bluuebunny/crossref_metadata_2025_split huggingface dataset:
The waiting game: natural history of a cataract waiting list in New Zealand
Authors: Riley Andrew F , Grupcheva Christina N , Malik Tahira Y , Craig Jennifer P , McGhee Charles NJ 
Published: September 2003

ABSTRACT Aims: To identify the demographic and visual function of patients on the reserve waiting list for cataract surgery at a large public hospital within New Zealand and to determine the ultimate outcome of those on a priority‐based, rationed, health‐care waiting list. Methods: Patients from a defined geographical population, placed on a reserve waiting list for possible cataract surgery, during the period January 1997 to March 2000, were invited to attend for further clinical assessment and asked to complete a visual assessment questionnaire. Results: Of 193 patients in the pilot study group who had been on the reserve waiting list for a mean of 18.2 ± 11.6 months (range 0.1–62.7 months), only 94 (49%) were deemed suitable for, and subsequently underwent, surgery in the public sector. Forty‐nine (25%) had undergone surgery earlier, the majority of these (84%) in the private sector. A further 23 (12%) patients were deceased, four (2%) declined surgery and in six (3%) cataract surgery was no longer indicated. The remaining 11 (6%) patients could not be traced. Patients still awaiting surgery had a mean age of 77.2 years (range 48–95 years). Fifty‐four were women. Vision had deteriorated by a mean of 0.05 LogMAR units, from Snellen equivalent 6/30 at listing to 6/36, over this time. Conclusions: Current methods of prioritization for cataract surgery are imperfect, as are the resources for performing adequate levels of cataract surgery. Analysis of a residual waiting list for cataract surgery highlights that the majority (51%) do not ultimately progress to cataract surgery in the public sector for a variety of reasons. During a mean waiting time of 1.5 years vision further deteriorates in this predominantly older population.
Diabetic retinopathy: effects of national guidelines on the referral, examination and treatment practices of ophthalmologists and optometrists
Authors: McCarty Catherine A , Taylor Kathryn I , McKay Robert , Keeffe Jill E 
Published: September 2003

ABSTRACT Objective: To investigate the changes in referral, examination and treatment practices for diabetic retinopathy by ophthalmologists and optometrists following the release of national guidelines. Methods: A two‐page self‐administered questionnaire was mailed to all Australian ophthalmologists and a random sample of 500 Australian optometrists prior to and 1 year after release of the National Health and Medical Research Council of Australia (NHMRC) clinical practice guidelines for the management of diabetic retinopathy. The questionnaires elicited information about current practice related to the management of patients with diabetic retinopathy. Results: Of the 464 contactable ophthalmologists who responded to the baseline survey, 374 (80.6% response) completed the follow‐up survey. The response rate for the contactable optometrists was 80.1% (310 of 384). There were almost no significant changes in management practices from baseline to follow up. For example, the percentage of ophthalmologists who reported that they were often or almost always confident in detecting moderate retinal thickening near the macula remained nearly identical from baseline to follow up (80.2% vs 79.1%). The rate was also similar from baseline to follow up for optometrists (31.1% vs 28.8%). The one area in which ophthalmologists reported significant changes in management towards agreement with the NHMRC guidelines was use of angiography; they were less likely to manage their patients this way (20.4% vs 14.2% with laser and 48.9% vs 38.4% without laser for increasing level of severity in clinical signs; both P < 0.05). Conclusions: The NHMRC guidelines for diabetic retinopathy have been successfully distributed to ophthalmologists and optometrists in Australia. However, the mere provision of the guidelines has had little impact on management practices. It will be important to determine if ongoing dissemination and implementation strategies not only increase awareness of health‐care practitioners to the guidelines, but also change behaviours.
Ophthalmologists in teaching hospitals: do we make a difference to patient outcome?
Authors: Bala Chandra , Poon Alexander C , Joblin Paul , McCluskey Peter J 
Published: September 2003

