Showing papers by "Flinders University published in 2003"

The genome sequence of the filamentous fungus Neurospora crassa

Abstract: Neurospora crassa is a central organism in the history of twentieth-century genetics, biochemistry and molecular biology. Here, we report a high-quality draft sequence of the N. crassa genome. The approximately 40-megabase genome encodes about 10,000 protein-coding genes—more than twice as many as in the fission yeast Schizosaccharomyces pombe and only about 25% fewer than in the fruitfly Drosophila melanogaster. Analysis of the gene set yields insights into unexpected aspects of Neurospora biology including the identification of genes potentially associated with red light photobiology, genes implicated in secondary metabolism, and important differences in Ca21 signalling as compared with plants and animals. Neurospora possesses the widest array of genome defence mechanisms known for any eukaryotic organism, including a process unique to fungi called repeat-induced point mutation (RIP). Genome analysis suggests that RIP has had a profound impact on genome evolution, greatly slowing the creation of new genes through genomic duplication and resulting in a genome with an unusually low proportion of closely related genes.

Idiopathic Parkinson's disease: possible routes by which vulnerable neuronal types may be subject to neuroinvasion by an unknown pathogen.

Abstract: The progressive, neurodegenerative process underlying idiopathic Parkinson's disease is associated with the formation of proteinaceous inclusion bodies that involve a few susceptible neuronal types of the human nervous system. In the lower brain stem, the process begins in the dorsal motor nucleus of the vagus nerve and advances from there essentially upwards through susceptible regions of the medulla oblongata, pontine tegmentum, midbrain, and basal forebrain until it reaches the cerebral cortex. With time, multiple components of the autonomic, limbic, and motor systems become severely impaired. All of the vulnerable subcortical grays and cortical areas are closely interconnected. Incidental cases of idiopathic Parkinson's disease may show involvement of both the enteric nervous system and the dorsal motor nucleus of the vagus nerve. This observation, combined with the working hypothesis that the stereotypic topographic expansion pattern of the lesions may resemble that of a falling row of dominos, prompts the question whether the disorder might originate outside of the central nervous system, caused by a yet unidentified pathogen that is capable of passing the mucosal barrier of the gastrointestinal tract and, via postganglionic enteric neurons, entering the central nervous system along unmyelinated praeganglionic fibers generated from the visceromotor projection cells of the vagus nerve. By way of retrograde axonal and transneuronal transport, such a causative pathogen could reach selectively vulnerable subcortical nuclei and, unimpeded, gain access to the cerebral cortex. The here hypothesized mechanism offers one possible explanation for the sequential and apparently uninterrupted manner in which vulnerable brain regions, subcortical grays and cortical areas become involved in idiopathic Parkinson's disease.

A Comparison of Outcomes With Angiotensin-Converting--Enzyme Inhibitors and Diuretics for Hypertension in the Elderly

Abstract: Background Treatment of hypertension with diuretics, beta-blockers, or both leads to improved outcomes. It has been postulated that agents that inhibit the renin–angiotensin system confer benefit beyond the reduction of blood pressure alone. We compared the outcomes in older subjects with hypertension who were treated with angiotensin-converting–enzyme (ACE) inhibitors with the outcomes in those treated with diuretic agents. Methods We conducted a prospective, randomized, open-label study with blinded assessment of end points in 6083 subjects with hypertension who were 65 to 84 years of age and received health care at 1594 family practices. Subjects were followed for a median of 4.1 years, and the total numbers of cardiovascular events in the two treatment groups were compared with the use of multivariate proportional-hazards models. Results At base line, the treatment groups were well matched in terms of age, sex, and blood pressure. By the end of the study, blood pressure had decreased to a similar exte...

Protein electrochemistry using aligned carbon nanotube arrays.

Abstract: The remarkable electrocatalytic properties and small size of carbon nanotubes make them ideal for achieving direct electron transfer to proteins, important in understanding their redox properties and in the development of biosensors. Here, we report shortened SWNTs can be aligned normal to an electrode by self-assembly and act as molecular wires to allow electrical communication between the underlying electrode and redox proteins covalently attached to the ends of the SWNTs, in this case, microperoxidase MP-11. The efficiency of the electron transfer through the SWNTs is demonstrated by electrodes modified with tubes cut to different lengths having the same electron-transfer rate constant.

