bluuebunny/crossref_metadata_2025 huggingface dataset:
Gigacycle fatigue response of tool steels produced by powder metallurgy compared to ingot metallurgy tool steels
Authors: Sohar Christian , Betzwar-Kotas Agnieszka , Gierl Christian , Danninger Herbert , Weiss Brigitte
Published: September 2010

In this work, the gigacycle fatigue response of several tool steel grades, produced by ingot metallurgy and powder metallurgy, has been studied using an ultrasonic frequency resonance testing device. In all cases the S–N curves exhibited a consistent drop up to 10 billion cycles, i. e. there is no fatigue “limit” with these materials. Surprisingly, there was virtually no effect of the composition and hardness of the materials, both for powder metallurgy and ingot metallurgy grades cold work tool steels and high speed steels exhibiting virtually the same S–N curves, however the powder metallurgy steels revealed significantly higher endurance strength levels than ingot metallurgy grades. In the ingot metallurgy tool steel grades, crack initiation started at large primary carbides or carbide clusters, while in the powder metallurgy grades, markedly smaller non-metallic inclusions turned out being the critical defects. Furthermore, it has been shown that it is very important to avoid introducing residual stresses into the specimen surfaces during preparation, since these stresses significantly affect the endurance strength levels and the location of crack initiating sites.
Taming the Pedagogy Dragon
Authors: Riggs Connie J.
Published: September 2010

Adult learning principles are the foundation of many organizations’ educational programs today. However, continuing education providers sometimes struggle to meet learners’ needs in new and creative ways. The tried-and-true principles are still valid, with a twist to meet the needs of contemporary learners. This column describes ways one education department has adapted adult learning strategies in its approach to continuing nursing education and professional development.
Using Stories to Bridge Cultural Disparities, One Culture at a Time
Authors: Millender Eugenia
Published: September 2010

Story theory can be the basis of the nurse’s culturally sensitive approach to gather patients’ health information and learn about and experience patients’ cultural values and beliefs. This article illustrates how story theory was used at the bedside of a Guatemalan Mayan patient to develop a culturally sensitive plan of care. Because nursing facilitates obtaining story at the bedside, nurses should consider using story theory to promote authentic communication that will bring voice to patients’ concerns and assist in finding meaningful, culturally competent health solutions. By identifying what matters most to the patient through intentional dialogue, nurses can assist in the transformation of the current health care system to a patient-centered system that links nursing practice with nursing knowledge and bridges the health disparity gap, one patient at a time.
Development of a Model Home Health Nurse Internship Program for New Graduates: Key Lessons Learned
Authors: Shur Coyle Joanne
Published: September 2010

A nursing shortage, the aging baby boomer population, an escalating need for home health care, and limited availability of health care dollars are threatening to undermine the quality of health care in the United States. The National Center for Health Workforce Analysis projects a deficit of 275,000 full-time equivalents by 2010 (−12%) and a deficit of 800,000 by 2020 (−29%). This article focuses on one home health agency’s strategy to support nurse graduates transitioning from student to professional nurse. Based on Benner’s (
1984
) hallmark theory from novice to expert, the goals of this program are to enhance job satisfaction and social integration, facilitate autonomy, increase critical thinking and psychomotor skills, and develop additional competencies. Eleven key lessons learned are outlined.
A 45-year-old Woman Who Had Been Sexually Abused
Authors: Seawell Monifa S. , Dziuba John
Published: September 2010

CME Educational Objectives

1.

Review the epidemiology and clinical manifestations of delusional disorders.

2.

Discuss the challenges associated with diagnosing and treating delusional disorders, particularly delusional disorder of the somatic type.

3.

Summarize the challenges faced in identifying and treating mental illness in medically ill patients.
Management of Subluxating Ulnar Nerve at the Elbow
Authors: Richard Marc J. , Messmer Caroline , Wray Walter H. , Garrigues Grant E. , Goldner Richard D. , Ruch David S.
Published: September 2010

Musculotendinous variations around the medial epicondyle can contribute to subluxation of the ulnar nerve at the elbow. This article reviews the presenting symptoms, operative findings, and results of surgery for subluxation of the ulnar nerve at the elbow. A retrospective evaluation was performed of 200 elbows managed operatively for medial elbow pathology over a 17-year period between 1990 and 2007. The patient charts were reviewed for chief complaint, radiographic studies, operative reports, and postoperative examination data. Seventeen patients (18 elbows) were treated for a subluxating ulnar nerve. Three patients were women and 14 were men, with a mean age of 27.6 years. Medial elbow pain was the chief complaint in all 17 patients. Seventeen elbows also demonstrated paresthesias in an ulnar nerve distribution. All patients were treated with anterior transposition of the ulnar nerve, and 11 patients (61%) were found to have a muscular anomaly.

At a mean follow-up of 17 months, the mean visual analog scale for pain improved from 6.0 to 2.0. There was no functional impairment reported for any patient at final follow-up. Of the 200 elbows surgically treated for medial elbow pathology, 17 patients (8.5%) demonstrated a subluxating ulnar nerve. These patients tend to be young and present with a primary complaint of medial elbow pain. In addition, a subluxating ulnar nerve is often associated with muscular anomalies, which must be addressed concurrently.
Incidence of Venous Thromboembolic Disease Following Hip Arthroscopy
Authors: Salvo John P. , Troxell Corey R. , Duggan Daniel P.
Published: September 2010

Venous thromboembolic disease is a known complication of orthopedic surgery. Hip arthroscopy is a technically demanding procedure with a significant learning curve and low reported complication rate. Few reports document the incidence of venous thromboembolic disease following hip arthroscopy. Our hypothesis was that the incidence of venous thromboembolic disease following hip arthroscopy was comparable to that reported for knee arthroscopy.

