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The purpose of the article is to analyse the application of the recommended approach for risk assessment and management in the internal financial control of public sector organizations in Bulgaria. The study is based on a questionnaire-based survey. 43 randomly selected organizations from the public sector of Bulgaria are surveyed in March 2018. The survey includes questions on a five-point Likert scale. One-dimensional distributions are used to summarize the data. The study found the one-sidedness and complexity of the risk assessment technique underlying the recommended approach, some shortcomings related to the application of the latter, and the need for training of internal auditors in the surveyed organizations. The survey is limited to public sector enterprises in Bulgaria. As a result of the study, it is recommended to expand the scope of preliminary control, the application of factual control, conducting training and introducing personal responsibility for adding data into risk registers. The results of the survey are useful for persons involved in the organization of internal financial control.

Aging is a biological process that all living beings, including humans, experience it. Therefore, it is crucial to notice and prevent some disorders such as anxiety in the field of aging. One of the undeniable facts about aging is recognizing the reality of death and anxiety that weakens compatibility in elderly. The present study aimed to investigate the relationship between psychological hardiness and practical commitment to prayer with death anxiety in the elderly. It was a descriptive-correlation survey. The statistical population included all the elderly man over 60, living in the 1th district of Tehran. 250 elderly men over 60 were selected using convenience sampling in local parks of the 1th district of Tehran. Psychological hardiness questionnaire by Kiamarsi et al., Templer Death Anxiety Scale and scale of attitude and practical commitment to prayer Enisi et al. were completed. Data were analyzed in SPSS-22 using Pearson's correlation coefficients and multiple linear regression with Enter Method. The results suggested a negative and significant correlation between psychological hardiness and practical commitment of Prayer in the Elderly (P

Risk is one of the main categories in а modern life. The research of its nature requires study of historical background of the category. The article presents dynamic of the understandings for risk in the economic theory. The purpose is to define the essence of the risk and its characteristics. Used methodology is related with literature review. After the conducted research it can be stated that risk is uncertainty connected with concrete economic fact.

The article describes risk conception as a leading perception in the field of internal control. The clarification of its nature and characteristics allow effective risk assessment and management. And so they are the most important precondition for achieving of organizational mission. The understandings of risk of the COSO, ISACA, Co Co, The Turnbull committee and the AMF are reviewed. The used methodology is a literature analysis. After the conducted research we can conclude that the risk is an uncertainty which impedes achieving of the organizational mission.

Josephson junctions can be used as sources of microwave radiation. However, synchronization of many junctions is required for achieving a coherent amplification of the emitted power. In this work we present an experimental study of large arrays containing up to one thousand Nb/Nb x Si 1- x /Nb junctions. The arrays exhibit profound cavity mode resonances, corresponding to the formation of standing waves at the electrode/substrate interface. We observe that resonant steps in the current-voltage characteristics appear above some threshold number of junctions, N th ≈ 100, and then progressively enhance in amplitude with further increment of the number of junctions in the resistive oscillating state. We use an external detector to measure the emission of electromagnetic waves. The emission power correlates with the step amplitude. Our results indicate that the emission is facilitated by the cavity modes in the electrodes. The modes are collectively excited by active junctions. In turn, the standing wave imprints its order on the array, facilitating mutual phase-locking of junctions. This provides an indirect coupling mechanism, allowing for the synchronization of junctions, which do not directly interact with each other. Our results demonstrate that electrodes can effectively work as a common external resonator, facilitating long-range phase-locking of large junction arrays with sizes larger than the emitted wavelength., (Copyright © 2022, Cattaneo et al.)

We analyze experimentally and theoretically mutual phase locking and electromagnetic interaction between two linear arrays with a large number of Josephson junctions. Arrays with different separation, either on the same chip or on two separate substrates are studied. We observe a large coherent gain, up to a factor of three, of emitted power from two simultaneously biased arrays, compared to the sum of powers from two individually biased arrays. The phenomenon is attributed to the phase locking of junctions in different arrays via a common electromagnetic field. Remarkably, the gain can exceed the factor of two expected for a simple constructive interference of two oscillators. The larger gain is explained by an additional consequence of mutual interaction between two large arrays. Mutual phase locking of large arrays does not only result in constructive interference outside the arrays, but also improved synchronization of junctions inside each array. Our conclusion is supported by numerical modelling., (Copyright © 2022, Galin et al.)

A patient with hyperopia and accommodative esotropia was implanted bilaterally with hyperopic angle-supported refractive implants. Control of the esotropia was achieved as was some improvement in fusional ability. After three years, the endothelium remains healthy, the eye is quiet and control of the esotropia is maintained.