Isolation and Identification of Actinobacteria from Surface-Sterilized Wheat Roots

Abstract: This is the first report of filamentous actinobacteria isolated from surface-sterilized root tissues of healthy wheat plants (Triticum aestivum L.). Wheat roots from a range of sites across South Australia were used as the source material for the isolation of the endophytic actinobacteria. Roots were surface-sterilized by using ethanol and sodium hypochlorite prior to the isolation of the actinobacteria. Forty-nine of these isolates were identified by using 16S ribosomal DNA (rDNA) sequencing and found to belong to a small group of actinobacterial genera including Streptomyces, Microbispora, Micromonospora, and Nocardiodes spp. Many of the Streptomyces spp. were found to be similar, on the basis of their 16S rDNA gene sequence, to Streptomyces spp. that had been isolated from potato scabs. In particular, several isolates exhibited high 16S rDNA gene sequence homology to Streptomyces caviscabies and S. setonii. None of these isolates, nor the S. caviscabies and S. setonii type strains, were found to carry the nec1 pathogenicity-associated gene or to produce the toxin thaxtomin, indicating that they were nonpathogenic. These isolates were recovered from healthy plants over a range of geographically and temporally isolated sampling events and constitute an important plant-microbe interaction.

Predicting obesity in early adulthood from childhood and parental obesity.

Abstract: OBJECTIVE: To determine the degree of tracking of adiposity from childhood to early adulthood, and the risk of overweight in early adulthood associated with overweight in childhood and parental weight status in a cohort of children born in the mid-1970s. DESIGN: Longitudinal observational study. SUBJECTS: Approximately 155 healthy boys and girls born in Adelaide, South Australia, 1975–1976 and their parents. MEASUREMENTS: Height and weight of subjects at 2 y, annually from 4 to 8 y, biennially from 11 to 15 y and at 20 y, and of parents when subjects were aged 8 y. Body mass index (BMI) of subjects converted to standard deviation scores and prevalence of overweight and obesity determined using worldwide definitions. Parents classified as overweight if BMI≥25 kg/m2. Tracking estimated as Pearson's correlation coefficient. Risk ratio used to describe the association between weight status at each age and parental weight status and weight status at 20 y and weight status at each earlier age, both unadjusted and adjusted for parental weight status. RESULTS: The prevalence of overweight/obesity increased with age and was higher than that reported in international reference populations. Tracking of BMI was established from 6 y onwards to 20 y at r-values >0.6, suggesting that BMI from 6 y is a good indicator of later BMI. Tracking was stronger for shorter intervals and for those subjects with both parents overweight compared with those with only one or neither parent overweight. Weight status at an earlier age was a more important predictor of weight status at 20 y than parental weight status, and risk of overweight at 20 y increased further with increasing weight status of parents. CONCLUSION: Strategies for prevention of overweight and targeted interventions for prevention of the progression of overweight to obesity are urgently required in school-aged children in order to stem the epidemic of overweight in the adult population.

Randomised, double blind, placebo controlled crossover trial of sustained release morphine for the management of refractory dyspnoea

