bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of climate change on birds
Authors: Crick Humphrey Q. P.
Published: September 2004

Weather is of major importance for the population dynamics of birds, but the implications of climate change have only recently begun to be addressed. There is already compelling evidence that birds have been affected by recent climate changes. This review suggests that although there is a substantial body of evidence for changes in the phenology of birds, particularly of the timing of migration and of nesting, the consequences of these responses for a species’ population dynamics is still an area requiring in‐depth research. The potential for phenological miscuing (responding inappropriately to climate change, including a lack of response) and for phenological disjunction (in which a bird species becomes out of synchrony with its environment) are beginning to be demonstrated, and are also important areas for further research. The study of climatically induced distributional change is currently at a predictive modelling stage, and will need to develop methods for testing these predictions. Overall, there is a range of intrinsic and extrinsic factors that could potentially inhibit adaptation to climate change and these are a high priority for research.
Can we detect change in the phenology of winter migrant birds in the UK?
Authors: Sparks Tim H. , Mason Chris F.
Published: September 2004

Although there is very strong evidence for an advance in the spring arrival dates of migrating birds, there are few data with which to examine the changes, if any, in the dates of winter migration. In this paper we examine data on the first arrivals and last departures of winter visitors from two UK county bird reports. A small number of changes in phenology and some relationships with climatic variables were present. However, results were often contradictory or inconclusive. As data such as these are highly variable we recommend a more thorough examination for climatic impact where records exist.
The possible impact of climate change on the future distributions and numbers of waders on Britain's non‐estuarine coast
Authors: Rehfisch Mark M. , Austin Graham E. , Freeman Steve N. , Armitage Michael J. S. , Burton Niall H. K.
Published: September 2004

The relationship between weather and wader distributions on non‐estuarine coasts is described and used to predict how future wader distributions may respond to climate change. The distributions of eight out of nine species of wader commonly wintering on the non‐estuarine coasts of Britain altered between two similar surveys, in 1984/85 and 1997/98, that covered 78% and 38% of Britain's 12 594 km of non‐estuarine coastline, respectively. These eight species moved at least in part either eastwards along the winter isotherms or northwards. These changes in distribution broadly coincide with a distributional shift towards the species’ respective breeding grounds and are correlated with the local winter weather over the period: increasingly mild extreme temperatures and changes in mean rainfall, mean wind speed and wind‐chill. Based on the scenarios for Britain's climate in 2020 and 2080, it is predicted that the distributions of the waders will move away from the west. The non‐estuarine coasts of Britain hold particularly high proportions of the international flyway populations of Ringed Plover Charadrius hiaticula, Sanderling Calidris alba, Purple Sandpiper Calidris maritima and Ruddy Turnstone Arenaria interpres that are all expected to show continuing decline to 2080. Overwintering waders appear to be good indicators of the effects of climate change.
Climate change and coastal waterbird populations – past declines and future impacts
Authors: Norris Ken , Atkinson Phil W. , Gill Jennifer A.
Published: September 2004

Considerable attention has been given to the impact of climate change on avian populations over the last decade. In this paper we examine two issues with respect to coastal bird populations in the UK: (1) is there any evidence that current populations are declining due to climate change, and (2) how might we predict the response of populations in the future? We review the cause of population decline in two species associated with saltmarsh habitats. The abundance of Common RedshankTringa totanusbreeding on saltmarsh declined by about 23% between the mid‐1980s and mid‐1990s, but the decline appears to have been caused by an increase in grazing pressure. The number of TwiteCarduelis flavirostriswintering on the coast of East Anglia has declined dramatically over recent decades; there is evidence linking this decline with habitat loss but a causal role for climate change is unclear. These examples illustrate that climate change could be having population‐level impacts now, but also show that it is dangerous to become too narrowly focused on single issues affecting coastal birds. Making predictions about how populations might respond to future climate change depends on an adequate understanding of important ecological processes at an appropriate spatial scale. We illustrate this with recent work conducted on the Icelandic population of Black‐tailed GodwitsLimosa limosa islandicathat shows large‐scale regulatory processes. Most predictive models to date have focused on local populations (single estuary or a group of neighbouring estuaries). We discuss the role such models might play in risk assessment, and the need for them to be linked to larger‐scale ecological processes. We argue that future work needs to focus on spatial scale issues and on linking physical models of coastal environments with important ecological processes.
Compensating for wetland losses in the United States
Authors: Zedler Joy B.
Published: September 2004

Impacts of climate change on US wetlands will add to those of historical impacts due to other causes. In the US, wetland losses and degradation result from drainage for agriculture, filling for urbanization and road construction. States that rely heavily on agriculture (California, Iowa, Illinois, Missouri, Ohio, Indiana) have lost over 80% of their historical area of wetlands, and large cities, such as Los Angeles and New York City, have retained only tiny remnants of wetlands, all of which are highly disturbed. The cumulative effects of historical and future degradation will be difficult to abate. A recent review of mitigation efforts in the US shows a net loss of wetland area and function, even though ‘no net loss’ is the national policy and compensatory measures are mandatory. US policy does not include mitigation of losses due to climate change. Extrapolating from the regulatory experience, one can expect additional losses in wetland areas and in highly valued functions. Coastal wetlands will be hardest hit due to sea‐level rise. As wetlands are increasingly inundated, both quantity and quality will decline. Recognition of historical, current and future losses of wetland invokes the precautionary principal: avoid all deliberate loss of coastal wetland area in order to reduce overall net loss. Failing that, our ability to restore and sustain wetlands must be improved substantially.
Managed realignment in the UK – the first 5 years of colonization by birds
Authors: Atkinson Philip W. , Crooks Steve , Drewitt Allan , Grant Alastair , Rehfisch Mark M. , Sharpe John , Tyas Christopher J.
Published: September 2004