Eighty-one consecutive patients undergoing hip arthroscopy were retrospectively reviewed. All patients underwent standard diagnostic hip arthroscopy under traction of the operative leg against a well-padded perineal post. All procedures were performed on an outpatient basis. Three of 81 patients (3.7%) developed a clinically symptomatic venous thromboembolic disease in the postoperative period. The diagnosis was suspected clinically and confirmed with the use of a Doppler ultrasound. No patient developed symptomatic pulmonary emboli. One patient used oral contraceptives and 2 had no known risk factors for venous thromboembolic disease. All patients were successfully treated with anticoagulation.

This is the first study to document multiple occurrences of venous thromboembolic disease following hip arthroscopy. This study demonstrated the incidence of symptomatic venous thromboembolic disease after hip arthroscopy to be 3.7%. Further study investigation is warranted regarding the incidence of symptomatic and asymptomatic venous thromboembolic disease following hip arthroscopy.
Fixation of 3- and 4-Part Proximal Humerus Fractures Using the PHILOS Plate: Mid-Term Results
Authors: Gaheer Rajinder Singh , Hawkins Amanda
Published: September 2010

Treatment of unstable, displaced, and comminuted fractures of the proximal humerus remains challenging, and optimal treatment continues to be controversial. Fifty-six patients with displaced 3- and 4-part fractures of the proximal humerus had open reduction and internal fixation using the proximal humeral internal locking system (PHILOS) plate (Synthes, Stratec Medical Ltd, Mezzovico, Switzerland).

Data were collected retrospectively, and clinical and radiological outcomes were assessed. Mean follow-up was 40 months (range, 18–62 months). The study shows that the PHILOS plate gives good results in the treatment of displaced 3- and 4-part fractures of the proximal humerus. Good fracture stability can be achieved early, allowing early mobilization without compromising fracture union. Most importantly, it requires minimal soft tissue dissection, does not need contouring, and gives good stability. No differences were observed in the functional outcomes of patients younger and older than 65 years.

Few complications were associated with the plate, and the number of ≥2 surgeries was minimal. The complications noted were 1 case each of superficial wound infection, failure of the plate, and persistent stiffness. One patient had screw perforation of the humeral head articular surface, and 1 had subacromial impingement. Of the 32 patients who had been in active employment before the injury, 28 returned to their previous occupation.
A Randomized, Prospective Study of Total Hip Wound Closure with Resorbable Subcuticular Staples
Authors: Fisher David A. , Bengero Lowell L. , Clapp Brenda C. , Burgess Mary
Published: September 2010

Resorbable subcuticular staples are a new way to close surgical wounds and have not been reported in the orthopedic literature. This randomized, controlled study compared a resorbable subcuticular staple system with stainless steel wound stapling in patients undergoing unilateral primary total hip arthroplasty (THA). Institutional Review Board approval and patient consent was obtained for all patients. Sixty patients (30 each group) were randomized to receive either resorbable subcuticular staples or stainless steel staples after primary THA. Incision length, number of staples used, and any staple insertion problems were recorded.

Subjective reports of pain levels or incision complaints were solicited, and wound photographs were obtained on days 1 and 14 and 6 weeks postoperatively. The presence of wound drainage, erythema, wound separation, or echymosis was recorded at each visit, as well as all postoperative complications. The average incision length in the resorbable group was 13.2 cm and required 16 staples for closure, compared to 15 cm and 20 staples for the metal staple group. No infections occurred in either group, although the incidence of erythema and wound drainage at 2 weeks was higher for patients in the stainless steel group. One patient with metal staples had a postoperative hematoma requiring secondary irrigation and debridement. Patient satisfaction was higher with the resorbable staples.

A resorbable subcuticular staple system can provide comparable wound closure to stainless steel staples following THA and may do so with less local discomfort, wound drainage, or erythematous reaction.
Allograft Alternatives: Bone Substitutes and Beyond
Authors: Goodman Stuart B.
Published: September 2010

Excessive wear debris, deep infection, periprosthetic fracture, and other causes can lead to bone loss associated with total joint replacements. When performing revisions, surgeons are often preoccupied by the failed implant and the method of replacement, and neglect an opportunity to replenish lost bone. Thus, when formulating a plan for revision total joint replacement, the surgeon should consider not only the hardware that should be used, but also ways in which lost bone could be restored. Autograft bone provides the best source for osteoprogenitor cells, growth factors, and a scaffold. However, autograft is limited in supply, and is generally associated with another incision, dissection, and accompanying morbidity. Osteoconductive bone void fillers such as morselized cancellous allograft bone, polymeric scaffolds, and biodegradable ceramics each have their merits and deficiencies; however, all of these materials function as a scaffold only, without the ability to induce bone formation. Osteoinductive growth factors are essential to bone growth and remodeling; however, exogenous growth factors are expensive, are given in large nonphysiological doses, may yield unpredictable clinical results, and may have significant adverse effects. Demineralized bone matrix contains a scaffold and variable amounts of several growth factors. Recently, the use of mesenchymal stem cells and osteoprogenitors, together with a suitable scaffold carrier has gained increasing popularity. With the addition of appropriate growth factors, this combination can provide all the necessary components for osteogenesis. Future basic and clinical research will define the indications and outcomes for new combination products for reconstruction of lost bone associated with revision total joint replacement.
The Role of Arthroscopy in Treating Osteoarthritis of the Knee in the Older Patient
Authors: Howell Stephen M.
Published: September 2010