Abstract: Objective To determine the efficacy of oral morphine in relieving the sensation of breathlessness in patients in whom the underlying aetiology is maximally treated. Design Randomised, double blind, placebo controlled crossover study. Setting Four outpatient clinics at a hospital in South Australia. Participants 48 participants who had not previously been treated with opioids (mean age 76, SD 5) with predominantly chronic obstructive pulmonary disease (42, 88%) were randomised to four days of 20 mg oral morphine with sustained release followed by four days of identically formulated placebo, or vice versa. Laxatives were provided as needed. Main outcome measures Dyspnoea in the morning and evening as shown on a 100 mm visual analogue scale, quality of sleep, wellbeing, performance on physical exertion, and side effects as measured at the end of the four day treatment period. Results 38 participants completed the study; three withdrew because of definite and two because of possible side effects of morphine (nausea, vomiting, and sedation). Participants reported significantly different dyspnoea scores when treated with morphine: an improvement of 6.6 mm (95% confidence interval 1.6 mm to 11.6 mm) in the morning and of 9.5 mm (3.0 mm to 16.1 mm) in the evening (P = 0.011 and P = 0.006, respectively). During the period in which they were taking morphine participants also reported better sleep (P = 0.039). More participants reported distressing constipation while taking morphine (9 v 1, P = 0.021) in spite of using laxatives. All other side effects were not significantly worse with morphine, although the study was not powered to address side effects. Conclusions Sustained release, oral morphine at low dosage provides significant symptomatic improvement in refractory dyspnoea in the community setting.

Leadership for organisational learning and improved student outcomes - What do we know?

Abstract: The Leadership for Organisational Learning and Student Outcomes (LOLSO) Research Project addresses the need to extend present understandings of school reform initiatives that aim to change school practices with the intention of supporting enhanced student learning. In this article results from LOLSO's teacher surveys ('teacher voice') and student surveys ('pupil voice') are organised around six of the project's major research questions: how is the concept of organisational learning (OL) defined in Australian secondary schools (teacher voice)? What leadership practices promote OL in schools (teacher voice)? What are some outcomes of schooling other than academic achievement (pupil voice)? What are the relationships between the non-academic and academic outcomes of schooling? Do school leadership and/or organisational learning contribute to student outcomes? What other factors contribute to student outcomes? The answers to these questions lead to four clear implications relating to distributive leadership, ...

Molecular and functional analysis identifies ALK-1 as the predominant cause of pulmonary hypertension related to hereditary haemorrhagic telangiectasia

Abstract: Background: Mutations of the transforming growth factor β (TGFβ) receptor components ENDOGLIN and ALK-1 cause the autosomal dominant vascular disorder hereditary haemorrhagic telangiectasia (HHT). Heterozygous mutations of the type II receptor BMPR2 underlie familial primary pulmonary hypertension. Objective: To investigate kindreds presenting with both pulmonary hypertension and HHT. Methods: Probands and families were identified by specialist pulmonary hypertension centres in five countries. DNA sequence analysis of ALK-1 , ENDOGLIN , and BMPR2 was undertaken. Cellular localisation was investigated by heterologous overexpression of mutant constructs in both BAEC and HeLa cells. The impact of a novel sequence variant was assessed through comparative analysis and computer modelling. Results: Molecular analysis of 11 probands identified eight missense mutations of ALK-1 , one of which was observed in two families. Mutations were located within exons 5 to 10 of the ALK-1 gene. The majority of ALK-1 mutant constructs appeared to be retained within the cell cytoplasm, in the endoplasmic reticulum. A novel GS domain mutation, when overexpressed, reached the cell surface but is predicted to disrupt conformational changes owing to loss of a critical hydrogen bond. Two novel missense mutations were identified in ENDOGLIN . Conclusions: The association of pulmonary arterial hypertension and HHT identifies an important disease complication and appears most common among subjects with defects in ALK-1 receptor signalling. Future studies should focus on detailed molecular analysis of the common cellular pathways disrupted by mutations of ALK-1 and BMPR2 that cause inherited pulmonary vascular disease.

Receptor activator NF kB ligand (RANKL) and osteoprotegerin (OPG) protein expression in periodontitis

