bluuebunny/crossref_metadata_2025 huggingface dataset:
Emulating Simulations of Cosmic Dawn for 21 cm Power Spectrum Constraints on Cosmology, Reionization, and X-Ray Heating
Authors: Kern Nicholas S. , Liu Adrian , Parsons Aaron R. , Mesinger Andrei , Greig Bradley
Published: October 2017

Current and upcoming radio interferometric experiments are aiming to make a statistical characterization of the high-redshift 21 cm fluctuation signal spanning the hydrogen reionization and X-ray heating epochs of the universe. However, connecting 21 cm statistics to the underlying physical parameters is complicated by the theoretical challenge of modeling the relevant physics at computational speeds quick enough to enable exploration of the high-dimensional and weakly constrained parameter space. In this work, we use machine learning algorithms to build a fast emulator that can accurately mimic an expensive simulation of the 21 cm signal across a wide parameter space. We embed our emulator within a Markov Chain Monte Carlo framework in order to perform Bayesian parameter constraints over a large number of model parameters, including those that govern the Epoch of Reionization, the Epoch of X-ray Heating, and cosmology. As a worked example, we use our emulator to present an updated parameter constraint forecast for the Hydrogen Epoch of Reionization Array experiment, showing that its characterization of a fiducial 21 cm power spectrum will considerably narrow the allowed parameter space of reionization and heating parameters, and could help strengthen Planck's constraints on

. We provide both our generalized emulator code and its implementation specifically for 21 cm parameter constraints as publicly available software.
Measurements of Physical Parameters of White Dwarfs: A Test of the Mass–Radius Relation
Authors: Bédard A. , Bergeron P. , Fontaine G.
Published: October 2017

We present a detailed spectroscopic and photometric analysis of 219 DA and DB white dwarfs for which trigonometric parallax measurements are available. Our aim is to compare the physical parameters derived from the spectroscopic and photometric techniques, and then to test the theoretical mass–radius relation for white dwarfs using these results. The agreement between spectroscopic and photometric parameters is found to be excellent, especially for effective temperatures, showing that our model atmospheres and fitting procedures provide an accurate, internally consistent analysis. The values of surface gravity and solid angle obtained, respectively, from spectroscopy and photometry, are combined with parallax measurements in various ways to study the validity of the mass–radius relation from an empirical point of view. After a thorough examination of our results, we find that 73% and 92% of the white dwarfs are consistent within 1σ and 2σ confidence levels, respectively, with the predictions of the mass–radius relation, thus providing strong support to the theory of stellar degeneracy. Our analysis also allows us to identify 15 stars that are better interpreted in terms of unresolved double degenerate binaries. Atmospheric parameters for both components in these binary systems are obtained using a novel approach. We further identify a few white dwarfs that are possibly composed of an iron core rather than a carbon/oxygen core, since they are consistent with Fe-core evolutionary models.
Electromagnetic Forces on a Relativistic Spacecraft in the Interstellar Medium
Authors: Hoang Thiem , Loeb Abraham
Published: October 2017

A relativistic spacecraft of the type envisioned by the Breakthrough Starshot initiative will inevitably become charged through collisions with interstellar particles and UV photons. Interstellar magnetic fields would therefore deflect the trajectory of the spacecraft. We calculate the expected deflection for typical interstellar conditions. We also find that the charge distribution of the spacecraft is asymmetric, producing an electric dipole moment. The interaction between the moving electric dipole and the interstellar magnetic field is found to produce a large torque, which can result in fast oscillation of the spacecraft around the axis perpendicular to the direction of motion, with a period of ∼0.5 hr. We then study the spacecraft rotation arising from impulsive torques by dust bombardment. Finally, we discuss the effect of the spacecraft rotation and suggest several methods to mitigate it.
Precessing Jet and Large Dust Grains in the V380 Ori NE Star-forming Region
Authors: Choi Minho , Kang Miju , Lee Jeong-Eun , Tatematsu Ken’ichi , Kang Sung-Ju , Sayers Jack , Evans II Neal J. , Cho Jungyeon , Kwon Jungmi , Park Geumsook , Ohashi Satoshi , Yoo Hyunju , Lee Youngung
Published: October 2017

The V380 Ori NE bipolar outflow was imaged in the SiO and CO

lines, and dense cores in L1641 were observed in the 2.0–0.89 mm continuum. The highly collimated SiO jet shows point-symmetric oscillation patterns in both position and velocity, which suggests that the jet axis is precessing and the driving source may belong to a non-coplanar binary system. By considering the position and velocity variabilities together, accurate jet parameters were derived. The protostellar system is viewed nearly edge-on, and the jet has a flow speed of ∼35 km s−1 and a precession period of ∼1600 years. The CO outflow length gives a dynamical timescale of ∼6300 years, and the protostar must be extremely young. The inferred binary separation of 6–70 au implies that this protobinary system may have been formed through the disk instability process. The continuum spectra of L1641 dense cores indicate that the emission comes from dust, and the fits with modified blackbody functions give emissivity power indices of β = 0.3–2.2. The emissivity index shows a positive correlation with the molecular line width, but no strong correlation with bolometric luminosity or temperature. V380 Ori NE has a particularly low value of β = 0.3, which tentatively suggests the presence of millimeter-sized dust grains. Because the dust growth takes millions of years, much longer than the protostellar age, this core may have produced large grains in the starless core stage. HH 34 MMS and HH 147 MMS also have low emissivity indices.
A reciclagem do lixo urbano como fonte de renda, e a preservação dos recursos naturais e ambientais
Authors: Nascimento Alair Ambrósio do , Oliveira Rafael Jesus de , De Menezes José Elmo
Published: October 2017

