bluuebunny/crossref_metadata_2025 huggingface dataset:
Antimicrobial activities of heparin‐binding peptides
Authors: Andersson Emma , Rydengård Victoria , Sonesson Andreas , Mörgelin Matthias , Björck Lars , Schmidtchen Artur
Published: March 2004

Antimicrobial peptides are effector molecules of the innate immune system. We recently showed that the human antimicrobial peptides α‐defensin and LL‐37 bind to glycosaminoglycans (heparin and dermatan sulphate). Here we demonstrate the obverse, i.e. structural motifs associated with heparin affinity (cationicity, amphipaticity, and consensus regions) may confer antimicrobial properties to a given peptide. Thus, heparin‐binding peptides derived from laminin isoforms, von Willebrand factor, vitronectin, protein C inhibitor, and fibronectin, exerted antimicrobial activities against Gram‐positive and Gram‐negative bacteria. Similar results were obtained using heparin‐binding peptides derived from complement factor C3 as well as consensus sequences for heparin‐binding (Cardin and Weintraub motifs). These sequence motifs, and additional peptides, also killed the fungus Candida albicans. These data will have implications for the search for novel antimicrobial peptides and utilization of heparin–protein interactions should be helpful in the identification and purification of novel antimicrobial peptides from complex biological mixtures. Finally, consensus regions may serve as templates for de novo synthesis of novel antimicrobial molecules.
Effect of Time of Spraying of Fungicide and Foliar Nutrient on Soybean Powdery Mildew
Authors: Yorinori M. A. , Klingelfuss L. H. , Paccola‐Meirelles L. D. , Yorinori J. T.
Published: March 2004

With the objective of determining the effects of initial infection level (% leaf area infected, % l.a.i.) at the time of fungicide and foliar nutrient application for the control of powdery mildew, a study was carried out under greenhouse conditions at Embrapa Soja, Londrina, P.R. The fungicide tebuconazole (100 g a.i./ha/application) and sulphur fungicide (2.0 kg a.i./ha/application), sprayed at 20, 30, 40 and 50% l.a.i. (growth stages V3 and V5, between R5.1 and R5.3), and three applications (at V3, V4 and R5.1, beginning at 20% l.a.i.) of tebuconazole were compared with sulphur foliar nutrient (sulphur at the dose of 125 g a.i./ha/application). The highly susceptible BR‐16 cultivar was used in a completely randomized design with 11 treatments, five replications (pots) and five plants per pot. The parameters evaluated were: % l.a.i., % yellowing leaf when the control reached growth stage R7.2 (between 50 and 75% yellow/mature leaves), % defoliation (% defol.) when the control plants reached R8.2 (pre‐harvest maturity), number of pods and seeds and seed weight (s.w.) per plant. The area under the disease progress curve (AUDPC) was determined based on disease progress. The % l.a.i. and AUDPC of the control (98% and 65.41) differed from other treatments (3.5–64.2% l.a.i. and 13.57–40.59 AUDPC). The % l.a.i. for the sulphur fungicide treatment (41.9–64.2%) and sulphur foliar nutrient (49.8%) were greater than for tebuconazole (3.5–28%). The % defol. of the control (90%) differed from tebuconazole applied at 30% initial infection (48%), with three applications (45%), and from sulphur foliar nutrient (47%). The s.w./plant of the control (2.23 g) was lower than that of tebuconazole treated at 40% IL (3.03 g) and at 20% IL (3.35 g) and for sulphur foliar nutrient (3.7 g). The initial disease severity (20–50% l.a.i.) did not affect the level of powdery mildew control and the sulphur foliar fertilizer resulted in greater number and higher s.w./plant.
Effect of Chestnut Ink Disease on Photosynthetic Performance
Authors: Gomes‐Laranjo J. , Araújo‐Alves J. , Ferreira‐Cardoso J. , Pimentel‐Pereira M. , Abreu C. G. , Torres‐Pereira J.
Published: March 2004

In order to evaluate the evolutionary impact of chestnut ink disease, infected trees (cv. Judia), were compared with non‐infected trees, in three separate months: July, September and October. The aim of this work is to analyse the effects of the infection using parameters related to plant water relations, gas exchange and biometric data of leaves and fruits. In this period, temperatures decreased from 31 to 16°C contrarily to precipitation, which increased from 18 to 178 mm, respectively. In consequence, leaf water potential changed between −1.6 and −1.0 MPa while in infected plants the values maintained around −1.2 MPa over the referred period. Nevertheless, at the gas exchanges level, differences in stomatal conductance, transpiration and photosynthesis were only detected in October. Concerning photosynthesis rate, the infected plants showed, in relation to September, a reduction around 35% whereas in non‐infected plants the decline was 25%. Alterations in the chlorophyll contents were also observed between September and October. In infected plants reduction on total amount of chlorophyll was from 18.6 to 13.4 mg/Wf, while in non‐infected plants values were only decayed from 15.1 to 13.1 mg/Wf. In relation to chlorophyll a/chlorophyll b ratio, plants infected by the oomycete preserved values in the level of 2.6, whereas in healthy plants values changed from 2.5 to 2.3. Leaves and fruits from infected chestnut trees were 13 and 20% smaller, respectively than those from non‐infected. Fruits from infected plants also had less starch but more crude protein.
Epidemiology of Pseudomonas syringae Pathovars Associated with Decline of Plum Trees in the Southwest of Germany
Authors: Hinrichs‐Berger J.
Published: March 2004

