bluuebunny/crossref_metadata_2025 huggingface dataset:
Mechanisms of successional dynamics: Consumers and the rise and fall of species dominance
Authors: Wootton J. Timothy
Published: March 2003

Insight into potential mechanisms of succession following disturbance to an ecological community can be gained by considering processes that contribute to the rise (colonization, interactions with established species) and demise (differential mortality) of specific stages within the successional sequence. Most successional theories focus on the rise to dominance, assuming demise is the result of competition, but other factors can cause differential mortality among species, including physical disturbance, senescence, and consumers. In rocky intertidal communities on the coast of Washington state, USA, gaps in mussel beds exhibit a succession from predator‐susceptible to predator‐resistant species following disturbance, suggesting that differential consumption by mobile species may play an important role in the demise of early succession species and the eventual dominance of the mussel Mytilus californianus. Experimental manipulation

of a dominant species earlier in succession, the blue mussel Mytilus trossulus,

demonstrated that this species inhibits the invasion of M. californianus in

the absence of predators. Experimental manipulation of predatory snails (Nucella

emarginata and Nucella canaliculata), which feed heavily on M. trossulus

but not M. californianus, greatly increased the rate at which M. californianus invaded gaps. These results and those of other studies indicate that consumers frequently have important effects on the dynamics of succession in benthic marine systems, and might also play a role in other settings.
Rapid assessment team reduces waiting time
Authors: Grant Steven , Spain David , Green David
Published: March 2003

Abstract

Objective: In an effort to reduce waiting times and improve the performance of the clinical indicator waiting time relative to triage category, a rapid assessment team was implemented.

Methods: The rapid assessment team consists of the rapid assessment team doctor and triage nurse. The rapid assessment team ensured, wherever possible, that patients were medically assessed prior to expiration of the waiting time appropriate to their National Triage Scale. Waiting time performance indicators, median waiting time and length of stay during the 3 months the rapid assessment team was operative were compared with the same period 1 year before.

Results: During the 3 month period where the rapid assessment team was operative, 59.0% of patients (n = 5877) were seen within accepted time standards and the median waiting time was 32 min. This compared with 39.1% (n = 3901) and 50 min, respectively, in the same period 1 year before (P < 0.001). There was no significant difference in median length of stay (3.2 h for both, P = 0.18). Improvements in waiting times occurred in all triage categories except category 1. Due to a lack of resources and funds, the rapid assessment team was discontinued on 4 October 1997.

Conclusions: The rapid assessment team reduces doctor waiting times. Departments considering implementing a rapid assessment team should ensure it is funded as a separate resource.
Safety of a nurse‐managed, titrated analgesia protocol for the management of severe pain in the emergency department
Authors: Coman Michael , Kelly Anne‐Maree
Published: March 2003

Objectives: The objectives of this study were: (i) to determine the adverse‐effects profile of a nurse‐managed, titrated intravenous analgesia protocol; and (ii) to characterize the use of opioid analgesics for acute pain in a setting where an intravenous analgesia protocol was in place.

Method: Retrospective chart audit of 401 consecutive cases (May–July 1996) of opioid analgesic administration for the management of pain in an adult metropolitan emergency department was performed.

Results: Of the 401 cases, 345 (86%) received opioid analgesia using the nurse‐managed, titrated analgesia protocol. Nineteen adverse events were documented in this group (5.5% of patients; 95% CI = 3.3–8.5%). There were 17 episodes of hypotension (blood pressure below 100 mmHg), one hypersensitivity reaction and one vagal reaction. There were no documented cases of respiratory depression and no patient was administered naloxone. Of the patients suffering hypotension, seven required no intervention and the remaining 10 responded well to an infusion of fluids.

Conclusion: The nurse‐managed, titrated intravenous analgesia protocol is a well‐used and safe method of providing analgesia.
Marine envenomation: An update — A presentation on the current status of marine envenomation first aid and medical treatments
Authors: Fenner Peter
Published: March 2003

Marine envenomation is common worldwide. The current first aid and medical treatments of envenomation discussed include stingray, stonefish, sea snakes and cone shells, as well as treatments for Chironex box jellyfish, Irukandji and other stinging jellyfish. Not all current recommended first‐aid treatments have been proven but most have a sound basis and appear effective. Further research is current.
Management of the first‐time transient ischaemic attack
Authors: Hankey Graeme J
Published: March 2003

The assessment and management of patients with a suspected transient ischaemic attack of the brain or eye is a daily task in busy emergency departments. They are common, affecting about 50 per 100 000 population each year. Conditions which mimic a transient ischaemic attack are even more common (e.g. migraine aura, partial seizures, benign paroxysmal positional vertigo, hysteria). This comprehensive review outlines an approach to the management of this complex and challenging problem.
Training for the role of triage in Australasia
Authors: Kelly Anne‐Maree , Richardson Drew
Published: March 2003

Objective:

To characterize the prerequisite experience and training undertaken by nurses for the role of triage in emergency departments in Australasia.

Methods:

Postal survey of charge nurses/unit nurse managers of all Australasian emergency departments accredited for specialist emergency physician training by the Australasian College for Emergency Medicine.

Results:

The response rate was 89%. The most common duration of prerequisite experience was 12–18 months. Most programmes use a combination of educational activities, with self‐directed learning packages, lectures and mentored experience being the most common. Three hospitals reported no preparation for triage.

