bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of surveillance methods for an epidemiological study of contact lens related microbial keratitis
Authors: Keay Lisa , Edwards Katie , Brian Garry , Naduvilath Thomas , Stapleton Fiona
Published: July 2004

Purpose: To evaluate surveillance methods in a pilot epidemiological study of contact lens related microbial keratitis (MK) cases identified by ophthalmic practitioners in Australia and New Zealand between May and August 2003 inclusive.

Methods: Twelve ophthalmologists and 55 optometrists from rural and metropolitan locations were sent a study information pack with postal reporting forms. After 2 months, practitioners were emailed a link to a website for Internet reporting. After 4 months, practitioners were prompted by email and then by telephone if a response was not received. Passive response rates were the rate of returns after posting information and emailing the website link. Active response rates included personalized email and telephone follow‐up.

Results: Ten cases of MK were identified by optometrists and five by ophthalmologists. The passive response rates were 79% and 58% for the first and second reporting periods, respectively. There was a lower response rate in the second reporting period compared to the first (P = 0.02). With active surveillance the response rate increased to 97% and 96%. A large proportion of optometrists (62%) and ophthalmologists (55%) used the website for at least one reporting period. Internet reporting was used by all New Zealand practitioners (5/5).

Conclusions: A surveillance study to estimate the incidence of contact lens related MK in Australia and New Zealand is feasible and acceptable. Internet‐based reporting offers a reliable, rapid and cost‐effective means of running a large scale, international surveillance study. Active surveillance methods are necessary to enhance reporting rates.
Retinoblastoma in Victoria, 1976−2000: changing management trends and outcomes
Authors: Dondey Joanne C , Staffieri Sandra , McKenzie John , Davie Gabrielle , Elder James
Published: July 2004

Purpose: To describe changes in the management of retinoblastoma in Victoria and to review the effect of newer, conservative treatments on preservation of eyes, visual outcome and mortality by comparing a similar group of patients treated over successive time intervals.

Methods: A retrospective analysis of all cases of retinoblastoma diagnosed and treated in Victoria between 1956 and 2000 was conducted. Historical data on 77 cases previously published by O’Day et al. was used for the period 1956−1976 (series 1). Data on 88 cases recorded in the Royal Children's Hospital (Melbourne) Retinoblastoma Database was used for the period 1976−2000. The latter group was subdivided into those treated between 1976 and 1989 (series 2), prior to the advent of modern eye saving treatments, and those treated subsequent to their introduction from 1990 to 2000 (series 3).

Results: In unilateral retinoblastoma, final enucleation rates for 1956−1976 (series 1) and 1976−1989 (series 2) were almost identical, being 98% and 97% of affected eyes, respectively (P = 1.00). Despite the newer treatments used after 1990 (series 3), 88% of affected eyes were still enucleated, representing a statistically similar outcome to series 2 (P = 0.33). In bilateral retinoblastoma, primary enucleation of the more involved eye was similar for series 1 (84%) and 2 (80%) but series 3 (41%) was substantially less than series 2 (P = 0.04) following the increased use of conservative treatments. In series 3, 59% of more involved eyes were treated conservatively compared with 16% (P = 0.007) and 20% (P = 0.04) for series 1 and 2, respectively. Despite attempts at eye salvage, the failure rate was higher in series 3 (29%) yielding a final enucleation rate of 70%, which represented a modest downward trend in the numbers of eyes finally enucleated; 84% (series 1), 73% (series 2) and 70% (series 3) (test for trend, P = 0.33). Bilateral enucleation rates were significantly lower, from 36% and 30% in series 1 and 2, respectively, to 7% in series 3 (test for trend, P = 0.02). As a consequence, more eyes were preserved over time, being 20/50 (40%) in series 1, 15/30 (50%) in series 2 and 21/34 (62%) in series 3. Comparison of visual outcome was hampered by incomplete data in series 1 but it appeared series 2 and 3 achieved better visual acuities with 67% and 62% of preserved eyes in bilateral cases measuring equal to or better than 6/12. Mortality rates in all series were low, being 7.8% in series 1, 4.5% in series 2 and nil in series 3.

Conclusions: Following the introduction of new conservative treatments, there has been an increase in preservation of eyes and improved visual outcome, and a dramatic decrease in numbers of bilateral enucleations without adversely affecting survival.
Life expectancy of patients with neovascular glaucoma drained by Molteno implants
Authors: Blanc John‐Paul , Molteno Anthony CB , Fuller J Robert , Bevin Tui H , Herbison Peter
Published: July 2004

Purpose: To determine the survival of patients with sighted eyes who had Molteno implants inserted for neovascular glaucoma.

Methods: Patients who had Molteno implants inserted for neovascular glaucoma between October 1977 and March 2001 at Dunedin Hospital, New Zealand, were reviewed. Relative survival analysis was then used to compare survival in this group to survival of the New Zealand population of the same age.

Results: A total of 114 patients had 131 Molteno implants inserted for neovascular glaucoma. Neovascular glaucoma was secondary to central retinal vein occlusion in 66 eyes (50%) and diabetes in 42 eyes (32%), and patients lost 52% or 6.53 years of their expected remaining life span. Age, sex and postoperative intraocular pressure control did not predict survival. The only predictor of improved survival was a preoperative visual acuity of 6/48 or better. These patients lost 21% (or 2.43 years) of expected remaining life compared to 62% (or 10.78 years) in those patients who had a presenting visual acuity of 6/60 or worse.