Objective: To investigate the effect of laser trabeculoplasty in the normal myopic eye on steroid intraocular pressure responsiveness in patients undergoing radial keratotomy., Materials and Methods: Diode laser trabeculoplasty was performed on 94 patients with myopia undergoing radial keratotomy who were then started on dexamethasone drops. Intraocular pressures were measured by applanation tonometry compensated for corneal flattening., Results: Twenty-eight percent of patients had an intraocular pressure increase of 6 mm Hg or more by the fourth week., Conclusion: Laser trabeculoplasty does not prevent steroid intraocular pressure increase in patients with myopia.

Adhesion of staphylococcal cells to intraocular lenses coated with heparin was studied under in vitro flow conditions (280 microl min(-1)) at 37 degrees C. The intraocular lenses were incubated with human cerebrospinal fluid for 1 h or with cerebrospinal fluid including 0.50% plasma for 12 h, prior to bacterial challenge. Two strains of Staphylococcus epidermidis selected for this study, were isolated from biomaterial-associated infections. Bacterial adhesion was quantitated by bioluminescence and visualized by fluorescence microscopy of acridine orange stained bacteria. Surface coating with heparin significantly decreased bacterial adhesion of both strains after incubation with cerebrospinal fluid including 0.50% plasma for 12 h (p = 0.0209). However, no difference in bacterial adhesion was obtained between intraocular lenses with and without heparin, after incubation with cerebrospinal fluid for 1 h (p = 0.327). Microscopy showed that more bacteria were present on intraocular lenses without heparin than on intraocular lenses with heparin. The results show that preincubation with a proteinaceous fluid influences subsequent bacterial adhesion to the polymer surface. The results suggest that IOLs with heparin coating may be less prone to bacterial adhesion under perfusion conditions after surface conditioning in human CSF with 0.50% plasma and a preincubation period of 12 h. Heparin coating might be a valuable tool to decrease implant-associated bacterial endophthalmitis.

A screening method using tissue culture techniques determined inertness of ocular alloplastics. Secondary rabbit kidney cells revealed the presence of toxic constituents by absence of growth or cytopathic changes, or both. The optical portions of the lenses studied were nontoxic, whereas the polyamide loops of one lens were toxic. A keratoprosthesis that had been in situ in a patient for two years was highly toxic in culture. A neutralized agar overlay technique was not sufficiently sensitive to screen anterior chamber implants. The tissue culture technique, in combination with chemical, optical, and animal experimentation, may be helpful in determining which implant systems are most suitable for in vivo use.

Uncomplicated placement of an intraocular lens at the time of routine cataract extraction is associated with a greater inflammatory response than simple lens extraction. We have shown that certain components of prosthetic intraocular lenses are capable of activating the complement system in human serum in such a fashion as to generate peptides capable of mediating acute inflammatory reactions. Normal human serum was incubated with intraocular lenses in vitro and then examined for cleavage products of C3 and C5 and for C5-derived chemotactic activity for human polymorphonuclear leukocytes. Polymethylmethacrylate lenses with nylon and polypropylene loops were found to be capable of causing cleavage of C3 (detected by crossed immunoelectrophoresis) and C5 (detected by single-dimension radioimmunoelectrophoresis) as well as generation of C5-derived chemotactic activity in human serum. Serum incubated with polymethylmethacrylate lenses without loop supports exhibited no such activity. Results of our studies indicate that certain nylon- and polypropylene-looped intraocular lenses are not "inert" biologically and may elicit acute inflammatory reactions.

Gas-liquid chromatography, infrared spectroscopy, or Raman spectroscopy were used to determine the level of monomer in intraocular lenses and in the preforms used in each step of the manufacturing process. Heating, lathing, molding, and grinding caused an increase in monomer content, presumably the result of depolymerization. The tendency of methylmethacrylate to volatilize, repolymerize, or dissolve precludes high monomer contents from persisting in intraocular lenses. Vacuum ovens or water baths significantly reduced the monomer content to levels of 0.5% or less. Lenses with a monomer content higher than that found in currently available commercial lenses had no effect on rabbit kidney cell cultures. Lens fragments with a similarly elevated monomer content were indistinguishable from lenses with a low monomer content in rabbit eyes. According to these data, monomer does not appear to be a toxic agent in currently available intraocular lenses.

