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Clinical trials seeking to delay or prevent the onset of type 1 diabetes (T1D) face a series of pragmatic challenges. Despite more than 100 years since the discovery of insulin, teplizumab remains the only FDA‐approved therapy to delay progression from Stage 2 to Stage 3 T1D. To increase the efficiency of clinical trials seeking this goal, our project sought to inform T1D clinical trial designs by developing a disease progression model‐based clinical trial simulation tool. Using individual‐level data collected from the TrialNet Pathway to Prevention and The Environmental Determinants of Diabetes in the Young natural history studies, we previously developed a quantitative joint model to predict the time to T1D onset. We then applied trial‐specific inclusion/exclusion criteria, sample sizes in treatment and placebo arms, trial duration, assessment interval, and dropout rate. We implemented a function for presumed drug effects. To increase the size of the population pool, we generated virtual populations using multivariate normal distribution and ctree machine learning algorithms. As an output, power was calculated, which summarizes the probability of success, showing a statistically significant difference in the time distribution until the T1D diagnosis between the two arms. Using this tool, power curves can also be generated through iterations. The web‐based tool is publicly available: https://app.cop.ufl.edu/t1d/. Herein, we briefly describe the tool and provide instructions for simulating a planned clinical trial with two case studies. This tool will allow for improved clinical trial designs and accelerate efforts seeking to prevent or delay the onset of T1D. [ABSTRACT FROM AUTHOR]

Clinical trials seeking type 1 diabetes prevention are challenging in terms of identifying patient populations likely to progress to type 1 diabetes within limited (i.e., short‐term) trial durations. Hence, we sought to improve such efforts by developing a quantitative disease progression model for type 1 diabetes. Individual‐level data obtained from the TrialNet Pathway to Prevention and The Environmental Determinants of Diabetes in the Young natural history studies were used to develop a joint model that links the longitudinal glycemic measure to the timing of type 1 diabetes diagnosis. Baseline covariates were assessed using a stepwise covariate modeling approach. Our study focused on individuals at risk of developing type 1 diabetes with the presence of two or more diabetes‐related autoantibodies (AAbs). The developed model successfully quantified how patient features measured at baseline, including HbA1c and the presence of different AAbs, alter the timing of type 1 diabetes diagnosis with reasonable accuracy and precision (<30% RSE). In addition, selected covariates were statistically significant (p < 0.0001 Wald test). The Weibull model best captured the timing to type 1 diabetes diagnosis. The 2‐h oral glucose tolerance values assessed at each visit were included as a time‐varying biomarker, which was best quantified using the sigmoid maximum effect function. This model provides a framework to quantitatively predict and simulate the time to type 1 diabetes diagnosis in individuals at risk of developing the disease and thus, aligns with the needs of pharmaceutical companies and scientists seeking to advance therapies aimed at interdicting the disease process. [ABSTRACT FROM AUTHOR]

The purpose was to investigate the effect of a school‐based physical activity (PA)‐intervention among 11‐ and 12‐year‐olds (6th‐ and 7th graders) across 4 years. Seven primary schools in Horten municipality in Norway received 45 min daily extra PA as part of the curriculum. The intervention started in 2015 with follow‐up in 2016–2019. The effect was measured after 1–4 years of participation, among the same children (6th to 7th grade) and among new children starting in 6th grade. Two control schools received no additional PA beyond the regular PA at school. The Self‐reported Strength and Difficulties Questionnaire (SDQ‐S) focusing on internalizing and externalizing difficulties were administrated. A statistical model for repeated measurements was used and adjusted for parents' educational level, sex, age, and waist‐to‐height ratio (WHtR). The significance level was p ≤ 0.01. In total, 1221 children completed the SDQ‐S. SDQ‐S scores were stable, and difficulties were relatively low. The control group had significantly lower SDQ‐S scores than the intervention group at start, indicating fewer difficulties. The adjusted effect within the intervention schools showed a borderline significant increase in total difficulty scores between 2018 and 2019 (mean difference: 1.02, 95% CI: −1.82, −0.23, p ≤ 0.01). Educational level showed a weak negative correlation with total difficulty score (r = −0.1). No significant change was reported within the control schools. Few psychosocial health problems among 11‐ and 12‐year‐olds were detected. The borderline increase in total difficulty score that was seen for the intervention schools, is believed to be of limited clinical relevance. [ABSTRACT FROM AUTHOR]

