Publications by authors named "Florence Hoogewoud"

15 Publications

  • Page 1 of 1

The Clinical Spectrum and Outcome of Uveomeningitis: A Comprehensive Analysis of 110 Cases.

Ocul Immunol Inflamm 2021 May 11:1-6. Epub 2021 May 11.

Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP), Paris, France.

Uveitis can be associated with meningitis (uveomeningitis) and the inflammation shared with the central nervous system. We aimed to describe the characteristics and outcome of uveomeningitis. We retrospectively analyzed 110 consecutive adult patients with uveomeningitis. The main causes of uveomeningitis were Vogt-Koyanagi-Harada (31%), syphilis (16%), sarcoidosis (12%), Behçet's disease (7%), and multiple sclerosis (5%). Sixteen percent of uveomeningitis remained of undetermined origin. Compared to etiology-matched uveitis without meningitis, patients with uveomeningitis were younger, had more frequent neurological manifestations, and had more frequent abnormal cerebral magnetic resonance imaging findings. In contrast, no ocular feature upon examination was significantly associated with the presence of meningitis. Patients with uveomeningitis were more frequently treated with immunosuppressants but uveitis relapse and systemic complications did not differ between groups. Uveomeningitis is associated with a limited spectrum of diseases. Meningitis does not seem to impact ocular and extraocular outcomes. Therefore, lumbar puncture should be performed on an individual basis during the diagnostic workup of uveitis.
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http://dx.doi.org/10.1080/09273948.2021.1898000DOI Listing
May 2021

Epidemiology of Childhood Uveitis in a Tertiary Care Center: A 20-Year Study.

Klin Monbl Augenheilkd 2021 Apr 14;238(4):469-473. Epub 2021 Apr 14.

Jules-Gonin Eye Hospital, Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland.

Purpose: To investigate demographics and causes of pediatric uveitis in a Swiss tertiary reference center over a 20-year period.

Materials And Methods: Retrospective cohort study on patients with uveitis aged less than 16 years seen at Jules-Gonin Eye Hospital between 1 January 2000 and 31 December 2019.

Results: Out of 2846 patients with uveitis seen in the Jules-Gonin Eye Hospital Ocular Immune-Infectiology Department, 317 (11.1%) were under 16 years of age and were included in this study. Median age at onset of the uveitis was 8.9 years (range 0 - 16). Anterior uveitis was the most frequent presentation (45.1%) followed by posterior uveitis in 26.2%, intermediate uveitis in 23.3%, and panuveitis in 5.4%. The inflammation was most frequently bilateral and non-granulomatous. A systemic inflammatory disease was found in 34% of the cases and an infectious cause in 24%.

Conclusion: The repartition of the location of the uveitis was similar to previous reports from Western countries. Uveitis in juvenile idiopathic arthritis is the most frequent etiology related to a systemic disease in children. An infectious cause was found in 24% of our patients, which is a greater proportion than in adult cohorts.
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http://dx.doi.org/10.1055/a-1384-0351DOI Listing
April 2021

[Ocular manifestations of Covid-19].

Rev Med Suisse 2021 Jan;17(723):206-208

Hôpital ophtalmique Jules-Gonin, Fondation asile des aveugles, Université de Lausanne, 1005 Lausanne.

The most frequent ocular manifestation of the SARS-CoV-2 is a conjunctivitis. It is found in 1-3% of patients and has unusually a benign course. In those patients but also in patients without ocular involvement, the virus can be detected by PCR in conjunctival swabs or in the tears. Whereas the presence of the virus in the conjunctiva is proven, its transmission through the conjunctiva is still discussed. Despite the poor level of evidence, the use of protective eyewear is recommended. Ocular thromboembolic events have been described in Covid-19. They can be found in the context of the Covid-related coagulopathy. A multidisciplinary approach should be provided in these cases. In the ICU, severe ocular complications might be indirectly related to Covid-19 in ventilated patients.
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January 2021

Comparison between the areas of scarred and active toxoplasmic retinochoroiditis.