During the past 8 years, 32 patients with melanoma of the choroid have been treated with cobalt-60 ophthalmic applicators. Excluding three patients lost to follow-up, 24 patients who have now been observed for at least 3 years after treatment form the subject of this study. Each application but two delivered 8,500 to 10,000 rads to the tumour apex. A second application was performed in large tumours showing a poor response to the initial plaque treatment. The factors affecting results include age of the patient, tumour size, total dose delivered, and dose rate. Three out of seventeen patients with tumour diameters greater than 12 mm died of their disease with pulmonary and/or liver metastasis. Three eyes required enucleation and no residual tumour was found in two specimens. Three patients, average age 76 years, died from causes other than melanoma. An 83 per cent relative survival, excluding the three patients lost to follow-up, compares favourably with enucleation. The low incidence of metastasis after radiotherapy suggests augmentation and/or continuation of the host's immune response. Low energy radiation using Iodine-125, with its unusual protective characteristics is ideal for treatment of choroidal melanoma.

We studied the effect of timolol on post-operative intraocular pressures (IOPs) in a control and experimental group of 30 eyes, each in patients who had uncomplicated intracapsular cataract extractions, most with iris clip lenses. Closure of the eye in each case was with three 6-0 silk sutures preplaced in a morticed incision. Six control eyes had IOP increases of 6 mm Hg or more within 24 hours of surgery. One patient treated with timolol had an IOP increase of 6 mm Hg or more. The differences in IOP between the control and experimental groups were statistically significant at the .01 level. The pressure lowering ability of timolol appears to be prophylactic as well as therapeutic. It is well suited for pseudophakic eyes as pressure reduction is not associated with pupillary alterations.

A population of 250 age-matched cataract patients was studied to determine if hospitalization was required for cataract extraction. The success of the procedure was not jeopardized if immediate ambulation was effected and postsurgical care carried out entirely on an ambulatory basis in a nonhospital environment. The cost containment potential of this approach cannot be readily achieved in the face of existing regulatory systems and insurance requirements.

Scanning and transmission electron microscopic examinations were performed on cat corneas after the steps usually taken to perform cataract extraction were completed. The endothelium did not replicate, but showed nuclear division or segmentation occasionally. In each case, the anterior segment was free from any evidence of inflammation one year after surgical treatment--unless a pseudophakos had been inserted: in some of these cases, significant numbers of white cells were present, a condition that may contribute to anterior segment complications from implants.

A retrospective study of 104 eyes that had iris-supported Sputnik intraocular lenses implanted and no surgery in the fellow eye and a separate series of 30 implanted eyes whose second eyes underwent surgery but did not receive implants disclosed that endothelial cell densities in the eyes with implants decreased immediately after surgery and then continued to decrease at the same rate as those of the control eyes. There was no sudden decrease in the endothelial cell counts during follow-up periods ranging from three to seven years. The main cause of large cell losses immediately after surgery, and possibly long-term corneal decompensation, was surgical manipulation rather than the presence of this style of intraocular lens.

The use of intraocular lenses in cataract surgery leads to a greater corneal complication rate than surgical treatment without such devices. It has been assumed that the predominant reason for this is surgical trauma at the time of lens insertion. A laboratory study to verify and analyze this difference has been carried out, the cat being used as an experimental model. This first report evaluates the effect of the usual steps of cataract extraction on the density of corneal endothelial cells.

Polymethylmethacrylate lenses with nylon-6 loops can activate the complement system. Such activation occurs primarily at the loops. This activation may be one pathway of implant-caused inflammation.

The Ridley method for intraocular lens sterilization employs 10% NaOH for one hour followed by long-term storage in 0.1% NaOH. Ten percent NaOH for one hour was found to be ineffective when 106 B. subtilis spores were used for study in the presence of a looped lens system. A three-hour period was found to be effective. Similar concentrations of organisms were not killed by 0.1% NaOH even after 30 days. Consequently, the standard Ridley method would be inadequate for looped lens systems and would not fulfill the requirements for terminal sterilization. Teh percent NaOH for three hours would appear to be an acceptable terminal sterilization method.

Cyclodialysis lens extraction is a safe, predictable procedure for simultaneous surgery of cataract and glaucoma. A few maneuvers outlined in this paper which differ from the cyclodialysis approach to the aphakic eye significantly reduce the problem of hyphema and corneal damage.

In a study of a selected age (greater than 60) and ocularly matched population requiring cataract extraction, a perfectly executed intracapsular cataract extraction followed by the introduction of a Fyodorov Type II ("Sputnik") lens did not lead to irreversible anterior or posterior segment changes different from those seen in a group followed for from 5 to 9 years. It did lead to an incidence of implant support dislocation and to membrane formation in about 10% of cases, reducible to about 2% with correctly made lenses and the appropriate use of postoperative drugs. The incidence of corneal degeneration (0), retinal detachment (2%), and intraretinal cystic maculopathy (3%) was equal in each group. Visual acuity levels were also equal. In appropriate cases, if the surgery is carried out with sufficient skill, the reward to risk ratio of implantation not only justifies but indicates the use of such lenses.

