bluuebunny/crossref_metadata_2025 huggingface dataset:
Tenoxicam does not alter renal function during anaesthesia in normal individuals
Authors: Slaven G. M. , Fawcett J. P. , Walker R. J. , Hodgson B. F. , Zacharias M.
Published: March 2008

Background: Anaesthesia and surgery alter renal function. Inhibition of prostaglandin synthesis by non‐steroidal anti‐inflammatory drugs (NSAIDs) administered with anaesthesia may further compromise renal function.

Aim: To study the effects of tenoxicam (NSAID) administered immediately prior to anaesthesia on renal function in normal individuals undergoing routine surgery.

Methods: A randomised single blind placebo controlled study comparing tenoxicam (40 mg intravenously) with placebo was carried out in 20 healthy (ASA I) patients undergoing lower spinal surgery. Glomerular filtration rate (GFR) was determined by creatinine clearance and renal tubular function measured as osmolar and free water clearance.

Results: GFR fell by 60% at the end of surgery but returned to pre‐operative values by six hours post‐operatively. There was no difference between placebo or tenoxicam with regard to changes in GFR. Tubular function was not altered by tenoxicam.

Conclusions: Current clinical practice of using NSAIDs for post‐operative analgesia in low risk individuals appears to have no adverse effects on renal function.
The Medical Emergency Team (MET): a model for the district general hospital
Authors: Daly F. F. S. , Sidney K. L. , Fatovich D. M.
Published: March 2008

Background: Most hospitals have a Cardiac Arrest Team, activated after cardiopulmonary arrest. The Medical Emergency Team (MET) is a newer concept, encompassing a proactive response to a wide range of emergencies with the aim of preventing irreversible organ failure and cardiopulmonary arrest.

Aim: To describe the application of the MET model to the district general hospital, the spectrum of clinical conditions encountered, outcomes and administrative problems.

Method: Data regarding each MET activation was collected prospectively.

Results: The MET responded to 68 calls to 63 patients in 12 months. The mean age was 60.4 years (range: neonatal to 94 years). The most common conditions leading to MET activation were chest pain (19.1%), cardiopulmonary arrest (14.7%), seizures (14.7%) and respiratory distress (13.2%).

Conclusion: This paper demonstrates that the application of the MET model to the district general hospital improves the process of patient care. We are unable to conclude whether the MET alters morbidity or mortality for hospital inpatients.
Population analysis of once‐daily dosing of gentamicin in patients with neutropenia
Authors: Peterson A. K. , Duffull S. B.
Published: March 2008

Background: Aminoglycoside antibiotics are used as first‐line therapy in the treatment of patients with febrile neutropenia. However, there is little information on the pharmacokinetics of aminoglycosides in this specific patient group and whether they differ from the accepted population values.

Aim: To determine the population pharmacokinetics of gentamicin for patients with febrile neutropenia, with or without sepsis.

Methods: Data were collected from 26 patients with febrile neutropenia receiving once‐daily gentamicin. Patient age, height, weight, estimated lean body weight (LBW), gender, serum creatinine (SCr), creatinine clearance (ClCr), and serum drug concentration data were collected. Severity of infection and degree or neutropenia were assessed. An initial two‐stage population analysis using a Bayesian dose‐individualisation programme was performed to estimate likely population values of the parameters. If these were significantly different from typical values then a true population analysis was to be performed.

Results: Data for 13 female and 13 male patients were collected. Median age was 57 years (range 19 to 87 years), estimated LBW (kg)=66 (±10), ClCr. (1/hour)=5.6 (±2.0) (mean ±SD). Results of the two‐stage approach follow [initial population values in square brackets]: Cl (l/hour)=0.73 (±0.12)XClCr+0.01×LBW [0.70 (±0.27)xClCr+0.01×LBW]; Vd (1)=0.28 (±0.05)XLBW [0.27 (±0.06)×LBW].

Conclusions: The population values of CI and Vd from the two‐stage approach do not differ significantly from initial population values of CI and Vd. Patients receiving gentamicin for febrile neutropenia may be considered pharmacokinetically similar to the general population receiving gentamicin. (Aust NZ J Med 1998; 28: 311–315.)
The effects of nebulised isotonic saline and terbutaline on breathlessness in severe chronic obstructive pulmonary disease (COPD)
Authors: Poole P. J. , Brodie S. M. , Stewart J. M. , Black P. N.
Published: March 2008

Background: There is anecdotal evidence that nebulised saline relieves breathlessness at rest in patients with severe chronic obstructive pulmonary disease (COPD). It is unclear whether nebulised beta agonists are any more effective than nebulised saline in relieving breathlessness at rest in these individuals.

Aim: To compare the effects of nebulised saline and nebulised terbutaline on breathlessness at rest in patients with severe COPD.

Methods: We studied 18 patients with severe COPD with a mean age of 71.1 years, forced expiratory volume in 1 second (FEV1) of 0.58 L and vital capacity (VC) of 1.59 L, in a randomised, double‐blind, crossover trial. The subjects received three doses of nebulised saline on one study day, and three doses of nebulised terbutaline (cumulative dose 10 mg) on the other. Breathlessness was measured using Likert and Visual Analogue Scales (VAS).