Eye (Lond) 2020 Nov 24. Epub 2020 Nov 24.

Service d'ophtalmologie, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Paris, France.

Background/objectives: To assess the ratio of scarred/active areas of fundus lesions in patients with presumed ocular toxoplasmosis.

Subjects/methods: Retrospective monocentric study of patients with presumed ocular toxoplasmosis seen between May 2004 and February 2018. Patients with a positive anti-Toxoplasma serology presenting characteristic fundus lesions. Cases with images of both baseline active and scarred lesions of the fundus were included. The borders of each active or scarred lesion were delineated on colour photographs by two independent observers and the area of the lesions was calculated using Digimizer 4.2.2 (MedCalc Software, Ostend, Belgium). The interobserver variability of the measures was recorded and their means were used for further calculations. To study the ratio of the area of scarred retinochoroiditis over the area of the baseline active lesion (R).

Results: A total of 171 cases (83 males, 88 females) with a mean age of 31.6 ± 13.8 years were included. The average areas of active and scarred retinochoroiditis were, respectively, 1.32 ± 1.59 and 1.79 ± 2.36 optic disc area. The average ratio between scarred and active areas of retinochoroiditis was 1.36 [range 0.54-2.18]. The administration of a systemic treatment [R = 1.25, p = 0.003], the absence of a pre-existing scar [R = 1.05, p < 0.001] and a peripapillary location of the lesion [R = 0.85, p < 0.001] were each significantly associated with smaller scarred/active area ratios.

Conclusions: We assessed in a standardized manner the ratio of scarred/active areas of toxoplasmic lesions and showed that the area of scarred lesions was on average slightly larger than the area of active retinochoroiditis.
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http://dx.doi.org/10.1038/s41433-020-01290-3DOI Listing
November 2020

[Anti-TNF-α in the treatment of non-infectious uveitis].

Med Sci (Paris) 2020 Oct 7;36(10):893-899. Epub 2020 Oct 7.

Ophtalmopole Hôpital Cochin; Assistance Publique-Hôpitaux de Paris; Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France - Centre de recherches des Cordeliers; Inserm UMR 1138, Physiopathologie des maladies oculaires : innovations thérapeutiques; Université de Paris, 15 rue de l'École de Médecine, 75006 Paris, France.

Non-infectious uveitis is a heterogenous group of potentially blinding ocular autoimmune diseases that may represent a manifestation of a systemic condition or may affect the eyes only. A systemically administered anti-TNF has recently been approved for the treatment of non-infectious uveitis, broadening the therapeutic arsenal available to control intraocular inflammation and reduce uveitis complications that can lead to vision loss. When uveitis affects only the eyes, a local anti-TNF-α administration strategy could optimize the ocular therapeutic effect and reduce undesirable systemic side-effects. A new ocular method of non-viral gene therapy, currently in development, may broaden the indications for ocular anti-TNF-α agents, not only for uveitis but also for other diseases in which TNF-α-mediated neuro-inflammation has been demonstrated.
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http://dx.doi.org/10.1051/medsci/2020160DOI Listing
October 2020

Anterior segment optical coherence tomography imaging in peripheral ulcerative keratitis, a corneal structural description.

BMC Ophthalmol 2020 May 25;20(1):205. Epub 2020 May 25.

Ophthalmology Department, Cochin Hospital, Paris University, Paris, France.

Background: Anterior segment optical coherence tomography (AS OCT) is a helpful tool used to diagnose and manage many corneal conditions, but its use has not been reported in case of peripheral ulcerative keratitis (PUK). The aim of this study is to describe AS OCT findings in cases of PUK.

Methods: Retrospective observational case series of six eyes presenting with a PUK and proven systemic vasculitis. Clinical course, slit lamp photographs, and AS OCT findings were the main outcomes.