A series of in vitro, in vivo, and clinical studies was performed to explore the safety and efficacy of argon laser and xenon arc photocoagulation in pseudophakia. The polymethylmethacrylate intracameral lens (Fyodorov) proved resistant to photothermal decomposition and allowed transmission of therapeutically effective energy levels to the retina. The argon laser delivered through a slit lamp and contact lens optical system appears to be the preferred method for posterior segment photocoagulation in pseudophakia. On the basis of five-day tissue culture studies and clinical experience of two years, the intracameral lens does not appear to be a toxic or transmission barrier to careful argon laser photocoagulation.

Clinical and histologic studies in 40 eyes of 35 patients with chronic open-angle glaucoma or chronic angle-closure glaucoma operated by various types of "trabeculectomies" were assessed to evaluate whether success was correlated with the surgical approach or with the presence of trabecular tissue in the pathologic specimen. It was clearly demonstrated that it is not necessary to localize or enter Schlemm's canal in order to perform successful trabeculectomies; it is not necessary to operate posterior to the scleral spur; and it is not necessary to excise either Schlemm's canal or trabecular tissue to achieve success. In essence, trabeculectomies primarily function as fistulizing operations carried out under scleral flaps substituting a scleral-conjunctival barrier to aqueous flow rather than the conjunctival barrier alone provided by standard glaucoma operations. This greater obstruction explains the absence of shallow chambers, the reduced incidence of polycystic bleb formation and, perhaps, an avoidance of long-term complications that often result from these two factors.

Timolol maleate is an effective agent of reducing intraocular pressure in patients with chronic open-angle glaucoma. To date, there are no adverse side effects demonstrable with use of this medication. Its mechanism of action is not clearly delineated but preliminary data suggest an effect on outflow facility.

Intraocular lens implantation may be associated with an inflammatory syndrome which leads to corneal decompensation and cystoid macular oedema. The inflammatory aspects often do not appear striking but manifest as mild ciliary flush, mild flare, moderate cells in the anterior chamber, and moderate vitritis. The cornea will decompensate in the presence of endothelial cell counts which are sufficient to maintain corneal clarity in the non-inflamed eye. Metal-looped lenses and poorly polished lenses cause iris chafing and capillary leakage which increase the severity of this syndrome. It is postulated that intraocular surgery initiates an inflammatory response which is augmented by certain components of intraocular lenses. The mediation for this increased inflammatory response may be inhibited by both steroidal and non-steroidal anti-inflammatory agents. The presence of white blood cells and their products, such as lysosomal enzymes, may be sufficient to perpetuate the inflammatory response and cause damage to abnormal and normal cells. The presence of protein and its immune components, as well as complement, may be involved in this syndrome.

Absence of an anemic, cystic bleb site, as well as reduced fluorescein fluorescence in this area after transcleral fistulizing surgery, infer failure. One method to create or augment bleb formation in suitable eyes is with the use of eccentric suction. This method creates localized ocular message, mobilizes conjunctiva and episclera, and provides a quantitative measure of bleb function.

Tissue cultures of secondary rabbit kidney cells were grown in maintenance medium containing varying concentrations of methylmethacrylate monomer from 5% to 0.05%. No pathologic changes were observed in those tissue cultures containing 0.1% or less monomer as compared to controls. Data from previous studies on the rate of elution of monomer from polymethylmethacrylate and from published studies of aqueous humor dynamics indicate that the monomer level in intraocular lenses will be less than the concentration toxic to living cells in tissue culture.

Pupillary block glaucoma is a potential complication of implantation. Early recognition and prompt medical therapy will generally successfully treat the condition. In some instances surgical treatment is required if medical therapy is inadequate. Laser iridectomy and laser photomydriasis are other alternatives to surgical therapy. This case reports successful treatment of pseudophakic pupillary block glaucoma using laser photomydriasis.

We performed a variety of tests to assess binocular function on monocular aphakic patients wearing contact lenses, monocular pseudophakic patients, bilateral spectacle-wearing aphakic patients, bilateral aphakic contact lens wearers, and bilateral pseudophakic patients. Stereoscopic acuity levels at distance and near when visual acuity was at least 6/12 (20/40) provided the most useful data. Pseudophakic patients and contact lens wearers performed equally well and outperformed spectacle wearers. Implant patients did not have superior stereoscopic acuity.

