bluuebunny/crossref_metadata_2025 huggingface dataset:
An Improved Channel Estimation Technique for IEEE 802.11p Standard in Vehicular Communications
Authors: Wang Tong , Hussain Azhar , Cao Yue , Gulomjon Sangirov
Published: December 2018

IEEE 802.11p based Dedicated Short-Range Communication (DSRC) is considered a potential wireless technology to enable transportation safety and traffic efficiency. A major challenge in the development of IEEE 802.11p technology is ensuring communication reliability in highly dynamic Vehicle-to-Vehicle (V2V) environments. The design of IEEE 802.11p does not have a sufficient number of training symbols in the time domain and pilot carriers in the frequency domain to enable accurate estimation of rapidly varying V2V channels. The channel estimation of IEEE 802.11p is preamble based, which cannot guarantee a suitable equalization in urban and highway scenarios, especially for longer length data packets. This limitation has been investigated by some research works, which suggest that one major challenge is determining an accurate means of updating channel estimate over the course of packet length while adhering to the standard. The motivation behind this article is to overcome this challenge. We have proposed an improved Constructed Data Pilot (iCDP) scheme which adheres to the standard and constructs data pilots by considering the correlation characteristics between adjacent data symbols in time domain and adjacent subcarriers in frequency domain. It is in contrast to previous schemes which considered the correlation in the time domain. The results have shown that the proposed scheme performs better than previous schemes in terms of bit error rate (BER) and root-mean-square error (RMSE).
Relationships between Different Field Test Performance Measures in Elite Goalball Players
Authors: Goulart-Siqueira Gabriel , Benítez-Flores Stefano , Ferreira Alexandre R. P. , Zagatto Alessandro M. , Foster Carl , Boullosa Daniel
Published: December 2018

Goalball is a Paralympic sport involving people with visual impairment. Little is known about the physical fitness of elite players of this sport, as previous studies only evaluated body composition and aerobic capacity. Thus, the aim of this study was to describe the performance of elite goalball players in different physical tests and to look for relationships between them. Eleven elite Brazilian goalball players, seven males and four females, were evaluated for body composition, maximal handgrip isometric force (MHGF), countermovement jump (CMJ), throwing velocity (TV) and the Yo-Yo intermittent recovery test level 1 (Yo-Yo IR1). Players produced 41.54 ± 8.41 kgf in MHGF, 34.81 ± 7.2 cm in CMJ, 14.21 ± 1.89 m∙s−1 in TV, and 505 ± 313 m in Yo-Yo IR1, with an estimated maximum oxygen consumption (VO2max) of 40.64 ± 2.63 mL∙kg−1∙min−1. Most performance tests exhibited moderate to high correlations among them, while the percentage of body fat correlated with both the CMJ and Yo-Yo IR1 results. The current study reveals that CMJ could be a valuable monitoring tool as it was correlated with all other performance tests. The highest correlation observed was with TV (r = 0.754; p < 0.05), which is a key capacity in goalball. Moreover, high levels of body fat could be detrimental to anaerobic performance.
Social Innovation and the Energy Transition
Authors: Hoppe Thomas , De Vries Gerdien
Published: December 2018

The transition to low carbon energy systems cannot solely rely on technological innovation. It also requires social innovation. In the context of energy transition social innovation can be defined as innovation that is social in its means and which contributes to low carbon energy transition, civic empowerment and social goals pertaining to the general wellbeing of communities. This article presents the editorial comment of the special issue “Social Innovation and the Energy Transition”. It seeks to answer the questions, “what does social innovation mean in the face of energy transition, and what are its implications?” This special issue yields 20 article contributions by authors from different academic disciplines within the behavioral and social sciences. From these contributions, key topics relevant to social innovation emerge, pertaining to: (i) technological innovation leading to new market models, actor configurations, and institutional settings creating room for social innovation; (ii) new governance arrangements; (iii) community energy, its impact, implications, and social incentives and policy to empower it; (iv) new participative research approaches to test and learn from livings labs and best practices; (v) ‘green nudges’ to stimulate behavioral change; and (vi), serious energy games. The editorial ends with suggestions for future research.
Fuzzy Measures of Multidimensional Poverty in the Mediterranean Area: A Focus on Financial Dimension
Authors: Ciani Martina , Gagliardi Francesca , Riccarelli Samuele , Betti Gianni
Published: December 2018

The main scope of the paper is to adopt a fuzzy sets approach for the measurement of multidimensional poverty over a period of eight years, from 2007 to 2015, which takes into account the effect of the 2008 economic and financial crisis. In particular, the focus is on the financial dimension of poverty, and its effects on citizens in the EU Mediterranean Area. The empirical analysis, based on the European Union—Statistics on Income and Living Conditions survey (EU-SILC), covers eight Mediterranean Countries.
Learning-Based Predictive Building Energy Model Using Weather Forecasts for Optimal Control of Domestic Energy Systems
Authors: Jeon Byung-Ki , Kim Eui-Jong , Shin Younggy , Lee Kyoung-Ho
Published: December 2018