Results: Both treatments led to a significant improvement in breathlessness on VAS and Likert scales but there was no significant difference in breathlessness scores for saline compared with terbutaline. There was a small but significant increase in FEV1 with terbutaline of 74 mL, but no change with saline.

Conclusions: A saline aerosol has no effect on lung function but reduces breathlessness at rest in subjects with severe COPD. Nebulised saline may be considered as an adjunct to the use of nebulised bronchodilators for the treatment of breathlessness in patients with COPD.
Management of germ cell carcinoma: state of the art
Authors: Levi J. A.
Published: March 2008

The management of all stages of germ cell carcinomas is fairly well defined with generally high rates of cure. In stage I disease surveillance and chemotherapy on relapse is as successful as initial adjuvant chemotherapy. More than 95% of patients will survive. In stage II disease either three to four cycles of chemotherapy, or retroperitoneal node dissection and subsequent chemotherapy if more than six nodes are positive or nodes are >2 cm diameter, or there is extra nodal extension, are equivalent with survival >95%.

For stage III disease, a new international prognostic classification has determined that the level of tumour markers, presence of non pulmonary visceral disease, or a mediastinal primary, indicate a poorer prognosis. Long term follow up studies reveal an overall percentage of relapses (4–5%) beyond two years and the need for long term follow up.
The primary angioplasty vs thrombolysis debate
Authors: Thompson Peter L.
Published: March 2008

Early and complete coronary reperfusion can improve survival in myocardial infarction. Primary angioplasty can achieve TIMI grade 3 flow (complete restoration) in over 90% of cases. In comparison thrombolysis can achieve TIMI grade 3 flow in only just over 50%. Comparative trials have shown superior rates of death and reinfarction with a low haemorrhagic risk with PTCA compared with thrombolysis. Early clinical trials showed a clear superiority of primary angioplasty over thrombolysis but larger trials with larger number of endpoints have shown less impressive superiority. Wider application in community studies has not shown the benefits promised in the earlier studies, possibly due to dilution of experience. The impact of newer stent regimens vs non‐newer thrombolytic and antithrombotic regimens can only be determined by further clinical trials.
Intervention with PTCA and CABG following thrombolysis for acute myocardial infarction
Authors: Tideman Philip A. , Fabri Jackie K. , Aylward Philip E. , Simes R. J.
Published: March 2008

The patterns of revascularisation with percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft (CABG) surgery in the GUSTO 1 trial patients in Australia are described.

In comparison with rates documented in earlier trials of thrombolytic therapy in Australia, the rates of revascularisation post‐thrombolysis increased by 50%, primarily due to a doubling in the rate of use of PTCA. However, the rates were low by international comparisons. There were marked variations in the rates of revascularisation between States, but no correlation with differences in mortality between States. The main predictors of post thrombolysis PTCA were prior angina, mild infarction and access to PTCA facilities.
The GUSTO 2b and related studies
Authors: Aylward Philip
Published: March 2008

Direct anti‐thrombin inhibitors such as hirudin have theoretical advantages over heparin. Two large studies in acute coronary syndromes were designed to test the thrombin hypothesis by demonstrating improved outcomes in hirudin treated patients. TIMI 9 assessed the effect of hirudin in patients with ST elevation receiving thrombolytic therapy. GUSTO 2 assessed the full spectrum of acute coronary syndromes of ST elevation and non‐ST elevation. Over 15,000 patients were entered into the studies and no major benefit was demonstrated for hirudin. This may, however, relate to endpoints measured and the timing of the anti‐thrombin.
Detection of reperfusion after thrombolytic therapy by the analysis of released biochemical markers
Authors: Cross David B.
Published: March 2008

Although the advent of thrombolytic therapy for acute coronary occlusion has substantially reduced the mortality of acute myocardial infarction (AMI), the best available thrombolytic regimens only achieve adequate reperfusion in a little over half the patients who are treated. The ability to detect failure of reperfusion by non‐invasive means would permit further therapy in this patient group who currently have a high mortality. As coronary reperfusion causes a rapid release of many myocardial proteins into the blood stream, analysis of the rate of release of markers such as myoglobin, troponin, and creatine kinase (CK) during the first 90 minutes after thrombolytic therapy can identify about 80% of the patients in whom thrombolytic therapy has been ineffective. An ideal marker of reperfusion would be rapidly released after reperfusion, rapidly cleared from the circulation, highly myocardial specific, and amenable to rapid quantitative assay to permit ‘real time’ determination of coronary patency status. At present myoglobin and cardiac troponins appear most promising for detection of reperfusion, but other markers such as CK isoforms may prove useful if reliable rapid assays become available.
Comparison of the long‐term efficacy of implantable defibrillators and sotalol for documented spontaneous sustained ventricular tachyarrhythmias secondary to coronary artery disease
Authors: Kovoor P. , Yung A. , Byth K. , Eipper V. E. , Uther J. B. , Cooper M. J. , Ross D. L.
Published: March 2008

Background: The relative efficacy of antitachycardia pacing implantable cardioverter defibrillators (ATPICD) and sotalol in the treatment of ventricular tachyarrhythmias is controversial.

Aim: To compare the mortality in patients treated with ATPICD and sotalol for documented spontaneous sustained ventricular tachyarrhythmias occurring late after previous myocardial infarction.

