bluuebunny/crossref_metadata_2025 huggingface dataset:
Parabens as Agents for Improving Crocetin Esters’ Shelf-Life in Aqueous Saffron Extracts
Authors: Maggi Luana , Carmona Manuel , Zalacain Amaya , Tomé Magdalena Martínez , Murcia María Antonia , Alonso Gonzalo Luis
Published: March 2009

The effect of parabens on the shelf-life of crocetin esters and picrocrocin in aqueous saffron solutions was studied. Degradation of saffron crocetin esters fits a first-order kinetics model, and the results indicated that the crocetin (β-D-glucosyl)-(β-D-gentiobiosyl) esters were more stable than the crocetin di-(β-D-gentiobiosyl) esters regardless of whether trans and cis isomers were considered. Under all tested conditions both parabens gave good results, especially propyl paraben that showed a greater influence on the degradation rate constant, except for cis-crocetin di-(β-D-gentiobiosyl) ester and cis-crocetin (β-D-glucosyl)-(β-D-gentiobiosyl) ester. In presence of propyl paraben (200 mg/L), the half-life periods of trans-crocetin di-(β-D-gentiobiosyl) esterimproved considerably, up to four-fold. Special attention has been paid to the effect of propyl paraben on 46 saffrons with different crocetin ester contents. No differences were observed in terms of picrocrocin. By analysis of variance, it is noteworthy that there were differences between the mean content of crocetin esters for all analysed saffron, except for trans-crocetin (β-D-glucosyl)-(β-D-gentiobiosyl) ester.
Vibration and Fluorescence Spectra of Porphyrin- CoredBis(methylol)-propionic Acid Dendrimers
Authors: Minaev Boris , Lindgren Mikael
Published: March 2009

Bis-MPA dendron-coated free-base tetraphenylporphyrin and zinc-tetraphenyl-porphyrin (TPPH2 and TPPZn) were studied in comparison with simple porphyrins (H2P, ZnP) by theoretical simulation of their infrared, Raman and electronic absorption spectra, as well as fluorescense emission. Infrared and fluorescence spectra of the dendrimers were measured and interpreted along with time-resolved measurements of the fluorescence. The 0-1 emission band of the dendron substituted TPPZn was found to experience a "heavy substitution"-effect. The 0-1 vibronic emission signal is associated with a longer decay time (approx. 7 - 8 ns) than the 0-0 emission (approx. 1 - 1.5 ns). The former contributed with more relative emission yield for larger dendron substituents, in agreement with the appearance of steady-state emission spectra showing increased contribution from the 0-1 vibronic fluorescence band at 650 nm. No such substitution effect was observed in the electronic or vibrational spectra of the substituted free-base variant, TPPH2. Vibration spectra of the parent porphyrins (H2P, ZnP, TPPH2 and TPPZn) were calculated by density functional theory (DFT) using the B3LYP/6-31G** approximation and a detailed analysis of the most active vibration modes was made based on both literature and our own experimental data. Based on the results of theoretical calculations the wide vibronic bands in the visible region were assigned. The vibronic structure also gave a qualitative interpretation of bands in the electronic absorption spectra as well as in fluorescence emission depending on the size of dendrimer substitution. From the results of time-dependent DFT calculations it is suggested that the TPPZn-cored dendrimers indicate strong vibronic interaction and increased Jahn-Teller distortion of the prophyrin core for larger dendrimer generations. Specifically, this leads to the entirely different behaviour of the emission spectra upon substitution of the TPPH2 and TPPZn variants, which was also experimentally observed. Since TPPH2 is originally of lower symmetry the specific distortion upon dendron substitution is not expected to the same extent, which also was in agreement with the experimental findings.
Alexander's Law Revisited
Authors: Jacobson Gary P. , McCaslin Devin L. , Kaylie David M.
Published: March 2009

Background: It is a common occurrence in the balance function laboratory to evaluate patients in the post-acute period following unilateral vestibular system impairment. It is important to be able to differentiate spontaneous nystagmus (SN) emanating from peripheral vestibular
system impairments from asymmetric gaze-evoked nystagmus (GEN) that originates from central ocular motility impairment. Purpose: To describe the three elements of Alexander's Law (AL) that have been used to define SN from unilateral peripheral impairment. Additionally, a fourth element
is described (i.e., augmentation of spontaneous nystagmus from unilateral peripheral vestibular system impairment) that differentiates nystagmus of peripheral vestibular system origin from nystagmus that originates from a central eye movement disorder. Research Design: Case reports
Study Sample: Case data were obtained from two patients both showing a nystagmus that followed AL. Intervention: None Data Collection And Analysis: Videonystagmography (VNG), rotational, vestibular evoked myogenic potential (VEMP), and neuro-imaging studies were presented
for each patient. Results: The nystagmus in Case 1 occurred as a result of a unilateral, peripheral, vestibular system impairment. The nystagmus was direction-fixed and intensified in the vision-denied condition. The nystagmus in Case 2, by appearance identical to that in Case 1, was
an asymmetric gaze-evoked nystagmus originating from a space-occupying lesion in the cerebello-pontine angle. Unlike Case 1, the nystagmus did not augment in the vision-denied condition. Conclusions: Although nystagmus following AL usually occurs in acute peripheral vestibular system
impairment, it can occur in cases of central eye movement impairment. The key element is whether the SN that follows AL is attenuated or augmented in the vision-denied condition. The SN from a unilateral peripheral vestibular system impairment should augment in the vision denied condition.
An asymmetric GEN will either not augment, decrease in magnitude, or disappear entirely, in the vision-denied condition.
Use of Linear Frequency Transposition in Simulated Hearing Loss
Authors: Korhonen Petri , Kuk Francis
Published: March 2009