Este estudo tem por objetivo discutir os impactos sociais e de renda causados pela reciclagem do lixo urbano na cidade de Goiânia, a partir da reutilização da matéria prima aplicada na elaboração de novos produtos próprios para o consumo humano, e os benefícios causados ao meio ambiente com a preservação das fontes de recursos naturais, e a redução da disposição inadequada do lixo no solo. O trabalho pesquisou a atuação das cooperativas de catadores de materiais recicláveis sob os seguintes aspectos: estrutura física das cooperativas, as condições de trabalho dos cooperados, a formação das cooperativas em redes, as parcerias firmadas com poder público municipal, os aspectos documental e legal.  A pesquisa utilizada foi de natureza exploratória qualitativa e quantitativa, o universo de atores entrevistados foi composto por membros da Prefeitura Municipal de Goiânia, como representantes da Agencia Municipal do Meio Ambiente (AMMA), e da Companhia de Urbanização de Goiânia (COMURG), Membro da Incubadora Social da Universidade Federal de Goiás (UFG), e representantes das quatorze cooperativas de catadores de materiais recicláveis cadastradas pela Prefeitura Municipal de Goiânia.
Método complementar para análise de investimentos em imobilizados
Authors: Carraro Nilton Cezar , Lima Carlos Roberto Camello
Published: October 2017

Com a economia cada vez mais globalizada, as empresas precisam ser competitivas para continuarem existindo e, nesse sentido, investir é fundamental. Com essa percepção, este trabalho busca alternativas aos processos de análise de investimento em ativo imobilizado. Entendida essa relação e não identificando na literatura pesquisada nenhuma proposta que respondesse a esses questionamentos, buscou-se, como objetivo para esse trabalho, criar uma forma alternativa de análise por intermédio da engenharia de produção e técnicas decorrentes, proporcionando a gestores e empresários um maior campo de visão na tomada de decisão de investimentos dessa natureza. Na estratégia de operações, encontrou-se respostas por meio dos objetivos de desempenho, o que possibilitou a criação de um fluxograma de análise, permitindo a compilação da análise financeira tradicional à análise estatística. Assim, o fluxograma de análise proposto neste trabalho vem ser mais um instrumento de suporte à decisão em investimentos em ativo imobilizado. Espera-se que os resultados promovidos por meio deste trabalho permitam novas pesquisas e que, de fato, as análises para investimento em ativos imobilizados doravante possam admitir esses novos preceitos.
Análise do Sistema Toyota em uma indústria de embalagens plásticas da região de Marília-SP
Authors: Detregiachi Filho Edson Detregiachi , Martins Natália Oliveira , Herrera Vânia Érica
Published: October 2017

Os sistemas de produção evoluíram significativamente, passando pelo artesanal, fordista e toyotista. Atualmente muitas empresas utilizam o Sistema Toyota de Produção, que tem como foco principal eliminar todo e qualquer desperdício que não agregam valor à produção para aumentar a produtividade e garantir a qualidade total de seus produtos. Como técnicas e ferramentas desse sistema podem ser citados o Just in Time, que tem a proposta de produzir bens e serviços no momento em que são necessários para atender a necessidade de seus clientes, a Autonomação que visa dar autonomia ao trabalhador sempre que houver necessidade e o Kaizen que tem como foco a melhoria contínua do processo produtivo entre outros. Este trabalho visa analisar a aplicação do Sistema Toyota de Produção em uma indústria de embalagens plásticas da região de Marília-SP, a fim de analisar os impactos positivos e negativos sofridos pela empresa na execução deste sistema. Os métodos de pesquisa utilizados foram pesquisa exploratória, com o levantamento de artigos e autores relevantes da área e leitura do material, e estudo de caso por meio de entrevistas realizadas na empresa em estudo. Esse trabalho obteve como principais resultados a otimização da produção com qualidade, redução de custos, redução de estoques, além da redução de desperdícios através da aplicação de ferramentas do Sistema Toyota de Produção.
Otimização da produtividade através da redução do tempo de setup em terminais de cartão de crédito
Authors: Santos Edilaine Gomes , Calipo Elthon Rodrigues , Gontijo Tiago Silveira
Published: October 2017

A necessidade de sobrevivência das empresas no mundo globalizado resulta numa busca constante por métodos e técnicas que reduzam e eliminem os desperdícios da produção, além de proporcionar maior satisfação aos seus clientes. Na busca em aumentar a eficiência da produtividade, na personalização dos terminais de cartão de crédito, utilizou-se a Metodologia Troca Rápida de Ferramentas (TRF), que é referência pela sua capacidade de reduzir o tempo de setup no chão de fábrica, e a utilização da ferramenta de qualidade Diagrama de Ishikawa para identificar as raizes do problema. O estudo de caso foi realizado em uma empresa do ramo de Eletroeletrônica localizada na região metropolitana de Belo Horizonte. Durante o estudo foi implementado os estágios conceituais da TRF e obteve resultados satisfatórios, em destaque a redução de 51% no tempo de setup, padronização das atividades e o ganho efetivo na otimização do processo de personalização de terminais de Cartão de Crédito.
O cenário da logística reversa em empresas multinacionais do município de Ponta Grossa-PR de 2010 e 2012
Authors: Pilatti Luís Eduardo , Picinin Claudia Tania , Nascimento Revenli Fernanda
Published: October 2017

