bluuebunny/crossref_metadata_2025 huggingface dataset:
Sharp genetic discontinuity across a unimodalHeliconiushybrid zone
Authors: Arias Carlos F. , Rosales Claudia , Salazar Camilo , Castaño Jully , Bermingham Eldredge , Linares Mauricio , McMillan W. O.
Published: September 2012

Hybrid zones are powerful natural systems to study evolutionary processes to gain an understanding of adaptation and speciation. In the Cauca Valley (Colombia), two butterfly races,Heliconius cydno cydnidesandHeliconius cydno weymeri,meet and hybridize. We characterized this hybrid zone using a combination of mitochondrialDNA(mtDNA) sequences, amplified fragment length polymorphisms (AFLPs), microsatellites and sequences for nuclear loci within and outside of the genomic regions that cause differences in wing colour pattern. The hybrid zone is largely composed of individuals of mixed ancestry. However, there is strong genetic discontinuity between the hybridizing races in mtDNAand, to a lesser extent, in all nuclear markers surveyed. The mtDNAclustering ofH. c. cydnideswith theH. cydnorace from the Magdalena Valley andH. c. weymeriwith theH. cydnorace from the pacific coast suggests thatH. c. cydnidescolonized the Cauca Valley from the north, whereasH. c. weymeridid so by crossing the Andes in the southern part, implying a secondary contact origin. Colonization of the valley byH. cydnowas accompanied by mimicry shift. Strong ecological isolation, driven by locally adaptive differences in mimetic wing patterns, is playing an important role in maintaining the hybrid zone. However, selection on wing pattern alone is not sufficient to explain the genetic discontinuity observed. There is evidence for differences in male mating preference, but the contribution of additional barriers needs further investigation. Overall, our results support the idea that speciation is a cumulative process, where the combination of multiple isolation barriers, combined with major phenotypic differences, facilitates population divergence in face of gene flow.
Exploring local immunological adaptation of two stickleback ecotypes by experimental infection and transcriptome‐wide digital gene expression analysis
Authors: Lenz Tobias L. , Eizaguirre Christophe , Rotter Björn , Kalbe Martin , Milinski Manfred
Published: September 2012

Understanding the extent of local adaptation in natural populations and the mechanisms that allow individuals to adapt to their native environment is a major avenue in molecular ecology research. Evidence for the frequent occurrence of diverging ecotypes in species that inhabit multiple ecological habitats is accumulating, but experimental approaches to understanding the biological pathways as well as the underlying genetic mechanisms are still rare. Parasites are invoked as one of the major selective forces driving evolution and are themselves dependent on the ecological conditions in a given habitat. Immunological adaptation to local parasite communities is therefore expected to be a key component of local adaptation in natural populations. Here, we use next‐generation sequencing technology to compare the transcriptome‐wide response of experimentally infected three‐spined sticklebacks from a lake and a river population, which are known to evolve under selection by distinct parasite communities. By comparing overall gene expression levels as well as the activation of functional pathways in response to parasite exposure, we identified potential differences between the two stickleback populations at several levels. Our results suggest locally adapted patterns of gene regulation in response to parasite exposure, which may reflect different local optima in the trade‐off between the benefits and the disadvantages of mounting an immune response because of quantitative differences of the local parasite communities.
Population structure of Phytophthora infestans in China – geographic clusters and presence of the EU genotype Blue_13
Authors: Li Y. , van der Lee T. , Zhu J. H. , Jin G. H. , Lan C. Z. , Zhu S. X. , Zhang R. F. , Liu B. W. , Zhao Z. J. , Kessel G. , Huang S. W. , Jacobsen E.
Published: September 2012

The population structure of Phytophthora infestans in China was studied and three mitochondrial haplotypes (Ia, IIa, IIb) were observed. Genetic analysis with 10 highly informative SSR markers identified 68 different genotypes, including three dominant clonal lineages. In the Chinese P. infestans population, the genotypes were strongly clustered according to their geographic origin. One of dominant clonal lineages was genetically similar to Blue_13, a dominant clonal lineage found in Europe since 2004. This is the first report of Blue_13 outside Europe. Only one mating type (A1) was found in the northern and southeastern provinces, but in southern and northwestern China both mating types were observed. The mating type ratio and SSR allele frequencies indicate that in China the sexual cycle of P. infestans is rare. These results emphasize that the migration of asexual propagules and the generation of subclonal variation are the dominant driving factors of the population structure of P. infestans in China. They may also have implications for the role of monitoring P. infestans populations in potato late blight management strategies in China.
Accuracy and precision of compounded ciclosporin capsules and solution
Authors: Umstead Meghan E. , Boothe Dawn M. , Cruz‐Espindola Crisanta , MacDonald John M. , Kennis Robert , Angarano Donna
Published: September 2012

Background –  The prescribing of compounded products that mimic US Federal Drug Administration approved drugs in the USA is inappropriate. Among the reasons are the lack of premarket regulatory assessment and the potential for an inferior product. This study describes the accuracy and precision of ciclosporin (CsA) strength when compounded as capsules (10 and 300 mg) and solutions (50 and 150 mg/mL).

