Fronto-orbital advancement and remodeling for craniosynostosis is extensive surgery and is associated with potential risks; the most significant of these is blood loss. We prospectively studied 116 consecutive patients undergoing fronto-orbital advancement by the same surgical team for a 5-year 6-month period to determine what factors are associated with blood loss and transfusion of blood products. The data collected on the calvarial sutures involved were whether the patient had a diagnosed syndrome, the age at operation, the length of the operation, the estimated blood volume lost during the perioperative course, the number of units of packed cells transfused (donor exposures), and the use of other blood products. The mean (SD) total blood volume lost was 116% (5.4) of the estimated preoperative volume. The median number of whole units of packed cells transfused was 2 units. Other blood products were given in 28% of the cases. There was significantly greater blood loss in those patients with recognized craniofacial syndromes, pansynostosis, an operating time longer than 5 hours, and an age of 18 months or younger at operation. The use of other blood products was associated with those patients losing a blood volume higher than the mean.
: Malaria has always exerted a heavy toll on mankind. At the turn of the 20th century millions died each year in India alone. No other infectious disease has had more impact on the human genome, particularly in tropical regions. In the past 150 years malaria has been first controlled and then eliminated in Europe, North America and Russia. This was achieved mainly by a dual attack on the malaria vector –the anopheline mosquito, and the malaria parasite in the human host. The successes in temperate regions led to a global eradication effort endorsed by the World Health Assembly in 1955. The campaign was armed with an effective insecticide, DDT, and an excellent new antimalarial drug, chloroquine. However by 1969 it was acknowledged that the ambitious goal of global eradication could not be achieved. Over the next three decades many of the successes of the eradication effort were reversed and malaria resurged across the tropical world. The resurgence was associated with resistance to the available insecticides and to the available antimalarial drugs. The tide has turned again over the past 15 years with substantial increases in international support for malaria control activities, widescale deployment of insecticide treated mosquito nets, and the belated introduction of highly effective artemisinin combination treatments for uncomplicated malaria and artesunate for severe malaria. Global malaria mortality and morbidity have fallen substantially. Malaria eradication is now back on the agenda. The challenges now are how to maintain the political and financial support for malaria control and elimination as case numbers fall, to reach those areas where control activities are still weak, to address seriously control of P. vivax, and to overcome two looming familiar threats; insecticide and drug resistance. Resistance to pyrethroids is increasing and resistance to artemisinin in P. falciparum has emerged in South-East Asia, and now extends to the border of India. Artemisinin resistance has not been contained, and combination partner drug resistance has predictably followed. Spread of resistance to Africa would be disastrous. A moderately effective vaccine has been developed and new drugs are in the pipeline, but they will not generally available for years. The future is uncertain.
Overflow of Northern Component Water, the precursor of North Atlantic Deep Water, appears to have varied during Neogene times. It has been suggested that this variation is moderated by transient behavior of the Icelandic mantle plume, which has influenced North Atlantic bathymetry through time. Thus pathways and intensities of bottom currents that control deposition of contourite drifts could be affected by mantle processes. Here, we present regional seismic reflection profiles that cross sedimentary accumulations (Björn, Gardar, Eirik, and Hatton Drifts). Prominent reflections were mapped and calibrated using a combination of boreholes and legacy seismic profiles. Interpreted seismic profiles were used to reconstruct solid sedimentation rates. Björn Drift began to accumulate in late Miocene times. Its average sedimentation rate decreased at ∼2.5 Ma and increased again at ∼0.75 Ma. In contrast, Eirik Drift started to accumulate in early Miocene times. Its average sedimentation rate increased at ∼5.5 Ma and decreased at ∼2.2 Ma. In both cases, there is a good correlation between sedimentation rates, inferred Northern Component Water overflow, and the variation of Icelandic plume temperature independently obtained from the geometry of diachronous V‐shaped ridges. Between 5.5 and 2.5 Ma, the plume cooled, which probably caused subsidence of the Greenland‐Iceland‐Scotland Ridge, allowing drift accumulation to increase. When the plume became hotter at 2.5 Ma, drift accumulation rate fell. We infer that deep‐water current strength is modulated by fluctuating dynamic support of the Greenland‐Scotland Ridge. Our results highlight the potential link between mantle convective processes and ocean circulation.