Methods: In this non‐randomised retrospective study of 139 consecutive patients all patients had inducible ventricular tachycardia at baseline electrophysiological studies. Before the availability of ATPICD, 22 patients were treated with sotalol as part of a randomised study comparing the efficacy of sotalol to amiodarone. After ATPICD became available sotalol was used in 49 patients in whom intravenous testing predicted sotalol to be effective and ATPICD were implanted in 68 patients in whom sotalol was predicted to be ineffective at electrophysiological testing. Thus, 68 patients were treated with an ATPICD and 71 with sotalol.

Results: The two groups were well‐matched for age, type of presenting arrhythmia, severity of coronary artery disease and ventricular function. At 36 months Kaplan‐Meier estimates of mortality from ventricular tachyarrhythmia were 0% with ATPICD and 15% with sotalol (p=0.03). Kaplan‐Meier estimates of total mortality at 36 months were 12% with ATPICD and 25% with sotalol (p=0.09). Multivariate analysis showed hazard ratio of 7.9 (p=0.06) for death from ventricular tachyarrhythmia in patients treated with sotalol compared to ATPICD.

Conclusions: While no difference in total mortality was demonstrated, treatment with ATPICD is probably superior to sotalol for preventing deaths due to ventricular tachyarrhythmia. (Aust NZ J Med 1999; 29: 331–341.)
Mechanical circulatory support devices in the treatment of heart failure
Authors: Knight J. L.
Published: March 2008

With an increasingly aging population, heart failure is a major health issue, affecting more than 10% of the population over 65 years of age, and costing hundreds of millions of dollars per year for ongoing care. Even with maximal medical therapy, annual mortality rates of in excess of 25% are commonly reported. Over the last three decades, various surgical approaches have been examined in the hope of improving the outcome of congestive cardiac failure. These procedures range from simple coronary revascularisation to left ventricular reduction surgery and cardiac transplantation. Although of value in selected situations, no surgical approach, beyond transplantation, has had significant impact on the outcome of heart failure.

In the last decade, development in the area of mechanical support for the failing heart has continued to expand at a rapid rate. Strong evidence now exists to show that in many patients with advanced heart failure, prolonged mechanical support results in significant myocardial recovery. There are currently several mechanical support devices available for clinical use, although most are considered experimental in this country. These devices are expensive and are not without significant complications, but early results of their use as either a bridge to transplantation or as a stand alone treatment, have been very encouraging. Currently available mechanical assist devices are described, with discussion of indications for implantation, complications and results of their use.
The role of diastolic ventricular interaction in abnormal cardiac baroreflex function in chronic heart failure
Authors: Atherton J. J. , Frenneaux M. P. , Thomson H. L.
Published: March 2008

Baroreflex abnormalities have been well documented in both patients with chronic heart failure and experimental animal models of heart failure. These abnormalities are associated with increased mortality and probably contribute to neurohumoral activation. While it is likely that several mechanisms contribute to reduced baroreflex sensitivity, it has been difficult to explain why baroreflex control mechanisms during acute volume unloading in patients with severe chronic heart failure should be directionally opposite to those in normal subjects. Volume unloading normally causes a reduction in baroreceptor activity, and hence an increase in sympathetic outflow; however, patients with chronic heart failure develop attenuated increases or paradoxical reductions in forearm vascular resistance, muscle sympathetic nerve activity, and noradrenaline spillover. It has been suggested that this probably represents paradoxical activation of left ventricular (LV) mechanoreceptors, but why LV receptors should behave in such a fashion has not been determined.

In the setting of diastolic ventricular interaction, the filling of the left ventricle is constrained by the surrounding pericardium and right ventricle. In these patients, the reduction in right ventricular (RV) volume that normally occurs during acute volume unloading allows for an increase in LV end‐diastolic volume (as opposed to the reduction in LV volume that normally occurs). We have demonstrated this to be important in some patients with chronic heart failure, and observed that baroreflex control of forearn vascular resistance was markedly impaired in these patients. We propose that the increase in LV volume that occurred during volume unloading would increase LV mechanoreceptor activity, and could therefore explain the paradoxical reductions in sympathetic outflow. As discussed, this has important therapeutic implications.
Monoclonal gammopathy of undetermined significance (MGUS) ‐ 31 year follow up of a community study
Authors: Colls B. M.
Published: March 2008

Background: When unselected healthy adults in the community have their serum screened by cellulose acetate or paper electrophoresis, monoclonal gammopathy of undetermined significance (MGUS) may be found in 0.5‐1%.

Aim: To report upon a 31 year follow up of MGUS in a New Zealand community.

Methods: Serum from 2192 subjects (82% of the adult population) of a New Zealand town was collected in 1967 and subsequently screened by cellulose acetate electrophoresis. Eleven of the 2192 (0.5%) were found to have MGUS. Clinical correlation was sought in 1970 and subsequently to elucidate the underlying cause.

Results: Seven of the 11 patients have developed a haematological malignancy. Two have been diagnosed as having Waldenstrom's macroglobulinaemia, one malignant lymphoma and acute myelomonocytic leukaemia and four developed myeloma. Myeloma developed at one, nine, 23 and 25 years after the original screening. One myeloma patient and one patient with MGUS are currently alive and well, 31 years after discovery of their gammopathy.