Arthroscopy of the osteoarthritic knee is a common and costly practice with limited and specific indications. The extent of osteoarthritis (OA) is determined by joint space narrowing, which is best measured on a weight-bearing radiograph of the knee in 30° or 45° of flexion. The patient older than 40 years with a normal joint space should have a magnetic resonance image taken to rule out focal cartilage wear and avascular necrosis before recommending arthroscopy. Randomized controlled trials of patients with joint space narrowing have shown that outcomes after arthroscopic lavage or debridement are no better than those after a sham procedure (placebo effect), and that arthroscopic surgery provides no additional benefit to physical and medical therapy. The American Academy of Orthopedic Surgeons guideline on the Treatment of Osteoarthritis of the Knee (2008) recommended against performing arthroscopy with a primary diagnosis of OA of the knee, with the caveat that partial meniscectomy or loose body removal is an option in patients with OA that have primary mechanical signs and symptoms of a torn meniscus and/or loose body. There is no evidence that removal of loose debris, cartilage flaps, torn meniscal fragments, and inflammatory enzymes have any pain relief or functional benefit in patients that have joint space narrowing on standing radiographs. Many patients with joint space narrowing are older with multiple medical comorbidities. Consider the complications and consequences when recommending arthroscopy to treat the painful osteoarthritic knee without mechanical symptoms, as there is no proven clinical benefit.
A Rapid Recovery Program: Early Home and Pain Free
Authors: Lombardi Adolph V. , Berend Keith R. , Adams Joanne B.
Published: September 2010

Enhancement of our perioperative pain management protocols has resulted in accelerated rehabilitation. At our facility, the majority of patients undergoing total and partial knee arthroplasty are treated with a single-shot spinal anesthetic consisting of a combination of bupivacaine and duramorph. The bupivacaine affords the immediate perioperative anesthetic while the duramorph results in sustained analgesia for a period of 12 to 24 hours. We use intra-articular injections delivered directly into the soft tissue of the knee. Our current intra-articular injection is 60 mL of 0.5% ropivacaine with 0.5 mg of epinephrine. In patients with a normal renal function, 30 mg of ketorolac is added. The injection is administered throughout all of the soft tissues in and around the knee. Prophylactic antiemetics are administered in the form of dexamethasone, ondansetron, and a scopolamine patch. The use of this perioperative anesthesia provides effective pain relief with no motor blockade. Patients are able to participate in physiotherapy within several hours of the operative procedure, performing active range of motion and ambulating with assistive devices. Patients with no significant cardiovascular history are given celecoxib preoperatively, which is continued for approximately 2 weeks postoperatively. Additionally, all patients are treated with oxycodone, either preoperatively or within 2 hours of arrival to the floor postoperatively. Patients younger than 70 years are given 20 mg of oxycodone while those older than 70 years are given 10 mg of oxycodone. The oxycodone is continued for the first 24 hours of the hospital stay. Patients are then managed with oxycodone and hydrocodone. Length of stay has decreased and currently averages <2 days.
Patellofemoral Arthroplasty
Authors: Lonner Jess H.
Published: September 2010

Isolated patellofemoral arthritis can occur in as many as 9% of patients older than 40 years and is particularly common in women, who often have subtle patellofemoral maltracking or malalignment. In fact, 24% of women with symptomatic knee arthritis have localized patellofemoral arthritis. Arthroplasty options can provide predictable pain relief, whereas other surgical measures for refractory patellofemoral arthritis—arthroscopic debridement, cartilage grafting, patellectomy, tibial tubercle unloading procedures—often have unsatisfactory results. While total knee arthroplasty (TKA) yields excellent results in >90% of patients with isolated patellofemoral arthritis, it is not desirable in patients who are young and active. Therefore, patellofemoral arthroplasty has a legitimate role in the treatment of isolated anterior compartment arthritis. Early patellofemoral implants were plagued by a high incidence of patellar maltracking, catching and subluxation, due to design features of the trochlear components, inadequate soft tissue balancing, and component malposition. Most importantly, contemporary onlay style trochlear components, implanted perpendicular to the anteroposterior axis of the femur, have substantially reduced the patellar maltracking that was so prevalent with inlay style prostheses for 3 decades. With onlay trochlear designs, early patella instability problems have been reduced, leaving late tibiofemoral degeneration as the primary cause of failure of patellofemoral arthroplasties. Several long-term studies have shown a rate of tibiofemoral degeneration of approximately 20% at 15 years. Finally, the results of TKA do not seem to be compromised by the presence of a prior patellofemoral arthroplasty.
DVT Prophylaxis: Better Living Through Chemistry: Opposes
Authors: Zywiel Michael G. , Johnson Aaron J. , Mont Michael A.
Published: September 2010

The association between total hip arthroplasty and subsequent postoperative deep venous thrombosis is of particular concern because it can lead to symptomatic venous thromboembolic events. However, controversy remains about the optimal approach to prophylaxis. Some authors recommend the use of various chemoprophylactic agents, while others advocate the use of mechanical devices or combinations. The ideal method of prophylaxis should be effective and easy to administer, have a predictable onset and duration, have minimal interaction with food or other drugs, be easily reversible, be cost effective, and have a low risk of side effects. While available chemoprophylactic agents address some of these attributes, all have substantial drawbacks. Among the most concerning effects for orthopedic surgeons is the increased risk of bleeding and hematoma formation, which can be associated with periprosthetic infections. These typically lead to additional surgical procedures and significant patient morbidity, and can adversely impact clinical outcomes.