Conclusion:

In Australasia, there is wide variability in required training and experience before triage duties are performed. Strategies to set suggested minimum standards in these areas and to make training activities more accessible are recommended.
Options in Prehospital analgesia
Authors: Borland Meredith L , Jacobs Ian , Rogers Ian R
Published: March 2003

Background: Prehospital analgesia options for paramedics have been limited due to the difficulty in achieving safe and effective pain relief without compromising transportation to hospital. The present paper identifies the analgesia methods currently available in the prehospital setting so as to evaluate the various options and highlight areas for future research.

Methods: A literature review of Medline and Embase databases from 1966 until the present was undertaken. Further hand searching of all the references identified in these papers was also performed. All current literature was analysed and categorized according to one of four levels of evidence using National Health and Medical Research Council of Australia guidelines (1999).

Results: There is a paucity of randomized control trials relating to prehospital analgesia. All published literature was level III or IV prospective or retrospective studies. Drug options used included nitrous oxide/oxygen mixtures, intravenous/intramuscular nalbuphine, intravenous tramadol and intravenous pure opiate agonists.

Conclusions: The evidence supporting analgesic options in the prehospital setting is limited. There are few published data in this area despite the inadequacy of pain relief being recognized as a weakness in prehospital care. Prehospital analgesia is an area worthy of innovative methods for the administration of safe and effective analgesics without significant impact on transport times. Such methods should be prospectively evaluated in well‐constructed trials.
Intranasal fentanyl reduces acute pain in children in the emergency department: A safety and efficacy study
Authors: Borland Meredith L , Jacobs Ian , Geelhoed Gary
Published: March 2003

Introduction: Provision of rapid, painless and effective analgesia to children remains problematic in the prehospital and emergency setting. Intranasal fentanyl has the potential to eliminate many of the problems of narcotic administration in children. The aim of this study, conducted in a tertiary paediatric emergency department was to evaluate the safety and efficacy of intranasal fentanyl in children.

Methods: Children in acute pain aged between three and 12 years inclusive were enrolled on presentation to the emergency department. Routine observations and pain scoring by the child and caregiver was undertaken prior to the child receiving fentanyl (20 µg for 3–7 year olds and 40 µg for 8–12 year olds) and at intervals of 5 min for 30 min Additional fentanyl at the dose of 20 µg was given 5 minutely as required. Caregivers and older children used a visual analogue scale (VAS) and the younger children used the Wong‐Baker faces scale (WBS).

Results: Forty five children were enrolled with a mean age of 8.0 years. The median dose of fentanyl administered was 1.5 µg/kg. Mean pain score in 32 children using the VAS was 62.3 mm (95% confidence interval 53.2–69.4 mm) at presentation and reduced at 10 min to 44.6 mm (95% confidence interval 36.2–53.1 mm). In 16 children using WBS the initial mean reading was 4.0 (95% confidence interval 3.3–4.7) and reduced to 2.2 (95% confidence interval 1.3–3.1) at 10 min. Caregiver pain scores showed a mean preintervention pain score of 64.9 mm (95% confidence interval 57.7–72.2 mm) with a significant reduction at 10 min to 41.7 mm (95% confidence interval 34.7–48.6 mm). There was no significant alteration in pulse rate, respiratory rate, and blood pressure or oxygen saturations. There were no negative side‐effects.

Conclusions: Early and significant reduction in pain (compared to baseline assessments) was achieved in children using intranasal fentanyl by 10 min and sustained throughout the 30 min of observations. This raises the possibility of using intranasal fentanyl in children in the prehospital setting as well as a role for this form of analgesia as triage nurse‐initiated administration in the emergency department.
Validation of a tool to safely triage selected patients with chest pain to unmonitored beds
Authors: Sultana Ronald V , Kerr Debra , Kelly Anne‐Maree , Cameron Peter
Published: March 2003

Objective: To externally validate a chest pain protocol that triages low risk patients with chest pain to an unmonitored bed.

Methods: Retrospective study of all patients admitted from the emergency department of a tertiary referral public teaching hospital with an admission diagnosis of ‘unstable angina’ or suspected ischemic chest pain. Data was collected on adverse outcomes and analysed on the basis of intention‐to‐treat according to the chest pain protocol.

Results: There were no life‐threatening arrhythmias, cardiac arrests or deaths within the first 72 h of admission in the group assigned to an unmonitored bed by the chest pain protocol ([0/244]; 0.0%: 95% confidence interval 0.0–1.5%). Four patients had an uncomplicated myocardial infarction, two patients had recurrent ischemic chest pain and one patient developed acute pulmonary oedema ([7/244]; 2.9%: 95% confidence interval 1.2–5.8%).

Conclusion: This retrospective study externally validated the chest pain protocol. Care in a monitored bed would not have altered outcomes for patients triaged to an unmonitored bed by the chest pain protocol. Compared to current guidelines, application of the chest pain protocol could increase the availability of monitored beds.
Presentation of near‐hanging to an emergency department in the Northern Territory
Authors: Davidson Jennifer A
Published: March 2003

Objective: To describe the epidemiology and outcomes of patients presenting after near‐hanging to an emergency department in the Northern Territory of Australia.

