bluuebunny/crossref_metadata_2025_split huggingface dataset:
Investigation of a cluster of Staphylococcus aureus invasive infection in the Top End of the Northern Territory
Authors: Skull S. A. , Krause V. , Coombs G. , Pearman J. W. , Roberts L. A. 
Published: March 2008

Abstract Introduction: Staphylococcus aureus invasive infection remains a serious condition associated with considerable morbidity and mortality. Following notification of five cases at Royal Darwin Hospital (RDH), we searched for related cases, determined their epidemiological characteristics and attempted to identify the source of this apparent cluster. Methods: We reviewed RDH microbiology records between June 1996 and April 1997 for S. aureus isolates with similar antibiograms to notified cases. We used antibiotic resistance patterns, bacteriophage typing and two molecular typing techniques to subtype implicated isolates. Hospital records were reviewed for admission details and associated costs were estimated. Results: Fifty‐four cluster‐related isolates occurred in 47 separate presentations. The peak incidence was in the wet season. The most important risk factor for staphylococcal invasive infection was the presence of skin sores/scabies in 17/54 cases (31%), followed by intravascular line use in 14/54 (26%), open trauma in 11/54 (20%), underlying end stage renal failure and alcoholism each in ten of 54 (18%). The mean admission length was 30 days and antibiotics were given for an average of 23 days. Death due to S. aureus infection occurred in eight of 47 (17%) presentations. S. aureus pneumonia was community acquired in 12/13 patients (92%) and six of 13 (46%) died. Ten of 13 (80%) pneumonia patients had at least one other focus of S. aureus infection. The cost of antibiotics and hospital bed per presentation was approximately $16,000. Presentations with skin sores/scabies cost considerably more ($31,000). No common epidemiologic features were found for community or hospital acquired cases. Conclusion: Considerable mortality and cost was attributable to cases of S. aureus invasive infection during this cluster; particularly those with community acquired pneumonia or skin sores/scabies. Staphylococcal antibiotic cover should be considered early for unwell patients presenting to hospital with pneumonia and other signs of potential S. aureus infection. It is appropriate to target public health efforts to prevent skin sores and to provide adequate treatment when they occur.
A comparison of the plasma disappearance of iohexol and 99m Tc‐DTPA for the measurement of glomerular filtration rate (GFR) in diabetes
Authors: Houlihan C. , Jenkins M. , Osicka T. , Scott A. , Parkin D. , Jerums G. 
Published: March 2008

Abstract Background: Changes in glomerular filtration rate (GFR) provide a valuable indicator of the progression of diabetic nephropathy. GFR is most commonly measured by the plasma clearance of radioisotopes, however, use of iohexol, a non‐ionic radiocontrast medium, is a recently described alternative and has shown good agreement with inulin clearance. A one‐compartment model is used for calculating GFR in most Australian centres but a two‐compartment model is more accurate. Aims: To set up a non‐radioisotopic method for assessment of GFR using iohexol, and to compare this with the currently used 99mTc‐diethylene‐triamine‐penta‐acetic acid (DTPA) method. Secondly, to compare GFR results using an unmodified one‐compartment model with a one‐compartment model subjected to the Brochner‐Mortensen modification. Methods: Twenty‐one patients with diabetes had assessment of GFR with simultaneous measurements of 99mTc‐DTPA and iohexol plasma clearance. Plasma clearance was determined by the slope intercept method and then modified according to the Brochner‐Mortensen equation. Plasma iohexol concentrations were determined by capillary electrophoresis. Results: There was no significant difference between iohexol and 99mTc‐DTPA derived GFR values, difference 4.3±7.7 mL/minute (mean±SD). This was despite 99mTc‐DTPA protein binding demonstrated in the range of 5–10%. Comparison of GFR results using an unmodified one‐compartment model with a Brochner‐Mortensen corrected one‐compartment model showed higher GFR values with the former, in the range of 20–30% for GFR values > 100 mL/minute. Conclusion: Iohexol provides an efficient alternative to radioisotopic methods for serial measurement of GFR in diabetic patients with hyperfiltration, incipient and overt nephropathy. A one‐compartment model with its inherent overestimation of GFR should be replaced by the Brochner‐Mortensen modified one‐compartment model.
Proximal shift of colorectal cancer in the Australian Capital Territory over 20 years
Authors: Miller A. , Gorska M. , Bassett M. 
Published: March 2008

