bluuebunny/crossref_metadata_2025 huggingface dataset:
Deliberation-Derived Process (DDP) evaluation
Authors: Renger Ralph , Foltysova Jirina
Published: January 2018

This article describes a methodology for conducting process evaluations. The Deliberation-Derived Process (DDP) evaluation develops questions based on deliberations occurring during the planning, design and early implementation phases of a program. The steps involved in completing a DDP evaluation are described and illustrated using a few case examples. It is argued DDP evaluation is especially useful in providing targeted and timely information to assist design staff in making improvements to the quality of a program. The advantages and drawbacks of DDP evaluation are also discussed.
Illuminative Evaluation as a Method Applied to Australian Government Policy Borrowing and Implementation in Higher Education
Authors: Alderman Lyn
Published: January 2018

Any government deciding to invoke widespread change in its higher education sector through implementation of new policies impacts on every institution and all staff and students, often in both the time taken up and the heightened emotions caused. The central phenomenon that this study addresses is the process and consequences of policy changes in higher education in Australia. The aim of this article is to record the research design through the perspective (evaluation research), theoretical framework (program evaluation) and methods (content analysis, descriptive statistical analysis and bibliometric analysis) applied to the investigation of the 2003 federal government higher education reform package. This approach allows both the intended and unintended consequences arising from the policy implementation of three national initiatives focused on learning and teaching in higher education in Australia to surface. As a result, this program evaluation, also known in some disciplines as policy implementation analysis, will demonstrate the applicability of illuminative evaluation as a methodology and reinforce how program evaluation will assist and advise future government reform and policy implementation, and will serve as a legacy for future evaluative research.
Modelling the Influences of Evaluation on School Principals: Towards Evaluation Capacity Building
Authors: Ikin Kerrie , McClenaghan Peter
Published: January 2018

School reviews form part of many school systems’ evaluation frameworks, most often with the dual purpose of accountability and improvement. With some modifications, such reviews also have potential as evaluation-capacity-building activities. This article demonstrates how to create evaluation capacity building by combining formative and summative evaluation in school reviews that can deliver both accountability and school improvement. Using a traditional school-review structure as a starting-point, a new school-review strategy was developed that engaged school principals as evaluators in ways that boosted evaluation capacity in their institutions. Two groups of principals were studied. From the case study that ensued it was found that principals who advised only as team members in other principals’ schools primarily engaged in single-loop learning. On the other hand, principals in the second group had to understand and apply criteria in the evaluation of their own schools, design evaluation strategies and techniques, and later reflect critically on the quality of evaluation practices and capacities in order to improve the values and assumptions influencing their own practices. This group demonstrated engagement in an integrated and experiential learning cycle of experiencing, reflecting, thinking and acting, and hence double-loop learning. In other words, the enhanced capacity of this latter group of principals included new skills, knowledge and understandings that became embedded in the culture and practices of their schools.

This article breaks new ground by establishing the limitations of a composite model of evaluation influence derived from current literature. Further, it uses empirical data from field trials to propose a new model that emphasises the role of catalytic values and double-loop learning in situations where leaders become transformational and formative evaluators in empowered communities of practice.
A Three-Way Approach to Evaluating Partnerships: Partnership Survey, Integration Measure and Social Network Analysis
Authors: Gomez-Bonnet Florent , Thomas Margaret
Published: January 2018

An increasing number of initiatives are delivered through cross-sectoral or cross-jurisdictional partnerships. Methods to evaluate partnerships have also proliferated, but tend to focus only on particular aspects of partnerships. None alone provide a comprehensive picture of how a partnership is working. Working on commissioned evaluations of partnership initiatives, we have faced the challenge of selecting appropriate methods to gather information on partnership processes—from program or community-level partnerships to partnerships across the highest levels of government. While many partnership evaluations rely on analysis of participants’ views on how effectively the partnership works, more powerful evaluation demands methods to collect systematic quantifiable data on the actual behaviour of the partnership and how it changes over time.

We reviewed a number of quantitative methods for assessing partnership processes and outcomes. As a result, we have been adapting and trialling three data collection tools to assess different aspects of partnerships:

1 A partnership survey (adapted from the Nuffield Partnership Assessment Tool): to collect systematic feedback from participating stakeholders on key partnership dimensions.

2 An integration measure (based on the Human Services Integration Measure developed by Browne and colleagues in Canada): to assess the level of cooperation between participating partners.

3 Social network analysis (employing a sociocentric approach and analysing data using UCINET1): to collect information on interactions between individuals in the partnership.