With current losses of saltmarsh running at > 100 ha per year in the UK, creation of new intertidal habitats through managed realignment is likely to be increasingly used. Potentially, this has biodiversity as well as engineering benefits. However, assessing the conservation value of many of the current UK schemes is difficult as the biological monitoring has been generally poor, with a few notable exceptions. At the Tollesbury and Orplands realignment sites, Essex, bird communities were dominated by terrestrial species during the first year of inundation and waterbird communities rapidly developed during the second and third years. Five years after the initial breach in the sea wall, communities were similar to surrounding mudflats but with some notable exceptions. Dunlin Calidris alpina and Common Redshank Tringa totanus that prey on the early colonizing Nereis and Hydrobia used the sites in the first 2 years. Eurasian Oystercatcher Haematopus ostralegus did not occur on the realignment site as there were no large bivalves, whereas Red Knot Calidris canutus used the site after 4–5 years coincidentally with the appearance of Macoma balthica. The differences in the bird communities occurred because UK sites are often small, enclosed and poorly drained. If at a suitable height in the tidal frame, UK managed realignment sites are successful in that they have developed saltmarsh and biologically active mudflats but they may lack the full range of biodiversity found in surrounding natural intertidal habitats, even decades after inundation.
Global and regional governmental policy and treaties as tools towards the mitigation of the effect of climate change on waterbirds
Authors: Boere Gerard C. , Taylor Douglas
Published: September 2004

Climate change will affect the breeding, staging and wintering areas of waterbirds. This may create a problem for the legal protection of important waterbird sites under the present international conventions. We analyse present obligations within a number of international conventions and conservation strategies, and formulate ways to mitigate for the effects of climate change by establishing site conservation within a framework of ecological networks and the overall flyway of species of waterbirds.
Preterm prelabour rupture of the membranes: A survey of current practice
Authors: BUCHANAN Sarah , CROWTHER Caroline , MORRIS Jonathan
Published: September 2004

Background:  Preterm prelabour rupture of the membranes (PPROM) complicates 1–2% of all pregnancies. Risks of remaining in utero need to be balanced against the risks of iatrogenic prematurity if early birth is planned.

Aims:  To assess and further define the current management of women with pregnancies complicated with PPROM in Australia.

Methods:  A mail out questionnaire was sent to all Australian Members and Fellows of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG).

Results:  There were 731 responses from RANZCOG Fellows and Members. Corticosteroids were used routinely in the setting of PPROM by 99% (95% confidence intervals (CI) 98.4–100.0%) of obstetricians. Tocolysis was used commonly by 75% (95% CI 98.4–100.0%). Antibiotics are also used routinely by 63% (95% CI 58.8–67.3%) of Australian obstetricians. For women presenting with PPROM less than 34 weeks’ gestation 56% (95% CI 48.1–60.0%) of obstetricians would plan to deliver these women prior to term, while for women presenting with PPROM greater than 34 weeks’ gestation 50% (95% CI 46.0–54.8%) would offer delivery to such women prior to term.

Conclusions:  There is significant variation in clinical practice in the management of women who present with PPROM in Australia. There is little consensus regarding the optimal timing of delivery for babies of women with pregnancies complicated with PPROM. The present survey supports the need and feasibility of a randomised controlled trial to assess the appropriate gestation at which to deliver women with PPROM near to term.
Vaginal birth after Caesarean versus elective repeat Caesarean for women with a single prior Caesarean birth: A systematic review of the literature
Authors: DODD Jodie , CROWTHER Caroline
Published: September 2004

Aims:  To assess the benefits and harms of planned elective repeat Caesarean section with planned vaginal birth after Caesarean section (VBAC).

Methods:  The Cochrane controlled trials register and MEDLINE (1966–current) were searched using the following terms: vaginal birth after C(a)esare(i)an; trial of labo(u)r; elective C(a)esare(i)an; C(a)esare(i)an section, repeat; randomis(z)ed controlled trial; randomis(z)ed trial; clinical trial; and prospective cohort study, to identify all published randomised controlled trials and prospective cohort studies. Primary outcomes related to success of trial of labour, need for Caesarean section, maternal and neonatal mortality, and morbidity.

Results:  There were no randomised controlled trials identified that compared planned elective repeat Caesarean birth with planned vaginal birth. Two prospective cohort studies were identified where all 449 women compared had a single prior Caesarean section in their immediately preceding pregnancy and were suitable for an attempted VBAC in their next pregnancy. For all outcomes, data were available from a single study only. Reported outcome data were available for maternal deaths (0/137 women), in utero fetal deaths (2/312 fetuses), neonatal deaths (0/137 infants), uterine scar dehiscence (2/137 women), uterine scar rupture (1/312 women), and infant Apgar score of less than seven at 5 min of age (9/312 infants). There were no statistically significant differences between planned elective repeat Caesarean section and planned VBAC.