Abstract: Objectives and background: This study investigated the expression of key mediators that regulate differentiation of osteoclasts, receptor activator of nuclear factor κB ligand (RANKL), and its natural inhibitor, osteoprotegerin (OPG), in periodontitis. We aimed to compare the levels of the RANKL and OPG in the granulomatous tissue adjacent to areas of alveolar bone loss from patients with periodontitis to that present in tissue from patients without periodontitis. In addition, we aimed to determine the types of cells expressing these factors in these tissues and to demonstrate the expression of the osteoclastic markers, RANK and tartrate-resistant acid phosphatase (TRAP), in periodontitis. Materials and methods: Frozen biopsy specimens were analysed using specific monoclonal antibodies and were evaluated by semiquantitative analysis and digital image analysis to compare levels of RANKL and OPG protein expression. Double labelling of frozen sections with antibodies to different cell lineage specific markers was used to determine the types of cells expressing these proteins. In situ hybridization was used to detect cells expressing RANK mRNA. Results: Semiquantitative image analysis demonstrated that significantly higher levels of RANKL protein (P < 0.05) were expressed in the periodontitis tissue. Conversely, OPG protein was significantly lower (P < 0.05) in the periodontitis tissues. RANKL protein was associated with lymphocytes and macrophages. OPG protein was associated with endothelial cells in both tissues. Many leukocytes expressing RANK mRNA and TRAP were observed in periodontitis tissues. Conclusion: The change in the levels of these key regulators of osteoclast differentiation may play a major role in the bone loss seen in periodontitis.

Media exposure, body dissatisfaction and disordered eating: television and magazines are not the same!

Abstract: Objective: This study aimed to investigate the relationship between media exposure and body dissatisfaction and disordered eating in a more finely grained way than in previous studies. Method: A sample of 104 female undergraduate students completed measures of both magazine and television exposure, as well as measures of body dissatisfaction, disordered eating, awareness and internalization of societal ideals. Results: While both media exposure variables were correlated with body dissatisfaction, the pattern of correlations was very different with the other variables. In particular, the amount of magazine reading, but not television watching, was positively correlated with internalization of thin ideals. On the other hand, time spent watching television was negatively correlated with awareness of sociocultural ideals and self-esteem. Discussion: It was concluded that the processes through which television and magazines impact on body dissatisfaction are different. The relationship between magazine exposure and body dissatisfaction is mediated by internalization of thin ideals, which is not the case for television exposure. Copyright © 2003 John Wiley & Sons, Ltd and Eating Disorders Association.

The relationship between women's body satisfaction and self-image across the life span: the role of cognitive control

Abstract: The authors examined the relationship between body dissatisfaction and self-image across the life span. A sample of 106 women between the ages of 20 and 65 years completed questionnaire measures of body dissatisfaction, body importance, cognitive control over the body, self-concept, and self-esteem. The authors found that body dissatisfaction and body importance did not differ among the groups of women who were younger, middle aged, and older. Although body dissatisfaction was related to self-concept and self-esteem for the entire sample, the strength of that relationship reduced with increasing age and increasing perceptions of cognitive control. The authors concluded that the cognitive strategies of women who were older protect their self-concept and self-esteem from the influence of body dissatisfaction.

Children's sociable and aggressive behaviour with peers: A comparison of the US and Australia, and contributions of temperament and parenting styles

Abstract: Links between both temperament and parenting, and children's sociable and aggressive behaviour with peers (physical and relational), were examined. The research was undertaken in two Western cultur...

ABC of learning and teaching in medicine. Curriculum design.

Abstract: The curriculum represents the expression of educational ideas in practice. The word curriculum has its roots in the Latin word for track or race course. From there it came to mean course of study or syllabus. Today the definition is much wider and includes all the planned learning experiences of a school or educational institution. The curriculum must be in a form that can be communicated to those associated with the learning institution, should be open to critique, and should be able to be readily transformed into practice. The curriculum exists at three levels: what is planned for the students, what is delivered to the students, and what the students experience. A curriculum is the result of human agency. It is underpinned by a set of values and beliefs about what students should know and how they come to know it. The curriculum of any institution is often contested and problematic. Some people may support a set of underlying values that are no longer relevant. This is the so called sabretoothed curriculum, which is based on the fable of the cave dwellers who continued to teach about hunting the sabretoothed tiger long after it became extinct. In contemporary medical education it is argued that the curriculum should achieve a “symbiosis” with the health services and communities in which the students will serve. The values that underlie the curriculum should enhance health service provision. The curriculum must be responsive to changing values and expectations in education if it is to remain useful.