An alternative to chemoprophylaxis is the use of pneumatic intermittent compression devices. Modern compression devices are portable and easy to use, and have a high rate of patient compliance. Several studies have demonstrated the efficacy of these devices in reducing the risk of symptomatic venous thromboembolic disease, in some cases resulting in lower mortality when compared to pharmacological agents. Additionally, these devices significantly reduce the risk of postoperative bleeding.
The Economics of New Age Arthroplasty: Can We Afford It?
Authors: Sculco Thomas P.
Published: September 2010

New technology in joint replacement design and materials adds cost that must be documented by improved outcomes. This is not always the case as the recent metal/metal data has shown. The current economics of arthroplasty have put increasing financial pressure on hospitals and will progress under new health care legislation. New technology must be cost-effective and this will be increasingly difficult in an era of outstanding long-term results with current designs. Cost may necessitate less expensive alternatives, eg, generic implants, in arthroplasty patients.

Joint replacement surgery has evolved over the past 4 decades into a highly successful surgical procedure. Earlier designs and materials that demonstrated inferior functional and long-term results have disappeared in a Darwinian fashion. Through this evolutionary process many of the current designs have proven efficacy and durability. Current outcome data indicates that hip and knee designs demonstrate 90% to 95% success rates at 15-year follow-up. Technologic advances are necessary to improve implant design and materials, however, only in an environment of reduced reimbursement to hospitals can the increase cost be justified.
Postoperative Pain Management
Authors: Nett Michael P.
Published: September 2010

Although the long-term results following traditional total joint arthroplasty are excellent, postoperative pain management has been suboptimal. Under-treatment of pain is a focus of growing concern to the orthopedic community. Poorly controlled postoperative pain leads to undesirable outcomes, including immobility, stiffness, myocardial ischemia, atelectasis, pneumonia, deep venous thrombosis, anxiety, depression, and chronic pain. Over the past decade, the attempt to minimize postoperative complications, combined with the move toward minimally invasive surgery and early postoperative mobilization, has made pain management a critical aspect of joint replacement surgery. Effective protocols are currently available; all include a multimodal approach. Debate continues regarding the ideal approach; however, reliance on narcotic analgesia alone is suboptimal.
Control Banding for Risk Management of Source Chemical Agents and Other Occupational Hazards
Authors: Chalupka Stephanie
Published: September 2010

In the absence of occupational exposure limits, control banding may be a useful strategy for assessing and controlling occupational hazards as part of a comprehensive safety and health program.
Wavefront-Guided vs Wavefront-Optimized LASIK: A Randomized Clinical Trial Comparing Contralateral Eyes
Authors: Miraftab Mohammad , Seyedian Mohammad A. , Hashemi Hassan
Published: September 2010

Purpose:

To compare wavefront-guided and wavefront-optimized LASIK in patients with myopic astigmatism up to −7.00 diopters (D) sphere and 3.00 D cylinder.

Methods:

In this prospective, comparative study, 41 patients had wavefront-guided LASIK in one eye and wavefront-optimized LASIK in the fellow eye. The LASIK flap was created with a Hansatome XP microkeratome (Bausch & Lomb). The ALLEGRETTO Concerto excimer laser (WaveLight Laser Technologie AG) was used for photoablation. Pupil centroid shift and cyclotorsion were not compensated in the wavefront-guided treatments. The ALLEGRETTO Wave analyzer was used to measure ocular wavefront aberrations, and the CSV-1000 instrument (VectorVision) was used to measure contrast sensitivity before and 1 and 3 months after LASIK.

Results:

Preoperative mean spherical equivalent refraction was −4.25±1.19 D (range: −7.50 to −2.50 D) and −4.15±1.21 D (range: −7.13 to −1.75 D) in the wavefront-guided and wavefront-optimized groups, respectively. Three months postoperatively, 33 (89.2%) eyes in the wavefront-guided group and 31 (83.8%) eyes in the wavefront-optimized group had uncorrected distance visual acuity of 20/20. Higher order aberrations increased from 0.28±0.08 μm (range: 0.13 to 0.48 μm) and 0.26±0.08 μm (range: 0.13 to 0.55 μm) to 0.45±0.17 μm (range: 0.18 to 0.71 μm) and 0.45±0.16 μm (range: 0.21 to 0.84 μm) in the wavefront-guided and wavefront-optimized groups, respectively. Except for C6 trefoil (
P
=.006), all Zernike polynomials increased in both groups postoperatively with no statistical difference between groups in spherical aberration (
P
=.41), C7 coma (
P
=.67), C8 coma (
P
=.79), and trefoil (
P
=.82). Contrast sensitivity did not decrease in either group and no statistically significant differences between groups were noted.

Conclusions:

Higher order aberrations, especially spherical aberration, increasd approximately the same amount in both groups.
Pediatric Refractive Surgery and Its Role in the Treatment of Amblyopia: Meta-Analysis of the Peer-Reviewed Literature
Authors: Alió Jorge L. , Wolter Nathaly V. , Piñero David P. , Amparo Fransisco , Sari Esin Sogutlu , Cankaya Cem , Laria Carlos
Published: September 2010

Purpose:

To provide an overview of the visual outcomes after pediatric refractive surgery in anisometropic amblyopia and to analyze the relationship of these outcomes with age and type of refractive surgery.