Conclusions:  There is a paucity of quality information available to assist women and their caregivers regarding optimal mode of birth for women with a single prior Caesarean section in their next pregnancy.
Induction of labour for women with a previous Caesarean birth: A systematic review of the literature
Authors: DODD Jodie , CROWTHER Caroline
Published: September 2004

Aims:  To compare the benefits and harms of planned elective repeat Caesarean section with induction of labour and to assess different methods of cervical ripening and induction of labour for women with a previous Caesarean birth who require induction of labour in a subsequent pregnancy.

Methods:  The Cochrane controlled trials register and MEDLINE (1966–current) were searched using the following terms: vaginal birth after C(a)esare(i)an, trial of labo(u)r, elective C(a)esare(i)an, C(a)esare(i)an repeat, induction of labo(u)r, prostaglandins, prostaglandin E2, misoprostol, prostaglandin E1 analogs, mifepristone, oxytocin, Syntocinon, randomis(z)ed controlled trial, randomis(z)ed trial and clinical trial, to identify all published randomised controlled trials with reported data comparing outcomes for women and infants who have a planned elective repeat Caesarean section with induction of labour; and different methods of induction of labour, where a prior birth was by Caesarean section.

Results:  There were no randomised controlled trials identified where women with a prior Caesarean birth, whose labour required induction in a subsequent pregnancy, compared elective repeat Caesarean section with induction of labour. There were three randomised controlled trials identified in which women with a prior Caesarean section were allocated to different methods of induction of labour – vaginal prostaglandin E2 versus intravenous oxytocin; mifepristone versus placebo; and vaginal misoprostol versus intravenous oxytocin. These studies varied considerably in the methods used and meta‐analysis was not appropriate.

Conclusions:  There is a paucity of safety information for induction of labour agents in the women with a scarred uterus, and caution should be exercised in their use.
Red blood cell iso‐immunisation in the Wellington area of New Zealand: The case for antenatal prophylaxis
Authors: TUOHY Jeremy F. , SANGALLI Michel , KIM Lawrence
Published: September 2004

The present study aimed to calculate the rate of Rhesus D iso‐immunisation during pregnancy in Wellington, New Zealand and to identify the timing of iso‐immunisation. The notes of all women and their babies with positive antenatal anti‐D antibody screens during the period 1994–2002 at the regional reference laboratory (Wellington Blood Transfusion Service) were reviewed to identify the antibody titre and the stage of pregnancy that the antibodies developed. Twelve percent of all tested pregnant women were Rhesus D negative and the annual immunisation rate during pregnancy was 1.4%. Sensitisation during the third trimester occurred in 50% of these women. Sensitisation in the third trimester was more common in primigravid women (87%) than in multiparous women (27%).
Hypertension during pregnancy in South Australia, Part 1: Pregnancy outcomes
Authors: HEARD Adrian R. , DEKKER Gus A. , CHAN Annabelle , JACOBS Danielle J. , VREEBURG Sophie A. , PRIEST Kevin R.
Published: September 2004

Background:  There have been conflicting reports about pregnancy outcome in the hypertensive disorders of pregnancy. The present study was undertaken to examine outcomes using a population database.

Aims:  To examine for differences in a range of pregnancy outcomes between three different groups of hypertensive women and normotensive women in South Australia.

Methods:  Nine pregnancy outcomes were compared for 70 386 singleton pregnancies in the South Australian perinatal data collection in 1998–2001, consisting of 639 women with pre‐existing hypertension, 5356 women with pregnancy hypertension, 448 women with superimposed pre‐eclampsia and 63 943 normotensive women. Means for the four groups were calculated for birthweight, gestational age, the baby's and mother's length of stay. The groups were also compared for perinatal deaths with an earlier period, 1991–1997.

Results:  While all three hypertensive groups had high incidences of induction of labour and emergency Caesarean, only pre‐existing hypertension and superimposed pre‐eclampsia were significantly associated with elective Caesarean section. All hypertensive groups had increased risks for low birthweight and preterm birth and special and neonatal intensive care. Uncomplicated pre‐existing hypertension was not associated with small for gestational age infants, but with preterm delivery between 32 and 36 weeks’ gestation. Superimposed pre‐eclampsia had the worst prognosis for perinatal and maternal morbidity. While pregnancy hypertension held the intermediate position, it was not associated with an increase in perinatal mortality. The perinatal mortality rate for women with hypertensive disorders in 1998–2001 was significantly lower than that of an earlier period and equivalent to that for normotensive women.

Conclusions:  Superimposed pre‐eclampsia occurs in approximately 40% of pregnancies of women with pre‐existing hypertension and has the most severe outcomes. The hypertensive disorders are associated with high levels of morbidity and intervention, but the high perinatal mortality associated with these disorders has fallen significantly.
Hypertension during pregnancy in South Australia, Part 2: Risk factors for adverse maternal and/or perinatal outcome – results of multivariable analysis
Authors: VREEBURG Sophie A. , JACOBS Danielle J. , DEKKER Gus A. , HEARD Adrian R. , PRIEST Kevin R. , CHAN Annabelle
Published: September 2004

Objective:  To identify factors associated with adverse pregnancy outcomes among women with hypertension during pregnancy

Design:  A population‐based retrospective multivariable analysis using the South Australian perinatal data collection.