A Logística Reversa (LR) ganhou impulso em todo o mundo devido à consciência global da degradação ambiental e do esgotamento dos recursos naturais. O presente artigo tem como objetivo apresentar o cenário da LR de sete empresas multinacionais do município de Ponta Grossa-PR de 2010 e 2012, de maneira adicional, avaliar o faturamento das empresas com relação as quantidade de práticas de LR com a quantidade de atividades com produtos retornados adotadas pelas mesmas. Requisitos essenciais – como a caracterização da empresa, faturamento, gestão de planejamento para produtos retornados, barreiras para uma gestão eficiente, avaliação do uso da logística reversa, foram abordados no trabalho por meio de um questionário aplicado em dois períodos: nos anos de 2010 e 2012. Todas as empresas contatadas responderam o questionário nas duas etapas. Os dados foram avaliados através da correlação de Spearman, considerando que estas variáveis apresentaram dados não normais. Porem os dados se mostraram significativos da relação faturamento e as atividades da LR.
Indicadores de design para a valorização dos resíduos da construção civil, da Indústria sucroalcooleira e da rizicultura no Maranhão
Authors: Lucca André De Souza , Oliveira Pâmela Nascimento , Schalcher Lucas Franco Corrêa , Moraes Letícia Fernanda Brito
Published: October 2017

Baseado nos trabalhos de Levantamento Bibliográfico Narrativo e de Revisão Bibliográfica Sistemática, o presente texto apresenta os resultados relativos a valorização dos resíduos da construção civil, da indústria sucroalcooleira e da rizicultura no Maranhão contidos no relatório técnico de pesquisa sobre as estratégias de design para a valorização dos recursos e produtos locais no território maranhense. A pesquisa teve como objetivo desenvolver um estudo para promover a competitividade das microrregiões maranhenses através da valorização do patrimônio natural local sob a ótica do design sustentável. Este trabalho reflete a premissa de que o uso sustentável da grande diversidade de recursos naturais presentes no estado do Maranhão pode gerar riqueza e melhorar a qualidade de vida de grande parte da população local envolvida com os processos de reaproveitamento, reciclagem e reutilização de resíduos. Como resultado, este trabalho estabeleceu indicadores de design para a valorização dos resíduos da construção civil, da indústria sucroalcooleira e da rizicultura no Maranhão.
Geração de energia elétrica por meio de fontes de energias renováveis: uma revisão sistemática da literatura sobre energia eólica
Authors: Braz Carlos Alberto , Rodrigues Reinaldo Luan , Siqueira Hugo Valadares
Published: October 2017

O presente estudo tem como objetivo geral a realização de uma revisão da literatura sobre a geração de energia elétrica por meio de energia eólica, bem como ilustrar as principais vantagens e desvantagens de se gerar tal energia. As fontes renováveis de energia são aquelas inesgotáveis, pois são encontradas na natureza em grande quantidade ou que possuem a capacidade de regeneração por meios naturais. Denomina-se energia eólica a energia cinética contida nas massas de ar em movimento (vento). Seu aproveitamento ocorre por meio da conversão da energia cinética de translação em energia cinética de rotação, com o emprego de turbinas eólicas, também denominadas aerogeradores, para a geração de eletricidade. Assim conclui-se que os estudos sobre geração de energias renováveis, mais especificamente a geração de energia eólica pode se tornar uma alternativa rentável e bem menos impactante do ponto de vista ambiental. Além de ser uma fonte infinita de geração.
Agricultura de precisão: inovação para a produção mundial de alimentos e otimização de insumos agrícolas
Authors: Artuzo Felipe Dalzotto , Foguesatto Cristian Rogério , Silva Leonardo Xavier da
Published: October 2017

A agricultura de precisão (AP) é uma inovação tecnológica que possibilita racionalizar o uso dos recursos naturais e insumos agrícolas, melhorando a eficiência no processo produtivo. Nesse sentido, o artigo tem por objetivo analisar o impacto da agricultura de precisão (AP): (a) na produção de alimentos e (b) no uso de fertilizantes. O estudo é estruturado por pesquisa bibliográfica com utilização de dados secundários. As variáveis analisadas foram: (a) produtividade (kg/ha) e (b) uso de fertilizantes agrícolas (kg/ha), tendo-se como base a cultura da soja. A adoção da AP pode ser difundida como uma alternativa para aumentar a produção de alimentos, considerando avaliações sobre a cultura da soja e, além disso, diminuir o uso de fertilizantes, de forma a interferir positivamente sobre a gestão dos recursos naturais.
Tecnologias sociais: panorama da Universidade Federal do Rio Grande do Norte
Authors: Sousa Denner Santiago de
Published: October 2017

A pesquisa empreendida consiste no mapeamento e avaliação dos projetos voltados a Tecnologias Sociais (TS) da Universidade Federal do Rio Grande do Norte (UFRN) no período de 2003 a 2014. A partir do levantamento de dados dos projetos de pesquisa, extensão e ações associadas registrados no Sistema Integrado de Gestão de Atividades Acadêmicas (SIGAA), o estudo seccionou os projetos nos índices SIM e NÃO CLASSIFICADOS – este subdividido em Não, Dialoga e Falta Informação. Em seguida, houve entrevistas com os executores universitários de 10 projetos identificados como TS com o objetivo de complementar as informações da triagem inicial. Dos 108 projetos levantados, identificou-se 15 como TS, 12 dialogam com o conceito, 22 não apresentaram suficiente informação e 59 não são TS. Os três principais fatores de exclusão para os projetos que tratavam de aplicação tecnológica foram 1) plano de trabalho pouco ou não participativo; 2) cronograma de ações impositivo e 3) dependência técnica.
Melhores programas de incubação em universidades da América Latina
Authors: Silva Amanda Luiza Soares , Cruz Cleide Ane Barbosa da , Gomes Iracema Machado de Aragão , Paixão Ana Eleonora Almeida
Published: October 2017