Plum decline was associated with Pseudomonas syringae pathovars syringae and morsprunorum in Baden‐Württemberg. The trunks of affected plum trees (Prunus domestica) were girdled by bacterial cankers resulting in sudden death of infected trees. Copper compounds that were applied extensively during leaf fall and bud burst, were not effective. A minority of P. syringae strains isolated from cankers on plum trees were moderately resistant, while most strains were sensitive to cupric ions. Invasions through blossoms, leaves and wounds during the vegetation period were limited to the infection sites and plum trees coped effectively with both P. syringae pathovars eliminating them eventually. Infections after dormancy including very rare leaf scar infections did not induce cankers on the trunk. However, infections of dormant trees through frost injuries, (pruning) wounds or non‐injurious ingress by freezing and thawing were serious, because they led to cankers girdling the trunk. Control strategies to manage plum decline have to be adapted to the disease cycle. They should concentrate on the dormant period beginning with early frosts in autumn and ending with bud burst.
Assessment of the Seedling Reactions of Turkish Barley Cultivars to Scald
Authors: Mert Z. , Karakaya A.
Published: March 2004

The reactions of 37 cultivars and two candidate lines of barley to five isolates of Rhynchosporium secalis and their mixtures were determined in assays under greenhouse conditions. Fungal isolates were collected from Ankara province and surrounding areas in Turkey. There were clear differences in the reactions of the cultivars to the fungal isolates and isolates differed in pathogenicity for each cultivar. Of all genotypes tested, seven cultivars (cvs Erginel 90, Şahin 91, Kıral 97, Akhisar 98, Çetin 2000, Çumra 2001, Avcı 2002) and one candidate line (candidate 4) were found to be resistant to all isolates and their mixtures. A5 was found to be the most virulent fungal isolate.
Factors Affecting Survival of Clavibacter michiganensis subsp. sepedonicus in Water
Authors: van der Wolf J. M. , van Beckhoven J. R. C. M.
Published: March 2004

The survival of Clavibacter michiganensis subsp. sepedonicus (Cms), the causal organism of bacterial ring rot in potato, was studied in water, to assess the risks for dissemination of Cms via surface water and infection of potato crops by irrigation. Cms was able to survive for a maximum period of 7 days in non‐sterile surface water at 10°C, a period during which Cms can be transported over long distances, but will also be strongly diluted. It is concluded that contamination of surface water with Cms can pose a threat on potato production only if aquatic host plants can multiply Cms in high densities. Survival of a fluidal and non‐mucoid strain was also studied in sterile ditch water and simulated ‘drainage water’, in sterile MilliQ water, in tap water, in physiological salt and in artificial xylem fluid. In addition, the influence of temperature and low oxygen conditions on persistence of Cms in some of these diluents was studied. A maximum survival period of 35 days was found for Cms in sterile tap water at 20°C, independent of the strain used. In the other diluents survival periods ranged between 0 and 21 days. Relatively poor survival was found in MilliQ water and artificial xylem fluid. Low temperatures of 4°C do not favour survival as it does in soil. Oxygen depletion affected survival detrimentally. Survival periods determined by agar dilution plating and a direct viable counting method, based on the use of indicators for esterase activity and membrane integrity were similar. Therefore, it was concluded that under the experimental conditions studied, Cms did not form cells in a viable but non‐culturable state.
Scanning Electron Microscopy on the Perithecial Development of Phyllactinia corylea on Mulberry‐II. Sexual Stage
Authors: Kumar Vineet , Gupta V. P.
Published: March 2004

Development of perithecia of Phyllactinia corylea (Pers.) Karst. on mulberry (Morus spp.) leaves was examined by scanning electron microscopy. Two short specialized structures, antheridium and ascogonium, emerged from two separate hyphae, were fused with each other and developed into an egg‐shaped perithecial primordia. These primordia later developed into globose immature perithecia, which covered with protruded wall cells with clear margins. A large number of hyphae emerged from near the base of globose perithecia, which radiated on the leaf surface and thus helped the perithecia to fix to the surface. Specific characteristic penicillate cells and acicular appendages originated from the immature perithecia. The penicillate cells developed with apical sterigma‐like projections from the wall cells of the upper part of immature perithecia, whereas the acicular appendages originated from the shrunken wall cells at the perithecial equatorial planes. On maturation of perithecia, the acicular appendages bent down and pushed the perithecia above the substrate and thus helped them to liberate out. The sterigma‐like projections were covered with paste‐like granular substance, which help the dispersed perithecia to attach to mulberry leaves and branches.
Enhancement of Defence Responses against Bayoud Disease by Treatment of Date Palm Seedlings with an Hypoaggressive Fusarium oxysporum Isolate
Authors: El Hassni M. , J'Aiti F. , Dihazi A. , Ait Barka E. , Daayf F. , El Hadrami I.
Published: March 2004

