bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of long‐term visual outcome after chemoreduction for management of intraocular retinoblastoma
Authors: Narang Subina , Mashayekhi Arman , Rudich Danielle , Shields Carol L 
Published: February 2012

AbstractBackground:  To determine the predictors of long‐term visual outcome after chemoreduction for management of intraocular retinoblastoma.Design:  Retrospective case series.Participants:  One hundred and forty eyes of 96 new retinoblastoma patients.Methods:  The clinical records were reviewed for demographical profile, tumour characteristics, treatment methods, treatment side effects and final visual outcome. Multivariate analysis was used to evaluate factors predictive of final visual acuity.Main Outcome Measure:  The clinical data were analysed for main outcome measures of good vision (visual acuity ≥6/12) or ambulatory vision (visual acuity ≥6/60). The correlation among predictor variables was determined using Pearson's product moment correlation for continuous variables, and t‐test and analysis of variance test for categorical baseline variables.Results:  Follow‐up ranged from 2 years to 14 years (median 75 months). The final mean logarithm of minimum angle of resolution visual acuity was 0.79. Ambulatory vision (≥6/60) was achieved in 100 of 140 (71%) eyes, and vision of ≥6/12 was seen in 52 eyes (37%). Extrafoveolar tumour and greater number of tumours in the eye were the only predictors of visual acuity ≥20/40. Greater number of tumours correlated with smaller mean basal tumour diameter. The mean basal tumour diameter was 9.8 mm in eyes with multiple tumours and 12.2 mm in eyes with single tumours (P = 0.03).Conclusion:  Long‐term ambulatory vision (≥6/60) was achieved in the majority (71%) of retinoblastoma containing eyes not requiring enucleation after treatment with chemoreduction and adjunctive therapy. Absence of foveolar involvement and greater number of tumours were the predictor of long‐ term visual outcome of 6/12 or better.
Fluids of the ocular surface: concepts, functions and physics
Authors: Cher Ivan 
Published: February 2012

AbstractGeneral adoption of the ocular surface (OS) concept has advanced the therapy of the external eye. Fresh physical findings have prompted new concepts; examples taken from each section of the text are: (i) ever‐present lipid sealant bridges the palpebral fissure capping the three‐dimensional ‘OS’ sac. The muco‐aqueous pool (MAP) is thus enclosed, secluded from atmosphere, evaporation mitigated. Hence, the OS is conceptually, a compartment. The term ‘dacruon’ (otherwise ‘tear film’) has been coined for the combined fluids of the OS, viz. lipid film and MAP. (ii) Investigative techniques of physics yield data on (say) surface tension and viscosity, and on functions such as anchorage of dacruon base to the varied mucosae of the OS, lubrication, renovation of intermarginal fluid layers as the eye opens after each blink, and refinement of optics and vision by the fluids attached to the cornea. (iii) Physical events in the opening eye produce the unique ‘black line’ phenomenon in which capillary force induces subsurface flows into thirsty menisci, bringing about parameniscal dark grooves, pupil‐ward of each meniscus. Attenuation of fluorescein in the shallowed fluid gaps behind each groove makes the dye appear unilluminated (‘black lines’) relative to adjacent full‐thickness MAP fluid glowing under cobalt‐blue illumination. Isolated from cornea by grooves and gaps, the meniscal fluid cannot pass freely over the cornea. It therefore streams through the menisci to nasolacrimal outflow.
Relationship between progression of visual field damage and choroidal thickness in eyes with normal‐tension glaucoma
Authors: Hirooka Kazuyuki , Fujiwara Atsushi , Shiragami Chieko , Baba Tetsuya , Shiraga Fumio 
Published: February 2012