Results: The AS OCT findings were found to correlate with the ocular disease's level of activity. In the acute stage, an absence of corneal epithelium, a scrambled appearance of the anterior stroma and a heterogeneous stromal reflectivity were observed. During the reduction of disease level activity, an irregular hyporeflective epithelium, a smoother anterior stroma, and a homogenous hyperreflective stroma were seen. At the healed stage, a filling of the corneal defect by a hyporeflective thick epithelium, the persistence of the hyperreflective underlying stroma, and a demarcation line were observed. The mean total corneal thickness at last follow-up was significantly thicker (509 ± 147 μm) compared with the mean corneal thickness at onset (408 ± 131 μm; P = 0.03).

Conclusions: AS OCT provides an assessment of structural changes occurring in PUK, useful for its diagnosis and monitoring.
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http://dx.doi.org/10.1186/s12886-020-01466-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7249626PMC
May 2020

Cancer-associated retinopathy preceding the diagnosis of cancer.

BMC Ophthalmol 2018 Nov 3;18(1):285. Epub 2018 Nov 3.

Department of Ophthalmology, National Referral Center for rare Ocular Diseases, Hôpital Cochin, APHP, Université Paris Descartes, Paris, France.

Background: The early diagnosis of cancer is of crucial importance and a key prognostic factor. Cancer-associated retinopathy (CAR) can be symptomatic prior to other manifestations directly related to malignant tumors. The aim of this study was to show that, in selected cases, ophthalmic findings are consistent enough with the diagnosis of CAR to trigger investigations aimed at detecting a previously unknown malignancy.

Methods: This was a monocentric retrospective case series performed in a tertiary referral center. Patients with a diagnosis of CAR were included. Diagnosis was based on the clinical presentation, the visual field and electroretinogram alterations. The clinical presentation, visual field testing and electroretinographic results were analyzed as well as the malignancies identified following the diagnosis of CAR. Follow-up data was collected.

Results: Four patients (two men, two women, median age 65.5 years) were included. All patients presented with posterior segment inflammation at initial presentation as well as advanced visual field loss and an extinguished electroretinogram. The best corrected decimal visual acuity was 0.8 or better in both eyes of three patients and decreased to 0.3 OD and O.2 OS in one patient due to a bilateral macular edema. No patient had a previously known history of cancer. Once the diagnosis of CAR was made, investigations aimed at identifying a malignant tumors subsequently led to the diagnosis of two cases of small cell lung tumors, of one prostate carcinoma and of a uterine sarcoma. The treatment of CAR included plasmapheresis, systemic corticosteroids, azathioprine, cyclosporine and periocular or intraocular corticosteroid injections. In all cases the intraocular inflammation resolved, but pigment mottling, diffuse retinal atrophy, optic disc pallor and arterial narrowing were among manifestations observed during the follow-up of the patients.

Conclusion: In selected patients, findings suggestive of CAR can be useful for the early detection of a cancer.
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http://dx.doi.org/10.1186/s12886-018-0948-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6215635PMC
November 2018

Pregnancy-induced Changes in Corneal Biomechanics and Topography Are Thyroid Hormone Related.

Am J Ophthalmol 2017 Dec 13;184:129-136. Epub 2017 Oct 13.

Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland; ELZA Institute, Dietikon, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Department of Ophthalmology, USC Roski Eye Institute, USC Los Angeles, Los Angeles, California. Electronic address:

Purpose: To identify biomechanical and topographic changes of the cornea during pregnancy and the postpartum period and its association to hormonal changes.

Design: Prospective single-center observational cohort study.

Methods: Participants were 24 pregnant women (48 eyes), monitored throughout pregnancy and after delivery. Biomechanical and topographic corneal properties were measured using the Ocular Response Analyzer (ORA) and a Scheimpflug imaging system (Pentacam HR) each trimester and 1 month after delivery. At the same consultations blood plasma levels of estradiol (E2) and thyroid hormones (TSH, T3t, T4t) were also determined. A factorial MANCOVA was used to detect interactions between hormonal plasma levels and ocular parameters.