Pretreatment of date palm seedlings with an hypoaggressive Fusarium isolate (AHD) protected them partially from further infection by Fusarium oxysporum f.sp. albedinis (Foa), the Bayoud disease pathogen. No mortality occurred during 2–3 months of incubation in plants pretreated with AHD, as opposed to aggressive isolate (ZAG) inoculated controls where up to 100% mortality was observed 15–30 days after inoculation. Such protection involved biochemical interactions between the host plant and AHD since no direct competition or antagonism was revealed between AHD and ZAG. The examination of the accumulation of phenolics and peroxidase activity, two parameters previously reported to be involved in date palm resistance to Foa, indicated that the response to AHD was correlated with the ability of pretreated date palm tissues to establish a faster defence response in the roots of both susceptible and resistant cultivars. Plants pretreated with AHD accumulated higher amounts of phenolics, mainly non‐constitutive hydroxycinnamic acid derivatives, which play a crucial role in date palm defence against Foa, as previously described by our group. These compounds were accumulated along with the constitutive caffeoylshikimic acids. A faster induction of peroxidase activity in response to Foa was also recorded in plants pretreated with AHD. Given the multi‐component nature of these induced responses, AHD could be part of integrated disease management strategies for a sustainable control of the palm tree Bayoud disease.
Parental perception of small ventricular septal defects in childhood
Authors: Lok SW , Menahem S
Published: March 2004

Objective:  The main aim of this study was to determine the understanding and perception of parents following the diagnosis of a minor cardiac abnormality, namely a small ventricular septal defect, in the child. Other aims included discovering the reasons behind these perceptions and whether they affected the parents’ management of their child and his/her cardiac problem.

Methods:  Fifty‐six infants and children from two tertiary centres and the private practices of the participating cardiologists were enrolled over a 5‐month period. Questionnaires were prepared and distributed to all their parents.

Results:  Complete data was obtained from 40 parents. Close to 80% of the parents perceived the small ventricular septal defect as a minor problem and most understood the nature of the defect. However, when asked about precautions for their child, only two‐thirds recalled the need for antibiotic prophylaxis. Most parents experienced distress and anxiety when told initially of the diagnosis but none reportedly restricted their child's physical activity.

Conclusions:  Most parents have a clear understanding and perception of their child's small ventricular septal defect. There is a need for further improvement to facilitate parental understanding, especially with regard to the need for antibiotic prophylaxis.
Long bone fractures in children under 3 years of age: Is abuse being missed in Emergency Department presentations?
Authors: Taitz J , Moran K , O'Meara M
Published: March 2004

Objective:  Distinguishing injuries due to accidents from those due to child abuse in young children is important to prevent further abuse. We aimed to study the presenting features, mechanism of injury, type of fracture and indicators of possible abuse in children under 3 years of age, presenting to the Emergency Department (ED) of a tertiary referral Children's Hospital, to see whether those injuries that were more likely abusive were distinguished from those that were more likely accidental.

Methods:  We analysed the medical records from the Emergency Department Information System of all children below 3 years of age, who were treated for a long bone fracture at the Sydney Children's Hospital, Randwick, NSW, over a 1‐year period. Demographic details, presenting complaint, mechanism of injury, type of fracture, other historical and examination data and action taken were noted. Nine indicators that raise suspicion of abuse were developed from the literature. Using these indicators, patients’ ED notes were reviewed to establish whether long bone fractures suspicious for abuse had been referred for further evaluation.

Results:  One hundred patients with a total of 103 fractures presented during the study period. No child had multiple fractures at a single visit. The fractures included 36 radius/ulna, 27 tibia/fibula, 20 humeral, 17 clavicular and three femoral. The mean age of patients was 21.6 months (range 13 days − 35 months). Fourteen patients were younger than 12 months. Review of the notes revealed 31 children with indicators suspicious for abuse, of whom 17 children had one indicator, 11 children had two indicators, and three children had three indicators. Only one child was referred for further evaluation to child protection.

Conclusion:  Abuse cannot usually be determined by fracture type alone. Doctors in the ED miss indicators for abuse because they do not look for these indicators in the history and examination. Knowledge of indicators that raise suspicion of abuse is needed for a further forensic assessment to occur. The development of specific referral guidelines, ongoing education and a comprehensive injury form may improve referral of children from the ED to child protection.
Health care delivery: Perspectives of young people with chronic illness and their parents
Authors: Farrant B , Watson PD
Published: March 2004

Objective:  To identify and compare perceptions of health care service delivery held by young people with chronic illness and their parents.

Methods:  A convenience sample of young people with chronic illness and their parents were invited to complete a confidential self‐report survey. The adolescents were aged 13−18 years inclusive and attended a specialist medical clinic.

