Your Patient and My Client: Perspectives from Legal Work With Unaccompanied Children

Drawing from a dozen years’ experience in providing legal services to unaccompanied immigrant children, the author describes the legal landscape navigated by immigrant children, and some of the challenges they face. The article suggests approaches to improved communication when serving a child who is an immigrant to the U.S., calls for an increase in cross-disciplinary collaboration, and concludes with a suggested reading and resource list

Exploring Employee Engagement in a Global Context – The Example of Germany

This research aims to gain in-depth understanding of the views, conceptualisations, and adaptions of Employee Engagement in Germany. While the empirical study focuses on Germany, the literature review was based on the findings from rich Anglo-US sources and was drawn from Human Resource Management, Human Resource Development, and Employee Engagement literature. Here, the topic of Employee Engagement was of increasing interest in academia, and to practitioners. Moreover, the limited literature on Employee Engagement published in German and on Germany was also reviewed. The review considered different perspectives on the phenomenon as well as emerging frameworks, and revealed that there was no unified Employee Engagement definition, but rather different drivers and output factors associated with the phenomenon. Furthermore, the author also reflected on potential German equivalents of the untranslatable Employee Engagement term, including Mitarbeitermotivation, for example. The social construction of the phenomenon according to literature was reviewed and is presented along with its evolution and various measurement approaches. Finally, the author reflected on cross-cultural and generational differences, as well as on the impact of language on the term’s meaning as well as its role in human resources. The empirical study itself used a multiple method approach, combining in-depth interviews and a documentary method, to gather data on the understanding and establishment of Employee Engagement in organisations in Germany. A pilot interview was conducted, followed by 18 indepth interviews with HR managers or equivalents from different industries, which contributed rich detail concerning the interviewees’ understanding of the phenomenon and its adoption and establishment by organisations. The documentary analysis supported the findings from the primary research and provided additional insights into the organisational Employee Engagement conceptualisation, which was primarily based on the implementation of (ad hoc) initiatives to drive Employee Engagement. Nevertheless, the term itself was rarely used and of less importance when it came to the phenomenon’s implementation. Instead, the interviews showed that the organisations’ focus was on perceived drivers, such as development possibilities, recognition, and appreciation as well as communication and transparency. This was to ensure employees’ trust, identification, and contribution into their employer, in order to achieve output factors including an increase in performance and loyalty as well as brand identification and involvement. Similarities and variance between the empirical findings and the literature review were presented and perspectives discussed. Here, definitional inconsistencies were found both in the findings and the existing literature, still parallels were identified with respect to an employee’s willingness to contribute cognitively, emotionally, and physically. These findings were also underpinned and supported by the results of the author’s documentary research. The organisations’ Employee Engagement approaches, especially with respect to the implementation of benefits as a driver, were identified throughout the Page 12 documentary research. While the documentary analysis also revealed no consistent definition for Employee Engagement, alternative approaches such as organisational culture and a strong we-sentiment through associations with family and friends were shown to drive Employee Engagement. Finally, the contribution of the research is presented together with its implications for theory and practice, but the study provides various insights, especially for practitioners of Employee Engagement in large organisations in Germany. The author identified that most organisations were using Employee Engagement in a piecemeal way and their individual reinventions of the phenomenon to tackle individual or common challenges, such as the fight for talents and loyalty, while only a few had established integrated Employee Engagement strategies which relied on different components. At the same time, the study provides national and international practitioners with insights into German-specific requirements and conditions, such as the involvement of workers’ councils in ensuring safety and driving Employee Engagement. Additionally, it contributes due to its use of a multiple method approach, as it enables researchers to analyse both the espoused organisational viewpoint and the perceptions of practitioners at the same time. The documentary analysis provides a rich set of data. Finally, further research implications are outlined, emerging from limitations of the current study, especially with respect to the long-term establishment of Employee Engagement in the participating organisations, its measurability, and its adoption in German Mittelstand business [Engl. Small and medium-sized businesses]

