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Accurate assessment of atopic dermatitis (AD) severity is critical when initiating and monitoring therapy. Use of existing research tools such as the Eczema Area and Severity Index (EASI) and Scoring Atopic Dermatitis (SCORAD) is complex and time-consuming in clinical practice. A previous analysis found the product of validated Investigator's Global Assessment (vIGA) and affected body surface area (BSA) to be an accurate and practical tool for routine assessment of paediatric AD.To evaluate the IGAxBSA composite as an alternative to EASI or SCORAD for assessment of AD disease severity and disease responsiveness.The relationship between IGAxBSA, EASI and SCORAD was assessed in a post hoc analysis of pooled data from the dupilumab clinical trial programme in adult and paediatric patients with moderate-to-severe AD who had received dupilumab or placebo, with or without topical corticosteroids (TCS). The trials are registered at ClinicalTrials.gov and EudraCT: LIBERTY AD SOLO 1 (NCT02277743, 2014-001198-15), LIBERTY AD SOLO 2 (NCT02277769, 2014-002619-40), LIBERTY AD SOLO-CONTINUE (NCT02395133, 2014-003384-38), LIBERTY AD CHRONOS (NCT02260986, 2013-003254-24), LIBERTY AD CAFÉ (NCT02755649, 2015-002653-35), LIBERTY AD ADOL (NCT03054428, 2015-004458-16), LIBERTY AD PEDS (NCT03345914, 2016-004997-16), LIBERTY AD OLE (NCT01949311, 2013-001449-15) and LIBERTY AD PEDS OLE (NCT02612454, 2015-001396-40).Using datapoints from pooled dupilumab randomized controlled trials (n = 3473) and open-label extension trials (n = 3045), we found that IGAxBSA correlated well with EASI and SCORAD, irrespective of treatment group and race (white, Asian, black). IGAxBSA correlated better with objective measures (EASI, SCORAD) than with patient- or caregiver-reported subjective measures. IGAxBSA correlated strongly with EASI and SCORAD in assessing disease change over time (r = 0·90, r = 0·76, respectively; P 0·0001), and concordance between IGAxBSA-50/75/90 and EASI-50/75/90 was excellent (88-94%).IGAxBSA is a valid alternative for assessment of AD disease severity and response over time, compared with EASI or SCORAD in patients with AD, irrespective of race.

Mass media extensively inform societies about events threatening the global food supply (e.g., pandemics or Brexit). Consumers exposed to such communication may perceive food resources as becoming scarcer. In line with the evolutionary account, these perceptions can shift decision-making in domains such as food preferences or prosociality. However, the current literature has solely focused on actual and past food insecurity experiences threatening mostly low-income families, thus neglecting the future-oriented perceptions among the general population. This paper broadens the food insecurity research scope by developing a new construct—anticipated food scarcity (AFS)—which is defined as the perception that food resources are becoming less available (in the future). We have developed and psychometrically validated the 8-item Anticipated Food Scarcity Scale (AFSS) in eight studies (N = 1333). The 8-item AFSS is unidimensional and has good psychometric qualities. The scale is sensitive to food scarcity cues and, therefore, can be used in experimental research. Moreover, the scale's relatively narrow set of items makes it an exceptionally potent tool for use in online surveys, field settings, and lab studies. Taken together, the AFSS presents an alternative approach to food scarcity measurement in affluent societies and, consequently, can foster novel research on food waste, sustainability, prosocial behaviors, and other similar topic areas.

The skull base attachment of the second lamella and suprabullar pneumatization are likely to be consistent landmarks if they are systematically classified. This study aimed to classify the pneumatization pattern according to the second lamella skull base attachment. A total of 202 computed tomography sides of 101 patients who underwent endoscopic sinus surgery were studied. Suprabullar pneumatization was defined as air cells present above the ethmoid bulla between the second and third lamellae. Its pattern was classified according to the air cell number and location as in the frontal cell classification. Type 0 suprabullar pneumatization was defined as no air cells between the ethmoid bulla and skull base; type 1, as a single suprabullar cell; and type 2, as multiple suprabullar cells above the ethmoid bulla. In type 3 pneumatization, the second lamella extended into the frontal sinus forming a frontal bullar cell. Type 2 was the most prevalent (40.1 %), followed by types 1, 3, and 0 (24.3, 23.3, and 12.4 %, respectively). The distance between the second lamella and anterior ethmoid artery was 8.93, 8.30, 8.50, and 11.25 mm in types 0, 1, 2, and 3 pneumatization, respectively. No patients had intraoperative injuries in the anterior ethmoid artery or lateral lamella. The second lamella skull base attachment and suprabullar pneumatization pattern could be systematically classified and be a consistent landmark to identify the frontal sinus opening.

With the tangible threat posed by the release of chemical and biological warfare (CBW) agents, detection of airborne pathogens is a critical military and security concern. Recent air sampling techniques developed for biocollection take advantage of Electrowetting on Dielectric (EWOD) to recover material, producing highly concentrated droplet samples. Bespoke EWOD-based digital microfluidics platforms are very well suited to take full advantage of the microlitre concentrated droplet resulting from this recovery process. In this paper we present a free-standing, fully automated DMF platform for immunoassay. Using this system, we demonstrate the automated detection of four classes of CBW agent simulant biomolecules and organisms each representing credible threat agents. Taking advantage of the full magnetic separation process with antibody-bound microbeads, rapid and complete separation of specific target antigen can be achieved with minimal washing steps allowing for very rapid detection. Here, we report clear detection of four categories of antigens achieved with assay completion times of between six and ten minutes. Detection of HSA, Bacillus atrophaeus (BG spores), MS2 bacteriophage and Escherichia coli are demonstrated with estimated limit of detection of respectively 30 ng ml-1, 4 × 104 cfu ml-1, 106 pfu ml-1 and 2 × 107 cfu ml-1. The fully-integrated portable platform described in this paper is highly compatible with the next generation of electrowetting-coupled air samplers and thus shows strong potential toward future in-field deployable biodetection systems and could have key implication in life-changing sectors such as healthcare, environment or food security.