Methods:

Systematic searches in PubMed, Embase, and Web of Science databases without data restrictions and a search by surveillance of the literature regarding pediatric refractive surgery were performed. Only studies reporting individual data of pediatric cases (age 1 to 17 years) undergoing photorefractive keratectomy (PRK), laser epithelial keratomileusis (LASEK), and LASIK were included. A total of 15 articles including data from a total of 213 amblyopic eyes were considered: LASIK in 95 eyes and surface ablation in 118 eyes. Changes in uncorrected (UDVA) and corrected distance visual acuity (CDVA) were investigated as well as their relation with age and ablation type.

Results:

A significant increase in logMAR UDVA and CDVA was found in the overall sample of amblyopic eyes after surgery (
P
<.001). A significant correlation was found between age and preoperative CDVA (r=0.34,
P
<.001) as well as between age and the change in CDVA after surgery (r=−0.38,
P
<.001). The change in UDVA was significantly superior for eyes undergoing surface ablation compared to those undergoing LASIK (
P
=.04). Corneal haze was the predominant complication, which was reported in 5.3% of LASIK cases and 8.5% of surface ablation cases.

Conclusions:

Laser refractive surgery is an effective option for improving the visual acuity in children with an amblyopic eye in association with anisometropia.
Efficacy of Different Excimer Laser Techniques in the Management of Recurrent Corneal Erosions
Authors: Hütz Werner W. , Stachs Oliver , Hengerer Fritz , Eckhardt Berthold
Published: September 2010

Background and Objective:

To investigate the efficacy of two excimer laser techniques for recurrent corneal erosions (RCEs).

Patients and Methods:

Of 100 patients with RCEs not responding to common treatments, 50 received transepithelial (group 1) and 50 received subepithelial (group 2) treatment of 20 pulses of a 193-nm excimer laser (170 J/cm
2
). Postoperative follow-up occurred at 4 and 52 weeks. Outcome measures were frequency of RCEs, haze formation, and refractive changes.

Results:

At first follow-up, 7 patients (14%) in each group displayed recurrence. At second follow-up, 12 patients in group 1 (24%) and 10 patients in group 2 (20%) had RCE. Follow-up recurrence risk was 6% to 27% in both groups at 4 weeks and 13% to 38% in group 1 and 10% to 34% in group 2 at 52 weeks. The spherical equivalent remained unaffected in group 1, but a statistically significant change was observed in group 2.

Conclusion:

Excimer laser treatment (transepithelial and subepithelial) of RCEs can be performed successfully on the intact epithelium without adjunct therapy or pain. The transepithelial technique is a simple and relatively painless way to reduce the rate of RCE and is equivalent to the well-established subepithelial treatment.
Bevacizumab for the Treatment of Pediatric Retinal and Choroidal Diseases
Authors: Sisk Robert A. , Berrocal Audina M. , Albini Thomas A. , Murray Timothy G.
Published: September 2010

Background and Objective:

To determine the efficacy of off-label intravitreal bevacizumab (IVB) for the treatment of pediatric retinal and choroidal vascular diseases.

Patients and Methods:

Retrospective, non-comparative, open-label, interventional, consecutive case series of all patients younger than 18 years treated with off-label IVB at a single center from January 1, 2005, to January 1, 2008. Primary outcome measures with best-corrected visual acuity by age-appropriate testing and central macular thickness by time-domain optical coherence tomography.

Results:

Thirty-five eyes of 33 patients were treated with IVB alone or in combination with other treatments for choroidal neovascularization, Coats’ disease, familial exudative vitreoretinopathy, and various other indications. IVB was used in 24 eyes to reduce excess retinal fluid and exudation. Mean Snellen visual acuity improved from 20/170 at baseline to 20/100 at 1 month (P= .006), 20/80 at 3 months (P= .006), and 20/50 at 6 months (P= .023). Central macular thickness improved from 356 μm at baseline to 287 μm at 6 months (P= .028). IVB was used in 11 eyes to control peripheral retinal neovascularization and iris rubeosis. Although IVB reduced vascular engorgement, it did not prevent the progression of preretinal tractional forces. Mean visual acuity was maintained at each time point. No systemic or ocular adverse events were directly attributable to IVB in any patient.

Conclusion:

IVB reduced vascular leakage and temporarily regressed pathologic neovascularization of the choroid, retina, and iris in this series of pediatric patients. Further prospective studies are warranted.
"Masculinity and popular television," by Rebecca Feasey
Authors: Bernhagen Lindsay
Published: September 2010

Review of Rebecca Feasey. Masculinity and popular television. Edinburgh: Edinburgh Univ. Press, 2008. Paperback, $36.00 (224p) ISBN 978-0-7486-2798-1.
Salivary C-Reactive Protein in Hashimoto's Thyroiditis and Subacute Thyroiditis
Authors: Rao Nivedita L. , Shetty Sukanya , Upadhyaya Krishnaraj , R. M Prasad , Lobo Eric C. , Kedilaya H. P. , Prasad Ganesh
Published: September 2010

C-reactive protein (CRP), an acute-phase reactant, has been identified as a saliva-based biomarker of inflammation. The objective of the study was to estimate and compare salivary CRP levels in Hashimoto's thyroiditis (HT) and Subacute thyroiditis (SAT). The study included 30 HT patients who presented with clinical features of hypothyroidism, 15 SAT patients who presented with clinical features of hyperthyroidism, and 20 healthy age- and sex-matched euthyroid controls. CRP levels in saliva were estimated using an Enzyme-Linked Immunosorbent Assay method with enhanced sensitivity. In HT, the mean salivary CRP levels did not differ significantly from controls. SAT patients had significantly elevated salivary CRP levels compared to HT patients and controls. The rise in salivary CRP levels in SAT patients conceivably reflects the presence of an inflammatory process. Saliva CRP levels appear to serve as inflammatory markers in SAT patients and may aid their clinical evaluation.
Functional mapping of language networks in the normal brain using a word-association task
Authors: Ghosh Shantanu , Basu Amrita , Kumaran Senthil S , Khushu Subash
Published: September 2010