SUMMARY: Chloroplasts possess a considerably reduced genome that is decoded via an almost minimal set of tRNAs. These features make an excellent platform for gaining insights into fundamental mechanisms that govern protein expression. Here, we present a comprehensive and revised perspective of the mechanisms that drive codon selection in the chloroplast of Chlamydomonas reinhardtii and the functional consequences for protein expression. In order to extract this information, we applied several codon usage descriptors to genes with different expression levels. We show that highly expressed genes strongly favor translationally optimal codons, while genes with lower functional importance are rather affected by directional mutational bias. We demonstrate that codon optimality can be deduced from codon–anticodon pairing affinity and, for a small number of amino acids (leucine, arginine, serine, and isoleucine), tRNA concentrations. Finally, we review, analyze, and expand on the impact of codon usage on protein yield, secondary structures of mRNA, translation initiation and termination, and amino acid composition of proteins, as well as cotranslational protein folding. The comprehensive analysis of codon choice provides crucial insights into heterologous gene expression in the chloroplast of C. reinhardtii, which may also be applicable to other chloroplast‐containing organisms and bacteria. Significance Statement: This work provides new insights into codon usage bias in chloroplasts. It is crucial for codon optimization of heterologous genes and to understand gene regulation in chloroplasts. [ABSTRACT FROM AUTHOR]

With the increasing in frequency, intensity, and side effects of grid outages caused by weather based events, the importance of resiliency is also increased. This study presents a novel multi-objective optimization problem for improving the resilience of smart grid against natural disasters in the presence of a considerable amount of line outages occurring due to the weather conditions. The proposed model considers the management of distributed energy resources (DERs), energy storages (ESs), and dynamic topology reconfiguration of the distribution network. The main goal is based on a dynamic resilient operational planning using prediction of weather condition. The objectives in the proposed approach are defined as: to minimise operational cost of distribution network from the system operator's viewpoint, to minimise the penalty costs for energy not supplied and side effects of outages, and to maximise benefits of DER-ES owners by using flexible reconfiguration and dynamic operational planning considering weather conditions. A hybrid optimization algorithm based on genetic algorithm and ɛconstraint method using fuzzy decision maker is employed to choose the best solution from a provided Pareto optimal set. The outcome of the Pareto solution specifies the best scheduling for DERs, ESs and switching of lines during the scheduling horizon. [ABSTRACT FROM AUTHOR]

The European transmission system operators specify grid codes to ensure a safe and reliable operation of the electrical power system, even during grid faults. Wind power plants have to comply with such specific requirements prior to installation and operation. Some of the requirements, however, are open to interpretation, especially because of lack of specification, and therefore, they pose technical challenges to full-converter wind turbines. In fact, different interpretations leave it open to debate on whether a requirement can be fulfilled or not. The rise time requirement across some European grid codes is discussed in this paper. First the uncertainties in some transmission system operators' definitions of rise time, step response time and settling time are presented, and then a comparative analysis is performed among calculation methods, such as instantaneous reactive current in alpha-beta reference frame, direct and quadrature reference frame and root mean square of the positive sequence component. The comparison results of both ideal cases and randomly selected measurements from actual full-converter wind turbine field tests show that the rise time of the reactive current is significantly affected by the calculation methods. This effect in some cases can make the difference between fulfilling the requirement or not. As a result of that, it is highlighted in this paper the need for a common understanding of the rise time requirements between industry and system operators, based on clear technical fundamentals. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The need for European Network Codes (NCs) was identified during the course of developing the third legislative package for an internal EU gas and electricity market. The first NC that was initiated by the European Commission covers 'Requirements for Generators' (NC RfG) (ENTSO‐E, 2013). After an extensive debate and drafting process across TSOs, DSOs, manufacturers, generation owners, industrial consumers, NRAs and policy makers, ENTSO‐E finalised drafting the NC RfG in March 2013 (Further changes, especially with respect to the fault‐current injection by wind power plant (WPP) were introduced during the process of transferring NC RfG to a EU Regulation as result of the ongoing discussions between the European Commission and relevant stakeholders. See the remark in Section 3 'Outlook and Conclusion'.). European wind turbine manufacturers represented by EWEA participated strongly in the dialog with ENTSO‐E and the stakeholder consultation. A delicate exercise in developing the NC RfG was the appropriate balance between those aspects that need to be defined exhaustively at European level, and the non‐exhaustive connection requirements where further specifications are needed at regional level to cover local system needs. Although improvements were seen, significant concerns still remain with the current document, largely focused on the uncertainty from the many non‐exhaustive requirements and therefore having to wait for the national Grid Code processes for many parameters. This study explores the need for fault‐ride‐through capability from a power system security point of view. The requirements stated in the NC RfG, capabilities of WPPs and challenges related to the non‐exhaustive requirements of the NC RfG are presented and discussed with the intention to provide technical background information, which may support the national implementation of these requirements. [ABSTRACT FROM AUTHOR]