Methods: A descriptive retrospective review of hospital and retrieval records was made of all patients presenting to the Royal Darwin Hospital between January 1995 and August 2000 as a result of near‐hanging.

Results: There were 72 patients who presented after near‐hanging in the study period. The majority of patients were young adult males of Aboriginal descent living in the Tiwi Islands. Psychiatric and drug abuse histories were a prominent feature. No cervical spine injuries were detected and there were no neurological deficits in the survivors.

Conclusion: Near‐hanging appears to be a significant problem among young indigenous males, especially those from the Tiwi Islands. Strategies to identify risk factors linked to suicide and to help empower families to reduce the incidence of self‐harm are integral to addressing this problem.
Early experience of sentinel lymph node biopsy in breast cancer with blue dye technique
Authors: Chung Chi‐Kin , Hung Wai‐Ka , Chan Miranda Chi‐Mui , Lau Yvonne , Mak Kong‐Ling , Yip Andrew Wai‐Chun
Published: March 2003

Objective: Sentinel lymph node biopsy (SLNB) is a minimally invasive staging procedure for breast cancer. Results of the first 30 cases of SLNB performed at Kwong Wah Hospital, Hong Kong, were reviewed.

Design: This feasibility study applied and assessed a new procedure in Chinese patients. The study was carried out at the Breast Centre, Kwong Wah Hospital, Hong Kong. Sentinel lymph node biopsy was performed with a blue dye technique alone. All patients had full axillary dissection after SLNB.

Patients: Female patients with invasive carcinoma of breast and no clinical palpable axillary lymph node were included.

Main outcome measures: Pathological results of both the SLN and the remaining axillary content were compared.

Results and Conclusion: Sentinel lymph nodes were successfully biopsied in 83% of cases. Sensitivity was 75% and accuracy was 88%. With experience, sentinel lymph node biopsy is feasible in Chinese patients.
The use of intraoperative angiography in the management of neurovascular disorders
Authors: Lui Wai‐Man , Fan Yiu‐Wah , Cheng Pui‐Wai , Wong Wai‐Cheong
Published: March 2003

Objective: To review our experience of intraoperative angiography in dealing with neurovascular disorders and to substantiate the usefulness of this investigation.

Method: From April 1999 to November 2000, 32 cases of intraoperative angiogram were studied.

Results: Two out of 30 intraoperative angiograms were unsuccessful. The angiographic machine broke down during one of the attempts. In one patient, intimal dissection of the femoral artery was noted during the procedure and the study was abandoned; the patient recovered uneventfully. Among the 30 completed angiograms, 19 were for cerebral aneurysm, 10 for arteriovenous malformation (AVM) and one for extracranial–intracranial (EC‐IC) bypass. There was no procedure‐related complication. Among the 19 angiograms performed for cerebral aneurysms, total occlusion was confirmed in 14 patients (74%), residual aneurysms were detected in two patients (10%) and branch occlusions were detected in three patients (16%). Of the 10 angiograms performed for AVM, total removal was confirmed in nine (90%), whereas residual AVM was detected in one patient (10%). One intraoperative angiogram for EC‐IC bypass confirmed the patency of the graft.

Conclusions: The study showed that cerebral intraoperative angiography is safe and frequently reveals unclipped aneurysm necks, unexpected major vessel occlusion and residual AVM. Intraoperative cerebral angiography should be recommended as a standard practice for treating neurovascular disorders.

Chinese Abstract

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Clinical outcome of conservative therapy for stage T1, grade 3 transitional cell carcinoma of the bladder
Authors: HARA ISAO , MIYAKE HIDEAKI , TAKECHI YOSHIZUMI , ETO HIROSHI , GOTOH AKINOBU , FUJISAWA MASATO , OKADA HIROSHI , ARAKAWA SOICHI , KAMIDONO SADAO ,   KOBE UROGENITAL TUMOR STUDY GROUP
Published: March 2003

Background: The objective of this study was to retrospectively investigate the effectiveness of transurethral resection of bladder tumor (TURBT) and intravesical instillation therapy for stage T1, grade 3 (T1G3) transitional cell carcinoma (TCC) of the urinary bladder.

Methods: Between January 1995 and December 1997, 97 patients with T1G3 TCC of the urinary bladder were treated by TURBT and adjuvant intravesical instillation with bacillus Calmette‐Guérin (BCG) or other anticancer agents. The recurrence‐free survival rates were evaluated according to several clinicopathological factors. The cases that progressed to muscle invasive disease were also analysed.

Results: In this series, the median follow‐up period was 25 months (range, 5– 41) after the initial TURBT. Intravesical recurrence was noted in 44 patients (45%), and the 1, 2, and 3 year recurrence‐free survival rates were 72%, 58%, and 42%, respectively. Multivariate analyses revealed that the risk of intravesical recurrence was significantly higher for patients who did not receive BCG therapy, irrespective of age, gender, tumor size, multiplicity, pathological stage, concomitant carcinoma in situ, and lymphovascular involvement. Moreover, after a median of 10 months, disease progression occurred in seven patients (7%), of which only one patient was treated by BCG therapy after initial TURBT.