© 2015 The Authors. Journal of Chemical Technology & Biotechnology published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Background There has been no nationwide epidemiological investigation of allergic rhinitis (AR) that was diagnosed by both questionnaires and laboratory tests in Korea. This study investigated the prevalence, risk factors, and comorbidities of AR in South Korea. Methods The Korean National Health and Nutritional Examination Survey examined a representative sample of the Korean population. A total of 2305 participants underwent immunoradiometric assay for specific IgE antibodies against common indoor allergens. Healthy, atopy only, and AR groups were defined according to the results of allergen test. The weighted prevalence for each group was calculated. Risk factors including food and comorbidities were identified using univariate or multivariate analyses. The patients were also categorized into four subgroups according to the Allergic Rhinitis and Its Impact on Asthma (ARIA) classification and associated comorbidities were analyzed. Results The prevalence of atopy only and AR was 30.0 ± 1.2% and 16.2 ± 1.0%, respectively. The multivariate analysis showed that the prevalence was influenced by sex (p < 0.01) for atopy only and sex (p = 0.09), age (p = 0.02), marital status (p = 0.24), and stress level (p = 0 for AR. Compared with the healthy group, asthma (odds ratio [OR] = 4.77), nasal polyp (NP; OR = 3.44), chronic rhinosinusitis (OR = 13.93), and olfactory dysfunction (OR = 4.88) were more prevalent in the AR group. Based on the ARIA guideline, intermittent mild rhinitis was most common (58.1%). Asthma was correlated to severity and atopic dermatitis and NPs was associated with persistency. Daily intake of less mackerel and more carrots, bread, and bean curd were associated with the increased risk of AR. Conclusion Prevalence, risk factors, and comorbidities of AR were evaluated in the general Korean population, which will contribute to prevention and treatment of AR and its comorbidities in Koreans.

Colorectal cancer is often preventable if the precursor adenoma is detected and removed. Although ultrasound is clearly not one of the widely accepted screening techniques, this non-invasive and radiation-free modality is also capable of detecting colonic polyps, both benign and malignant. Such colon lesions may be encountered when not expected, usually during general abdominal sonography. The discovery of large colonic polyps is important and can potentially help reduce the incidence of a common cancer, whereas detection of a malignant polyp at an early stage may result in a curative intervention. This pictorial review highlights our experience of sonographic detection of colonic polyps in 43 adult patients encountered at our institutions over a 2-year period. 4 out of 50 discovered polyps were found to be malignant lesions, 3 polyps were hyperplastic, 1 polyp was a hamartomatous polyp and the rest were benign adenomas. The smallest of the detected polyps was 1.3 cm in diameter, the largest one was 4.0 cm (mean 1.7 cm; median 1.6 cm). In each case, polyps were discovered during a routine abdominal or pelvic examination, particularly when scanning was supplemented by a brief focused sonographic inspection of the colon with a 6–10 MHz linear transducer. In this paper, we illustrate the key sonographic features of different types of commonly encountered colonic polyps in the hope of encouraging more observers to detect these lesions, which may be subtle.

In continuation of an experimental investigation reported earlier by the authors on bolted moment joints in ferrocement construction, this study regards (1) further testing of ten such joints to broaden the range of the principal parameters – thickness of the connected ribs and location of bolts and (2) simple analytical modeling for design. Test results, as presented and discussed in this paper, indicate that the mode of failure of a joint depends on whether the applied moment is in the opening or closing mode. Under the closing mode, failure always occurs by shear punching of the bearing plates through the connected ribs. In contrast, failure in the opening mode occurs by bending failure of either the connected or the longitudinal rib. Based on observed failure modes, expressions have been derived for predicting the strength of such a joint. A comparison of theoretical predictions with present test results and those reported earlier shows good agreement.

Aim: To evaluate the reliability of transcutaneous bilirubinometry (TcB) during and after phototherapy. Methods: TcB was performed on the forehead and chest of infants with neonatal jaundice when capillary blood was sampled for bilirubin determination in a control group of 240 neonates. In a second group of 70 neonates exposed to phototherapy the same procedure was performed after at least 24 h of exposure; on the forehead, TcB was done in the centre of the unexposed area and also on the adjacent exposed area, and the exposed chest. During the post-phototherapy period, TcB was again done during the first and second days, at least 18–24 h after cessation of phototherapy. The results were then statistically evaluated and regression curves were plotted. Results: A close correlation between TcB values and bilirubin levels was observed in the control group. In the phototherapy group, a correlation was also found between the TcB and the bilirubin values, but this correlation was significantly poorer than that of the controls; the correlation for the covered part of the forehead was significantly better than that of the exposed part but still poorer than that of the controls, though the difference was no longer significant. Skin colour recovered during the post-phototherapy period and correlation was better than that during exposure and no longer significantly different from that of the controls. Conclusion: Through its bleaching effect on the skin, phototherapy affects the correlation between TcB and the bilirubin values, but does not totally eliminate it. The unexposed parts show a better correlation, though this was still poorer than that of the controls. Recovery of skin colour occurred within 18–24 h after cessation of exposure.

In this Letter, we report that after oxidation in air and reduction in hydrogen the existing carbon nanotube arrays can be used as a substrate to grow another nanotube array. The two arrays are connected through a thin catalyst layer. Micro-Raman study of these two nanotube arrays shows that they have different characteristic spectra. Besides the small shift in the peak frequencies of the two kinds of arrays in Micro-Raman spectra, we have observed changes in the relative intensities of D, G and D ′ lines and proposed the mechanism of this phenomenon.

The benefits of employing a quaternary phase-only hologram, programmed onto a silicon backplane Spatial Light Modulator (SLM) are evaluated with respect to insertion loss and crosstalk isolation between two single-mode fibre ports. It is shown that insertion loss for a binary phase hologram with current FLCs, is comparable to that of quaternary phase holograms utilising deformed-helix (DH) FLCs. Its worst-case crosstalk performance is no worse than that of a quaternary phase hologram for a typical regular fibre array design.

Just in time waste data is useful for a number of reasons; these include the ability to streamline operations, the ability to be more responsive to the environment, and the improvement in productivity, quality assurance, scheduling and cost savings. Les informations ‘juste a temps’ relatives aux pertes de temps et de productivite sont utiles pour plusieurs raisons. Elles offrent notamment la possibilite de rationaliser les operations, de mieux repondre aux besoins du milieu, d'ameliorer la productivite et l'assurance qualite, de renforcer les plannings et de reduire les coUts.