Purpose: To demonstrate the usability of new acoustic cues provided by a commercial hearing aid using linear frequency transposition. The importance of auditory training in realizing the benefit was evaluated. Research Design: Quasi-experimental study design. All subjects
were tested both with conventional amplification and with linear frequency transposition before and after directed training. Study Sample: A total of nine normal hearing participants with simulated high frequency hearing loss at and above 1600 Hz participated in the study. All
subjects were native English speakers ranging in age from 18 to 24 years. Intervention: Identification of voiceless phonemes in CV, VC, and CVC context processed with and without linear frequency transposition was evaluated. Identification test was carried out four times. Between test
trials, participants completed 15 minutes of self-paced training using transposed stimuli. Results: Prior to any training, transposition did not improve phoneme identification scores. Training of 30 minutes improved the overall identification scores of the transposed stimuli
over the nontransposed stimuli by 14.4%. Conclusions: The results demonstrated that frequency transposition produces acoustic cues that normal hearing listeners with a simulated hearing loss at and above 1600 Hz may be trained to utilize.
A Systematic Review to Determine The Effectiveness of Using Amplification in Conjunction With Cochlear Implantation
Authors: Olson Anne D. , Shinn Jennifer B.
Published: March 2009

Background: The question regarding the use of amplification with implantation is timely and relevant in today's clinical settings where an increased number of adults with measurable hearing are receiving cochlear implants due to the expanding implant criteria, especially among
individuals seeking bilateral implantation. Purpose: To review the evidence available to answer the clinical question: “Does amplification in the ear opposite of a cochlear implant provide improved communication function for adult users?” Research Design: A systematic
review of the evidence that met the search criteria related to the use of amplification in adult implant users. All types of experiments were included with the exception of expert opinion. This systematic review ranked the levels of evidence related to these studies and distinguished the levels
of evidence from judgments about the grade and strength of recommendations for the stated clinical question. Study Sample: Fifty-two articles were initially reviewed with a final 11 articles meeting the search criteria and identified for in-depth analysis. Data Collection and Analysis:
Several electronic databases and textbooks were searched to locate the evidence related to bimodal stimulation. Each article was reviewed using a check sheet and assigned a ranking for level of evidence (Levels 1‐6) based on the type of research design that was used and a grade of evidence
(A‐D) based on the quality, relevance, and extensiveness of the study. Finally the level and grade were collapsed into only three categories to indicating the strength of the recommendations coming from each study and were classified as either strong (I), moderate (II), or weak (III).
Results: Several trends about bimodal stimulation were observed, which include (1) significantly better speech understanding in the bimodal condition for many participants; (2) in noise, the largest bimodal benefits in speech recognition; (3) variable findings on localization tasks;
and (4) overall significant improvement in functional ability based on self-assessments. The preponderance of evidence received grades of B or C. Conclusions: The evidence available indicates “moderate” (II) strength in support of bimodal stimulation for adult implant users.
Clinicians should encourage their clients to consider bimodal fittings. Additional research is needed about optimal time frame for introducing bimodal fittings as well as establishing a clinical profile of patients who may benefit most from this intervention compared to bilateral implantation.
Asperger's Syndrome and High-Functioning Autism
Authors: Carpenter Laura Arnstein , Soorya Latha , Halpern Danielle
Published: March 2009

CME Educational Objectives

1.

Describe the distinguishing and overlapping features of Asperger's syndrome and high-functioning autism.

2.

Review diagnostic strategies for suspected Asperger's syndrome and high-functioning autism.

3.

Identify the major treatment approaches for Asperger's syndrome and high-functioning autism
Autism Spectrum Disorders: Prevalence and Vaccines
Authors: Peacock Georgina , Yeargin-Allsopp Marshalyn
Published: March 2009

CME Educational Objectives

1.

Define the concept of disease prevalence and its relationship to the increase noted in autism spectrum disorders over the past decade.

2.

Discuss the history surrounding controversies about autism, the measles-mumpsrubella (MMR) vaccine, and thimerosal.

3.

Review the most current scientifically rigorous population-based evidence regarding the purported link between autism spectrum disorders and childhood vaccines.
CNA Empowerment: Effects on Job Performance and Work Attitudes
Authors: Cready Cynthia M. , Yeatts Dale E. , Gosdin Melissa M. , Potts Helen F.
Published: March 2009

In this analysis, the effects of empowerment were examined among a sample of certified nursing assistants (CNAs) representing a wide range of empowerment levels. On the basis of survey responses from 298 CNAs and 136 nurses in five nursing homes where CNA-empowered work teams had been implemented and five nursing homes with more traditional management approaches, the results indicated that CNA empowerment had a variety of effects. CNAs with high empowerment and the nurses who worked with them tended to report better CNA performance and work-related attitudes. Both were also less likely to be thinking about leaving their jobs. With the help of lessons learned from new culture change initiatives, and with commitment, effort, and attention, nursing homes and other health care providers can reap the benefits associated with employee empower-ment strategies, such as CNA-empowered work teams.
Effects of Tangible Social Support and Depression on Diabetes Self-Efficacy: A Study of Hispanic Older Adults
Authors: Coffman Maren J.
Published: March 2009