Methods –  Preparation choices reflected current prescribing practices. Each was acquired by prescription from five pharmacies at three different times, 14–45 days apart. Atopica® (10 and 100 mg; Novartis, Greensboro, NC, USA) and three human generics (50 and 100 mg capsules and 100 mg/mL solution) were positive controls. Physical characteristics were assessed. Accuracy (percentage predicted) was based on CsA strength measured by high‐performance liquid chromatography and precision was based on replications (n = 3) from each pharmacy.

Results –  Accuracy of positive controls ranged from 92 to 103%. For compounded solutions, physical characteristics differed markedly between but not within pharmacies. Capsule accuracy was 10 ± 0.98 mg (101%) for 10 mg and 290 ± 9.6 mg (97%) for 300 mg; and solution accuracy was 45 ± 9.9 mg/mL (90%) for 50 mg/mL and 127 ± 18 mg/mL (85%) for 150 mg/mL. The precision for 50 mg/mL oral solution was 0.67–11%, and for 150 mg/mL, 3.7–14%. Accuracy for all preparations varied, with the least accurate deviating by 34% from labelled strength. Precision for all capsules ranged from 0.6 to 8.7%.

Conclusions and clinical importance –  Compounded CsA solutions may deviate by more than 10% from the labelled strength. Bioavailability and clinical efficacy of compounded CsA remain unknown, and such products should be prescribed only in appropriate circumstances.
Cue reactivity and its inhibition in pathological computer game players
Authors: Lorenz Robert C. , Krüger Jenny‐Kathinka , Neumann Britta , Schott Björn H. , Kaufmann Christian , Heinz Andreas , Wüstenberg Torsten
Published: September 2012

Despite a rising social relevance of pathological computer game playing, it remains unclear whether the neurobiological basis of this addiction‐like behavioral disorder and substance‐related addiction are comparable. In substance‐related addiction, attentional bias and cue reactivity are often observed. We conducted a functional magnetic resonance study using a dot probe paradigm with short‐presentation (attentional bias) and long‐presentation (cue reactivity) trials in eight male pathological computer game players (PCGPs) and nine healthy controls (HCs). Computer game‐related and neutral computer‐generated pictures, as well as pictures from the International Affective Picture System with positive and neutral valence, served as stimuli. PCGPs showed an attentional bias toward both game‐related and affective stimuli with positive valence. In contrast, HCs showed no attentional bias effect at all. PCGPs showed stronger brain responses in short‐presentation trials compared with HCs in medial prefrontal cortex (MPFC) and anterior cingulate gyrus and in long‐presentation trials in lingual gyrus. In an exploratory post hoc functional connectivity analyses, for long‐presentation trials, connectivity strength was higher between right inferior frontal gyrus, which was associated with inhibition processing in previous studies, and cue reactivity‐related regions (left orbitofrontal cortex and ventral striatum) in PCGPs. We observed behavioral and neural effects in PCGPs, which are comparable with those found in substance‐related addiction. However, cue‐related brain responses were depending on duration of cue presentation. Together with the connectivity result, these findings suggest that top‐down inhibitory processes might suppress the cue reactivity‐related neural activity in long‐presentation trials.
Human T‐cell proliferation in response to thrombin‐activated GTKO pig endothelial cells
Authors: Ezzelarab Corin , Ayares David , Cooper David K. C. , Ezzelarab Mohamed B.
Published: September 2012

Ezzelarab C, Ayares D, Cooper DKC, Ezzelarab MB. Human T‐cell proliferation in response to thrombin‐activated GTKO pig endothelial cells. Xenotransplantation 2012; 19: 311–316. © 2012 John Wiley & Sons A/S.

Abstract:  Background:  Thrombin formation is a key feature in the activation of coagulation in pig xenograft recipients. As thrombin is known to activate endothelial and immune cells, we explored whether thrombin activation of pig endothelial cells (EC) was associated with an increased human T‐cell response.

Methods:  α1,3‐galactosyltransferase gene‐knockout (GTKO) pig aortic EC (pAEC) were activated by porcine interferon‐gamma (pIFNγ), human (h)IFN‐γ, or thrombin. Swine leukocyte antigen (SLA) class I and class II expression were measured. Human peripheral blood mononuclear cells (PBMC) and CD4+ T‐cell proliferation in response to activated pAEC, the effect of thrombin on pig CD80/CD86 mRNA, and the effect of thrombin inhibition by hirudin were evaluated.

Results:  After pAEC activation, SLA I expression did not change, and only pIFNγ upregulated SLA II expression. PBMC proliferation to pIFNγ‐ and thrombin‐activated pAEC was significantly higher (P < 0.001 and P < 0.01) than to non‐activated pAEC. CD4+ T‐cell proliferation to pIFNγ‐ and thrombin‐activated pAEC was significantly higher (P < 0.001 and P < 0.01) than to non‐activated pAEC. Thrombin inhibition by hirudin reduced thrombin‐induced upregulation of pAEC CD86 mRNA, and significantly reduced human PBMC proliferation to pAEC in comparison with thrombin alone (P < 0.05).

