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PurposeThe purpose of this paper is to expand upon existing theories of entrepreneurial cognitions. It constructs an information‐processing framework of entrepreneurship (I‐Pe) that holistically maps out the entrepreneurial opportunity recognition process. This framework demonstrates how various entrepreneurial needs and attitudes, as well as entrepreneurial motivators, impact on the diagnosis and assessment of informational cues. It describes how opportunity‐related information is processed by entrepreneurs in order to reach a decision of acceptance or rejection of potential business opportunities.Design/methodology/approachThe paper commences with a case study of New Zealand's winner of the Entrepreneur of the Year Award, Bill Day and his company Seaworks, a marine contracting firm. The case content is based on personal interviews by the authors as well as secondary data. The case describes how Seaworks achieved its current level of success. A number of Bill Day's uniquely entrepreneurial behaviours are then mapped into a cognitive framework describing influential elements of the entrepreneurial decision processes. This framework is derived from interdisciplinary research encompassing the study of entrepreneurship, psychology and cognitive neuroscience.FindingsEntrepreneurs have a heightened ability and awareness for recognising and audaciously exploiting business opportunities. They persistently and continually seek opportunity‐laden information in order to satisfy internal motivators such as need for achievement and the fulfilment of competitive urges. The case study describes an entrepreneurial mind that is attracted and stimulated by elements of excitement and fun. This entrepreneur is driven by business challenges that match and stretch his skills, knowledge, and abilities. Business related informational cues are sought and processed to calculate profit potential, the level of risk, and the cost of enactment. Final calculations are filtered. Benefits and potentially positive outcomes are amplified in the calculation process, while potential complications are regarded as challenges to be overcome rather than obstacles to be avoided.Practical implicationsThe I‐Pe framework derived from this research clearly demonstrates uniquely entrepreneurial decision processes. It advances our understanding of entrepreneurial cognitions and entrepreneurial decision behaviours, which has applications for the teaching of business skills as well as increasing our understanding of the phenomenon that has been termed “entrepreneurship”.Originality/valueThis paper is based on an original case study written by the authors and integrates cognitive theory within the context of entrepreneurial behaviour in order to explain why entrepreneurs are so successful at recognising and exploiting opportunities.

The relative strengths and weaknesses of 'stages of development' models for explaining small firm growth have attracted significant research attention. Despite this there remains little consensus regarding the ways in which SME owner-managers and their firms experience growth, and the transitions and milestones it comprises. In an attempt to heed the call for ongoing investigations into this phenomenon this paper reports on a project investigating the topic in the context of New Zealand small and medium-sized enterprises (SMEs). Findings from 50 interviews with small firm owner-managers are reported, along with conclusions and suggestions for future research.

To describe the association between pregnancy associated plasma protein A (PAPP-A), alpha-fetoprotein (AFP) and adverse perinatal outcome.We conducted a multicenter prospective cohort study of 8,483 women attending for prenatal care in southern Scotland between 1998 and 2000. The risk of delivering a small for gestational age infant, delivering preterm, and stillbirth were related to maternal serum levels of PAPP-A and AFP.Women with a low PAPP-A were not more likely to have elevated levels of AFP. Compared with women with a normal PAPP-A and a normal AFP, the odds ratio for delivering a small for gestational age infant for women with a high AFP was 0.9 (95% confidence interval [CI] 0.5-1.6), for women with a low PAPP-A was 2.8 (95% CI 2.0-4.0), and for women with both a high AFP and a low PAPP-A was 8.5 (95% CI 3.6-20.0). The odds ratio for delivering preterm for women with a high AFP was 1.8 (95% CI 1.3-2.7), for women with a low PAPP-A was 1.9 (95% CI 1.3-2.7), and for women with both a low PAPP-A and a high AFP was 9.9 (95% CI 4.4-22.0). These interactions were statistically significant for both outcomes (P = .03 and .04, respectively). There was a nonsignificant trend toward a similar interaction in relation to stillbirth risk. Of the women with the combination of a low PAPP-A and high AFP, 32.1% (95% CI 15.9-52.4) delivered a low birth weight infant.Low maternal serum levels of PAPP-A between 10 and 14 weeks and high levels of AFP between 15 and 21 weeks gestation are synergistically associated with adverse perinatal outcome.II-2.

An explorative trip was made to southwesternTurkey in April 1995 in search of pear thrips,Taeniothrips inconsequens (Uzel)(Thysanoptera: Thripidae), and its naturalenemies. Forty-three females and 13 males of apreviously undescribed species of the genusCeranisus Walker (Hymenoptera:Eulophidae) were found, mainly in floweringArbutus andrachne L. Although theparasitoid was found in association withseveral thrips species, but especially T.inconsequens adults and larvae, its host orhosts were not determined. The parasitoid isdescribed and given the name Ceranisusantalyacus S. Triapitsyn.