We have found that the complementarity of these methods provides a robust and more complete picture of the processes and outcomes of partnership initiatives and can be used in combination with qualitative methods to enhance the robustness of partnership assessments.
The illogic of logic models
Authors: Kushner Saville
Published: January 2018

It is a fundamental obligation of the evaluator to support the evaluand in theorising about their initiative and their assumptions of change. Most initiatives we evaluate are fragile in some sense—often they are charting new territory that may be contested. No one finds innovation comfortable or easy—it is too complex. Finding a way into that complexity and reducing it to practical understanding is one reason for an evaluation. However, this does not go as far as to say that all such initiatives are characterised by an overarching logic (it may even be unethical to insist that there must be a logic), that is, a discrete ‘theory of change’. In fact, there may be no logic, or multiple logics. In any event, there are many ways of understanding programs and logical analysis is but one.
The case for rights-based budgeting and spending in India
Authors: Kumra Neha
Published: January 2018

The National Plan of Action for Children (Ministry of Women and Child Development, 2005) in India contained commitments to fulfil the rights of children1 in the areas of survival, development, protection and participation, while also emphasising the need for ‘child budgeting’. The Child Budget, as defined by the Government of India, is the total magnitude of budget outlays on child-specific programmes and schemes. Budgets however, can also serve as tools for advocacy, monitoring and participation and thus, facilitate rights-based monitoring and evaluation. This understanding of budgets has the potential to impact the process of budget formulation and execution throughout the institutional framework, from policy design to service delivery. Major challenges for budgets to serve rights-based monitoring and evaluation include ineffective public dissemination of budget information and a lack of understanding of the process of budget formulation and execution among stakeholder groups (children, civil society). In India, the participation of stakeholder groups in the design, implementation and monitoring processes of Child Budget formulation and execution has been minimal. This is pertinent in light of the recommendation for India by the UN Committee on the Rights of the Child, to develop rights-based initiatives to public provision of goods and services, including those designed to assist disadvantaged social groups to effectively make claims on public services.
Evaluation as an integrated management tool: Embedding an evaluator into a program
Authors: Downing Liam , Rogan Sue
Published: January 2018

In 2013, Charles Sturt University submitted a successful proposal for a $4.4 million, two-year program called Future Moves. The program aimed to raise aspirations for university study among primary and secondary school students. The Manager of Pre-Entry Programs and the Director of Academic Success at Charles Sturt University made the decision to create a dedicated evaluation position within the program—a first for the university. The ‘embedded evaluator’ position differs from an external evaluator (as an independent, external observer) and an internal evaluator (who is typically also responsible for aspects of program management).

The article demonstrates that this role has the ability to contribute greatly to knowledge of programs and the ability of program managers to make informed, evidence-based decisions in close to real time. While it could be argued that embedded evaluators are biased, the article outlines ways in which this has been addressed. The experience of the Future Moves evaluation and management team (referred to throughout the article) serves as a compelling case study of the advantages and the potential pitfalls of embedded evaluation, whilst providing program managers, funders and evaluators with valuable insight into how similar programs could be evaluated.
Gearing up for Trade—Evaluating Australia's Contribution to Trade Facilitation in South East Asia and the Pacific
Authors: Goodwins David , Negi Kanupriya , Van Diermen Peter
Published: January 2018

Trade facilitation refers to the simplification and harmonisation of international trade procedures to assist the movement of goods. It is a key factor for international trade efficiency and the economic development of countries. It has gained world prominence and recognition under the World Trade Organization's (2015) Trade facilitation agreement. Trade facilitation obstacles are now considered bigger barriers to trade than tariffs and quotas. Developing countries are increasingly looking at trade facilitation measures to enhance administrative efficiency and effectiveness, reduce costs and time to markets, and increase predictability in global trade. But how is Australia positioned to assist countries with this transition?

The Gearing up for trade evaluation assessed the effectiveness of Australia's support for trade facilitation in Asia and the Pacific, and examined whether the investments have assisted partner countries to better integrate with regional and global economies. The evaluation focussed on four major Department of Foreign Affairs and Trade (DFAT) trade facilitation investments and found that they have been effective in addressing capacity issues, encouraging pro-poor outcomes, and exemplify good global practice. To assist with future programming, the evaluation recommended some practical improvements to the DFAT program and investment managers in the use of integrated approaches, private sector engagement, gender equality and women's economic empowerment, and monitoring and evaluation.
Congenital Midline Upper Lip Sinuses
Authors: Kün-Darbois Jean-Daniel , Chatellier Anne , Paré Arnaud , Caillot Aude , Ambroise Béatrice , Bénateau Hervé , Veyssière Alexis
Published: January 2018

Congenital sinuses of the upper lip are rare congenital malformations. There have been only 40 cases described in the literature. We report 3 cases of congenital midline upper lip sinus in Caucasian children. Two of those lesions were associated with other anomalies (complete cleft palate and hemifacial macrosomia or submucous cleft palate with bifid uvula). The pathophysiology remains unexplained yet. Congenital upper lip sinuses can be considered as possible microforms of cleft-lips. Associated anomalies are frequent and must be sought. The treatment is a full excision of the sinus tract and of the skin around the punctum in order to avoid risks of recurrence.
Young Adults’ Experience of Appearance-Altering Orthognathic Surgery
Authors: Liddle Morna J. , Baker Sarah R. , Smith Keith G. , Thompson Andrew R.
Published: January 2018

Objective:

To gain an experiential account of the processes of change associated specifically with orthognathic surgery. Design: A qualitative design was used. Semistructured interviews were carried out with 7 participants approximately 1 week before and 6-8 weeks after surgery. The data were analyzed using interpretative phenomenologic analysis (IPA).

Setting:

Participants were recruited from a NHS Dental Hospital. Participants: Patients aged 16 to 25 years scheduled to undergo orthognathic surgery on both the upper and lower jaws were purposively sought to participate. Seven participants aged between 18 and 25 years and who had undergone a bimaxillary osteotomy completed interviews (5 females and 2 males).