Conclusions:  Thrombin upregulates CD86 mRNA on pAEC, which is associated with increased human T‐cell proliferation against pAEC. Hirudin reduces CD86 mRNA in thrombin‐activated pAEC and is associated with downregulation of the human T‐cell proliferative response. The transplantation of organs from GTKO pigs transgenic for human thrombomodulin, and/or endothelial protein C receptor, in addition to therapeutic regulation of thrombin activation may reduce the cellular response to a pig xenograft and thus reduce the need for intensive immunosuppressive therapy.
Phase equilibria and metamorphic evolution of garnet‐mica‐plagioclase gneisses from the Qiliping terrane in the western Dabie Orogen, central China
Authors: Zhang Jing‐Sen , Zhang Jing , Zhou Jun‐Jie , Zhang Hong‐Fen
Published: September 2012

The extensive gneisses in the high‐pressure and ultrahigh‐pressure metamorphic terrane in the Dabie‐Sulu orogen usually show no evidence of eclogite‐facies metamorphism. The garnet‐mica‐plagioclase gneisses from the Qiliping region in the western Dabie Orogen, comprise garnet, phengite, biotite, plagioclase, quartz, rutile, ilmenite, chlorite, epidote, and hornblende. The garnet porphyroblasts, with inclusions of quartz, epidote, and rutile, exhibit slight compositional zonations, from core to mantle with an increase in pyrope and a decrease in spessartine, and from mantle to rim with a decrease in pyrope and grossular and an increase in spessartine. The high‐Si phengite indicates that the gneisses may be subjected to a high‐pressure metamorphism. By the P–T pseudosections calculated in a system NCKMnFMASHTO (Na2O‐CaO‐K2O‐MnO‐FeO‐MgO‐Al2O3‐SiO2‐H2O‐TiO2‐O) for two representative samples, the metamorphic P–T path, reconstructed by the compositionally zoned garnet, shows that the prograde metamorphism is characterized by a temperature increase with a slight pressure increase from the conditions of 17.6 ± 1.5 kbar at 496 ± 15°C to the peak‐pressure ones of 21.8 ± 1.5–22.7 ± 1.5 kbar at 555 ± 15–561 ± 15°C; the early retrograde stage is dominated by decompression with a temperature increase to the maximum of 608 ± 15–611 ± 18°C at 10.3 ± 1.5–11.0 ± 1.5 kbar; and the late retrograde one is predominated by pressure and temperature decreases. The mineral assemblages in the prograde metamorphism are predicted to contain garnet, glaucophane, jadeite, lawsonite, phengite, quartz, rutile, and/or chlorite, which is different from those observed at present. Such high‐pressure metamorphism can partly be reconstructed by the P–T pseudosection in combination with the high‐Si phengite and garnet compositions in the core and mantle. This provides an important constraint on the subduction and exhumation of the terrane during the continent–continent collision between the Yangtze and Sino‐Korean cratons.
Review of neonatal alloimmune thrombocytopenia
Authors: Risson David C , Davies Mark W , Williams Bronwyn A
Published: September 2012

Neonatal alloimmune thrombocytopenia (NAIT), with an incidence of one in 1000 live births, is the most common cause of severe thrombocytopenia and intra‐cerebral haemorrhage in term neonates. NAIT results from trans‐placental passage of maternal antibodies against a paternally derived fetal platelet alloantigen. Clinical presentation varies from unexpected thrombocytopenia on a blood film in a well newborn to intracranial haemorrhage (ICH). In contrast to haemolytic disease of the newborn, NAIT can present in a first pregnancy, and subsequent pregnancies are usually more severely affected. The role of antenatal screening for maternal alloantibodies instead of fetal blood sampling to identify at‐risk fetuses remains uncertain, but there is a trend towards less invasive maternally directed treatment for at‐risk pregnancies. Neonatal management is aimed at preventing or limiting thrombocytopenic bleeding with transfusion of antigen‐matched platelets.
A fatal case of hypernatraemic dehydration in a neonate
Authors: Staub Eveline , Wilkins Barry
Published: September 2012

Problems with lactation can result in hypernatraemic dehydration in the neonate, with potentially severe adverse consequences. This is illustrated in this fatal case of a 10 day old neonate who presented with excessive hypernatraemic dehydration due to insufficient breast milk intake, resulting in cerebral sinus vein thrombosis with cerebral haemorrhage and infarction. Differential diagnosis included excessive sodium intake (through inappropriately mixed formula or house remedies or through hyperaldosteronism) and high water deficit (renal or gastrointestinal losses, nephrogenic or central diabetes insipidus), all of which were ruled out by specific investigations or history. No evidence was found for inborn error of metabolism. The dehydration in this baby, however, was accentuated by trans‐epidermal water loss due to an ichthyosiform skin condition. This first ever reported Australian fatality from neonatal hypernatraemic dehydration supports the concern of health care professionals over rising incidences of this entity in exclusively breastfed infants, and should encourage endorsement of improved monitoring of weight loss in newborns and breastfeeding support for their mothers.
Breast milk banking: Current opinion and practice in Australian neonatal intensive care units
Authors: Lam Eva Y , Kecskés Zsuzsoka , Abdel‐Latif Mohamed E
Published: September 2012

Aim:  To find out the knowledge and attitudes of health‐care professionals (HCPs) in Australian neonatal intensive care units (NICUs) towards breast milk banking (BMBg) and pasteurised donated breast milk (PDBM).