Written and verbal information versus verbal information only for patients being discharged from acute hospital settings to home

Abstract: Background It is becoming commonplace for patients to be discharged earlier from acute hospital settings to their own homes and be required to manage various aspects of their own care. This has increased the need for detailed information to be given to patients and/or significant others to enable them to effectively manage care at home. It has been suggested that providing written health information can assist in this self management. Objectives To determine the effectiveness of providing written health information in addition to verbal information for patients and/or significant others being discharged from acute hospital settings to home. Search methods Computerised searches from 1990 to September 2005 in the Cochrane Consumers and Communication Review Group Specialised Register and Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), EMBASE, CINAHL, PsycINFO, ERIC, OVID (including Ageline, EBM Reviews, DARE, Best Evidence, Pre-MEDLINE and PsycARTICLES), Sociological abstracts, Austhealth and bibliographies in articles that met inclusion criteria. Selection criteria Articles were selected if they were randomised control trials or controlled clinical trials; included patients discharged from acute hospital settings to home; the patient and/or significant others received written health information and verbal information in the intervention group, and verbal information only in the control group; and the intervention (written health information and verbal information) was provided at discharge. Data collection and analysis Two review authors independently screened abstracts to determine relevance. Relevant full paper copies were then reviewed against the inclusion criteria. The findings were extracted by one author and confirmed by the other author. The two trials that met the inclusion criteria were too disparate to warrant meta-analysis. Main results The participants in the two trials were parents of children who were discharged from children's hospitals, one in the United States (n = 197) the other in Canada (n = 123). Provision of verbal and written health information significantly increased knowledge and satisfaction scores. Authors' conclusions This review recommends the use of both verbal and written health information when communicating about care issues with patients and/or significant others on discharge from hospital to home. The combination of verbal and written health information enables the provision of standardised care information to patients and/or significant others, which appears to improve knowledge and satisfaction. Many of our objectives could not be addressed in this review due to lack of trials which met the review's inclusion criteria. There is therefore scope for future research to investigate the effects of providing verbal and written health information on readmission rates, recovery time, complication rates, costs of health care, consumers' confidence level, stress and anxiety and adherence to recommended treatment and staff training in the delivery of verbal and written information. In addition there are other factors which impact on the effectiveness of information provided that were not considered in this review but are worthy of a separate systematic review, such as the impact of patient and/or significant others being involved in the development of the written information and cultural issues around development and provision of information. Due to concerns about literacy levels for some population groups, other systematic reviews should also focus on other modes of delivery of information besides the written format.

Intensity of rainfall and severity of Melioidosis, Australia

Abstract: In a 12-year prospective study of 318 culture-confirmed cases of melioidosis from the Top End of the Northern Territory of Australia, rainfall data for individual patient locations were correlated with patient risk factors, clinical parameters, and outcomes. Median rainfall in the 14 days before admission was highest (211 mm) for those dying with melioidosis, in comparison to 110 mm for those surviving (p=0.0002). Median 14-day rainfall was also significantly higher for those with pneumonia. On univariate analysis, a prior 14-day rainfall of 125 mm was significantly correlated with pneumonia (odds ratio [OR] 1.70 [confidence interval [CI] 1.09 to 2.65]), bacteremia (OR 1.93 [CI 1.24 to 3.02]), septic shock (OR 1.94 [CI 1.14 to 3.29]), and death (OR 2.50 [CI 1.36 to 4.57]). On multivariate analysis, rainfall in the 14 days before admission was an independent risk factor for pneumonia (p=0.023), bacteremic pneumonia (p=0.001), septic shock (p=0.005), and death (p<0.0001). Heavy monsoonal rains and winds may cause a shift towards inhalation of Burkholderia pseudomallei.