Conclusions: Patients with neovascular glaucoma had a markedly reduced life expectancy, which has improved in recent years when compared to that of the normal sex and age‐matched New Zealand population. Patients presenting with better vision (6/48 or better) survived significantly longer than those presenting with poorer vision.
Five‐year follow up of selective laser trabeculoplasty in Chinese eyes
Authors: Lai Jimmy SM , Chua John KH , Tham Clement CY , Lam Dennis SC
Published: July 2004

Purpose: To study the effectiveness and safety of selective laser trabeculoplasty (SLT) on primary open‐angle glaucoma and ocular hypertension in Chinese eyes.

Methods: This was a prospective randomized controlled clinical study in which 58 eyes of 29 patients with primary open‐angle glaucoma or ocular hypertension were included. One eye of each patient was randomized to receive SLT (Group 1) and the fellow eyes received medical treatment (Group 2). Patients were evaluated after laser treatment at 2 h, 1 day, 1 week, 2 weeks, 1 month, 3 months, 6 months, and then yearly.

Results: All patients (13 male, 16 female) were Chinese. The mean age was 51.9 ± 14.7 years. The mean baseline intraocular pressure was 26.8 ± 5.6 mmHg in group 1 and 26.2 ± 4.2 mmHg in group 2 (P = 0.62). The failure rate, defined as intraocular pressure >21 mmHg with maximal medications, was 17.2% in group 1 and 27.6% in group 2 at 5‐year follow‐up (P = 0.53). Eight eyes (27.6%) in group 1 required medications to control the intraocular pressure to below 21 mmHg. There was no statistically significant difference in the intraocular pressure reductions between the two groups at all time intervals (P > 0.05). The mean number of antiglaucoma medications was significantly lower in the SLT than the medical treatment group up to 5 years of follow up (P < 0.001). Transient post‐SLT intraocular pressure spike >5 mmHg was observed in three eyes (10.3%).

Conclusion: With fewer medications, SLT gives similar intraocular pressure reduction to medical therapy alone in Chinese patients with primary open‐angle glaucoma or ocular hypertension.
Short‐term effect of latanoprost on ocular circulation in ocular hypertension
Authors: Akarsu Cengiz , Bilgili Yasemin Karadeniz , Taner Pelin , Ünal Birsen , Ergin Ahmet
Published: July 2004

Purpose: To determine the short‐term effects of latanoprost on retrobulbar circulation in ocular hypertension.

Methods: Forty‐six eyes of 23 consecutive bilateral ocular hypertensive patients with an intraocular pressure (IOP) of greater than 22 mmHg were evaluated in a prospective controlled study. All subjects received a single drop of latanoprost 0.005% in one eye and placebo in the fellow control eye. Systemic circulatory parameters, intraocular pressure, blood flow velocities, and resistance indices of the ophthalmic, short posterior ciliary and central retinal arteries were measured using colour Doppler imaging at baseline and 2 h and 8 h after dosing.

Results: Latanoprost lowered IOP significantly after 2 h and 8 h (P < 0.01). The mean IOP reduction was 6.7 mmHg 8 h after dosing. At baseline, there were no statistically significant differences in any retrobulbar vessels of eyes that received a single drop of latanoprost when compared with the eyes that received placebo (P > 0.05). Comparisons with baseline and latanoprost conditions revealed that latanoprost did not alter the blood flow velocities and resistance indices in the ophthalmic (P > 0.05), posterior ciliary (P > 0.05) and central retinal (P > 0.05) arteries 2 h and 8 h after dosing. The systolic and diastolic blood pressures (P = 0.74, P = 0.29, respectively) and pulse rate (P = 0.68) remained unchanged over the 8‐h period.

Conclusions: This study found that a single drop of latanoprost significantly reduces intraocular pressure 8 h after dosing. However, it does not have any short‐term effects on the retrobulbar haemodynamics in ocular hypertensive eyes.
Systemic and ocular comorbidity of cataract surgical patients in a western Sydney public hospital
Authors: Pham Thuan Quoc , Wang Jie Jin , Rochtchina Elena , Maloof Anthony , Mitchell Paul
Published: July 2004

Background: This study aimed to assess the frequency of major systemic and ocular comorbidities among cataract surgical patients attending a large general public hospital.

Methods: Consecutive patients aged 60+ years who had undergone cataract surgery at Westmead Hospital from July 2001 to December 2002 were included. Preoperative information was obtained from patient medical records.

Results: A total of 773 cataract surgical procedures were performed during the 18‐month period, including 668 (86.4%) aged 60+ years. Complete data were available for 653 eyes (97.8%); 62.2% were women. The mean age at surgery was 74.6 (± 7.2) years. Frequent systemic comorbidities included: angina (20.2%), previous myocardial infarct (15.0%), diabetes (27.5%) and hypertension (56.3%); 12.5% were current smokers. Major preoperative ocular comorbidities included age‐related maculopathy (12.6%), diabetic retinopathy (9.0%) and glaucoma (10.6%). Preoperatively, 21.7% of this group had severe visual impairment (visual acuity [VA] <6/60), 30.6% had moderate impairment (VA <6/24 −≥6/60) and 30.6% had mild impairment (VA <6/12 −≥6/24); 28.5% had presenting VA ≥6/12.