Abstract Background: Several studies in other countries have demonstrated a change in subsite distribution of colorectal cancer, with increasing proximal cancers. Confirmation of such a change in Australia would have implications for screening and diagnosis of colorectal cancer. Aims: To determine whether there has been an increase in the proportion of proximal colorectal cancers in Australia, and whether there have been changes in other clinical and pathological aspects of colorectal cancer. Methods: A study of the hospital files of patients with colorectal cancer diagnosed and treated at all hospitals in the Australian Capital Territory (ACT) between 1989 and 1995 was compared with data from a published study of patients diagnosed between 1969 and 1976. Results: There was a proximal shift of cancers with a significant increase in the proportion of tumours in the hepatic flexure, ascending colon and caecum, more marked for females than males. There was a corresponding reduction in distal colorectal cancers. Time from onset of symptoms to diagnosis decreased, risk factors for colorectal cancer were noted more frequently, and endoscopy replaced barium enema X‐ray as the main diagnostic modality. The resectability of cancers increased, stay in hospital and 30 day mortality declined. Despite apparent earlier presentation and improved surgical resectability, the proportion of patients with localised disease (Dukes' stage A and B) had not changed significantly. Conclusions: We have detected a number of changes in clinical and pathological aspects of colorectal cancer over a 20 year period in the ACT, including a proximal shift in the subsite distribution of colorectal cancer. These changes suggest that proximal and distal colorectal cancers may have a different aetio‐pathogenesis, and have implications for the investigation of patients with suspected colorectal cancer and in screening high‐risk groups.
Management of Graves' disease in Australia
Authors: Walsh J. P. 
Published: March 2008

Abstract Background: Surveys of physicians in Europe, the USA and elsewhere have shown marked international differences in the management of Graves' disease. There are no comparable data on clinical practice in Australia. Aims: To examine the current management of Graves' disease by Australian endocrinologists, particularly controversial aspects of management. Methods: A questionnaire, modified from previous studies, was sent to members of the Endocrine Society of Australia, asking how they would manage a 43‐year‐old female with a first episode of Graves' disease. Eight variations on this index case (goitre size, age, sex, severity, recurrent disease) were then introduced. A novel ninth variation, recurrent Graves' disease accompanied by moderate ophthalmopathy, was added. Results: Responses from 130 endocrinologists who regularly managed Graves' disease in adults were analysed. For the index case, medical treatment with antithyroid drugs was recommended by 81% of respondents and radioiodine by 19%. Most respondents also recommended medical treatment for a patient aged 19 years, a patient with a large goitre, no goitre or severe hyperthyroidism. For an older patient aged 71 years, however, 57% of endocrinologists recommended radioiodine, and the remainder medical treatment. For recurrent Graves' disease after previous medical treatment, 76% of respondents recommended radioiodine, 22% medical treatment and 2% surgery. By contrast, for an identical case accompanied by moderate ophthalmopathy, 54% recommended medical treatment, 27% surgery and only 19% radioiodine. Conclusions: Most endocrinologists in Australia recommend medical treatment for a first episode of Graves' disease. Radioiodine is used mainly in older patients and for recurrent disease. In the presence of significant ophthalmopathy, most endocrinologists avoid the use of radioiodine.
Fasting plasma glucose in non‐diabetic elderly women predicts increased all‐causes mortality and coronary heart disease risk
Authors: Simons L. A. , Friedlander Y. , McCallum J. , Simons J. 
Published: March 2008

