 3-dimensionally, segmented, and its volume was calculated.

Results:

There were no statistically significant differences between the age and gender distributions of the groups. There was a statistically significant difference in the MSVs of the cleft (10996.78±3522.89 mm3) versus the noncleft side (10382.3±3416.2 mm3; P < .05)] but no significant difference between the MSVs of the right and left sides ( P > .05). In the intergroup comparison, the mean MSVs of the UCLP patients (10701.52±3369.33 mm3) were significantly smaller than those of the control group (16054.08 ± 5293.96 mm3; P < .001).

Conclusions:

The MSVs of the UCLP patients showed a statistically significant decrease compared to those of the controls ( P < .001). There was also a significant difference in the MSVs of the cleft and noncleft sides of the UCLP patients ( P < .05).
Otologic Disease Following Palatoplasty In International Cleft Palate Cohort
Authors: Markey Jeff , Maine Rebecca , Daniels Kimberly , Yu Emily Yang , Gregory George , Hoffman William , Palacios Jorge
Published: January 2018

Objective:

Study the prevalence of otologic disease in a pediatric post-palatoplasty population with no prior ear tube placement in resource-deprived countries and assess patient characteristics associated with these abnormal results.

Design:

Retrospective data review.

Participants:

Ecuadorian and Chinese children identified during humanitarian cleft lip and palate repair trips with cleft palates undergoing palatoplasty from 2007 to 2010.

Interventions:

Tympanometry and otoacoustic emission (OAE) testing performed following palatoplasty. Patients’ parents administered surveys regarding perceived hearing deficits.

Main Outcome Measures:

Age, gender, Veau classification, follow-up time, laterality, and country of origin were evaluated for possible association with type B tympanogram, “Refer” Otoacoustic results, and presence of hearing difficulty as identified by a parent. Significant predictors were further evaluated with multivariate analysis.

Results:

The cohorts included 237 patients (129 Ecuadorian, 108 Chinese); mean age: 3.9 years; mean follow-up: 4.2 years. Thirty-nine percent scored type B, 38% failed OAE testing, and 8% of parents noted hearing deficits. The country of origin and a younger age were identified as predictive variables regarding type B tympanogram. Follow-up time, country of origin, and bilateral OAE “Refer” results all significantly predicted parental questionnaire results. Subsequent multivariable analysis further demonstrated effect modification between the 2 variables of age at palatoplasty and country of origin when predicting type B vs type A tympanometry.

Conclusion:

Without otologic intervention, cleft palate children in resource-deprived settings suffer type B tympanometry and failed OAE results with similar to increased incidences to other studied cleft palate populations with otologic interventions available.
Custom-Made Palatal Shield Use in Cleft Palate and Fistula Repair
Authors: Tan Anouk , Heijdenrijk Kees , Moues Chantal M.
Published: January 2018

Objective:

To review our experience with a polymethylmethacrylate (PMMA) protective shield used as an adjunct to protect the newly restored palate in wide bilateral cleft and complex fistula closure without diet restrictions.

Design:

Clinical cohort study.

Setting:

Division of Plastic Surgery and Maxillary Surgery.

Patients:

A selection of 22 cleft palate children undergoing (tertiary) palatal fistula repair (n = 16) or closure of a complex wide primary palatal defect (n = 6).

Interventions:

One month prior to surgery, a plaster model of the palate was made adding a 5- to 8-mm-thick layer of dental putty to the level of the dental arch. On top of the putty, a 1.5-mm-thick PMMA shield was created to cover the postoperative elevated and restored palate.

Main outcome measures:

Fistula recurrence rate, postoperative complications, days of hospitalization.

Results:

All patients maintained durable and safe palatal closure without fistula recurrence within the follow-up period, varying from 1 until 4 years. Recovery was fast, with a mean duration of hospitalization of 1.5 days. All patients could directly resume their normal diet.