Results:

Themes were identified in connection with the overall journey of treatment being a rite of passage; the treatment’s role in raising awareness about the anomalies in appearance; the initial shock at the changes that followed surgery; the uncertainty about treatment; the impact of actual negative reactions of others; and the role of significant others in the decision-making process.

Conclusions:

Participants described undergoing a much more complex process of adjustment to change in appearance than has been identified elsewhere within the literature, and the study highlights the nuanced fashion in which both medical and parental communication influence patient expectation and experience of surgery. There is a need to improve communication between clinicians, families, and young adults seeking orthognathic surgery. Further studies are needed to investigate the processes associated with seeking to change facial appearance resulting from other forms of dentofacial condition.
Primary Liver Cancers—Part 1
Authors: Jiang Kun , Al-Diffalha Sameer , Centeno Barbara A.
Published: January 2018

Hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) are the 2 most common primary malignant liver tumors, with hepatocellular and bile ductular differentiation, respectively. This article reviews the key histopathological findings of these 2 primary liver cancers and includes a review of the role of ancillary testing for differential diagnosis, risk stratification according to the American Joint Committee on Cancer (AJCC) staging recommendation, and a review of precancerous lesions. A literature review was conducted to identify articles with information relevant to precancerous precursors, current histopathological classification, ancillary testing, and risk stratification of primary malignant liver tumors. The histomorphology of normal liver, preinvasive precursors, primary malignancies, and morphological variants, and the utilization of ancillary tests for the pathological diagnosis are described. Dysplastic nodules are the preinvasive precursors of HCC, and intraductal papillary neoplasms of bile ducts and biliary intraepithelial neoplasia are the preinvasive precursors of CC. Benign liver nodules including focal nodular hyperplasia and adenomas are included in this review, since some forms of adenomas progress to HCC and often they have to be differentiated from well-differentiated HCC. A number of morphological variants of HCC have been described in the literature, and it is necessary to be aware of them in order to render the correct diagnosis. Risk stratification is still dependent on the AJCC staging system. The diagnosis of primary liver carcinomas is usually straightforward. Application of the appropriate ancillary studies aids in the differential diagnosis of difficult cases. The understanding of the carcinogenesis of these malignancies has improved with the standardization of the pathological classification of preinvasive precursors and studies of the molecular pathogenesis. Risk stratification still depends on pathological staging.
Atorvastatin Reduces Plasma Inflammatory and Oxidant Biomarkers in Patients With Risk of Atherosclerotic Cardiovascular Disease
Authors: Mayyas Fadia , Baydoun Duha , Ibdah Rasheed , Ibrahim Khalid
Published: January 2018

Background:

Oxidative stress and inflammation are associated with endothelial injury and coronary artery disease. Inflammatory factors that promote oxidative damage include endothelin-1 (ET-1), myeloperoxidase (MPO), and C-reactive protein (CRP). Current guidelines recommend the use of statins in patients with risk of atherosclerotic cardiovascular disease (ASCVD).

Aim:

To assess the impact of atorvastatin on plasma inflammatory and oxidant biomarkers in patients with moderate to very high risk of ASCVD.

Method:

Two hundred ten patients presented to the cardiology clinic were included and stratified into low, moderate, high, and very high risk of ASCVD. Moderate- (20 mg/d) to high-intensity (40 mg/d) atorvastatin was prescribed. Plasma levels of lipids, ET-1, CRP, MPO, total nitrite, lipid peroxides (thiobarbituric acid reactive substances [TBARS]), and superoxide dismutase (SOD) activities were measured at baseline and 12 weeks after treatment.

Result:

Relative to low-risk patients, baseline plasma inflammatory markers of CRP, MPO, ET-1, and nitrite were higher in patients with very high risk of ASCVD, whereas plasma SOD was lower (all P < .05). Use of high and moderate atorvastatin therapy significantly reduced low-density lipoprotein and total cholesterol levels, as well as plasma levels of CRP, MPO, nitrite, and TBARS, and increased plasma SOD activity in patients with moderate to very high risk of ASCVD, independent of lipid-lowering effects.

Conclusions:

Key markers of oxidative stress/inflammation such as CRP, ET-1, total nitrite, and MPO are associated with an increased risk of ASCVD. Moderate- and high-intensity atorvastatin use reduces plasma oxidative stress and inflammation regardless of ASCVD risk and independent of its lipid-lowering effect.
Engaging Young Carers With Science Through Textile-Based Crafts
Authors: Hobbs Laura Kate , Ollerenshaw Kerry
Published: January 2018

Textile-based crafts were used to engage young carers (under 18s providing care for another person) and accompanying adults in learning about underlying chemistry concepts, in an economically deprived area of northwest England; the region of the United Kingdom with the highest number of young carers. This science-crafts collaboration was supported by the Royal Society of Chemistry Outreach Fund and a British Science Week Community Grant. Feedback from participants indicated strong positive impacts on interest in and understanding of chemistry and its relevance to everyday life, social benefits, and, for accompanying adults, increased confidence in engaging young people with learning about chemistry.
Three-dimensional nonlinear coupled dynamic modeling of a tip-loaded rotating cantilever
Authors: Al-Solihat Mohammed Khair , Nahon Meyer , Behdinan Kamran
Published: January 2018