Conclusions: The incidence of MGUS in this community is only half that detected in a comparable study. The association with haematological malignancy in this study (64%) is considerably higher than that found in the Swedish study (6%), possibly because of the longer follow up in New Zealand. MGUS should not only be studied in depth at the time of its discovery, but needs very long term follow up as the underlying disease may not surface until the third decade.
A cost‐analysis of two approaches to infection control in a lung function laboratory
Authors: Side E. A. , Harrington G. , Thien F. , Walters E. H. , Johns D. P.
Published: March 2008

Background: The Thoracic Society of Australia and New Zealand (TSANZ) guidelines for infection control in respiratory laboratories are based on a ‘Universal Precautions’ approach to patient care. This requires that one‐way breathing valves, flow sensors, and other items, be cleaned and disinfected between patient use. However, this is impractical in a busy laboratory. The recent introduction of disposable barrier filters may provide a practical solution to this problem, although most consider this approach to be an expensive option.

Aim: To compare the cost of implementing the TSANZ infection control guidelines with the cost of using disposable barrier filters.

Methods: Costs were based on the standard tests and equipment currently used in the lung function laboratory at The Alfred Hospital. We have assumed that a barrier filter offers the same degree of protection against cross‐infection between patients as the TSANZ infection control guidelines. Time and motion studies were performed on the dismantling, cleaning, disinfecting, reassembling and re‐calibrating of equipment. Conservative estimates were made as to the frequency of replacing pneumotachographs and rubber mouthpieces based on previous equipment turnover. Labour costs for a scientist to reprocess the equipment was based on $20.86/hour. The cost of employing a casual cleaner at an hourly rate of $14.07 to assist in reprocessing equipment was also investigated. The new high efficiency HyperFilterTM disposable barrier filter, costing $2.95 was used in this cost‐analysis.

Results: The cost of reprocessing equipment required for spirometry alone was $17.58 per test if a scientist reprocesses the equipment, and $15.56 per test if a casual cleaner is employed to assist the scientist in performing these duties. In contrast, using a disposable filter would cost only $2.95 per test. Using a filter was considerably less expensive than following the TSANZ guidelines for all tests and equipment used in this cost‐analysis.

Conclusions: The TSANZ infection control guidelines are expensive and impractical to implement. However, disposable barrier filters provide a practical and inexpensive method of infection control.
The clinical associations of mitotic spindle autoantibodies in a South Australian cohort
Authors: Limaye V. , Roberts‐Thomson P. , Gillis D. , Pile K.
Published: March 2008

Background: The mitotic spindle apparatus (MSA) is a unique structure of microtubules and associated proteins involved in the segregation and reorganisation of chromosomes during cell division. Autoantibodies to the MSA (anti‐MSA) are reported to occur rarely, but are easily identified during the immunofluorescent detection of anti‐nuclear antibodies (ANA), and are generally reported as part of that investigation.

Aims: As the clinical significance of these antibodies is unknown, our aim was to identify the clinical features of subjects identified with anti‐MSA, and in a subset investigate the co‐association with organ specific anti‐thyroid antibodies.

Methods: All ANA results from the three major immunology laboratories serving South Australia between January 1993 and June 1998 were retrospectively reviewed to identify anti‐MSA subjects. Clinical details were extracted from hospital or general practice records using a standard proforma. Thyroid autoantibodies were measured using standard technique. A control group of consecutive ANA positive, anti‐MSA negative individuals had anti‐thyroid antibodies measured. Statistical comparison used χ2 test.

Results: Fifty‐five subjects (43F) were identified with mean age 59.8 (range 17–91); 39 had specific diagnoses, with 16 identified as part of non‐specific investigations. ‘Arthritis’ broadly accounted for the largest group, transient inflammatory arthritis n=7, degenerative joint disease n=6, rheumatoid arthritis n=5. Adenocarcinoma and mesothelioma accounted for one case each. Thirty‐two subjects had anti‐thyroid antibodies tested, with ten of 21 and two of 11 positive among the groups with anti‐MSA titre >1:80 and <1:40 respectively, χ2=2.7, p=0.1. Anti‐thyroid antibodies were detected more frequently among the high titre anti‐MSA group (ten of 21) compared with high titre positive ANA, negative anti‐MSA group (two of 11), RRisk 4.4, χ2=5.34, p=0.02.

Conclusion: This study confirmed the relative rarity of anti‐MSA and that its association is primarily with rheumatic diseases. The coincidence of mesothelioma is novel with only two previous reports of malignancy and anti‐MSA. The co‐association of high titre anti‐MSA and thyroid autoantibodies suggest that the latter should be a follow up investigation if the former is identified as part of an investigative screen.
Treatment of de novo acute myeloid leukaemia in Hong Kong: a twenty‐year experience (1975 to 1996)
Authors: Chim C. S. , Liang R. , Kwong Y. L. , Lie A. K. W. , Todd D. , Chan T. K.
Published: March 2008

Background: Small patient numbers and short follow‐up are common in some acute myeloid leukaemia (AML) studies and data on secondary malignancies after treatment of AML are rare.

Aims: To determine the prognostic factors and long‐term treatment results.