The article focuses on a research which explores the screening and diagnostic outcomes of the state-funded New South Wales Statewide Eyesight Preschooler Screening program for 4-year-old children. It mentions the importance of early detection and treatment to achieve optimal treatment outcomes for children with vision disorders. The methods used in the research are mentioned.

Background This paper reports on the aetiology and outcome of childhood open and closed globe eye injuries presenting to the Children's Hospital at Westmead, Sydney, Australia from January 2000 to December 2008. Design Hospital-based retrospective study. Participants Two hundred three cases of childhood eye injuries identified in a nine-year period, comprising 81 open globe and 122 closed globe injuries. Methods Hospital records were examined for demographic data and injuries were classified into open globe and closed globe, based on the Ocular Trauma Classification. Main Outcome Measures Parameters affecting the final visual outcome such as type of injury, zone of injury, initial visual acuity, wound length (only in open globe injuries) and lens injury were assessed. Results Most of the eye injuries resulted from the child poking itself or being poked accidentally (26%), with the home being the most common place of injury. A favourable visual outcome was noted with closed globe injuries as compared with open globe injuries ( P < 0.01). Parameters that indicated a poor visual outcome included globe ruptures, zone 3 injuries, poor initial visual acuity, wound length >10 mm and lens trauma. Final visual acuity of 6/12 or better was observed in 68% of injured eyes. Conclusions This study demonstrated improved visual outcomes when compared with previous studies. However, many unsalvageable childhood eye injuries with little useful vision were evident, and most disconcerting is that the majority of childhood eye injuries in this study were preventable. [ABSTRACT FROM AUTHOR]

Background: Propranolol is a novel therapeutic agent in the treatment of cutaneous infantile haemangiomas. We assessed the effect of propranolol therapy in infantile haemangiomas of the orbit. Methods: A case series of four patients with orbital infantile haemangiomas were referred for management in our tertiary referral hospitals. Two of the patients had inadequate responses to prior corticosteroid therapy. One of the patients was commenced on propranolol at 2.5 years of age when the lesion was not in the proliferative phase. This represented the first case report of propranolol treatment for infantile haemangioma outside infancy. The other three children were in their infancy when propranolol was commenced. The patients were treated with oral propranolol. Results: All patients had significant improvement in their physical appearance, ocular examination findings and size of their lesions on radiological evaluation. No side-effects of propranolol treatment were observed. Conclusions: Propranolol is a promising treatment against infantile haemangiomas in the orbit, not only in infants but also in an older child with a stable lesion. [ABSTRACT FROM AUTHOR]