Conclusions:

A PMMA shield has been shown to be a safe and helpful adjunct in complex fistula repair and late anterior palate repair.
Strengths and Difficulties Questionnaire (SDQ)
Authors: Bjerke Susanna Memmen , Feragen Kristin Billaud , Bergvik Svein
Published: January 2018

Objective:

Informant discrepancies on psychological measures may affect the assessment, classification, and treatment of children’s mental health. Concordance between different informants has been shown to be low to moderately correlated. The present study examined the agreement between children with cleft lip and/or palate (CL/P) and their parents.

Design:

Cross-sectional data from 7 consecutive birth cohorts based on routine psychological assessments at age 10 with comparisons to national reference groups.

Setting:

Centralized and multidisciplinary treatment setting.

Participants:

323 children age 10, born with CL/P and their parents (participation rate: 89%).

Outcome measures:

Strengths and Difficulties Questionnaire (SDQ).

Results:

Children born with CL/P and their parents tend to follow similar patterns of disagreement on the SDQ as reported in the general population, with children reporting more symptoms than their parents, and boys having more problems than girls on most subscales. Child and parent reports were low to moderately correlated, and not affected by the child’s gender or the presence of conditions additional to the cleft.

Conclusions:

Differences between informants on the SDQ reflect different perspectives of the child’s adjustment, and both informants are important in the assessment of mental health. Children with CL/P and their parents do not significantly differ from children and parents in the general population on their agreement of the child’s psychological adjustment. As with the general population, clinical assessments should be based on a mixture of both informants’ reports.
Rating Nasolabial Aesthetics in Unilateral Cleft Lip and Palate Patients
Authors: Schwirtz Roderic M. F. , Mulder Frans J. , Mosmuller David G. M. , Tan Robin A. , Maal Thomas J. , Prahl Charlotte , de Vet Henrica C. W. , Don Griot J. Peter W.
Published: January 2018

Objective:

To determine if cropping facial images affects nasolabial aesthetics assessments in unilateral cleft lip patients and to evaluate the effect of facial attractiveness on nasolabial evaluation.

Design:

Two cleft surgeons and one cleft orthodontist assessed standardized frontal photographs 4 times; nasolabial aesthetics were rated on cropped and full-face images using the Cleft Aesthetic Rating Scale, and total facial attractiveness was rated on full-face images with and without the nasolabial area blurred using a 5-point Likert scale.

Setting:

Cleft Palate Craniofacial Unit of a University Medical Center.

Patients:

Inclusion criteria: nonsyndromic unilateral cleft lip and an available frontal view photograph around 10 years of age. Exclusion criteria: a history of facial trauma and an incomplete cleft. Eighty-one photographs were available for assessment.

Main Outcome Measures:

Differences in mean CARS scores between cropped versus full-face photographs and attractive versus unattractive rated patients were evaluated by paired t test.

Results:

Nasolabial aesthetics are scored more negatively on full-face photographs compared to cropped photographs, regardless of facial attractiveness. (Mean CARS score, nose: cropped = 2.8, full-face = 3.0, P < .001; lip: cropped = 2.4, full-face = 2.7, P < .001; nose and lip: cropped = 2.6, full-face = 2.8, P < .001).

Conclusion:

Aesthetic outcomes of the nasolabial area are assessed significantly more positively when using cropped images compared to full-face images. For this reason, cropping images, revealing the nasolabial area only, is recommended for aesthetical assessments.
Addressing the Social Determinants of Health: A Call to Action for School Nurses
Authors: Schroeder Krista , Malone Susan Kohl , McCabe Ellen , Lipman Terri
Published: January 2018

Social determinants of health (SDOH), the conditions in which children are born, grow, live, work or attend school, and age, impact child health and contribute to health disparities. School nurses must consider these factors as part of their clinical practice because they significantly and directly influence child well-being. We provide clinical guidance for addressing the SDOH when caring for children with three common health problems (obesity, insufficient sleep, and asthma). Given their unique role as school-based clinical experts, care coordinators, and student advocates, school nurses are well suited to serve as leaders in addressing SDOH.
Domestic Politics and the Motives of Emerging Donors: Evidence from Turkish Foreign Aid
Authors: Kavakli Kerim Can
Published: January 2018