Methods: A retrospective study of patients with de novo AML under the age of 60 over a 20‐year period in which two induction therapy regimens: 7:3 (1975–1983) and 7:3:7 (1984–1996) and three consolidation chemotherapy regimens: 5:2 (1975–1983), 5:2:5 (1984–1990) and Ara‐C/mitoxantrone (1991–1996) were used. Disease‐free (DFS), overall survivals (OS) and prognostic factors were analysed.

Results: Two‐hundred and two of 276 (73%) patients attained complete remission (CR). The CR rates of 7:3 and 7:3:7 regimens were 70.5% and 74.5% respectively (p=0.92). The median DFS was 12 months and the projected DFS at 10‐ and 20‐years were 23% and 21% respectively. For patients consolidated with 5:2, 5:2:5 and Ara‐C/ mitoxantrone, the median DFS was 15 m, 12 m and 11 m respectively and the projected ten‐year DFS were 27%, 21% and 18% respectively (p=0.2). Ninety per cent of relapses occurred within two years from remission but there were two late relapses at 109 m and 120 m respectively. Young age and FAB M3 subtype were favourable prognostic factors to OS (p=0.04) and DFS (p=0.006) respectively. There was no secondary solid tumour in the long‐term survivors.

Conclusion: Our experience confirmed the efficacy of standard‐dose Ara‐C/daunorubicin and the prognostic value of age and FAB subtype. Median and projected DFS were similar to western studies.
Helicobacter pylori eradication with lansoprazole, amoxycillin and clarithromycin: testing an ideal regimen in a multicultural south east Asian population and examining factors potentially influencing eradication
Authors: Kaushik S. P. , Vu C.
Published: March 2008

Background: From European and North American data, it is recommended in the Asia Pacific consensus statement, that one week therapy with a proton pump inhibitor, amoxycillin and clarithromycin be used for Helicobacter pylori eradication, in areas of high metronidazole resistance. The efficacy of this regimen is unknown in Singapore.

Aim: To assess the efficacy, safety and compliance of an H. pylori eradication regimen and examine clinical factors that potentially determine eradication.

Methods: Consecutive outpatients from a multicultural, south east Asian, population with H. pylori infection, with or without peptic ulcer, were treated with lansoprazole 30 mg, amoxycillin 1 gm, clarithromycin 500 mg, twice a day for seven days. Eradication was assessed by either rapid urease, histology or urea breath test. Compliance and side effects were recorded. The eradication rate and effect of ethnicity, age, sex, usage of alcohol, smoking and non‐steroidal anti‐inflammatory drugs, history of ulcer and endoscopic diagnosis on eradication were examined by univariate and multivariate analysis.

Results: Of 113 patients, the eradication rate by intention to treat was 98/113 (87%) (95% confidence interval [CI] 80–93%) and per protocol was 98/106 (92%) (95% CI 87–97%). Using Fisher's exact test, eradication was more successful in Chinese (intention to treat and per protocol respectively p=0.02 and p<0.001) compared to non‐Chinese. By logistic regression analysis ethnicity was an independent factor associated with eradication success (p=0.0025). Side effects occurred in five (4.4%), resulting in cessation of treatment.

Conclusions: This one week eradication regimen is safe and effective in south east Asians. Chinese ethnicity may be associated with a higher likelihood of eradication success.
The potential impact of global environmental change on population health
Authors: Tong S.
Published: March 2008

Due to rapid industrial changes and increased pressure of people on fragile ecosystems, large‐scale environmental perturbations have been occurring on Earth. Major current environmental problems that can be expected to have a substantial effect on human health include human‐induced climate change and stratosphere ozone depletion, because they threaten the ecological support systems on which human life depends. The most serious potential consequence of global environmental change is the erosion of Earth's life‐support systems. The public health assessments of the present and future anthropogenic damage to the biosphere have important implications for human health and wellbeing. Medical practitioners have an important role to play in this field.
A comparison of two dosing regimens of zidovudine in Thai adults with early symptomatic HIV infection. Conducting clinical HIV trials in South‐East Asia
Authors: Phanuphak P. , Grayson M. L. , Sirivichayakul S. , Suwanagool S. , Ruxrungtham K. , Hanvanich M. , Ratanasuwan W. , Ubolyam S. , Hughes M. D. , Wanke C. A. , Hammer S. M.
Published: March 2008

Aim: To compare the clinical and immunological efficacy, and tolerance of two dosage regimens of zidovudine (ZDV) in an adult Thai population with early symptomatic human immunodeficiency virus (HIV) disease and to identify important clinical issues associated with conducting HIV trials in South‐East Asia.

Methods: HIV‐infected Thai adults, with early symptomatic HIV disease and CD4 lymphocyte counts less than 400/mm3, who were managed in the infectious diseases clinics at two university teaching hospitals in Bangkok, Thailand, were enrolled in a randomised, open‐label, dose‐regimen comparison trial of ZDV. Two oral ZDV dosing regimens: regimen A, 100 mg tid+200 mg nocte (ZDV‐A) vs regimen B, 250 mg bid (ZDV‐B) were compared. The main outcome measures were:

1. Clinical efficacy: rate of progression to acquired immunodeficiency syndrome (AIDS) or death.

2. Immunologic efficacy: changes in CD4 lymphocyte numbers compared to baseline; rate of decline of CD4 lymphocyte numbers to less than 100/mm3.