Methods:  Cross‐sectional structured survey of HCPs in all 25 NICUs in Australia.

Results:  Response rate was 43.4% (n= 358 of 825). Participants included nurses and midwives (291, 81.3%) and the remainder were neonatologists and neonatal trainees (67, 18.7%). A variable number of HCPs agreed that PDBM would decrease the risk of necrotising enterocolitis (81%) and allergies (48.9%), 8.4% thought PDBM will carry risk of infections and 78.8% agreed that PDBM is preferable over formula, but only 67.5% thought that establishing breast milk banks (BMBs) are justifiable. Significant differences were found between doctors and nurses/midwives, with 19.4% of doctors compared with 5.8% of nurses/midwives agreed that PDBM carried an increased risk of infection. Although, over 90% of nurses/midwives and 70% of doctors agreed that the donation of breast milk is important, only 71% of nurses/midwives and 52.2% of doctors thought that setting up a BMB was justifiable.

Conclusion:  The opinions about BMBg differ widely between HCPs; however, the majority support the practice. HCPs had different knowledge gaps in regard to BMBg. Nurses/midwives positively view the practice of BMBg more strongly compared with neonatologists.
Lung protective ventilation in extremely preterm infants
Authors: Dargaville Peter A , Tingay David G
Published: September 2012

The lungs of an extremely preterm infant ≤28 weeks gestation are structurally and biochemically immature and vulnerable to injury from positive pressure ventilation. A lung protective approach to respiratory support is vital, aiming to ventilate an open lung, using the lowest pressure settings that maintain recruitment and oxygenation and avoiding hyperinflation with each tidal breath. For infants with severe respiratory distress syndrome and persistent atelectasis, lung protective ventilation requires recruitment using stepwise pressure increments, followed by reduction in ventilator pressures in search of an optimal point at which to maintain ventilation. Several studies, including a single randomised controlled trial, have found this lung protective strategy to be more effectively administered using high‐frequency oscillatory ventilation rather than conventional ventilation. Many extremely preterm infants have minimal atelectasis and low oxygen requirements in the first days of life, and the ventilatory approach in this case should be one of avoidance of factors including overdistension that are known to contribute to later pulmonary deterioration. From a practical perspective, this means setting positive end‐expiratory pressure at the lowest value that maintains oxygenation and restricting tidal volume using a volume‐targeted mode of ventilation.
Infant formulas for preterm infants: In‐hospital and post‐discharge
Authors: Tudehope David I , Page Denise , Gilroy Melissa
Published: September 2012

The availability and composition of preterm and post‐discharge formulas (PDFs) have undergone considerable changes over the last decade. Human milk, supplemented with multi‐component fortifier, is the preferred feed for very preterm infants as it has beneficial effects for both short‐ and long‐term outcomes compared with formula. If supply of mother's milk or donor milk is inadequate, a breast milk substitute specifically designed for premature infants is the next option. Preterm formula is intended to provide nutrient intakes to match intrauterine growth and nutrient accretion rates and is enriched with energy, macronutrients, minerals, vitamins, and trace elements compared with term infant formulas. Post‐natal longitudinal growth failure has been reported almost universally in extremely preterm infants. Since 2009, a nutritionally enriched PDF specifically designed for preterm infants post hospital discharge with faltering growth has been available in Australia and New Zealand. This formula is an intermediary between preterm and term formulas and contains more energy (73 kcal/100 mL), protein (1.9 g/100 mL), minerals, vitamins, and trace elements than term formulas. Although the use of a PDF is based on sound nutritional knowledge, the 2012 Cochrane Systematic Review of 10 trials comparing feeding preterm infants with PDF and term formula did not demonstrate any short‐ or long‐term benefits. Health professionals need to make individual decisions on whether and how to use PDF.
Growth monitoring of low birthweight infants: What references to use?
Authors: Tudehope David , Gibbons Kristen , Cormack Barbara , Bloomfield Frank
Published: September 2012

Growth charts are the mainstay of monitoring growth in babies who were born small or preterm. A variety of different charts are available, each with specific limitations. Most birthweight centile charts underestimate growth restriction in preterm babies and there are few good charts for monitoring longitudinal growth in preterm babies; it is important to be aware of the limitations of using cross‐sectional data for monitoring longitudinal growth. Customised centile charts of fetal growth are used increasingly for antenatal monitoring for small‐for‐gestational age fetuses despite a lack of robust evidence. It is also unclear whether customised centile charts should be used for assessing birthweight, particularly in babies born at term. Faltering post‐natal growth in preterm babies is very common but need not be universal with close attention to nutrition. Monitoring of growth trajectories through infancy following either fetal growth restriction or post‐natal faltering growth is important to ensure proportional growth, particularly during periods of accelerated growth. This review will discuss these issues in the context of current practice in Australia and New Zealand.
Magnetic resonance imaging of the brain at term equivalent age in extremely premature neonates: To scan or not to scan?
Authors: Smyser Christopher D , Kidokoro Hiroyuki , Inder Terrie E
Published: September 2012