AbstractBackground:  To measure choroidal thickness in normal eyes and in patients with normal‐tension glaucoma using enhanced depth imaging optical coherence tomography and evaluate the association between choroidal thickness and progression of visual field damage.Design:  Cross‐sectional comparative study.Participants:  A total of 62 eyes of 62 normal subjects and 45 eyes of 45 normal‐tension glaucoma patients were examined.Methods:  The choroid was measured at the fovea and 3 mm nasal and temporal from the fovea. In the separate study, both eyes of the patients with normal‐tension glaucoma were included in the analyses. Visual fields were measured with automated perimetry. Changes in mean deviation per year (dB/year), that is, mean deviation slope, were calculated.Main Outcome Measures:  Difference in the choroidal thickness between the normal subjects and the patients with normal‐tension glaucoma. The relationship between mean deviation slope and the choroidal thickness in eyes with normal‐tension glaucoma was analysed.Results:  Compared with normal subjects, the choroidal thickness was significantly thinner in eyes with normal‐tension glaucoma at 3 mm nasal from the fovea (P = 0.02). There was a significant correlation between the choroidal thickness at 3 mm nasal from the fovea and the mean deviation slope (Pearson's r = 0.413; P < 0.001).Conclusion:  The decrease in the thickness of the choroid at 3 mm nasal from the fovea in eyes with normal‐tension glaucoma may be associated with progressive visual field loss. Thus, choroidal abnormalities may play a role in the pathogenesis of normal‐tension glaucoma.
Singapore Malay Eye Study: rationale and methodology of 6‐year follow‐up study (SiMES‐2)
Authors: Rosman Mohamad , Zheng Yingfeng , Wong Wanling , Lamoureux Ecosse , Saw Seang‐Mei , Tay Wan‐Ting , Wang Jie Jin , Mitchell Paul , Tai E‐Shyong , Wong Tien Y 
Published: February 2012

AbstractBackground:  To describe the rationale and study design of a follow‐up epidemiological eye study among Singaporean Malay adults.Design:  Follow‐up prospective population‐based study.Participants:  Participants of the Singapore Malay Eye Study (SiMES‐1), which was conducted from August 2004 to June 2006.Methods:  This is a follow‐up study of the 3280 participants who participated in the SiMES‐1 and are residing in Singapore. All participants of this follow‐up study will undergo various standardized validated questionnaires on socio‐demographics, quality of life and impact of visual impairment. Participants will undergo assessment of blood pressure, anthropometry, presenting and best corrected visual acuity, subjective refraction, ocular biometry, slit lamp and dilated eye examination, Goldmann tonometry, optic disc imaging, digital lens and retinal photography. Retinal tomography, retinal optical coherence topography and fundus autofluorescence will also be performed. Gonioscopy and visual fields examination will be performed on selected individuals.Main Outcome Measures:  Incidence, risk factors and impact of visual impairment and major eye diseases.Results:  A total of 3280 people who participated in the SiMES‐1 will be contacted and invited to participate in this follow‐up study. It is estimated that 12.8% of the participants will be deceased and there will be an 80% participation rate for the survivors of SiMES‐1 (approximately 2288 participants).Conclusion:  SiMES‐2 will be one of the few follow‐up epidemiological eye studies among Asians and will determine the cumulative 6‐year incidence, progression, risk factors and impact of major eye diseases in Singaporean Malay adults.
Clinical signs of uveitis associated with latent tuberculosis
Authors: Ang Marcus , Hedayatfar Alireza , Zhang Rongli , Chee Soon‐Phaik 
Published: February 2012

AbstractBackground:  To identify the clinical ocular signs of uveitis associated with latent tuberculosis.Design:  Retrospective case‐control study.Participants:  Consecutive patients from Singapore National Eye Centre Uveitis over 9 years. Sixty‐two patients with uveitis associated with latent tuberculosis were compared with 72 matched controls diagnosed with other known uveitides.Methods:  Patients were categorized as: (A) predominantly anterior segment inflammation (anterior uveitides) and (B) predominantly posterior segment inflammation (intermediate, posterior or pan‐uveitides). The diagnostic performance of combining these clinical signs with investigations such as interferon‐gamma release assay positivity and chest X‐ray results suggestive of pulmonary tuberculosis was done using area under the receiver operator characteristic curve.Main Outcome Measures:  Sensitivity, specificity and likelihood of association with tuberculosis of various clinical signs.Results:  Extensive posterior synechiae and concomitant anterior scleritis in Group A; low‐grade anterior chamber activity, retinal phlebitis and severe vitritis in Group B were significantly associated with latent tuberculosis. Combining these clinical signs with a positive interferon‐gamma release assay and tuberculin skin test improved the diagnostic performance in both groups (area under the receiver operator characteristic curve for Group A = 0.779; Group B = 0.789).Conclusion:  Patients with a combination of suggestive clinical signs with positive interferon‐gamma release assay and tuberculin skin test are more likely to be accurately diagnosed with uveitis associated with latent tuberculosis, which responds to anti‐tuberculosis therapy.
Perceived age of facial features is a significant diagnosis criterion for age‐related carotid atherosclerosis in Japanese subjects: J‐SHIPP study
Authors: Kido Miwako , Kohara Katsuhiko , Miyawaki Saori , Tabara Yasuharu , Igase Michiya , Miki Tetsuro 
Published: February 2012