Results: Significant differences in corneal biomechanical and topographic parameters were found during pregnancy in relation to T3t (p = .01), T4t (p < .001), T3t/T4t (P = .001), and TSH (p = .001) plasma levels. E2 plasma levels (p = .092) and time period of measurement (p = .975) did not significantly affect corneal parameters. TSH levels significantly affected the maximal keratometry reading (p = .036), the vertical keratometry reading (p = .04), and the index of height asymmetry (p = .014). Those results persist after excluding hypothyroidism patients from the statistical analysis.

Conclusions: Hormonal changes affecting corneal biomechanics and topography during pregnancy could be thyroid related. Dysthyroidism may directly influence corneal biomechanics and represents a clinically relevant factor that needs further investigation.
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http://dx.doi.org/10.1016/j.ajo.2017.10.001DOI Listing
December 2017

Prognostic Factors in Syphilitic Uveitis.

Ophthalmology 2017 12 2;124(12):1808-1816. Epub 2017 Aug 2.

Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Paris, France; Present address: Department of Internal Medicine, Hôpital St. Louis, Paris, France. Electronic address:

Purpose: To identify predictors of treatment success in syphilitic uveitis (SU).

Design: Retrospective multicentric analysis of patients treated for SU.

Participants: A total of 95 eyes (66 patients, mean [standard deviation] aged 49 [12.5] years, 31 [47%] of whom were human immunodeficiency virus [HIV]+) were analyzed.

Methods: Activity of SU was assessed at 1 week and 1 month after treatment onset, and at last follow-up. Improvement was defined by a ≥2-step decrease of both anterior chamber and vitreous haze inflammation levels, and by the size reduction in chorioretinal lesions.

Main Outcome Measures: Recovery was defined as the resolution of inflammation in all anatomic structures at 1 month.

Results: Panuveitis and posterior uveitis were the most frequent findings. Inflammatory parameters were higher in HIV+ patients. Recovery was reported in 65% and 85% of eyes at 1 month and at last follow-up, respectively. In multivariate analysis, after adjusting for initial best-corrected visual acuity and the antimicrobial treatment regimen, clinical improvement at 1 week (corrected risk ratios [cRR], 3.5 [2.3-3.8]; P = 0.001) was predictive of recovery at 1 month, whereas the use of periocular dexamethasone injections (cRR, 0.05 [0.02-0.6]; P = 0.01) and methylprednisolone pulses negatively affected the outcomes of eyes.

Conclusions: Early improvement is the strongest predictor of ophthalmological recovery in SU.
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http://dx.doi.org/10.1016/j.ophtha.2017.06.003DOI Listing
December 2017

Traumatic retinal detachment--the difficulty and importance of correct diagnosis.

Surv Ophthalmol 2016 Mar-Apr;61(2):156-63. Epub 2015 Jul 26.

Department of Ophthalmology, University Hospitals of Geneva, Geneva, Switzerland.

Accurate characterization of a retinal detachment as traumatic is often difficult, but is important because it may instigate a careful search for occult coexistent traumatic pathology, affect the prognosis and the treatment of both eyes, influence insurance coverage benefits and medical-legal determinations, and is essential for epidemiologic studies. We review the epidemiology and pathophysiology of traumatic retinal detachment, common obstacles to correct diagnosis, diagnostic guidelines, and outline categories of traumatic causal relationships. Because there is no generally accepted definition of traumatic retinal detachment, we offer a practical one. Categorization as traumatic should be based on the particular history and physical examination rather than epidemiologic criteria.
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http://dx.doi.org/10.1016/j.survophthal.2015.07.003DOI Listing
September 2016

Antibacterial efficacy of accelerated photoactivated chromophore for keratitis-corneal collagen cross-linking (PACK-CXL).