OBJECTIVE To study the effect of phototherapy for neonatal hyperbilirubinaemia on thyroid function as neonatal thyroid screening is sometimes performed during exposure to phototherapy. METHODOLOGY Infants with non-haemolytic hyperbilirubinaemia were sequentially allocated to fibre-optic phototherapy, conventional daylight phototherapy, or a combination of both. Bilirubin concentration was monitored 12 hourly by capillary blood sampling; venous blood was sampled for thyroid stimulating hormone (TSH) and free thyroxine (fT4) determinations, at start of exposure, at 24 h, end of exposure and 1 day later. Comparable unexposed infants served as controls. RESULTS All 123 study infants and 25 controls remained well during the study. Bilirubin levels declined during phototherapy, being most rapid in the combination group. The TSH and fT4 values at start of exposure were 3.86 +/- 0.41 mU/L (mean +/- SEM) and 33.20 +/- 1.16 pmol/L, respectively, in the fibre-optic group, 3.62 +/- 0.38 mU/L and 37.22 +/- 1.76 pmol/L in the daylight group, and 4.40 +/- 0.48 mU/L and 29.91 +/- 1.13 pmol/L in the combined group, compared with 5.77 +/- 0.40 mU/L and 34.46 +/- 1.68 pmol/L in the control group. The TSH and fT4 values declined with increasing age in the phototherapy and control groups with end of exposure values of 2.90 +/- 0.28 mU/L and 27.71 +/- 0.71 pmol/L, 2.77 +/- 0.31 mU/L and 33.52 +/- 1.22 pmol/L, and 3.44 +/- 0.30 mU/L and 27.54 +/- 0.88 pmol/L, respectively, compared with 4.21 +/- 0.61 mU/L and 27.19 +/- 2.33 pmol/L (at 72 h) in the control group. The pattern of TSH and fT4 decline in the exposed and control groups was similar, being related to increasing age. CONCLUSIONS The validity of neonatal thyroid screening is not affected by fibre-optic or conventional phototherapy or by both combined.

The objective of this study was to investigate the correlation of transcutaneous bilirubinometry (TcB) and plasma bilirubin concentrations in full-term Chinese, Malay and Indian infants. TcB was performed with the Minolta Airshields bilirubinometer on Chinese, Malay and Indian full-term infants. The readings were taken on the chest (sternum) and forehead (glabella) when capillary blood was sampled for bilirubin determination. Five hundred and forty TcB indices in 253 Chinese infants, 282 in 169 Malay infants, and 182 in 120 Indian infants were obtained over the sternum and forehead. A good correlation between the TcB indices and the bilirubin concentrations was observed in Chinese, Malay and Indian infants : r = 0.78 (chest), r = 0.73 (forehead) ; r = 0.86 (chest), r = 0.84 (forehead) ; and r = 0.84 (chest), r = 0.82 (forehead). The correlation was just as good when the combined values were evaluated together : r = 0.80 (chest) r = 0.75 (forehead). In Chinese infants, correlation at values below 250 μmol l -1 was significantly better than that at values over 250 μmol -1 r = 0.80 versus r = -0.20, p < 0.00001 (chest), and r = 0.74 versus r = 0.07, p < 0.00001 (forehead). However, a safer cut-off point clinically would be 200 μmol l -1 , since only relatively few higher bilirubin values were encountered when TcB indices were below 200 μmol l -1 . The same pattern was noticed with the other two groups, and the combined group. Thus, TcB provides a non-invasive, cost-effective screening method for significant neonatal jaundice, sparing infants and parents physical and emotional stress, and medical and nursing personnel extra work and inconvenience.

A 3-year study (Jan. 1986-Dec. 1988) in the Kandang Kerbau Hospital revealed 678 infants with birth defects in 44,842 livebirths, (15.13 per 1,000 live births, 95% confidence intervals, CI 14.0–16.2). There were 161 cases with musculoskeletal abnormalities (3.5 per 1,000, 95% CI 3.06-4.19), 111 gastrointestinal system malformations (2.47 per 1,000, 95% CI 2.04-2.58), 88 chromosomal abnormalities (1.96 per 1,000, 95% CI 1.57-2.42), 78 cardiovascular system abnormalities (1.74 per 1,000, 95% CI 1.38-2.17), 73 urogenital system defects (1.63 per 1,000, 95% CI 1.28-2.05), and 52 central nervous system defects (1.16 per 1,000, 95% CI 0.87-1.52). The prevalence of cleft lip, cleft palate, and cleft lip/palate was 1.72 per 1,000, and Down's Syndrome 1 in 700. At review, six weeks later, the false positive rate was 4% in the infants with defects, and in the group of 709 normal controls (matched by race, maternal age, ward class and time/date of birth), the false negative rate was 0.84%. The strongest risk factors were a family history of birth defects (odds ratio, OR 3.3, 95% CI 1.8-6.4), and previous abnormal sibling(s) (OR 2.4, 95% CI 1.1–5.3). Other risk factors included drug intake during pregnancy (OR 1.2, 95% CI 0.8-2.0), becoming significant with ingestion during the first trimester (OR 1.4, 95% CI 1.1-1.8). Traditional medicine (mainly Chinese herbs during pregnancy) had a slightly higher risk (OR 1.4, 95% CI 1.0–2.0). The National University Hospital keeps a register of birth defects; trained nurses interview all mothers using a set questionnaire. Evaluation of 11,460 livebirths over a 3-year period (1991–1993) revealed 472 cases (41.19 per 1,000 livebirths, 95% CI 37.48-44.90) with 171 musculoskeletal defects (14.92 per 1,000 livebirths, 95% CI 12.69-17.16), 105 cardiovascular defects (9.16 per 1,000, 95% CI 7.41-10.91), 64 urogenital defects (5.58 per 1,000, 95% CI 4.22-6.95), 30 gastrointestinal defects (2.62 per 1000, 95% CI 1.68-3.55), 35 mixed system defects (3.06 per 1,000, 95% CI 2.04-4.07), and 18 chromosomal abnormalities (1.57 per 1,000, 95% CI 0.85-2.30). The prevalence of cleft lip/cleft lip and palate was 1.48 per 1,000. This higher prevalence could be due to the present practice of routine screening of every infant on the first day of life, together with a careful assessment for musculoskeletal defects, especially congenital dislocation of the hips.

Objective:To illustrate a case of an iatrogenic mucosal tear in the trachea which caused a one-way valve effect, obstructing the airway and manifesting as post-extubation stridor.Case report:We report a case of iatrogenic tracheal mucosal tear secondary to violent movement during intubation. The patient presented with post-extubation stridor that worsened over three days. Initial evidence suggested tracheal stenosis. Computed tomography scans revealed a mucosal tear at the level of the seventh cervical to second thoracic vertebrae. The tear was caused by forceful inflow of air as breathing became more and more difficult, resulting in a false tract. A tracheostomy changed the direction of airflow, bypassing the tear. The inflated tracheostomy tube cuff acted as a stent to keep the flap in place as healing occurred.Conclusion:Iatrogenic laryngotracheal injuries are common, especially when endotracheal intubation is performed under unfavourable emergency conditions. A tracheal mucosal tear is a rare entity which is almost always undiagnosed. However, a tracheal mucosal flap may be suspected when changes in patient position alter the nature and severity of the resultant stridor and/or respiratory distress. In such cases, an inflated tracheostomy tube cuff should be kept in place for an adequate period, to act as a stent and help keep the flap in place while healing occurs.