To repair a ruptured filtering bleb, we used the conjunctiva alone, or combined with its undissected Tenon's fascia, to cover the sclerostomy site. We used mattress sutures to thread the new flap into a vertical corneal groove anterior to the sclerostomy, creating a firm, nonretracting but still sufficiently "porous" cover that maintained filtration and resisted infection and perforation. Seven of eight cases of ruptured filtering blebs have been successfully repaired in this manner with the maintenance of adequate filtration.

A randomized prospective study of 100 consecutive cataract operations was designed to ascertain the need for hospitalization for this procedure. The results clearly indicate that immediate ambulation and discharge of the cataract patient do not detract from the very high success rate of this operation. The random nature of this study adds strong support to those surveys that have similarly concluded that hospitalization and postoperative restrictions are not necessary for the great majority of cataract patients.

Epinephrine maculopathy occurred in one eye of a patient that spontaneously developed intraretinal cystic maculopathy in the other eye. The clinical and fluorescein angiographic apperance of the two conditions were identical. It is likely that the two conditions have a common organic denominator.

Nylon 66 and polypropylene are chemotactic in human serum while PMMA from intraocular lenses is not. Chemotactic activity is unaltered by Ridley, 5 per cent NaOH, or ethylene oxide sterilization. Chemotaxis is but one manifestation of an overall inflammatory process that may be involved in implant-induced corneal and retinal dysfunction.

Discs of polymethylmethacrylate containing 0-5 per cent. unpolymerized monomer were heated to create increasing concentrations of unpolymerized fragments up to 3-7 per cent. These fragments were then studied in tissue culture and in the anterior chambers of rabbits. No toxicity was evident in culture nor was there a difference in anterior segment response to the discs containing various concentrations of monomer. It would appear that the inflammatory response after implantation is predominantly mechanical in origin.

We have compared long-term intraocular pressure control in patients with open angle glaucoma, cupping and atrophy of the optic nerve head and visual field loss as well as cataract after: trabeculectomy posterior to the scleral spur and cataract extraction without implantation in 108 patients. guarded posterior lip sclerectomy, cataract extraction and Mark VIII or Mark IX anterior chamber implantation in 28 patients. argon laser trabeculoplasty followed by lens extraction and implantation in 27 patients. Approximately 75 per cent of patients achieve intraocular pressures of 18 mm Hg or less without medication after (a), and approximately 40 per cent of patients achieve similar control without medication after (b). Approximately 25 per cent of these glaucoma patients have intraocular pressure levels of less than or equal to 18 mm Hg on topical medication three months after ALT, and none achieve this control without medication. Cataract surgery with anterior or posterior chamber implantation caused loss of topical control in four of the seven patients benefiting from ALT. These data imply that combined surgery with or without implantation produces better and more significant intraocular pressure control than the presently utilized techniques of ALT subsequently followed by lens extraction and implantation.

Of 145 patients registered for an investigation of timolol, 27 patients were dropped for unrelated reasons. Among the remaining 118 patients (212 eyes), a significant reduction in intraocular pressure resulted from twice-a-day topical instillation of 0.25 or 0.5% timolol to ocular hypertensives, primary open-angle glaucoma or aphakic glaucoma patients. Outflow facility improved only slightly, but remained improved throughout the course of this study. A significant reduction in aqueous secretion, however, was the predominant cause of intraocular pressure reduction. Timolol alone controlled intraocular pressure in 87% of ocular hypertensives, in 68% of patients with chronic open-angle glaucoma and in 68% of patients with angle-unobstructed aphakic glaucomas. The addition of epinephrine brought the intraocular pressure to less than 22 mm Hg in 85% of the total group of patients.

In a series of cataract patients excluding myopic individuals, under age 60 years, and cases in which vitreous loss occurred, retinal detachment was no less frequent after intracapsular cataract extraction and Sputnik iris supported lenses than in controls. Both groups were followed up for a minimum of two years. The detachments predominantly occurred from retinal breaks in areas of the retina that looked normal preoperatively.

Serial endothelial photographs were taken preoperatively and postoperatively in 200 eyes; 111 eyes contained a Rayner iris clip lens, 54 eyes contained a Fyodorov Sputnik lens, and 35 eyes had no lens. Central endothelial cell density was changed in all instances, with counts in implanted eyes declining 25 to 30%, and in nonimplanted eyes 10 to 15%. In both instances, the decline essentially ceased at about three months. The cause of the greater decline in implanted eyes appeared to be mechanical and subsequent cell loss after the 90-day period was virtually equal for the two groups. Methods that may be used to alter the difference in cell density occurring with implantation are best analyzed by using the 90-day period data for comparison.