Abstract Aim: To confirm the hypothesis that upper normal plasma glucose levels in non‐diabetic subjects are independently predictive of mortality and cardiovascular disease (CVD). Methods: ’The study reports on 113 months’ follow‐up in a prospective study of CVD in the Australian elderly, The Dubbo Study. The cohort, first examined in 1988–89, consisted of 2805 men and women 60 years and older. Of the cohort, 2419 (86%) were defined as non‐diabetic. The prediction of outcomes by quartile of fasting plasma glucose was examined in a Cox proportional hazards model, after linkage to hospital and death records. Results: All‐causes mortality increased progressively across quartile of fasting plasma glucose in both sexes, reaching statistical significance only in women. Coronary heart disease (CHD) incidence increased similarly, the increases being proportionately greater in women. Ischaemic stroke did not show a consistent gradient with fasting plasma glucose. After adjustment for age and other risk factors, all‐causes mortality, CHD and ischaemic stroke incidence were not significantly related to plasma glucose in men. In women, all‐causes mortality and CHD incidence showed a significant gradient with glucose quartile. Hazard Ratio (95% confidence intervals) for death in glucose Quartile IV (5.3–6.0 mmol/L) was 1.49 (1.03–2.14) and for CHD incidence was 1.52 (1.08–2.15). Subjects in the upper quartiles of fasting plasma glucose showed a clustering of overweight, hypertension, elevated serum triglycerides, reduced high density lipoprotein cholesterol and excess of small dense low density lipoprotein, suggestive of the Insulin Resistance Syndrome. Conclusion: Fasting plasma glucose levels in the upper normal range in non‐diabetic elderly subjects appear to be associated with increased all‐causes mortality and CHD, especially in women.
Treatment of Chinese acromegaly with a combination of bromocriptine and octreotide
Authors: Li J. K. Y. , Chow C. C. , Yeung V. T. F. , Mak T. W. L. , Ko G. T. C. , Swaminathan R. , Chan J. C. N. , Cockram C. S. 
Published: March 2008

Abstract Background: Good results have been reported with combined use of octreotide and bromocriptine in acromegalic Caucasians. Data concerning the efficacy and tolerability of this combination treatment in Chinese acromegalic patients are scanty. Aim: The aim of this study was to assess the efficacy and tolerability of combined therapy using bromocriptine and octreotide in the treatment of acromegaly in Chinese patients and to compare the cost‐effectiveness of various regimes. Methods: Sixteen Chinese acromegalic patients with growth hormone (GH) concentration not suppressible to below 5 mU/L (2 μg/L) during an extended OGTT were recruited to undergo four phases of the study. During the study period, the patients were given bromocriptine alone, bromocriptine and low dose octreotide, bromocriptine and medium dose octreotide, and medium dose octreotide alone. Plasma concentrations of GH and insulin‐like growth factor‐1 (IGF‐1) were measured before and after the completion of each phase. Results: The number of patients reaching target GH concentrations was significantly higher when treated with octreotide compared to baseline (p<0.05). Bromocriptine alone had a significant effect but not to the extent of octreotide alone. A combination of low dose octreotide and bromocriptine is as efficacious in the treatment of acromegaly as high dose octreotide. None of the patients suffered from serious adverse effects. Conclusion: The results confirmed the usefulness and tolerability of bromocriptine and octreotide in Chinese acromegalics. The most cost‐effective regime in this study was a combination of low dose octreotide and bromocriptine.
A prospective study of atropine premedication in flexible bronchoscopy
Authors: Hewer R. D. , Jones P. M. , Thomas P. S. , Mckenzie D. K. 
Published: March 2008

Abstract Aim: This study aimed to assess the effect of atropine premedication prior to flexible bronchoscopy. The rationale for using atropine is that it will dry secretions and allow a better view of the bronchial tree. There is also the theoretical benefit of protection against vasovagal episodes and bronchospasm. Methods: Twenty patients were randomised in a double‐blind manner to receive either 500 meg of atropine intramuscularly or 1 mL of 0.9% saline intramuscularly 30 minutes prior to bronchoscopy. Both groups received a standard dose of intramuscular pethidine. Variables studied included a pre‐procedure electrocardiograph, a rhythm strip during the procedure, serial measurements of blood pressure, continuous pulse oximetry, and spirometry pre‐ and post‐bronchoscopy. Subjective measures recorded were a secretion score, rated 0–3 by the bronchoscopist using a four point visual analogue scale. A patient questionnaire was designed to establish the presence or absence of symptoms, including those related to atropine. Results: There were no significant differences recorded in the duration of procedure, percentage fall in FEV1, secretion scores, or other physiological measures. The only significant difference between the two groups was dry mouth in the atropine group (p<0.001). There was a fall in forced vital capacity from baseline which was significant in the saline group (p<0.005), and not the atropine group, but it was not significant when compared between groups. A ß2 adrenergic agonist would, however, be more appropriate to prevent such a fall in spirometry. Conclusions: These results fail to demonstrate a benefit of intramuscular atropine as premedication for fibreoptic bronchoscopy.
Use of a peripherally implanted subcutaneous permanent central venous access device for chemotherapy – the Singapore General Hospital experience
Authors: Ang P. , Chia K. H. , Teoh M. K. , Wong K. K. Y. 
Published: March 2008