Methods:  Perinatal data on 70 386 singleton births in 1998–2001 were used in multivariable analyses on three groups: all women combined, all hypertensive women and women with pregnancy hypertension only, in order to identify independent risk factors for requirement for level II/III care, preterm birth, small for gestational age (SGA) birth and maternal length of stay greater than 7 days.

Results:  The risks for the four morbidities were all increased among women with hypertension compared with normotensive women. Those with pre‐existing hypertension had the lowest risk (with odds ratios (OR) 1.26–2.90). Pregnancy hypertension held the intermediate position (OR 1.52–5.70), while superimposed pre‐eclampsia was associated with the highest risk (OR 2.00–8.75). Among women with hypertension, Aboriginality, older maternal age, nulliparity and pre‐existing or gestational diabetes increased the risk for level II/III nursery care, preterm birth and prolonged hospital stay. Smokers had shorter stays, which may be related to their decreased risk of having a Caesarean section or operative vaginal delivery. Asian women, Aboriginal women, smokers and unemployed women had an increased risk for having an SGA baby, while women with pre‐existing or gestational diabetes had a reduced risk.

Conclusions:  Among hypertensive pregnant women, nulliparity, older maternal age, Aboriginality, unemployment and diabetes are independent risk factors for one or more major adverse pregnancy outcomes. Smoking does not always worsen the outcome for hypertensive women except for SGA births.
Effect of tubal ligation on ovarian reserve and the ovarian stromal blood supply
Authors: KELEKCI Sefa , YORGANCIOGLU Zehra , YILMAZ Bülent , YASAR Levent , SAVAN Kadir , SONMEZ Suha , KART Cavit
Published: September 2004

Aim:  Our aim was to evaluate possible adverse effects of tubal ligation on ovarian reserve and ovarian stromal vascular support.

Methods:  Ninety‐one women who underwent tubal ligation, using a modified Pomeroy technique, were studied. The main outcome measurements were serum follicle stimulating hormone, luteinising hormone and oestradiol levels, ovarian volume, number of antral follicles and Doppler study of ovarian stromal artery on the third day of the menstrual cycle immediately before, 1 month and 12 months after the surgical intervention.

Results:  Statistically significant elevation of follicle stimulating hormone levels was observed at 1 and 12 months after tubal ligation (P < 0.05).

Conclusion:  Doppler flow studies of the ovarian stromal arteries showed that there were no significant differences before and after tubal ligation.
Endometrial thickness and the Doppler sonographic parameters of the uterine arteries as discriminators of endometrial status in postmenopausal women receiving anti‐hypertensive treatment
Authors: OZCAKIR Hasan Tayfun , INCEBOZ Umit Sungurtekin , UTUK Ozan , BAYTUR Yesim Bulbul , CAGLAR Husnu
Published: September 2004

Aim:  The aim of the present study was to establish the Doppler sonographic parameters of the uterine arteries in postmenopausal patients with or without hypertension and to determine the value of their measurement in the prediction of endometrial pathology.

Methods:  Healthy postmenopausal women (n = 23) and the ones receiving anti‐hypertensive medication (n = 34) examined for both endometrial thickness and Doppler velocimetry of the uterine arteries by transvaginal sonography.

Results:  There was no sigificant difference between endometrial thickness and uterine artery Doppler sonographic parameters in hypertensive postmenopausal women compared to normotensive controls.

Conclusion:  The role of Doppler examination in the differential diagnosis of endometrial pathology in patients with or without hypertension seemed not to be effective.
A customised birthweight centile calculator developed for a New Zealand population
Authors: McCOWAN Lesley , STEWART Alistair W. , FRANCIS Andre , GARDOSI Jason
Published: September 2004

Background:  Traditionally, small for gestational age is defined as birthweight <10th percentile using sex‐adjusted centile charts. However, this criterion includes constitutional variation due to maternal height, weight, ethnic group and parity.

Aims:  To develop customised birthweight centiles for a New Zealand population.

Methods:  National Women's Hospital database of births from 1993 to 2000 was used to identify eligible women with singleton pregnancies who had data available on the following: scan result for dating at gestation <24 weeks, maternal height and weight at booking, parity and ethnic origin. Multiple regression was used to determine the coefficients applicable to New Zealand.

Results:  A total of 4707 pregnancies met the inclusion criteria comprising: European 1688 (36.0%), Maori 419 (8.9%) Samoan 506 (10.7%), Tongan 326 (6.9%), Chinese 751 (16.0%), Indian 214 (4.6%) and other 803 (17.1%). Mean term birthweight for an average nulliparous European woman was 3530 g. Babies of Maori and Indian ethnicity were on average 67 g and 150 g lighter, respectively, than European babies. Samoan, Tongan and Chinese babies were 84 g, 124 g and 101 g heavier, respectively.

Conclusions:  There are significant differences in birthweight between European and the other major ethnic groups in New Zealand. They relate to maternal physiological variables, for which coefficients have been derived and incorporated into freely available software that enables improved clinical assessment of fetal and neonatal weight.
Term birthweight centiles for babies from New Zealand's main ethnic groups
Authors: McCOWAN Lesley , STEWART Alistair W.
Published: September 2004

Background:  There are significant differences in mean birthweights between New Zealand's main ethnic groups. Birthweight centiles developed predominantly from babies of European ethnicity may therefore not be appropriate to classify babies from other ethnic groups.