This paper presents a general three-dimensional flexible dynamic model of a tip-loaded rotating cantilever beam. For generality, the beam tip is assumed to be loaded with a rigid body with an arbitrary center of mass position, and subject to external force and moment. The coupled longitudinal (axial), bending–bending, and twist elastic motions are considered to formulate the system dynamics. The beam structural internal damping is modeled utilizing Rayleigh’s dissipation function. As well, the influence of gravity is considered. A symbolic code is developed to derive the equations of motion, and it is subsequently used to simulate the dynamics of two numerical case studies. The time response results are found to be in an excellent agreement with those reported from the literature. The effects of internal damping and coupling among the elastic motions on the system dynamic response are then investigated.
Dense Breast Notification Laws: Impact on Downstream Imaging After Screening Mammography
Authors: Horný Michal , Cohen Alan B. , Duszak Richard , Christiansen Cindy L. , Shwartz Michael , Burgess James F.
Published: January 2018

Dense breast tissue is a common finding that decreases the sensitivity of mammography in detecting cancer. Many states have recently enacted dense breast notification (DBN) laws to provide patients with information to help them make better-informed decisions about their health. To test whether DBN legislation affected the probability of screening mammography follow-up by ultrasound and magnetic resonance imaging (MRI), we examined the proportion of times screening mammography was followed by ultrasound or MRI for a series of months pre- and post-legislation. The subjects were women aged 40 to 64 years, covered by private health insurance, undergoing screening mammography from 2007 to 2014. Except for Hawaii, Maryland, and New York, DBN legislation significantly increased the probability of ultrasound follow-up in all states that implemented DBN legislation before December 2014. It also increased the probability of MRI follow-up in California, North Carolina, Pennsylvania, and Texas. The financial and access consequences merit further study.
Molecular typing of Lactobacillus brevis isolates from Korean food using repetitive element-polymerase chain reaction
Authors: Kaur Jasmine , Sharma Anshul , Lee Sulhee , Park Young-Seo
Published: January 2018

Lactobacillus brevis is a part of a large family of lactic acid bacteria that are present in cheese, sauerkraut, sourdough, silage, cow manure, feces, and the intestinal tract of humans and rats. It finds its use in food fermentation, and so is considered a “generally regarded as safe” organism. L. brevis strains are extensively used as probiotics and hence, there is a need for identifying and characterizing these strains. For identification and discrimination of the bacterial species at the subspecific level, repetitive element-polymerase chain reaction method is a reliable genomic fingerprinting tool. The objective of the present study was to characterize 13 strains of L. brevis isolated from various fermented foods using repetitive element-polymerase chain reaction. Repetitive element-polymerase chain reaction was performed using three primer sets, REP, Enterobacterial Repetitive Intergenic Consensus (ERIC), and (GTG)5, which produced different fingerprinting patterns that enable us to distinguish between the closely related strains. Fingerprinting patterns generated band range in between 150 and 5000 bp with REP, 200–7500 bp with ERIC, and 250–2000 bp with (GTG)5 primers, respectively. The Jaccard’s dissimilarity matrices were used to obtain dendrograms by the unweighted neighbor-joining method using genetic dissimilarities based on repetitive element-polymerase chain reaction fingerprinting data. Repetitive element-polymerase chain reaction proved to be a rapid and easy method that can produce reliable results in L. brevis species.
A Customer Scorned
Authors: Pugh Harrison B. , Brady Michael K. , Hopkins Lucas M.
Published: January 2018

This research examines the implications of manager reprimands of frontline employees following a service failure incident. Drawing upon social exchange theory and looking at both customer and employee reactions, three studies find that customers are more satisfied with failed service encounters when they are aware the employee was reprimanded. This effect is on par with other types of service recoveries, mediated by deontic justice perceptions and moderated by the customer’s just-world beliefs, such that high believers are more satisfied than low believers when they are told about an employee’s reprimand. Direct observation of the reprimand acts as a key boundary condition whereby customers become dissatisfied when they are present during the reprimand. Furthermore, we find that customer perceptions of frontline reprimands are tied to reprimand privacy, whereas employee perceptions are tied to reprimand civility. This research is the first to simultaneously examine the effects of workplace reprimands on customer and frontline employee satisfaction. For managers, our findings illuminate the usefulness of communicating employee reprimands to customers, thus representing a low-cost alternative to other types of recovery efforts.
Ready and Waiting: Heterosexual Men’s Decision-making Narratives in Initiation of Sexual Intimacy
Authors: Montemurro Beth , Riehman-Murphy Christina
Published: January 2018

Recent sexualities scholarship generally frames men as adhering to narratives of sexual assertion and constructions of hegemonic masculinity. However, research on masculinities notes scripts are changing and providing mixed messages regarding the expression of sexualities for heterosexual men. Given this, we look closely at sexual scripts in initiation of sexual intimacy as a means of exploring transformation in sexualities and understanding men’s interpersonal/intrapsychic narratives as expressions of masculinities. Based on in-depth interviews with sixty-nine heterosexual men, ages twenty to fifty-nine, we found that interviewees recounted feelings of readiness and desire for sex as boys and young men. We also found that though, as boys and young men, interviewees felt ready for and desired sex, yet in first experiences, they shared they were anxious and usually waited for partners to initiate or for clear clues partners were ready. Men’s accounts reflect concerns with sexual performance and the incongruence of sexual scripts at the cultural and interpersonal/intrapsychic levels, as well as a private expression of masculinity, reserved for situations with intimate partners.
Primary Vitrectomy for Rhegmatogenous Retinal Detachment: An Analysis of Failure
Authors: Richardson E.C. , Verma S. , Green W.T. , Woon H. , Chignell A.H.
Published: January 2018

Purpose

To find the cause of failure in primary vitrectomy for rhegmatogenous retinal detachment.