ABSTRACT Purpose: To determine the type and frequency of consultations with the eye department of a major tertiary care teaching hospital. Methods: A retrospective review was undertaken of the medical records of inpatient consultations within the Ophthalmology Department of Royal Prince Alfred Hospital over the period from 1 July 1995 to 30 June 1997. The consults were divided into six types of consultation. A determination was made of the outcome and effect on patient management of each consultation. Results: There were 506 consultations over the 2‐year period. For 389 patients a full ophthalmic assessment was requested and 175 of them (45%) had an ophthalmological diagnosis made or had change in management as a result of the consultation. Conclusion: Ophthalmological consultation is a valuable inpatient consultation service that makes a significant difference in the management of patients from other medical and surgical units within the hospital.
Transcaruncular medial orbitotomy for stabilization of the posterior limb of the medial canthal tendon
Authors: Francis Ian C , Wilcsek Geoffrey A , Sharma Shanel , Coroneo Minas T 
Published: September 2003

ABSTRACT Purpose: A method to stabilize the posterior limb of the medial canthal tendon (MCT), using a transcaruncular medial orbitotomy (TMO) approach, is described in a stepwise fashion. The technique described is a modified version of procedures published by Ritleng, Crawford and Collin, and Fante and Elner. Methods: A prospective clinical evaluation of MCT stabilization via the TMO approach was undertaken in 11 consecutive patients who presented with MCT laxity as one of the features of their ectropion. These cases are initially described in detail in two representative case reports, and summarized in 11 cases. The stepwise surgical approach is outlined. Results: All patients had improved symptomatology in terms of epiphora and comfort. Furthermore, in all cases the lid position was improved or normalized. In four of the 11 cases (36%) the lower punctum did not ultimately reside in the lacrimal lake, but the punctal position was nevertheless improved and the MCT was stabilized. Conclusion: The TMO procedure provides both excellent MCT stabilization and adequate placement of the lower lacrimal punctum onto the globe. It does not require canalicular resection, and avoids continued anterior displacement of the medial lower lid which may occur when only the anterior limb of the MCT is addressed surgically.
Evaluation of the quality of generic polymethylmethacrylate intraocular lenses marketed in India
Authors: Combe Richard , Watkins Rod , Brian Garry 
Published: September 2003

ABSTRACT Purpose: To determine the quality of single‐piece, all‐ polymethylmethacrylate (PMMA) intraocular lenses (IOLs) from eight generic manufacturers marketing their product in India. This assessment of quality was made with respect to compliance with international standards for the manufacture of IOLs, specifically those parameters most likely to affect patient postoperative visual acuity and the long‐term biocompatibility of the implanted lens. Methods: Ten IOLs from each of eight manufacturers were purchased randomly from commercial retail outlets in India. Each IOL, in a masked fashion, had its physical dimensions, optical performance and cosmetic appearance assessed, using the methods prescribed in ISO 11979‐2 and 11979‐3. Validation of manufacturing process controls were determined by statistical process control techniques. Four IOLs from each manufacturer were also tested for the presence of unpolymerized PMMA using gas chromatography. Results: Only lenses from two IOL manufacturers complied with the optical and mechanical standards. All other manufacturers’ lenses failed one or more of these tests. Intra‐ocular lenses from only two producers met with surface quality and bulk homogeneity standards. All others exhibited defects such as surface contamination and scratches, poor polishing, and chipped or rough positioning holes. Lenses from two producers exhibited high levels of methylmethacrylate monomer (MMA). Conclusions: Non‐clinical grade PMMA starting material may have been used in the manufacture of IOLs by some producers. Critical manufacturing defects occurred in the IOLs from five of the eight producers tested. Only one manufacturer's IOLs met all specifications, and on statistical analysis demonstrated good manufacturing process control with respect to the properties tested. With the widespread acceptance of IOL implantation in developing countries, such as India, it is essential that in the rush to make this the norm, the quality of implants used not be overlooked.
Childhood cataracts
Authors: Chia Wei‐Lin A , Martin Frank 
Published: September 2003