Self-objectification and esteem in young women: the mediating role of reasons for exercise

Abstract: In this study we investigated the interrelationships between self-objectification, reasons for exercise, body satisfaction, body esteem, and self-esteem. A questionnaire that assessed each of these constructs was completed by 104 female participants between the ages of 16 and 25 who exercised regularly at a fitness center. Self-objectification and appearance-related reasons for exercise were significantly negatively related to body satisfaction, body esteem, and selfesteem, and functional reasons for exercise were positively related to each of these outcome measures. Self-objectification also predicted the reasons women exercise. More important, reasons for exercise were found to mediate the relationships between self-objectification and body satisfaction, body esteem, and self-esteem. It was concluded that objectification theory can be extended usefully into the realm of exercise and that, among women who exercise, motivations for exercise account for the reduced body satisfaction and self-esteem for women high on self-objectification.

Body dissatisfaction, dieting awareness and the impact of parental influence in young children.

Abstract: Objectives: This study aimed to assess the level of body dissatisfaction and dieting awareness in young children. Method: A sample of 135 children aged between 5 and 8 years old were individually interviewed. Body dissatisfaction was assessed by means of figure preference ratings, and dieting awareness by responses to a brief scenario. Results: The difference between boys' ratings of current and ideal figures was not significant at any age; nor was that of 5-year-old girls. However, 6-, 7- and 8-year-old girls rated their ideal figure as significantly thinner than their current figure. For dieting awareness there was no significant gender effect, although level of dieting awareness increased with age. Multiple regression analyses showed that body dissatisfaction was predicted by gender and perception of mothers' body dissatisfaction, while age was the only significant predictor of dieting awareness. Conclusions: A substantial proportion of young children have internalized societal beliefs concerning the ideal body shape and are well aware of dieting as a means for achieving this ideal. In particular, the desire for thinness emerges in girls at around age 6.

Homozygosity for CAG mutation in Huntington disease is associated with a more severe clinical course

Abstract: Huntington disease is caused by a dominantly transmitted CAG repeat expansion mutation that is believed to confer a toxic gain of function on the mutant protein. Huntington disease patients with two mutant alleles are very rare. In other poly(CAG) diseases such as the dominant ataxias, inheritance of two mutant alleles causes a phenotype more severe than in heterozygotes. In this multicentre study, we sought differences in the disease features between eight homozygotes and 75 heterozygotes for the Huntington disease mutation. We identified subjects homozygous for the Huntington disease mutation by DNA testing and compared their clinical features (age at onset, symptom presentation, disease severity and disease progression) with those of a group of heterozygotes, who were assessed longitudinally. The age at onset of symptoms in the homozygote cases was within the range expected for heterozygotes with the same CAG repeat lengths, whereas homozygotes had a more severe clinical course. The observation of a more rapid decline in motor, cognitive and behavioural symptoms in homozygotes was consistent with the extent of neurodegeneration as available at imaging in three patients, and at the post-mortem neuropathological report in one case. Our analysis suggests that although homozygosity for the Huntington disease mutation does not lower the age at onset of symptoms, it affects the phenotype and the rate of disease progression. These data, once confirmed in a larger series of patients, point to the possibility that the mechanisms underlying age at onset and disease progression in Huntington disease may differ.

Relation of inflammation and benefit of statins after percutaneous coronary interventions.

Abstract: Background— Beyond lipid lowering, statins are known to possess antiinflammatory and antithrombotic properties. Recent studies suggested an association between statins and early reduction in death or myocardial infarction (MI) after percutaneous coronary interventions (PCIs). We sought to examine the interrelationship between inflammation, statin use, and PCI outcomes. Methods and Results— In the year 2000, 1552 consecutive United States residents underwent elective or urgent PCI at the Cleveland Clinic and were prospectively followed for 1 year. Preprocedural serum high-sensitivity C-reactive protein (hsCRP) levels were routinely measured. Patients who had statins initiated before the procedure (39.6%) had a lower median hsCRP level (0.40 versus 0.50 mg/dL, P=0.012) independent of the baseline cholesterol levels and had less frequent periprocedural MI (defined by CKMB ≥3×upper limit of normal, 5.7% versus 8.1%, P=0.038). At 1 year, statin pretreatment was predictive of survival predominantly among patien...

Specialist outreach clinics in primary care and rural hospital settings.