Conclusion: These findings suggest that intravesical instillation with BCG combined with TURBT is an effective conservative treatment for T1G3 TCC of the bladder. Patients with negative prognostic factors should be treated by BCG rather than other anticancer agents after TURBT.
Optic nerve cysticercosis
Authors: Bajaj Mandeep S , Pushker Neelam
Published: March 2003

Cysticercosis of the optic nerve is an extremely rare entity and only seven cases have been reported in the world literature. A case of optic nerve cysticercosis in a 25‐year‐old woman is reported, along with a review of literature. The patient presented with two episodes of pain, diminution of vision and proptosis. Computed tomography and ultrasonography revealed an intraneural cyst with scolex in the retrobulbar portion of the optic nerve. A positive enzyme‐linked immunosorbent assay test for cysticercosis further confirmed the diagnosis. Medical therapy in the form of oral albendazole and steroids resulted in complete resolution of the cyst, with few visual sequelae.
Septic superior ophthalmic vein thrombosis
Authors: Walker James C , Sandhu Avinda , Pietris George
Published: March 2003

An illustrative case of septic superior ophthalmic vein thrombosis secondary to a staphylococcus orbital cellulitis is presented and correlated with autopsy findings. A literature review and discussion of the risks and benefits of anti­coagulation in this setting is outlined.
Impact of groundwater abstraction on a Banksia woodland, Swan Coastal Plain, Western Australia
Authors: Groom By Philip K. , Froend Ray H. , Mattiske Elizabeth M.
Published: March 2003

Summary The Gnangara Groundwater Mound, centred 38 km north of Perth, Western Australia, is a large, shallow unconfined aquifer that is currently under abstraction as part of the public metropolitan water supply. To investigate the impact of lowering groundwater levels on a Banksia woodland on the Mound, vegetation monitoring near a groundwater abstraction bore (known as P50) began 1 year before becoming operational. In February 1991, 2 years after abstraction commenced, extensive death of the Banksia overstorey was observed within close proximity of the bore, following a short period of high summer temperatures. The site was subsequently revisited and the understorey floristic composition, abundance and vigour of overstorey species resurveyed, and compared with data collected from a site under long‐term monitoring and not currently influenced by abstraction. A lowering of groundwater level by 2.2 m at P50 between the summers of 1990 and 1991, resulting from the cumulative effects of abstraction and below average annual rainfall (low groundwater recharge), coincided with a loss of between 20 and 80% of adults of overstorey species and up to 64% of adults of understorey species within 200 m of the bore. Over a similar time period no significant decreases in the abundance of overstorey or understorey species were recorded in the monitored site not influenced by groundwater abstraction. Of the overstorey species, Holly‐leaf Banksia (Banksia ilicifolia) displayed the greatest susceptibility and lowest net recovery following the abstraction event at P50. The negative impact of groundwater drawdown on Holly‐leaf Banksia populations makes this overstorey species an important indicator of decreasing groundwater levels on the Gnangara Groundwater Mound. Water stress may have been the primary cause of vegetation death in close proximity to the P50 bore, although this would have been exacerbated by extreme summer temperatures (> 45°C) recorded during February 1991. The P50 scenario represents a localized response to an acute drawdown event, in association with other environmental factors, and provides invaluable information on the assessment of groundwater abstraction and poor groundwater recharge events on a Banksia woodland community. However, there are limitations in using the community response at P50 to manage the impact of drawdown events on other plant communities occurring on sandy, shallow aquifers.
Clues to the ‘burning question’: Pre‐European fire in the Sydney coastal region from sedimentary charcoal and palynology
Authors: Mooney Scott D. , Radford Kate L. , Hancock Gary
Published: March 2003

Summary The concentration and influx of charcoal in a 210Pb‐dated sediment core were used to investigate the recent fire history of Jibbon Lagoon in Royal National Park, NSW. Fire events of the recent (historic) past were compared to this record in an attempt to test its sensitivity. Recent fire events were not always reflected in the charcoal results. Nonetheless it can be concluded that since about AD 1930 the area has been characterized by a relatively high frequency of fires. The analysed sediments of the pre‐European period contained a low concentration of charcoal, and only one large conflagration appears to have occurred in approximately the last 1600 years. How Aboriginal people used fire in this landscape is still uncertain. However, it is possible that they did not regularly burn the landscape, or if they did, it was in such a way that the delivery of charcoal to the lagoon was minimal. This study thus suggests that the idea of the ubiquitous use of fire by Aboriginal people should be further, and critically, analysed.
Institutions to sustain ecological and social systems
Authors: Brunckhorst David J.
Published: March 2003

Summary The foundation for a sustainable future is the continuation of ecological processes and functions across landscapes dominated by human activity; whether hunter‐gathering, agriculture, pastoralism, suburban living, commercial and industrial centres or wilderness recreation. However, actions to sustain ecological systems, flows and functions must be integrated across the human dimensions of regional landscapes. Such regions encompass natural areas, human living places and a mosaic of other land uses. Institutional change is required to develop new organizational forms, adjust policies and develop adaptive capacity to demonstrate restoration and maintenance of all forms of social, economic and ecological capital. No matter where on the globe, future sustainability will depend on the system of resource governance that mediates the relationship between the society and the economy and, in contrast, the continuation of ecosystem functional processes. The present article examines the forms of capital, social and institutional change that need to be considered to make progress towards sustainable futures. The discussion further considers the spatial management context in which these interweaved social, ecological and economic processes take place.