Why do developing countries give foreign aid? Although emerging donors are gaining importance in development finance, lack of systematic data on their aid allocation limits our understanding of their motives. We address this gap using detailed data on a major new donor, Turkey, since 1992. We show that domestic politics has had a large impact on Turkey’s priorities in giving aid. Turkish aid used to be determined by international alignments and coethnicity, but after the Islamic AKP ( Adalet ve Kalkınma Partisi) took power, political ties lost importance. Turkey began to give more economic aid to trade partners and more humanitarian aid to Muslim nations. While this new focus on trade ties makes Turkey more similar to traditional donors, the growing role of cultural ties sets Turkey apart. The broader lesson of this study on Turkey is that government change can significantly influence the way emerging donors give aid and these changes can vary in predictable ways across different types of aid.
A Pooled-Data Analysis of Three Randomized, Double-Masked, Six-Month Clinical Studies Comparing the Intraocular Pressure Reducing Effect of Latanoprost and Timolol
Authors: Hedman K. , Alm A.
Published: January 2018

Purpose

To compare the intraocular pressure (IOP) reduction by latanoprost and timolol, and to study factors of prognostic value for assessing this reduction.

Methods

We analyzed 829 patients included in three phase III studies comparing six months' treatment with 0.005% latanoprost once daily and 0.5% timolol twice daily in patients with open-angle glaucoma or ocular hypertension. Analysis of covariance controlled for differences in baseline IOP and sex was used to assess the IOP reduction.

Results

Latanoprost reduced diurnal IOP (average of morning, noon and afternoon assessments) by 7.7 mmHg (31%) and timolol by 6.5 mmHg (26%) after six months of treatment. Thus the diurnal IOP was reduced 1.2 mmHg (18%) more with latanoprost than with timolol (p<0.001). Latanoprost-treated patients showed a further decrease in morning IOP of 0.7 mmHg (9%, p<0.001) from the initial morning IOP reduction obtained at two weeks. No such further decrease in IOP was seen with timolol. Higher baseline diurnal IOP resulted in a larger diurnal reduction during treatment with both drugs (p<0.001). Diurnal IOP in women was reduced 0.7 mmHg (11%) less than males with both drugs (p<0.001).

Conclusions

Latanoprost was more effective than timolol in reducing mean diurnal IOP. The effect after two weeks was maintained for timolol while with latanoprost there was a further, significant IOP reduction from two weeks to six months. Baseline IOP was the only factor of clinical importance found to be of prognostic value for assessing the IOP reduction.
The Efficacy of 2.5% Phenylephrine and Flurbiprofen Combined in Inducing and Maintaining Pupillary Dilatation during Cataract Surgery
Authors: Öztürk F. , Kurt E. , Ínan Ü.Ü. , Ílker S.S.
Published: January 2018

Purpose

To evaluate the effectiveness of phenylephrine 2.5% and flurbiprofen 0.03% combined in inducing and maintaining mydriasis during extracapsular cataract extraction (ECCE).

Methods

One hundred patients undergoing ECCE + intraocular lens (IOL) implantation were randomly divided into four groups. The first group was given phenylphrine 10%, the second group phenylephrine 10% + flurbiprofen, the third group phenylephrine 2.5% and fourth group phenylephrine 2.5% + flurbiprofen. Cyclopentolate 1% was used in all patients. Phenylephrine and cyclopentolate were instilled preoperatively four times during 1 hour and flurbiprofen was given four times the day before surgery and twice with an hour's interval before operation. Pre-operative and post-cortex aspiration horizontal pupil diameters were measured with callipers viewed through the operating microscope.

Results

Pupil diameters in pre-operative and post-cortex aspiration were no different in the 2.5% and 10% phenylephrine groups (p>0.05). Both diameters were larger and pupillary constriction was smaller in the flurbiprofen groups (p<0.05).