3. Toxicity, as defined by clinical symptomatology and laboratory parameters.

Results: Two hundred and four patients were enrolled (103 ZDV‐A; 101 ZDV‐B) of whom 195 were followed beyond baseline. Patients were typical of those encountered with HIV in Thailand: mean age 33 years; 89% male; 88% heterosexual HIV acquisition; mean baseline CD4 lymphocyte count 241/mm3. Follow‐up while on therapy was comparable for the two groups (mean +SD): 533+236 days (ZDV‐A) vs 5925210 days (ZDV‐B). One hundred and eleven patients (57%; 51 ZDV‐A, 60 ZDV‐B) were treated for at least 22 months (669530 days). Clinical and immunological outcomes for ZDV‐A and ZDV‐B, including rate of progression to AIDS or death, development of non‐AIDS‐defining opportunistic infections, mean changes in CD4 lymphocyte numbers/mm3, difference in area under the CD4:time distribution curve and difference in the rate of decline of CD4 lymphocyte numbers to less than 100/mm3, were not significantly different. The presence of oral hairy leukoplakia or unintential weight loss of 10–20% at enrolment were significantly associated with the later development of AIDS (p=0.03 and 0.04, respectively). ZDV‐associated toxicity was similar for both regimens. Maintaining protocol adherence and appropriate clinical follow‐up emerged as important practical issues.

Conclusion: In Thai adults, ZDV 100 mg tid+200 mg nocte and ZDV 250 mg bid have similar clinical and immunological efficacy. Rates of ZDV toxicity are comparable to those reported in non‐Asian populations. Despite limitations in medical care access and maintaining long‐term follow‐up, successful trials of antiretroviral agents are feasible in South‐East Asia and multi‐drug treatment trials should be pursued in appropriate institutions.
Teaching asthma management: an evidence‐based educational approach
Authors: Yates D. H. , Shah S. , Veitch E. , Thomas P. S.
Published: March 2008

Background: Asthma management plans and asthma education have been incorporated into recent guidelines, and implementation of these reduces asthma morbidity. Junior doctors are frequently involved in asthma management, but teaching about asthma in medical school is seldom assessed. We studied asthma knowledge, confidence in practical asthma management, and the effectiveness of an interactive asthma education workshop in final year medical students. Thirty‐five students attended the workshop, with 26 returning questionnaires on both of the two sessions.

Methods: Students attended a two hour asthma workshop comprising interactive teaching sessions on management of acute and stable asthma, and a practical session using asthma devices. Theoretical knowledge was assessed by a 20 item questionnaire, completed immediately prior to the workshop and after two weeks, at a feedback session. Practical knowledge was assessed by confidence scores in use of asthma devices on a five point scale (not at all confident to very confident), before, immediately after the workshop, and after two weeks.

Results: Students scored poorly in questions on: predictors of asthma mortality, nebuliser and Turbuhaler® use, asthma management plans, and physical signs in acute asthma. Mean (SE) knowledge score increased significantly from 64.4% (6.1) to 74.2% (5.6) (p<0.05; paired t‐test) at two weeks. Confidence scores rose significantly for all practical aspects of asthma management (p<0.01; Wilcoxon matched pairs test), and declined at two weeks, but still remained significantly higher than at baseline (p<0.05).

Conclusions: Medical students had poor knowledge about several important features of asthma care. The asthma workshop was effective in increasing knowledge and confidence in management of asthma in the short term, and could be useful in optimising implementation of asthma guidelines in clinical practice and potentially later in training of junior medical officers.
The impact of penicillin resistance on the outcome of invasive Streptococcus pneumoniae infection in children
Authors: Rowland K. E. , Turnidge J. D.
Published: March 2008

Background: Invasive infections caused by Streptococcus pneumoniae with reduced susceptibility to penicillin are increasing in prevalence in Australia.

Aims: To determine the impact of reduced susceptibility of S. pneumoniae to penicillin on morbidity, mortality and treatment of invasive infection.

Methods: Retrospective case note review of children with invasive S. pneumoniae infection over a 26 month period. Penicillin minimum inhibitory concentrations (MIC) were determined by E test. Primary clinical outcome measures included days to defervescence, duration of hospital stay, complication rates and mortality. The secondary outcome of financial cost was examined. Comparisons between outcomes of patients with infections caused by susceptible and non‐susceptible strains were performed with Student's t test. Pearson χ2, Mann‐Whitney U tests and multiple logistic regression.

Results: Sixty‐eight episodes of invasive pneumococcal disease were reviewed: 14 isolates (21.1%) had reduced susceptibility or resistance to penicillin (PNSSP, MIC 0.125 mg/L‐1.5 mg/L). Ten patients had meningitis, 21 had pneumonia, 22 had bacteraemia with another focus and 15 had bacteraemia without an obvious focus. PNSSP were more common in patients with meningitis and pneumonia. No patients died. Overall, patients with infections caused by PNSSP had significandy longer hospitalisation and longer time to defervescence. Complication rates were not significantly different between groups. Outcome differences were no longer significant when meningitis patients were excluded from the analysis. The PNSSP group received more expensive intravenous antibiotics and their infections were significandy more costly to treat.