Methods

Retrospective review of 171 consecutive cases of RRD treated by primary pars plana vitrectomy (PPV) from a tertiary referral centre to identify the 25 cases in which surgery had failed. Detachments with giant or macula breaks at initial presentation, with proliferative diabetic retinopathy or with PVR greater than grade B were excluded.

Results

The failure rate after the first operation was 14.6% and the commonest cause of failure was missed retinal breaks, accounting for 64.3% of failures.

Conclusion

Missed retinal breaks are the commonest cause of failure of primary PPV for RRD although proliferative vitreoretinopathy may contribute to surgical failure. This re-emphasises the importance of assiduous peroperative retinal examination.
Orbital Lipogranuloma after Sinus Surgery
Authors: Rosner M. , Kurtz S. , Shelah M. , Rosen N.
Published: January 2018

Purpose

To report the treatment and histopathological findings in two cases who developed eyelid swelling, proptosis and diplopia due to orbital and lid lipogranuloma after endoscopic surgery of the maxillary and ethmoidal sinuses.

Methods

To relieve the proptosis and diplopia, debulking surgery was done on the eyelids and orbit. The tissue removed was sent for histopathological examination.

Results

The two patients improved after surgery. The eyelid swelling, proptosis and diplopia subsided and ocular movements became normal. Histopathologic examination disclosed an extensive lipogranuloma.

Conclusions

Extensive orbital and eyelid lipogranuloma causing proptosis and diplopia is a rare complication of endoscopic sinus surgery, and can be relieved by surgical debulking.
Cystoid Macular Edema in Patients with Acquired Immune Deficiency Syndrome and Cytomegalovirus Retinitis
Authors: Eid Farah M. , Muccioli C. , Rinkevicius M. , Lima L. Barata , Belfort R.
Published: January 2018

Purpose

To describe cystoid macular edema in patients with acquired immune deficiency syndrome treated with highly active anti-retroviral therapy, who had or had not already had cytomegalovirus retinitis.

Materials and Methods

Case report.

Results

Five acquired immune deficiency syndrome (AIDS) patients, successfully treated with highly active anti-retroviral therapy, were studied. Two had inactive cytomegalovirus retinitis and cystoid macular edema in both eyes. Two had inactive cytomegalovirus retinitis in both eyes and cystoid macular edema in one eye. One patient had inactive cytomegalovirus retinitis in one eye and cystoid macular edema in both eyes.

Conclusions

Cystoid macular edema may occur in AIDS patients treated with highly active anti-retroviral therapy even in cases without previous retinitis.
Ocular Findings in Sturge-Weber Syndrome
Authors: Çelebí S. , Alagöz G. , Aykan Ü.
Published: January 2018

Purpose

We reviewed the rare ocular findings of Sturge-Weber syndrome (SWS) and the results of implantation of the Ahmed valve in cases associated with glaucoma.

Methods

Seven patients (range 18 to 52 years) diagnosed as SWS were reviewed as clinical findings over two years. An anterior chamber maintainer was placed in patients with glaucoma to maintain stable intraocular pressure and minimize the risk of intraocular hemorrhage due to sudden pressure changes during surgery, when an Ahmed valve is implanted.

Results

Episcleral venous vessels were prominent in all cases. Diffuse choroidal hemangiomas were seen in three cases. Nevus of Ota was observed in only one case. Three cases had juvenile glaucoma. One also had buphthalmos. No intraocular hemorrhage or choroidal effusion was observed intraoperatively in valve-implant patients. The surgical treatment of the patients with glaucoma gave favorable outcomes.

Conclusions

Rare ocular findings such as choroidal hemangioma and nevus of Ota are sometimes seen in SWS. Drainage valve implantation, with an anterior chamber maintainer, is a good choice for treatment when surgery is done in cases with glaucoma. This method may reduce the risk of intraoperative suprachoroidal effusion and expulsive hemorrhage by stabilizing intraocular pressure within normal limits during the surgery.
Low-Dose Oral Clonidine as Premedication before Intraocular Surgery in Retrobulbar Anesthesia
Authors: Weindler J. , Kiefer R.T. , Rippa A. , Wiech K. , Ruprecht K.W.
Published: January 2018

Purpose

We investigated whether low-dosed oral clonidine premedication before elective intraocular surgery in retrobulbar anesthesia is effective in terms of anxiolysis, sedation, stable hemodynamics, lower intraocular pressure and perioperative endocrine stress response.

Methods

In a prospective, randomised, double-blind study, 44 patients scheduled for elective intraocular surgery received either 0.15 mg clonidine (n=22) or a matched placebo (n=22) orally 60 minutes before retrobulbar anesthesia. The main study parameters were sedation, anxiolysis, hemodynamics and intraocular pressure. Additionally, mediators of endocrine stress responses were measured five times, in 13 patients after clonidine and 12 after placebo.