Conclusion: The data indicate a high frequency of comorbid systemic and ocular diseases among cataract surgical patients.
Cataract surgery in Australia: a profile of patient‐centred outcomes
Authors: Pager Chet K , McCluskey Peter J , Retsas Con
Published: July 2004

Background: Few studies have addressed quality of life or satisfaction outcomes for patients undergoing cataract surgery, particularly in Australia. The purpose of this study was to describe a sample of patients undergoing cataract surgery in typical metropolitan practices in Sydney, with a particular focus on the impact upon quality of life and satisfaction with vision.

Methods: One hundred and eleven patients were recruited prior to surgery and followed through 3 months postoperatively. Patients reported basic demographic information, VF‐14 visual disability and SF‐36 quality of life information, along with the degree of satisfaction and trouble with vision they experienced. Surgeons’ records provided information about type and severity of cataract, refractive error, ocular comorbidity and visual acuity.

Results: Patients enjoyed strongly significant improvement in visual acuity, disability, trouble and satisfaction with vision, with a median postoperative Snellen acuity of 6/7.5, and 82% within 1 D refraction. Not wearing glasses was the most commonly stated patient goal for undergoing surgery. Prior to surgery 23% of all driving patients did so illegally due to poor vision; after surgery 21% of non‐drivers began driving again, all legally. Nonetheless, quality of life did not improve. Those who failed to achieve improvements in satisfaction with vision were more likely to be female, have lower educational attainment or have high visual function preoperatively. Change in visual acuity was not predictive.

Conclusions: The findings from this study indicate that cataract surgery outcomes in Australia compare well with international standards, and emphasize the inadequacy of visual acuity to measure relevant surgical outcomes. Increased preoperative counselling may be required in those groups less likely to attain high levels of satisfaction. Finally, the role of cataract surgery to improve quality of life must be investigated further, as this is the ultimate goal of the procedure.
Photoscreening for diabetic retinopathy: a comparison of image quality between film photography and digital imaging
Authors: Klais Christina MC , Grupchev Ivan D , McGhee Charles NJ , Donaldson Mark L
Published: July 2004

Purpose: Retinal images from patients attending an urban screening centre before and after the transition from film photography to digital image acquisition were analysed for quality of image.

Methods: A total of 1946 diabetic patients, aged 12−92 years (mean 55.6 ± 14.88 years), were included in this retrospective study of retinal screening techniques. Each imaging group was subdivided into age‐matched groups. In all subjects pupils were pharmacologically dilated before photography. The images were reviewed by the same three experienced observers and graded at the time of screening from grade 1 (excellent quality) to grade 4 (unreadable).

Results: Of 938 patients in the film group, 31.3% had excellent images, 38.2% good, 22.7% poor and 7.8% were unreadable. Of the 1008 patients in the digital imaging group, 25.3% had excellent images, 46.3% good, 14.6% poor and 13.8% were unreadable. A significant difference was observed in patients over 65 years of age who exhibited a threefold increase in failure rate with digital imaging (33.7% v 11.3%)(P < 0.0001).

Conclusion: In this study population a statistically significant degradation of image quality was observed in those older than 65 years following transition to digital photography. This has implications for service provision planning.
Auckland Proliferative Diabetic Vitrectomy Fellow Eye Study
Authors: Vote Brendan J , Gamble Greg D , Polkinghorne Philip J
Published: July 2004

Background: To review medical and ophthalmic findings of primary diabetic vitrectomy patients to examine indices important in progression to fellow eye surgery.

Methods: A retrospective analysis was undertaken of all diabetic patients undergoing vitreoretinal surgery at Auckland Public Hospital between January 1992 and July 1996. Kaplan−Meier survival analysis was performed along with univariate and multivariate (Cox Proportional Hazards) data analysis.

Results: One hundred and fourteen primary diabetic vitrectomy cases were reviewed with mean follow‐up duration of 4 years. Thirty‐eight per cent (n = 43) of the study group underwent fellow eye surgery at a mean time of 1.6 years after first eye surgery. Fourteen patients were already blind in the fellow eye at baseline, and five patients refused second eye surgery on intention to treat. Thus there were 62 (54%) patients with severe (surgical threshold) fellow eye disease diagnosed within the follow‐up period. The presence of either tractional retinal detachment or combined rhegmatogenous/tractional retinal detachment but without vitreous haemorrhage in the presenting eye was, in this series, a risk factor for fellow eye surgery (OR 5.56; 95% CI 1.96−15.8). Maori and Pacific Islander ethnicity was significantly associated with traction retinal detachment (OR 2.23; 95% CI 1.05−4.7). At data analysis 57% (n = 60) of the study patients had died. The mean time to death was 4.3 years, with 84% of these patients having evidence of renal disease at the time of their first eye surgery. Good visual function in at least one eye was maintained in many patients.

Conclusions: A substantial proportion of diabetic vitrectomy patients require fellow eye surgery. Absence of vitreous haemorrhage in the presenting eye (i.e. tractional or combined rhegmatogenous/tractional retinal detachments but without vitreous haemorrhage) was predictive of need for fellow eye surgery. The need for diabetic vitrectomy correlates with poor survival in this study population.
Determination of relative contribution of the superior and inferior canaliculi to the lacrimal drainage system in health using the drop test
Authors: Murgatroyd Helen , Craig Jennifer P , Sloan Brian
Published: July 2004

Purpose: The aim of this study was to explore the use of the ‘drop test’ as a method of assessing maximal lacrimal outflow capacity, and to measure the relative contribution of the superior and inferior canaliculi to the drainage capacity in normal subjects.