Aims:  To develop ethnic specific birthweight centiles for New Zealand babies delivered at term (>37 weeks).

Methods:  Births from the National Women's Hospital database from 1993 to 2000 who also had scan data at <24 weeks comprised the study population (n = 10 292). Multiple pregnancies, fetal abnormalities, stillbirths and preterm births were excluded. For six ethnic groupings, born at gestational weeks from 38 to 41, sex specific centiles were generated and smoothed.

Results:  Birthweight centiles were constructed from 5203 European, 801 Maori, 825 Samoan, 577 Tongan, 1058 Chinese, 433 Indian and 1395 other ethnic group births. Mean birthweights by ethnic group were: European 3521 g, Maori 3467 g, Samoan 3691 g, Tongan 3791 g, Chinese 3418 g, Indian 3192 g and other 3466 g. Tongan and Samoan babies were significantly heavier and Indian babies were significantly lighter than babies from all other ethnic groups (P < 0.001 for all comparisons). Overall Maori babies were approximately 50 g lighter than European babies but this difference was not statistically significant (P = 0.08), whereas Chinese babies were significantly lighter with a mean birthweight 100 g less than European (P < 0.001).

Conclusions:  These ethnic specific centile charts are likely to identify term babies with inappropriate growth better than population centiles generated predominantly from one ethnic group.
Clinical utility of magnetic resonance imaging and the preoperative identification of low risk endometrial cancer
Authors: LOSCO Giovanni , SYKES Peter , ANDERSON Nigel , ROBERTS Hugh , FULTON James , FRASER Hamish
Published: September 2004

Background:  Magnetic resonance imaging (MRI) is reported to offer the best imaging of local disease in endometrial cancer. We audited MRI scans to identify their clinical utility, particularly in the preoperative identification of ‘low risk’ endometrial cancer (grade one or two endometrioid tumours confined to the inner half of the myometrium).

Aim:  To correlate histological and MRI findings and to establish our ability to preoperatively identify women with ‘low risk’ tumours.

Study design:  A retrospective audit of MRI scans in women with a new diagnosis of endometrial cancer from July 1998 to November 2002. Radiology and pathology reports and surgical staging data were extracted. Independently a team of radiologists reviewed MRI films and the findings were compared to pathology.

Results:  Thirty‐nine patients were included. Only 10% of original reports contained all the clinically relevant information. On review, the sensitivity for the detection of myometrial invasion was 90%, specificity 71%, positive predictive value (PPV) 93% and negative predictive value (NPV) 63%. For the detection of deep invasion, sensitivity was 56%, specificity 77%, PPV 64% and NPV 71%. All women with grade one or two tumours having no invasion or grade one having superficial invasion detected on MRI had pathological ‘low risk’ disease.

Conclusions:  Magnetic resonance imaging scans as reported offered limited clinical benefit. Attention needs to be given to MRI sequencing and reporting protocols. If the review results can be confirmed by prospective studies, MRI offers significant clinical utility in the identification of low risk patients and their surgical treatment planning.
Association of pre‐eclampsia with hyperhomocysteinaemia and methylenetetrahydrofolate reductase gene C677T polymorphism in a Turkish population
Authors: YILMAZ Hülya , ÜNLÜÇERÇI Yesim , GÜRDÖL Figen , ISBILEN Elif , ISBIR Turgay
Published: September 2004

Background:  Hyperhomocysteinaemia is a common finding in a wide variety of pathological conditions that exhibit endothelial disturbances. In the pathogenesis of pre‐eclampsia, endothelial cell activation or dysfunction has been proposed as a central feature, and the presence of hyperhomocysteinaemia in varying degrees has been detected. One of the known causes of hyperhomocysteinaemia is polymorphism in the methylenetetrahydrofolate reductase gene that lowers the activity of the enzyme.

Aims:  In the current study, we measured plasma homocysteine concentrations in pre‐eclamptic pregnants, and searched for the altered methylenetetrahydrofolate reductase (MTHFR) gene in which the cytosine 677 was replaced by the thymine (C677T polymorphism).

Methods:  The study groups consisted of 64 pre‐eclamptic and 47 normotensive healthy pregnant women in their third trimester. The C677T transition in the MTHFR gene was detected by HinfI restriction enzyme analysis and subsequent electrophoresis in a 3% agarose gel. Total homocysteine concentrations were measured by high performance liquid chromatography.

Results:  The prevalence of the homozygous mutant thymine‐thymine genotype was non‐significant in the pre‐eclamptic group. Total homocysteine in the plasma of pre‐eclamptic women was found to be increased in comparison with healthy pregnant women (P < 0.001). Any influence of the allelic distribution on plasma homocysteine concentrations was not detected in either group. However, pre‐eclamptic patients bearing the non‐mutated cytosine‐cytosine genotype had significantly higher homocysteine levels than those with an uncomplicated pregnancy (P = 0.009), ruling out the possibility that the presence of a mutated allele is associated with the hyperhomocysteinaemia seen in pre‐eclamptic women.

