Surgical outcomes of isolated lens coloboma with or without cataract among young adults

Objective: To evaluate the visual and refractive outcomes after phacoemulsification surgery in eyes with isolated lens coloboma. Design: Prospective, consecutive case series. Participants: Eighteen eyes with isolated lens coloboma of 13 patients were included in the study. Mean patient age was 13.9 ± 6.5 years. Methods: Patients underwent phacoemulsification surgery, with combined implantation of capsular tension ring (CTR) and intraocular lens. In colobomas of less than 120°, a CTR was used, whereas in colobomas of more than 120°, a Cionni-modified single eyelet CTR was used to achieve better capsular centration. The main outcome measures were uncorrected distance visual acuity, corrected distance visual acuity, refraction, and keratometry. Results: Mean logMAR uncorrected distance visual acuity and corrected distance visual acuity improved significantly from 1.53 ± 0.35 and 1.02 ± 0.47 before surgery to 0.67 ± 0.51 and 0.52 ± 0.49 at the last visit of the follow-up (p < 0.001). Mean refractive cylinder and spherical equivalent decreased significantly from –6.73 ± 1.73 and –6.72 ± 4.07 D preoperatively to –1.40 ± 1.39 and –0.83 ± 1.31 D at the end of the follow-up (p = 0.001 and p = 0.01, respectively). Mean keratometric astigmatism at preoperative and postoperative visits were 1.58 ± 0.97 and 1.65 ± 0.94 D, respectively (p = 0.70). Conclusions: Phacoemulsification with CTR and intraocular lens implantation is an effective and safe option for providing a refractive correction and a significant visual improvement in eyes with isolated lens coloboma.

Reverse Geometry Hybrid Contact Lens Fitting in a Case of Donor-Host Misalignment after Keratoplasty

Purpose: To report the successful outcome obtained after fitting a new hybrid contact lens in a cornea with an area of donor-host misalignment and significant levels of irregular astigmatism after penetrating keratoplasty (PKP). Materials and methods: A 41-year-old female with bilateral asymmetric keratoconus underwent PKP in her left eye due to the advanced status of the disease. One year after surgery, the patient referred a poor visual acuity and quality in this eye. The fitting of different types of rigid gas permeable contact lenses was performed, but with an unsuccessful outcome due to contact lens stability problems and uncomfortable wear. Scheimpflug imaging evaluation revealed that a donor-host misalignment was present at the nasal area. Contact lens fitting with a reverse geometry hybrid contact lens (Clearkone, SynergEyes Carlsbad) was then fitted. Visual, refractive, and ocular aberrometric outcomes were evaluated during a 1-year period after the fitting. Results: Uncorrected distance visual acuity improved from a prefitting value of 20/200 to a best corrected postfitting value of 20/20. Prefitting manifest refraction was +5.00 sphere and -5.50 cylinder at 75°, with a corrected distance visual acuity of 20/30. Higher order root mean square (RMS) for a 5 mm pupil changed from a prefitting value of 6.83 µm to a postfitting value of 1.57 µm (5 mm pupil). The contact lens wearing was referred as comfortable, with no anterior segment alterations. Conclusion: The SynergEyes Clearkone contact lens seems to be another potentially useful option for the visual rehabilitation after PKP, especially in cases of donor-host misalignment.

Developing a programme theory to explain how primary health care teams learn to respond to intimate partner violence: a realist case-study

Background: Despite the progress made on policies and programmes to strengthen primary health care teams’ response to Intimate Partner Violence, the literature shows that encounters between women exposed to IPV and health-care providers are not always satisfactory, and a number of barriers that prevent individual health-care providers from responding to IPV have been identified. We carried out a realist case study, for which we developed and tested a programme theory that seeks to explain how, why and under which circumstances a primary health care team in Spain learned to respond to IPV. Methods: A realist case study design was chosen to allow for an in-depth exploration of the linkages between context, intervention, mechanisms and outcomes as they happen in their natural setting. The first author collected data at the primary health care center La Virgen (pseudonym) through the review of documents, observation and interviews with health systems’ managers, team members, women patients, and members of external services. The quality of the IPV case management was assessed with the PREMIS tool. Results: This study found that the health care team at La Virgen has managed 1) to engage a number of staff members in actively responding to IPV, 2) to establish good coordination, mutual support and continuous learning processes related to IPV, 3) to establish adequate internal referrals within La Virgen, and 4) to establish good coordination and referral systems with other services. Team and individual level factors have triggered the capacity and interest in creating spaces for team leaning, team work and therapeutic responses to IPV in La Virgen, although individual motivation strongly affected this mechanism. Regional interventions did not trigger individual and/ or team responses but legitimated the workings of motivated professionals. Conclusions: The primary health care team of La Virgen is involved in a continuous learning process, even as participation in the process varies between professionals. This process has been supported, but not caused, by a favourable policy for integration of a health care response to IPV. Specific contextual factors of La Virgen facilitated the uptake of the policy. To some extent, the performance of La Virgen has the potential to shape the IPV learning processes of other primary health care teams in Murcia.