Background: Language functions are known to be affected in diverse neurological conditions, including ischemic stroke, traumatic brain injury, and brain tumors. Because language networks are extensive, interpretation of functional data depends on the task completed during evaluation. Aim: The aim was to map the hemodynamic consequences of word association using functional magnetic resonance imaging (fMRI) in normal human subjects. Materials and Methods: Ten healthy subjects underwent fMRI scanning with a postlexical access semantic association task vs lexical processing task. The fMRI protocol involved a T2FNx01-weighted gradient-echo echo-planar imaging (GE-EPI) sequence (TR 4523 ms, TE 64 ms, flip angle 90º) with alternate baseline and activation blocks. A total of 78 scans were taken (interscan interval = 3 s) with a total imaging time of 587 s. Functional data were processed in Statistical Parametric Mapping software (SPM2) with 8-mm Gaussian kernel by convolving the blood oxygenation level-dependent (BOLD) signal with an hemodynamic response function estimated by general linear method to generate SPM{t} and SPM{F} maps. Results: Single subject analysis of the functional data (FWE-corrected, P≤0.001) revealed extensive activation in the frontal lobes, with overlaps among middle frontal gyrus (MFG), superior, and inferior frontal gyri. BOLD activity was also found in the medial frontal gyrus, middle occipital gyrus (MOG), anterior fusiform gyrus, superior and inferior parietal lobules, and to a smaller extent, the thalamus and right anterior cerebellum. Group analysis (FWE-corrected, P≤0.001) revealed neural recruitment of bilateral lingual gyri, left MFG, bilateral MOG, left superior occipital gyrus, left fusiform gyrus, bilateral thalami, and right cerebellar areas. Conclusions: Group data analysis revealed a cerebellar-occipital-fusiform-thalamic network centered around bilateral lingual gyri for word association, thereby indicating how these areas facilitate language comprehension by activating a semantic association network of words processed postlexical access. This finding is important when assessing the extent of cognitive damage and/or recovery and can be used for presurgical planning after optimization.
Case report: MRI of the brain in metronidazole toxicity
Authors: Kalia Vishal , Saggar Kavita ,   Vibhuti
Published: September 2010

Metronidazole is a commonly used antimicrobial drug. When used excessively, it can cause encephalopathy. We report the MRI findings in one such case. A 43-year-old male patient was treated with metronidazole for 2 months, for an amebic liver abscess and presented with neurological signs and symptoms. MRI of the brain showed findings consistent with metronidazole toxicity.
Case Series: Cyclops lesion - extension loss after ACL reconstruction
Authors: Dhanda Sunita , Sanghvi Darshana , Pardiwala Dinshaw
Published: September 2010

Localized anterior arthrofibrosis (cyclops lesion) is the second most common cause of extension loss after anterior cruciate ligament (ACL) reconstruction. We present and discuss two patients with prior ACL reconstructions, who presented with pain and loss of extension following surgery. MRI and arthroscopy of the knee revealed typical features of a cyclops lesion. The patients showed significant symptomatic improvement following arthroscopic resection of these lesions.
Technical Note: MRI-guided breast biopsy - our preliminary experience
Authors: Taneja Sangeeta , Jena Amarnath , Kumar Kapil , Mehta Anurag
Published: September 2010

The diagnostic potential of breast MRI can be fully utilized only when it is possible to biopsy lesions detected on MRI, especially when they are not visible on mammography or USG. We would like to describe our experience with MRI-guided wire localization and biopsy.
Analysis of 13C and 18O isotope data of CO2 in CARIBIC aircraft samples as tracers of upper troposphere/lower stratosphere mixing and the global carbon cycle
Authors: Assonov S. S. , Brenninkmeijer C. A. M. , Schuck T. J. , Taylor P.
Published: September 2010

Abstract. The project CARIBIC (http://caribic-atmospheric.com) aims to study atmospheric chemistry and transport by regularly measuring many compounds in the free troposphere and the upper troposphere/lowermost stratosphere (UT/LMS) by using passenger aircraft. Here we present CO2 concentrations and isotope results, and analyze the data together with supporting trace gas data. 509 CARIBIC-2 samples (highest precision and accuracy δ13C(CO2) and δ18O(CO2) data) from June 2007 until March 2009, together with CARIBIC-1 samples (flights between November 1999 and April 2002, 350 samples in total, 270 for NH, mostly δ13C(CO2) data) give a fairly extensive, unique data set for the NH free troposphere and the UT/LMS region. Total uncertainty of the data is the same as reported for the global monitoring program by NOAA-ESRL. To compare data from different years a de-trending is applied. In the UT/LMS region δ13C(CO2), δ18O(CO2) and CO2 are found to correlate well with stratospheric tracers, in particular N2O; δ18O(CO2) appears to be a useful, hitherto unused, tracer of atmospheric transport in the UT/LMS region and also inter-hemispheric mixing. By filtering out the LMS data (based on N2O distributions), the isotope variations for the free and upper troposphere are obtained. These variations have only small latitudinal gradients, if any, and are in good agreement with the data of selected NOAA stations in NH tropics. Correlations between δ13C(CO2) and CO2 are observed both within single flight(s) covering long distances and during certain seasons. The overall variability in de-trended δ13C(CO2) and CO2 for CARIBIC-1 and CARIBIC-2 are similar and are generally in agreement, which underscores agreement between high and low resolution sampling. Based on all correlations, we infer that the CO2 distribution in the NH troposphere along CARIBIC flight routes is chiefly regulated by uplift and pole-wards transport of tropical air up to approximately 50° N. The main reason for variability of signals in the troposphere (which is larger for the higher resolution sampling during CARIBIC-2) is mixing of different tropospheric air masses affected by different CO2 sources and sinks. The effect of stratospheric flux appears to be limited. All in all it is demonstrated that CARIBIC produced new important and reliable data sets for little explored regions of the atmosphere. A logical next step will be global scale modeling of 13C and especially 18O, which is linked to the hydrological cycle.
An over-land aerosol optical depth data set for data assimilation by filtering, correction, and aggregation of MODIS Collection 5 optical depth retrievals
Authors: Hyer E. J. , Reid J. S. , Zhang J.
Published: September 2010