Summary Phenotypic plasticity and microevolution represent the two processes by which phenotypic traits in a population can track environmental change. While there is a growing literature documenting microevolution in reproductive traits in naturally occurring animal populations, few studies to date have examined either between‐individual variation in levels of plasticity or how selection acts on plasticity. We present here mixed‐effect linear models analysing changes in calving date in relation to autumn rainfall observed over a 30‐year study of 2147 red deer on the Isle of Rum, Scotland. The study period is characterized by a phase of low and rising population density (up to and including 1980), followed by a phase of high and fluctuating population density (1981 to present). Variation within individual females explained a population‐level trend of delayed calving dates following years of high autumn rainfall. There was significant variation between females both in their average calving dates and in their individual plastic responses of calving date to autumn rainfall. Females born in the low population density phase were, on average, phenotypically plastic for the calving date–autumn rainfall relationship, and showed significant variation in plasticity. Selection favoured individuals with early average calving dates among these females. Among females born at high population density, there was on average no significant plasticity for calving date, but variation in plastic responses was still present. Selection favoured females with increasingly positive plastic responses of calving date to autumn rainfall. We argue that early experience of high population density affects the physiological condition of females, making an environmental response (calving early following dry autumns) in later life physiologically untenable for all but a few high quality individuals. These same few individuals also tend to be fitter and have higher reproductive success.
Permission to include the report granted by Gary O’Connor, Chief Executive Officer, ONTARIO PROBLEM GAMBLING RESEARCH CENTRE
No abstract is provided for this article.
Dr. Nicholas White writes that the main reason malaria-related mortality has increased while mortality associated with most other treatable and preventable infections has decreased is the continued deployment of ineffective antimalarial drugs in the face of increasing resistance.
In non-territorial species, individuals can move freely and should be distributed in an ideal free manner between habitats and areas with respect to resources that influence lifetime reproductive success (LRS). Consequently, no relationship between diet quality and LRS should be expected. However, there have been no attempts to test this prediction. The present paper investigates the relationship between forage habitat use and LRS in red deer (Cervus elaphus) hinds within three neighbouring areas on the Isle of Rum which differed in their amounts of high-quality-forage habitat. Within areas, hinds move widely and have access to the same resources. We found no correlation between LRS of individual hinds and their use of high-quality-forage habitat (i.e. short Agrostis/Festuca grassland). Our analysis suggests that high hind densities on short Agrostis/Festuca grassland offset any advantages of increased access to preferred forage. These results support the hypothesis that red deer hinds are distributed in an ideal free manner with respect to the use of high-quality-forage habitat. However, hinds rarely leave areas where they are born, and the analysis suggests that constraints in changing areas hindered an ideal free distribution on a larger spatial scale. Consequently, mean LRS was not the same within the three investigated areas: one area, with a low amount of short Agrostis/Festuca grassland and a low hind density, contributed more male offspring (and more total offspring) per hind to the population than the other two areas.
No abstract is provided for this article.
Quinidine has proved more effective than quinine against chloroquine-resistant Plasmodium falciparum both in vitro and in patients with uncomplicated disease. To examine the effectiveness and pharmacokinetics of quinidine for this use, we treated 14 patients who had severe falciparum malaria with intravenous quinidine gluconate; a loading dose of 15 mg of the base per kilogram of body weight was followed by 7.5 mg per kilogram every eight hours. Two of the five patients with cerebral malaria died, but parasitemia was eliminated in the 12 survivors. Two patients had recurrent parasitemia on Days 25 and 28. Times required for parasite clearance and elimination of fever (49.4 +/- 17.8 and 69.5 +/- 18.7 hours, respectively) were comparable to those in earlier studies with a loading dose of quinine. Quinidine appears to have a larger volume of distribution than quinine. The elimination half-life was 12.8 hours, the volume of distribution was 1.68 liters per kilogram, total clearance was 1.75 ml per kilogram per minute, and urinary clearance was 0.62 ml per kilogram per minute. Electrocardiographic changes were common but there were no dysrhythmias. In two patients, blood pressure fell during the initial infusion of quinidine. Quinidine gluconate is more widely available than quinine in many countries, and our findings show that it is effective in severe falciparum malaria.