Results

After clonidine 86% of the patients showed sedation and after placebo 90.9% showed no sedation (p<0.01). Clonidine produced effective anxiolysis (Erlanger-Anxiety-Scale: 31.6 ± 2.6 points vs. 38.1 ± 8.5 points) before the operation (p<0.01). Systolic blood pressure was significantly lower after clonidine. Effects on mean and diastolic blood pressure were small but statistically significant. Norepinephrine and cortisole plasma concentrations were significantly lower after clonidine. Intraocular pressure was significantly lower too (p<0.05). No clinically relevant adverse effects were observed e.g. inappropriate sedation, hypotension (<100 mmHg), bradycardia (<50 bpm) or hypoxemia (SpO2<90%).

Conclusions

Oral low-dose clonidine produces light sedation, significant anxiolysis and stable hemodynamics, and attenuates the endocrine response to perioperative stress. Thus, clonidine seems sufficient to increase patient comfort for intraocular surgery and might even offer clinically worthwhile benefits such as stable hemodynamics and a reduced response to perioperative stress.
Treatment of Trichiasis with Argon Laser
Authors: Başar E. , Özdemir H. , Özkan Ş. , Cicik E. , Mirzataş Ç.
Published: January 2018

Purpose

In this prospective study, argon laser photocoagulation was used to eliminate misdirected cilia. The cases were followed up to see the results and recurrences with this treatment.

Methods

60 eyelids of 45 patients with trichiasis were treated with the argon laser. After topical anesthesia a blue-green argon laser was used with 1 watt power, for 0.20 seconds, with 100 micrometer beam diameter. The beam was directed coaxially to the lash follicle to create a 2–3 mm crater and vaporization was observed. After crater formation, the laser parameters were changed to 1.2 watt power, for 0.20 seconds, with 200 micrometer beam diameter, to destroy residual follicular tissue. Up to five lashes were treated in one session. At the end of each session an antibiotic ointment was used t.i.d. for a week.

Results

Patients have been followed for 4–12 months (mean 6 months). Recurrences have been seen in 15 of 60 eyelids (25%). Laser treatment has been used with the same protocol for the cases with recurrence and results have been successful in eight of them. Post-operatively severe pain, hemorrhage, scar formation, neovascularization of lid margin, or infection were not seen in any patient. In three cases mild hypopigmentation and in three other cases mild lid notching were observed.

Conclusions

Argon laser lash ablation can be done as an effective office procedure with topical anesthesia. The advantages include low recurrence and complication rates in carefully selected patients and minimal postoperative discomfort.
Preoperative Gentamicin Eye Drops and Chlorhexidine Solution in Cataract Surgery. Experimental and Clinical Results
Authors: Montan P.G. , Setterquist H. , Marcusson E. , Rylander M. , Ransjö U.
Published: January 2018

Purpose

1) To evaluate the effects on the conjunctival flora of gentamicin ophthalmic eye drops 0.3%, given four times in 45 minutes, and a conjunctival rinse with 10 ml chlorhexidine 0.05% solution. 2) To investigate retrospectively the rate of endophthalmitis after cataract operations when these antimicrobials were applied preoperatively.

Methods

Seventy-six patients undergoing standard phacoemulsification operations were enrolled in the experimental part of the study. Cultures were taken preoperatively, 5 minutes after prophylaxis with either chlorhexidine or gentamicin. To assess the combined effects of chlorhexidine and gentamicin, cultures were taken after the cataract operation. Hospital charts were reviewed for cases of endophthalmitis in 1994 and 1995, when this prophylactic protocol was used at the St Erik's cataract surgery department.

Results

The conjunctival microflora was significantly suppressed by chlorhexidine rinsing alone (p = 0.001), while no other significant anti-bacterial effects were observed with the experimental prophylaxis. The endophthalmitis rate was 32/12. 806 operations (0.25%).

Conclusions

Topical rinsing with chlorhexidine solution suppresses conjunctival flora in the short term. Combined topical chlorhexidine and gentamicin prophylaxis does not eliminate postoperative endophthalmitis caused by gram-positive bacteria.
The Eye in Cystic Fibrosis
Authors: Castagna I. , Roszkowska A.M. , Famà F. , Sinicropi S. , Ferreri G.
Published: January 2018

Purpose

To investigate modifications of ocular surface and lens transparency in patients with cystic fibrosis in relation to the stage of digestive insufficiency.

Methods

Forty consecutive patients with cystic fibrosis and 24 age- and sex-matched healthy volunteers were examined. The tear tests (Schirmer's basic test, tear film break-up time) and conjunctival exfoliative cytology (CC) were used to study the ocular surface. The lens transparency was measured with the Opacity Lens Meter 701 (OLM 701, Interzeag AG, Switzerland). Digestive insufficiency was evaluated by the steatocrit method.

Results

Significant changes in conjunctival cytology and lens opacity, and abnormal tear tests were detected in CF patients; the alterations were more pronunced in patients with severe digestive insufficiency.