Abstract Background: Venous access for chemotherapy patients at the Singapore General Hospital has conventionally been via an externalised (Hickman) catheter. A peripherally implanted permanent subcutaneous central venous access device (P.A.S.Port) was introduced in 1996. Aims: We review its use, complications and cost competitiveness with other chemotherapy delivery systems. Methods: A retrospective study of clinical records was conducted with follow up interviews of patients and nursing staff. Results: Twelve patients had the P.A.S.Port inserted for administration of chemotherapy as an outpatient procedure. Immediate complications were pain (8%) and bruising (8%). One port‐related infection (8%) one week following insertion was reported and one patient complained of interference with elbow movement as a late complication. Cost analysis was favourable for P.A.S.Port over an externalised Hickman catheter or chest‐placed port at one year. Patient and nursing staff acceptance was high. Conclusion: P.A.S.Port insertion is a safe outpatient procedure and is an alternative for permanent venous access.
Phaeochromocytomas discovered during coronial autopsies in Sydney, Melbourne and Auckland
Authors: McNeil A. R. , Blok B. H. , Koelmeyer T. D. , Burke M. P. , Hilton J. M. 
Published: March 2008

Abstract: Background: The diagnosis of phaeochromocytoma can be difficult and previous autopsy studies have found that many of these tumours are not recognised during life. Aim: To determine the incidence of phaeochromocytoma during coronial autopsies and the characteristics of the individuals concerned. Method: Review of coronial autopsy records from Auckland (1981–97), Melbourne (1991–97) and Sydney (1991–97). Results: Twenty‐two patients were found giving an incidence of 0.05% (one tumour per 2031 autopsies) with similar figures in each centre. Thirteen of the patients were men, 12 were overweight (body mass index >25 kg/m2) and three of the seven Auckland patients were Maori. Fourteen of the tumours were left‐sided, one was extra‐adrenal and none had metastasised. The one patient with bilateral tumours had multiple endocrine neoplasia syndrome type 2 (MEN‐2) which had not been recognised during life. The heart weight was increased in 95% of the patients. The tumour may have contributed to the patient's death in up to 50% of the cases, although the true significance of these lesions as a cause of death remains unclear. Three patients died soon after general anaesthetics had been given for unrelated reasons. Conclusions: Even though phaeochromocytomas are uncommon, we fail to diagnose a significant number of these tumours during life. Methods are needed to increase the detection of phaeochromocytoma and to distinguish functional and non‐functional tumours.
A serological re‐evaluation of acute non‐A non‐B hepatitis from the early 1970s
Authors: Binotto E. , Boughton C. R. , Vollmer‐Conna U. , Hawkes R. , Robertson P. , Whybin R. , Duffy Y. , Lloyd A. R. 
Published: March 2008