Conclusion:  In our pre‐eclamptic study population, a mild hyperhomocysteinaemia was observed. This finding seems to be a consequence of hypertension and vascular injury rather than an independent factor with a genetic origin.
Causes of late fetal death in New Zealand 1980–1999
Authors: CRAIG Elizabeth D. , STEWART Alistair W. , MITCHELL Ed A.
Published: September 2004

Background:  In recent years there has been an emerging interest in sudden unexplained intrauterine death.

Aims:  To determine the major causes of late fetal death (LFD) in New Zealand during 1980–1999 and to document the proportion of deaths considered unexplained. In addition, to quantify the number of LFD undergoing post‐mortem during this period.

Methods:  Using the Office for National Statistics (UK) hierarchical classification system, all information available on death certificates was used to assign a single cause to LFD for the period 1980–1999. Trends were analysed using logistic regression and risk factor profiles established for each cause of death. Post‐mortem rates and the characteristics of those failing to undergo post‐mortem were analysed for the period 1989–1999.

Results:  LFD rates declined from 60.1 per 10 000 in 1980–1981 to 30.5 in 1998–1999. The declines were not uniform across all causes, with intrapartum deaths declining 73%, congenital anomalies 70% and antepartum asphyxia 50%. In contrast, unspecified deaths increased 1%, and with the decline in other causes of death, also increased proportionally, from 10.8% of LFD in 1980–81 to 28.1% in 1998–1999. Post‐mortem rates fell by 31% during 1989–1999, with Maori and Pacific babies and those in more deprived New Zealand Deprivation Index areas being significantly less likely to undergo post‐mortem.

Conclusions:  While total LFD rates declined significantly during 1980–1999, rates of unspecified LFD remained static. Low post‐mortem rates, however, suggest that many of these deaths may be uninvestigated rather than truly unexplained. Nevertheless, the persistence of a category of death which, to date, has failed to improve with advances in obstetric technology suggests that further measures are necessary if New Zealand's LFD rates are to continue to decline.
Outcome after a cytological prediction of glandular abnormality
Authors: MITCHELL Heather S.
Published: September 2004

Background:  The National Health and Medical Research Council of Australia Guidelines for the Management of Women with Screen Detected Abnormalities are under review. The availability of population‐based Australian data on the outcome after a cytology prediction of glandular abnormality was considered relevant to revising the recommended investigations for women with these abnormalities.

Aim:  To describe the outcome of women with cytological predictions of glandular abnormalities of the cervix during 1999.

Methods:  A longitudinal study using data held by the Pap Test Registers of Australia.

Results:  Over a 24 month period, 70% (95% confidence interval (CI) 62–78%) of women whose cytology was reported as adenocarcinoma in situ (AIS) were confirmed as having high‐grade disease. Among women whose cytology was reported as ‘inconclusive: possible high‐grade glandular disease’, the proportion of women having high‐grade disease was 25% (95% CI 20–30%). For cytology reports of minor non‐specific change (MNSC) of glandular cells, the proportion of women having high‐grade disease was 10% (95% CI 8–12%). Cancer was diagnosed in 16%, 5% and <1% of women with index cytology reports of AIS, inconclusive and MNSC, respectively.

Conclusions:  These results can be used to inform an evidence‐based approach to the investigation and management of abnormal glandular cytology reports. The results can also be used to better inform women about the significance of their abnormal cytology.
Stem cells in gynaecology
Authors: GARGETT Caroline E.
Published: September 2004

Currently, there is enormous interest in stem cells as a new treatment modality for regenerative medicine, commencing when human embryonic stem (hES) cells were first cultured from spare in vitro fertilisation‐derived embryos. Emerging evidence also suggests that somatic stem cells may have greater differentiation potential. Stem cell research is now in an exciting phase of development and has the potential to dramatically influence therapeutics as hES cell derivatives and/or adult stem cells are applied to regenerative medicine or to deliver gene therapy. Human ES cells show apparently limitless proliferative potential and differentiation capacity into all tissue types. Adult stem cells are rare cells, which maintain the tissue in which they reside. The challenges facing the use of hES cells and adult stem cells in medicine are highlighted and examples of their use in laboratory studies and the clinic are given. Adult stem cells have been identified in diverse tissues, including human bone marrow, breast, prostate, brain and liver. We hypothesised that adult stem cells reside in the endometrium, a highly proliferative, cyclically regenerating tissue. Our research has demonstrated, for the first time, that human endometrium contains a small population of epithelial cells (0.22%) and stromal cells (1.25%) that exhibit stem/progenitor cell behaviour in vitro; clonogenicity. The progeny in these colonies have been characterised and growth factors supporting clonogenicity identified. The goal is to examine the role of putative endometrial stem/progenitor cells in proliferative disorders of human endometrium, such as endometriosis, adenomyosis, endometrial hyperplasia and endometrial cancer, and the action of hormone‐replacement therapy on the post‐menopausal endometrium.
Maternal mortality in Australia, 1973–1996
Authors: SULLIVAN Elizabeth A. , FORD Jane B. , CHAMBERS Georgina , SLAYTOR Emma K.
Published: September 2004

Aims:  Maternal mortality has declined dramatically over the past 30 years in developed countries. This retrospective study aims to provide an epidemiological overview of maternal deaths in Australia between 1973 and 1996.