ABSTRACT Objective: The aim of this study was to determine the surgical outcome of childhood cataracts. Method: Between 1990 and 1997, 137 patients less than 10 years of age (181 eyes) underwent cataract surgery at the Royal Alexandra Hospital for Children/New Children's Hospital. Data were collected retrospectively from medical records and supplemented with data from referring ophthalmologists. Results: In the majority of patients (53.0%), the cause of cataract was unknown. Sixty‐two patients (45.3%) had bilateral and 75 patients (54.7%) had unilateral cataracts. In 84 patients (107 eyes; 59.1%), the onset of visually significant cataract was estimated to be before the age of 2 years. Reliable postoperative visual acuity (VA) was obtained in 150 eyes from 116 patients. The mean LogMAR VA was 0.71 ± 0.55 in bilateral cataracts and 1.17 ± 0.68 in unilateral cataracts. Visual acuity was poor (LogMAR VA > 1.0) in 71.8% of unilateral cataracts (compared to 27.9% in bilateral cataracts, P < 0.0001), and in 64.9% when onset was less than 2 years (compared to 22.4% in later onset cataract, P < 0.0001). Posterior capsular opacity requiring laser or surgical removal was noted in 40 patients (44 eyes; 24.4%). Other complications included raised intraocular pressure in six patients (seven eyes; 3.7%), displaced intraocular lens or iris capture in 11 patients (12 eyes; 6.6%), ectopic pupil in five patients (five eyes; 2.7%), and severe inflammation in eight patients (12 eyes; 6.6%). There was cosmetically significant esotropia or exotropia in 24 patients (23 eyes; 12.7%). Conclusion: The prognosis for vision was significantly poorer in unilateral and earlier onset cataract. The importance of early diagnosis, prompt treatment and vigilant postoperative follow up in this subgroup cannot be over‐emphasized.
Fatigue crack nucleation and growth in filled natural rubber
Authors: MARS W. V. , FATEMI A. 
Published: September 2003

ABSTRACTRubber components subjected to fluctuating loads often fail due to nucleation and the growth of defects or cracks. The prevention of such failures depends upon an understanding of the mechanics underlying the failure process. This investigation explores the nucleation and growth of cracks in filled natural rubber. Both fatigue macro‐crack nucleation as well as fatigue crack growth experiments were conducted using simple tension and planar tension specimens, respectively. Crack nucleation as well as crack growth life prediction analysis approaches were used to correlate the experimental data. Several aspects of the fatigue process, such as failure mode and the effects of R ratio (minimum strain) on fatigue life, are also discussed. It is shown that a small positive R ratio can have a significant beneficial effect on fatigue life and crack growth rate, particularly at low strain range.
Axial fatigue of a gas‐nitrided quenched and tempered AISI 4140 steel: effect of nitriding depth
Authors: LIMODIN N. , VERREMAN Y. , TARFA T. N. 
Published: September 2003

ABSTRACTFatigue testing under fully reversed axial loading (R=−1) and zero‐to‐tension axial loading (R= 0) was carried out on AISI 4140 gas‐nitrided smooth specimens. Three different treatment durations were investigated in order to assess the effect of nitriding depth on fatigue strength in high cycle fatigue. Complete specimens characterization, i.e., hardness and residual stresses profiles (including measurement of stabilized residual stresses) as well as metallographic and fractographic observations, was achieved to analyse fatigue behaviour. Fatigue of the nitrided steel is a competition between a surface crack growing in a compressive residual stress field and an internal crack or ‘fish‐eye’ crack growing in vacuum. Fatigue life increases with nitriding depth until surface cracking is slow enough for failure to occur from an internal crack. Unlike bending, in axial fatigue ‘fish‐eye’ cracks can initiate anywhere in the core volume under uniform stress. In these conditions, axial fatigue performance is lower than that obtained under bending and nitriding depth may have no more influence. In order to interpret the results, special attention was given to the effects of compressive residual stresses on the surface short crack growth (closure effect) as well as the effects of internal defect size on internal fatigue lives. A superimposed tensile mean stress reduces the internal fatigue strength of nitrided steel more than the surface fatigue strength of the base metal. Both cracking mechanisms are not equally sensitive to mean stress.
Dialogue and decision in a moral context
Authors: Ipperciel Donald 
Published: September 2003