Abstract: Background: The epidemiology and natural history of recently discovered viruses, which may be responsible for cases of seronegative infectious hepatitis, are currently being investigated. Retrospective studies of stored sera can provide a historical perspective of these infections. Aims: To re‐evaluate the serological, demographic and clinical characteristics of patients hospitalised in the early 1970s with acute hepatitis. Methods: The stored sera of 57 patients hospitalised between 1971 and 1974 with acute hepatitis, designated at that time as non‐A non‐B (NANB) hepatitis, were re‐tested using commercially available enzyme‐linked immunosorbent assays (ELISAs) for the presence of anti‐hepatitis A virus (HAV) IgM, hepatitis B surface antigen (HBsAg), anti‐hepatitis C virus (HCV) IgG, and anti‐hepatitis E virus (HEV) IgG. Stored sera from a group of 57 patients concurrently hospitalised for other conditions were also tested. Detailed records of the original epidemiological interviews were examined to compare patient demographics, risk factors for infectious hepatitis and clinical data for the NANB hepatitis group and an original control group of 604 hospitalised patients. Results: Serum from 15 of the 57 (26%) previously designated NANB hepatitis cases had elevated anti‐HAV IgM and are likely to represent missed cases of hepatitis A. Thirteen (23%) of cases previously designated as NANB hepatitis had positive hepatitis C antibody tests. These patients were younger and significantly more likely to have used intravenous drugs than control patients. Three NANB hepatitis and two hospital control patients were anti‐HEV IgG antibody positive. All of these individuals were born in, or had travelled to, developing countries. Serum from 27 (47%) of the NANB hepatitis patients were negative on all tests. These hepatitis non‐A‐E cases included children and elderly adults, but as a group were significantly more likely to have used intravenous drugs than hospitalised control patients.
Overriding the co‐limiting import of carbon and energy into tuber amyloplasts increases the starch content and yield of transgenic potato plants
Authors: Zhang Lizhi , Häusler Rainer E. , Greiten Christian , Hajirezaei Mohammad‐Reza , Haferkamp Ilka , Neuhaus H. Ekkehard , Flügge Ulf‐Ingo , Ludewig Frank 
Published: March 2008

SummaryTransgenic potato (Solanum tuberosum) plants simultaneously over‐expressing a pea (Pisum sativum) glucose‐6‐phosphate/phosphate translocator (GPT) and anArabidopsis thalianaadenylate translocator (NTT1) in tubers were generated. Double transformants exhibited an enhanced tuber yield of up to 19%, concomitant with an additional increased starch content of up to 28%, compared with control plants. The total starch content produced in tubers per plant was calculated to be increased by up to 44% in double transformants relative to the wild‐type. Single over‐expression of either gene had no effect on tuber starch content or tuber yield, suggesting that starch formation within amyloplasts is co‐limited by the import of energy and the supply of carbon skeletons. As total adenosine diphosphate‐glucose pyrophosphorylase and starch synthase activities remained unchanged in double transformants relative to the wild‐type, they cannot account for the increased starch content found in tubers of double transformants. Rather, an optimized supply of amyloplasts with adenosine triphosphate and glucose‐6‐phosphate seems to favour increased starch synthesis, resulting in plants with increased starch content and yield of tubers.
THE MONEY THAT GROWS ON TREES
Authors: BROOKFIELD H. C. 
Published: March 2008

From a paean of praise to the innovator:When you first brought these trees and told us we should grow them, we scoffed at you and said ‘We have plenty of trees already; what use are these new ones?’ But now we see we were wrong: money grows on those trees. On the indivisibility of systems:No one part of the model‐system is more important than any other part. We may consider each model as a vital link in a communications system. We may identify feedback effects. Every change in technology or change in aspiration levels will lead to a re‐appraisal of the environment. Every movement of knowledge over space will need to be checked against environment and environment itself will change as a result of the decisions made. Changes in social structure may lead to changes in organizational behaviour and so on.
Economic Restructuring and Regional Change in Australia
Authors: TAYLOR MICHAEL 
Published: March 2008

This paper examines geographical dimensions of the actual and potential impacts of economic restructuring on individual regions in Australia from the perspective of the jobs and services that support people and families. Four examples are discussed:The discussion raises four sets of concerns for the future: potential social dislocation in rural and remote communities; the erosion of the employment and service bases of those same communities; the vulnerability of sections of society, especially women and disadvantaged ethnic groups; and the imprecision involved in disentangling webs of cross subsidy and community service obligations in Australia.

rural community decline;
the impact of tariff reduction on the textiles, clothing and footwear industries;
ailway restructuring and potential job loss;
telecommunications restructuring and the aspects of funding community service obligations (CSOs).