Purpose: To characterize the ophthalmic features and causes of visual loss in a cohort of Melanesians living in New Caledonia with nanophthalmos. Methods: In this observational study, axial length, visual acuity (VA), cycloplegic autorefraction were assessed and dilated fundus examination was performed. Visual impairment was defined as VA < 6/12 in the better eye, hypermetropia as >+1.0 dioptre (D), astigmatism as ≥1.0 D and anisometropia as ≥1.0 D difference between both eyes. Unilateral amblyopia was defined as at least a two-line difference in VA between both eyes and bilateral amblyopia as VA < 6/12 in both eyes which was not adequately explained by refractive error and macular folds. Results: Seventeen community-dwelling participants (aged 1.1–45.3 years) with short axial length (range from 16.1 to 21.6 mm) were identified. Of the 17 subjects, 14 were found to have crowded optic discs, three with papillomacular folds, three with a papillomacular band and three with macular radial folds. Further, all subjects demonstrated bilateral hypermetropia (range from +1.3 D to +15.1 D). A high proportion of subjects had astigmatism (12) and anisometropia (nine) in at least one eye. Visual impairment was found in nine subjects: five bilateral and four unilateral. Causes of visual impairment included amblyopia (seven), ametropia (seven) and macular folds (two). Amblyopia was attributed to several factors, including hypermetropia, anisometropia, astigmatism and esotropia. Conclusions: In this sample of Melanesians with nanophthalmos, a spectrum of ophthalmic features that was consistent with intraocular crowding was found. Over half of the subjects were visually impaired, mostly due to amblyopia and ametropia. Further characterization of the underlying genetic cause of nanophthalmos in this cohort will be the focus of future studies. [ABSTRACT FROM AUTHOR]

Background: To report the 31-year experience of outcomes in retinoblastoma from a single centre. Methods: A retrospective analysis of consecutive cases of retinoblastoma diagnosed and treated at the Westmead Children’s Hospital, Sydney between 1974 and 2005 was performed. The subjects were analysed as two groups: those diagnosed between 1974 and 1989 (series α) and those diagnosed between 1990 and 2005 (series β). Results: There were a total of 142 patients included in the study, with a median follow up of 72 months. There were 84 patients with unilateral disease and 58 patients (116 eyes) with bilateral disease. The total enucleation rate remained high throughout both series for those with unilateral disease: 89% (series α) and 95% (series β). There was a reduction in enucleations performed for those with bilateral disease from 68.4% (series α) to 43.6% (series β) ( P < 0.025). There were no bilateral enucleations performed after 1995. Actuarial Kaplan–Meier curves showed that 56% of all preserved eyes had not recurred at a median follow up of 95 months and 78.1% had avoided enucleation. Overall 43% of preserved eyes attained a visual acuity better than or equal to 6/12 and 55% achieved a visual acuity better than 6/60. There were four deaths due to retinoblastoma. Five patients were diagnosed with a second non-ocular malignancy. The most common treatment-related complications were cataracts, facial deformity, sepsis and febrile neutropaenia. Conclusions: The introduction of newer globe-preserving treatments for retinoblastoma was associated with equivalent visual outcomes, stable mortality rate and a greater number of short-term complications but avoided the late side-effects associated with external beam radiotherapy. [ABSTRACT FROM AUTHOR]