Conclusions: Infections widi penicillin non‐susceptible S. pneumoniae are associated with higher morbidity than infections with penicillin susceptible strains, and treatment of diese infections is more expensive, due to higher drug costs and longer hospital stay.
Group B streptococcal meningitis in adults: recent increase in Southeast Asia
Authors: Wilder‐Smith E. , Chow K. M. , Kay R. , Ip M. , Tee N.
Published: March 2008

Background: Meningitis caused by Streptococcus agalactiae (Group B Streptococcus) is rare in adults and usually affects patients with predisposing conditions.

Aims: To describe an increase in adult group B streptococcal meningitis occurring in parallel in Hong Kong and Singapore.

Methods: All cases of bacterial meningitis admitted to the Prince of Wales Hospital, Hong Kong and Singapore General Hospital in 1998, aged 15 years or above, were reviewed. Medical records for the previous ten years were searched for previous cases of adult group B streptococcal meningitis.

Results: In 1998, 29 adult patients with bacterial meningitis were admitted to the two hospitals. S. agalactiae was isolated in 11 cases, Streptococcus pneumoniae in three cases, Klebsiella pneumoniae in two cases, and Pseudomonas pseudomallei in one case. In 11 cases no bacteriological diagnosis could be made. Two patients with adult group B streptococcal meningitis had predisposing conditions for infection. One patient died before a definite diagnosis could be established. A ten year review of records revealed one previous case of adult group B streptococcal meningitis in a patient with multiple risk factors.

Conclusions: An increase of group B streptococcal meningitis has occurred among adults admitted to two major hospitals in two Southeast Asian cities. In the majority of cases there were no identifiable predisposing conditions. The cause of this increase of group B streptococcal remains unclear.
Cost, price, and revenue differentials in electricity supply: Queensland and Australia
Authors: WADLEY DAVID
Published: March 2008

Queenslanders consume relatively less but pay more for electricity than most Australians, a penalty surprising in a State with the nation's largest sources of energy. An explanation lies in the industry's relative youth and dynamic performance, strong post‐war capitalisation, inherent monopoly organisation and the issue of product differentiation expressed in peak/off‐peak pricing. Such matters pose particular problems in the Queensland market which is numerically small and areally dispersed. Examination of production and distribution economics reveals that Queensland fuel is presently not cheap and that some of the penalty derives from the strong capitalisation which the system is undergoing. Further pressures lie in the lack of scale economies and in financial policies of supply authorities such as spatial price equalisation. Many factors bear on future prices and predictions are difficult. Nevertheless Queensland's energy advantages should ensure that unless major change transforms the economic environment the price of electricity relative to that in other States falls during the next two decades.
Spatio‐temporal localization of New Zealand dairying
Authors: MORAN WARREN , NASON SARAH J.
Published: March 2008

Changes in the localization of dairy farming in New Zealand are interpreted in terms of environmental advantages, inter‐regional competition, transportation costs and policies, and the behaviour of cooperative dairy companies. Since the 1920s dairying has become increasingly localized in environmentally advantaged areas. Competition among dairy companies resulted in o ver‐extension of supply areas and disequilibrium between collection costs and economies of scale at the plant. Subsequently, some rationalisation of supply areas has occurred, notably since the adoption of tanker collection from the 1950s with cooperative dairy companies using differential transport pricing policies to discourage suppliers at the spatial margins.
Sediment and solute transport in a representative basin
Authors: GEARY PHILLIP M.
Published: March 2008

Suspended sediment and total dissolved material concentrations in stream flow were studied in Deep Creek Representative Basin near Cessnock, N.S.W. between April, 1976 and June, 1977. Sediment and solute transport rates were calculated at two gauging stations for individual flood events and low flow periods using the hourly hydrograph record, stage/season concentration‐discharge relationships and calculated rating curves. Limitations in the use of the rating curve suggest that during flood hydrographs of long return period, calculated transport rates may be in error. A continuous record of concentration variation was sampled during one runoff event enabling comparisons to be made between methods of load calculation. For the satisfactory calculation of transport rates during extreme flood hydrographs, it is essential that concentration variation be accurately defined.
Rainfall, floods and river channel changes in the upper Hunter
Authors: ERSKINE WAYNE , BELL F. C.
Published: March 2008

Since 1946, there has been a significant increase in annual rainfall in the Hunter Valley, especially for stations in the western sector. Contemporaneous increases in rainfall intensities of frequent storms and flood peaks have also been recorded. From analyses of the data, together with a review of recent environmental changes in the Hunter Valley, it is concluded that human disturbance of the catchment has played no significant part in the increase in flood magnitude. Instead, the change in floods may be completely attributed to the variation in rainfall regime. The altered hydrologic regime combined with a decrease in sediment yield from extra‐channel sources appears to be the primary cause of recent river channel changes.
Auto‐production systems in Japan: organisational and locational features
Authors: SHEARD PAUL
Published: March 2008

Through their highly controlled production systems Japanese auto‐makers have succeeded to a considerable degree in extending the basic principles of modern factory production–specialisation and timing–to regional space. Thousands of firms, large and small, hierarchically connected in subcontracting layers supply a myriad of parts and engineering services to the auto‐makers. Automakers minimise the level of stocks of parts at their plants by requiring their direct suppliers to make frequent deliveries. These firms function as extensions of the auto‐maker's plant with the result that the regional production system functions with precision approaching that of a single well‐organised factory.
Step‐functional incidence and impact of drought in Pastoral Australia
Authors: DURY G. H.
Published: March 2008