The efficacy of phototherapy in a group of 427 infants with hyperbilirubinaemia associated with glucose-6-phosphate dehydrogenase (G6PD) deficiency and a comparable group of 3924 G6PD normal infants with non-haemolytic hyperbilirubinaemia was evaluated. Phototherapy was highly effective in reducing bilirubin levels in both groups of infants, being significantly more effective in the group with normal G6PD status. Failure rate was very low (2.03/1000) in the group with normal G6PD status and nil in the G6PD deficient group. Bilirubin rebound after phototherapy was unremarkable with very few infants requiring a second exposure--4.68/1000 in the G6PD deficient group and 6.37/1000 in the G6PD normal group. All the babies tolerated phototherapy well. Phototherapy would therefore seem to be a simple and effective method for the management of severe jaundice associated with G6PD deficiency.

LIM L.M., CHIU L.H., DOHRMANN J. & TAN K.-L. (2010) Registered nurses' medication management of the elderly in aged care facilities. International Nursing Review57, 98–106 Background: Data on adverse drug reactions (ADRs) showed a rising trend in the elderly over 65 years using multiple medications. Aim: To identify registered nurses' (RNs) knowledge of medication management and ADRs in the elderly in aged care facilities; evaluate an education programme to increase pharmacology knowledge and prevent ADRs in the elderly; and develop a learning programme with a view to extending provision, if successful. Method: This exploratory study used a non-randomized pre- and post-test one group quasi-experimental design without comparators. It comprised a 23-item knowledge-based test questionnaire, one-hour teaching session and a self-directed learning package. The volunteer sample was RNs from residential aged care facilities, involved in medication management. Participants sat a pre-test immediately before the education, and post-test 4 weeks later (same questionnaire). Participants' perceptions obtained. Findings: Pre-test sample n = 58, post-test n = 40, attrition rate of 31%. Using Microsoft Excel 2000, descriptive statistical data analysis of overall pre- and post-test incorrect responses showed: pre-test proportion of incorrect responses = 0.40; post-test proportion of incorrect responses = 0.27; Z-test comparing pre- and post-tests scores of incorrect responses = 6.55 and one-sided P-value = 2.8E-11 (P

The effect of citrate phosphate dextrose (CPD) blood transfusion on the acid base, glucose and electrolyte status of VLBW infants was studied in infants aged 1–7, 8–20 and > 20 days; a 4th group composed of infants > 20 days subjected to a second transfusion was also studied. All the infants remained clinically well during and after the transfusion. Only the infants in the group 1–7 days experienced a signifcant fall in ionic Ca and PO2. No significant change in all the other parameters studied was observed. In the other groups of infants studied, the changes observed were not significant, and became less with increasing age and repeat transfusion. VLBW infants apparently tolerate CPD blood transfusion well.

BACKGROUND AND PURPOSE: To our knowledge, there has been no study that compares the radiation dose delivered to the eye lens by 16- and 64-section multidetector CT (MDCT) for standard clinical neuroimaging protocols. Our aim was to assess radiation-dose differences between 16- and 64-section MDCT from the same manufacturer, by using near-identical neuroimaging protocols. MATERIALS AND METHODS: Three cadaveric heads were scanned on 16- and 64-section MDCT by using standard neuroimaging CT protocols. Eye lens dose was measured by using thermoluminescent dosimeters (TLD), and each scanning was repeated to reduce random error. The dose-length product, volume CT dose index (CTDI(vol)), and TLD readings for each imaging protocol were averaged and compared between scanners and protocols, by using the paired Student t test. Statistical significance was defined at P < .05. RESULTS: The radiation dose delivered and eye lens doses were lower by 28.1%–45.7% (P < .000) on the 64-section MDCT for near-identical imaging protocols. On the 16-section MDCT, lens dose reduction was greatest (81.1%) on a tilted axial mode, compared with a nontilted helical mode for CT brain scans. Among the protocols studied, CT of the temporal bone delivered the greatest radiation dose to the eye lens. CONCLUSIONS: Eye lens radiation doses delivered by the 64-section MDCT are significantly lower, partly due to improvements in automatic tube current modulation technology. However, where applicable, protection of the eyes from the radiation beam by either repositioning the head or tilting the gantry remains the best way to reduce eye lens dose.

Aim: The purpose of this paper is to present a study that explored the experiences of orthopaedic patients injured in motor vehicle accidents (MVAs), from the time of the accident until 6 months after being discharged from hospital. Background: Trauma injuries from MVAs are increasing, with the number of deaths from such injuries continuing to rise. Victims often sustain open fractures to more than one part of their body and need rehabilitation and support to adjust to long-term chronic or permanent disability. In the last decade, research pertaining to trauma nursing has concentrated on neurologically injured patients. Although there is a paucity of research on the nursing perspective of psychological care for non-neurologically injured patients, the majority of studies located were mainly quantitative in nature and did not analyse the personal experiences of orthopaedic patients. Method: A qualitative naturalistic inquiry approach was used, which provided a first-hand account of the traumatic MVA event experienced by six orthopaedic participants in Singapore. Data were collected from face-to-face in-depth interviews. Participants were voluntarily recruited through purposeful sampling and ‘snowballing’. Interviews were audiotaped and transcribed verbatim in preparation for analysis. Findings: The analysis of information explicated four main themes: the experience of the event, the effect of hospitalization, surviving the event and self-transformation. Conclusion: The study provided an understanding of orthopaedic patients’ experience of MVA in Singapore. The findings of the study have the potential to contribute to the limited qualitative research available concerning victims’ experiences of MVAs and nurses caring for MVA victims.