AbstractOne of the most widely accepted tenets in postmetaphysical normative ethics is the principle of dialogue as a foundational authority. Conceptually, the dialogical model is valuable, in that it allows a binding yet mutable underpinning of moral discourse. However, dialogue has its limits. The main drawback lies in the fact that deliberations can be very lengthy, perhaps even infinite. In other words, deliberation does not always lend itself to action. From the vantage point of applied ethics, in this case, bioethics and forensic ethics, this is not a minor shortcoming since these disciplines are concerned with situations involving some sort of urgency. Aporia is not an option in most cases. It is thus pressing to consider the moment of decision inherent to moral judgement and action that puts an end to dialogue. From the realm of abstract norm justification, one must move on to the contextualist discourse of application. To be rational, however, decision must avoid authoritativeness or any type of arbitrariness. What, then, could serve as a reasonable criteria for the rational application of norms? What aspects should be envisaged for a sound reflective decision? This paper will attempt to sketch some answers that could contribute to the question of the necessary contextual application of accepted norms by paying heed to, systemizing and sometimes finding fault in the arguments given by judges who had to settle cases touching sensitive moral issues.
Researching nursing practice: does person‐centredness matter?1
Authors: McCormack Brendan 
Published: September 2003

AbstractPerson‐centredness is common speak in nursing and health care literature. Increasingly there is an expectation that practitioners adopt person‐centred principles in their practice and organizations are expected to respect the values of the service user. However, in the research methodology literature, there is little explicit attention paid to the concept of person‐centredness in research practice. Instead, there continues to be a reliance on traditional ‘ethical principles’ to guide effectiveness in research work. This paper argues that the principles of person‐centredness that are espoused in nursing practice should also underpin nursing and health care research. A framework for person‐centred research is proposed and issues concerning its implementation in practice are discussed.
Language deterioration in four Japanese–Portuguese bilingual patients with Alzheimer's disease: a trans‐cultural study of Japanese elderly immigrants in Brazil
Authors: MEGURO Kenichi , SENAHA Mirna LH , CARAMELLI Paulo , ISHIZAKI Junichi , CHUBACCI Rosa YS , MEGURO Mitsue , AMBO Hideo , NITRINI Ricardo , YAMADORI Atsushi 
Published: September 2003

AbstractBackground:  Bilingualism is an area of linguistics that has been investigated in aphasic patients. However, bilingualism and Alzheimer's disease (AD) have not been fully investigated despite the fact that language impairment is a frequent symptom of AD. Brazil has the greatest number of Japanese immigrants and, consequently, there are many bilingual people who are fluent in both Japanese and Portuguese in Brazil.Methods:  Using the results from a previous epidemiological survey, we found four AD patients who were fluent in both Japanese and Portuguese before developing AD, and performed the following evaluations in both languages: confrontation naming, oral reading ability, vocabulary comprehension (matching words and drawings), written lexical decision and the Western Aphasia Battery (WAB).Results:  All patients demonstrated impaired naming ability in both languages. Oral reading ability was most impaired in the case of Kanji, followed by irregular words in Portuguese. The patients could recognize and pronounce Kana perfectly, and regular Portuguese words almost perfectly. In the severest case, the patient showed disturbed lexical comprehension and lexical decision, especially when faced with Kanji. The WAB classified three patients as having anomic aphasia in both languages, whereas in the severest case the patient was classified as having anomic aphasia in Portuguese and Wernicke aphasia in Japanese.Conclusion:  These results may reflect different patterns in language deterioration as AD progresses, with Kanji being more readily affected by the disease than Kana and Portuguese. This is the first study to focus on Japanese–Portuguese bilingualism in AD patients.
Clinical experience of quetiapine in 24 elderly patients with delirium
Authors: OMURA Keiko , AMANO Naoji 
Published: September 2003