Although social support has been found to promote health and decrease depression in individuals with diabetes, little research has examined the kinds and sources of support. This descriptive correlational study examined the effects of diabetes-related tangible social support and depression on diabetes self-efficacy in Hispanic older adults. Participants were predominantly Puerto Rican, and many were depressed. Primary support needs included transportation and communication; family was the primary source of support. Variables associated with diabetes self-efficacy included tangible support and education. Understanding the relationship between diabetes tangible support, depression, and diabetes self-efficacy will help nurses adapt their care.
Care of Community-Dwelling Older Adults by Faith Community Nurses
Authors: Rydholm Laura , Moone Rajean , Thornquist Lisa , Alexander Wanda , Gustafson Vicki , Speece Bethany
Published: March 2009

In this state-funded study of the impact of faith community nursing, 1,061 notes regarding 713 older adults were retrieved from 75 faith community nurses. Critical contacts were mapped using the Data, Interpretation, Action, Response, and Yield (DIARY) charting format. DIARY notes revealed that disabilities were seemingly avoided when reluctant older adults were coaxed to access care before their illnesses escalated. The nurses solicited help from blended networks, procured assistive devices, cued family members, made environments safe, reengaged those who were despairing, calmed those who were anxious, facilitated recovery aftercare, advocated for those who were neglected, and helped caregivers navigate end-of-life decisions.
Korean Older Adults’ Perceptions of the Aging Process
Authors: Chung Yeon-Gang , Kim Kyung-Hee , Choi Kyung-Sook , Kwon Hye-Jin , Park Kyung-Sook , Choi Mi-Hye , Yom Young-Hee
Published: March 2009

This qualitative study was conducted to describe Korean older adults’ perceptions of the aging process. A total of 18 Korean older adults were interviewed, and a grounded theory approach was used to analyze the interview data. The participants were found to perceive aging as a process of Generating, Expressing, and Transforming of Growing Futility. The degree to which they perceived their Growing Futility depended on the actions and interactions of a set of conditional structures. This study revealed five patterns of Korean older adults’ perception of the aging process. These findings allow for the possibility of a more refined theoretical development for the aging process, especially when a comparative study becomes available through cross-cultural qualitative research.
Caring for Hospitalized Older Adults at Risk for Delirium: The Silent, Unspoken Piece of Nursing Practice
Authors: Dahlke Sherry , Phinney Alison
Published: March 2009

More than half of hospitalized older adults will experience delirium, which—if left untreated—can lead to detrimental outcomes. Despite the prevalence and severity of delirium, nurses recognize less than one third of cases. Because little is known about how nurses manage this problem, a qualitative study was conducted to explore how nurses care for hospitalized older adults at risk for delirium. The data revealed that nurses care for older adults by Taking a Quick Look, Keeping an Eye on Them, and Controlling the Situation. The context in which nurses choose their priorities and interventions was reflected in the themes of the Care Environment and Negative Beliefs and Attitudes about older adults. Nurses are caring for an older population whose care requirements are different than those of younger people and in a context where this challenging work is rarely addressed. To improve care, the older population must be acknowledged, and nurses must possess the knowledge and resources needed to meet this population’s unique needs.
Sleep and the Sleep Environment of Older Adults in Acute Care Settings
Authors: Missildine Kathy
Published: March 2009

The purpose of this descriptive pilot study was to describe sleep characteristics of hospitalized older adults and the nighttime environmental noise and light they encountered. Study participants included patients in an acute care setting; actigraphy and light and sound meters were used to measure the variables. Mean sleep time was 215 minutes, and the average sleep efficiency was 44.72%. Nighttime sleep was fragmented into 5 to 38 intervals of 15 to 24 minutes, with frequent awakenings. Mean light levels were 6.14 lux, with peak intensities of 59.68 lux lasting 95 minutes each night. Mean sound levels were 52.87 dB(A). Sleep was markedly impaired in an environment of elevated light and sound levels. Understanding the role of noise and light in the sleep efficiency of ill older adults can help nurses identify sources of noise and light and initiate sleep improvement protocols.
Using an Associational Trends Framework to Understand the Meaning of Obsessive Reminiscence
Authors: Puentes William J.
Published: March 2009

When the psychodynamics of simple reminiscence, the kind of reminiscence used to manage anxiety, are disrupted, individuals can become stuck on certain memories and begin to obsess or ruminate about them. Generally, obsessive reminiscence is identified as nonpurposive and dysfunctional. However, interpreting the content of obsessive reminiscence within an associational trends framework demonstrates that useful diagnostic information can be gleaned from obsessive reminiscence. This information can be incorporated into the treatment plan to enhance the quality of care delivered to clients, as well as clients’ interpersonal relationships.
User Perceptions of In-Home Medication Dispensing Devices
Authors: Wakefield Bonnie J. , Orris Lindsay J. , Holman John E. , Russell Cynthia L.
Published: March 2009