The aim of this study is to develop a model that can accurately calculate building loads and demand for predictive control. Thus, the building energy model needs to be combined with weather prediction models operated by a model predictive controller to forecast indoor temperatures for specified rates of supplied energy. In this study, a resistance–capacitance (RC) building model is proposed where the parameters of the models are determined by learning. Particle swarm optimization is used as a learning scheme to search for the optimal parameters. Weather prediction models are proposed that use a limited amount of forecasting information fed by local meteorological centers. Assuming that weather forecasting was perfect, hourly outdoor temperatures were accurately predicted; meanwhile, differences were observed in the predicted solar irradiances values. In investigations to verify the proposed method, a seven-resistance, five-capacitance (7R5C) model was tested against a reference model in EnergyPlus using the predicted weather data. The root-mean-square errors of the 7R5C model in the prediction of indoor temperatures on all the specified days were within 0.5 °C when learning was performed using reference data obtained from the previous five days and weather prediction was included. This level of deviation in predictive control is acceptable considering the magnitudes of the loads and demand of the tested building.
Evaluation of the Influencing Factors on Job Satisfaction Based on Combination of PLS-SEM and F-MULTIMOORA Approach
Authors: Ijadi Maghsoodi Abteen , Azizi-ari Iman , Barzegar-Kasani Zahra , Azad Mehdi , Zavadskas Edmundas Kazimieras , Antucheviciene Jurgita
Published: December 2018

A primary issue that is being discussed nowadays in organizations is continuous improvement of the organization itself, because the procedure of periodic evaluation is an important tool to maintain the improvement of the organization. An essential factor in any organization is the human resources as a key asset to guide organizations to sustain their competitive advantages by employing particular knowledge and skills to form a comprehensive and sustainable human resource management. Evaluation of job satisfaction has become a part of the strategic approach toward incorporating business policies and human resource actions in modern day organizations. The current research study presents a novel hybrid validation framework to evaluate and appraise the factors influencing job satisfaction based on the fuzzy MULTIMOORA approach and partial least-squares path modeling (PLS-PM). The proposed fuzzy MCDM technique and statistical method validate each other to present an optimal assessment of influencing factors in job satisfaction. Eventually, a real-world case study in regard to influential factors in job satisfaction has been suggested in this study, to show that the proposed framework is a practical and accurate method to tackle an assessment problem in a real-world application of influencing factors in job satisfaction in a cross-industrial multi-national construction and geotechnical engineering organization in Iran.
Detection and Characterization of Enterovirus B73 from a Child in Brazil
Authors: Ribeiro Geovani de Oliveira , Luchs Adriana , Milagres Flávio Augusto de Pádua , Komninakis Shirley Vasconcelos , Gill Danielle Elise , Lobato Márcia Cristina Alves Brito Sayão , Brustulin Rafael , Chagas Rogério Togisaki das , Abrão Maria de Fátima Neves dos Santos , Soares Cassia Vitória de Deus Alves , Witkin Steven S. , Villanova Fabiola , Deng Xutao , Sabino Ester Cerdeira , Delwart Eric , Da Costa Antonio Charlys , Leal Élcio
Published: December 2018

Enterovirus B73 is a new member of the Enterovirus B species. First detected in the USA, it has been subsequently identified in China, India, Oman, and the Netherlands. In this study, we characterize the first B73 strain (named TO-127) to be detected in South America. TO-127 was obtained from a child with acute gastroenteritis living in a rural area in Northern Brazil. The subject was not infected with any known enteric pathogens such as norovirus, rotavirus, helminths, or enteric bacteria. Analysis of the nearly full-length TO-127 genome (6993 nt) indicated a 74–75% nucleotide similarity with EV-B73 strains from other countries. Evolutionary analysis suggests that B73 is endemic and widespread.
Clinical Indications and Compassionate Use of Phage Therapy: Personal Experience and Literature Review with a Focus on Osteoarticular Infections
Authors: Patey Olivier , McCallin Shawna , Mazure Hubert , Liddle Max , Smithyman Anthony , Dublanchet Alain
Published: December 2018

The history of phage therapy started with its first clinical application in 1919 and continues its development to this day. Phages continue to lack any market approval in Western medicine as a recognized drug, but are increasingly used as an experimental therapy for the compassionate treatment of patients experiencing antibiotic failure. The few formal experimental phage clinical trials that have been completed to date have produced inconclusive results on the efficacy of phage therapy, which contradicts the many successful treatment outcomes observed in historical accounts and recent individual case reports. It would therefore be wise to identify why such a discordance exists between trials and compassionate use in order to better develop future phage treatment and clinical applications. The multitude of observations reported over the years in the literature constitutes an invaluable experience, and we add to this by presenting a number of cases of patients treated compassionately with phages throughout the past decade with a focus on osteoarticular infections. Additionally, an abundance of scientific literature into phage-related areas is transforming our knowledge base, creating a greater understanding that should be applied for future clinical applications. Due to the increasing number of treatment failures anticipatedfrom the perspective of a possible post-antibiotic era, we believe that the introduction of bacteriophages into the therapeutic arsenal seems a scientifically sound and eminently practicable consideration today as a substitute or adjuvant to antibiotic therapy.
Classification of Stable Isotopes and Identification of Water Replenishment in the Naqu River Basin, Qinghai-Tibet Plateau
Authors: Chen Xi , Wang Guoli , Wang Fuqiang
Published: December 2018