In the last decade, the role of magnetic resonance imaging (MRI) in neonatal care for prematurely born infants has rapidly expanded and evolved. Recent investigations addressed many of the practical issues pertaining to image acquisition and interpretation, enabling high‐quality MR images to be obtained without sedating medications in preterm infants at any institution. Expanded application has demonstrated that MRI provides superior ability to assess cerebral development and identify and define cerebral injury in comparison to other imaging modalities. Term equivalent MRI results have been shown to correlate with neurodevelopmental outcomes, providing improved predictive ability over other neuroimaging, clinical or physical examination measures. Regular utilisation of MRI in this population is fundamental to gaining the knowledge and expertise necessary for rational, accurate application. Ongoing experiences will continue to shape the nature and type of information available to clinicians and families using MRI, further refining its role as a routine element of neonatal care.
Preterm patent ductus arteriosus: Should we treat it?
Authors: Evans Nick
Published: September 2012

Debate about the importance of the preterm patent ductus arteriosus (PDA) remains unresolved. Ultrasound studies of PDA have suggested that the haemodynamic impact may be much earlier after birth than previously thought, but we still do not know when to treat a PDA. Studies that have tested symptomatic or pre‐symptomatic treatment are mainly historical and have not tested the effect of no treatment. Prophylactic treatment is the best studied regimen, but improvements in some short‐term outcomes do not translate to any difference in longer term outcomes. Neonatologists have been reluctant to engage in trials that test treatment against not treating at all or very rarely. Targeting treatment on the basis of the early post‐natal constrictive response of the duct is currently being tested as a possible strategy.
Use of oxygen for delivery room neonatal resuscitation in non‐tertiary Australian and New Zealand hospitals: A survey of current practices, opinions and equipment
Authors: Bhola Kavita , Lui Kei , Oei Ju Lee
Published: September 2012

Background:  Delivery room resuscitation of hypoxic newborn infants with pure or 100% oxygen causes oxidative toxicity and increases mortality. Current international resuscitation guidelines therefore recommend that oxygen be used judiciously. However, this requires staff education and special equipment that may not be available in non‐tertiary maternity hospitals where the majority of births occur.

Aim:  To determine current attitudes, practices and available equipment for the use of air and blended oxygen for newborn delivery room resuscitation in non‐tertiary maternity hospitals of Australia and New Zealand (ANZ).

Methods:  Structured questionnaires sent by mail and e‐mail after personal phone contact. A total of 203 eligible hospitals in ANZ were identified. A second mailing was conducted a month later for non‐responders.

Responders:  Final response rate was 64% (n= 130: 70% physicians, 30% midwives). The majority (121, 93%) of respondents were aware of Australian Resuscitation Council recommendations, but only one in five hospitals had the capacity to deliver blended oxygen and 38% used pulse oximeters at delivery. Only 24 (18.5%) hospitals had guidelines. Air would be used by 68 (57%) hospitals to resuscitate term infants compared to 35 (31%) for preterm infants. Most (111, 91%) advocated the use of blended oxygen despite the lack of facilities.

Conclusion:  Only one in five ANZ non‐tertiary maternity hospitals had the capacity to resuscitate newborn infants with air or blended oxygen. Most are aware of current recommendations and agreed that the use of less oxygen would be beneficial for this purpose. Further study into the necessary infrastructure required to implement these guidelines are recommended.
Role of breastfeeding in childhood cognitive development: A propensity score matching analysis
Authors: Boutwell Brian B , Beaver Kevin M , Barnes James C
Published: September 2012

Aim:  To examine whether the association between breastfeeding and childhood cognitive development is direct or whether the association is spurious owing to confounding variables.

Method:  The current study conducted a propensity score matching (PSM) analysis using data from the Early Childhood Longitudinal Study, Birth Cohort.

Results:  The results of PSM models revealed that prior to matching, the association between breastfeeding and cognitive functioning was significant (mean difference = 3.20, t‐value = 7.86, 95% confidence interval (CI) = 2.40–4.00, P ≤ 0.05). After controlling for a range of confounding factors, the mean difference was reduced by 40% (mean difference = 1.92, t‐value = 3.75, 95% CI = 0.92–2.93, P ≤ 0.05); however, significant differences remained between groups.

Conclusion:  The results produced in the current study provide tentative evidence that breastfeeding may have an influence on the development of cognitive abilities in children. Additional research is necessary, however, in order to further evaluate the causal impact and exact developmental pathway of breastfeeding on childhood cognitive growth.
It's time: A new era for paediatrics and child health in Australia
Authors: Oberklaid Frank
Published: September 2012