Background: To assess the prevalence and causes of visual impairment in patients with craniosynostotic syndromes of Apert, Crouzon, Pfeiffer, Saethre–Chotzen and craniofrontonasal dysplasia. Methods: The medical records of patients who attended the Craniofacial Clinic at two large paediatric hospitals in Sydney, Australia between 1983 and 2004 were retrospectively reviewed. Presenting visual acuity (VA) was assessed using tests appropriate to age and cognition: ‘fix and follow’ in infants (<18 months old), Teller card acuity in preverbal children (18 months to less than 3 years old), Kay picture test or Sheridan–Gardiner test in children aged between 3 and less than 6 years and Snellen chart in those aged 6 years or older. Visual impairment was defined as the inability to fix and follow or presenting VA < 6/12 in the better eye. Amblyopia was defined as a two-line difference in VA between both eyes in the absence of an organic eye disease. Results: Sixty-three patients with craniosynostotic syndromes were identified, of whom 55 had VA assessed at the first visit. Of these 55, 19 (35.5%) had bilateral visual impairment and 5 (9.1%) had unilateral visual impairment. Causes of visual impairment include amblyopia (16.7%), ametropia (25%), optic atrophy (16.7%) and exposure keratopathy (4.2%). Risk factors for amblyopia include strabismus (43.3%), astigmatism (≥1.5 dioptres) (39.5%), hypermetropia (18.4%) and anisometropia (≥1.5 dioptre difference between both eyes) (15.8%). Six of the 63 patients (9.5%) had papilloedema; those who were followed up showed gradual resolution of papilloedema following timely decompressive surgery. Conclusions: A high prevalence of visual impairment in patients with craniosynostotic syndromes was found, almost half of them due to potentially correctable causes, including amblyopia and ametropia. Optic atrophy remains an important cause of visual impairment. Further studies are needed to assess the timing and efficacy of intervention for modifiable causes of visual loss in craniosynostotic syndromes. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to retrospectively review uveitis cases at The Children's Hospital at Westmead, Sydney, since its inception in 1997 to 2001, including patients presenting at the Camperdown, Sydney, campus between 1989 and 1997 attending Westmead for further care. Comparison is made with international centres.Methods: Information was obtained from medical records.Results: Forty patients (53 eyes) presented, of whom 23 (57.5%) were female and 17 (42.5%) were male (mean age 6.7 years). Of 53 eyes, 35 (66%) had anterior uveitis, three (5.7%) intermediate uveitis, seven (13.2%) posterior uveitis and eight (15.1%) panuveitis. Twenty-seven (67.5%) patients had disease unilaterally and 13 (32.5%) bilaterally. Twenty-four (60%) cases were idiopathic. Seven (17.5%) cases were associated with juvenile rheumatoid arthritis, three (7.5%) with herpes zoster, two (5%) with herpes simplex, two (5%) with toxocara, one (2.5%) with toxoplasma, and one (2.5%) with ulcerative colitis. Complications included cataract in 14 (26.4%) eyes; band keratopathy in four (7.5%) eyes; macular scarring in three (5.7%) eyes; and glaucoma in four (7.5%) eyes. Last measured acuity was 6/6 for 19 (35.8%) eyes,≤6/18 for 15 (28.3%) eyes and<6/60 for eight (15.1%) eyes.Conclusions: Despite small numbers, the comparisons of this study with some international studies, and its contrasts with other studies, are due to similarities and differences amongst these studies with respect to factors of referral bias, and the aetiological basis of disease. [ABSTRACT FROM AUTHOR]

Aim: To review presenting ages, referral sources, amblyopia type and treatment compliance in children attending a typical public hospital ophthalmology clinic with no formal amblyopia screening program in place. Methods: One hundred and twenty-seven children attending the outpatients clinics of The Children's Hospital at Westmead for amblyopia management between January 2001 and May 2003 were reviewed. Presenting age, amblyopia type, referral source, treatment prescribed and compliance achieved were analysed using means, 95% confidence intervals (CI), and Mantel−Haenszel χ2 statistic. Results: General practitioners and paediatricians provided most referrals. The mean presenting age was 32.9 (95% CI 29.0−36.9) months. There was no significant association between presenting age and amblyopia type (χ2 = 6.00, P = 0.11, d.f. = 3), but a trend was found with deprivation amblyopia identified earliest, and pure anisometropic amblyopia identified latest (χ2 = 5.65, P = 0.02, d.f. = 1). Compliance to patching did not differ significantly between sexes, with calculated aggregate compliance of 67.3% (95% CI: 59−75%) for boys and 66.3% (95% CI: 60−73%) for girls. Compliance to patching also did not differ significantly between amblyopia types (χ2 = 3.61, P = 0.3, d.f. = 3). Compliance was best among younger and older children, and worst among those aged 15−30 months. There was no association between patching compliance and treatment duration. Conclusion: Amblyopia is a preventable form of blindness. A multidisciplinary approach must be taken. Resources and education should be targeted at general practitioners and paediatricians who have the greatest opportunities to perform amblyopia screening. Teachers are an important resource in identifying cases missed at previous informal screening opportunities. Amblyopia treatment must be intensified and individualized between the ages of 15−30 months when compliance is poorest. [ABSTRACT FROM AUTHOR]