Conclusions

2.5% phenylephrine was as effective as 10% phenylephrine, with and without flurbiprofen, in inducing and maintaining pupil dilatation during ECCE surgery.
Matrix Metalloproteinase 2: Involvement in Keratoconus
Authors: Smith V. A. , Easty D.L.
Published: January 2018

Purpose

The activation of matrix metalloproteinase-2 (MMP-2) is postulated to be a crucial pathogenic factor behind progressive and chronic diseases in which basement membranes are disrupted. An ocular example is keratoconus. The purpose of the present enquiry was therefore to investigate and compare the activities of the MMP-2 secreted by keratocytes of normal and keratoconic corneas.

Methods

The spectrum of MMP-2 activities secreted by cultures of keratocytes derived from normal and keratoconic corneas was analysed by zymography. Subsequently, selected preparations were assayed for peptidase activity, using Type I, Type III, Type IV and Type V collagen as substrate, under native conditions and after treatment with a variety of putative activating reagents.

Results

Although MMP-2 of Mr 65,000 on SDS gelatin polyacrylamide gels is the major protease secreted by keratocytes of normal corneas, the keratocytes of early-phase keratoconic corneas secrete an additional zymographic activity of Mr 61,000. From their N-terminal amino acid sequences, both these proteins were shown to be conformers of proMMP-2. Treatment with SDS followed by protein fractionation was required to achieve in vitro activation of the MMP-2 secreted by normal corneal keratocytes. Treatment with SDS alone partially activated the enzyme produced by early-phase keratoconic corneal keratocytes. This procedure and autocatalysis, yielded an enzyme of Mr 43,000 that selectively hydrolysed Type IV and denatured Type 1 collagen.

Conclusions

The zymographic gelatinase activities of apparent Mr 65,000 and 61,000 are conformers of corneal proMMP-2. Activated enzyme, of Mr 43,000, is more readily generated from protein preparations of the culture media of early phase keratoconic corneal keratocytes than from protein preparations of the culture media of normal corneal keratocytes.
Punctum to Punctum Adhesion after Dacryocystorhinostomy Using Silicone Tubes
Authors: Sellar P.W.
Published: January 2018

Adhesion between the upper and lower punctum is described after dacryocystorhinostomy with silicone stent intubation. The cause is attributed to trauma at the punctal openings and a tight silicone stent loop. Advice is given on how to avoid the complication.
Retinal Arterial Macroaneurysm in a Young Patient with Chronic Renal Failure
Authors: Yilmaz G. , Çakmakçi S. , Aydin P.
Published: January 2018

Purpose

To report the youngest case of retinal arterial macroaneurysm.

Method

Case Report.

Results

Clinical examination and fundus fluoroscein angiography revealed retinal arterial macroaneurysm in a 23-year-old patient with chronic renal failure.

Conclusions

Acquired macroaneurysm may develop even in a very young patient, especially with chronic renal failure.
The Control of Matrix Metalloproteinase-2 Expression in Normal and Keratoconic Corneal Keratocyte Cultures
Authors: Parkin B.T. , Smith V.A. , Easty D.L.
Published: January 2018

Purpose

Early phase keratoconic comeas and their cultured keratocytes abnormally produce the Mr 62,000 form of the matrix metalloproteinase-2 (MMP-2). It is known that platelet derived growth factor (PDGF) and transforming growth factor-β (TGF-β) are involved in the regulation of MMP activity and tissue inhibitor of metalloproteinase (TIMP) production in non-ocular tissues. The purpose of this enquiry was to determine whether these growth factors also play a role in the activity and/or production of corneal MMP-2 and TIMP, and whether their activity could account for the existence of the Mr 62,000 form of MMP-2 in keratoconic corneas.

Methods

Confluent cultures of normal and early-phase keratoconic corneal keratocytes were established and incubated in serum-free media in the presence or absence of PDGF and TGF-β. The proteins secreted by these cells over periods of 7 days were harvested for analysis. The total protein produced was determined spectrophotometrically. MMP-2 was visualised by SDS-gelatin polyacrylamide gel electrophoresis and assayed using radiolabelled type IV collagen as substrate. The enzyme inhibitors, TIMP-1 and TIMP-2, were quantified by dot blot immunoassay.