Despite the growth of female entrepreneurship little significant research has been done in New Zealand on the participation of women in family-owned firms . The purpose of this study is to help fill this gap. This study was based on six case studies and uses the qualitative grounded theory method. The study found that women were motivated to work in a family business for affirmative reasons and regarded their work as both worthwhile and satisfying. Involvement in the family business was seen as a positive dimension of family life. The participants made a deliberate choice to work in the family business, albeit for differing reasons. Working in the family firm was not seen as a 'less than best' option but as a positive choice. His contrasts with a common view in the literature that women often end up working in family businesses as a result of negative circumstances.

Docosahexaenoic acid (DHA) (22:6n−3) is a polyunsaturated fatty acid that is an essential constituent of membranes, particularly of the nervous system. Infants acquire DHA from their mothers, either prenatally via the placenta or postnatally in milk. The present study aimed to test the hypothesis that maternal supplementation during the second and third trimesters of pregnancy enriches maternal and/or fetal DHA status. In a randomised, prospective, double-blind study 100 mothers received either fish-oil capsules containing 400mg DHA/g (200mg/d) (n50), or placebo containing 810mg oleic acid/g (400mg/d) (n50) from 15 weeks gestation until term. Venous blood samples were obtained from mothers at 15, 28 and 40 weeks, and from the umbilical cord at birth. Total fatty acids in plasma and erythrocytes were analysed by GC–MS. There were no significant differences between maternal groups in baseline DHA, as a proportion of total fatty acids (g/100g total fatty acids) or concentration (nmol/ml), in plasma and erythrocytes. DHA concentrations in plasma at 28 weeks (P=0·02) and erythrocytes at both 28 weeks (P=0·03) and term (P=0·02) were 20% higher in supplemented mothers than the placebo group. DHA accounted for a higher proportion of total fatty acids in erythrocytes of supplemented mothers at 28 weeks (P=0·003) and term (P=0·01). There were no significant differences between groups in DHA (g/100g total fatty acids or nmol/l) in cord blood. Maternal DHA status was maximal in mid-trimester and declined to term, at a lower rate in supplemented compared with unsupplemented mothers. Maternal DHA supplementation significantly increases maternal DHA status and limits the last trimester decline in maternal status, aiding preferential transfer of DHA from mother to fetus.

The aim of this study was to compare the information that midwives, obstetricians and geneticists report they would give parents following the prenatal diagnosis of Klinefelter syndrome. Fifty midwives, 135 obstetricians and 66 geneticists completed a brief questionnaire assessing the information they reported providing to parents following the prenatal diagnosis of Klinefelter syndrome. Geneticists reported providing more information about Klinefelter syndrome than midwives and obstetricians, particularly positive information about the condition. The information parents receive after the prenatal diagnosis of Klinefelter syndrome may vary according to the specialty of the health professionals consulted. This variation may reflect differences in the information these groups have about the condition. It remains to be determined whether such variation leads to different decisions about whether or not to continue with the pregnancy and subsequent parental adjustment.

In skating over thin ice, our safety lies in speed (Ralph Waldo Emerson 1803-82)