The Australian College of Paediatrics (ACP) was established in 1978; part of the stated rationale was to ‘acquire equal status to other colleges in medicine’ . . . and to become . . . ‘to which governments, or other organisations dealing with children, could officially turn to for advice’. After less than 2 decades, the ACP ceased to exist, and paediatricians became members of the Paediatrics and Child Health Division of the Royal Australasian College of Physicians (RACP). Many would now argue that the decision to dissolve the ACP and instead become a division within the RACP, though not taken lightly and made for what seemed at the time to be good reasons, might have been a mistake. While there have been some benefits, overall the public profile and national influence of paediatricians has been diminished. Paediatricians as a group have had little influence on policy formulation as it pertains to children and families, and the present administrative arrangements within the RACP raise considerable bureaucratic barriers for paediatricians to be able to contribute in a constructive and timely manner. It is suggested that paediatricians cannot be effective advocates for the health and wellbeing of children when they are but a relatively small and powerless group that resides within a large body of professionals whose primary interest is in various aspects of adult medicine. It is time that paediatricians (re)established their own college and controlled their own destiny. While such a step is not without its challenges, many would argue that it is an essential and timely step if we are to address our political and public health responsibilities.
Missed congenital hypothyroidism in an identical twin
Authors: Azam Anita , Cutfield Wayne , Mouat Fran , Hofman Paul L , Jefferies Craig , Webster Dianne , Gunn Alistair Jan
Published: September 2012

Newborn screening for congenital hypothyroidism has been remarkably effective, although rare cases of false negative screening have been reported in same sex twins, presumptively due to fetal blood exchange. We report a case in which the diagnosis of congenital hypothyroidism due to thyroid ectopia in a monozygotic twin was delayed by 8 months, with a normal newborn screening TSH level of 11 mIU/L blood (normal < 15 mIU/L) at 2 days of life. This is the first such case since the national New Zealand newborn screening programme introduced screening for congenital hypothyroidism in 1981 (30 years ago). Repeating thyroid studies at 14 days of age in same‐sex twins has been advocated to avoid delayed diagnosis, but given the low risk, may not be cost effective. It is important to maintain a high index of suspicion in same‐sex twin pregnancies of potential congenital hypothyroidism.
Juvenile Parkinsonism
Authors: Ware Tyson L , Srinivasan Jayasri , Gonzalez Linda , Hardikar Winita , Scheinberg Adam M , Baker Louise , Prakash Chidambaram , Ryan Monique M
Published: September 2012

We present the case of a 14‐year‐old boy presented with a recent history of progressive neurologic decline and extrapyramidal features. The history and findings with illustrative figures are detailed, and a diagnostic approach to the presentation is considered. The therapeutic options and broader management issues are briefly reviewed.
Early identification of autism: A comparison of the Checklist for Autism in Toddlers and the Modified Checklist for Autism in Toddlers
Authors: Sunita  , Bilszta Justin LC
Published: September 2012

There is still debate as to what is the most effective strategy for identifying the early signs of autism in very young children. Two levels of screening having been advocated: broad‐based developmental surveillance and targeted screening. Two popular tools for use in developmental surveillance are the Checklist for Autism in Toddlers (CHAT) and the Modified Checklist for Autism in Toddlers (M‐CHAT). The purpose of this article is to summarise the current evidence for screening for autistic symptoms in very young children using CHAT and M‐CHAT. A systematic search was carried out of electronic database and other sources for original studies which evaluated the use of CHAT and M‐CHAT in screening for autism in children younger than 5 years of age. Studies were included for review if they evaluated the sensitivity and/or specificity of CHAT or M‐CHAT, or described the best age to administer these instruments. The available evidence suggests that characteristic behaviours in autism should be evident in simple forms before the age of 18 months, while screening at 24 months should be conducted to identify those who regress. Administering a screening tool during 18‐ to 24‐month well‐child visits improves early identification of autism, while the stability of diagnosis at the ages of 18 months and 24 months is confirmed. M‐CHAT has slightly better sensitivity and specificity compared to CHAT, and is preferable to use as a developmental surveillance screening instrument.
Urodynamic findings in women with insensible incontinence
Authors: Brucker Benjamin M , Fong Eva , Kaefer Daniela , Shah Sagar , Rosenblum Nirit , Nitti Victor W
Published: September 2012

Objectives

To define the urodynamic study findings among women with insensible urinary incontinence.

Methods

Women complaining of insensible incontinence who underwent urodynamics at our center were identified. Coexisting symptoms of stress incontinence, urgency incontinence and/or mixed incontinence were recorded. The primary outcome was the urodynamic study finding. Urodynamic stress incontinence, detrusor overactivity incontinence, combination of both or neither (no incontinence) were the possible diagnoses.

Results

A total of 58% of patients had insensible incontinence alone and 42% had insensible incontinence combined with other urinary incontinence symptoms. Of the patients with insensible incontinence alone, 37% had no incontinence on urodynamics, whereas urodynamic stress incontinence was diagnosed in 52%. Isolated urodynamic stress incontinence was found in 73% of patients with insensible and stress incontinence symptoms. In patients with insensible plus urgency incontinence, isolated detrusor overactivity incontinence and detrusor overactivity incontinence with urodynamic stress incontinence were found in the same percentage of women (40% each). In patients with symptoms including stress urinary incontinence, stress incontinence was the predominant urodynamic finding.