Results:  Participants comprised 53 young people (response rate 88%, 53/60) and 45 parents (response rate 75%, 45/60). Both young people and their parents rate honesty, confidentiality, having good medical knowledge and good listening skills as the most important qualities for a health care provider. Compared to the parent group, fewer young people report the presence of these desired qualities in their current health care provider. A quarter of young people (25%, 13/53) report they do not always trust health professionals to keep their information confidential, and 19% (10/53) of young people report having withheld information from a health professional due to a lack of trust. Some parents and young people would like to discuss a wider range of health topics, including mental health issues, than they currently do with their health provider. Young people and their parents report limited planning with their current health provider for transition to adult health services.

Conclusions:  Young people with chronic illnesses have significant levels of dissatisfaction with the health care they receive; this has the potential to impact on their use of health care services and their health outcomes. There is a need for increased provider awareness of the important qualities of health care service delivery to young people.
Invasive pneumococcal disease in the Australian Capital Territory and Queanbeyan region: Do high infant rates reflect more disease or better detection?
Authors: Andresen DN , Collignon PJ
Published: March 2004

Objective:  To describe the epidemiology of invasive pneumococcal disease in the Australian Capital Territory (ACT) and Queanbeyan region prior to the introduction of conjugate pneumococcal vaccines.

Methodology:  Residents with sterile site isolates of Streptococcus pneumoniae from 1998 to 2000 were identified from a prospective bacteraemia surveillance project involving all ACT public hospitals, supplemented by retrospective laboratory‐based detection of other sterile site isolates.

Results:  Incidence of invasive pneumococcal disease was 15.2 cases per 105 per year, and 193.4 per 105 per year in infants under 2 years. Primary bacteraemia was significantly more common in infants and young children than in older subjects. Reduced penicillin susceptibility was observed in 9.6% of isolates, and no high‐level penicillin resistance was observed.

Conclusions:  Infants in the ACT and Queanbeyan have a higher invasive pneumococcal disease incidence than similar populations worldwide. Better detection is the most likely explanation. This population would be ideal for studies of the ‘real life’ effectiveness of infant conjugate vaccination.
Prevalence and correlates of paediatric asthma and wheezing in a largely rural USA population
Authors: Arif AA , Borders TF , Patterson PJ , Rohrer JE , Xu KT
Published: March 2004

Objective:  The prevalence of asthma among children has been increasing in the United States and it is estimated that there are approximately 5 million children with asthma. This cross‐sectional survey sought to estimate the prevalence of asthma and asthma symptoms and potential risk factors among children aged 16 and younger, in a largely rural population in the USA.

Methods:  This study was a telephone survey of 1500 households in the South Plains/Panhandle region of Texas. Parents of children were interviewed with a response rate of 64%. Having been diagnosed with asthma by a physician and a report of wheezing in the last 12 months were used as dependent variables in multivariate logistic regressions with several sociodemographic and environmental factors as potential confounders.

Results:  The age‐adjusted prevalence of asthma and wheezing among children were approximately 15 and 18%, respectively. The prevalence of asthma was highest (20%) among children aged 11−16 (P < 0.001). Living in urban areas was associated significantly with asthma and wheezing. Non‐Hispanic blacks reported significantly increased odds of asthma in their children (adjusted odds ratio (OR) = 2.04, 95%CI 1.02−4.08), whereas Mexican‐Americans reported significantly reduced odds of asthma (adjusted OR = 0.48, 95%CI 0.29−0.78) and wheezing (adjusted OR = 0.58, 95%CI 0.37−0.89) in their children. The odds of asthma (adjusted OR = 1.78, 95%CI 1.09−2.92) and wheezing (adjusted OR = 2.45, 95%CI 1.52−3.95) was highest among children in the highest body mass index quartile. No significant association with pet ownership and exposure to second‐hand smoke with asthma and wheezing was observed in this study.

Conclusion:  Urban residence, non‐Hispanic black and Mexican‐American race/ethnicity, and being overweight were significantly associated with the increased risk of asthma and/or wheezing.
Management guidelines for Helicobacter pylori infection: Utilization by paediatric gastroenterologists in Australasia
Authors: Day AS , Mitchell HM , Bohane TD
Published: March 2004

Objective:  Although there are published guidelines representing the consensus of several large groups, it is unclear whether these are used by practitioners in the management of Helicobacter pylori infection in children and if the guidelines are relevant to particular regions of the world. The aim of this study was to answer these questions in regard to the Australasian region.

Methods:  An email‐based questionnaire was circulated to Australasian paediatric gastroenterologists to ascertain aspects of practice related to H. pylori infection in children and to review practitioner awareness and use of the guidelines.

Results:  Twenty‐five (78%) of 32 questionnaires were completed. Current practice reported by the respondents followed the principles of the published guidelines. However, only 15 gastroenterologists were aware of the guidelines: a number of these practitioners were uncomfortable adapting the published guidelines to their local situation.

Conclusions:  Although widely distributed in the paediatric gastroenterology literature, guidelines for management of H. pylori infection may not be utilized fully by individual practitioners. As these guidelines are updated, based upon current developments in the understanding of H. pylori disease, attempts should be made to ensure that such documents are widely distributed to practitioners and that they reflect regional variations in disease patterns.
Increasing prevalence of type 2 diabetes in adolescents
Authors: Hotu S , Carter B , Watson PD , Cutfield WS , Cundy T
Published: March 2004

Objective:  The rising prevalence of obesity in childhood and adolescence in North America has been paralleled by the emergence of type 2 diabetes in the adolescent age group. We have examined trends in the prevalence of type 2 diabetes in adolescents attending a diabetes clinic in Auckland, New Zealand.