Method: The drop test involves instilling measured aliquots of normal saline over 3‐min periods to raise the tear lake medially. Both eyes were assessed; however, for the right lacrimal drainage system only, sequential insertion and then removal of silicone punctal plugs was performed. After each stage the maximal lacrimal drainage capacity was measured. No punctal plugs were placed in the puncta on the left side.

Results: Complete data were collected from 20 subjects with a mean age of 35.6 years. The intraclass correlation coefficient for the five left eye readings was 0.98 (CI 0.96−0.99) and the limits of agreement of a single reading were −22.6 to +93.0 µL/3 min. Without intervention, no statistically significant difference was found in the mean lacrimal outflow between the left and right eyes (P = 0.16). A statistically significant reduction in outflow resulted from punctal occlusion (P < 0.05). Presenting the proportion of lacrimal outflow as a percentage of the combined values of the superior and inferior canaliculi, 59.9% of outflow occurred through the inferior canaliculus.

Conclusion: The drop test was found to provide a simple and repeatable method of assessing lacrimal drainage in a minimally invasive manner in the clinical setting. In healthy volunteers in the supine position 60% of maximal lacrimal outflow capacity occurs through the inferior canaliculus.
Anti‐GM1 antibodies: the cause of otherwise unexplained ophthalmoplegias?
Authors: Kowal Lionel , Gajus Michelle Andrea , Kornberg Andrew J
Published: July 2004

Purpose: To report four patients with otherwise unexplained ophthalmoplegia who were found to have elevated levels of anti‐GM1 antibodies.

Methods: Retrospective chart evaluation of 50 consecutive patients with otherwise unexplained ophthalmoparesis. All patients were tested for anti‐GM1 antibodies.

Results: Six out of 50 cases (12%) were found to have elevated anti‐GM1 antibodies, far greater than the 2.7% found in the general population. Four of the subjects with elevated anti‐GM1 antibodies are reported.

Conclusion: Although the mechanism and relationship between the neural antibodies and ophthalmoparesis is not understood, it is proposed that the presence of anti‐GM1 antibodies should be considered in cases of otherwise unexplained ophthalmoplegia.
Pseudogerontoxon
Authors: Jeng Bennie H , Whitcher John P , Margolis Todd P
Published: July 2004

Pseudogerontoxon is a lesion that resembles a small segment of arcus senilis or gerontoxon and is seen in many individuals with limbal vernal or atopic keratoconjunctivitis. It is an important clinical finding because pseudogerontoxon is often times the only clinical evidence of previous allergic eye disease. To the authors’ knowledge, pseudogerontoxon has only rarely been mentioned, and has never been pictured, in the peer‐reviewed literature. Three examples are presented of this important clinical entity.
Clinical Case Notes
Authors: Foroozan Rod
Published: July 2004

The case is reported of a 61‐year‐old man who developed shock‐induced anterior ischaemic optic neuropathy (SIAION) after undergoing radical prostatectomy. Visual loss began on the third postoperative day. Only one other patient with SIAION after prostatectomy has been reported in the past. SIAION may result in fixed visual loss after radical prostatectomy and ophthalmic evaluation should not be delayed in patients with postoperative visual loss.
Clinical Case Notes
Authors: Ooi Kenneth G‐J , Drummond Suzannah R , Thompson Kirsteen J , Roberts Fiona , Kemp Ewan G
Published: July 2004

Churg−Strauss syndrome is a rare diffuse vasculitis of which the ocular manifestations have been well documented. However, reports of conjunctival involvement in Churg−Strauss syndrome are scarce. Such a presentation is described in a man with Candida albicans infection as well as ankylosing spondylitis, and a possible aetiological linkage is established amongst all three.
Clinical Case Notes
Authors: Sobha Sivaprasad , Rajan Madhavan S , Jackson Heather
Published: July 2004

Laser in situ keratomileusis (LASIK) is a well‐accepted refractive surgical procedure; however, reports of complications of hyperopic surgery are scarce. This is the first report of bilateral macular choroidal neovascular membrane following bilateral hyperopic LASIK surgery. It highlights important considerations in older patients undergoing the procedure.
Clinical Case Notes
Authors: Chua William C‐T , Martin Peter A , Kourt Georgina
Published: July 2004

Transitional cell carcinoma (TCC) is a common bladder tumour, 10−15% of which will exhibit invasive behaviour. About 50% of patients with invasive TCC will eventually develop distant metastases, usually to lymph nodes, lung or bones. The case is reported of bladder TCC metastasizing to the orbit.
Mean‐Based Iterative Procedures in Linear Models with General Errors and Grouped Data
Authors: Rivero Carlos , Valdés Teófilo
Published: July 2004

Abstract. We present in this paper iterative estimation procedures, using conditional expectations, to fit linear models when the distributions of the errors are general and the dependent data stem from a finite number of sources, either grouped or non‐grouped with different classification criteria. We propose an initial procedure that is inspired by the expectation‐maximization (EM) algorithm, although it does not agree with it. The proposed procedure avoids the nested iteration, which implicitly appears in the initial procedure and also in the EM algorithm. The stochastic asymptotic properties of the corresponding estimators are analysed.
Variance Estimation in Spatial Regression Using a Non‐parametric Semivariogram Based on Residuals
Authors: Kim Hyon‐Jung , Boos Dennis D.
Published: July 2004