As incubadoras universitárias são centros de inovação utilizadas para ensinar aos alunos, aos professores e aos funcionários habilidades empreendedoras e apoiar na criação de negócios. O estudo foi caracterizado como descritivo e qualitativo. O método utilizado foi a pesquisa documental nos sites dos programas de incubação e do governo do México, Chile, Brasil, Peru e Colômbia, apontados pela UBI Global, organização que ajuda incubadoras e aceleradoras em 70 países. O período de pesquisa foi entre Maio e Junho de 2016. O objetivo geral é descrever as principais práticas de incubação das melhores incubadoras universitárias da América Latina. Os principais resultados incluíram práticas de incubação, tais como, a capacitação empreendedora, a assessoria à Propriedade Intelectual – PI, a formação de redes de negócios, a consultoria, a tutoria e a mentoria com profissionais qualificados, a elaboração de planos de negócios, os estudos de viabilidade técnica, os estudos de impacto social e econômico, os programas de internacionalização e a interação Universidade-Empresa-Governo - UEG.
Planejamento estratégico situacional: o caso da incubadora de bases biotecnológica da UFT
Authors: Rodrigues Waldecy , Mota Sobrinho Alexsandro , Cançado Airton Cardoso , Castro Fabiula
Published: October 2017

A pesquisa objetiva aplicar o Planejamento Estratégico Situacional (PES) na dinamização da incubadora de base biotecnológica da Universidade Federal do Tocantins (UFT) no Campus Gurupi.  Para tanto, apresenta a metodologia PES e faz também uma discussão acerca de sua implementação e os principais resultados das ações estratégicas desenvolvidas.   Com a aplicação do método foi possível diagnosticar os principais pontos críticos da Incubadora e propor soluções estruturadas para sua solução.  Por fim, pode-se concluir que o PES se apresenta como uma técnica de planejamento bastante valiosa e com grande potencial para o desenvolvimento prático em organizações públicas flexíveis e adaptativas como foi o caso deste estudo.
Pediatric Somatic Symptom Disorder: An Overview
Authors: Sharma Neha , Daley Mary , Vente Teresa
Published: October 2017

Prevalence estimates of somatic symptom disorder (SSD) in the pediatric population are highly variable, due in part to the evolution of terminology and diagnostic criteria used to define the illness. The likelihood of encountering patients with somatic symptoms is quite high regardless of specialty, as it is well-established that SSD is associated with significant health care use across all settings. The diagnostic uncertainty inherent to SSD can lead to frustration and distrust of the health care system, creating substantial challenges in maintaining a strong therapeutic alliance. Mental health consultation concomitant with medical testing can expedite the diagnostic process, foster a therapeutic alliance, and help build trust with the team of providers, while providing support for children and their families. The recommended treatment is a multidisciplinary approach with an emphasis on symptomatic relief and return of function, while avoiding any excessive medical testing or treatment.

[
Psychiatr Ann.
2017;47(10):507–511.]
Obsessive-Compulsive Disorder in Children and Adolescents: An Overview
Authors: Albanna Ammar , Bazaid Khalid , Azeem Muhammad Waqar
Published: October 2017

Pediatric obsessive-compulsive disorder (OCD) is a complex neuropsychiatric disorder that is characterized by the presence of distressing and impairing recurrent obsessions and/or compulsions. OCD affects up to 4% of children and adolescents, and constitutes a significant societal burden and causes marked distress and functional impairments in affected people and their families. The assessment of pediatric OCD should comprehensively capture comorbid conditions. Cognitive-behavioral therapy (CBT) is the first-line treatment for pediatric OCD. For moderate to severe cases, CBT may be combined with pharmacological treatment. First-line medications for pediatric OCD are selective serotonin reuptake inhibitors, and the US Food and Drug Administration has approved fluoxetine, sertraline, and fluvoxamine for use in pediatric OCD. Most children with OCD achieve remission or significant improvement in their symptoms.

[
Psychiatr Ann.
2017;47(10):512–518.]
Generalized Anxiety Disorder in Children and Adolescents: An Update
Authors: Imran Nazish , Haider Imran Ijaz , Azeem Muhammad Waqar
Published: October 2017

Generalized anxiety disorder (GAD), despite being among the most common psychopathology of children and adolescents, often goes undetected and untreated. GAD is characterized by excessive worry for more than 6 months about a variety of situations, events, or activities (especially school performance among children), inability to control the worry, and presence of at least one physical symptom. The interplay of various risk factors (genetic, environmental, and psychosocial) and protective factors is seen in youth with GAD, and comorbidity is common. GAD is associated with significant distress and disability independent of comorbid disorders. A multimodal approach that includes psychoeducation, psychological therapies (in particular cognitive-behavioral therapy), family therapy, and pharmacological treatment provides the best outcome for children and adolescents with GAD.

[
Psychiatr Ann.
2017;47(10):497–501.]
Understanding End-of-Life Decision-Making Terminology Among African American Older Adults
Authors: Moss Karen O. , Deutsch Nancy L. , Hollen Patricia J. , Rovnyak Virginia G. , Williams Ishan C. , Rose Karen M.
Published: October 2017

The purpose of the current study was to examine understanding of end-of-life (EOL) decision-making terminology among family caregivers of African American older adults with dementia. This qualitative descriptive study was part of a larger mixed-methods study from which a subset of caregivers (
n
= 18) completed interviews. Data were analyzed using descriptive statistics and content analyses guided by methods of qualitative analysis. Caregiver interpretation of EOL decision-making terminology varied between associations before and/or after death. EOL decision making was most often a family decision, based on past experiences, and included reliance on resources such as faith or spirituality and health care providers. Patients and families attach meaning to health care terms that should be aligned with health care providers' understanding of those terms. Results provide insight to improve EOL decision making in this population via tailored interventions for patients, families, and health care providers. [
Journal of Gerontological Nursing, 44
(2), 33–40.]
Superior Capsular Reconstruction
Authors: Hartzler Robert U. , Burkhart Stephen S.
Published: October 2017