BACKGROUND: Kidney retransplants carry increased immunologic risk. One possible contributor to this risk may be re-exposure to human leukocyte antigens (HLA) common to a previous donor but foreign to the recipient. Conflicting publications have assessed this risk, so to examine our experience 259 kidney retransplants were analyzed. METHODS: A retrospective cohort of retransplant patients from 1973 to 2005 with minimum 12 months follow up was examined. Using multivariable modeling, important confounders were controlled for identifying factors significantly affecting graft survival. RESULTS: Re-exposure to HLA class I (HLA-A or B) antigens, peak panel reactive antibodies and donor source were the most important determinants of allograft survival, despite a negative conventional or anti-human globulin-augmented T cell crossmatch. We failed to demonstrate that recipient re-exposure to HLA class II (HLA-DR) or positive B cell crossmatch were associated with adverse outcomes. Sample size and molecular versus serologic methods may have influenced the former, while inability to determine antibody specificities may have influenced the latter. Controlling for other variables, the adjusted risk of graft loss associated with re-exposure to HLA class I increased by 71% (P=0.006) and occurred early, consistent with recall of memory cytotoxic T lymphocyte or antibody responses. CONCLUSIONS: Kidney recipients re-exposed to mismatched HLA class I antigens appear to be at heightened risk of early graft loss. Such patients may benefit from pretransplant identification of donor specific antibodies using solid phase methods and heightened vigilance for acute rejection. Future studies may indicate whether more intensive immunosuppression for these patients is warranted.

Beta-thalassemia is the most-common genetic disorder of hemoglobin synthesis in Malaysia, and about 4.5% of the population are heterozygous carriers of the disorder. Prenatal diagnosis was performed for 96 couples using the Amplification Refractory Mutation System and Gap-Polymerase Chain Reaction. We identified 17 beta-globin defects-initiation codon for translation (T-G), -29 (A-G), -28 (A-G), CAP +1 (A-C), CD 8/9 (+G), CD 15 (G-A), CD 17 (A-T), CD 19 (A-G), Hb E (G-A), IVS1-1 (G-T), IVS1-5 (G-C), CD 41/42 (-CTTT), CD 71-72 (+A), IVS2-654 (CT), poly A(A-G), 100-kb Ggamma(Agammadeltabeta) degrees and 45-kb Filipino deletions. The 192 beta-alleles studied comprised Chinese (151 patients), Malay (21), Orang Asli from East Malaysia (15), Filipino (1), Indian (1), Indonesian Chinese (2), and Thai (1). In the Chinese, 2 beta-globin defects at CD 41/42 and IVS2-654 were responsible for 74% of beta-thalassemia. beta-mutations at CD 19, IVS1-1 (G-T), IVS1-5, poly A, and hemoglobin E caused 76% of the hemoglobin disorders in the Malays. The Filipino 45-kb deletion caused 73.3% of bthalassemia in the Orang Asli. Using genomic sequencing, the rare Chinese beta-mutation at CD 43 (G-T) was confirmed in 2 Chinese, and the Mediterranean mutation IVS1-1 (G-A) was observed in a Malay beta-thalassemia carrier. The beta-globin mutations confirmed in this prenatal diagnosis study were heterogenous and 65 (68%) couples showed a different globin defect from each other. The use of specific molecular protocols has allowed rapid and successful prenatal diagnosis of beta-thalassemia in Malaysia.

Introduction Imatinib mesylate (IM) is the first-line treatment and gold standard for treatment of chronic myeloid leukemia (CML). Pharmacokinetic profile of IM and its active metabolite, N-desmethylimatinib (M1) in CML patients are clinically important. Objectives This study aimed to determine the influence of CYP1A2, CYP3A5 and CYP2C19 polymorphisms on the drug response of IM in Asian CML. We also aimed to determine the pharmacokinetic profile for both IM and M1 in CML patients with prescription 400 mg PO. Methodology A total of 250 healthy volunteers (controls) and 50 CML patients (cases) receiving IM were enrolled in a prospective pharmacogenetic study. CYP1A2, CYP3A5 and CYP2C19 polymorphisms were genotyped in both control and case groups using PCR-RFLP. In the pharmacokinetic study, serum IM and M1 concentrations were measured using the validated ultra-high performance liquid chromatography method on first three CML patients with 400 mg IM PO. The χ2 test was used to correlate CYP1A2, CYP3A5 and CYP2C19 genotypes to good responder and resistant group. Results The genotype frequencies of CYP1A2, CYP3A5 and CYP2C19 SNP will be discussed in Malays, Chinese and Indians. In the pharmacokinetic study, we observed high standard deviation (>20% of mean) in volume of distributions (Vd), clearance (CL) and area under curve (AUC) for both IM and M1. For IM, Vd = 113.32 ± 43.52 l, CL = 5.01 ± 1.19 l h-1 and AUC = 62 953.33 ± 9791.38 ng h l-1, whereas for M1, Vd = 415.27 ± 228.72 l, CL = 4.84 ± 3.85 l h-1 and AUC = 5585.15 ± 2950.42 ng h l-1. This preliminary study suggested a high interindividual pharmacokinetic variability in Malaysian CML patients. M1 concentration during steady state (C0) and its time concentration profile were different as per reported in Caucasian population. It suggested that Asians may have a different IM metabolism profile from Caucasians. Summary In short, the preliminary pharmacokinetic data highlighted the potential differences of metabolism profile between Asian and Caucasian. Future validation in a larger sample size is ongoing.

The launch of the National Green Technology Policy (NGTP) in 2009 is a manifesto of the government's seriousness in implementing "green" initiatives for the country. Specifically for buildings, the government promotes the application of renewable energy (RE) and energy efficiency (EE) and the application of green building index. With the introduction of Low Carbon Cities Framework, Green Pass, Green Neighbourhood, Green Building Index by various agencies and organisations in Malaysia, it is time to look back and see how all these tools could come together. This paper attempts to identify the challenges in harmonising the green initiatives for policy makers toward greener environment for sustainability.

The objective of this study is to investigate empirically the extent to which self-efficacy contributes to the development of green entrepreneurial intention. The measurement constructs of self-efficacy were classified into market opportunities, innovative environment, initiating relationships, defining purpose, coping with challenges, and developing human resources. The study comprises 252 usable convenient samples through structured questionnaires. The coefficient of determination R2 shows that the variance of intention to entrepreneurship is explained by the variance of the independent variables. It was also found that the model is fit for prediction.