The stable isotopic study of the mechanism of runoff replenishment in the Qinghai-Tibet Plateau is a time-consuming and complicated process requiring complex monitoring data and scientific evaluation methods. Based on the data of water stable isotopes (18O and 2H) in the Naqu River basin, the present paper developed a framework of the variable fuzzy evaluation model (VFEM) to provide a method to classify stable isotopes and generalize the source identification of water replenishment by rainfall or snowmelt in the Naqu River basin. The grade eigenvalues of tributaries were ranked from low to high as follows: 1, 1.005, 1.089, 1.151, 1.264, 1.455 and 2.624. Three sets of tributaries were distinguished. The grade eigenvalues of the Najinqu, Bazongqu, Mumuqu, Chengqu and Gongqu Rivers were small, indicating that these tributaries were strongly supplemented by precipitation and snowmelt; the grade eigenvalue of the Zongqingqu River was in the medium range (1.455); the third group included the Mugequ River with a high status value (2.624). This study mainly highlighted the combination of the classification of stable isotopes and plots of δ2H vs. δ18O in the source identification of water replenishment, which will be helpful for studying runoff replenishment and the evolution mechanism in the Qinghai-Tibet Plateau.
Destination Resilience and Sustainable Tourism Development
Authors: Holladay Patrick J.
Published: December 2018

Measuring the resilience of a dynamic system is a difficult undertaking. This article is an effort to present intersecting theories between destination resilience and sustainable tourism. Traditional tourism management relies on a narrow focus based in scientific approaches that are
often linear in concept. This type of thinking may lead to some limitations in planning and a full understanding of how the tourism industry operates on various scales. Resilience describes the capacity of a system to absorb change and continue to persist. Sustainability is the intersection
of social, economic, institutional, and ecological variables. In this article, a heuristic model is presented that combines and adapts Butler's Tourism Area Life Cycle and Holling's Adaptive Cycle. This heuristic model is intended to stimulate theories on destination resilience within the
context of sustainable tourism.
Examining International Food Travelers' Engagement in Behaviors to Protect Themselves From Foodborne Illnesses While Abroad
Authors: Schroeder Ashley , Pennington-Gray Lori , Mandala Laura
Published: December 2018

In recent times, food travel has continued to gain in popularity and food and beverage activities are an important consideration for travelers. According to World Food Travel Association (WFTA), more than 9 in 10 travelers are now considered to be food travelers because they have participated
in a "food or beverage experience other than dining out, at some point in the past 12 months." At the same time, travelers are an at-risk population for foodborne illnesses due to their tendency to eat out and experience local gastronomy. While health care providers and tourism service
providers can and should advise travelers on ways to mitigate foodborne risks, it is ultimately the responsibility of travelers to protect themselves. Accordingly, the purpose of this study was to investigate antecedents of food travelers' engagement in personal protective behaviors (PPBs)
related to foodborne illnesses during two phases of the travel experience: prior to and during travel. The independent variables were the extent of prior international travel experience, prior experience with foodborne illnesses, concerns about food safety, and food safety and
foodborne illness risk perceptions. Data were collected via an online panel of food travelers from the US who had traveled outside of the country at least once in their lifetime (n = 758). Results revealed that concerns about food safety were antecedents of engagement in all five PPBs.
Risk perceptions were antecedents of engagement in the during travel PPBs. The extent of prior international travel experience and prior experience with foodborne illnesses were inconsistent antecedents. The first two findings suggest that cognition (in terms of risk perceptions) is a driver
of engagement in PPBs during travel and affect (in terms of concerns) is a driver of engagement in PPBs prior to and during travel. Theoretical and practical implications, as well as limitations and suggestions for future research are discussed.
URBAN GREEN SPACES IN VIEW OF BALANCE BETWEEN SOCIAL AND ECONOMIC INTERESTS
Authors: Stauskas Vladas
Published: December 2018

When discussing the priorities and leverage in urban development, we usually use such concepts as „economic potential“, „financial investment“, „a great quantity of constructions1“, etc. However, the final result should in fact strive for human happiness, health, love for your city, wish to live there.

The urban structure of a city always contains a system of open green spaces. These areas are important not only from ecological and aesthetical point of view, but also for social communication as well as raising the economic value of plots. The paper, giving an example of contemporary development of the resort of Palanga, deals with tendencies and problems resulting from the privatization process and great mistakes in locating urbanized plots in the areas of the Lithuanian seaside. The areas, which in the Master Plan are foreseen for new parks, forests and hydroparks, started to be used for construction of private buildings.

Generally, in Lithuania not only resort areas, but also any open spaces and even outer wood areas suffer from a bad tendency to treat them exceptionally as potential plots for building construction. In the case of Palanga we meet with the danger of continuous urbanization of the seaside, what consequently means decrease of the quality of the resort as well as fall in land prices in future.

Progressive examples from foreign countries and the European Union directives are given, where the quantity of green areas in a city is considered as one of the most important criteria of its modernity and quality.

The paper is based on a continuous experience of the author and on the recent work at Institute of Architecture and Contraction on the impact of land privatization on land prices and urban development. Reasonable balance between private and public interests is nesessary, and we still lack it.
GREENERY OF FORMER MANOR SITES IN THE CONTEXT OF URBAN DEVELOPMENT
Authors: Vitkuvienė Jurga
Published: December 2018

Problems on the role of greenery of former manors in the urban structure are discussed in the paper. Importance of integrating manor greenery into an urban environment is analyzed. A few examples of relationship between manor greenery and urban structures are described. Distinguishing features of manor greenery in the context of town greenery are established. The purpose of the paper lies in discussing the following issues: usage of former manor greenery, its protection in an urbanized environment, and prospects of its usage for quantitative and qualitative urban development.
MODELLING OF EFFICIENT CITY PARK DESIGN
Authors: Makutėnienė Daiva , Žiūrienė Rytė
Published: December 2018