Methods:  Surveys of the prevalence of type 2 diabetes in attendees at the adolescent diabetes clinic at the Auckland Diabetes Centre were undertaken in 1996 and 2002. The proportion of type 2 diabetes in incident cases of diabetes diagnosed between these years was also calculated.

Results:  The prevalence of type 2 diabetes was 1.8% (2/110) in 1996, and 11.0% (18/163) in 2002 (P = 0.008). Type 2 diabetes accounted for 12.5% (6/48) of incident cases of diabetes in the years 1997−1999, and 35.7% (10/28) of cases in the years 2000−2001, indicating a sharp rise in the incidence (P = 0.017) between the two periods. At diagnosis the mean age of the type 2 diabetes subjects was 15 years and the mean body mass index 34.6 kg/m2. Risk factors for cardiovascular disease were common in the subjects with type 2 diabetes: 85% had dyslipidaemia, 58% had increased albumin excretion rates and 28% had systolic hypertension.

Conclusions:  Obesity‐related type 2 diabetes now accounts for a substantial proportion of newly recognized diabetes in the adolescent age group − and this proportion is escalating rapidly. Adverse cardiovascular risk factors are prevalent in this population. Public health measures to curtail the rise of obesity in childhood and adolescence are required urgently.
Vaginal foreign bodies
Authors: Stricker T , Navratil F , Sennhauser FH
Published: March 2004

Objective:  To evaluate the clinical features and outcome in girls with a vaginal foreign body.

Methods:  Retrospective review of medical records of 35 girls with a vaginal foreign body seen in an outpatient clinic for paediatric and adolescent gynaecology between 1980 and 2000.

Results:  The ages ranged from 2.6 to 9.2 years. The most common symptom was blood‐stained vaginal discharge/vaginal bleeding (49%). Duration of symptoms varied from 1 day to 2 years. Fifty‐four percent of the patients recalled insertion of the foreign object, usually by the girl herself. All but three patients (91%) either recalled insertion of the foreign object and/or had vaginal bleeding or blood‐stained or foul‐smelling vaginal discharge, and/or visualization or palpation of the foreign body in physical examination. Symptoms resolved after removal of the foreign body followed by a single irrigation with Providon‐Iod (Betadine®).

Conclusion:  In the majority of patients a carefully obtained history and physical examination suggest the diagnosis of a vaginal foreign object. The leading symptoms are vaginal bleeding and blood‐stained or foul smelling vaginal discharge. Removal of the foreign object followed by a single irrigation with Providon‐Iod is the definitive treatment and does not require additional measures.
Neonatal resuscitation: Review of ventilation equipment and survey of practice in Australia and New Zealand
Authors: O'Donnell CPF , Davis PG , Morley CJ
Published: March 2004

Objective:  The equipment used to provide positive pressure ventilation at neonatal resuscitation varies between institutions. Available devices were reviewed and their use surveyed in a geographically defined region. The aim of this study was to establish which resuscitation equipment is used at neonatal intensive care units in Australia and New Zealand.

Methods:  A questionnaire was sent to a neonatologist at each of the 29 neonatal intensive care units in Australia and New Zealand, asking which resuscitation equipment they used. If it was not returned, follow up was by email and telephone.

Results:  Data was obtained from all units. Round face masks are used at all centres. Anatomically shaped masks are infrequently used at two of the three centres (10%) that have them. Straight endotracheal tubes are used exclusively at 23 (79%) centres. Shouldered tubes are used infrequently at three of the six centres that have them. The Laerdal Infant Resuscitator self‐inflating bag is used at 22 (76%) centres. Flow‐inflating bags are used at 12 (41%) centres. The Neopuff Infant Resuscitator is used at 14 (48%) centres. Varying oxygen concentrations are provided at delivery at 6/25 (24%) centres.

Conclusions:  There is a paucity of evidence for the efficacy of the equipment used currently to resuscitate newborn infants. This complete survey of the tertiary centres in a geographical region shows considerable variation in practice, reflecting this lack of evidence and consequent uncertainty among clinicians. Further research is necessary to determine which devices are preferable for this most important and common intervention.
Paracetamol pro re nata orders: An audit
Authors: Lamb SA , Henry RL
Published: March 2004

Objectives:  Paracetamol is used widely in hospital practice, but little is known of the details concerning prescribing practices. This study compared the prescribing habits of physicians with regard to paracetamol, pro re nata (PRN), with the nursing interpretation of the order and with evidence‐based practice.

Methods:  The charts of 313 children were reviewed. An audit of 100 children, in whom paracetamol PRN had been prescribed, noted whether an indication for its use was written by the physician. The physician was asked what he/she intended the prescription to mean. The nurses who had signed for administration were asked what their indications were for giving the paracetamol. The hospital guidelines on the prescribing of paracetamol were compared to the clinical practices of the doctors and nurses.