The purpose of this study was to characterize patient and clinician perceptions of programmable medication devices (dispensers and timers) being marketed to consumers to improve medication adherence. Using principles of usability testing, 33 volunteer staff and clinic patients rated seven devices. Raters scored devices on cueing and alarms, storage and dispensing, machine characteristics, potential to improve adherence, and cost. Medication dispensers ranked highest overall. However, even if the Department of Veterans Affairs paid for them, patient participants would be unlikely to use them. No significant differences were found across the devices in the perceived likelihood that the device would improve medication adherence. In this article, we provide a set of criteria for patients who might choose such a device and clinicians who may recommend these kinds of devices. More work is needed in the design and deployment of these devices if they are to be part of a successful medication adherence plan.
Older Home-Care Patients’ Preferred Approaches to Depression Care: A Pilot Study
Authors: Fyffe Denise C. , Brown Ellen L. , Sirey Jo Anne , Hill Elizabeth G. , Bruce Martha L.
Published: March 2009

The purpose of this pilot study was to explore the approaches to depression care preferred by older home-care patients and examine characteristics associated with those preferences. Twenty-eight long-term home-care patients, ages 62 to 95, were interviewed. Patients ranked their depression care preferences and provided rationale for their responses. Results indicated prayer was preferred by the highest percentage of patients (50%). Comparing patients with and without depression experience, prayer was preferred by the latter group. The results highlight the importance of addressing patient preferences during care planning to improve participation in geriatric depression care management.
Person-Centered Caregiving Instruction for Geriatric Nursing Assistant Students: Development and Evaluation
Authors: Grosch Kerry , Medvene Louis , Wolcott Hannah
Published: March 2009

This research describes the development and evaluation of a 2-hour program that taught geriatric nursing assistant students person-centered caregiving skills. The person centeredness of caregiving skills among students who completed the training, as well as those who did not, was evaluated by coding their videotaped interactions with a standardized long-term care resident. Residents reported more satisfaction with students who had completed the special training, although there was little difference between the actual behavior of students in the intervention and control conditions. Students’ interpersonal cognitive complexity was associated with their ability to provide care in person-centered ways.
Strategies For Translating the Resident Care Plan into Daily Practice
Authors: Adams-Wendling Linda , Piamjariyakul Ubolrat , Bott Marge , Taunton Roma Lee
Published: March 2009

The Omnibus Budget Reconciliation Act of 1987 required nursing facilities to complete a standardized comprehensive assessment known as the Resident Assessment Instrument (RAI) and to formulate a plan of care from the RAI to guide nursing care. The purpose of this retrospective case study was to examine the issues around the translation of nursing facility resident care plans to documents that guide daily care. Data were obtained by auditing 96 resident care plans in 10 nursing facilities in two states. Despite the importance of the resident plan of care, the audit revealed the provider approaches to resident problems varied appreciably in nursing facilities. The results of this study support the need for further research to assist in the development and implementation of strategies in nursing facilities that focus on standardized practices. Consistent systems can be promoted that translate the resident care plan into daily practice.
The Promise of Spirit at WorkIncreasing Job Satisfaction and Organizational Commitment and Reducing Turnover and Absenteeism in Long-Term Care
Authors: Kinjerski Val , Skrypnek Berna J.
Published: March 2009

The effectiveness of a spirit at work program in long-term care was evaluated using a quasi-experimental, pretest-post-test design. These findings, along with focus group results, provide strong support that the program increased spirit at work, job satisfaction, organizational commitment, and organizational culture (particularly teamwork and morale), leading to a reduction in turnover and absenteeism—two major concerns in the long-term care sector. This study suggests that implementation of a spirit at work program is a relatively inexpensive way to enhance the work satisfaction of employees, increase their commitment to the organization (thus reducing turnover and absenteeism), and ultimately improve the quality of resident care.
Fatal Pulmonary Embolism in a Polytraumatized Patient Following Hip Arthroscopy
Authors: Bushnell Brandon D. , Dahners Laurence E.
Published: March 2009

Prophylaxis of venous thromboembolic disease for patients undergoing orthopedic procedures remains a controversial topic. Deep venous thrombosis and pulmonary embolism are well studied in the total joint arthroplasty population, as are the various options for prevention and treatment. In the past few years, hip arthroscopy has enjoyed increasingly broader indications and applications, especially in patients who have suffered trauma to the hip. Current studies of hip arthroscopy, however, have not reported venous thromboembolic disease as a complication. No guidelines exist for venous thromboembolic disease prophylaxis associated with hip arthroscopy, perhaps because the need for such guidelines has not materialized. This article describes a case of fatal pulmonary embolism associated with hip arthroscopy after traumatic injury. A literature review reveals that this is the first report of this complication and that no guidelines exist regarding prophylaxis of venous thromboembolic disease in hip arthroscopy. Surgeons performing this technique should make treatment decisions on an individualized basis, considering patient- and injury-specific factors.
Bilateral Heel Panniculitis Presenting as Calcaneal Osteomyelitis
Authors: Marmor Meir , Haim Amir , Drexler Michael , Pritsch Tamir
Published: March 2009

Panniculitis is an inflammatory process of the subcutaneous adipose layer (panniculos adiposus). It is frequently a sign of systemic disease with a wide range of clinical presentations. The histopathological findings are diverse, making diagnoses difficult.