J Refract Surg 2014 Dec;30(12):850-4

Purpose: To investigate whether optimized photoactivated chromophore for keratitis-corneal collagen cross-linking (PACK-CXL) treatment settings allow accelerating treatment while maintaining antibacterial efficacy.

Methods: Staphylococcus aureus and Pseudomonas aeruginosa strains were irradiated with ultraviolet-A light of equal fluence but different intensity settings (18 mW/cm² for 5 minutes and 36 mW/cm² for 2.5 minutes). The killing rate was determined by comparing the number of colony-forming units between cross-linked specimens and non-irradiated controls. The potential additional effect of 0.001% benzalkonium chloride was also investigated.

Results: The killing rates for Staphylococcus aureus were 92.5% ± 5.5% (5 minutes at 18 mW/cm²) and 94.4% ± 2.9% (2.5 minutes at 36 mW/cm²). For Pseudomonas aeruginosa, the killing rates were 93.2% ± 8.3% (5 minutes at 18 mW/cm²) and 92.9% ± 5.0% (2.5 minutes at 36 mW/cm²). The presence of benzalkonium chloride in the riboflavin solution did not increase the killing rate significantly.

Conclusions: The antibacterial efficacy of PACK-CXL follows the Bunsen-Roscoe law of reciprocity and can be maintained even when the irradiation intensity is considerably increased. These optimized settings may allow a shortened treatment time in the future for PACK-CXL and thus help facilitate the transition from the operating room to the slit lamp for treatment.
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http://dx.doi.org/10.3928/1081597X-20141118-01DOI Listing
December 2014

Misdirected aqueous flow in rhegmatogenous retinal detachment: a pathophysiology update.

Surv Ophthalmol 2015 Jan-Feb;60(1):51-9. Epub 2014 Aug 10.

Ophthalmology Service, Geneva University Hospitals, Geneva, Switzerland. Electronic address:

It is widely accepted that the origin of subretinal fluid in rhegmatogenous retinal detachment (RRD) is liquid vitreous and that posterior vitreous detachment (PVD) and associated retinal tears are caused by vitreoretinal traction from intra-ocular currents, contraction of collagen fibers, and gravity. These explanations, however, are incomplete. We present a new synthesis of experimental and clinical evidence, updating understanding of fundamental pathophysiological processes in RRD. Misdirected aqueous flow is shown to more convincingly explain the origin of subretinal fluid in clinical RRD, to be the most likely cause of acute PVD and retinal tear formation, and also to contribute to initial detachment of the retina at retinal tears. Misdirected aqueous flow in RRD is a pathophysiological process, rather than the "aqueous misdirection syndrome", and occurs without visible anterior chamber shallowing or acute glaucoma.
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http://dx.doi.org/10.1016/j.survophthal.2014.07.002DOI Listing
May 2015

Corneal biomechanical properties at different corneal cross-linking (CXL) irradiances.

Invest Ophthalmol Vis Sci 2014 May 2;55(5):2881-4. Epub 2014 May 2.

Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland.

Purpose: New corneal cross-linking (CXL) devices are capable of using higher UV-A light irradiances than used in original CXL protocols. The Bunsen-Roscoe law states that a photochemical reaction should stay constant if the delivered total energy is kept constant; however, little clinical data are available to support this hypothesis.

Methods: We investigated the biomechanical properties of four groups (n = 50 each) of porcine corneas. Three groups were exposed to riboflavin 0.1 % and UV-A irradiation of equal total energy (3 mW/cm(2) for 30 minutes, 9 mW/cm(2) for 10 minutes, and 18 mW/cm(2) for 5 minutes). Controls were exposed to riboflavin 0.1% without irradiation. Young's modulus of 5-mm wide corneal strips was used as an indicator of corneal stiffness.