Conclusions

In patients who have incontinence symptoms in addition to insensible incontinence, these symptoms are highly predictive of urodynamic findings. In particular, women with insensible incontinence, concomitant stress incontinence symptoms are most predictive of urodynamic findings (i.e. urodynamic stress urinary incontinence). In contrast, where insensible incontinence represents the only symptom, urodynamic findings vary widely, with a significant proportion having non‐diagnostic studies.
Stage‐specific impact of extended versus standard pelvic lymph node dissection in radical cystectomy
Authors: Simone Giuseppe , Papalia Rocco , Ferriero Mariaconsiglia , Guaglianone Salvatore , Castelli Emanuele , Collura Devis , Muto Giovanni , Gallucci Michele
Published: September 2012

Objectives

To evaluate the impact of an extended versus a standard pelvic lymph node dissection on disease‐free survival and cancer‐specific survival of patients with non‐metastatic muscle‐invasive urothelial carcinoma of the bladder treated with radical cystectomy.

Methods

We retrospectively analyzed data of 933 patients collected in two prospectively‐maintained institutional databases between 2002 and 2010. Patients who met inclusion criteria (high‐grade urothelial carcinoma, have not undergone neoadjuvant treatments, have not undergone salvage cystectomy) were included for analysis. The upper boundary was the iliac bifurcation for standard lymph‐node dissection and the aortic bifurcation for the extended lymph node dissection, respectively. Univariable and multivariable Cox regression analyses were carried out to identify independent predictors of disease‐free survival and cancer‐specific survival and, subsequently, the effect of extended lymph node dissection was determined with a multivariable Cox analysis after stratifying for significant covariates.

Results

At multivariable analysis, once adjusted for the effect of the other covariates, extended lymph node dissection was an independent predictor of disease‐free survival (hazard ratio 1.95, P < 0.001) and cancer‐specific survival (hazard ratio 1.80, P < 0.001). The benefit of an extended pelvic lymph node dissection on disease‐free survival and cancer‐specific survival was significant across all pT stages (all P < 0.05) except for pT <2 and across all pN stages (pN = 0, P = 0.011 and P = 0.034 for disease‐free survival and cancer‐specific survival, respectively; pN1 and pN2, all P < 0.001).

Conclusions

The staging accuracy and the survival benefit provided by extended pelvic lymph node dissection suggests the adoption of this template as the standard template for patients with muscle‐invasive urothelial carcinoma of the bladder undergoing radical cystectomy.
Tradescantia management in a New Zealand National Park
Authors: Hurrell Geoff A. , Belton Tom , Lusk Carolyn S. , Lamoureaux Shona L.
Published: September 2012

The invasive plant species, Tradescantia fluminensis, first appeared in the Whakapohai Reserve in South Westland, New Zealand, during the 1960s, and by 2002, it had spread throughout the 43‐ha riparian reserve. It was presumed at high risk of spreading to neighbouring National Parks because of its ability to spread by floodwaters. A restoration project with the aim of eradicating Tradescantia in the reserve began in May 2002, at which time eight transects were established. The cover of Tradescantia was measured before control, and after on six subsequent occasions. The initial cover of Tradescantia was estimated to be about 17% of the entire reserve in 2002 and declined with annual control to <0.1% in 2011. The effects of this management regime on the forest community are described along with documentation of the costs and time put into achieving these outcomes.
Biofortification of plants with altered antioxidant content and composition: genetic engineering strategies
Authors: Zhu Changfu , Sanahuja Georgina , Yuan Dawei , Farré Gemma , Arjó Gemma , Berman Judit , Zorrilla‐López Uxue , Banakar Raviraj , Bai Chao , Pérez‐Massot Eduard , Bassie Ludovic , Capell Teresa , Christou Paul
Published: September 2012

Antioxidants are protective molecules that neutralize reactive oxygen species and prevent oxidative damage to cellular components such as membranes, proteins and nucleic acids, therefore reducing the rate of cell death and hence the effects of ageing and ageing‐related diseases. The fortification of food with antioxidants represents an overlap between two diverse environments, namely fortification of staple foods with essential nutrients that happen to have antioxidant properties (e.g. vitaminsCandE) and the fortification of luxury foods with health‐promoting but non‐essential antioxidants such as flavonoids as part of the nutraceuticals/functional foods industry. Although processed foods can be artificially fortified with vitamins, minerals and nutraceuticals, a more sustainable approach is to introduce the traits for such health‐promoting compounds at source, an approach known as biofortification. Regardless of the target compound, the same challenges arise when considering the biofortification of plants with antioxidants, that is the need to modulate endogenous metabolic pathways to increase the production of specific antioxidants without affecting plant growth and development and without collateral effects on other metabolic pathways. These challenges become even more intricate as we move from the engineering of individual pathways to several pathways simultaneously. In this review, we consider the state of the art in antioxidant biofortification and discuss the challenges that remain to be overcome in the development of nutritionally complete and health‐promoting functional foods.
WAGE BARGAINING AND MERGER INCENTIVES WITH ASYMMETRIC COSTS
Authors: Nakamura Yasuhiko
Published: September 2012