Abstract. MODIS Collection 5 retrieved aerosol optical depth (AOD) over land (MOD04/MYD04) was evaluated using 4 years of matching AERONET observations, to assess its suitability for aerosol data assimilation in numerical weather prediction models. Examination of errors revealed important sources of variation in random errors (e.g., atmospheric path length, scattering angle "hot spot"), and systematic biases (e.g., snow and cloud contamination, surface albedo bias). A set of quality assurance (QA) filters was developed to avoid conditions with potential for significant AOD error. An empirical correction for surface boundary condition using the MODIS 16-day albedo product captured 25% of the variability in the site mean bias at low AOD. A correction for regional microphysical bias using the AERONET fine/coarse partitioning information increased the global correlation between MODIS and AERONET from r2=0.62–0.65 to r2=0.71–0.73. Application of these filters and corrections improved the global fraction of MODIS AOD within (0.05±20%) of AERONET to 77%, up from 67% using only built-in MODIS QA. The compliant fraction in individual regions was improved by as much as 20% (South America). An aggregated Level 3 product for use in a data assimilation system is described, along with a prognostic error model to estimate uncertainties on a per-observation basis. The new filtered and corrected Level 3 product has improved performance over built-in MODIS QA with less than a 15% reduction in overall data available for data assimilation.
EFECTO DE CULTIVOS EN ASOCIO PEPINO (Cucumis sativus L.), PIPIAN (Cucúrbita pepo L.) Y FRIJOL DE VARA (Vigna unguiculata L. Walp), EN LA OCURRENCIA POBLACIONAL DE INSECTOS PLAGAS, BENEFICOS Y EL RENDIMIENTO EN TISMA, MASAYA
Authors: Jiménez-Martínez Edgardo , Sandino-Díaz Victor , García-Guevara Karen , Angulo-Rivas Leydy
Published: September 2010

El presente estudio se realizó con el objetivo de comparar el efecto que tiene el sistema en asocio de cultivos sobre la ocurrencia poblacional de insectos plagas, benéficos y el uso equivalente de la tierra. El estudio se estableció en la finca "Berlín", ubicada en el Municipio de Tisma - Masaya, en los meses de diciembre 2006 a febrero 2007. Para el desarrollo de esta investigación se establecieron cuatro parcelas, una parcela se sembró en arreglo de los cultivos (pepino, pipián y fríjol de vara) y tres parcelas se sembraron con los cultivos solos de pepino, pipián y fríjol de vara. En cada estación se tomaron semanalmente las siguientes variables: número de insectos plagas y benéficos por planta, y durante la cosecha, el rendimiento de cada cultivo para calcular el uso equivalente de la tierra (UET). En general se observó una tendencia de menor número de insectos plagas y mayor número de insectos benéficos en la parcela de los cultivos asociados en comparación con los cultivos solos, aunque no se encontró diferencias significativas entre los dos sistemas de cultivos. Se calculó el uso equivalente de la tierra (UET) y se encontró que el sistema en asocio (pepino, pipián y fríjol de vara) presentó el mejor aprovechamiento de la tierra al obtener rendimientos de 31, 40 y 11 % más de producción respectivamente que los cultivos solos, haciendo un mejor uso de la tierra por unidad de área. Palabras clave: Cultivos en asocio, Plaga, Insectos Benéficos, Uso equivalente de la tierra.DOI: 10.5377/calera.v10i14.23
EVALUACIÓN DE ALTERNATIVAS PARA LA PROTECCIÓN DE SEMILLEROS DE TOMATE (Lycopersicum esculentum Mill) CONTRA EL ATAQUE DEL COMPLEJO MOSCA BLANCA (Bemisia tabaci, Gennadius)-GEMINIVIRUS
Authors: Jiménez-Martínez Edgardo , Sandino-Díaz Victor , Rodríguez-Salguera Victor Hugo , Morales-Blandón Luis
Published: September 2010