We present a case of heel panniculitis, initially misdiagnosed as calcaneal osteomyelitis. Our intention is to make physicians, treating these type of patients, aware of the possibility of this rare disease, especially in situations when conventional therapy is not successful.

A 66-year-old woman was admitted to the hospital with the initial diagnosis of suspected calcaneal osteomyelitis of her right heel, presumably due to a foreign body penetration a few months prior. Initial treatment with intravenous antibiotics was unsuccessful. When significant fluctuation developed, she underwent incision and drainage of her right heel. Postoperatively, her right heel condition did not improve and similar phenomena appeared on her left side. She continued to deteriorate up to the point when panniculitis was diagnosed and corticosteroid treatment was initiated. Her condition rapidly improved after this treatment.

A subtype of panniculitis, erythema induratum, was the probable cause of our patient's symptoms. This type usually appears on the posterior calves or feet of young to middle-aged women and is characterized by erythematous nodules that spontaneously ulcerate and drain. The history of a foreign body penetration was determined to be a “red-herring,” leading us to the initial diagnosis of soft tissue infection and osteomyelitis.
Humeral Head Plasty for a Chronic Locked Anterior Shoulder Dislocation
Authors: Mehta Vishal
Published: March 2009

This article presents the case of a 52-year-old man with a chronic anterior shoulder dislocation accompanied by a massive Hill-Sachs lesion. The dislocation occurred 6 weeks prior to presentation as the result of a seizure. At the time of the initial injury, the patient was treated in the emergency department and told that his shoulder was reduced. Despite this, he continued to experience pain and inability to move his shoulder. Repeat radiographs and magnetic resonance imaging (MRI) revealed an anterior shoulder dislocation with a massive Hill-Sachs lesion that was locked onto the anterior glenoid. Attempts at a gentle closed reduction in the operating room failed, necessitating an open reduction that involved an extensive capsular release and a Bankart repair. The Hill-Sachs lesion was managed with a humeral head-plasty performed with an 8-mm anterior cruciate ligament guide (Smith & Nephew, Andover, Massachusetts) placed adjacent to the lesser tuberosity. The Hill-Sachs lesion was tamped out to restore the contour of the humeral head and back filled with allograft. Postoperative MRI of the shoulder revealed successful restoration of the contour of the humeral head, although avascular necrosis was present. At 6-month follow-up, the patient reported no instability or pain and had resumed his activities of daily living without difficulty. He regained forward flexion of 165°, abduction of 160°, internal rotation of 75°, and external rotation of 70°. This article presents the successful management of a large, engaging Hill-Sachs lesion using a novel bone-tamping technique that provides an alternative to coracoid transfer procedures and osteochondral allografting.
Unicameral Bone Cyst of the Humeral Head: Arthroscopic Curettage and Bone Grafting
Authors: Randelli Pietro , Arrigoni Paolo , Cabitza Paolo , Denti Matteo
Published: March 2009

Arthroscopic surgery has improved greatly over the past decade. Treatment of various juxta-articular disorders around the shoulder have benefited from endoscopic approaches. Cystic lesions of the shoulder on the scapular side have been treated in this way. This article describes a case of a 29-year-old patient with a unicameral bone cyst on the posterior aspect of the humeral head. Arthroscopic visualization using an accessory posteroinferior portal localized the cyst through the bare area of the humeral head. A cannulated burr was used to create an opening through the cortical wall between the cyst and the joint, and a careful curettage was performed. The cavity was filled with a demineralized bone matrix enriched with autologous blood packed into an arthroscopic cannula and delivered through the accessory portal. The patient reported pain relief immediately postoperatively and at follow-up. This case demonstrates the feasibility of arthroscopic treatment of a simple bone cyst of the humeral head. We believe that the knowledge of the juxta-articular anatomy allows the applications of scope-assisted procedures to be expanded, maximizing the results of a technique that allows a shorter recovery and less painful rehabilitation.
Adhesive Capsulitis Demonstrated on Magnetic Resonance Imaging
Authors: Shaikh Abe , Sundaram Murali
Published: March 2009

The case:

A 32-year-old diabetic man presented with decreased range of motion in his right shoulder.
Clinical Evolution of Neuroretinitis in Parry–Romberg Syndrome
Authors: de Crecchio Giuseppe , Forte Raimondo , Strianese Diego , Rinaldi Michele , D’Aponte Antonella
Published: March 2009

A 16-year-old girl with Parry–Romberg syndrome presented with monolateral exudative neuroretinitis and retinal telangiectasis that had been observed for 42 months. She was treated with immunosuppressive therapy with A-cyclosporine for 1 year, followed by laser treatment of telangiectasis. Her visual acuity improved from 20/200 to 20/70 in 1 year with a reduction of neuroretinal exudation. Laser treatment resulted in a further improvement of visual acuity to 20/40. Clinical findings remained unchanged during 2 years of follow-up. The association of immunosuppressive treatment and laser therapy may improve neuroretinal disease in the presence of Parry–Romberg syndrome.
Retinopathy of Prematurity Treatment and Vitreous Hemorrhage
Authors: Funnell Charlotte L. , Simmons Ian G.
Published: March 2009