Conclusions

Cystic fibrosis patients present ocular surface abnormalities and lens transparency modifications and their severity is related to the digestive insufficiency. Simple, rapid and non-invasive tear tests and cytological procedures might be used as additional tests for assessing the severity of cystic fibrosis.
Ocular Ferning during the Menstrual Cycle in Healthy Women
Authors: Tatlipinar S. , Gedik Ş. , Írkeç M. , Orhan M. , Erdener U.
Published: January 2018

Purpose

The aim of the study is to investigate whether tear ferning patterns change during different phases of the menstrual cycle.

Methods

The tear ferning test was performed on twelve normal women of childbearing age at three day intervals throughout one complete menstrual cycle. Serum hormone levels (progesterone, estrogen, testosterone) were measured.

Results

Eight women showed type I ferning, and the other four had type II ferning initially. These patterns did not change during the menstrual cycle. Serum hormone levels were all in the normal range. Since no change in ferning pattern was detected during the menstrual cycle, the ferning test can be done at any time in women.

Conclusions

This study showed no effect of different menstrual cycle phases on tear ferning patterns.
The Effects of Beta-Blockers on Ocular Blood Flow in Patients with Primary Open Angle Glaucoma: A Color Doppler Imaging Study
Authors: Altan-Yaycioglu R. , Türker G. , Akdöl S. , Acunaş G. , Izgi B.
Published: January 2018

Purpose

To evaluate the effects of four commonly used beta-blockers on ocular blood flow in patients with primary open angle glaucoma (POAG).

Methods

Eighty eyes of 40 subjects with POAG were included in the study. Subjects were randomly divided into four groups given timolol maleate 0.50%, betaxolol HCl 0.50%, carteolol 1% or levobunolol 0.50% drops, applied twice daily (one drug to each group). Before beginning the treatment and at the end of the first month ocular blood flow velocity was measured using the color Doppler imaging (CDI) method. In the ophthalmic artery (OA), central retinal artery (CRA) and temporal posterior ciliary artery (TPCA) the peak systolic (PS) and end-diastolic (ED) blood flow velocities were measured and resistive index (RI) values were calculated. The results within each group were analysed using the matched paired student's t-test. The data between groups was compared with one-way analysis of variance (ANOVA) and Tukey-Kramer multiple comparison tests.

Results

The timolol group showed a significant increase in RI values of TPCA. In the betaxolol group RI decreased significantly in CRA and TPCA, whereas in the carteolol group there was a significant decrease only in CRA. In the levobunolol group there was no change in any artery.

Conclusions

Betaxolol seemed to have a greater vasodilator effect than carteolol, and levobunolol had no effect on the retinal and choroidal vasculature. Timolol may have some vasoconstrictive effect in the ciliary vasculature.
Increase of Free Oxygen Radicals in Aqueous Humour Induced by Selective Nd:YAG Laser Trabeculoplasty in the Rabbit
Authors: Guzey M. , Vural H. , Satici A. , Karadede S. , Dogan Z.
Published: January 2018

Purpose

To investigate the impact of selective Nd:YAG laser trabeculoplasty on free oxygen radicals and antioxidant enzymes of the aqueous humour in the rabbit.

Methods

One eye of 18 rabbits was subjected to 360° selective laser trabeculoplasty (LT) with a frequency-doubled Nd:YAG laser (532 nm). The anterior chamber aqueous humour was aspirated 3, 12 hours and 1, 3, 7, 10 days after treatment. Lipid peroxide (LPO) and glutathione S transferase (GST) levels and superoxide dismutase (SOD) activities of aqueous humour were measured.

Results

Concentrations of LPO in the aqueous humour of the treated eyes were significantly higher than the untreated eyes until the 7th day. Aqueous SOD activity significantly decreased 3 hours after LT and remained low until day 7. Aqueous GST levels were significantly decreased between 12 hours and 7 days after the LT.

Conclusions

Selective LT was followed by an immediate increase in the aqueous humour LPO concentration and decreases of SOD and GST in the rabbit, probably due to photo-vaporization and photodisruption caused by the frequency- doubled Nd:YAG laser. The increased aqueous LPO levels suggest that free oxygen radicals are formed in the pigmented trabecular meshwork during LT, and may be responsible for the inflammatory complications of this procedure.
Uveitis in HIV-Infected Patients
Authors: Mwanza J-C.K. , Kayembe D.L.
Published: January 2018

Purpose

To determine the prevalence of HIV infection and to find out the possible causes (associated conditions) of uveitis in HIV-infected patients.

Methods

We retrospectively analyzed the data of 581 patients with uveitis diagnosed over an 11-year period. All patients received a routine eye examination and most of them a general examination as well as complementary tests.

Results

The prevalence of HIV infection was 14.3% (89 patients). Anterior uveitis (62%) was the most frequent form, followed by posterior uveitis (22%), panuveitis (12%) and intermediate uveitis (4%). Associated conditions or causes were found in 88% of these 89 patients, the most frequent being Herpes zoster ophthalmicus (43%), tuberculosis (16%), CMV infection (12%) and toxoplasmosis (10%).

Conclusions

In HIV-infected patients uveitis is frequently associated with opportunistic infections.
Fibrinolytic Response to Retinal Detachment Surgery under General or Local Anesthesia
Authors: Malukiewicz-Wiśniewska G. , Kotschy M.
Published: January 2018

Purpose

To evaluate perioperative changes in fibrinolysis in patients undergoing retinal detachment surgery under general or local anesthesia.