Con el objetivo de evaluar alternativas de protección físicas y químicas de semilleros de tomate, se llevó a cabo un ensayo en el Municipio de Tisma, Masaya; en el período comprendido entre mayo y septiembre del año 2007. Los tratamiento evaluados fueron: Semillero de tomate puestos en el suelo protegidos con Nim®, Semillero de tomate en bandejas protegido con Gaucho®-confidor®, semillero de tomate en el suelo protegidos con malla antivirus (Microtúnel) y semilleros de tomate en bandejas protegido bajo la tecnología de Microinvernadero. De acuerdo a los resultados obtenidos, los tratamientos que presentaron los porcentajes más bajos de virosis fueron los tratamientos de Microinvernadero y Microtúnel. Los mayores rendimientos del cultivo se obtuvieron en el tratamiento semillero protegido en Microinvernadero. Finalmente, se realizó un análisis económico basado en un presupuesto parcial en el cual, el tratamiento Microinvernadero presentó, el segundo mayor costo variable pero a la vez el mayor beneficio neto en comparación con los otros tratamientos. Además, los tratamientos que fueron no dominados (Microinvernadero y Gaucho-confidor) se les determinó la Tasa de Retorno Marginal, concluyéndose así, que el microinvernadero fue la tecnología mas rentable; por tal razón, es la alternativa que en este estudio se puede recomendar para los productores de este municipio. Palabras clave: Mosca blanca, Geminivirus, Tomate, Microtunel, Microinvernadero, Tisma, Nicaragua.DOI: 10.5377/calera.v10i14.26
LA AGRICULTURA URBANA Y PERI-URBANA: UNA ALTERNATIVA PARA EL DESARROLLO LOCAL EN NICARAGUA
Authors: García Armando Flores
Published: September 2010

DOI: 10.5377/calera.v10i14.29
COMPOSICIÓN, ESTRUCTURA Y DINÁMICA DE DOS SITIOS DE BOSQUE SECO SECUNDARIO EN EL SUROESTE DE NICARAGUA: PAUTAS PARA EL DISEÑO E IMPLEMENTACIÓN DE ALTERNATIVAS DE MANEJO
Authors: Noguera-Talavera Álvaro , Obando Raúl , Oliva Eric
Published: September 2010

En dos comarcas del municipio de Nandaime, Granada, se llevóa cabo un estudio de dinámica del bosque seco secundario, conel propósito de obtener pautas para la definición de actividadesde manejo forestal. Para monitorear y determinar el cambiodurante un año, se establecieron cinco parcelas permanentesde muestreo en sitios de edades de 11 y 16 años después dehaber sido abandonados para actividades agrícolas. En lasparcelas se levantó información relacionada a la composicióny estructura de los fustales, latizales y brinzales. Parámetrospoblacionales fueron calculados a partir de la aplicación deun modelo exponencial de cambios en tiempos continuos.La riqueza y diversidad florística fueron diferentes entrecomunidades, siendo el sitio de 11 años, el que presentó losmás altos valores. Las diferencias estructurales entre sitiosfueron determinadas por los valores en área basal y volumen.El sitio de 16 años contiene el doble de área basal y 30% másdel volumen que el bosque más joven. El número de individuospor hectárea disminuyó en los dos sitios en relación a la primeramedición. Los valores de mortalidad fueron iguales (2%) en losdos sitios. El reclutamiento fue mayor en el sitio de 16 años.La ganancia en área basal contribuyo al incremento de toda lamasa, solamente en el sitio de 11 años. Las especies de interéscomercial local presentan pocos o ningún individuos a nivel dela regeneración natural. Los sitios estudiados presentan desdeanejo a mediano plazo.Abreviaturas: Dap, diamétro a la altura del pecho; H, altura;ICA, incremento corriente anual.DOI: 10.5377/calera.v9i12.1
POTENCIAL ESCÉNICO DE LA RESERVA NATURAL CERRO DATANLÍ-EL DIABLO EN JINOTEGA, CON FINES ECO TURÍSTICOS
Authors: Tapia Emelina L , Hueck Jimmy , Cassells René R , Blandón Isaac D
Published: September 2010

El estudio fue realizado en la RN Cerro Datanlí- El Diablo,Jinotega. El objetivo principal fue identificar sitios conpotencial belleza escénica aun no considerados para laejecución de actividades ecoturísticas que tiendan a mejorar lacalidad de vida de sus pobladores locales a partir de la visitade turistas y nacionales. Los mejores atractivos naturalese infraestructura existente se homogenizaron mediante laconsulta a lugareños y a través de la observación personal. Lametodología se desarrolló en tres etapas: (1) Recolección de lainformación secundaria, selección y ubicación de la zona deestudio y de contactos (MARENA, PAGJINO, Líderes locales).(2) Giras de campo para llevar a cabo: el DRP auxiliado con tresherramientas participativas; la identificación de 22 sitios conpotencial ecoturístico, 3 problemas principales que limitan sudesarrollo, recorridos por 7 senderos ecológicos que facilitó laidentificación de 17 sitios posibles como miradores de paisajesdiversos y 5 sitios donde se pueden observar y escuchar cantaraves exóticas como el Quetzal; aplicación de encuestas a lospobladores locales (niños y jóvenes ambientalistas, mujeresy productores) con el fin de conocer su participación enactividades de protección, conservación y manejo de losrecursos naturales. (3) Elaborar los mapas de los senderos através del programa Arc View 3.2, se ubicaron los principalesatractivos, propuestas de cambios en los recorridos basados enpendientes del terreno, análisis de visibilidad de miradores ysegún los atractivos principales en los sendero. La informaciónfacilitó incluir el diseño de un modelo de infraestructura enlos senderos (gradas, miradores y puentes) para el tráficode visitantes y la elaboración de tres propuestas de paquetesturísticos que contienen información básica de los recursosnaturales existentes en la reserva natural.Palabras clave: Atractivos naturales; calidad de vida;Diagnóstico Rural Participativo; ecoturismo; encuestas;miradores de senderos; paquetes turísticos; potencial bellezaescénica; Sistema de Posicionamiento Global GPS.DOI: 10.5377/calera.v9i13.12