Two cases of hemorrhagic retinopathy of prematurity associated with thrombocytopenia are presented. The negative prognosis of vitreous hemorrhage in retinopathy of prematurity and the option of platelet transfusions are discussed.
Ring Corneal Infiltrate and Progressive Ring Thinning Following Primary Varicella Infection
Authors: Khan Arif O. , Al-Assiri Abdullah , Wagoner Michael D.
Published: March 2009

Unilateral stromal keratitis is a known rare sequela of primary varicella infection. The authors describe a unique case of immunological (Wessely) ring formation and progressive ring thinning following primary varicella infection in a 6-year-old girl.
Binocular Potential Score: A Novel Concept
Authors: Singh Vinita , Panday Manish , Agarwal Siddharth
Published: March 2009

Objective:
To assess the predictive value of an objective system for preoperative binocular potential scoring on the postoperative outcome in horizontal concomitant strabismus.

Methods:
A prospective interventional study of 100 patients undergoing surgery for horizontal concomitant strabismus was conducted. The binocular potential score (BPS) was evaluated on the basis of age of onset, duration, intermittency, variability, vision, and responses on synoptophore and Worth four-dot test. Patients were grouped according four grades (I = the best and IV = the weakest). The surgical outcome was evaluated by binocular function and ocular alignment.

Results:
All patients with a BPS of grade I maintained good binocular function postoperatively. Within-grade analysis revealed a statistically significant improvement in postoperative binocular function in patients with a BPS of grade II (P = .0047), grade III (P = .0030), and grade IV (P = .0143). Grade comparisons showed significant differences between grades II and IV (P = .00) and grades III and IV (P = .0005), but not between grades II and III.

Conclusions:
The BPS is a useful tool for predicting surgical outcome and it may be valuable to conduct multicentric trials using this objective measurement.
Assessment of Amplitude and Control of the Distance Deviation in Intermittent Exotropia
Authors: Arnoldi Kyle A. , Reynolds James D.
Published: March 2009

Purpose:
A period of monocular occlusion (patch test) has been recommended to determine the magnitude of the distance exotropia to target with surgery. The hypothesis tested by this study was that patients with good control at distance are more likely to demonstrate tenacious distance fusion following occlusion than those with poor control. The results will assist in determining which patients require a preoperative patch test.

Methods:
This was a prospective study of 33 consecutive patients with exotropia scheduled for strabismus surgery. All had a complete sensorimotor examination in addition to measurement of convergence amplitudes and remeasurement of the strabismus following a 60-minute patch test.

Results:
The mean change in distance deviation following occlusion was 0.5 ± 0.6 prism diopters, and the median change was 0.0 prism diopters (P > .40). Eighteen percent had an increase in the distance exotropia of 5 prism diopters or more (tenacious distance fusion). Patients with poor control at distance by the cover–uncover test or convergence amplitude testing were unlikely to show tenacious distance fusion with the patch test (P < .001).

Conclusion:
The patch test may be avoided if control over the distance deviation is poor.
Lid Position Changes Following Inferior Rectus Recession
Authors: Coats David , Raab Edward
Published: March 2009

Wagner: A 54-year-old woman with thyroid ophthalmopathy underwent a 6-mm recession of the right inferior rectus muscle for right hypotropia. Although she no longer has diplopia following surgery, she is concerned about the appearance of her right eye. She says that it now appears higher to her and the right lower lid seems to be too low. She is more concerned about this than the symptoms she initially had. What is taking place here and can this be corrected?
An Epidemiological Analysis of Retinopathy of Prematurity Over 10 Years
Authors: Giannantonio Carmen , Papacci Patrizia , Molle Fernando , Lepore Domenico , Gallini Francesca , Romagnoli Costantino
Published: March 2009

Purpose:
To analyze the incidence of retinopathy of prematurity (ROP) in a single neonatal intensive care unit over 10 years to clarify its ROP profile and how it was modified by advances in neonatal care.

Methods:
Epidemiological data related to incidence and severity of ROP were collected over 10 years. Premature infants with a birth weight of less than 1,500 g underwent a screening fundus examination and ROP was defined according to the International Classification of Retinopathy of Prematurity. The survival rates and incidence of ROP were calculated and compared for two consecutive time periods (1995–1999 vs 2000–2004), dividing the study population into subgroups according to their birth weights and gestational age.

Results:
Data of 607 preterm infants were collected. Survival rate significantly improved in the later time period (from 76.6% to 88.6%). The incidence of total, severe, and surgical ROP did not differ overall in the two time periods despite changes in survival rate, although some changes occurred in the most immature infants over time.

Conclusion:
Increased survival of immature infants seemed to correlate with an increased risk for severe ROP and need for retinal ablation therapy, even if the incidence did not reach statistical significance.
Leukocoria in Children
Authors: Haider Syed , Qureshi Waseem , Ali Amanat
Published: March 2009

The aim of this study was to establish the causes of leukocoria in pediatric patients in a tertiary hospital environment. All patients younger than 10 years who presented with leukocoria between January 1, 1999, and December 31, 2000, were included in the study; 39 (55%) patients were boys and 32 (45%) patients were girls. Sixty percent of the patients who presented with leukocoria had congenital cataract (18% unilateral and 42% bilateral). Other causes included retinoblastoma (11% unilateral and 7% bilateral), retinal detachment (2.8% unilateral and 1.4% bilateral), bilateral persistent hyperplastic primary vitreous (4.2%), and unilateral Coats’ disease (4.2%). Leukocoria in children demands immediate attention because a significant number of children have pathology that either threatens life or causes permanent visual disability.
Success Rate and Cause of Failure for Late Probing for Congenital Nasolacrimal Duct Obstruction
Authors: Maheshwari Rajat
Published: March 2009

Purpose:
To evaluate the outcome of late probing for congenital nasolacrimal duct obstruction in children 2 to 6 years old and to identify the cause of failure in these children.