Aim:  Vascular aging is known to be a major determinant of life expectancy. Recently, perceived age was reported to be a better predictor for mortality than chronological age. Based on these findings, we investigated whether or not perceived age was related to atherosclerosis in a general population.Methods:  The participants were 273 individuals aged ≥50 years who participated in the Skin‐doc in Anti‐Aging Doc program. Facial photos were taken under a shadowless lamp from three directions (antero‐posterior, and 60° right and left oblique projection) using a high‐resolution digital camera. Perceived age was assessed either by 19 professional nurses in the geriatric ward or using facial identification program software. Carotid intima‐media thickness (IMT), radial augmentation index (AI) and brachial‐ankle pulse wave velocity (baPWV) were measured as indices for atherosclerosis.Results:  The perceived age difference (expressed as the difference between perceived age and chronological age), when estimated either by nurses or software, was significantly and negatively associated with chronological age. Subjects who were evaluated by nurses to be younger than their chronological age had significantly lower carotid IMT after adjustment for chronological age. Conversely, carotid IMT was an independent and negative determinant of looking young, as perceived by nurses. Similar observations were also made between perceived age using facial identification software and carotid IMT. Radial AI and baPWV were not associated with perceived age.Conclusion:  These findings show that carotid atherosclerosis is related to perceived age. This association might underlie previous findings showing that perceived age predicts life expectancy. Geriatr Gerontol Int 2012; ••: ••–••.
Insulin use is not significantly predictive for prostate cancer mortality in diabetic patients: a 12‐year follow‐up study
Authors: Tseng Chin‐Hsiao 
Published: February 2012

Study Type – Prognosis (inception cohort)Level of Evidence 2aWhat's known on the subject? and What does the study add?Even though a lower risk of prostate cancer has been reported in patients with diabetes, they may have a higher risk of cancer development involving the liver, pancreas, endometrium, colorectum, breast and bladder. Insulin may have mitogenic properties besides its metabolic function. However, whether exogenous insulin use for glycaemic control in diabetic patients could increase the risk of prostate cancer has rarely been studied.This is the first prospective follow‐up study for up to 12 years to show that exogenous insulin use for glycaemic control in the diabetic patients is not significantly predictive for prostate cancer mortality.OBJECTIVE
To evaluate whether insulin use in diabetic patients could be predictive for prostate cancer mortality.
PATIENTS AND METHODS
A total of 39 135 diabetic men aged ≥40 years from a nationally representative cohort were followed prospectively from 1995 to 2006 for prostate cancer mortality.
Cox proportional hazards models were used to estimate the hazard ratios for the following independent variables: age, diabetes type, diabetes duration, body mass index, smoking, insulin use and area of residence.
The models were created for patients aged ≥40 years and ≥65 years, separately; and before and after excluding patients with a duration between onset of diabetes and prostate cancer mortality <5 years.
RESULTS
A total of 105 diabetic men died of prostate cancer during follow‐up.
Age was the only significant risk factor.
Insulin use was associated with an insignificantly higher risk of prostate cancer mortality ranging from 24% to 49%.
When stratified by the duration of insulin use <5 and ≥5 years, a lack of significant association was also observed.
CONCLUSIONS
Insulin use in diabetic patients does not significantly predict the mortality from prostate cancer.
Further confirmation in other ethnicities is needed.
REEXAMINATION OF THE ETHICS OF PLACEBO USE IN CLINICAL PRACTICE
Authors: ASAI ATSUSHI , KADOOKA YASUHIRO 
Published: February 2012