Methods:  Data were abstracted from national maternal mortality data collection and triennial reports for the period 1973–1996 for women who died from pregnancy‐related causes while pregnant or within 42 days of a pregnancy being delivered or terminated. Deaths were restricted to those classified as direct or indirect maternal deaths. Maternal mortality age‐specific mortality ratios were calculated. The leading causes of death were examined.

Results:  Of the 584 deaths, 363 were direct and 221 indirect. The leading causes of direct death were pulmonary embolism (18.4%) and hypertensive disorders (16.3%). Cardiovascular disease accounted for 41% of indirect deaths. The maternal mortality ratio declined from 12.7 deaths per 100 000 confinements in 1973–1975 to 6.2 in 1991–1993, and was 10.0 for the entire 24‐year period. For women aged 40–44 years the ratio declined from 165.1 to 14.2 between 1973 and 1996. The ratio for Indigenous mothers was three times higher than for non‐Indigenous mothers, being 34.8 in the most recent triennium 1994–1996.

Conclusions:  Although maternal deaths are rare in Australia, apparent health inequality persists with Indigenous mothers continuing to have a higher risk of maternal death. While mortality in traditionally higher risk women aged > 40 years has declined, women with morbid cardiovascular disease continue to be over‐represented in the deaths. The comparatively high rate of deaths from pulmonary embolism needs to be addressed.
Computational Analysis of an Axial Flow Pediatric Ventricular Assist Device
Authors: Throckmorton Amy L. , Untaroiu Alexandrina , Allaire Paul E. , Wood Houston G. , Matherne Gaynell Paul , Lim David Scott , Peeler Ben B. , Olsen Don B.
Published: September 2004

Abstract: Longer‐term (>2 weeks) mechanical circulatory support will provide an improved quality of life for thousands of pediatric cardiac failure patients per year in the United States. These pediatric patients suffer from severe congenital or acquired heart disease complicated by congestive heart failure. There are currently very few mechanical circulatory support systems available in the United States as viable options for this population. For that reason, we have designed an axial flow pediatric ventricular assist device (PVAD) with an impeller that is fully suspended by magnetic bearings. As a geometrically similar, smaller scaled version of our axial flow pump for the adult population, the PVAD has a design point of 1.5 L/min at 65 mm Hg to meet the full physiologic needs of pediatric patients. Conventional axial pump design equations and a nondimensional scaling technique were used to estimate the PVAD's initial dimensions, which allowed for the creation of computational models for performance analysis. A computational fluid dynamic analysis of the axial flow PVAD, which measures approximately 65 mm in length by 35 mm in diameter, shows that the pump will produce 1.5 L/min at 65 mm Hg for 8000 rpm. Fluid forces (∼1 N) were also determined for the suspension and motor design, and scalar stress values remained below 350 Pa with maximum particle residence times of approximately 0.08 milliseconds in the pump. This initial design demonstrated acceptable performance, thereby encouraging prototype manufacturing for  experimental  validation.
Current Status of the Gyro Centrifugal Blood Pump—Development of the Permanently Implantable Centrifugal Blood Pump as a Biventricular Assist Device (NEDO Project)
Authors: Nosé Yukihiko , Furukawa Kojiro
Published: September 2004

Abstract: The New Energy and Industrial Technology Development Organization (NEDO) project was started in 1995. The goal is the development of a multipurpose, totally implantable biventricular assist device (BVAD) that can be used for any patient who suffers from severe heart failure. Our C1E3 (two‐week pump) centrifugal pump, called the Gyro pump, has three design characteristics: a magnetic coupling and double pivot bearing system, an eccentric inlet port, and secondary vanes on the bottom of the impeller. The pump was miniaturized. The C1E3 evolved into the NEDO PI‐601, a totally implantable centrifugal pump for BVAD. The current NEDO PI‐710 pump (five‐year pump) system includes a centrifugal pump with pivot bearings, a hydraulically‐levitated impeller, an rpm‐controlled miniaturized actuator (all‐in‐one actuator plus controller), an emergency clamp on the left outflow, and a Frank–Starling‐type flow control. The final mass production model is now finalized, and the final animal study  and  two‐year  endurance  studies are ongoing.
Outcomes of Congenital Heart Surgery Patients After Extracorporeal Life Support at Texas Children's Hospital
Authors: Ündar Akif , McKenzie E. Dean , McGarry Mary C. , Owens W. Richard , Surprise Deborah L. , Kilpack Vicki D. , Mueller Maryann W. , Stayer Stephen A. , Andropoulos Dean B. , Towbin Jeffrey A. , Fraser Charles D.
Published: September 2004

Abstract: The objective of this study was to investigate the outcomes of children with heart failure of various etiologies requiring temporary use of currently available technology in the U.S.A. after extracorporeal life support (ECLS) [left ventricular assist device (LVAD) or extracorporeal membrane oxygenation (ECMO)] at Texas Children's Hospital. Between July of 1995 and October of 2002, 2847 patients underwent congenital heart surgical repairs with the aid of cardiopulmonary bypass at Texas Children's Hospital. During this period, 17 patients required chronic mechanical circulatory assistance with Biomedicus centrifugal pump (n = 8) or Thoratec LVAD (n = 4), and ECMO (n = 5). Six out of 17 patients required ECLS for postcardiotomy heart failure. Seven of the 17 patients had congenital heart disease, six had cardiomyopathy, three had late acute rejection following heart transplantation, and one had myocardial infarction. Twelve patients survived and five patients expired. Six of 12 survivors recovered sufficient cardiac function to allow device removal; and the remaining six patients underwent heart transplantation. Three out of five deaths were ECMO patients. The need for ECLS following repair of congenital heart disease is extremely rare in our institution. The requirement for the use of ECMO confers a significantly higher mortality presumably because of associated combined cardiopulmonary failure. Congenital heart disease appears to be associated with significantly higher mortality.
A Bridge from Short‐term to Long‐term Left Ventricular Assist Device—Experimental Verification of a Physiological Controller
Authors: Wu Yi , Allaire Paul E. , Tao Gang , Adams Milton , Liu Yingjie , Wood Houston , Olsen Don B.
Published: September 2004