Longitudinal observation of the retinal nerve fibre layer in glaucoma patients treated with brimonidine combined with timolol or timolol alone

INTRODUCTION. The aim of the study was to evaluate the retinal nerve fibre layer (RNFL) thickness loss in primary open-angle glaucoma (POAG) patients treated topically with anti-glaucoma drops containing brimonidine and timolol combination or solely timolol. MATERIALS AND METHODS. Retrospective case series study of patients with POAG diagnosis followed up for a five-year period. Inclusion criteria were fulfilled by a group of 98 patients consisting of 53 combination and 45 monotherapy treatments. Intraocular pressure (IOP) at the level of 21 mm Hg or below for each measurement was observed in 52 patients, while incidences of pressure above 21 mm Hg were measured in 46 patients. POAG diagnosis was based on standard optical coherence tomography, IOP, and visual field examinations. RESULTS. Mean annual loss of RNFL thickness in the overall study group (if IOP levels are not taken into consideration) treated with timolol monotherapy was 1.8 ± 1.5 μm, while in group treated with brimonidine + timolol combination therapy it was 1.7 ± 1.5 μm (p > 0.05). In selected groups of patients with incidents of pressure rises, the mean annual loss of retinal nerve fibre layer thickness was 1.8 ± 1.6 and 1.9 ± 1.4 μm, respectively, for the monotherapy and combination therapy groups (p > 0.05). In the group of patients with no reported IOL rises, mean annual loss of RNFL thickness was 1.8 ± 0.9 and 1.1 ± 0.4 μm, respectively, for the monotherapy and combination therapy groups (p < 0.01). No significant differences were observed for the visual field mean deviation. CONCLUSIONS. POAG patients with low values of IOP might achieve slower progression of RNFL thinning on brimonidine combined with timolol therapy.

Bootstrapping of Corneal Optical Coherence Tomography Data to Investigate Conic Fit Robustness

Background: Fitting of parametric model surfaces to corneal tomographic measurement data is required in order to extract characteristic surface parameters. The purpose of this study was to develop a method for evaluating the uncertainties in characteristic surface parameters using bootstrap techniques. Methods: We included 1684 measurements from a cataractous population performed with the tomographer Casia2. Both conoid and biconic surface models were fitted to the height data. The normalised fit error (height—reconstruction) was bootstrapped 100 times and added to the reconstructed height, extracting characteristic surface parameters (radii and asphericity for both cardinal meridians and axis of the flat meridian) for each bootstrap. The width of the 90% confidence interval of the 100 bootstraps was taken as uncertainty and quoted as a measure of the robustness of the surface fit. Results: As derived from bootstrapping, the mean uncertainty for the radii of curvature was 3 µm/7 µm for the conoid and 2.5 µm/3 µm for the biconic model for the corneal front/back surface, respectively. The corresponding uncertainties for the asphericity were 0.008/0.014 for the conoid and 0.001/0.001 for the biconic. The respective mean root mean squared fit error was systematically lower for the corneal front surface as compared to the back surface (1.4 µm/2.4 µm for the conoid and 1.4 µm/2.6 µm for the biconic). Conclusion: Bootstrapping techniques can be applied to extract uncertainties of characteristic model parameters and yield an estimate for robustness as an alternative to evaluating repeat measurements. Further studies are required to investigate whether bootstrap uncertainties accurately reproduce those from repeat measurement analysis

Quantitative measurement of pseudoexfoliation in the anterior segment of the eye performed in visible light