The design of urban parks is a complicated and intensive process. Structural design modelling and management is needed which can be efficiently realized using information technologies to reach the required results allowing to satisfy not only the demands of all groups of interest, but also aesthetical, ecological, town planning and the like requirements. Currently systems used for urban park design (GIS, landscape planning, visualization systems) can fulfil tasks which are given only by a designer. In order to use these systems more efficiently it is advisable to create an integrated design system which can incorporate design and database systems. To develop such an integrated system a model of intelligent park design should be created for transfering part of analytical work to computer, when the available data, design criterion and requirements of all groups of interest are estimated. A scheme of the basic structure of an integrated design system and some more detailed stages of design are presented in the paper.
LESSONS FROM INTERNATIONAL COMPETITION FOR VILLETTE PARK (PARC DE LA VILLETTE) IN PARIS
Authors: Pilkauskas Regimantas
Published: December 2018

In 1982 the French Government initiated an international competition for Villette Park (Parc de La Villette) in Paris. 470 projects from 38 countries were submitted for the competion. One of them was created by the Lithuanians: Augis Gučas, Regimantas Pilkauskas, Robertas Statsėnas and Gediminas Budreika. The winner of the competition was a group of authors from the USA under the leadership of an architect Bernard Tshumi. The project was created according to a postmodernistic rather than traditional park conception providing for an active function as well as a complex urban form of the Park.
SOCIAL SPACES AND DEVIATIONS OF VILNIUS CITY
Authors: Juškevičius Pranciškus
Published: December 2018

The paper analyses formation of social spaces and social deviations in Vilnius city and its regional environment, links with the localization mobility and other indications of the urban functional and physical structure, urban expansion, i e the process of metropolis formation and the quality of a living environment.
PECULIARITIES OF GENESIS, DEVELOPMENT AND VALUES OF VILNIUS HISTORIC SUBURBS
Authors: Dijokienė Dalia
Published: December 2018

The object of investigation is peculiarities of the genesis, development and values of Vilnius historic suburbs. Historic suburbs are the territories of a town which at one stage of their genesis were suburbs and their founding is interrelated with the founding of the town and which were in formation until the mid nineteenth century. The territory under study is the administrative boarders of Vilnius in 1939–1940. Most European towns no longer have such territories: they have lost their uniqueness, gradually disappeared or were destroyed during wars and have been replaced by modern urban structures and parks. In Lithuania the historic kernels of towns are still surrounded by historic suburbs. The investigation includes a chronological table presenting the development of Vilnius town, an analysis of the following urban structure elements of the suburbs: the network of streets; the structure of land holdings; the type of building-up of squares, streets and land holdings; complexes and ensembles of buildings; distinct features of the natural settings; panoramas and silhouettes; compositional links with the town’s kernel; distinctive urban and architectural features of the historic suburbs under study preserved up to date. The reasons of founding of the suburbs are defined and their types are distinguished. It is stated that historic suburbs have historic and cultural value. The values of historic suburbs play a role in the preservation of the town’s uniqueness and supplement the process of the town’s formation.
STRATEGIC ASPECTS OF DEVELOPING SPATIAL STRUCTURE OF RECREATIONAL LANDSCAPE STRENGTHENING LITHUANIA’S CULTURAL IDENTITY IN THE CONTEXT OF BALTIC STATES
Authors: Grecevičius Petras , Marčius Romas
Published: December 2018

Analysis of the potential and resources of each region in the country is necessary for improving the living conditions of an individual. The present task of the Lithuanian recreational system is to allow effective use of recreational resources on the Baltic seacoast. Recreational landscapes play an important role on which the prestige of a country depends. Its foreign visitors have an influence on appearance of new economic relations and investments into its economy. They leave a country with an impression about the potential of its economy, society and culture. This makes it important to ensure a constant growth of existing and future recreational sites, resorts and holiday settlements. This study deals with some of the strategic aspects of the country’s future development. Some concrete proposals on improving formation of recreational landscape are presented in the paper.
OBJECTIVES OF DEVELOPING OLD PARK RECREATIONAL RESOURCES IN SEACOAST LANDSCAPE FORMATION
Authors: Grecevičius Petras , Marčius Romas
Published: December 2018

During the last 15 years disagreements between the process of urbanization and environmental (historic, cultural) heritage have clearly increased. Klaipėda old parks and their fragments are disappearing fast, and hard efforts for protection of parks in Palanga, Kretinga, Plungė, Rietavas are needed. The density of construction in park surroundings is increased, and approaches to the parks and their environmental quality are reduced. The formation of settlement greenery systems in which old parks are the basic components of their spatial structure becomes more complicated. In accordance with modern European requirements and the Lithuanian Master Plan, priority should be given to greenery in the spatial settlement structure. To preserve the individuality of Lithuanian landscapes it is necessary to apply measures of planning that would help to combine natural and cultural components providing for a high quality of landscape not only in a short run but also in the remote future. One of such measures is understanding of an important role of historic parks in the spatial structure of coastal settlements and their management.

The provision of sustainable development declared by world community commits to analysing particular regional and settlement possibilities, resources for significant improvement of peoples life quality. Resorts are distinguished by their singularity. They have an influence on the national attraction of Lithuania and facilitate state image formation. Some strategic aspects of a harmonious development of historic parks on the Lithuanian seacoast are analised in the work. Specific proposals for improving the results of landscape formation are also presented.
VILNIUS CITY – BETWEEN METAPHOR AND PRAGMATIZM
Authors: Vyšniūnas Algis
Published: December 2018

Urban solutions in Vilnius were mostly of a practical rather than aestethical character. After World War II architects of urban design, whose activity used to change substantly historically settled cities, became more active. In Lithuania the conception of heritage developed gradually lagging behind dominating European tendencies; therefore, Vilnius city has been strongly influenced by individual creative works. The most obvious materialized conception of that kind is the idea of “architectural hills“. Currently this conception is widely criticized, and at the same time new restraints protecting the old town are set. These restraints often contradict the development of the city, which is inevitable bearing in mind the status of Vilnius city (the capital) and the size of administrated territory.