Results:  Seventy‐four percent of all the charts had an order for paracetamol. An audit of 100 children revealed that only one physician had provided written indications for administration of paracetamol. There were frequent miscommunications between physicians and nurses about the intention of the order for paracetamol. Nurses tended to administer paracetamol at lower temperatures than doctors had intended. In other cases, what the physician had intended as the indication for paracetamol was quite different from what the nurse understood. There were also considerable variations in interpretations within their craft groups.

Conclusion:  What was observed in this study was idiosyncratic ordering and administration of paracetamol. It is unlikely that this problem is unique to a single hospital. The current situation needs to be addressed as a system issue, with the challenge being to develop more objective indications for the use of paracetamol, and to ensure the medical staff are more explicit in what their orders mean.
One‐year neurodevelopmental outcome after moderate newborn hypoxic ischaemic encephalopathy
Authors: Carli G , Reiger I , Evans N
Published: March 2004

Objectives:  To define the 1‐year neurodevelopmental outcome for survivors of moderate (Sarnat stage 2) neonatal hypoxic‐ischaemic encephalopathy (HIE) to facilitate appropriate parental counselling.

Methods:  Hospital‐based retrospective review of admissions to a tertiary newborn intensive care unit between 1988 and 2000. All babies admitted for seizures were reviewed and those in whom the probable diagnosis was moderate HIE were identified from chart review. Perinatal variables, number of anticonvulsants, duration of hospital stay and 1‐year neurodevelopmental outcome was recorded in survivors.

Results:  Fifty‐three babies who survived probable moderate HIE were identified. Forty‐two of these were seen at 1 year of age. Of these, 22 (52%) had normal development and neurological examination and four (9.5%) had mild developmental delay with normal neurological examination. Thirteen babies (31%) had cerebral palsy, 11 of whom also had developmental delay. Two infants (5%) who had been severely impaired at 6 months died before 1 year of age. Overall, 36% of survivors of the neonatal period had significant disability and or had died by 1 year of age. Duration of anticonvulsant treatment and length of hospital stay were significantly related to adverse outcome.

Conclusions:  These data suggest morbidity rates after moderate HIE in the upper end of the range previously described in the literature. Systematic longer‐term follow up of this high‐risk group of infants is needed.
Growth hormone and insulin‐like growth factor 1 levels and their relation to survival in children with bacterial sepsis and septic shock
Authors: Önenli‐Mungan N , Yildizdas D , Yapicioglu H , Topaloglu AK , Yüksel B , Özer G
Published: March 2004

Objectives:  Despite improved supportive care, the mortality of sepsis and septic shock is still high. Multiple changes in the neuroendocrine systems, at least in part, are responsible for the high morbidity and mortality. A reduced circulating level of insulin‐like growth factor and an elevated level of growth hormone are the reported characteristic findings early in the course of sepsis and septic shock in adults. The aim of this study was to evaluate the changes of growth hormone/insulin‐like growth factor 1 axis in sepsis and septic shock and investigate the relationship between these hormones and survival.

Methods:  Fifty‐one children with sepsis (S), 21 children with septic shock (SS) and 30 healthy, age‐ and sex‐matched children (C) were enrolled in this study. Growth hormone, insulin‐like growth factor 1 and cortisol levels of the sepsis and septic shock groups were obtained before administration of any inotropic agent.

Results:  Growth hormone levels were 32.3 ± 1.5 µIU/mL (range 4−56), 15.9 ± 0.6 µIU/mL (range 11−28) and 55.7 ± 2.7 µIU/mL (range 20−70) in S, C and SS groups, respectively. The difference between the growth hormone levels of the S and C groups, S and SS groups, and C and SS groups were significant (P < 0.001). Non‐survivors (54.7 ± 1.6 µIU/mL) had significantly higher growth hormone levels than survivors (29.4 ± 1.5 µIU/mL) (P < 0.001). Insulin‐like growth factor 1 levels were 38.1 ± 2.1 ng/mL (range 19−100), 122.9 ± 9.6 ng/mL (range 48−250) and 22.2 ± 1.9 ng/mL (range 10−46) in the S, C and SS groups, respectively, and the difference between the insulin‐like growth factor 1 levels of the S and C, S and SS, and C and SS groups were significant (P < 0.001). Non‐survivors (8.8 ± 1.1 µg/dL) had significantly lower cortisol levels than survivors (40.9 ± 2.1 µg/dL) (P < 0.001). We detected a significant difference between the levels of cortisol in non‐survivors (19.7 ± 1.8 µg/dL) and survivors (33.9 ± 0.9 µg/dL) (P < 0.01).