Key words ecological, forms of capital, governance, institutions, landscape,

social.
Short Note
Authors: Cummings Jason
Published: March 2003

Using process‐orientated parameters to assess degradation.
Examination compliance and screening for diabetic retinopathy: a 2‐year follow‐up study
Authors: Lee Sue J , Sicari Catia , Harper C Alex , Livingston Patricia M , McCarty Catherine A , Taylor Hugh R , Keeffe Jill E
Published: March 2003

Early detection and timely treatment of diabetic retinopathy can preserve vision, yet many people with diabetes do not have their eyes examined regularly. The purpose of this study was to examine eye care practices of people with diabetes who had not previously accessed eye care services on a regular basis. Screening with non‐mydriatic retinal photography for diabetic retinopathy was initiated in 1996, and targeted people with diabetes who did not access eye care services on a regular basis. Each test area was revisited 2 years after the initial screening. Patients that did not attend the biennial screening were followed up by mail survey. Although none of the participants in this study had been previously accessing eye care services on a regular basis, 87% did so after attending the screening. These results indicate that mobile screening with non‐mydriatic photography, as an adjunct to current eye care services, has the potential to increase examination compliance for diabetic retinopathy and to achieve sustained behaviour change.
Insulin receptor and insulin receptor substrate‐1 in rat retinae
Authors: Gosbell AD , Favilla I , Baxter KM , Jablonski P
Published: March 2003

Insulin receptor substrate‐1 (IRS‐1) is a major cytosolic substrate of the insulin receptor. Expression of insulin receptor and IRS‐1, and the distribution of these components of the insulin‐signalling pathway, were investigated in rat retinae. Insulin receptor and IRS‐1 were located in retinal sections with anti‐insulin receptor and anti‐IRS‐1 antibodies. Reverse transcription–polymerase chain reaction (RT‐PCR) of retinal mRNA was performed with primers specific for insulin receptor and IRS‐1 gene sequences. Immunohistochemistry demonstrated distinct but closely associated staining patterns for insulin receptor and IRS‐1 throughout rat retinae. The RT‐PCR product from rat retinal insulin receptor mRNA corresponded to the high affinity insulin receptor isoform. The RT‐PCR product for retinal IRS‐1 mRNA agreed with that predicted from the gene sequence. The expression of IRS‐1 and insulin receptors indicates a signalling mechanism by which insulin can influence retinal metabolism or function.
A measure of handicap for low vision rehabilitation: the impact of vision impairment profile
Authors: Hassell Jb , Weih Lm , PhD Je Keeffe
Published: March 2003

This study aims to further develop the Impact of Vision Impairment (IVI) profile into a practical, valid instrument for use in low vision rehabilitation. The IVI item pool was derived from focus groups of people with impaired vision, relevant content of existing quality of life questionnaires, and the administration of two trial versions. The second trial version of IVI was administered to 256 people who were vision impaired. Items were deleted if they were of little or no concern or were unable to be performed by most people, had moderate to high inter‐item correlation, or did not contribute to a factor in the factor analysis. Two items were deleted due to floor and ceiling effects, 11 due to moderate to high inter‐item correlation r≥ 0.6. None were removed as a result of factor analysis. The first three factors explained 59% of the variance. This reduced version of the IVI, a tool able to determine rehabilitation needs for people who are vision impaired, will now undergo its final validation procedures.
Management and prognosis of end‐stage glaucoma
Authors: Gillies William E , Brooks Anne Mv , Strang Nicole T
Published: March 2003

Purpose: We followed, for a long term, end‐stage glaucoma patients as defined by the level of legal blindness.

Methods: Follow up was for 7.7 ± 1.8 years (range 2–9) for 22 patients (13 men and nine women) having 32 eyes with functional vision. Age at exit was 74.6 ± 15.5 years (range 33–89). Humphrey computerized perimetry and applanation tonometry were used throughout. We attempted to hold intraocular pressure below 15 mmHg using as much medical therapy as required.

Results: All visual fields were less than 10° diameter at exit, but at entry seven eyes of six patients still had a field between 10º and 20°, the rest were all less than 10°. Corrected visual acuity at entry was 6/9 to 6/6 in 21 eyes of 16 patients and none had less than 6/60. At exit 16 eyes had 6/9 to 6/6 and five eyes had less than 6/60, but no patient had complete loss of vision. Mean intraocular pressure (IOP) throughout was below 15 mmHg in all but four patients, whose (IOP) were less than 20 mmHg, using multiple medications if necessary. All patients had undergone prior surgery and/or laser trabeculoplasty.