Objectives: To evaluate the efficacy of phototherapy for hyperbilirubinaemia in preterm infants with and without the respiratory distress syndrome (RDS). Methodology: Prospective cohort study of preterm infants cared for at Kandang Kerbau Hospital, Singapore: 170 with RDS and 477 without RDS, sepsis or other complications (control group) presenting with non-haemolytic hyperbilirubinaemia at about the same time were exposed to daylight phototherapy when bilirubin concentrations exceeded 255 μmol/L or 222 μmol/L if

SRPX2 (Sushi repeat-containing protein, X-linked 2) has recently emerged as a multifunctional protein that is involved in seizure disorders, angiogenesis and cellular adhesion. Here, we analyzed this protein biochemically. SRPX2 protein was secreted with a highly post-translational modification. Chondroitinase ABC treatment completely decreased the molecular mass of purified SRPX2 protein to its predicted size, whereas heparitinase, keratanase and hyaluroinidase did not. Secreted SRPX2 protein was also detected using an anti-chondroitin sulfate antibody. These results indicate that SRPX2 is a novel chondroitin sulfate proteoglycan (CSPG). Furthermore, a binding assay revealed that hepatocyte growth factor dose-dependently binds to SRPX2 protein, and a ligand–glycosaminoglycans interaction was speculated to be likely in proteoglycans. Regarding its molecular architecture, SRPX2 has sushi repeat modules similar to four other CSPGs/lecticans; however, the molecular architecture of SRPX2 seems to be quite different from that of the lecticans. Taken together, we found that SRPX2 is a novel CSPG that is overexpressed in gastrointestinal cancer cells. Our findings provide key glycobiological insight into SRPX2 in cancer cells and demonstrate that SRPX2 is a new member of the cancer-related proteoglycan family.

We report our clinical experience with phototherapy in 3802 infants; 3629 were exposed to "standard" daylight phototherapy and 173 to "high-intensity" blue-light phototherapy. High-intensity blue-light phototherapy was twice as effective as standard daylight phototherapy in decreasing bilirubin concentrations. No failures occurred with high-intensity phototherapy compared with an overall failure rate of 1.84/1000 with daylight lamps; these cases were transferred to high-intensity phototherapy with prompt response. Rebound after cessation of phototherapy was greater in those exposed to high-intensity blue light with a significantly greater number requiring a second exposure. However, the incidence was still low. No third exposure was required in any infant. Nursing of infants under high-intensity blue light was more difficult and inconvenient as was clinical monitoring. The light also caused more stress on the nursing and medical personnel. However, the infants tolerated both types of phototherapy equally well. High-intensity blue-light phototherapy would seem to be the treatment of choice for infants with rapidly increasing or very high bilirubin levels, as well as in those not responding adequately to daylight phototherapy.

A case-control study of birth defects was carried out in Kandang Kerbau Hospital in Singapore for a three-year period from January 1986 until December 1988. This paper presents the descriptive profile of birth defects among livebirths seen in that hospital. Out of 44,842 livebirths, 678 babies were found to have birth defects, giving a prevalence of 15.13 per 1000 livebirths (95% CI 14.0-16.2). The musculoskeletal system was the most frequently affected system accounting for 161 cases with a prevalence of 3.59 per 1,000 livebirths (95% CI 3.06-4.19), followed by 111 cases with defects of the gastrointestinal system (2.47 per 1,000 livebirths 95% CI 2.04-2.98), 88 cases of chromosomal disorders (prevalence of 1.96 per 1,000 livebirths 95% CI 1.57-2.42), 78 cases with defects of the cardiovascular system (1.74 per 1,000 livebirths 95% CI 1.38-2.17), 73 cases with defects of the urogenital system (1.63 per 1,000 livebirths 95% CI 1.28-2.05), and 52 cases with defects of the central nervous system (1.16 per 1,000 livebirths 95% CI 0.87-1.52). The prevalence of cleft lip, cleft palate in isolation, and cleft lip and palate combined was 1.72 per 1,000 livebirths and the occurrence of Down's syndrome was 1 in 700 livebirths. When reviewed 6 weeks postpartum, the rate of false positives at birth was 4%. In a control group of 709 "normal" cases at birth, the rate of cases not detected at birth but detected at 6 week follow-up, false negatives was 0.84%.A case-control study of birth defects was carried out in Kerdang Kerbau Hospital in Singapore over a 3-year period from January 1986 to December 1988. This paper presents the descriptive profile of birth defects among live births seen in that hospital. Of 44,842 live births, 678 babies were found to have birth defects, which gives a prevalence of 15.13/1000 live births (95% CI 14.0-16.2). The musculoskeletal system was the most frequently affected system, accounting for 161 cases with a prevalence of 3.59/1000 live births (95% CI 3.06-4.19), followed by 111 cases with gastrointestinal system defects (2.47/1000 live births, 95% CI 2.04-2.98), 88 cases of chromosomal disorders 1.96/1000 live births, 96% CI 1.57-2.42), 78 cases with cardiovascular system defects (1.74/1000 live births, 95% CI 1.38-2.17), 73 cases with urogenital system defects (1.63/1000 live births, 95% CI 1.28-2.05), and 52 cases with central nervous system defects (1.16/1000 live births, 95% CI 0.87-1.52). The prevalence of cleft lip, cleft palate in isolation, and cleft lip an palate combined was 1.72/1000 live births and the occurrence of Down's syndrome was 1 in 700 live births. When reviewed 6 weeks postpartum, the rate of false positives at birth was 4%. Among a control group of 709 normal cases at birth, the rate of cases not detected at birth but at the 6-week followup showed a rate of 0.84% false negatives.

The efficacy of ‘standard’ daylight phototherapy and ‘high intensity’ blue light phototherapy for neonatal jaundice from ABO-HD, or of a non-haemolytic nature was evaluated. Altogether 77 full-term infants with ABO-HD and 3,020 with non-haemolytic jaundice were studied. Both groups of infants responded well to standard daylight phototherapy; the response in non-haemolytic hyperbilirubinaemia was significantly greater. High intensity blue light phototherapy was significantly more effective in reducing bilirubin levels than standard daylight phototherapy in both groups of infants with no failure being encountered. Four infants with non-haemolytic jaundice did not respond adequately to white light (1.4/1,000); they needed high intensity blue light for adequate response. Bilirubin rebound was mild. Four infants in the blue light group needed a second exposure (28.3/1,000) compared with 20 in the white light group (6.9/1,000), a difference that was significant. Standard white light phototherapy is usually adequate for ABO-HD as well as non-haemolytic hyperbilirubinaemia. High intensity blue light would be preferable where a more rapid and greater response is desirable.

Phototherapy is now the preferred method of treatment for neonatal hyperbilirubinemia by virtue of its noninvasive nature and its relative freedom from major complications. It is also convenient, easy to use, and inexpensive in terms of personnel, equipment, and disposals. Long-term experience with phototherapy has demonstrated its safety as well as efficacy. With high-intensity phototherapy at saturation dose, even severe hemolytic hyperbilirubinemia can be adequately controlled; only pack-cell transfusions are required to correct the resulting anemia. It should be stressed, however, that adequate monitoring of the well-being of the baby together with the bilirubin levels should always be observed carefully. The lamps should be kept cool during phototherapy and be changed regularly after every 2000 hours of use. Observing such precautions will ensure the efficacy and safety of phototherapy.