Due to objective reasons political decisions and the activity of energetic private investors have a strong influence on the development of the city. In the chain an investor–administrator–professional there exists uneven proportion of participation thus spoiling the final result.

The paper presents the main contradiction between the city development and heritage supporters and ways of solving it.
ONE MORE DISCUSSION ABOUT “ARCHITECTURAL HILLS“ OF THE CAPITAL OF VILNIUS
Authors: Mačiulis Algimantas
Published: December 2018

The problem of high-rise buildings in the capital of Vilnius is discussed. The question is whether the natural and urban-architectural structure of Vilnius city, its silhouetteand panorama, the harmony of urbanized and natural territories, of the old and new architecture are not disturbed. The author mantains that the city silhouette and panoramas change, and it is impossible to preserve the historic city elements as unchanged values. The statements of various specialists on this issue are presented in the paper. First of all it is said that a harmonious context is the main criterion of aesthetic architecture nowadays. The idea of the soviet period in Lithuania of creating the conception of “architectural hills“ is discussed.
LEGAL BASIS FOR LAND USE MANAGEMENT IN INTEWAR LITHUANIA
Authors: Ramanauskas Evaldas
Published: December 2018

The paper discusses legal documents related to land use management. The main legal principles are evaluated that played an important part in land use management in the period of the Lithuanian independence in 1918–1940. One of the most important documents was The Issue of Land Reform. The author of this document was Mykolas Krupavičius. In land use regulation the main question is land property. The issues related with land use management are evaluated in accordance with public interest. These issues and their principles are compared with those of today.
LASIK Flap Characteristics Using the Moria M2 Microkeratome With the 90-µm Single Use Head
Authors: Aslanides Ioannis M , Tsiklis Nikolaos S , Astyrakakis Nikolaos I , Pallikaris loannis G , Jankov Mirko R
Published: December 2018

ABSTRACT

PURPOSE: To evaluate the accuracy and consistency of corneal flap thickness, horizontal diameter, and hinge size with the Moria M2 90-µm single use head.

METHODS: Fifty-two myopic patients (104 eyes), mean age 32.6 years, underwent bilateral LASIK with a superior hinged flap using the Moria M2 microkeratome (90-µm single use head). Prospective evaluation included flap thickness (subtraction method), diameter, hinge size, interface particles, intraoperative complications, and visual recovery.

RESULTS: The mean preoperative spherical equivalent refraction was -5.72±2.59 diopters (D) (range: -2.88 to -10.75 D) and -5.84±2.73 D (range: -3.13 to -9.38 D) for right and left eyes, respectively. The mean preoperative central corneal thickness was 548±24µm and 547±25 µm for right and left eyes, respectively. The mean preoperative steepest K was 44.12±1.28 D and 44.41±1.27 D for right and left eyes, respectively. Corneal diameter (white-to-white) was 12±0.4 mm and 11.9±0.4 mm for right and left eyes, respectively. The mean postoperative flap thickness was 109±18 µm (range: 67 to 152 µm) and 103±15 µm (range: 65 to 151 µm) for right and left eyes, respectively. The mean postoperative flap diameter was 9.4±0.3 mm (expected mean according to the nomogram given by the company was 9.5 mm). The mean postoperative hinge chord was 4.4±0.4 mm (expected mean 4.2 mm). No interface particles were detected on slit-lamp examination.

CONCLUSIONS: The Moria M2 90-µm single use head is safe with reasonable predictability for LASIK flap creation. [J Refract Surg. 2007;23:45-49.]
Reduced Best Spectacle-corrected Visual Acuity from Inserting a Thicker Intacs Above and Thinner Intacs Below in Keratoconus
Authors: Chan Colin C K , Wachler Brian S Boxer
Published: December 2018

ABSTRACT

PURPOSE: To report a case of decreased best spectacle-corrected visual acuity (BSCVA) 2 months after Intacs implantation.

METHODS: A 33-year-old woman with keratoconus and contact lens intolerance underwent Intacs surgery in the left eye at another institution. Two segments were used-a thinner one (0.25 mm) below the cone and a thicker one (0.35 mm) above the cone.

RESULTS: Two months postoperatively, the patient presented to our practice with BSCVA reduced from 20/20 to 20/30. The superior lntacs segment was explanted, the inferior segment was exchanged for a thicker one (0.35 mm), and collagen cross-linking with riboflavin treatment was performed. This resulted in visual, topographic, and refractive improvement with BSCVA returning to 20/20.

CONCLUSIONS: Single inferior segment Intacs may be more appropriate for paracentral and peripheral cones. Collagen cross-linking may help cause further flattening. Using asymmetrical segments, with the thicker segment above the cone, may increase distortions and result in loss of BSCVA. [J Refract Surg. 2007;23:93-95.]
Corneal Haze Following PRK With Mitomycin C as a Retreatment Versus Prophylactic Use in the Contralateral Eye
Authors: Netto Marcelo V , Chalita Maria Regina , Krueger Ronald R
Published: December 2018

ABSTRACT

PURPOSE: To report photorefractive keratectomy (PRK) treated with mitomycin C (MMC) for previous corneal haze in one eye and PRK with MMC to prevent corneal haze formation in the fellow eye.