Comparing Common Data Environment Platforms for Student Collaborative Working: A Case Study from Ulster University

PAS1192-2 (2013) outlines the “fundamental principles of Level 2 information modeling”, one of these principles is the use of what is commonly referred to as a Common Data Environment (CDE). A CDE could be described as an internet-enabled cloudhosting platform, accessible to all construction team members to access shared project information. For the construction sector to achieve increased productivity goals, the next generation of industry professionals will need to be educated in a way that provides them with an appreciation of Building Information Modelling (BIM) working methods, at all levels, including an understanding of how data in a CDE should be structured, managed, shared and published. This presents a challenge for educational institutions in terms of providing a CDE that addresses the requirements set out in PAS1192-2, and mirrors organisational and professional working practices without causing confusion due to over complexity. This paper presents the findings of a two-year study undertaken at Ulster University comparing the use of a leading industry CDE platform with one derived from the in-house Virtual Learning Environment (VLE), for the delivery of a student BIM project. The research methodology employed was a qualitative case study analysis, focusing on observations from the academics involved and feedback from students. The results of the study show advantages for both CDE platforms depending on the learning outcomes required.

A Minor Change?: A Case Study of Carleton Place's Integration of Minor Variance Procedures into Ontario's Development Permit System

The Development Permit System has been introduce with minimal directives for establishing a decision making process. This is in opposition to the long established process for minor variances and suggests that the Development Permit System does not necessarily incorporate all of Ontario’s fundamental planning principles. From this concept, the study aimed to identify how minor variances are incorporated into the Development Permit System. In order to examine this topic, the research was based around the following research questions: • How are ‘minor variance’ applications processed within the DPS? • To what extent do the four tests of a minor variance influence the outcomes of lower level applications in the DPS approval process? A case study approach was used for this research. The single-case design employed both qualitative and quantitative research methods including a review of academic literature, court cases, and official documents, as well as a content analysis of Class 1, 1A, and 2 Development Permit application files from the Town of Carleton Place that were decided between 2011 and 2015. Upon the completion of the content analysis, it was found that minor variance issues were most commonly assigned to Class 1 applications. Planning staff generally met approval timelines and embraced their delegated approval authority, readily attaching conditions to applications in order to mitigate off-site impacts. While staff met the regulatory requirements of the DPS, ‘minor variance’ applications were largely decided on impact alone, demonstrating that the principles established by the four tests, the defining quality of the minor variance approval process, had not transferred to the Development Permit System. Alternatively, there was some evidence that the development community has not fully adjusted to the requirements of the new approvals process, as some applications were supported using a rationale containing the four tests. Subsequently, a set of four recommendations were offered which reflect the main themes established by the findings. The first two recommendations are directed towards the Province, the third to municipalities and the fourth to developers and planning consultants: 1) Amend Ontario Regulation 608/06 so that provisions under Section 4(3)(e) fall under Section 4(2). 2) Change the rhetoric from “combining elements of minor variances” to “replacing minor variances”. 3) Establish clear evaluation criteria. 4) Understand the evaluative criteria of the municipality in which you are working.

The ICC Debate and the EU-U.S. Struggle for Influence: The Case of the Balkan-6. ACES Working Paper No. 11, October 2007

The objectives of the European Union (EU) and the United States (US) for the countries of the Balkan region are generally assumed to be complementary. They both stress and condition their support and assistance on the progress that these countries make with regards to economic modernization, build-up of social institutions, and respect for international law. However, this rhetoric doesn't always match the facts on the ground. Often, instead of dealing with a cohesive set of policy recommendations, the countries in the region are faced with contradictory alternatives and zero-sum choices. The debate over the development of the International Criminal Court (ICC) was such a case. It centered on whether the countries in the region should exempt US personnel from the jurisdiction of the Court while in the country and thus rendering them immune from prosecution for any crimes committed for which the US courts were not willing or able to take any action. The final outcome was mixed. Three of the countries - Croatia, Serbia (and Montenegro), and Slovenia - decided not to give in to US pressure, while the remaining three - Albania, Bosnia and Herzegovina, and Macedonia - ignored the pleas and threats of the EU and of the various international non-governmental organizations and decided to sign Bilateral Immunity Agreements (BIAs) with the US. How can one explain such divergent outcomes? I argue that the credibility of actors involved played an important role in determining whether threats coming from the US or the EU were more credible, thus tipping the scales in favor of signing BIAs with the US. However, the issue of threat credibility serves only to narrow down the choices of actors. Further determination of the outcome necessitates a look at the nature of the security context in which these countries exist and operate.