Conclusions:  There were elevated levels of growth hormone with decreased levels of insulin‐like growth factor 1 in children during sepsis and septic shock compared to healthy subjects. In addition, there were even higher levels of growth hormone and lower levels of insulin‐like growth factor 1 in non‐survivors than in survivors. We think that both growth hormone and insulin‐like growth factor 1 may have potential prognostic value to serve as a marker in bacterial sepsis and septic shock in children. As there is insufficient data in the paediatric age group, more studies including large numbers of patients and additionally evaluating cytokines and insulin‐like growth factor binding proteins are needed.
Infant pertussis deaths and the management of cardiovascular compromise
Authors: McEniery JA , Delbridge RG , Reith DM
Published: March 2004

Abstract:  Infants infected with Bordetella pertussis in the first few weeks of life are at risk of death from ‘overwhelming cardiovascular compromise despite intensive care support’. The mechanisms of this severe disease are not completely understood. Three case histories, including that of one infant who survived, are presented. Two of the patients died despite intensive therapy with pressors and, in one child, milrinone. The third child survived following treatment with nitric oxide and sildenafil. Hence, sildenafil in combination with nitric oxide shows promise as a therapy for the haemodynamic consequences of pertussis toxaemia and this should prompt clinical trials for their efficacy for this condition.
Genital abnormalities mimicking congenital adrenal hyperplasia in premature infants
Authors: Greaves R , Kanumakala S , Read A , Zacharin M
Published: March 2004

Abstract:  Unusual genital appearances in premature infants can be easily mistaken for true ambiguous genitalia, with alarming consequences. The results of blood and urine tests carried out for premature infants can be misleading due to persistence of the foetal zone of the adrenal cortex. More importantly, misdiagnosis is devastating for the parents and adds significantly to their distress. Here, we describe two patients with transient genital abnormalities and abnormal biochemical tests.
Complex glycerol kinase deficiency leads to psychomotor and body‐growth failure
Authors: Zaffanello M , Zamboni G , Tonin P , Solero GP , Tatò L
Published: March 2004

Abstract:  Complex glycerol kinase deficiency usually presents with Duchenne muscular dystrophy, glycerol kinase deficiency and adrenal hypoplasia congenital. We describe a follow‐up patient with complex glycerol kinase deficiency who had appropriate intrauterine development, but who at 1 month of age manifested severe growth delay and psychomotor retardation. Targeted therapy did not bring about the regression of symptoms: both bodyweight and height were below the 3rd centile until 8 years of age, and his Griffith's Mental Development scale score was 71 at age 5 years.
Advances in paediatric rheumatology: Beyond NSAIDs and joint replacement
Authors: Munro JE , Murray KJ
Published: March 2004

Over the previous three decades there have been a number of dramatic changes in our understanding of both the pathogenesis and epidemiology of the rheumatic diseases of childhood. Improvements in the classification of paediatric‐onset arthritides and international collaboration in terms of multicentre research have led to the development of new therapeutic agents and better methods of outcome assessment for these chronic and often disabling conditions. Fortunately for children with paediatric rheumatic diseases treatment regimes are now available that provide excellent disease control for many and remission induction for some. Challenges include clearer definition of the genetics and pathogenesis of the diseases, delineation of reliable biological markers for diagnosis and monitoring of disease activity. The future should also herald early identification of those with a poorer prognosis, together with the design of more powerful, safer and cheaper remission‐inducing agents, given to the right patients at the right time.
Sociology and political arithmetic: some principles of a new policy science1
Authors: Lauder Hugh , Brown Phillip , Halsey A.H.
Published: March 2004

This paper advances the position that sociology needs to develop an approach to research which focuses on fundamental social problems. In doing so it shares many of the intellectual values and goals of political arithmetic while seeking to move methodologically beyond it. Since such problems are complex they will require, typically, interdisciplinary input and a concomitant approach to the development and appraisal of theories. We are not, therefore, advocating the primacy of sociology but arguing that it has a distinctive part to play in addressing the fundamental problems of the twenty‐first century. However, a policy‐oriented sociology has also to take up the task, so clearly defined by the tradition of political arithmetic, which is to hold governments to account. Consequently a central principle of a new policy science is that it should contribute to democratic debate about policy.
Talking about money: public participation and expert knowledge in the Euro referendum1
Authors: Evans Robert
Published: March 2004

This paper uses the proposed UK referendum on the single European currency as a means of investigating the effect of democratizing science on the scrutiny of conflicting expert advice. Although the referendum has not happened yet, and may not happen at all, the campaigners for and against the Euro have none the less been working for several years to ensure that if, and when, it does happen they are in a position to win it. By exploring how campaigners on both sides of the debate understand the concerns of voters, the paper shows how they are working towards a referendum in which the political dimensions of the Euro are actively minimized in order to avoid alienating key ‘floating voters’. Instead, the campaign is expected to focus on the economic costs and benefits of the Euro for individuals and households, with only limited discussion of issues relating to sovereignty. Whether or not the campaign groups, particularly those that oppose the Euro, can maintain this line remains to be seen but if there is a full and frank public debate about the economic, social and political stakes, then this will be despite the referendum rather than because of it.
Social influences on corporate political donations in Britain1
Authors: Bond Matthew
Published: March 2004

It is argued that institutional features of the British state create collective action problems for the mobilization of corporations as donors to the Conservative Party. Social factors are necessary for overcoming these problems. Using social network analyses, the effect that interlocking directorates have on 250 large British corporations’ decisions to donate are analysed. Instead of the central mobilizing factor being diffuse inner circle mechanisms positively influencing the decision to make a donation, the results show that more particularistic mechanisms such as information bias and control are equally important.
The sociology of subjectivity, and the subjectivity of sociologists: a critique of the sociology of gender in the Australian family
Authors: Uhlmann Allon J.
Published: March 2004