Abstract: Background Specialist medical practitioners have conducted clinics in primary care and rural hospital settings for a variety of reasons in many different countries. Such clinics have been regarded as an important policy option for increasing the accessibility and effectiveness of specialist services and their integration with primary care services. Objectives To undertake a descriptive overview of studies of specialist outreach clinics and to assess the effectiveness of specialist outreach clinics on access, quality, health outcomes, patient satisfaction, use of services, and costs. Search methods We searched the Cochrane Effective Practice and Organisation of Care (EPOC) specialised register (March 2002), the Cochrane Controlled Trials Register (CCTR) (Cochrane Library Issue 1, 2002), MEDLINE (including HealthStar) (1966 to May 2002), EMBASE (1988 to March 2002), CINAHL (1982 to March 2002), the Primary-Secondary Care Database previously maintained by the Centre for Primary Care Research in the Department of General Practice at the University of Manchester, a collection of studies from the UK collated in "Specialist Outreach Clinics in General Practice" (Roland 1998), and the reference lists of all retrieved articles. Selection criteria Randomised trials, controlled before and after studies and interrupted time series analyses of visiting specialist outreach clinics in primary care or rural hospital settings, either providing simple consultations or as part of complex multifaceted interventions. The participants were patients, specialists, and primary care providers. The outcomes included objective measures of access, quality, health outcomes, satisfaction, service use, and cost. Data collection and analysis Four reviewers working in pairs independently extracted data and assessed study quality. Main results 73 outreach interventions were identified covering many specialties, countries and settings. Nine studies met the inclusion criteria. Most comparative studies came from urban non-disadvantaged populations in developed countries. Simple 'shifted outpatients' styles of specialist outreach were shown to improve access, but there was no evidence of impact on health outcomes. Specialist outreach as part of more complex multifaceted interventions involving collaboration with primary care, education or other services wasassociated with improved health outcomes, more efficient and guideline-consistent care, and less use of inpatient services. The additional costs of outreach may be balanced by improved health outcomes. Authors' conclusions This review supports the hypothesis that specialist outreach can improve access, outcomes and service use, especially when delivered as part of a multifaceted intervention. The benefits of simple outreach models in urban non-disadvantaged settings seem small. There is a need for good comparative studies of outreach in rural and disadvantaged settings where outreach may confer most benefit to access and health outcomes.

Sky Service: The Demands of Emotional Labour in the Airline Industry

Abstract: Following Hochschild's The Managed Heart, which emphasized the problematic features that emotional labour had for women flight attendants, a critical literature emerged which focused on the more enjoyable aspects of emotional labour in service employee experience. This article draws on this literature and analyses emotional labour as a gendered cultural performance but takes issue with the individualizing and pluralistic tenor in the post-Hochschild discussions. Using a qualitative and quantitative study of nearly 3000 Australian flight attendants, it focuses on organizational and occupational health and safety variables, as well as sexual harass-ment and passenger abuse — factors barely discussed by Hochschild's critics. The qualitative data indicate that emotional labour is both pleasurable and difficult at different times for the same individual. Gender is still pivotal, as Hochschild suggested, linking emotional labour with sexual harassment. At the same time, the most significant predictors from the quantitative study of whether emotional labour would be costly were organizational. Variables such as whether flight attendants felt valued by the company show that the airline management context is highly influential in the way in which emotional labour is experienced. As a means of understanding the complex relations in this important and eroticized area of service work where flight attendants, airline crews, airline management and passengers have convergent and conflicting interests, the article also deploys a new concept: ‘demanding publics’, to refer to trangressions of the legitimate boundaries of the service worker.