Abstract. The empirical semivariogram of residuals from a regression model with stationary errors may be used to estimate the covariance structure of the underlying process. For prediction (kriging) the bias of the semivariogram estimate induced by using residuals instead of errors has only a minor effect because the bias is small for small lags. However, for estimating the variance of estimated regression coefficients and of predictions, the bias due to using residuals can be quite substantial. Thus we propose a method for reducing this bias. The adjusted empirical semivariogram is then isotonized and made conditionally negative‐definite and used to estimate the variance of estimated regression coefficients in a general estimating equations setup. Simulation results for least squares and robust regression show that the proposed method works well in linear models with stationary correlated errors.
Inference for Observations of Integrated Diffusion Processes
Authors: Ditlevsen Susanne , Sørensen Michael
Published: July 2004

Abstract. Estimation of parameters in diffusion models is investigated when the observations are integrals over intervals of the process with respect to some weight function. This type of observations can, for example, be obtained when the process is observed after passage through an electronic filter. Another example is provided by the ice‐core data on oxygen isotopes used to investigate paleo‐temperatures. Finally, such data play a role in connection with the stochastic volatility models of finance. The integrated process is not a Markov process. Therefore, prediction‐based estimating functions are applied to estimate parameters in the underlying diffusion model. The estimators are shown to be consistent and asymptotically normal. The theory developed in the paper also applies to integrals of processes other than diffusions. The method is applied to inference based on integrated data from Ornstein–Uhlenbeck processes and from the Cox–Ingersoll–Ross model, for both of which an explicit optimal estimating function is found.
Outlier Identification Procedures for Contingency Tables using Maximum Likelihood and L1 Estimates
Authors: Kuhnt Sonja
Published: July 2004

Abstract.  Observed cell counts in contingency tables are perceived as outliers if they have low probability under an anticipated loglinear Poisson model. New procedures for the identification of such outliers are derived using the classical maximum likelihood estimator and an estimator based on the L1 norm.
Goodness‐of‐fit Tests for Mixed Models
Authors: Ritz Christian
Published: July 2004

Abstract.  Mixed linear models have become a very useful tool for modelling experiments with dependent observations within subjects, but to establish their appropriateness several assumptions have to be checked. In this paper, we focus on the normality assumptions, using goodness‐of‐fit tests that make allowance for possible design imbalance. These tests rely on asymptotic results, which are established via empirical process theory. The power of the tests is explored empirically, and examples illustrate some aspects of the usage of the tests.
Flexible Class of Skew‐Symmetric Distributions
Authors: Ma Yanyuan , Genton Marc G.
Published: July 2004

Abstract.  We propose a flexible class of skew‐symmetric distributions for which the probability density function has the form of a product of a symmetric density and a skewing function. By constructing an enumerable dense subset of skewing functions on a compact set, we are able to consider a family of distributions, which can capture skewness, heavy tails and multimodality systematically. We present three illustrative examples for the fibreglass data, the simulated data from a mixture of two normal distributions and the Swiss bills data.
On Robust and Efficient Designs for Risk Estimation in Epidemiological Studies
Authors: Dette Holger
Published: July 2004

Abstract.  We consider the design problem for the estimation of several scalar measures suggested in the epidemiological literature for comparing the success rate in two samples. The designs considered so far in the literature are local in the sense that they depend on the unknown probabilities of success in the two groups and are not necessarily robust with respect to their misspecification. A maximin approach is proposed to obtain efficient and robust designs for the estimation of the relative risk, attributable risk and odds ratio, whenever a range for the success rates can be specified by the experimenter. It is demonstrated that the designs obtained by this method are usually more efficient than the commonly used uniform design, which allocates equal sample sizes to the two groups.
Income Distribution, Price Elasticity and the ‘Robinson Effect’
Authors: Benassi Corrado , Chirco Alessandra
Published: July 2004

In The Economics of Imperfect Competition, Joan Robinson argued that an increase of the consumers’ incomes should make demand less elastic—which, although reasonable about individual demand as an assumption on preferences, suggests a role for income distribution as far as market demand is concerned. We use Esteban's (International Economic Review, Vol. 27 (1986), No. 2, pp. 439–444) income share elasticity to provide sufficient conditions on income distribution that support the ‘Robinson effect’—i.e. such that a negative (positive) relationship between individual income and price elasticity translates into a negative (positive) relationship between mean income and market demand elasticity. The paper also provides a framework to study the effects of distributive shocks on the price elasticity of market demand.
Implementation of the Socially Optimal Outcome
Authors: Liao Chun‐Hsiung , Tauman Yair
Published: July 2004

We show that a welfare maximizing planner in a Cournot oligopoly can easily implement the socially optimal outcome by offering the firms a per unit subsidy in return for upfront fees. The planner announces a subsidy and auctions it off to a limited number of firms. It is shown that if at least one firm is excluded and not subsidized, the socially optimal outcome can be achieved while the planner runs no deficit. The planner does not impose any regulation on the firms. They accept his offer willingly and voluntarily. Yet, every firm makes zero net profit and consumers extract the entire surplus.
Interest Rates and Information
Authors: Colombo Ferdinando
Published: July 2004

In a lending relationship, a bank learns information on its borrowers. Adverse selection makes the usefulness and value of this information depend on the interest rates the bank charges in the different periods. The optimal intertemporal screening of borrowers calls for a monopolistic bank to smooth interest rates. In a repeated relationship, interest rates are lower than in a one‐period setting; furthermore, they are less volatile and the quality of the loans is higher than under competition (with symmetric information). Information sharing may reduce both the probability that a debt will be paid and the sum of banks’ and borrowers’ profits.
Effects of coasting on the outcome of intracytoplasmic sperm injection‐embryo transfer cycles
Authors: AKTAN Erdal , BOZKURT Kaan , OZER Dilek , YUCEBILGIN Sait , KARADADAS Nedim , BILGIN Onur
Published: July 2004

Objectives:  To determine the effects of ‘coasting’ on the outcome of controlled ovarian hyperstimulation (COH) and intracytoplasmic sperm injection–embryo transfer (ICSI–ET).