Conclusions: Even though visual loss slowly progressed, most patients with end‐stage glaucoma retained functional vision for a long period when intraocular pressure was held below 15 mmHg. More stringent early control of intraocular pressure may avoid the development of end‐stage glaucoma.
Carotid artery ectasia coexistent with primary open angle glaucoma
Authors: Ellis Mark F , Scott Mark , Erwin Groeneveld
Published: March 2003

A 60‐year‐old smoker presented with high intraocular pressure in the right eye with a right afferent pupil defect and visual field suggestive of primary open angle glaucoma in the right eye only, when an examination 2 years earlier had revealed no hint of ocular pathology. Radiological investigations demonstrated prominent ectasia of the internal carotid arteries extending into the proximal middle cerebral arteries. The changes in the carotids extended throughout the cavernous sinus regions, encroached on the under surface of the optic chiasm and were closely related to the internal aspects of both optic canals. In primary open angle glaucoma management, neural imaging is not normally recommended; however, neural imaging investigations should be considered if the presentation is not typical of a chronic bilateral optic neuropathy.
Phenotypic analyses of limbal epithelial cell cultures derived from donor corneoscleral rims
Authors: Barnard Zeke , Apel Andrew JG , Harkin Damien G
Published: March 2003

Grafted cultures of limbal epithelial cells aid repair of the corneal epithelium, but their phenotype is unclear. In this study, the phenotype of cultures that were similar in age to those used clinically were analysed. Limbal epithelial cells were isolated from donor corneoscleral rims and grown in various media, including those designed for keratinocytes. Successful cultures in each medium developed predominantly small (10 μm) tightly packed cells. Immunocytochemistry and western blotting revealed expression of keratins 3, 14 and 19. Expression of these keratins in situ was confirmed by immunohistochemistry. Basal limbal epithelial cells were positive for keratins 14 and 19, and suprabasal cells were positive for keratin 3. However, intense staining for keratin 14 was also observed at the inner cut edge of corneoscleral rims. These findings demonstrate the potential importance of keratins 14 and 19 as markers of epithelial cell differentiation in the human cornea.
Changes in management of diabetic retinopathy by Australian ophthalmologists as a result of the NHMRC clinical guidelines
Authors: McCarty Catherine A , Wright Suzie , McKay Rob , Taylor Kathryn I , Keeffe Jill E ,   the Working Group on Evaluation of NHMRC Diabetic Retinopathy Guidelines
Published: March 2003

Purpose: To document changes in management of diabetic retinopathy by Australian ophthalmologists after release of the National Health and Medical Research Council (NHMRC) clinical guidelines.

Methods: Self‐administered questionnaires were mailed to Australian ophthalmologists prior to release of the NHMRC guidelines for the management of diabetic retinopathy, and at one and 2.5 years after release of the guidelines. The questionnaires elicited information about current management practices in relation to diabetic retinopathy.

Results: The response rate for the baseline and two follow‐up surveys was 82%, 81%, and 80%, respectively. More than 85% of the ophthalmologists responded that the guidelines were useful in improving management, were easy to understand, and were already part of their routine clinical practice. A relatively small percentage (12%) felt that the guidelines made recommendations that were not practical or feasible. Contrary to the NHMRC guidelines, at the second follow‐up survey, only 50% of the ophthalmologists said that they would almost never perform fluorescein angiography in eyes with mild non‐proliferative diabetic retinopathy. The change from baseline to the second follow‐up in the percentage of ophthalmologists who would perform cataract surgery after treating clinically significant macular oedema (as advised by the NHMRC guidelines) was statistically significant (baseline = 83.7%, 95% confidence limit = 80.4, 87.0; second follow up = 90.4, 95% confidence limit = 87.3, 93.5).

Conclusions: Distribution of the printed NHMRC Clinical Practice Guidelines: Management of Diabetic Retinopathy and full colour Retinopathy Chart resulted in a significant change in the recommended order of treatment of clinically significant macular oedema. However, no significant change in the use of fluorescein angiography was documented.
Corneal endothelial response to induced myopia in the chicken
Authors: Hirst Lawrence W , Bancroft Josephine , Bi C Jia‐Qi , Ohlrich Stephen
Published: March 2003

Purpose: To investigate the role of corneal endothelial surface enlargement in the chicken myopia model in inducing corneal endothelial changes.

Methods: Lid suture was performed on one eye of 1‐day‐old cockerels. Five chickens were killed at 1 week, and four chickens killed at each of 3 weeks, 6 weeks, and 10 weeks postnatal. The endothelial morphology was obtained by flat mounting the endothelial surface and the subsequent digitisation. Comparisons were undertaken between the control unsutured eye and the lid‐sutured eye endothelium, and between the central endothelial areas compared to the peripheral endothelial areas in both the myopic and the normal corneas. Calculation of the contribution to the endothelial change by hypertrophy and mitosis were calculated using Bahn’s formula.

Results: Total endothelial surface area increased significantly over time in the myopic model compared to control eyes but the mean cell area of endothelial cells remained the same for both the enlarged myopic endothelial surface area and in the normal controls. Sampling from the central and the peripheral corneal endothelial surface also disclosed no difference. The mean cell area did increase steadily with age but was the same for both normal and myopic corneas.

Conclusions: It would appear that there are equal contributions from hypertrophy and mitosis in the myopic group and the normal corneal group with a slightly increasing trend towards mitotic activity in the myopic corneal endothelial layer.
Diode laser trans‐scleral cyclophotocoagulation for glaucoma following silicone oil removal
Authors: Kumar Atul , Dada Tanuj , Singh Rajinder P , Kedar Sachin
Published: March 2003

Purpose: To evaluate the effect of trans‐scleral cyclophotocoagulation (TSCP) on intraocular pressure (IOP) in eyes with medically uncontrolled secondary glaucoma persisting after intravitreal silicone oil removal.