Abstract: A physiological controller is a key component to optimize the performance of left ventricular assist devices (LVADs) from short term to long term (10–20 years). The difficulties of its design lie in the inaccurate modeling of any particular human cardiovascular system because of limited knowledge, the large fluctuation of systemic parameters in normal daily life, nonlinearity introduced by one‐way heart valves, and restriction on available sensors. The desired physiological controller for a permanent LVAD is expected to handle different activity levels such as sleeping, resting and exercising, and different pathological levels of left ventricular failure. In this study, a physiological controller designed for a long‐term continuous flow (CF) LVAD was tested in a mock circulatory loop. The pressure head across the LVAD and motor signals were used as feedback signals, which were obtained from long‐term reliable sensors. Three activities and five different pathological levels of left ventricular failure were simulated to test the performance of the designed controller. The experimental results showed that the designed controller restored the total peripheral flow and arterial pressure, and decreased the left ventricular end‐diastolic pressure to a safe range. The suction of the left ventricle was successfully reversed by the designed controller. The controller thus was proven to be able to control the LVAD properly in many of the possible physiological conditions experienced by LVAD recipients in long term.
Development of an Implantable Undulation Type Ventricular Assist Device for Control of Organ Circulation
Authors: Yambe Tomoyuki , Abe Yusuke , Imachi Kou , Shiraishi Yasuyuki , Shibata Mune‐Ichi , Yamaguchi Tasuku , Wang Quintian , Duan Xudong , Liu Hongjian , Yoshizawa Makoto , Tanaka Akira , Matsuki Hidetoshi , Sato Fumihiro , Haga You‐Ichi , Esashi Masayoshi , Tabayashi Kouichi , Mitamura Yoshinori , Sasada Hiroshi , Umezu Mitsuo , Matsuda Takehisa , Nitta Shin‐Ichi
Published: September 2004

Abstract: It is well known that a rotary blood pump (RP) is effective as a small ventricular assist device (VAD). It might be still more effective if pulsation was available. The undulation pump (UP), which is a type of small RP, can also produce pulsation. In Japan, a development project for an implantable type UP ventricular assist device (UPVAD) is now advanced. Six universities and some companies together have been in charge of the development project for 5 years. In this study, the influence which the UP under development has on circulation in internal organs was investigated. Goats with the same weight as an average Asian person were used for the experiment. The left chest cavity was opened after resection of the fourth rib and the heart was approached. A cannula was inserted in the left ventricle from the apex. An outflow cannula was inserted into the left descending aorta. Heart muscle was excised using a newly developed puncher. The UPVAD was implanted using a left‐heart bypass system. The myocardial blood flow, carotid arterial blood flow, and the kidney blood flow were recorded together with an electrocardiogram, blood pressure, and the flow rate. In these animal experiments, the blood circulation dynamic state was stabilized and sufficient support of the left heart was observed. Myocardial blood flow, carotid arterial flow, and a kidney blood flow increase resulting from UPVAD support was observed. Often the problem of multiple organ failure is important at the time of clinical application of a ventricular assist device. Assisting circulation to internal organs is important for prevention of multiple organ failure. It was concluded that the UPVAD might be useful for prevention of multiple organ failure.
Component Engineering for an Implantable System
Authors: Wang Qingtian , Yambe Tomoyuki , Shiraishi Yasuyuki , Esashi Masayoshi , Haga Youichi , Yoshizawa Makoto , Sato Fumihiro , Matsuki Hidetoshi , Imachi Kou , Abe Yusuke , Sasada Hiroshi , Nitta Shin‐ichi
Published: September 2004

Abstract: Component engineering is important for the development of implantable‐type rotary blood pumps (RP). The authors are conducting elementary development of an implantable artificial heart. A sensor system detects information in the living body. An automatic control system performs the drive control. Energy is provided by a transcutaneous energy transmission system (TETS). Various artificial hearts are being created. Miniaturization resulting from an increase in operating frequency is planned. A vibrating flow pump (VFP) has a reduced size of pumping chamber because of the high‐speed reciprocating movement. Undulation pump ventricular assist devices (UPVAD) are small, lightweight rotary pumps. VFPs are useful in the medical treatment of multiple organ failure (MOF). UPVADs are planned to be permanent‐use RPs. The purposes of these two artificial hearts differ, although they have a common component. The authors are developing TETS by using amorphous fibers, making efficient power transmission possible. Control information input from a micro or nano sensor is realized. A control algorithm has been developed and baroreflex control has been successful. Artificial heart development, fully exploiting component engineering, continues.