Design:  Retrospective study.

Setting:  IVF Centre, Ozel Ege Tup Bebek Merkezi, Izmir, Turkey.

Sample:  Twenty‐six coasted and 52 non‐coasted COH and ICSI–ET patients were enrolled in this retrospective study.

Methods:  Coasted patients were enrolled consecutively during the study period, and two non‐coasted controls were selected from our database for each coasted patient. Coasting was decided when serum oestradiol level was ≥4000 pg/mL. Groups were compared using χ2 and Mann–Whitney U‐tests for statistical analysis.

Main Outcome Measures:  Number of oocytes collected, metaphase II (MII) oocytes and cleaving embryos, the fertilisation rate and clinical pregnancy rate were the main outcome measures.

Results:  Number of oocytes collected, number of MII oocytes, number of cleaving embryos, fertilisation rate and clinical pregnancy rate for the coasted and non‐coasted groups were 15.5 ± 5.2 and 14.0 ± 7.1, 9.7 ± 4.8 and 9.3 ± 3.9, 6.8 ± 3.9 and 5.8 ± 3.1, 0.85 ± 0.18 and 0.78 ± 0.18, 13/26 and 24/52, respectively; these differences were not statistically significant. None of the patients in the coasted group were hospitalised for signs or findings of severe ovarian hyperstimulation syndrome.

Conclusions:  Coasting does not adversely affect the number and the function of mature oocytes and the clinical pregnancy rate.
Safer laparoscopic trocar entry: It's all about pressure
Authors: TSALTAS Jim , PEARCE Scott , LAWRENCE Anthony , MEADS Alan , MEZZATESTA Joseph , NICOLSON Scott
Published: July 2004

This prospective observational study aimed to assess the feasibility of adapting peritoneal hyperdistention to 25 mmHg during laparoscopy in an Australian hospital environment. A total of 1150 consecutive diagnostic or operative laparoscopies were performed. All cases were monitored for early detection of untoward physiological changes. All patients had Veress needle insufflation with distension to 25 mmHg prior to insertion of the primary trocar. No patients experienced any surgical entry complications or adverse clinical effects noted during anaesthetic. The aim of the current study is to assess the feasibility and safety of increasing the peritoneal insufflation pressure to 25 mmHg for primary trocar insertion.
Ethnicity and fetal growth in Fiji
Authors: MATHAI Matthews , SCHRAMM Mary , BARAVILALA Wame , SHANKAR Viswanathan , ANTONISAMY Belavendra , JEYASEELAN Lakshmanan , BERGSTRÖM Staffan
Published: July 2004

Background:  Indigenous Fijians and the descendants of Asian Indians constitute the two major ethnic groups in Fiji. There are differences between the two groups in perinatal outcomes.

Aims:  To study fetal growth patterns in the two ethnic groups and to ascertain the influence, if any, of ethnicity on fetal growth.

Methods:  A longitudinal study was carried out on women with sure dates, regular cycles, no known risk factor complicating pregnancy and having their first antenatal examination before 20 weeks. Symphysis‐fundal height, biparietal diameter, abdominal circumference and femur length were measured by the same observer at recruitment and at follow‐up visits until delivery. Infant measurements were recorded soon after birth.

Results:  Indian babies were on average 795 g lighter, had 5.5 days shorter mean length of gestation and slower growth of biparietal diameter and abdominal circumference when compared to Fijian babies. Ethnicity of the mother was significantly associated with the difference in growth even after adjusting for other factors known to influence fetal growth.

Conclusion:  Given the ethnic differences in fetal growth and maturation, it would be appropriate to use ethnicity‐specific standards for perinatal care in Fiji.
Intrapartum pain management at the Royal Hospital for Women
Authors: HENRY Amanda , NAND Swaran L.
Published: July 2004

Aims:  To explore use of, and women's satisfaction with, intrapartum pain management at Royal Hospital for Women (RHW), Sydney, Australia.

Methods:  From October 2002 to January 2003 women aged over 16 who had been in labour at RHW were given a questionnaire to complete in the first week post‐partum regarding their intrapartum pain management. Supplementary information was obtained from patient records.

Results:  A total of 496 women participated (69% response rate), including 95 birth centre clients. The mean age was 32 years and 73% percent had a normal vaginal delivery. At least one form of pain management (‘natural’, nitrous oxide, pethidine, epidural, local infiltration of the perineum) was used by 463 (93%) women, with 74% using two or more methods. Labour pain was ‘worse’ or ‘much worse’ than expected for 55%. Seventy‐two percent were ‘very’ or ‘quite’ satisfied with overall pain management. Epidural analgesia had the highest utility scores (89%‘very useful’) and likelihood of use in subsequent labours (67%), and pethidine the lowest. Factors affecting analgesic use included cervical dilation on admission, labour length, English‐speaking background, delivery suite versus birth centre care, parity, and syntocinon use.