METHODS: A 40-year-old woman underwent PRK with MMC to treat previous corneal haze (secondary to previous PRK without MMC) for residual refractive error of +0.50 +0.25 × 165 in the left eye and PRK with MMC to prevent corneal haze in the right eye.

RESULTS: Postoperative slit-lamp examination revealed no haze in the right eye, but continued mild haze in the left eye.

CONCLUSIONS: Treatment with PRK and MMC for previous corneal haze is not as effective as primary PRK with MMC in preventing postoperative corneal haze formation. [J Refract Surg. 2007;23:96-98.]
Removal of an Intracorneal Hydrogel Implant for Hyperopia After LASIK
Authors: Vossmerbaeumer Urs , Ditzen Klaus , Jonas Jost B
Published: December 2018

ABSTRACT

PURPOSE: To report a case of intracorneal hydrogel lens implantation for hyperopia after repeat LASIK surgery.

METHODS: A 34-year-old man underwent intracorneal lens implantation following two LASIK procedures for correction of hyperopia.

RESULTS: The decentered intracorneal lens was removed due to ocular pain and inflammation, epithelial ingrowth under the corneal flap, and high order aberrations. Pain and inflammation resolved, and corneal stability was regained >6 months after removal of the lens.

CONCLUSIONS: Intracorneal lenses may require explantation if previous laser ablative procedures fail to correct refractive errors. [J Refract Surg. 2007;23:102-104.]
Comparison Between LASEK and LASIK for the Correction of Low Myopia
Authors: de Benito-Llopis Laura , Teus Miguel A , Sánchez-Pina Jose M , Hernández-Verdejo Jose L
Published: December 2018

ABSTRACT

PURPOSE: To compare the refractive results of laser epithelial keratomileusis (LASEK) and laser in situ keratomileusis (LASIK) for the correction of low myopia.

METHODS: A prospective, interventional, non-randomized, observer-masked study was performed of patients with myopia of =£-2.50 diopters (D) (cylinder =sl.50 D) who had undergone either LASEK or LASIK. Refractive analysis was performed by a masked observer preoperatively and 1 day, 1 week, and 1 and 3 months postoperatively.

RESULTS: Seventy-nine eyes that fulfilled the inclusion criteria in each group were included in the study. No statistically significant differences were noted in age, gender, or preoperative refractive error between groups. Postoperative uncorrected visual acuity (UCVA) was significantly lower in LASEK eyes 1 and 7 days postoperatively (P=. 0001). At 1 and 3 months postoperatively, no significant differences were noted between the groups in UCVA (P=. 07), but best spectacle-corrected visual acuity 3 months postoperatively was significantly better in LASEK eyes (P=Ol). The refractive error was similar in both groups (P= .3).

CONCLUSIONS: Visual improvement after LASEK for low myopia is significantly slower than after LASIK. Visual outcomes at 3 months postoperatively were similar with both techniques for the correction of low myopia. [J Refract Surg. 2007;23:139-145.]
Outcomes of ZB5M Angle-supported Anterior Chamber Phakic Intraocular Lenses at 12 Years
Authors: Javaloy Jaime , Alió Jorge L , Iradier Maria T , Abdelrahman Ayman M , Javaloy Tomas , Borrás Fernando
Published: December 2018

ABSTRACT

PURPOSE: To evaluate the visual and refractive stability and the potential long-term risks associated with ZB5M phakic intraocular lens (PIOL) implantation.

METHODS: A retrospective, non-randomized, cumulative clinical study was performed over 12 years in a consecutive group of 225 eyes implanted with the ZB5M PIOL. The main analyzed variables were visual and refractive outcomes (best spectacle-corrected visual acuity [BSCVA], uncorrected visual acuity [UCVA], and spherical equivalent), endothelial cell density, and postoperative complications.

RESULTS: Mean preoperative spherical equivalent refraction was -17.23±7.69 diopters (D) and 12 years postoperatively it was -1.80+0.80 D. Mean BSCVA at 1- and 12-year follow-up was 0.38±0.19 and 0.57+0.18, respectively (Wilcoxon test, P<.001). At 12 years postoperatively, 3.5% of eyes lost 3*2 lines of BSCVA. An initial 10.6% reduction in endothelial cell density was noted in the first year, followed by a mean annual rate of decrease of 1.78%. The cumulative incidence of pupil ovalization was 34.7% (78 eyes), and there was no statistical correlation with endothelial cell impairment. Bilateral hypertensive uveitis was diagnosed in 3 (1.33%) eyes.

CONCLUSIONS: The ZB5M PIOL offers good refractive outcomes and stability in the long-term; however, endothelial cell loss increases over 12 years, requiring annual endothelial cell counts. [J Refract Surg. 2007;23:147-158.]
Centration on the Cornea Vertex Normal During Hyperopic Refractive Photoablation Using Videokeratoscopy
Authors: de Ortueta Diego , Schreyger Frank D
Published: December 2018

ABSTRACT

PURPOSE: To evaluate a method for centering the ablation in standard hyperopic LASIK using an excimer laser with a video-based eye tracker system.

METHODS: Results of 52 consecutive hyperopic eyes treated with the ESIRIS excimer laser were retrospectively reviewed. Ablation was shifted from the pupil center to the vertex normal of the cornea using pupillary offset measured with the Keratron Scout videokeratoscope. Outcomes were assessed 3 months postoperatively.