ABSTRACTA placebo is a substance or intervention believed to be inactive, but is administered by the healthcare professional as if it was an active medication. Unlike standard treatments, clinical use of placebo usually involves deception and is therefore ethically problematic. Our attitudes toward the clinical use of placebo, which inevitably includes deception or withholding information, have a tremendous effect on our practice regarding truth‐telling and informed consent. A casual attitude towards it weakens the current practice based on shared decision‐making and mutual trust between patients and healthcare professionals. Issues concerning the clinical use of placebo are thus intimately related to patient‐provider relationships, the public's trust in medicine, and medical education. A review of recent survey studies suggests that the clinical use of placebo appears to be fairly well accepted among healthcare professionals and is common in clinical settings in various countries. However, we think that an ethical discussion is urgently needed because of its controversial nature. If judged to be ethically wrong, the practice should end. In the present paper, we discuss the ethicality of the clinical use of placebo with deception and argue against it, concluding that it is unethical and should be banned. We will show that most arguments in favor of the clinical use of placebo can be refuted and are therefore incorrect or weak. These arguments will be presented and examined individually. Finally, we will briefly consider issues relevant to the clinical use of placebo without deception.
MORAL FICTION OR MORAL FACT? THE DISTINCTION BETWEEN DOING AND ALLOWING IN MEDICAL ETHICS
Authors: HUDDLE THOMAS S. 
Published: February 2012

ABSTRACTOpponents of physician‐assisted suicide (PAS) maintain that physician withdrawal‐of‐life‐sustaining‐treatment cannot be morally equated to voluntary active euthanasia. PAS opponents generally distinguish these two kinds of act by positing a possible moral distinction between killing and allowing‐to‐die, ceteris paribus. While that distinction continues to be widely accepted in the public discourse, it has been more controversial among philosophers. Some ethicist PAS advocates are so certain that the distinction is invalid that they describe PAS opponents who hold to the distinction as in the grip of ‘moral fictions’. The author contends that such a diagnosis is too hasty. The possibility of a moral distinction between active euthanasia and allowing‐to‐die has not been closed off by the argumentative strategies employed by these PAS advocates, including the contrasting cases strategy and the assimilation of doing and allowing to a common sense notion of causation. The philosophical debate over the doing/allowing distinction remains inconclusive, but physicians and others who rely upon that distinction in thinking about the ethics of end‐of‐life care need not give up on it in response to these arguments.
DISPUTING THE ETHICS OF RESEARCH: THE CHALLENGE FROM BIOETHICS AND PATIENT ACTIVISM TO THE INTERPRETATION OF THE DECLARATION OF HELSINKI IN CLINICAL TRIALS
Authors: WOODS SIMON , MCCORMACK PAULINE 
Published: February 2012

ABSTRACTIn this paper we argue that the consensus around normative standards for the ethics of research in clinical trials, strongly influenced by the Declaration of Helsinki, is perceived from various quarters as too conservative and potentially restrictive of research that is seen as urgent and necessary. We examine this problem from the perspective of various challengers who argue for alternative approaches to what ought or ought not to be permitted. Key themes within this analysis will examine these claims and argue they have implications for the interests of the research subject, research governance and regulation. Using our work with TREAT‐NMD, the neuromuscular clinical trials network, we posit that there is a place for advancing the discourse of moral rights and moral duties in the context of research, especially from the perspective of patients and their families, and for including the politics of patient activism and empowerment. At the same time we remain vigilant to the danger that the therapeutic misconception and other serious vulnerabilities for the patient population in clinical trials, are at risk of being overlooked.
Earlier initiation of antiretroviral therapy, increased tuberculosis case finding and reduced mortality in a setting of improved HIV care: a retrospective cohort study
Authors: Hermans SM , van Leth F , Manabe YC , Hoepelman AIM , Lange JMA , Kambugu A 
Published: February 2012

ObjectivesHigh early mortality after antiretroviral therapy (ART) initiation in resource‐limited settings is associated with low baseline CD4 cell counts and a high burden of opportunistic infections. Our large urban HIV clinic in Uganda has made concerted efforts to initiate ART at higher CD4 cell counts and to improve diagnosis and care of patients coinfected with tuberculosis (TB). We sought to determine associated treatment outcomes.MethodsRoutinely collected data for all patients who initiated ART from 2005 to 2009 were analysed. Median baseline CD4 cell counts by year of ART initiation were compared using the Cuzick test for trend. Mortality and TB incidence rates in the first year of ART were computed. Hazard ratios (HRs) were calculated using multivariable Cox proportional hazards models.ResultsFirst‐line ART was initiated in 7659 patients; 64% were women, and the mean age was 37 years (standard deviation 9 years). Median baseline CD4 counts increased from 2005 to 2009 [82 cells/μL (interquartile range (IQR) 24, 153) to 148 cells/μL (IQR 61, 197), respectively; P < 0.001]. The mortality rate fell from 6.5/100 person‐years at risk (PYAR) [95% confidence interval (CI) 5.5–7.6 PYAR] to 3.6/100 PYAR (95% CI 2.2–5.8 PYAR). TB incidence rates increased from 8.2/100 PYAR (95% CI 7.1–9.5 PYAR) to 15.6/100 PYAR (95% CI 12.4–19.7 PYAR). A later year of ART initiation was independently associated with decreased mortality (HR 0.91; 95% CI 0.83–1.00; P = 0.04).ConclusionsBaseline CD4 cell counts have increased over time and are associated with decreased mortality. Additional reductions in mortality might be a result of a better standard of care and increased TB case finding. Further efforts to initiate ART earlier should be prioritized even in a setting of capped or reduced funding for ART programmes.
Improved serological response to H1N1 monovalent vaccine associated with viral suppression among HIV‐1‐infected patients during the 2009 influenza (H1N1) pandemic in the Southern Hemisphere
Authors: Maruszak H , Jeganathan S , Smith DE , Robertson P , Barnes T , Furner V 
Published: February 2012