Superior capsular reconstruction (SCR) of the shoulder has recently gained popularity as an option for joint-preserving shoulder surgery for patients with an irreparable rotator cuff tear. In the absence of glenohumeral arthritis, rotator cuff tear irreparability should only be diagnosed for most patients after a careful diagnostic arthroscopy. Superior capsular reconstruction adds biological, passive, superior constraint to the glenohumeral joint, thereby optimizing the rotator cuff force couples and improving joint kinematics. At short-term follow-up, SCR has been shown to be effective for pain relief and restoration of active shoulder motion, even in the worst cases of shoulder dysfunction (true shoulder pseudoparalysis). The rapid early adoption and expansion of SCR is justified by its excellent anatomical, biomechanical, and short-term clinical results. The techniques for arthroscopic SCR using dermal allograft continue to improve; however, the operation remains technically demanding. Patients with risk factors for irreparability and who might benefit from reconstruction of the superior capsule should be counseled about the operation as an additional, joint-preserving procedure that can be done in conjunction with arthroscopic, partial rotator cuff repair. [
Orthopedics.
2017; 40(5):271–280.]
The Treatment of Congenital Nasolacrimal Duct Obstruction in Children: A Retrospective Review
Authors: Eustis H. Sprague , Nguyen An H.
Published: October 2017

Purpose:

To compare success and extrusion rates of the monocanalicular and bicanalicular Crawford intubation systems (JEDMED Instrument Company, St. Louis, MO).

Methods:

A retrospective review of all children who were diagnosed as having congenital nasolacrimal duct obstruction and treated with lacrimal intubation from 2005 to 2014 was performed. The total number of eyes included was 168 (75 and 93 right and left eyes, respectively). Bicanalicular intubation was used in 80 eyes (bicanalicular group) and monocanalicular intubation was used in 88 eyes (monocanalicular group).

Results:

Success occurred in 63 (78.75%) and 82 (93.18%) eyes in the bicanalicular and monocanalicular groups, respectively (
P
= .00653). Extrusion occurred in 24 (30%) and 11 (12.5%) eyes, respectively (
P
= .00528).

Conclusions:

Monocanalicular intubation for congenital nasolacrimal duct obstruction is superior to bicanalicular intubation. Extrusion and reoperation rates are significantly lower.

[
J Pediatr Ophthalmol Strabismus
. 2018;55(1):65–67.]
The Efficacy of Bilateral Lateral Rectus Recession According to Secondary Deviation Measurements in Unilateral Exotropic Duane Retraction Syndrome
Authors: Mezad-Koursh Daphna , Leshno Ari , Klein Ainat , Stolovich Chaim
Published: October 2017

Purpose:

To evaluate the surgical results of asymmetric bilateral lateral rectus recession in exotropic Duane retraction syndrome with abnormal face turn toward the opposite side according to secondary deviation measurements.

Methods:

Retrospective chart review.

Results:

Seven cases of unilateral exotropic Duane retraction syndrome were reviewed. All cases had globe retraction on adduction and exotropia with limited adduction, five of which also had mild limitation of abduction. Four cases had upshoot/downshoot on adduction and all patients had face turn. Exotropia was measured in forced primary position. The average lateral rectus recession was 6.36 mm (range: 5.5 to 7.5 mm) in the affected eye and 7.36 mm (range: 6.5 to 8.5 mm) in the healthy eye. The mean follow-up period was 282 days. Mean exotropia in the forced primary position improved from 27.9 ± 5.7 prism diopters (PD) preoperatively to 7.9 ± 16.8 PD postoperatively (
P
= .025). Head position resolved completely in all but one case (
P
=.031). There were no significant changes in ductions.

Conclusions:

The results suggest that asymmetric bilateral lateral rectus recession in exotropic Duane retraction syndrome with abnormal head turn posture successfully eliminates abnormal head turn posture and exotropia in most cases.

[
J Pediatr Ophthalmol Strabismus
. 2018;55(1):47–52.]
Optical Coherence Tomography–Assisted Limbal Dermoid Removal
Authors: Evans Jacob A. , Ko Ashley , Larson Scott A.
Published: October 2017

This report and accompanying video show the novel use of intraoperative optical coherence tomography (OCT) in the excision of a limbal dermoid. Examining for residual opaque tissue in the cornea accompanied by OCT imaging is a useful technique to confirm complete excision of the lesion.

[
J Pediatr Ophthalmol Strabismus
. 2017;54:e58–e59.]
Endophthalmitis Following Pediatric Cataract Surgery: An International Pediatric Ophthalmology and Strabismus Council Global Perspective
Authors: Gharaibeh Almutez M. , Mezer Eedy , Ospina Luis H. , Wygnanski-Jaffe Tamara
Published: October 2017

Purpose:

To compile international data on the risk factors, diagnosis, and treatment of endophthalmitis following pediatric cataract surgery.

Methods:

An e-mail containing a link to an online survey was sent to all members of the American Association for Pediatric Ophthalmology and Strabismus. The questionnaire examined the incidence, risk factors, treatment, outcomes, and prophylaxis of endophthalmitis following pediatric cataract surgery around the world.

Results:

Two hundred thirty-seven ophthalmologists answered the questionnaire. Eight ophthalmologists (3.4%) encountered 22 cases of endophthalmitis following pediatric cataract surgery during their practice. Most patients with endophthalmitis following pediatric cataract surgery were 2 to 4 years of age (36.4%). An intraocular lens was implanted in 59.1% of cases, most of which were acrylic intraocular lenses (53.8%). The main presenting symptoms were photophobia (50%) and pain (40.9%). The most common signs were conjunctival injection (36.4%) and hypopyon (31.8%). The final visual acuity was counting fingers or worse in 86% of cases. The most common cultured organism was
Staphylococcus aureus
(31.8%). The most common management of endophthalmitis following pediatric cataract surgery was a combination of intravitreal, systemic, and topical antibiotics (36.4%). Most ophthalmologists (68.2%) administered prophylactic intracameral antibiotic treatment during surgery and 50% used vancomycin.