RESULTS: All eyes preoperatively had a nasally oriented vertex normal in relation to the pupil center. Three months postoperatively a refractive outcome of <0.50 diopters of spherical equivalent was achieved in 94% (49/52) of eyes. No eye lost more than one line of best spectacle-corrected visual acuity.

CONCLUSIONS: Standard hyperopic LASIK with the ESIRIS laser system leads to good predictable efficacy and safety results when the ablation center is shifted to the cornea vertex normal based on videokeratoscopy data. [J Refract Surg. 2007;23:198-200.]
Transverse Keratotomy Followed by LASIK for the Treatment of Naturally Occurring Astigmatism
Authors: Haq Faisal E , Speaker Mark G , Nilforoushan Mohammad Reza , Tullo William , Morsehauser Dana
Published: December 2018

ABSTRACT

PURPOSE: To evaluate the efficacy of transverse keratotomy followed by LASIK for patients with high amounts of naturally occurring astigmatism.

METHODS: Thirteen eyes with naturally occurring astigmatism ranging from -3.75 to -6.50 diopters (D) underwent sequential transverse keratotomy (60° at 6 mm) and LASIK procedures. The effect of these two procedures on the amount of astigmatism was studied.

RESULTS: Transverse keratotomy led to a 46% reduction in refractive cylinder from -5.50±0.80 D to -3.00±1.00 D. After LASIK, the initial refractive astigmatism was reduced by 90% to -0.50±0.50 D with a minimum follow-up of 6 months.

CONCLUSIONS: The combined technique of transverse keratotomy followed by LASIK is an effective and accurate way to treat high amounts of naturally occurring astigmatism, allowing the size of the optical zone of the excimer laser ablation to be maximized. [J Refract Surg. 2007;23:209-211.]
Prophylactic Mitomycin C to Inhibit Corneal Haze After Photorefractive Keratectomy for Residual Myopia Following Radial Keratotomy
Authors: Nassaralla Belquiz A , McLeod Stephen D , Nassaralla João J
Published: December 2018

ABSTRACT

PURPOSE: To evaluate the efficacy and safety of mitomycin C (MMC) 0.02% in inhibiting haze formation after excimer laser photorefractive keratectomy (PRK) for residual myopia following radial keratotomy (RK).

METHODS: A prospective, nonrandomized, noncomparative interventional case series was conducted of 22 eyes (14 patients) with residual myopia after RK performed at a single institution. All eyes were treated with PRK and a single intraoperative topical application of MMC 0.02% solution for 2 minutes using a soaked cellulose sponge placed over the ablated area. Refraction, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and slit-lamp evidence of corneal opacity (haze) were evaluated over 12 months.

RESULTS: Twelve months postoperatively, 3 eyes showed grade 1 haze, and 2 eyes showed grade 0.5 haze. Twelve months postoperatively, 2 (9%) eyes had UCVA ≥20/20. No eye before and 17 (77%) eyes after treatment had UCVA 3*20/40, and no eye before and 9 eyes (40.9%) after treatment had UCVA 2=20/25. Best spectacle-corrected visual acuity was 2=20/40 in all (100%) eyes and 21 (95%) eyes before and after treatment, respectively, and 2=20/25 in 12 (54.5%) eyes before and after treatment. One (4.5%) eye lost 1 line of BSCVA. Mean spherical equivalent refraction achieved was -0.18 diopters (D) (range: -0.75 to +0.50 D) compared to -2.72 D (range: -1.50 to -4.00 D) before treatment. Twelve months after treatment, 19 (85.5%) eyes had a refractive outcome within ±0.50 D.

CONCLUSIONS: A single intraoperative application of MMC 0.02% for 2 minutes appears to be effective in preventing subepithelial haze after PRK for residual myopia in patients with undercorrection or regression following RK. [J Refract Surg. 2007;23:226-232.]
Early Transient Visual Acuity Loss After LASIK Due to Steroid-induced Elevation of Intraocular Pressure
Authors: Frucht-Pery Joseph , Landau David , Raiskup Frederik , Orucov Faik , Strassman Eyal , Blumenthal Eytan Z , Solomon Abraham
Published: December 2018

ABSTRACT

PURPOSE: To report the clinical course of early transient reduction of uncorrected visual acuity (UCVA) after LASIK surgery resulting from steroid-induced elevation of intraocular pressure (IOP).

METHODS: Twenty-nine eyes of 15 patients who received topical corticosteroids after uneventful myopic LASIK surgery and had a decrease in UCVA within the first 3 weeks were evaluated retrospectively.

RESULTS: Intraocular pressure increased by 4 to 30 mmHg from preoperative to postoperative days 4 to 20. Twenty-seven of 29 eyes had a decrease in UCVA and/or best spectacle-corrected visual acuity (BSCVA). All eyes, except one, had edema without evidence of inflammation in the interface or the remainder of the cornea. Discontinuation of topical corticosteroids and application of anti-glaucoma medications resulted in a decrease of IOP to normal levels, reduction or disappearance of the edema, and recovery of BSCVA.

CONCLUSIONS: Early onset steroid-induced elevation of IOP after LASIK may cause corneal edema and a sudden decrease in UCVA. Rapid diagnosis and treatment can control IOP and recover the visual loss. [J Refract Surg. 2007;23:244-251.]
Inter- and Intraobserver Reliability of Pupil Diameter Measurement During 24 Hours Using the Colvard Pupillometer
Authors: Yoon Michael K , Schmidt Gregory , Lietman Thomas , McLeod Stephen D
Published: December 2018

ABSTRACT

PURPOSE: To evaluate the inter- and intraobserver agreement of pupil size diameter measurements determined using the Colvard pupillometer.