ObjectivesPatients infected with HIV‐1 were targeted for vaccination against H1N1 influenza because of their anticipated increased risk of mortality associated with H1N1 infection. Reports regarding the efficacy of vaccination in HIV‐1‐infected patients have suggested a reduced immunogenic response compared with the general population. Hence, the study aimed to determine the serological response to pandemic H1N1 influenza vaccine in HIV‐1‐infected patients in a clinical setting.MethodsA retrospective review of all HIV‐1‐infected patients who attended mass H1N1 vaccination between October 2009 and March 2010 at an Australian HIV clinic was carried out. Pre‐ and post‐vaccination H1N1 antibody titres were measured. The main outcome measure was response to the vaccination, which was defined as an H1N1 antibody titre of ≥ 1:40 using a haemagglutination inhibition (HI) assay.ResultsBaseline blood samples were collected from 199 patients, of whom 154 agreed to receive vaccination; of these, 126 had pre‐ and post‐vaccination HI titres measured. Seventy‐seven of 199 patients (38.7%) showed a baseline antibody titre of ≥ 1:40. Eighty‐five (67.4%) showed a fourfold or greater increase in titre and 109 of 126 (86.5%) achieved an antibody titre of ≥ 1:40 after vaccination. The serum HI H1N1 antibody geometric mean titre (GMT) for the 126 paired samples was 39.32 ± 3.46 pre‐vaccination and increased to 237.36 ± 3.94 [standard deviation (SD)] post‐vaccination (P < 0.001). In a binary logistic regression analysis, HIV viral load and baseline HI antibody titre were significantly associated with post‐vaccination increase in HI H1N1 antibody titre.ConclusionsA high prevalence of HI H1N1 antibodies was found before vaccination in the cohort, consistent with previous exposure to H1N1 influenza virus. The response to vaccination was considered adequate, as more than two‐thirds of patients achieved a fourfold or more increase in antibody titre after vaccination. The response to vaccination was significantly greater in those patients who were aviraemic for HIV, suggesting that antiretroviral therapy improves the humoral response, which is important in optimizing vaccine effectiveness.
International Strategic Choice of Minimum Quality Standards and Welfare*
Authors: LUTZ STEFAN , PEZZINO MARIO 
Published: February 2012

AbstractThis article looks at the influence of minimum quality standards in a two‐region partial‐equilibrium model of vertical product differentiation and trade. Three alternative standard‐setting arrangements are considered: full harmonization, national treatment and mutual recognition. The analysis integrates the choice of a particular standard‐setting alternative by governments into the model. The article provides a set of sufficient conditions for which mutual recognition emerges as one regulatory alternative that always improves welfare in both regions. Mutual recognition, being the default procedure if governments do not reach a unanimous decision, is the only possible equilibrium of the game.
Who's Afraid of Justice? A Rejoinder to Danny Nicol
Authors: NEYER JÜRGEN 
Published: February 2012

AbstractDanny Nicol argues in this journal that my effort to devise a realistic normative conception of the European Union is unconvincing. I respond to his objections by correcting a number of misunderstandings of my original argument. I also use a more principled standard for providing evidence that the EU is indeed structurally unfit for democracy and emphasize the argument that the supranational layer of the EU is in need of a normative standard that is independent from the idea of democracy. The last section explicates the strength of normative realism.