Sequences of precipitation in pastoral Australia can be described by square waves: that is to say, their variation is step‐functional. Sampling suggests that similar variation typifies pasture quality, station income, station economies in general, and rates of stock loss. Patterns of management response to drought can also display abrupt change, in consequence of certain types of managerial decision. Where stock losses ascribed to drought can be separated off from total losses, step functions again appear. Up to certain limits, however, drought appears to be merely one of several killers. Prospects of drought prediction appear to be minimal, unless successful use can be made of analogue prediction and/or of variations in the Southern Oscillation and related systems. The incidence of runs of wet and dry years is essentially random. Where an individual series can be recognised as random with persistence, the persistence effect means the prolongation of drought, when this actually occurs.
Weathering evidence for an additional glacial stage in Tasmania
Authors: KIERNAN KEVIN
Published: March 2008

Quantitative studies of relative dating parameters, including subsurface dolerite weathering rind thickness and weathering front penetration, permit the differentiation of three broad groupings of till deposits in several valleys in north‐central, western, western‐central and south‐western Tasmania. An early cold climatic phase–theLinda Glacial Stage–is recognised on the basis of this weathering evidence which also indicates that there have been at least two more recent Glacial Stages of decreasing severity, termed here theHentyandMargaret Glacial Stagesrespectively. This three‐fold model bears a striking similarity to that of Lewis (1945) which was rejected nearly three decades ago. However, whereas Lewis' model was founded upon erosional evidence, the present study is based entirely upon depositional and weathering evidence.
Planning rural land development: forestry and agriculture in northeastern Australia
Authors: Mcdonald G. T.
Published: March 2008

Australia has a limited area of land suitable for the production of food, fibre and forest products and governments are under increasing pressure from relevant industry groups to release those small areas of land that are not already committed. Land use decisions of this type are predominantly political ones, but the politicians are influenced by whatever facts can be mustered to support competing interests. This article presents a number of measures of the likely efficiency and regional economic impacts of plantation forestry and agriculture, based on sugar cane in the Herbert Valley, where such a land use decision must be made by politicians in the near future.
Industrial reorganisation and coal production in Australia, 1860–1982: an historical materialist analysis
Authors: GIBSON KATHERINE D.
Published: March 2008

From an historical materialist perspective, the essential quality of industrial change is that it is the product of conflict resident both in the relationship of struggle between capital and labour over the accumulation of surplus value and in the competitive relations between individual capitals over the appropriation of profits. This article is essentially methodological in that it identifies the specific competitive and conflictual determinants of profitability internal to an industry and the external influences of the wider economy which contribute to that industry's ‘relative’ profitabilityvis a visinvestment capital. It argues that the emerging pattern of economic change is structured by a tendency towards crisis and declining profitability. The history of black coal production in Australia is examined in the light of this method and emerging theory of industrial reorganisation.
Mean airstreams of Australia
Authors: WENDLAND WAYNE M. , McDONALD NEIL S.
Published: March 2008

Streamline analyses of mean monthly resultant surface winds over Australia are presented. Mean confluences represent either cyclone trajectories, or modal fronts. These analyses suggest that Australia's annual airstream climate is of two regimes: that of September to March inclusive, and April to August inclusive. The winter half‐year is exemplified by a continental airstream source in southern Australia which diverges over virtually the entire continent. It continues into September and October, although dominating only the southern third to half of Australia, and is absent from November to March. During the summer half‐year a new pattern emerges, with three maritime air stream sources represented over the continent: first, air from the Southern Ocean penetrates the south coast reaching its furthest northward extension from December to March inclusive; a second source originating over the Pacific Ocean dominates eastern and northern Australia; and a monsoon source originating over the Indian Ocean which flows overland affecting northern Western Australia. Two modal confluences are noted, one over northwestern Australia from November‐February separating monsoon flow from that emanating from the east, and another extending from the west central coast east‐southeastward to the southeast coast from November‐March separating Southern Ocean air from that originating over the Pacific Ocean.
Changes in stream channel morphology at tributary junctions, Lower Hunter Valley, New South Wales
Authors: GIPPEL CHRISTOPHER
Published: March 2008

Many empirically derived models of downstream changes in channel form are based on the concept of hydraulic geometry, whereby changes in channel morphological variables are related by a continuous power function to increasing discharge or its surrogate. However, changes in discharge throughout a drainage basin are normally concentrated at the junctions of stream channels. At junctions, the relationship between discharge and channel morphology is discontinuous. Some Lower Hunter Valley stream channels were surveyed upstream and downstream of tributary junctions. While significant regional downstream relationships were established, consistent trends at tributary junctions were not apparent from the data. It is possible that considerable scatter evident in ratios of change on either side of each junction was due to local within‐site variability. In addition, the relative timing of discharge inputs and the nature of introduced sediment loads could be important in determining the magnitude and direction of channel change at tributary junctions. Interrelated changes in cross‐sectional, profile and planform variables may be expected below junctions. The resultant channel morphology, in terms of these variables, might not be wholly determinate.