Methods:
Records of 65 nasolacrimal duct obstructions in 62 children (39 boys and 23 girls) aged 2 to 6 years who underwent primary probing for congenital nasolacrimal duct obstructions were evaluated. The main observations were the type of obstruction encountered during probing (complex/simple), age at the time of probing, and success rate depending on the type of obstruction. Success was the main outcome measure and was defined as complete resolution of all signs and symptoms at 1 week of follow-up. The Mann–Whitney test for statistical significance was used to compare the results between simple and complex nasolacrimal duct obstructions.

Results:
Six children had bilateral obstruction. The average age at the time of probing was 37.71 months in children with complex obstruction and 37.27 months in children with simple obstruction. Twenty-one eyes (32.20%) had complex obstruction and 44 eyes (67.69%) had simple obstruction. The success rate was 33% in children with complex obstruction and 97.72% in children with simple obstruction, which was statically significant. The overall success rate of the whole cohort was 76.92%.

Conclusion:
Older children with simple obstruction undergoing late probing had an excellent success rate in this study (97.72%). Complex obstruction is the main risk factor for failure of probing in older children. Probing is a successful and viable option in older children.
Combined Eyelid and Strabismus Surgery: Examining Conventional Surgical Wisdom
Authors: McCracken Michael S. , del Prado Jonathan D. , Granet David B. , Levi Leah , Kikkawa Don O.
Published: March 2009

Purpose:
To determine whether satisfactory results of both eyelid surgery and strabismus surgery can be obtained when these procedures are performed in the same setting in selected patients.

Methods:
Nine patients (16 eyelids) who had undergone surgery in the same setting for eyelid malposition and strabismus of the horizontal rectus muscles, with or without concurrent vertical rectus muscle surgery, were retrospectively reviewed. Eyelid malposition surgery success was defined as a postoperative margin reflex distance (MRD1) within 1 mm of the target. Strabismus surgery success was defined as a postoperative deviation within 8 prism diopters of orthophoria or a decrease in binocular diplopia if the patient had a less than 8 prism diopters deviation in primary gaze preoperatively.

Results:
Eyelid retraction repair was performed on 13 upper eyelids, levator advancement was performed on 2 eyelids, and frontalis suspension was performed on 1 eyelid. Four patients underwent bilateral medial rectus recession and the remaining 5 patients received varying strabismus surgery. Four patients received adjustable sutures. Mean follow-up was 11 months. Postoperatively, 13 of 16 eyelids (81%) achieved an MRD1 within 1 mm of the target. Eight of 9 patients (89%) demonstrated satisfactory strabismus correction.

Conclusion:
Combined eyelid malposition and strabismus surgery can be successfully performed in selected cases, particularly when the strabismus surgery involves the horizontal rectus muscles. Combined surgery is not recommended in cases that do not involve the horizontal rectus muscles.
Safety and Efficacy of Silicone Rod Frontalis Suspension Surgery for Childhood Ptosis Repair
Authors: Morris Carrie L. , Buckley Edward G. , Enyedi Laura B. , Stinnett Sandra , Freedman Sharon F.
Published: March 2009

Purpose:
To evaluate the safety and efficacy of silicone rod frontalis suspension surgery for childhood ptosis.

Methods:
The authors retrospectively studied 89 consecutive children (110 eyelids) who had silicone rod frontalis suspension surgery for ptosis at Duke University Eye Center from 1983 to 2004. Marginal reflex distance1 (MRD1) elevation of 2 mm or more (vs preoperative MRD1) was considered satisfactory. MRD1 was measured as the vertical distance from the corneal light reflex in primary gaze to the upper eyelid margin. The postoperative eyelid symmetry (≤ 1 mm = satisfactory) was the difference between the MRD1 of the surgical and fellow eyelid.

Results:
Median age at surgery was 45 months (range: 3 to 223 months) and median follow-up was 17 months (range: 1 to 88 months). Ptosis types (number of eyelids) were unilateral congenital (53), bilateral congenital (30), third nerve palsy (16), Marcus Gunn jaw wink (7), trauma (2), and myasthenia gravis (2). Median MRD1 elevation was 2 mm or greater for all ptosis types, whereas satisfactory postoperative symmetry occurred in 60% of unilateral and 100% of bilateral congenital ptosis cases (last follow-up). Complications occurred in 10 eyelids (9%) and re-operation occurred in 10 eyelids (9%).