The incidence, clinical presentation and severity of bronchopulmonary dysplasia (BPD) in 110 consecutive very low birthweight (VLBW) infants admitted to the National University Hospital Neonatal Intensive Care Unit between October 1985 and January 1989 is reviewed. Thirty-two infants died, giving an overall survival rate of 70.90%. Sixty infants (54.4%) required mechanical ventilation in the first week of life; 24 (40%) of these infants died. Of the 36 survivors, 23 required oxygenation at 28 days of life and 21 fulfilled the criteria for BPD (35% of the 60 ventilated and 58% of the survivors). The incidence of BPD in all VLBW infants is 19% and of VLBW survivors 27%. Birthweight and gestational age appear to be important determinants. All the survivors in the 501-750 g birthweight group developed BPD compared to 6.25% in those above 1250 g. None of those >30 weeks gestation developed BPD. Two forms of BPD were observed; the ‘severe’ group presented radiologically with chest radiographs characteristic of Stage IV BPD, while the ‘mild’ group with small or normal sized lungs demonstrated irregular strands of radio-densities alternating with areas of normal or increased lucency. The duration of mechanical ventilation and oxygen dependency were significantly longer in the ‘severe’ group, with the mean maximum peak inspiratory pressure, mean airway pressure, and Fio2 required in the first week of life being also significantly higher. Hyaline membrane disease was the main cause of respiratory failure requiring ventilation. The other causes were persistent pulmonary hypertension (1) and apnoea of prematurity (3); all of the latter developed only mild BPD. Those who developed BPD required a significantly longer period of hospitalization, a longer period to regain their birthweight and attain a weight of 2 kg, and a higher incidence of retinopathy of prematurity compared with those without BPD even after correcting for the earlier gestational age of the BPD group.

To evaluate the efficacy of phototherapy for nonhemolytic hyperbilirubinemia in breast-fed and formula-fed infants and infants receiving formula and breast milk.Prospective study.Nursery for healthy infants.Full-term healthy infants with nonhemolytic hyperbilirubinemia (bilirubin concentration,255 micromol/L [14.9 mg/dL] or 222 micromol/L [13.0 mg/dL] at ages younger than 48 hours) were treated with conventional phototherapy by using daylight fluorescent lamps. Three groups of infants were studied: group 1, formula-fed infants; group 2, breast-fed infants; and group 3, infants receiving formula and breast milk. All patterns of feeding started at birth. Phototherapy was terminated only when bilirubin concentrations had decreased to less than 185 micromol/L (10.8 mg/dL); the minimum exposure period was 24 hours.A total of 163 infants were studied: group 1, 79; group 2, 34; and group 3, 50. The age at the start of exposure was comparable in all groups. The mean+/-SD weight loss as a percentage of birth weight was as follows: group 1, 2.8%+/-5.0%; group 2, 6.1%+/-3.4%; and group 3, 3.2%+/-2.6%. The duration of exposure to phototherapy was as follows: group 1, 54.1+/-20.8 hours; group 2, 64.6+/-25.1 hours; and group 3, 54.9+/-21.5 hours; the 24-hour rate of decrease in the bilirubin concentration was as follows: group 1, 18.6%+/-11.7%; group 2, 17.1%+/-9.6%; and group 3, 22.9%+/-9.4%. The overall rate of decrease in the bilirubin concentration for the duration of exposure to phototherapy was as follows: group 1, 0.8%+/-0.3% per hour; group 2, 0.6%+/-0.3% per hour; and group 3, 0.8%+/-0.3% per hour. Weight loss at the start of phototherapy was significantly greater in group 2 compared with group 1 (P.001) and group 3 (P.001), although the hemoglobin and hematocrit values were comparable. The duration of exposure to phototherapy was not significantly different in the 3 groups (P=.06); however, the duration of exposure of group 2 infants was 10 hours more than that of the other 2 groups. The 24-hour rate of decrease in the bilirubin concentration in group 3 was significantly better than that of group 2 (P = .007) and group 3 (P = .02); the rates of decrease for groups 2 and 3 were similar (P = .52). The overall rate of decrease in the bilirubin concentration during the duration of exposure to phototherapy in group 2 was significantly less than that of group 1 (P = .002) and group 3 (P.001); the rates for groups 1 and 3 were similar (P = .35). The postexposure rebound bilirubin concentrations were comparable in all groups during the first 2 days; however, the duration of moderate jaundice in group 2 was more prolonged.The response to phototherapy of group 2 infants was significantly slower than that of group 3 and group 1 infants; this response was still of adequate efficacy. The addition of formula to the feedings for totally breast-fed infants, without suspension of breast-feeding, would enhance the efficacy of phototherapy and reduce exposure time.

The immunogenicity and safety of recombinant yeast-derived hepatitis B vaccine given in doses of 0.6 microgram, 1.25 microgram, 2.5 micrograms and 5.0 micrograms were studied in 4 comparable groups of children aged 1-12 years. All children received three doses of vaccine at time 0, 1 month and 5 months. Immunogenicity appeared to be satisfactory in all 4 groups of children. In the early phase of the study, a dose-response relationship was observed but there was no significant difference in the geometric mean titre among all 4 groups for any period studied. Antibody levels peaked at 9 months, declining thereafter. The geometric mean titre one year after the first vaccine dose was not significantly lower than that at the peak (9 months) in any individual group studied. The second year geometric mean titre was similar in all 4 groups and lower than that of the first year. Sero-conversion with antibody titres greater than or equal to 10 mIU/ml was 100% in the 5.0 micrograms group and greater than 90% in the other 3 groups. There were no adverse reactions of any significance. The immunogenicity of recombinant yeast-derived hepatitis B vaccine was found to be adequate even at as low a dosage as 0.6 microgram when administered in a 3-dose regimen.