Patients

Prospective study of 81 patients (43 male, 38 female), aged from 15 to 82 (mean 50.7 SD = 17.8) years, undergoing retinal detachment surgery (encirclement with scleral buckling) under general anesthesia (group A), and 14 patients (6 male, 8 female) aged from 15 to 78 (mean 52.9, SD =19.8) years, operated under local anesthesia (group B). Excluded were patients with venous or arterial disease or other factors that could change the parameters investigated.

Methods

Blood was sampled from a cubital vein one day before surgery, immediately after induction of anesthesia but before surgery, immediately after completion of the operation but before the termination of anesthesia and after the operation (on days 1 and 4). In patients' citrated plasma, tissue plasminogen activator antigen (t-PA-Ag), plasminogen activator inhibitor type 1 antigen (PAI-1 Ag) and activity (PAI-1), fibrin-fibrinogen degradation products (FDP) and euglobulin lysis time (ELT) were measured.

Results

The pattern of changes in perioperative fibrinolytic activity was similar in both groups. Intraoperative levels of FDP were significantly higher and ELT shorter than preoperatively. In both groups t-PA Ag concentration was significantly increased on the first postoperative day. There were no changes in PAI-1 in both groups. Postoperatively, the FDP concentration was reduced and ELT prolonged.

Conclusions

Retinal detachment surgery induces intraoperative activation of fibrinolysis in the systemic circulation regardless of the type of anesthesia.
Bilateral Orbital Hemorrhage Induced by Labor
Authors: Oruç S. , Şener E. Cumhur , Akman A. , Sanaç A. Şefik
Published: January 2018

We describe a woman in whom bilateral orbital hemorrhage occurred during labor. She developed sudden proptosis and complete loss of vision bilaterally. After a stillbirth, she underwent total hysterectomy because of atonic uterus and postpartum hemorrhage. The location of the hematomas was confirmed by magnetic resonance imaging. Clinical resolution occurred in one month but both eyes remained blind. Fundoscopy revealed bilateral atrophy of the optic discs.
Bilateral Glaucomatous Optic Neuropathy in Takayasu's Disease without Cervical Arterial Stenosis
Authors: Kapran Z. , Atmaca L.S. , Albayrak Z. , Uyar M. , Eltutar K.
Published: January 2018

Purpose

Although significant decrease in retinal perfusion is usually not observed before all of the cervical arteries became markedly narrowed in patients with Takayasu's disease (TD), we present bilateral glaucomatous optic neuropathy in a patient with TD without any cervical arterial stenosis.

Methods

Ophthalmoscopic examination disclosed glaucomatous optic neuropathy in both eyes with 7/10-cup/disc ratio in the right eye and 9/10 in the left eye. Left subclavian selective arteriographic examination demonstrated segmental high-grade stenosis, namely 90 percent stenosis in the mid portion of the left subclavian artery. Arteriography, digital subtraction angiography (DSA), magnetic resonance angiography (MRA) and color Doppler sonography revealed patent cervical, carotid interna, ophthalmic, retinal and posterior ciliary arteries.

Results

Patient was followed up for 48 months with frequent intervals and there was no deterioration of visual acuity, visual field and optic neuropathy without any antiglaucomatous treatment.

Conclusions

Although it is a known fact that classical ophthalmic manifestations of the TD occur only when major cervical arteries are occluded, no occlusion was observed in this patient with bilateral optic atrophy. The optic nerve damage is caused by various factors, but these factors require much elucidation before the optic neuropathy can be understood.
Comparison of Lodoxamide 0.1% Ophthalmic Solution and Levocabastine 0.05% Ophthalmic Suspension in Vernal Keratoconjunctivitis
Authors: Verin Ph. , Allewaert R. , Joyaux J.C. , Piozzi E. , Koliopoulos J. , Bloch-Michel E.
Published: January 2018

Purpose

To compare the clinical efficacy and safety of lodoxamide 0.1% ophthalmic solution with levocabastine 0.05% ophthalmic suspension, each given four times daily (QID) for three months to patients with vernal keratoconjunctivitis (VKC).

Methods

The study was conducted multinationally according to a triple-masked parallel design in 95 VKC patients, with assessments at baseline then monthly during the three months of treatment. The primary efficacy variables were a Physician's Clinical Judgement Scale and a Patient's Overall Judgement Scale of improvements from baseline. Signs and symptoms of VKC were also assessed.

Results

Both primary efficacy variables showed significantly greater overall improvement of VKC from baseline with lodoxamide than levocabastine. The superiority of lodoxamide was demonstrated by the Physician's Clinical Judgement Scale at months 2 and 3, with a trend at month 1, and by the Patient's Overall Judgement Scale at months 1, 2 and 3. All signs and symptoms of VKC improved significantly from baseline at all time points, regardless of treatment (p<0.001). However, relative to levocabastine, conjunctival discharge, photophobia and lacrimation were significantly reduced by lodoxamide at months 1, 2 and 3, itching at months 2 and 3, and bulbar conjunctiva at month 3. The temporal improvement of superior tarsal papillae did not differ significantly between treatments. Both were well tolerated.

Conclusions

Lodoxamide 0.1% and levocabastine 0.05% eye drops, instilled four times daily for three months, were effective, safe and well tolerated by patients with VKC, but lodoxamide was significantly superior to levocabastine.