METHODS: The eyes of 69 patients were examined fjl) using the Colvard pupillometer under mesopic and scotopic conditions by two examiners and repeated 1 hour (T2) and 24 hours (T3) later. The limits of agreement (mean difference between measurements ±2 standard deviations) were calculated for measurements between examiners (inter-examiner agreement) and between different time points measured by the same examiner (intra-examiner agreement).

RESULTS: At Tl, there was a 99% and a 97% chance of two different examiners producing readings within 0.5 mm under mesopic and scotopic conditions, respectively. There was a 15% chance and a 9% chance of finding a pupil difference >0.5 mm over 1 hour under mesopic and scotopic conditions, respectively. For mesopic and scotopic measurements taken 24 hours apart, there was a 31% chance and a 21% chance, respectively, of finding a difference >0.5 mm by the same examiner.

CONCLUSIONS: This study showed high interobserver agreement under scotopic conditions, with 98% of measurements between two examiners falling within 0.5 mm, but substantial variability in pupil diameter measurements over 24 hours. These results suggest that serial office measurements may be necessary to establish the true range of pupil size. [J Refract Surg. 2007;23:266-271.]
Microkeratome-assisted Posterior Lamellar Keratoplasty in Pseudophakic and Aphakic Corneal Edema
Authors: Hashemi Hasan , Noori Jila , Zare Mohammad A , Rahimi Firoozeh
Published: December 2018

ABSTRACT

PURPOSE: To evaluate the outcome of microkeratomeassisted posterior lamellar keratoplasty for replacing diseased endothelium in Pseudophakie and aphakic corneal edema.

METHODS: Microkeratome-assisted posterior lamellar keratoplasty was performed on 10 eyes with Pseudophakie or aphakic corneal edema. A nasal hinged 130to 250-/;m-thick flap was created with an automated microkeratome. The underlying 7.0-mm trephined button of deep stroma and endothelium was substituted with the same size donor button prepared by removing a same-sized flap and trephination of the remaining donor bed. The donor lenticule was fixated without sutures in position; the retracted flap was repositioned and sutured to the peripheral recipient tissue. The viscoelastic content of the anterior chamber was replaced by air to hold the graft in position.

RESULTS: All surgeries were uneventful except for one case of donor button posterior dislocation forming a secondary anterior chamber, which was corrected through donor button exchange 1 month postoperatively. All uncomplicated cases had stable refraction and corneal topography as early as 1 month after surgery, which was maintained in follow-up examinations. In two eyes, corneal astigmatism >5.00 diopters was recorded. One case of prolonged re-epithelial ization and two cases of epithelial interface ingrowth occurred.

CONCLUSIONS: Microkeratome-assisted posterior lamellar keratoplasty is an alternative to conventional penetrating keratoplasty for patients with diseased corneal endothelium, significantly reducing the time of visual rehabilitation. Determination of the relative advantages of this technique over penetrating keratoplasty and other recent alternative endothelial graft procedures relies on controlled prospective studies. [J Refract Surg. 2007;23:272-278.]
Confocal Microscopy and Histopathological Examination of Diffuse Lamellar Keratitis in an Experimental Animal Model
Authors: Silva Ma Victoria de Rojas , Abraldes Maximino J , Díez-Feijóo Elío , Yáñez Purificación Mera , Javaloy Jaime , Sánchez-Salorio Manuel
Published: December 2018

ABSTRACT

PURPOSE: To investigate the cell populations and structural alterations of the cornea in an experimental model of diffuse lamellar keratitis (DLK) using confocal microscopy and histopathology.

METHODS: A corneal flap was cut in 22 eyes of 11 New Zealand rabbits and the stromal interface was exposed to balanced salt solution (BSS, BSS group) and Pseudomonas aeruginosa lipopolysaccharide (LPS) endotoxin (5 mg/mL) (LPS 5 mg/mL group) and (3.5 mg/mL) (LPS 3.5 mg/mL group). Postoperatively, eyes were examined with a slit-lamp microscope (DLK grading) and confocal microscopy. Animals were sacrificed on day 3 (BSS group and LPS 5 mg/mL group) and day 4 (LPS 3.5 mg/mL group). Corneoscleral buttons were excised and processed for histopathologic examination.

RESULTS: Seven eyes were excluded. Slit-lamp microscopy revealed no cellular infiltration in the BSS group (five eyes). In the LPS groups, all eyes developed DLK, with iritis only observed in grade III eyes. In the LPS 5 mg/mL group, four eyes had DLK grade III, with iritis in three eyes. In the LPS 3.5 mg/mL group, three eyes had grade Il and three eyes had grade III with iritis. On confocal microscopy, the BSS group had no cellular infiltration. Dense accumulation of inflammatory cells at the interface was noted in both LPS groups. Histopathology in the BSS group had a normal appearance. In the LPS groups, an inflammatory infiltrate was present at the interface that consisted of three cell populations - eosinophils, neutrophils, and lymphocytes.

CONCLUSIONS: Lipopolysaccharide endotoxin induced DLK in all exposed eyes, with iritis in a considerable proportion of eyes. The infiltrate consisted of three cell populations. Confocal microscopy showed the infiltrate in all affected eyes. Histopathological and confocal microscopic findings correlated well with the clinical appearance. [J Refract Surg. 2007;23:299-304.]