Results: We observed a decreased stiffening effect with increasing UV-A intensity. Young's modulus at 10% strain showed significant differences between 3 mW/cm(2) and 9 mW/cm(2) (P = 0.002), 3 mW/cm(2) and 18 mW/cm(2) (P = 0.0002), 3 mW/cm(2) and the control group (P < 0.0001), and 9 mW/cm(2) and the control group (P = 0.015). There was no difference between 18 mW/cm(2) and the control group (P = 0.064) and between 9 mW/cm(2) and 18 mW/cm(2) (P = 0.503).

Conclusions: The biomechanical effect of CXL decreased significantly when using high irradiance/short irradiation time settings. Intrastromal oxygen diffusion capacity and increased oxygen consumption associated with higher irradiances may be a limiting factor leading to reduced treatment efficiency. Our results regarding the efficiency of high-irradiance collagen cross-linking (CXL) raise concerns about the clinical efficiency of the new high-irradiance CXL devices already used in clinical practice without proper validation.
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http://dx.doi.org/10.1167/iovs.13-13748DOI Listing
May 2014

Comparison of functional recovery of manual dexterity after unilateral spinal cord lesion or motor cortex lesion in adult macaque monkeys.

Front Neurol 2013 22;4:101. Epub 2013 Jul 22.

Domain of Physiology, Department of Medicine, Faculty of Sciences, Fribourg Cognition Center, University of Fribourg , Fribourg , Switzerland.

In relation to mechanisms involved in functional recovery of manual dexterity from cervical cord injury or from motor cortical injury, our goal was to determine whether the movements that characterize post-lesion functional recovery are comparable to original movement patterns or do monkeys adopt distinct strategies to compensate the deficits depending on the type of lesion? To this aim, data derived from earlier studies, using a skilled finger task (the modified Brinkman board from which pellets are retrieved from vertical or horizontal slots), in spinal cord and motor cortex injured monkeys were analyzed and compared. Twelve adult macaque monkeys were subjected to a hemi-section of the cervical cord (n = 6) or to a unilateral excitotoxic lesion of the hand representation in the primary motor cortex (n = 6). In addition, in each subgroup, one half of monkeys (n = 3) were treated for 30 days with a function blocking antibody against the neurite growth inhibitory protein Nogo-A, while the other half (n = 3) represented control animals. The motor deficits, and the extent and time course of functional recovery were assessed. For some of the parameters investigated (wrist angle for horizontal slots and movement types distribution for vertical slots after cervical injury; movement types distribution for horizontal slots after motor cortex lesion), post-lesion restoration of the original movement patterns ("true" recovery) led to a quantitatively better functional recovery. In the motor cortex lesion groups, pharmacological reversible inactivation experiments showed that the peri-lesion territory of the primary motor cortex or re-arranged, spared domain of the lesion zone, played a major role in the functional recovery, together with the ipsilesional intact premotor cortex.
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http://dx.doi.org/10.3389/fneur.2013.00101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3717526PMC
July 2013

Transitory topographical variations in keratoconus during pregnancy.

J Refract Surg 2013 Feb;29(2):144-6

Department of Ophthalmology, Geneva University Hospital, Switzerland.

Purpose: To highlight two cases of keratoconus with significant variations of corneal curvature during pregnancy that reversed several months after delivery.

Methods: Case reports and literature review.

Results: Two women experienced a significant decrease of corrected distance visual acuity during pregnancy. Evaluation of corneal topography by Scheimpflug imaging revealed transitory variations of the keratometric values in both patients during the gestational period. These topographical alterations were evident not only during pregnancy, but also in the postpartum period, with stabilization of corneal topography several months after delivery.

Conclusions: These clinical cases indicate that hormonal changes occurring regularly during gestation may have a severe impact on the progression of keratoconus. However, these changes are transient and fully reversible. Therefore, physicians should be reluctant to perform cross-linking during or directly after pregnancy and should wait until the corneal curvature has been stabilized.
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http://dx.doi.org/10.3928/1081597X-20130117-11DOI Listing
February 2013