Abstract Background: Contact lenses play an important role in the management of childhood aphakia. However, the use and care of the lenses can be challenging. The aim of this study was to determine how parents coped and what problems they encountered. Methods: Thirty-one families of aphakic children who were fitted with contact lenses between 1990 and 1997 were contacted and invited to participate in a telephone survey. Results: Thirty families agreed to participate. Eighteen families (60%) were still using contact lenses successfully at the time of the study. Four families (13.3%) stopped using contact lenses within a year because of overwhelming difficulties handling the lenses. There was an initial learn­ing process that was often stressful and frustrating. The learning curve lasted from 1 to 24 months (first quartile 2.0 months; median 3.3 months; third quartile 15.0 months). The personality of the parent, temperament of the child and the frequency at which problems occurred may all have contributed to how each family coped with the lenses. Common initial problems included inserting the lenses into the eyes of an uncooperative child and the loss of lenses. Other problems included irritation associated with dryness, and the financial cost of maintaining the lenses. Conclusion: Although most parents initially found contact lenses daunting, 70% of families surveyed eventually learned to cope well. Parents felt that proper education of both parents and children on why the lenses were required, a good appreciation of problems that may occur, a strong social support network and adequate financial aid were important factors in learning to cope. [ABSTRACT FROM AUTHOR]

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 (LogMARVA > 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 overemphasized. [ABSTRACT FROM AUTHOR]

Purpose: To determine the visual and cosmetic outcome following the surgical correction of isolated congenital ptosis. Methods: A retrospective review of the outcome of isolated congenital ptosis corrected under the supervision of one surgeon at The Children's Hospital, Camperdown, between January 1983 and January 1993 was examined. Some 65 patients with 80 involved eyes were identified; 30 eyes underwent a levator resection procedure, 40 eyes underwent a brow suspension using donor stored fascia lata, and in 10 eyes a brow suspension was performed using mersilene mesh. Results: In 78 eyes of 63 patients, a good cosmetic result was achieved. In two patients (two eyes) a poor cosmetic result was achieved. These two patients refused further surgery following an undercorrection of their initial ptosis. The recurrence rates for the primary procedures were 16.7% for levator resection procedures, 35% for brow suspension procedures using donor fascia lata, and 30% for brow suspension surgery using mersilene mesh. Some 35.3% of eyes following mersilene slings required further surgery for granulomas and exposed mersilene mesh compared with 6% having similar complications with stored fascia lata. Nine patients (11.25%) had reduced visual acuity (one line or more on the Snellen chart or its equivalent with the other tests used) on the operated side. Only one patient was found to have significant astigmatism. Conclusions: An acceptable cosmetic result was achieved with one operation in 75.3% of cases. In 20.8% of cases a second operation was required and in 3.9% of cases three or more operations were required. This series supports the view that where possible, levator resection is the preferred form of surgery to correct congenital ptosis. When the levator function is inadequate, brow suspension is performed. The use of donor fascia lata resulted in a good cosmetic appearance with a low occurrence of surgical side effects. Amblyopia, when strictly defined, occurred in 11.25% of eyes despite early surgery for severe cases and intensive amblyopia therapy. Management requires repeated follow up for early detection and introduction of occlusion therapy or surgical ptosis correction. [ABSTRACT FROM AUTHOR]

Fifty patients born with congenital rubella in 1939-1945 were reviewed in 1967. In 1991 this cohort was again studied and their ophthalmic features are presented here. The presence of two new cataracts and one case of possible choroidal neovascularisation are again noted; apart from these three eyes, the group showed no evidence of other delayed manifestations of the congenital rubella syndrome. A review is given of the ocular complications of the congenital rubella syndrome, with particular emphasis on the late complications. [ABSTRACT FROM AUTHOR]