Melioidosis: an important cause of pneumonia in residents of and travellers returned from endemic regions

Abstract: Melioidosis is endemic in South East Asia, Asia and northern Australia. Infection usually follows percutaneous inoculation or inhalation of the causative bacterium, Burkholderia pseudomallei, which is present in soil and surface water in the endemic region. While 20-36% of melioidosis cases have no evident predisposing risk factor, the vast majority of fatal cases have an identified risk factor, the most important of which are diabetes, alcoholism and chronic renal disease. Half of all cases present with pneumonia, but there is great clinical diversity, from localised skin ulcers or abscesses without systemic illness to fulminant septic shock with multiple abscesses in the lungs, liver, spleen and kidneys. At least 10% of cases present with a chronic respiratory illness (sick >2 months) mimicking tuberculosis and often with upper lobe infiltrates andlor cavities on chest radiography. As with tuberculosis, latency with reactivation decades after infection can also occur, although this is rare. Confirmation of diagnosis is by culture of B. pseudomallei from blood, sputum, throat swab or other samples. Microbiology laboratories need to be informed of the possibility of melioidosis, as those not familiar with it can misidentify the organism. Antibiotic therapy is initial intensive therapy with i.v. ceftazidime or meropenem or imipenem +/-cotrimoxazole for ≥ 10 days, followed by eradication therapy with cotrimoxazole +/-doxycycline +/- chloramphenicol (first 4 weeks only) for ≥3 months. Melioidosis has been increasingly recognised in returning travellers in Europe and recently melioidosis and colonisation with B. pseudomallei have been documented in cystic fibrosis patients visiting or resident in endemic areas.

Parental Identification of Early Behavioural Abnormalities in Children with Autistic Disorder

Abstract: The aim of the study was to identify early behavioural abnormalities in children later diagnosed with autistic disorder. Accurate identification of such deficits has implications for early diagnosis, intervention and prognosis. The parents of 153 children with autistic disorder completed a questionnaire asking them to describe early childhood behaviours of concern and to recall the age of onset. Core deficit-linked behaviours were then identified and the ontogeny of their development was noted. Behaviour categories were: (1) gross motor difficulties, (2) social awareness and play deficits, (3) language and communication difficulties, and (4) unusual preoccupations. The findings supported the notion that the nature and prevalence of these deficits depend on age. Consistent with past research, there was a significant interval between parents first noticing abnormalities and the making of a definitive diagnosis. The implications for this delay are discussed.

A preliminary controlled evaluation of a school‐based media literacy program and self‐esteem program for reducing eating disorder risk factors

Abstract: Objective This study compared the efficacy of a media literacy program and a self-esteem program designed to reduce general and specific risk factors for eating disorders. Method Four classes of 86 grade 8 students (53 boys and 33 girls), mean age of 13 years, were randomly assigned to either a control condition or one of the two intervention conditions. Assessment of general and specific risk factors was carried out at baseline, postintervention and 3-month follow-up. Results At postintervention the media literacy group had lower mean scores on weight concern than the control group (p =0.007) but the self-esteem group did not. There were some differences on self-esteem measures at the 3-month follow-up. Discussion Media literacy programs combined with an interactive, student-centered framework may potentially be a safe and effective way of reducing risk factors for eating disorders. The impact of teaching style needs to be further evaluated in prevention research. © 2003 by Wiley Periodicals, Inc. Int J Eat Disord 33: 371–383, 2003.

Percent body fat via DEXA: comparison with a four-compartment model.

Abstract: This study compared body composition by dual-energy X-ray absorptiometry (DEXA; Lunar DPX-L) with that via a four-compartment (4C; water, bone mineral mass, fat, and residual) model. Relative body fat was determined for 152 healthy adults [30.0 +/- 11.1 (SD) yr; 75.10 +/- 14.88 kg; 176.3 +/- 8.7 cm] aged from 18 to 59 yr. The 4C approach [20.7% body fat (%BF)] resulted in a significantly (P < 0.001) higher mean %BF compared with DEXA (18.9% BF), with intraindividual variations ranging from -2.6 to 7.3% BF. Linear regression and a Bland and Altman plot demonstrated the tendency for DEXA to progressively underestimate the %BF of leaner individuals compared with the criterion 4C model (4C %BF = 0.862 x DEXA %BF + 4.417; r(2) = 0.952, standard error of estimate = 1.6% BF). This bias was not attributable to variations in fat-free mass hydration but may have been due to beam-hardening errors that resulted from differences in anterior-posterior tissue thickness.