Methods: Clinical records of 21 eyes of 21 patients who underwent TSCP for medically uncontrolled glaucoma persisting after the removal of intravitreal silicone oil, injected during vitreoretinal surgery for proliferative vitreoretinopathy (PVR), were reviewed retrospectively. Diode laser contact TSCP was applied at a power setting of 1.5–2.5 W, for a maximum duration of 2 s, and a total of 40 spots (10 spots each quadrant). All the patients were evaluated for visual acuity, IOP and number of medications used.

Results: The patients were followed up for a mean ± SD period of 39.9 ± 4.27 weeks (range 36–48 weeks). The IOP was found to have decreased significantly from a pretreatment value of 34.5 ± 5.37 mmHg (range 24–44 mmHg) to 20.47 ± 4.49 mmHg at 6 months of follow up (range 12–30 mmHg, P < 0.01, Student’s paired t‐test). The total number of glaucoma medications being used reduced from 3.38 ± 0.5 to 1.08 ± 0.80 postoperatively (P < 0.01, Wilcoxon’s rank sum test). There was no significant difference in the visual acuity before and after the procedure. Thirteen eyes required a second sitting of TSCP, and five of these required a third sitting. For a successful outcome (IOP < 24 mmHg), a mean of 1.56 sittings (range 1–3 sittings) per eye were needed.

Conclusion: Patients with medically uncontrolled glaucoma persisting after intravitreal silicone oil removal can be treated with TSCP; however, the reduction of IOP is variable. The IOP usually falls after a mean of 2–3 sittings of TSCP.
The efficacy and safety of intraoperative and/or postoperative 5‐fluorouracil in trabeculectomy and phacotrabeculectomy
Authors: Singh Ravinder P , Goldberg Ivan , Mohsin Mohamed
Published: March 2003

Purpose: First, to assess the safety and efficacy of using 5‐fluorouracil (5‐FU) to improve trabeculectomy and phacotrabeculectomy success rates, and second, to assess the efficacy of intraoperative and reduced postoperative 5‐FU following trabeculectomy compared with a more intensive course of postoperative 5‐FU alone.

Methods: In a retrospective, unmatched, non‐randomized consecutive series study, 186 eyes of 186 patients who had filtration surgery were followed for 2 years in four groups: 51 patients had undergone trabeculectomy surgery with postoperative 5‐FU, 51 had phacotrabeculectomy with postoperative 5‐FU, 56 had trabeculectomy with both intraoperative and postoperative 5‐FU, and 28 patients had trabeculectomy without antifibrotics.

Results: At all times mean intraocular pressure (IOP) was reduced in all groups (P < 0.001 for each group). Success was defined as IOP < 16 mmHg and > 30% IOP reduction at the 2‐year follow up. It was achieved in 71% of the trabeculectomy patients with intraoperative and postoperative 5‐FU, 76% of the trabeculectomy group with only postoperative 5‐FU, 55% of the phacotrabeculectomy/ 5‐FU group, and in 29% of the trabeculectomy‐only eyes (between‐group differences P < 0.01). Success rates were not significantly different for the intraoperative and postoperative 5‐FU trabeculectomy versus the postoperative 5‐FU‐only eyes, but the former had fewer postoperative 5‐FU injections and corneal ulceration (P < 0.01 for both).

Conclusions: 5‐Fluorouracil was safe and improved trabeculectomy survival. Intraoperative 5‐FU allowed fewer postoperative 5‐FU injections and fewer side‐effects without compromising success rates. Phacotrabeculectomy with postoperative 5‐FU had a lower surgical success rate than did trabeculectomy with 5‐FU and this was not statistically different from trabeculectomy without 5‐FU.
Prosthetic conformers: a step towards improved rehabilitation of enucleated children
Authors: Vincent Andrea L , Webb Michael CF , Gallie Brenda L , Héon Elise
Published: March 2003

Abstract Enucleation in children is distressing for families, particularly because of concerns of cosmesis. In the last 2 years the authors have used painted conformers instead of clear conformers to make the postoperative healing and rehabilitation period easier on the families. A set of six prosthetic conformers (small, medium and large; blue and brown) was available in the operating room. An appropriately sized and colour‐matched conformer was placed in the socket at the end of surgery and kept for an average of 4−6 weeks. This decreased the psycho­logical impact of enucleation, yet achieved the goals of an ideal conformer allowing optimal wound healing without pressure to fit a permanent individualized prosthesis earlier than 6 weeks after surgery. The acceptance of families to prosthetic conformers in this paediatric population has been very positive, improving rehabilitation of the family and the enucleated child.
Normal readers have an upper visual field advantage in change detection
Authors: Rutkowski Jacqueline S , Crewther David P , Crewther Sheila G
Published: March 2003

The ability to detect change has not been well studied in children. A research paradigm was used involving search for a change made to one of four letter targets, presented twice, with a gap of 250 ms. Sixty‐one schoolchildren, aged 7.3 − 12.9 years, participated in the study. The duration of the first presentation was such that each child was detecting change at a rate of 71% correct. The mean duration was 0.91 s (SD = 0.58 s), with older children not significantly faster in detecting change. In the second phase, using the duration established in the first phase, the effect of cue condition on detection was studied. An upper visual field advantage for change detection was clearly evident for un‐cued trials. The most likely explanation derives from the masking produced by the reappearance of the four targets, which interferes with the process of change detection. The greater dorsal pathway representation of the lower visual field implies greater masking there, yielding better change detection in the upper visual field.
Garlic and the strabismus surgeon
Authors: Carden Susan M , Good William V , Carden Patricia A , Good Robert M
Published: March 2003