Conclusions:

Endophthalmitis following pediatric cataract surgery is an uncommon, multifactorial complication with poor visual prognosis. Efforts directed at minimizing its risk, such as treating potential predisposing systemic conditions, improving sterilization techniques, optimizing operative conditions to reduce complications and surgery duration, and using subconjunctival and intracameral antibiotics, decrease its incidence. Early postoperative evaluation, subsequent follow-up visits, and keeping a high index of suspicion should facilitate the recognition of endophthalmitis following pediatric cataract surgery to avoid delaying treatment.

[
J Pediatr Ophthalmol Strabismus
. 2018;55(1):23–29.]
Anteriorization of the Normally Acting Inferior Oblique Muscles to Treat Dissociated Vertical Deviation Associated With Juvenile Glaucoma
Authors: Kassem Rehab Rashad
Published: October 2017

A case of dissociated vertical deviation, ptosis, and juvenile glaucoma is described. J deformity anteriorization of the normally acting inferior oblique muscles was chosen to preserve the superior fornix for glaucoma surgeries by avoiding superior rectus recession and to prevent narrowing of the palpebral fissure by avoiding an inferior rectus tuck.

[
J Pediatr Ophthalmol Strabismus
. 2017;54:e63–e66.]
Dignity in Older Adults With Schizophrenia Residing in Assisted Living Facilities
Authors: Robison Darlene , McInnis-Perry Gloria , Weeks Lori E. , Foley Vicki
Published: October 2017

There is a lack of nursing literature on older adults' perceptions of dignity, specifically those of older adults with schizophrenia. With the aging population, mental health services and support for older adults with schizophrenia will become a greater priority. The purpose of the current descriptive phenomenological study was to describe the meaning of the lived experience of dignity for older adults with schizophrenia residing in assisted living facilities. A purposive sample of eight older adults with schizophrenia residing in assisted living facilities participated in semi-structured interviews following the descriptive phenomenological psychological method. Five intertwined constituents were identified: (1) dignity is an intrinsic or self-regarding experience; (2) dignity is an experience that is reciprocal, extrinsic, and regards others, and is embedded in social relationships; (3) dignity can be eroded by ageism, stigma, discrimination, and alienation; (4) dignity can be interrupted when positive and negative symptoms of schizophrenia are present and misunderstood by others; and (5) dignity can be enhanced when oneself and others embrace a recovery-focused relationship. Implications for mental health nursing are provided. [
Journal of Psychosocial Nursing and Mental Health Services, 56
(2), 20–28.]
Very Late–Onset Schizophrenia-Like Psychosis: A Clinical Update
Authors: Cort Elizabeth , Meehan Jennifer , Reeves Suzanne , Howard Robert
Published: October 2017

Psychosis symptoms (delusions and hallucinations) are multifactorial in origin and, in later life, occur in the context of schizophrenia, delirium, dementia, delusional and schizophrenia-like disorders, mood disorders, and alcohol or substance abuse. The current article provides a clinical overview of very late–onset (after age 60) schizophrenia-like psychosis (VLOSLP), summarizing the literature on treatment options and reflecting on the role of psychiatric–mental health nurses (PMHNs). Increased awareness of the clinical presentation, key features, and evidence-based treatment options will assist PMHNs to confidently recognize this often under-diagnosed disorder and adopt a more assertive role in terms of engagement and follow up. Pragmatic research involving individuals with VLOSLP is required to increase the evidence base for treatment and improve outcomes of care. [
Journal of Psychosocial Nursing and Mental Health Services, 56
(1), 37–47.]
Qualitative Study of Depression Literacy Among Korean American Parents of Adolescents
Authors: Jeong Yoo Mi , McCreary Linda L. , Hughes Tonda L.
Published: October 2017

Lack of depression literacy is associated with low help-seeking behaviors for mental health care in adolescents. As parents generally determine adolescents' health care, ensuring parents can recognize depressive symptoms is crucial. The current study explored depression literacy among Korean American parents of adolescents ages 12 to 19 using a qualitative descriptive design. Semantic content analysis was performed using data from three focus group interviews conducted in 2015 with Korean American parents (10 mothers, four fathers) of adolescents. Participants lacked knowledge about the biological causes and medicinal treatment of depression. Most believed that depression cannot be fully treated, relapses occur easily, and medication is taken indefinitely. Gender influenced perceptions of symptoms. Parents often overlooked children's depressive symptoms until schools alerted them. Nursing interventions should educate parents about the biological causes of depression, strategies for addressing adolescents' symptoms, community-based professional resources, and success stories about depression treatment. [
Journal of Psychosocial Nursing and Mental Health Services, 56
(1), 48–56.]
Visual Performance With Bifocal and Trifocal Diffractive Intraocular Lenses: A Prospective Three-Armed Randomized Multicenter Clinical Trial
Authors: Kaymak Hakan , Breyer Detlev , Alió Jorge L. , Cochener Beatrice
Published: October 2017

PURPOSE:

To evaluate and compare quality of vision and reading performance outcomes after implantation of bifocal refractive-diffractive, bifocal apodized diffractive, or trifocal diffractive-refractive intraocular lenses (IOLs).

METHODS:

This randomized, prospective, three-armed multicenter (Spain, Germany, and France) trial included 104 eyes of 52 patients (mean age: 63.2 ± 7.7 years). Patients underwent cataract surgery with bilateral implantation of either AT LISA 809M (Carl Zeiss Meditec, Jena, Germany: AT LISA group, 38 eyes), AT LISA tri 839MP (Carl Zeiss Meditec: AT LISA tri group, 32 eyes), or ReSTOR SN6AD1 (Alcon Laboratories, Inc., Fort Worth, TX: ReSTOR group, 34 eyes) IOLs. Visual and refractive outcomes, depth of focus, and reading performance were evaluated at 1, 6, and 12 months postoperatively.