Objective. To evaluate the efficacy of fiber-optic phototherapy using the standard Ohmeda Biliblanket, a large version, double standard Biliblankets, and conventional phototherapy using daylight fluorescent lamps in full-term, healthy infants with nonhemolytic hyperbilirubinemia.Methods. Full-term, healthy infants with nonhemolytic hyperbilirubinemia (bilirubin concentration, >255 μmol/L or 222 μmol/L at Results. A total of 171 infants were studied; 42 were exposed to standard fiber-optic phototherapy, 43 to large fiber-optic phototherapy, 42 to double–fiber-optic phototherapy, and 44 to conventional phototherapy. Durations of exposure were 87.05 ± 6.09 (SEM), 82.57 ± 5.84, 64.85 ± 5.43, and 62.61 ± 3.74 hours, respectively; the 24-hour decline rates were 10.26% ± 1.84%, 14.50% ± 1.53%, 21.82% ± 1.71%, and 19.00% ± 1.65%, respectively; the overall decline rates over the whole exposure period were 0.47% ± 0.03%, 0.52% ± 0.04%, 0.71% ± 0.05%, and 0.75% ± 0.04% per hour, respectively. The efficacy of double–fiber-optic phototherapy and conventional phototherapy was similar and significantly better than that of the large fiber-optic mat and the standard fiber-optic mat in duration, 24-hour decline rate, and overall decline rate. The large mat was slightly better than the standard-size mat with regard to 24-hour decline rate and overall decline rate, but this difference was not significant. Failure of phototherapy occurred only in the large fiber-optic mat group (3 of 43) and the standard fiber-optic mat group (4 of 42); none occurred in the other two groups, but differences not statistically significant. The nursing personnel were more comfortable with single fiber-optic phototherapy, which caused no initial disturbance to the swaddled infants as did conventional phototherapy, but found double–fiber-optic phototherapy difficult to use.Conclusion. For efficacy of fiber-optic phototherapy in full-term infants to be comparable to that of our conventional phototherapy, the light dose of the standard mats needs to be doubled. fiber-optic phototherapy, neonatal hyperbilirubinemia, efficacy.

Objective. —Nonresponse to hepatitis B vaccine in the perinatal period occasionally occurs. This report documents the results of reimmunization of nonresponders to perinatal immunization. Design. —From a cohort of 1154 infants immunized with plasma-based vaccine in the perinatal period and followed up for more than 8 years, 45 nonresponders were identified. These children were reimmunized at 4 years of age. Each child received a yeast-derived recombinant hepatitis B vaccine on a 0-, 1-, and 5-month schedule, 33 children with 10-μg and 12 with 5-μg doses. Blood was sampled 1 month after the third vaccination and thereafter at 1, 2, and 4 years. Setting. —The follow-up clinic where the cohort of children was regularly seen. Patients. —Forty-five 4-year-old children who had no antibody to hepatitis B despite perinatal immunization. Main Outcome Measure. —Antibody levels to hepatitis B surface antigen. Results. —Seroconversion with titers higher than 10 mlU/mL occurred in all children. More than 70% still had titers higher than 10 mlU/mL 4 years after vaccination. Conclusion. —Nonresponders to perinatal hepatitis B vaccination respond well to subsequent vaccination. ( JAMA . 1994;271:859-861)

Summary An investigation was made into the onset and severity of neonatal jaundice in 114 patients following spontaneous labour and labour induced by (a) amniotomy, (b) amniotomy and simultaneous infusion of oxytocin, (c) amniotomy and simultaneous administration of oral prostaglandin E2, (PGE2,). No significant difference in serum bilirubin levels in the first five days of life was found in the four groups.

Neonatal jaundice and its relationship to glucose-6-phosphate dehydrogenase (G6PD) status of healthy, term Chinese infants was evaluated in 220 G6PD-deficient infants, 26 intermediate infants who were observed for 3 weeks, and 116 normal (control) infants. Each infant was free of isoimmunisation, cephalhaematomas, or contusions. The mode of labour, method of delivery, and type of feeds had no appreciable effect on daily bilirubin levels. "Elevated" physiological jaundice was associated with normal and G6PD-deficient status; there was no increased haemolysis. G6PD-deficient status was associated with jaundice significantly raised especially in the first week of life, and prolonged beyond that of the "elevated" physiological jaundice. Significantly increased though mild haemolysis was observed. Close surveillance is therefore required for G6PD-deficient infants at least for the first week of life, the period of increased risk. With G6PD-intermediate infants, only the usual measures for normal infants are required.

Phototherapy with either daylight or blue lamps resulted in the development of the bronze baby syndrome in 13 infants. 'Thermotherapy' with an incandescent bulb emitting light mainly in wavelengths not effective for phototherapy caused this syndrome in the 14th infant with respiratory failure. Hepatic dysfunction was present in all infants. The infants were well in spite of the bronzing, after their initial condition had improved. Bronzing disappeared within two months in all but one infant; in eight infants with regular blood examination, the hepatic function became normal by ten months of age, but spectroscopy demonstrated the presence of the pigment(s) even at one year. Normal development was observed.

The effect of exchange transfusion with ACD blood on electrolyte levels was studied in 60 exchanges performed on 57 infants. The blood levels of potassium, sodium and chloride in donor blood were markedly different from those in the infants. The effect of the exchange procedure on the electrolyte levels in the infants was, however, relatively small and rapidly reversed after the exchange. ACD blood not exceeding 5 days old seems to have little effect on the infants' electrolyte levels during exchange transfusion.

The relative effectiveness of phototherapy and exchange transfusion for nonhemolytic neonatal hyperbilirubinemia was compared in two closely matched groups of infants. Although the exchange transfusion achieved an immediate reduction of bilirubin level, the "rebound" was rapid and tended to offset this reduction. The more gradual and steady effect of phototherapy resulted in a significantly lower serum bilirubin level at 1, 2, and 3 days after commencement of therapy; the rebound after phototherapy was small. Phototherapy was demonstrated to be more effective than exchange transfusion in achieving prolonged reduction of bilirubin levels for nonhemolytic hyperbilirubinemia. With more efficient lamps delivering more energy in the desired spectrum, it would seem feasible to treat hyperbilirubinemia of whatever etiology with this safer and more convenient form of therapy, though sometimes only as in adjunct therapy.

SYNOPSIS An unusual case of heteropagus is presented, in which a limb was attached to the sacral area of an otherwise apparently normal infant. A sausage-shaped mass resembling a limb is most unusual and has never been documented before. Obvious amniotic bands were also present at the point of attachment and presumably contributed to the constriction at this area. Progress was normal after removal of this appendage.

A brain tissue embolus was observed in a major pulmonary artery in the right lung, in a neonate who died from intracranial haemorhage 36 hours after delivery. This is the fifth documented case in a neonate and the only one in whom survival had occurred beyond one hour. Brain tissue emboli in the pulmonary circulation occur very rarely; it has been described in adults and children with head injuries. In newborn infants with severe congenital malformations of the central nervous system, brain tissue has been found growing in the lungs; the possibility of this being the result of prenatal brain trauma with embolization has been raised. In newborn infants, pulmonary brain tissue embolism as a result of birth trauma has been reported only very rarely; as far as the authors are aware, only four such cases have been documented. In view of the rarity of this condition, it was thought that the present case merited reporting.