Introduction: Pseudoexfoliation syndrome (PEX) is a systemic disease involving the accumulation of pathological material deposits in the tissues of the anterior segment of the eye. The problem of modern ophthalmology is a quantitative assessment of the severity of PEX in the diagnosis and evaluation of the treatment progress in patients.Material and method: For the purposes of this study, 52 images of the anterior segment of the eye with the resolution of M × N = 1280 × 960 pixels were obtained in jpg format using the slit lamp CSO 450-SL. The patients were aged 50-80 and were recruited from Poland. All patients who participated in the study provided written informed consent after explanation of the nature and possible consequences of the study. The image analysis method proposed by the authors contains the calculation of the direction field, setting a straight perpendicular line passing through each pixel of the edge of the pupil, the calculation of the intersection of straight lines in order to determine the central point of the pupil position, the detection of the contour of PEX and the outer border of the iris with the use of the polar coordinate system. All analyzed parameters were set automatically with one exception parameter chosen manually depending on the slit lamp type.Results: A fully automatic measurement of PEX was carried out with the proposed method. Quantitative results enable to perform reproducible tests independently of the research centre. Owing to the image analysis method proposed by the authors, it is possible to obtain results in no more than 1 second on the Intel Core 2 Quad CPU 2.50 GHz with a measurement error below 3%. Other known methods of image analysis and processing that are compared in this paper give results with a greater error (4-35%) which depends on the degree of magnification (×6, ×16, ×20) and are not fully automatic.Conclusions: The methods of image analysis and processing enable a quantitative, repeatable and automatic measurement of the severity and progress of PEX syndrome. They support medical diagnosis and automatic archiving of results

Comparative Study of Anterior Eye Segment Measurements with Spectral Swept-Source and Time-Domain Optical Coherence Tomography in Eyes with Corneal Dystrophies

Purpose. To compare anterior eye segment measurements and morphology obtained with two optical coherence tomography systems (TD OCT, SS OCT) in eyes with corneal dystrophies (CDs). Methods. Fifty healthy volunteers (50 eyes) and 54 patients (96 eyes) diagnosed with CD (epithelial basement membrane dystrophy, EBMD = 12 eyes; Thiel-Behnke CD = 6 eyes; lattice CD TGFBI type = 15 eyes; granular CD type 1 = 7 eyes, granular CD type 2 = 2 eyes; macular CD = 23 eyes; and Fuchs endothelial CD = 31 eyes) were recruited for the study. Automated and manual central corneal thickness (aCCT, mCCT), anterior chamber depth (ACD), and nasal and temporal trabecular iris angle (nTIA, tTIA) were measured and compared with Bland-Altman plots. Results. Good agreement between the TD and SS OCT measurements was demonstrated for mCCT and aCCT in normal individuals and for mCCT in the CDs group. The ACD, nTIA, and tTIA measurements differed significantly in both groups. TBCD, LCD, and FECD caused increased CCT. MCD caused significant corneal thinning. FECD affected all analyzed parameters. Conclusions. Better agreement between SS OCT and TD OCT measurements was demonstrated in normal individuals compared to the CDs group. OCT provides comprehensive corneal deposits analysis and demonstrates the association of CD with CCT, ACD, and TIA measurements

Anterior segment intraocular metallic foreign body causing chronic hypopyon uveitis

Intraocular foreign body (IOFB) is a common association of penetrating ocular trauma. Early diagnosis and removal of IOFBs especially if they are metallic is very important to determine further management and the final result of treatment. Missed IOFB may present in different clinical aspects that may limit its detection and symptoms may only become apparent after a prolonged period of time. We report a case of a missed metallic intraocular foreign body in the anterior chamber over a 2-year period without causing severe inflammatory reaction and presented with uveitis later. A 42-year-old man presented with a progressive blurring of vision, pain, photophobia, and redness in the left eye for 3 months. He had a history of traffic accident 2 years ago and he was accepted to intensive care unit for 3 days. Three months ago, in another center, he was admitted to hospital for 1 week and intravitreal antibiotics and medical treatment were given for pain, photophobia, and redness in his left eye. In five o’ clock meridian of the angle, there was an IOFB coated with hypopyon was observed under biomicrocopic magnification. Plain X-ray and computed tomography confirmed the foreign body in the left eye. After obtaining informed consent from the patient, the foreign body was removed under local anesthesia