RESULTS:

The AT LISA tri group showed significantly better 12-month uncorrected (UIVA) and binocular distance-corrected (DCIVA) intermediate visual acuity (
P
≤ .016) than the AT LISA group. The AT LISA tri group showed a significantly better 3-month UIVA compared to the ReSTOR group (
P
= .042). Binocular uncorrected and corrected distance visual acuities were not significantly different among groups (
P
≥ .092) at the 12-month follow-up. A total of 85.3%, 90.0%, and 78.1% of eyes had a spherical equivalent within ±0.50 D in the AT LISA, AT LISA tri, and ReSTOR groups, respectively, at 12 months (
P
= .038). No statistically significant differences between the trifocal and bifocal groups were detected for reading performance (
P
≥ .055).

CONCLUSIONS:

The trifocal diffractive-refractive IOL provides enhanced intermediate visual restoration compared to bifocal diffractive-refractive or apodized diffractive IOLs. The addition of an intermediate focal point did not deteriorate far or near vision. A comparable reading performance was maintained with the trifocal lens.

[
J Refract Surg.
2017;33(10):655–662.]
Femtosecond Laser–Assisted Capsulotomy: Histological Comparison of Four Different Laser Platforms
Authors: Hengerer Fritz H. , Mittelbronn Michel , Hansmann Martin-Leo , Auffarth Gerd U. , Conrad-Hengerer Ina
Published: October 2017

PURPOSE:

To compare histological analyses of capsulotomies from different laser systems with regard to tissue alteration, laser spot formation, and energy settings.

METHODS:

Four femtosecond laser platforms approved for cataract surgery were evaluated: LenSx (Alcon Laboratories, Inc., Fort Worth, TX), Catalys (Abbott Medical Optics, Santa Ana, CA), Victus (Tecnolas/Bausch & Lomb, Munich, Germany), and LensAR (Topcon, Gamagori, Japan). Ten human anterior lens capsulotomy disks from each laser system were analyzed: five by means of light microscopy and five by transmission electron microscopy (TEM). TEM was used especially to examine the cellular and stromal changes at the cutting edges. The cellular demarcation line was measured at 15 points along the rim and statistically compared with the findings from all laser platforms. Three capsules of each laser platform were prepared for TEM to evaluate the cellular and tissue edges of the laser cuttings.

RESULTS:

All capsulotomies revealed a circular demarcation zone of different sizes along the cutting edges. Light microscopy showed a radial tissue damage of 36.0 ± 12.3
μ
m after Victus laser capsulotomy, 8.9 ± 2.9
μ
m after Catalys laser capsulotomy, 25.2 ± 5.6
μ
m after LensAR laser capsulotomy, and 39.8 ± 5.1
μ
m after LenSx laser capsulotomy. Differences between the damaged tissue zones correlated with the laser systems and their energy settings.

CONCLUSIONS:

The use of less energy and larger spot separation led to smaller collateral damaged tissue areas along the cutting edges. The aberrant laser spots along the cutting edge may result in weakening of the remaining tissue, thereby enhancing the risk for capsular ruptures during surgery.

[
J Refract Surg.
2017;33(10):670–675.]
Age-Related Changes in Corneal Astigmatism
Authors: Shao Xu , Zhou Kai-Jing , Pan An-Peng , Cheng Xue-Ying , Cai He-Xie , Huang Jin-Hai , Yu A-Yong
Published: October 2017

PURPOSE:

To analyze the changes in corneal astigmatism as a function of age and develop a novel model to estimate corneal astigmatic change according to age.

METHODS:

This was a cross-sectional study of right eyes of 3,769 individuals. Total corneal astigmatism, keratometric astigmatism, anterior corneal astigmatism, and posterior corneal astigmatism were measured by a Scheimpflug tomographer. Smoothing fitting curves of polar values of corneal astigmatism as a function of age were drawn and average changes in corneal astigmatism at different ages were calculated.

RESULTS:

Two turning points of age on total corneal astigmatism were 36 and 69 years. The average change of total corneal astigmatism toward against-the-rule astigmatism was 0.13 diopters (D)/10 years from 18 to 35 years, 0.45 D/10 years from 36 to 68 years, and decreased after 69 years, mainly caused by anterior corneal astigmatism. The mean magnitude of posterior corneal astigmatism was −0.33 D and exceeded 0.50 D in 14.27% of eyes. The vectorial difference between total corneal astigmatism and keratometric astigmatism was correlated with posterior corneal astigmatism, polar value of anterior corneal astigmatism, age, and corneal higher order aberrations (
r
= 0.636; standard partial regression coefficients were 0.479, −0.466, 0.282, and 0.196, respectively; all
P
< .001). Based on the non-linear model to estimate corneal astigmatic change with age, a formula was developed to calculate recommended correction of astigmatism according to age and astigmatic type.

CONCLUSIONS:

The rate of change of total corneal astigmatism showed a non-linear trend toward against-the-rule astigmatism, which was low at young and old age, high at middle age, and should be taken into account when performing surgery to correct astigmatism.

[
J Refract Surg.
2017;33(10):696–703.]
Pupil Dynamics Induced by Light Reflex After Posterior Chamber Phakic Intraocular Lens Implantation
Authors: Totsuka Kazuko , Ishikawa Hitoshi , Kamiya Kazutaka , Shoji Nobuyuki , Shimizu Kimiya
Published: October 2017

PURPOSE:

To assess the light reflex of the pupil after Implantable Collamer Lens (ICL) (KS-aquaPORT; STAAR Surgical, Nidau, Switzerland) implantation to determine whether the ICL implantation might affect the pupil dynamics.