In this era of reflexive sociology it is commonplace that subjectivity is of great sociological concern, and that the comprehension by social researchers of their own subject position is essential. Still, old habits die hard. Focusing on selected texts in the sociology of the Australian family, this paper traces the effects of failing to focus the sociological gaze on subjectivity and its variation across society. Highlighted are some patterns of analytic misconstruction of subjectivity, especially the substitution of measurement for a theory of practice, and the projection by sociologists of their own class‐specific subjectivity onto society at large. Ultimately, this misconstruction turns works like those discussed in this paper into a powerful denial of alternative subjectivities, and a reinforcement of the socially dominant perspective.
Working part‐time: achieving a successful ‘work‐life’ balance?1
Authors: Warren Tracey
Published: March 2004

The role of part‐time employment in the balancing of women's employment and family lives has generated an immense literature. Using data on women working part‐time and full‐time in different level occupations in theBritish Household Panel Survey, this paper argues that it is now vital to move these balancing debates on from their location within work–family rhetoric and to re‐position the study of women's working time in broader work‐life discussions. Work–family debates tend to neglect a number of key domains that women balance in their lives, in addition to family and employment, including their financial security and their leisure. The paper shows that examining the financial situations and the leisure lives of female part‐timers in lower level jobs reveals a less positive picture of their ‘life balancing’ than is portrayed in much work–family literature. Instead, they emerged as the least financially secure employees and, linked to this, less satisfied with their social lives too. It is concluded that since the work‐life system is multi‐ and not just two‐dimensional, it is important to examine how all life domains interrelate with each other. In this way, we would be in a better position to begin to assess all the benefits and disadvantages associated with working part‐time and with other work‐life balancing strategies.
Long term effects of oestrogen therapy on bone loss in postmenopausal women: a 23 year prospective study
Authors: Ahlborg Henrik G. , Johnell Olof , Karlsson Magnus K.
Published: March 2004

Objective  To determine the long term effect of oestrogen therapy on bone loss after menopause.

Design  Prospective observational study over 23 years.

Setting  Malmö, Sweden.

Subjects  Twenty‐eight women taking oestrogen and 196 women not taking oestrogen during the follow up.

Methods  Bone mineral density of the forearm was measured by single‐photon absorptiometry at age 48 and 72 years. Use of oestrogen therapy was noted.

Main outcome measure  Rate of forearm bone loss between the age of 48 and 72 years.

Results  Women taking oestrogen, for a median of 17 years (range 4 to 26), had 8.7 percentage points (95% CI 3.8–13.5) lower rate of bone loss compared with women not taking oestrogen during the same period. Each year of oestrogen therapy reduced the rate of bone loss by 0.8 percentage points (95% CI 0.2–1.4).

Conclusions  The use of oestrogen seems to reduce the rate of bone loss over a period of 23 years, and the longer the duration of the therapy, the less bone loss.
Amniotic fluid inflammatory proteins and digestive compounds profile in fetuses with gastroschisis undergoing amnioexchange⋆
Authors: Burc Laurence , Volumenie Jean‐Luc , De Lagausie Pascal , Guibourdenche Jean , Oury Jean‐François , Vuillard Edith , Sibony Olivier , Blot Philippe , Saizou Carole , Luton Dominique
Published: March 2004

Objective  In gastroschisis, an inflammatory process related to the presence of digestive compounds may be involved in intestinal damage. We measured the amniotic fluid concentrations of total protein, ferritin and amylase, lipase, γ‐glutamyl transferase and bile acids before each amnioexchange performed in women whose infants had gastroschisis. We estimated the correlation among total proteins, ferritin and digestive compounds and postnatal outcome.

Design  All women whose infants had gastroschisis in our fetal medicine unit are offered repeated amnioexchange during the third trimester of pregnancy to improve the quality of the exteriorised bowel at birth. Amniotic fluid was sampled at the beginning of each amnioexchange and total proteins, ferritin and digestive compounds were assayed.

Setting  This study was conducted in the Department of Perinatology of the University Hospital Robert Debré in Paris.

Population  Thirty pregnant women with a gastroschisis affected fetus diagnosed antenatally.

Methods  The biological results were expressed as multiples of the median with respect to a control population.

Main outcome measure  Gestational age at delivery and the outcome of the infants were recorded and correlated with amniotic fluid total proteins, ferritin and digestive compounds.

Results  There was a positive correlation (P < 0.01) between digestive compounds (except amylase at the final amnioexchange) and ferritin on the one hand, and all digestive compounds and total proteins concentration at the final amnioexchange on the other. In addition, among total proteins amylase and lipase, lipase concentrations were related with parameters of short term outcome (P < 0.05).

Conclusion  Amniotic total proteins and ferritin are elevated in fetuses presenting with gastroschisis as a consequence of an inflammatory process. Inflammation may be induced by the presence of digestive compounds in the amniotic fluid. The concentrations of which may constitute a marker of short term outcome of the newborn infant.