Potential side‐effects caused by complementary medicines are often not anticipated. A case is reported of bilateral retro‐bulbar haemorrhages with elevated intraocular pressure during strabismus surgery that occurred as a result of odourless garlic tablet ingestion prescribed by a naturopath. A near‐catastrophic event was averted with rapid recognition and medical treatment. This is believed to be the first such report of haemorrhaging in ophthalmic surgery induced by garlic. It is concluded that unregulated naturopathic prescribing is potentially dangerous; doctors need to ask specifically about naturopathic potions.
Eye health in rural Australia
Authors: Madden Anna C , Simmons David , McCarty Catherine A , Khan Munir A , Taylor Hugh R
Published: March 2003

A review of the current literature relating to eye health in rural Australia was conducted. Few studies have been undertaken, with most information provided by the Australian Institute of Health and Welfare databases, The National Trachoma and Eye Health Program of 1980 and the Visual Impairment Project in Victoria in the mid 1990s. Key findings were that the rural population has an increased prevalence of pterygium, cataract, ocular trauma and glaucoma, but no difference in refractive error or diabetic retinopathy (although data are limited). Rural residents are more likely to have seen an optometrist but less likely to have seen an ophthalmologist. Interventions have been undertaken in ophthalmologist training to increase the rural workforce and tele‐ophthalmology to provide city‐based metropolitan ophthalmological support for rural practitioners. Further epidemiological data and evaluated interventions are urgently required to help identify and address the needs of rural Australian communities.
Respiratory epithelial orbital cysts
Authors: Mee Jared J , McNab Alan A , McKelvie Penny
Published: March 2003

Congenital or post‐traumatic respiratory epithelial lined cysts of the orbit are very rare, and such cysts more commonly occur as mucocoeles secondary to chronic paranasal sinus disease. Four new cases of such cysts are described herein, three presumed choristomas and one occurring after trauma. Two of three presumed choristomatous (congenital) cysts occurred in sites that were atypical for the commoner dermoid cyst. One occurred in the superior orbit between the superior rectus and levator palpebrae superioris muscle and one in the temporal fossa and lateral orbit. The third choristomatous lesion occurred in the superotemporal orbit with a well‐defined bony defect, a typical pattern of the commoner dermoid cyst. The fourth case, a presumed traumatic respiratory epithelial cyst, probably arose from ethmoidal sinus mucosa. Respiratory epithelial orbital cysts are very rare and may occur in sites that are atypical for the commoner orbital dermoid cyst.
Capnocytophaga canimorsus endophthalmitis following cataract surgery
Authors: Phipps Simon E , Tamblyn David M , Badenoch Paul R
Published: March 2003

An elderly man developed endophthalmitis 1 week after cataract extraction and lens implantation. Intraocular samples were collected and the patient received intravitreal vanco­mycin and ceftazidime, and topical tobramycin. A Gram stain of vitreous humour revealed spindle‐shaped Gram‐negative bacilli. He was then given systemic clindamycin and topical ofloxacin. Capnocytophaga canimorsus, a member of the oral flora of dogs and cats, was cultured after 3 days. The infection resolved leaving the patient with a visual acuity of 6/60. An attempt was made to culture the organism from the mouth of the patient's pet dog. This was unsuccessful and the source of the infection remains unknown.
Low vision rehabilitation in patients with age‐related macular degeneration at a tertiary eye care centre in southern India
Authors: Khan Sarfaraz A , Das Taraprasad , Kumar Sharmila Mohan , Nutheti Rishita
Published: March 2003

Purpose: To evaluate the specific needs and types of low vision devices (LVDs) in patients with age‐related macular degeneration (AMD) so as to use the residual vision effectively.

Methods: One hundred consecutive patients with diagnosis of AMD were evaluated to ascertain the degree of visual disability. Different LVDs were used to suit the specific needs of individual patients. The distribution of LVDs for distance and near and other rehabilitation measures were stratified for vision ≥6/18 and <6/18. Statistical analysis was performed using χ2 test/Fisher's exact test and paired t‐test.

Results: The percentage of patients with visual acuity <6/18 reduced from 72.2% (26/36) to 47.2% (17/36) with the use of standard spectacles (P = 0.03). Similarly, the percentage of patients with visual acuity <6/18 reduced from 85.7% (6/7) to 14.3% (1/7) with the use of a telescope (P = 0.029). The optical devices for near tasks included spectacle magnifiers (n = 59), stand magnifiers (n = 19), and hand magnifiers (n = 18). With these LVDs, the near vision improved from 0.13 (decimal notations) to 0.39 (P < 0.001). Eighty‐six patients were given at least one of the LVDs and 20% were prescribed more than one near device (bifocals, spectacle magnifiers, hand magnifiers, stand magnifiers). Additionally, patients also needed counselling (n = 89) and training on eccentric viewing (n = 39), coin identification (n = 45), and independent mobility (n = 41).

Conclusion: The overall management of a patient with AMD must include counselling, prescription of appropriate LVDs and training to utilize the residual vision to its fullest advantage. This is expected to improve the patient's quality of life.