METHODS:

This study examined 28 eyes of 28 consecutive patients who underwent implantation of the posterior phakic ICL for the correction of myopia and astigmatism. Patient age at the time of surgery was 31.1 ± 6.8 years (range: 25 to 42 years). Preoperative refraction was −7.38 ± 2.26 diopters (D) (range: −3.25 to −11.80 D). Light reflex was evaluated using the infrared pupillometer Iriscorder C7364 (Hamamatsu Photonics, Hamamatsu, Japan). Measured parameters included pupil diameter (D1), constriction ratio, maximum constriction velocity, maximum dilation velocity, and the time required to recover 63% of the pupil diameter (T5). At 6 months postoperatively, the authors also investigated the relationship with the amount of vault using the Pentacam (Oculus Optikgeräte, Wetzlar, Germany). Evaluations with the instrument were performed before and at 1, 3, and 6 months after surgery.

RESULTS:

There was no significant association found between any of the parameters (analysis of variance, D1:
P
= .99, constriction ratio:
P
= .59, maximum constriction velocity:
P
= .87, maximum dilation velocity:
P
= .13, T5:
P
=.57). The vault of the ICL at 6 months postoperatively was 382.1 ± 176.5
μ
m. There were no significant associations between the maximum constriction velocity, maximum dilation velocity, and amount of vaulting (Spearman correlation coefficient maximum constriction velocity:
r
= 0.07,
P
= .71, maximum dilation velocity:
r
= 0.26,
P
= .28).

CONCLUSIONS:

The light reflex of the pupillary dynamics continued to be maintained at 6 months after ICL implantation. Current findings also verified that ICL implantation had little influence on the postoperative function of the iris.

[
J Refract Surg.
2017;33(10):704–707.]
Comparison of Corneal Endothelial Cell Loss Between Two Femtosecond Laser Platforms and Standard Phacoemulsification
Authors: Al-Mohtaseb Zaina , He Xu , Yesilirmak Nilufer , Waren Daniel , Donaldson Kendall E.
Published: October 2017

PURPOSE:

To analyze and compare the changes in endothelial cell density (ECD) and cumulative dissipated energy (CDE) in patients having cataract surgery with two different femtosecond laser platforms and standard phacoemulsification.

METHODS:

This prospective non-randomized comparative study included patients scheduled to undergo cataract extraction using femtosecond laser–assisted cataract surgery (FLACS) (60 eyes) or standard phacoemulsification (60 eyes) between September 2013 and March 2016. The main outcome measures were CDE and percentage of endothelial cell loss. Comparative analysis of CDE and percentage of endothelial cell loss between the two phacoemulsification platforms with respect to conventional and FLACS techniques was performed.

RESULTS:

The CDE and the 1-month mean percentage of endothelial cell loss was 6.11 ± 3.52 and 9.06% ± 8.77% in the standard phacoemulsification group and 4.65 ± 3.61 and 6.00% ± 8.02% in the FLACS group, respectively (
P
= .039). In the subgroup analysis based on cataract grading, the CDE was significantly less in the FLACS group compared to the standard phacoemulsification group in both the early and advanced cataract group (
P
= .002). The percent decrease in endothelial cell loss was statistically lower in the FLACS group when compared to the standard phacoemulsification group in the advanced cataract subgroup (
P
= .02).

CONCLUSIONS:

FLACS pretreatment resulted in a decrease in CDE and less endothelial cell loss when compared to standard phacoemulsification. The decrease in endothelial cell loss was more prominent in the denser cataract group; thus, FLACS may be most beneficial in those cases. There was no significant difference in results between the two laser platforms.

[
J Refract Surg.
2017;33(10):708–712.]
Four-Stage Procedure for Keratoconus: ICRS Implantation, Corneal Cross-linking, Toric Phakic Intraocular Lens Implantation, and Topography-Guided Photorefractive Keratectomy
Authors: Coskunseven Efekan , Sharma Daya Papalkar , Grentzelos Michael A. , Sahin Onurcan , Kymionis George D. , Pallikaris Ioannis
Published: October 2017

PURPOSE:

To evaluate a four-stage combined treatment for keratoconus including intrastromal corneal ring segment (ICRS) implantation followed by corneal cross-linking (CXL), toric phakic intraocular lens (IOL) implantation, and topography-guided photorefractive keratectomy (TG-PRK).

METHODS:

In this retrospective interventional case series, 11 eyes of 7 patients with progressive keratoconus were treated with a four-stage procedure including the following: Keraring ICRS (Mediphacos Ltda, Belo Horizonte, Brazil) implantation followed by CXL, phakic IOL implantation, and TG-PRK (minimum 6 months between each stage). Minimum follow-up was 12 months after TG-PRK.

RESULTS:

Both mean uncorrected distance visual acuity and corrected distance visual acuity (CDVA) improved from 0.025 decimal (20/800 Snellen) and 0.093 decimal (20/215 Snellen) preoperatively to 0.68 decimal (20/30 Snellen) and 0.73 decimal (20/27 Snellen), respectively, after the combined treatment (
P
< .0001). Mean postoperative CDVA of 0.73 decimal (20/27 Snellen) was similar to preoperative contact lens CDVA of 0.72 decimal (20/28 Snellen). Mean manifest refraction spherical equivalent reduced from 16.78 ± 3.58 to 0.59 ± 0.89 diopters (
P
< .0001) and mean refractive astigmatism reduced from 5.16 ± 1.86 to 0.82 ± 0.28 diopters (
P
< .0001).

CONCLUSIONS:

This four-stage procedure appears to be an effective and safe approach for corneal stabilization and improvement of functional vision in patients with keratoconus. Larger case series with a longer follow-up are required to thoroughly evaluate the efficacy, safety, and stability of this combined approach.

[
J Refract Surg.
2017;33(10):683–689.]