Conclusions:  Women at RHW use a variety of pain management methods in labour and most use multiple methods. Labour was rated more painful than expected by a majority; however, most were satisfied with their pain management. Labour length and cervical dilation on admission were most predictive of pain management use.
Study of peripheral circulation in non‐pregnant, pregnant and pre‐eclamptic women using applied potential tomography
Authors: AHMED Badreldeen
Published: July 2004

Background:  Profound changes are known to occur in the cardiovascular system during pregnancy, involving an increase in cardiac output and a fall in peripheral resistance. In some women these adaptations may be inappropriate and this may result in pregnancy‐induced hypertension and pre‐eclampsia.

Aims and methods:  The aims of the study were to evaluate the relatively new, non‐invasive technique of applied potential tomography (APT) in measurements of peripheral blood flow, to study peripheral blood flow in a sample of non‐pregnant, pregnant and pre‐eclamptic women, and to investigate whether the adaptive changes in the peripheral circulation are different in pre‐eclampsia compared with normal pregnancy. Applied potential tomography was used to assess peripheral vascular reactivity, by monitoring fluid distribution in calf muscles during postural change

Results:  The APT technique was able to detect peripheral vasoconstriction in response to an increase in intramural pressure brought about by passive lowering of the leg (peripheral mechanisms). The peripheral vasoconstriction response was found to be more prominent in woman with pre‐eclampsia.

Conclusions:  The presence of a local reflex in the lower limb had been postulated and the effect of this reflex on the peripheral circulation could be detected using APT, regardless of how it was initiated. In normal pregnant women this reflex was diminished when compared to non‐pregnant women, which might contribute to the reduction in peripheral vascular resistance seen in normal pregnancy. This reflex was defective in pre‐eclampsia and this lack of adaptation may be a local reflex contributing to the raised peripheral resistance, which in turn may be a factor in high blood pressure in pre‐eclampsia.
Single or multiple embryo transfer following in vitro fertilisation for improved neonatal outcome: A systematic review of the literature
Authors: DARE Marianna R. , CROWTHER Caroline A. , DODD Jodie M. , NORMAN Robert J.
Published: July 2004

Background:  The aim of the current review was to determine if single versus two or more embryos, or double versus three or more embryos, transferred to the woman of a subfertile couple at in vitro fertilisation (IVF) maximises the likelihood of pregnancy, while minimising the likelihood of multiple pregnancy and adverse sequelae.

Methods:  Studies were identified that reported maternal, infant and cost outcomes following embryo transfer at IVF.

Results:  Three randomised trials and 17 cohort studies were included. From two randomised trials, single embryo transfer was found to result in decreased incidence of clinical pregnancy, multiple pregnancy and low birthweight. In the cohort studies for single embryo transfer compared with transfer of two or more embryos the incidence of live birth and singleton pregnancies was unchanged, and the incidence of multiple pregnancies and low birthweight was reduced. For double embryo transfer compared with the transfer of three or more embryos, the incidence of clinical pregnancy, live birth, preterm birth and low birthweight babies was reduced.

Conclusions:  Information on neonatal and maternal outcomes following transfer of different numbers of embryos is limited. Transfer of one embryo does not alter the likelihood of a singleton pregnancy or birth when compared to transfer of two or more embryos. Transfer of one or two embryos decreases the risk of a multiple pregnancy, preterm birth and low birthweight. Further large, well‐designed randomised trials are required to provide maternal and neonatal outcomes of relevance to a couple undergoing IVF.
Presence of a single fetal major anomaly in a twin pregnancy does not increase the preterm rate
Authors: CHANG Yao‐Lung , CHAO An‐Shine , CHENG Po‐Jen , CHUNG Chao‐Lun , CHUEH Ho‐Yen , CHANG Shuenn‐Dyh , SOONG Yung‐Kuei
Published: July 2004

Objective:  To evaluate whether the presence of one major anomaly in a twin pregnancy would affect the perinatal outcome of the unaffected co‐twin.

Materials and methods:  From 1992 May to July 2003, a total of 1400 twin pregnancies were included in the present study and there were 35 pairs of twins with one major anomaly. Major anomaly was defined as the anomaly that had a significant impact on neonatal morbidity and mortality. The perinatal outcomes of the affected and unaffected co‐twins, the gestational age of diagnosis of the anomaly and the gestational age of delivery were the parameters for evaluation.

Result:  The incidence of a twin with one major anomaly was 2.5%. Nineteen of 35 (54.3%) affected twins and five of the 35 (14.3%) unaffected co‐twins suffered a perinatal death. In the five cases of unaffected co‐twins suffering a perinatal death, four were intrauterine fetal deaths and one was a neonatal death. Three of the perinatal deaths of the unaffected co‐twins could be attributed to twin‐to‐twin transfusion syndrome. The gestational age at delivery, the perinatal mortality rate, and the incidence of low 5 min Apgar scores of the unaffected co‐twins were not different from those in twin pregnancies without a major anomaly.

Conclusion:  The perinatal outcomes of the unaffected co‐twin were not affected by the fact that its counterpart had one major anomaly, nor were these twin pregnancies at increased risk of preterm labour.
Factors identified during the neonatal period associated with risk of cerebral palsy
Authors: WALSTAB Janet E. , BELL Robin J. , REDDIHOUGH Dinah S. , BRENNECKE Shaun P. , BESSELL Christine K. , BEISCHER Norman A.
Published: July 2004

Objective:  To identify factors during the neonatal period that are associated with the subsequent development of cerebral palsy (CP).