Results

The addition of PDGF or TGF-β to the culture medium of keratoconic corneal keratocytes had no significant effect on overall protein production, MMP-2 activity or on the amounts of TIMP-1 and TIMP-2 secreted. These observations also applied to normal corneal keratocytes, with the exception that PDGF induced expression of the Mr 62,000 species of MMP-2.

Conclusions

PDGF may be involved in the production of the Mr 62,000 species of MMP-2 that is abnormally produced by early-phase keratoconic corneal keratocytes.
Surgical Approach in Terson Syndrome: Vitreous and Retinal Findings
Authors: Augsten R. , Königsdörffer E. , Strobel J.
Published: January 2018

Purpose

To report some interesting findings in patients with bilateral Terson syndrome.

Methods

We describe six eyes from three patients with Terson syndrome. Pars plana vitrectomy was performed in one eye twelve weeks, and in four eyes six months after the acute event. In one eye blood was suddenly spontaneously absorbed after four months.

Results

The four eyes operated six months after injury showed severe complications and final visual acuity was between light perception and 0.6. The eye with surgical attendance twelve weeks after the acute injury had an uneventful course, and final visual acuity was 0.7.

Conclusions

Because of severe ocular complications and with a view to early rehabilitation, vitrectomy has been recommended for eyes with bilateral Terson syndrome, without spontaneous blood resorption. Surgery should be performed in at least one eye not later than four to eight weeks after the acute injury.
Macular Translocation: Histopathologic Findings in Swine Eyes
Authors: Roig-Melo E.A. , Alfaro D.V. , Heredia-Elizondo M.L. , Yarbrough L.M. , Game A.B. , Apple D.J. , Quirol H.M.
Published: January 2018

Purpose

Macular translocation has been proposed as an alternative technique in the treatment of some cases of choroidal neovascularization. The purpose of the paper is to report the histopathologic findings in the retina of swine eyes undergone macular translocation.

Methods

Ten eyes of ten Yucatan pigs underwent posterior pars plana vitrectomy and scleral imbrication to achieve macular translocation. Mattress sutures were preplaced at the equator of the eyes. After a pars plana vitrectomy, balanced saline solution was injected under the temporal retina to produce a retinal detachment. Scleral imbrication was achieved by tightening the mattress sutures. An air-fluid exchange was performed and the eye was filled with sulfur hexafluoride 18%. The eyes were enucleated 2, 4, 8 and 12 weeks after surgery and analyzed under light and electron microscopy.

Results

Macular translocation was achieved in all cases. The major findings consist of a minimal decrease in the number of photoreceptors outer segments; also a change in the morphology was noted. This included some degree of loss of vertical alignment and an increase in the interphotoreceptor space. There was a recovery in the morphology of the photoreceptors over time.

Conclusions

Minimal changes in the photoreceptors and retinal pigment epithelium are observed when macular translocation is performed with recovery of these changes over time. Scleral imbrication is an effective technique to achieve translocation of the fovea.
Systematic, Combined Treatment Approach to Nasolacrimal Duct Obstruction in Different Age Groups
Authors: Çiftçi F. , Akman A. , Sönmez M. , Ünal M. , Güngör A. , Yaylali V.
Published: January 2018

Purpose

To report the outcome of a step-by-step treatment approach for congenital nasolacrimal duct obstruction (CNDO).

Methods

Three-hundred and fifty eyes with CNDO were included in the study. A number of treatment methods were applied systematically until a successful outcome was achieved. Listed in order from simple to more complex, the following methods were used: conservative management (massage and topical antibiotics), high-pressure syringing, probing, and silicone intubation. Treatment efficacy was determined according to age (Group 1: 0–6 months, Group 2: 7–12 months, Group 3: 13–24 months, Group 4: 25–72 months) and success rates were compared.