AbstractBackground:  A recent study reported that patients with delirium responded well to the administration of atypical antipsychotic agents. In the present study we administered quetiapine to patients with delirium and obtained good results.Methods:  This study included 24 patients (10 men, 14 women), referred to the psychiatry department during admission to other hospital departments, who were diagnosed as having delirium according to the diagnostic and statistical manual of mental disorders (4th edition) (DSM‐IV) between April 2001 and September 2002. The mean age of the patients was 76.5 years (men 71.0 years; women 80.5 years). An initial dose of quetiapine was established at 25–50 mg/day. Depending on the symptoms, the dose and frequency were increased as required. According to Trzepacz's delirium rating scale (DRS), the treatment response was evaluated prior to the administration of quetiapine and 1, 3, 5 and 7 days after administration began.Results:  Prior to the administration of quetiapine, the mean DRS score was 18.1. The mean scores were 12.2, 10.8, 9.7 and 8.9 after 1, 3, 5 and 7 days of quetiapine administration, respectively. These values were significantly lower than the value before administration (P < 0.001). Seven days after the administration of quetiapine commenced, the total DRS score was lower than the cutoff point (12) in 20 patients (83.3%). In 18 patients (75.0%), delirium was clinically relieved. Doses ranged from 25 mg/day to 125 mg/day, with a mean dose of 54.7 mg/day. With respect to the administration method, the majority of patients (i.e. 13 patients) received quetiapine once per day (after dinner). Somnolence was observed in three patients as a side‐effect of quetiapine administration. However, this side‐effect improved after 1–2 days, without decreasing the dose.Conclusions:  Quetiapine may be useful for controlling delirium and concerning side‐effects and extrapyramidal symptoms were not recorded in the present study. Thus, it is appropriate to trial quetiapine in the treatment of delirium.
Visual motor gestalt task indicates that ‘deficit schizophrenics’ become severely disturbed with age
Authors: TATEYAMA Masato , TAKEDA Ryutaro , TOKUNO Motoharu , HASHIMOTO Motohide , FUKUKAWA Yasuyuki , OSADA Hisao , UEMATSU Yoshinobu 
Published: September 2003

AbstractBackground:  ‘Deficit syndrome’ in people with schizophrenia is one of the primary negative symptoms that might be linked to organic brain changes. In the present study the visual motor gestalt functions of schizophrenics using the Bender–Gestalt test (BGT) were assessed.Methods:  Fifty‐eight chronic schizophrenics (DSM‐IV) were the subjects who took part in this study (26 men and 32 women with an average age of 53.5 years and a mean duration of illness of 31.4 years). We performed BGT and used the scoring system of Pascal–Suttell. At the same time patients’ symptoms were also rated using the brief psychiatric rating scale and the Simpson and Angus extrapyramidal symptom scale from Keio University. The subjects were also divided into ‘deficit’ and ‘non‐deficit’ groups according to the criteria of Carpenters et al. 1988.Results:  The mean total BGT score for all subjects was 48.2, which was midway between the scores for normal subjects and patients with organic brain diseases. The BGT score for subjects correlated significantly with age (rs = 0.44, P < 0.01). Although no significant difference in the total BGT scores existed between the ‘deficit’ and ‘non‐deficit’ groups, the correlation with age was more marked in the deficit subjects than in the non‐deficit subjects (rs = 0.725, P < 0.01 vs rs = 0.2705, P < 0.1). There also existed significant correlations between the BGT scores and the total scores of parkinsonism (rs = 0.265, P < 0.05). The multiple regression analysis of the BGT scores, nevertheless, revealed a higher correlation with age rather than parkinsonism scores of patients with schizophrenia, especially in the deficit group (β = 0.559, contribution = 31.8% vs β = 0.295, contribution = 9.1%).Conclusion:  Performance of the visual motor gestalt task revealed that deficit subjects become severely disturbed with age, suggesting that these individuals are more vulnerable to the brain aging process.
Stock Valuation and Learning about Profitability
Authors: Pástor Ľuboš , Pietro Veronesi 
Published: September 2003

AbstractWe develop a simple approach to valuing stocks in the presence of learning about average profitability. The market‐to‐book ratio (M/B) increases with uncertainty about average profitability, especially for firms that pay no dividends. M/B is predicted to decline over a firm's lifetime due to learning, with steeper decline when the firm is young. These predictions are confirmed empirically. Data also support the predictions that younger stocks and stocks that pay no dividends have more volatile returns. Firm profitability has become more volatile recently, helping explain the puzzling increase in average idiosyncratic return volatility observed over the past few decades.
Currency Orders and Exchange Rate Dynamics: An Explanation for the Predictive Success of Technical Analysis
Authors: Osler Carol L. 
Published: September 2003

AbstractThis paper documents clustering in currency stop‐loss and take‐profit orders, and uses that clustering to provide an explanation for two familiar predictions from technical analysis: (1) trends tend to reverse course at predictable support and resistance levels, and (2) trends tend to be unusually rapid after rates cross such levels. The data are the first available on individual currency stop‐loss and take‐profit orders. Take‐profit orders cluster particularly strongly at round numbers, which could explain the first prediction. Stop‐loss orders cluster strongly just beyond round numbers, which could explain the second prediction.