Using linked data to evaluate medical and financial outcomes of motor vehicle crashes in Connecticut.

Federal Highway Administration, Washington, D.C.

Virtual case manager : tactical implementation plan.

"During the 1996 spring session, the General Assembly passed and the Governor signed landmark legislation creating a Department of Human Services (DHS) effective July 1, 1997. The new department consolidates three human services departments in their entirety : Department of Alcoholism and Substance Abuse (DASA) - Department of Rehabilitation Services (DORS) - Department of Mental Health and Developmental Disabilities (DMH/DD)."

The role of Community Health Workers. Historical perspective of facilitators and barriers. Case study in Vaupés, Colombia

Thesis (Master's)--University of Washington, 2016-06

Relationships between First Generation College Students and Faculty: A Case Study of a Small Rural Private University

Thesis (Ed.D.)--University of Washington, 2016-06

The 2014 chikungunya virus outbreak in the U.S. Virgin Islands: epidemiology, long-term health outcomes, and economic burden

Thesis (Ph.D.)--University of Washington, 2016-06

General practitioners' role in preventive medicine: scenario analysis using alcohol as a case study

The purpose of this analysis is threefold: first, to extract from the literature, current levels of GP detection of at-risk drinking by their patients, rates at which general practitioners (GPs) offer an intervention; and the effectiveness of these interventions; secondly, to develop a model based on this literature to be used in conjunction with scenario analysis; and thirdly, to consider the cost implications of current efforts and various scenarios. This study deals specifically with Australian general practice. A two-step procedure is used in the scenario analysis, which involves identifying opportunities for detection, intervention, effectiveness and assigning probabilities to outcomes. The results suggest that increasing rates of GP intervention achieves greatest benefit and return on resource use. For every 5% point increase in the rate of GP intervention, an additional 26 754 at-risk drinkers modify their drinking behaviour at a cost of $231.45 per patient. This compares with a cost per patient modifying drinking behaviour of $232.60 and $208.31 for every 5% point increase in the rates of detection and effectiveness, respectively. The knowledge, skill and attitude of practitioners toward drinking are significant, and they can be the prime motivators in persuading their patients to modify drinking behaviour.

Investigating information requirements for evaluating effectiveness of marine protected areas - Indonesian case studies

Identifying the information needs of managers and other stakeholders is an important first step in designing an evaluation of management effectiveness for marine protected areas (MPAs) that will be relevant to local circumstances and useful for improving management practices. Information requirements for evaluating effectiveness were investigated at two MPAs in Indonesia. Results show that, despite similar management objectives, information needs for evaluation differ between sites and those differences reflect the unique context within which management operates in each case. The scope of information needs at each site covers a broad range of issues including context, planning, resources, processes, outputs, and outcomes. Relevant components of a variety of different evaluation tools will need to be used to satisfy information needs at these sites. Evaluation tools that are based primarily on stated management objectives or the expressed views of a few key stakeholders are unlikely to be very useful for improving management in these cases.

Revegetation strategies for bauxite refinery residue: A case study of Alcan Gove in Northern Territory, Australia

Alumina extraction from bauxite ore with strong alkali produces waste bauxite refinery residue consisting of residue sand and red mud. The amount and composition of refinery residue depend on the purity of the bauxite ore and extraction conditions, and differs between refineries. The refinery residue is usually stored in engineered disposal areas that eventually have to be revegetated. This is challenging because of the alkaline and sodic nature of the residue. At Alcan Gove's bauxite refinery in Gove, Northern Territory, Australia, research into revegetation of bauxite residue has been conducted since the mid-1970s. In this review, we discuss approaches taken by Alcan Gove to achieve revegetation outcomes (soil capping of refinery residue) on wet-slurry disposal areas. Problems encountered in the past include poor drainage and water logging during the wet season, and salt scalding and capillary rise during the dry season. The amount of available water in the soil capping is the most important determinant of vegetation survival in the seasonally dry climate. Vegetation cover was found to prevent deterioration of the soil cover by minimising capillary rise of alkalinity from the refinery residue. The sodicity and alkalinity of the residue in old impoundments has diminished slightly over the 25 years since it was deposited. However, development of a blocky structure in red mud, presumably due to desiccation, allows root penetration, thereby supplying additional water to salt and alkali-tolerant plant species. This has led to the establishment of an ecosystem that approaches a native woodland.