Results

Conservative management was applied only in children less than 1 year of age, and was successful in 91.8% of Group 1 and 60% of Group 2 eyes. The difference between these two success rates was significant (p = 0.003). High-pressure syringing was performed in children under 24 months of age, with success rates of 41.7% in Group 1, 33.3% in Group 2, and 12.5% in Group 3. The overall success rate for first probing in all groups was 76.1%, with a range of 69.4% to 80.9%. After second probing, the overall cure rate for the entire cohort was 88.0%, with a range of 74.9% to 94.8%. There was no real difference in probing cure rates relative to age (p > 0.05). Silicone intubation was indicated and performed in two eyes of Group 2 children, three eyes of Group 3, and nine eyes of Group 4. Two ducts in Group 4 eyes remained obstructed after silicone intubation.

Conclusions

The systematic treatment approach to CNDO, including conservative management and minimally invasive procedures such as high-pressure syringing, probing, and silicone intubation, is highly successful. In this study, the cure rate for this combined approach was 100% in youngsters under 2 years of age and 94.5% in children 2 to 6 years old.
Ibopamine Treatment in Chronic Hypotony Secondary to Long-Lasting Uveitis. A Case Report
Authors: Pivetti-Pezzi P. , Da Dalt S. , La Cava M. , Pinca M. , De Gregorio F. , Virno M.
Published: January 2018

Purpose

To assess the clinical efficacy of ibopamine eye drops in severe hypotony secondary to chronic progressive uveitis.

Methods

Case report. A 47-year-old man with a 37-year history of diffuse uveitis and severe refractory hypotony was treated with topical 2% ibopamine (Trazyl®) six times a day. Intraocular pressure, visual acuity, visual field and side effects were recorded during 15 months of follow-up.

Results

IOP, visual acuity and visual field increased after four days of therapy and lasted for two months when the drug was suspended because of the onset of filamentous keratopathy. A new course of treatment with 2% ibopamine eye drops in a different solvent (BSS®) resulted in a stable increase in IOP, VA and visual field, with no side effects in a follow-up of 13 months.

Conclusions

Ibopamine 2% eye drops in BSS® solvent seem effective in the treatment of uveitis-related hypotony.
Large Bilateral Lateral Rectus Recession in Large Angle Divergence Excess Exotropia
Authors: Çelebi S. , Kükner A.Ş.
Published: January 2018

Purpose

Classic teaching suggests that surgery for intermittent exotropia should be based on distance/near differences. True divergence excess exotropia should be treated with symmetric lateral rectus recession. The aim of this study was to investigate the effect of large bilateral lateral rectus (LR) recession in large-angle intermittent exotropia.

Methods

Thirty-three consecutive patients with large-angle divergence excess exotropia ranging from 50 to 65 (mean 56.7 ± 6.3) prism diopters were treated with 8.0 to 9.5 mm (mean 8.8 ± 0.7 mm) recession of both LR muscles.

Results

Successful alignment was achieved in 25 cases (76%) while residual exotropia was seen in eight patients (24%) within the limit of 15 prism diopters. Mean follow-up time was 28.5 ± 8.4 (range 13 to 38) months. Abduction deficit due to this procedure was not seen in any case.

Conclusions

We conclude that large bilateral LR recession is an appropriate surgical method for large-angle divergence excess exotropia.
Nasolacrimal Polyurethane Stent Placement: Preliminary Results
Authors: Perena M.F. , Castillo J. , Medrano J. , De Gregorio M.A. , Loras E. , Cristobal J.A.
Published: January 2018

Purpose

To present our initial results in the treatment of nasolacrimal obstruction by placing a polyurethane stent.

Methods

74 nasolacrimal stents were implanted under fluoroscopic guidance in obstructed nasolacrimal systems of 64 patients. Dacryocystography and CT were used to verify the position and patency of the stents. Mean follow-up was 15 months. Clinical examinations were done at the first week, first month, third month and sixth month after stent placement.

Results

Polyurethane stents were successfully inserted and permeable in 59 patients (92.1%), but could not be inserted in 5 patients (7.8%). Epiphora was solved and permeable in 53 cases (82.8%), it was not permeable but asymptomatic in 2 cases (3.1%), and was not permeable but symptomatic in 4 (6.2%). In 5 cases (7.8%) stents remained permeable although patients complained of epiphora.

Conclusions

Polyurethane stent placement is a non-invasive technique that can replace dacryocystorhinostomy, giving better results and tolerance.