Conclusion:
The use of silicone rod frontalis suspension surgery for ptosis repair in pediatric patients is modestly effective, with few complications and easy removal and adjustment.
Cataract Surgery in Pediatric Uveitis
Authors: Zaborowski Anthony G. , Quinn Anthony G. , Dick Andrew D.
Published: March 2009

Uveitis in children is associated with several sight-threatening ocular complications, including the formation of cataracts. The surgical management of uveitic cataracts in children is both challenging and controversial and, unlike in adult uveitic cataracts, surgery has historically been associated with poor visual outcomes. Juvenile idiopathic arthritis-associated uveitis in particular poses unique therapeutic challenges and the issue of correction of aphakia in these patients remains a contentious one. The growing use of immunotherapies and, where needed, targeted biologic agents in childhood uveitis increases our potential to implant lenses and predict outcomes. The authors review the available evidence base for the treatment of these children.
A Multicenter Comparison of Polymyxin B Sulfate/trimethoprim Ophthalmic Solution and Moxifloxacin in the Speed of Clinical Efficacy for the Treatment of Bacterial Conjunctivitis
Authors: Granet David B. , Dorfman Mark , Stroman David , Cockrum Paul
Published: March 2009

Purpose:
To compare the speed of clinical efficacy for two currently available topical antibiotics: polymyxin B sulfate/trimethoprim (polymyxin/trimethoprim) and 0.5% moxifloxacin ophthalmic solution.

Methods:
Eighty-four eyes of 56 patients younger than 18 years with a clinical diagnosis of bacterial conjunctivitis were enrolled in this multi-center study. Patients were randomly assigned to receive either 1 drop of polymyxin/trimethoprim four times daily for 7 days or 1 drop of 0.5% moxifloxacin three times daily for 7 days. Ocular signs and symptoms were evaluated at baseline and 24 and 48 hours after the start of dosing. Microbiological cultures were collected at baseline and 48 hours. Patients rated ocular symptoms and adverse events on day 7 via telephone interview. Primary efficacy assessment included relief of all signs and symptoms of bacterial conjunctivitis.

Results:
All patients but one completed all visits. At the 48-hour visit, complete resolution of ocular signs and symptoms was observed in 81% of the patients treated with moxifloxacin and 44% of the patients treated with polymyxin/trimethoprim (P = .001). No adverse events were reported.

Conclusion:
Moxifloxacin 0.5% administered three times daily is safe and cures bacterial conjunctivitis more effectively and significantly faster than polymyxin/trimethoprim dosed four times daily. The majority of patients were cured and symptom-free by 48 hours. Therefore, moxifloxacin is cost-effective and significantly more efficacious than polymyxin/trimethoprim in the speed by which it reduces the symptoms and disease transmission.
Congenital Homonymous Hemianopia and Cortical Migration Abnormalities in a Young Adult
Authors: Shinder Roman , Wolansky Leo , Turbin Roger E.
Published: March 2009

Congenital homonymous hemianopia is an uncommon entity usually diagnosed in early adulthood, with the patient having no prior knowledge of a visual field defect. The authors describe an 18-year-old woman with asymptomatic congenital homonymous hemianopia and an unusual constellation of associated intracranial abnormalities.
[J Pediatr Ophthalmol Strabismus 2009;46:38–41.]
The Impact of Age-Related Vision Loss
Authors: Girdler Sonya , Packer Tanya L. , Boldy Duncan
Published: March 2009

Age-related vision loss is a condition affecting the quality of life of an ever-increasing number of older adults. The purposes of this study were to describe the impact of age-related vision loss, identify the factors that influence adaptation, and describe the perceived problem areas in the daily lives of older adults. Twenty-two older adults with vision loss participated in four focus groups. Analysis of transcripts revealed that the main themes were the impact of vision loss, factors that aid adaptation, and participation in meaningful activities. Findings from the focus group study revealed the importance of considering participants' physical loss of vision in the context of their psychological, occupational, and social worlds. This study pointed to the importance of occupation in adaptation to age-related vision loss and yielded many recommendations that could be integrated into models of low vision rehabilitation. Future research is now required to evaluate the implementation of these recommendations and further develop evidence-based practice in this field.
Tissue Glue in Sutureless Vitreoretinal Surgery for the Treatment of Wound Leakage
Authors: Batman Cosar , Ozdamar Yasemin , Aslan Ozlem , Sonmez Kenan , Mutevelli Seda , Zilelioglu Guler
Published: March 2009

Background and Objective:
To assess the surgical outcomes of the use of tissue glue to close sclerotomy sites when required and the views of ultrasound biomicroscopy of the sclerotomy sites in 23-and 25-gauge vitrectomy systems.

Patients and Methods:
A 25-gauge transconjunctival sutureless vitrectomy was performed in 38 eyes and a 23-gauge transconjunctival sutureless vitrectomy was performed in 46 eyes for various vitreoretinal diseases. Wound leakage occurred at the sclerotomy sites at the end of the surgery in 6 eyes with 23-gauge transconjunctival sutureless vitrectomy and 7 eyes with 25-gauge transconjunctival sutureless vitrectomy. The sclerotomy sites were closed by using tissue glue to prevent wound leakage and evaluated with ultrasound biomicroscopy postoperatively.

Results:
No wound leakage was observed at the end of the surgical procedure or during the follow-up period. Abnormal fibrous ingrowth was not detected at the sclerotomy sites by means of ultrasound biomicroscopy.

Conclusion:
The results demonstrated the efficacy of tissue glue for closing site ports when wound leakage is observed in transconjunctival sutureless vitreoretinal surgery.