This paper examines how wage bargaining within each firm influences the relationship between an equilibrium ownership structure and the most preferred ownership structure from the viewpoint of social welfare, in a unionized oligopoly of asymmetric firms with respect to productivity of capital. We consider the merger incentive of each firm’s owner when the wage level is determined through bargaining between the firm’s owner and union. We derive a condition for both the degree of cost asymmetry among existing firms and the relative bargaining power of each firm’s owner to her/his union such that each ownership structure can be observed in equilibrium. We also show that although the two types of ownership structures with the merger involving the least efficient firm can be equilibria and socially optimal, these structures are observed only when both the degree of cost asymmetry and the relative bargaining power of each firm’s owner are moderate. Finally, we analyse the relationship among the cooperative game approach employed in this paper and two non‐cooperative merger formation approaches, and examine the robustness of the results obtained in this paper against the change in the assumption regarding each firm’s cost function.
Morphological Externalisation and the Old Irish Verbal ParticleRo1
Authors: García‐Castillero Carlos
Published: September 2012

The basic claim of this paper is that the noticeable variation in the positioning of the Old Irish (= OIr.) perfectivising particleroin the verbal complex can be accounted for in terms of a process of morphological externalisation. In order to make clear the extent of this claim, I first offer a brief description of the morphological structure implied by the OIr. verbal complex and I propose a classification of the OIr. forms including the particlero. Second, I develop a notion of morphological externalisation, specifically, of its mechanism of change, according to which externalisation involves a sequence of paradigmatic reanalysis and proportional analogy, and which may serve to explain the reordering of morphemes observed both in Haspelmath’s (1993) and in Mithun’s (1999) studies. Finally, I explain the assumed change in which the particlerochanges its position within the OIr. verbal complex as an example of externalisation in complex morphological structures of the type dealt with in Mithun’s study.
On Morphological Realignments in Old English Root Nouns1
Authors: Adamczyk Elżbieta
Published: September 2012

The present paper addresses the issue of gradual reorganisation of the early English nominal inflection, effected by an interplay of phonological and morphological factors, which led to a complete overhaul of the system inherited from Proto‐Germanic. One of minor classes which fell victim to the process of analogical restructuring was a group of root nouns which tended to fluctuate between inherited and innovative paradigmatic patterns. The attested vacillation of forms testifies to the presence of disintegrative tendencies in their paradigms. The aim of the present study is to track the pattern behind the dissemination of these tendencies, as well as to explore the extent to which the inherited paradigm disintegrated, forsaking the original inflection to the benefit of the productive declensional types. The significance of factors such as frequency of occurrence, productivity of inflectional patterns, or gender affiliation is recognised, with a view to investigating the mechanism of the restructuring process and its theoretical implications. The findings of the investigation reveal that the paradigm of root nouns, albeit not free from the impact of the productive inflection, was to a large extent preserved intact, and, when compared to other minor declensional classes, can be considered relatively conservative.
Patient care, satisfaction and service quality in health care
Authors: Senić Vladimir , Marinković Veljko
Published: September 2012

It is becoming increasingly important in the healthcare setting to treat patients as consumers and measure their satisfaction with medical services rendered. As such, patient satisfaction should be considered an important output of a country's healthcare system, basically reflecting the stage of its development. The conducted study tested students’ satisfaction with the quality of service provided by student polyclinics. In particular, the study has analysed the impacts of personal relationships, promptness and tangibility on student satisfaction. The findings imply that all three factors significantly affect patient satisfaction, with personal relationships having the strongest impact. Such results suggest that healthcare providers should encourage their doctors to devote more time to their patients and show genuine concern for patients’ problems if they wish to improve overall satisfaction of their patients with the delivered services.
Gender, social acceptability and the adoption of supermarkets: evidence from Libya
Authors: Sehib Khairia , Jackson Elizabeth , Gorton Matthew
Published: September 2012

This paper explores factors affecting consumers' adoption of supermarkets in a nation whose retail environment has been dominated by traditional markets and small independent stores for generations. In‐depth interviews with Libyan shoppers (n = 32) indicate that social acceptability is a major factor governing adoption of supermarkets. In Libya, food shopping has traditionally been a task for male household members, with markets regarded as inappropriate spaces for female alone or with other women. However, the safer, cleaner and less crowded environment offered by large supermarkets has contributed to women feeling more comfortable shopping for food, and henceforth being able to shop as independent consumers. This has been welcomed by both men and women; traditional culture, rather than constraining the spread of supermarkets, may act as a facilitator. For practitioners, a critical factor underpinning the development of supermarkets in Libya will be the degree to which they offer a more female‐friendly and safer shopping experience than traditional retail outlets.
The Political Economy of Contract Farming in China's Agrarian Transition
Authors: ZHANG QIAN FORREST
Published: September 2012

How does rural China's political economy determine the motivations and constraints that drive small farmers and agribusiness companies into contract farming and shape its practice and impact? This paper identifies three distinctive features of contract farming in China – varied impact on rural inequality, unstable contractual relations and lack of competitiveness with other alternatives – and proposes tentative explanations linked to three features in rural China's political economy: strong collective institutions, active state support for agriculture and strong domestic markets. The recent turn in China's agrarian transition towards vertical integration of agriculture with industries is, however, undermining these conditions and may move China towards more convergence with other countries. Studying contract farming in China's unique political economy context shows not only how variations in the political economy can alter its practice and impact, but also how it needs to be evaluated in comparison with competing alternatives.