A rare case of primary congenital ectropion of all 4 eyelids in a child with Down's syndrome is reported to emphasise the problems of surgical management and to distinguish the condition from congenital eversion of the eyelids. Congenital ectropion is associated with other eyelid abnormalities and usually requires surgical measures to protect the cornea in contrast to congenital eversion which is characterised by the protrusion of oedematous conjunctiva from everted eyelids. This usually resolves spontaneously with simple supportive measures and no structural or functional eyelid abnormality remains. [ABSTRACT FROM AUTHOR]

A study was made of 112 children with preseptal cellulitis, orbital cellulitis, subperiosteal abscess, and orbital abscess. These were consecutive admissions to the Royal Alexandra Hospital for Children, Sydney, during the period June 1976 to August 1985. The average age was 3 years 6 months. The clinical and radiological signs for each group were defined. Of the 112 children, 43.8% (with an average age of 3 years 3 months) had a clinical history of an upper respiratory tract infection. Trauma was a factor in 13.4% of patients. Haemophilus influenzae was recovered from blood culture in two patients and from conjunctival culture in seven patients. The average age of this group was 3 years 7 months. Plain radiographs taken of 53 patients revealed evidence of paranasal sinus disease in 29 (54.7%). Computerized tomography was performed in 14 patients. Of seven patients requiring surgical drainage of orbital or subperiosteal abscess (average age 7 years 2 months), five had clinical upper respiratory tract infection. [ABSTRACT FROM AUTHOR]

Previous research has found that greater autonomy for incarcerated adolescents associated with pro-social outcomes. The present paper interprets the pro-social impact of autonomy in terms of three established lines of research in social psychology: leadership style, coercive social control, and reactance. In addition, it attempts to clarify whether autonomy in this setting has a direct influence on residents' values or an indirect influence resulting from an increase in residents' acceptance of the treatment goals. Data were collected by questionnaires administered to 434 residents and 156 staff members at four residential institutions for adjudicated adolescents. The data were analyzed using a structural equation model with unobserved variables (LISREL). A model positing both direct and indirect influences of autonomy fit the data very well. Autonomy contributed to pro-social values both through greater acceptance of the treatment goals as well as through a direct influence on values. [ABSTRACT FROM AUTHOR]

Expanded measures of government product normally include imputations for the services of government capital. This article discusses several approaches to measuring the value of the services of government capital and focuses on the conceptual and empirical difficulties associated with making such imputations. In addition, four sets of alternative estimates for 1948-79 are presented. [ABSTRACT FROM AUTHOR]

A 14-year-old boy presented with a 6-month history of bilateral slowly enlarging conjunctival lesions. There was no associated ocular or systemic symptomatology. Examination revealed bilateral salmon-coloured nodular lesions of the bulbar conjunctiva. The remainder of his ophthalmic and general examinations were normal. Extensive investigation excluded regional or systemic involvement. Excision biopsy of the lesions showed a predominantly mature B lymphocyte infiltrate with immunohistochemistry and flow cytometry consistent with reactive lymphoid hyperplasia. Polymerase chain reaction testing for Epstein–Barr virus was negative. At 2 years follow-up, the patient remained healthy and there was no evidence of recurrence. Benign lymphoid hyperplasia of the conjunctiva with bilateral involvement is extremely rare in children. Only a few case reports have been documented in the literature. [ABSTRACT FROM AUTHOR]

There have been nine previously reported cases of intraocular lacrimal gland choristoma. This case report is of an infant with an intraocular lacrimal gland choristoma which was managed conservatively for a 19-month period until the onset of glaucoma. Tumour biopsy was initially performed because until this time the tumour's behaviour suggested it was not malignant. The latter was confirmed on biopsy, however hypotony resulted following the surgical intervention. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Epidemiology of traumatic head injury from a major paediatric trauma centre in New South Wales, Australia" by J. E. Amaranath and colleagues in the previous issue.

Editorial. Comments on the lecture of ophthalmologist David Moran on the high cost of prosthesis, especially intra-ocular lenses. Consequence of ignoring the substantial cost for an international company to bring a product to market; Views on the high pricing and unreasonable markups and profits within the Australian prosthetics industry.