Design:  Case–control study.

Setting:  Ten hospitals in Victoria, Australia.

Sample:  Cases were babies with moderate or severe CP identified from the Victorian Cerebral Palsy Register. Controls were matched with cases for year of birth, plurality, sex, birthweight, gestation and hospital of birth.

Methods:  A range of neonatal variables was compared between cases and controls, initially in a univariate analysis and subsequently in a logistic regression. The analysis was matched where possible. Where missing data prevented a matched analysis, an adjusted unmatched analysis was performed.

Main outcome measures:  Those neonatal factors making an independent contribution to the risk of CP in both term and preterm infants.

Results:  Among babies born at term, 73% of cases and 2% of controls were identified by at least one of the following factors: seizures, congenital abnormalities of the brain and elsewhere, ‘other lesions’, abnormal muscle tone and meconium aspiration. Among babies born preterm, 68% of cases and 26% of controls were identified by the following factors: seizures, intraventricular haemorrhage, periventricular leukomalacia, ‘other lesions’ and abnormal muscle tone.

Conclusions:  The neonatal factors which best identify neonates who will subsequently develop CP are different for term and preterm babies. Babies born at term are identified more efficiently than those born preterm. Among term babies especially, some of these factors are clearly of a long‐standing nature and are not associated with delivery.
Late pregnancy termination within a legislated medical environment
Authors: DICKINSON Jan E.
Published: July 2004

Aims:  To review the indications and outcomes for abortion beyond 20 weeks’ gestation within an environment of legislated notifiable pregnancy termination.

Methods:  In Western Australia legislation allowing abortion ≥20 weeks’ gestation for serious maternal‐fetal conditions was enacted in May 1998. Late abortions are only permitted in a single state institution and are notifiable by law. All pregnancy terminations ≥20 weeks’ gestation performed since this legislation were prospectively identified with the indications and outcomes reviewed.

Results:  During the study period, 219 women underwent abortion ≥20 weeks’ gestation, representing 0.5% of all abortions in the state. Comparison with 438 contemporanous medical abortions for fetal anomaly at 14–20 weeks’ gestations was made. Misoprostol was the primary abortifacient for both. The median maternal age for termination at 14–20 weeks was 32 years (interquartile range (IQR) 27, 36) and 30 years (IQR 26, 34) at ≥20 weeks’ gestation (P < 0.001). There was no significant difference in maternal gravidity or parity. The principal indications for terminations ≥20 weeks were: karyotypic (28.8%); cardiac anomalies (15.5%) and neural tube defects (11.9%). Cardiac anomalies represented 5.0% of fetal anomaly terminations at 14–20 weeks (P < 0.01). The median time for medical abortion was 15.4 h (IQR 11.5, 23.2) at 14–20 weeks’ gestation compared with 18.3 h (IQR 13.3, 26.1) at gestations greater than 20 weeks (P < 0.001). A total of 13.2% of terminations were performed at gestations beyond 24 weeks.

Conclusions:  Abortion ≥20 weeks’ gestation under medically regulated legislation is used primarily for serious fetal anomalies. The women are younger and the abortion duration is greater for late pregnancy termination compared with those conducted at earlier gestations. The majority of late terminations occur <23 weeks’ gestation and the incidence has remained stable since the legislation was enacted.
First Australian trial of the birth‐training device Epi‐No: A highly significantly increased chance of an intact perineum
Authors: KOVACS Gabor T. , HEATH Penny , HEATHER Campbell
Published: July 2004

Background:  A German report suggested significantly better outcomes in terms of perineal care, second stage length and neonatal outcome for users of Epi‐No.

Objective:  To carry out a pilot study of the first use of the Epi‐No birth training device in Australia for women having their first baby.

Study population and methods:  Forty‐eight primigravidae having their confinement at Birralee Birthing Unit who used the device compared to all other primigravida who delivered during the same period.

Results:  The study shows a highly significantly improved outcome for the perineum when users are compared to primigravid non‐user controls. We could not demonstrate decreased instrumental delivery rates nor a better outcome in term of Apgar scores.

Discussion:  The Epi‐No device should be offered as an option to all primigravidae to use during the late third trimester.
The Integrative Revolution in Couple and Family Therapy
Authors: LEBOW JAY
Published: July 2004

A quiet revolution has resulted in significant movement toward integrative practice in couple and family therapy. This article examines the present status of integrative methods, highlighting the factors that have led to their broad acceptance, issues surrounding the definition of integration and the nomenclature used, the content of recent approaches, and specific conceptual developments and directions.
Patterns of Sexual Coercion in Adult Heterosexual Relationships: An Exploration of Male Victimization
Authors: BUSBY DEAN M. , COMPTON SUSAN V.
Published: July 2004

The sexual coercion of adult males by females in heterosexual relationships has received little empirical attention. The purpose of this study was to identify and describe such relationships — in comparison with relationships involving the sexual coercion of females, of both males and females, and of neither — through analysis of data for 3,032 couples that completed the Preparation for Marriage instrument (Holman, Busby, & Larson, 1989). Current individual and couple characteristics were investigated for male subjects and their partners. The results revealed greater deficiencies in relational resources and commitment in coercive versus noncoercive couples. In addition, gender differences were noted among results for different victim/offender configurations.