In skating over thin ice, our safety lies in speed (Ralph Waldo Emerson 1803-82) PART A: STRUGGLING IN A DERUGULATED WORLD Context and Environment In the last few decades, the New Zealand textile, clothing and footwear (TCF) sector has experienced enormous restructuring and has downsized by 90 percent as a result of a rapidly changing business landscape. Manawatu Knitting Mills (MKM) is one of the few survivors. It is the oldest knitting company in New Zealand, having been founded in Palmerston North in 1884. The radical economic reforms of the 1980s had a greater impact on MKM than the Great Depression of the 1930s. MKM had to contend with both industry turmoil and the fallout from the 1987 stock market crash. These events badly affected MKM's parent company, resulting in potentially debilitating financial problems. It was all a huge mess. MKM's management was forced to change their thinking on how the company should be structured and managed. This caused John Hughes, MKM's long-suffering General Manager at that time, to state: By 1997 it was obvious that there were problems at MKM, in spite of some significant restructuring in the previous three years. It was obvious that the model used was not working. We had to find some way to restructure, reinvent or re-engineer the company. The company had either to find a solution or close. The Enterprise The basis of MKM's business is natural fibres. MKM's CEO, John Hughes states that, Our main point of differentiation is that we are a knitwear manufacturer using natural fibres, supplying two specific markets, the tourist market and the sports market.' Possum, camel, alpaca, cashmere and angora fibres are used, but the main raw material is wool, including merino. This is in spite a trend away from wool in recent years. Wool has suffered badly in the consumer's eye outside New Zealand. It is seen as expensive, hard to take care of, scratchy and heavy. MKM has responded by making its woollen garments lighter and by making care easier. 'But we haven't tinkered with the price because we regard our products as having exclusivity qualities.' The Manager: John Hughes John Hughes, the current CEO of Manawatu Knitting Mills has been in the 'rag trade' for 30 years. In 1985, he moved to Manawatu Knitting Mills as General Manager. He subsequently became Managing Director of MKM's parent company. This was a family owned business with knitwear, property, and investment interests. Problem of Being A Subsidiary MKM's presence as a subsidiary in the group resulted in an undesirable 'ruggedness' in the industry landscape. As a purchaser of wool yarn MKM was paradoxically not only a customer of the parent company, which manufactured wool yarn, but also a competitor to its other customers. As a result, MKM was perceived as a thorn in the side of every parent company customer in Australasia. The problem arose mainly in the tourist market area because MKM was supplying the same products as the parent company's other customers. The issue of intellectual property also had to be considered. As part of the wool spinning process, the parent company was aware of its customers' fashions and seasonal colours. Although there was never an actual conflict of interest, the potential existed. This resulted in MKM being restricted to certain markets only, because of the sensitivity of the parent company trading arrangements. John comments, 'The problem was that if MKM competed on its own merits, our competitors would scream and the flak would come back to us via the parent company.' Every strategy that was employed had to be a compromise to keep the parent company happy. In spite of these problems, MKM survived, albeit with difficulties in the protected markets of the early 1980s. However, when tariff barriers started coming down in the mid 1980s, the textile and garment industry was forced to undertake substantial restructuring. …

Objective To describe the association between the Outcomes of pregnancies diagnosed with Klinefelter syndrome (KS) and the speciality of the health professional providing pre- and post-diagnostic counselling. Method Data were extracted from the case notes of the 111 cases of KS diagnosed prenatally between 1986 and 1997 in eight geographical regions in live European countries The data extracted included: outcome of pregnancy, maternal age, social class. parity, gestational age at diagnosis, year of diagnosis and specialities of the health professionals conducting pre- and post-diagnosis consultations. Results The overall termination rate was 44% (49/111: 95% confidence interval: 35 to 54). Using multivariable logistic regression analysis, the only significant predictor of continuation of the pregnancy was the specialities c the health professionals conducting post-diagnosis counselling: the affected pregnancy was more likely to continue when post-diagnosis counselling involved only a genetics specialist (relative risk: 2.42 (1.14 to 5.92)). Conclusion There is an association between whether or not a woman terminates a pregnancy affected by an unfamiliar fetal anomaly and the professional background of the health professional providing postdiagnostic counselling. The causal nature of this association remains to be determined. Copyright (C) 2002 John Wiley Sons, Ltd.

We present a case report of a naevoid lentigo maligna (World Health Organisation level 1 melanoma) on the nose of a 46-year-old man. He was under surveillance because of a past history of two melanomas and developed a new lesion. The visible lesion was 1.6 mm in maximum diameter as measured by the scale on the dermatoscope footplate. The dermatoscopic structures present were limited to dots arranged asymmetrically. We believe that the fact that some of these dots were grey provided a useful clue to the diagnosis of melanoma.

While there are several published comprehensive stepwise algorithmic methods for diagnosing pigmented skin malignancy, only limited material has been published for the stepwise assessment of non-pigmented lesions. We present a method based on pattern analysis, with a stepwise assessment, first, for ulceration, second, for white clues (defined as white lines, or in the case of a raised lesion any of the keratin clues: dermatoscopic white circles, dermatoscopic white structureless areas or surface keratin), and third, if no ulceration or white clues are present, proceed to vessel pattern analysis. This is a novel method, and apart from the assessment of white clues in raised lesions, it has not been formally tested. The priority of keratin clues in raised lesions over vessel pattern analysis has, however, been verified. It is conceded that this method is less specific than methods which have clues of pigmented structures, and accepting these limitations, Prediction without Pigment is a decision algorithm intended to guide the clinician in the decision as to whether to perform a biopsy rather than consistently leading to a specific diagnosis. Reaching a more specific diagnosis at the end of our flowchart can be achieved by weighing of clues both clinical and dermatoscopic, and that ability can be expected to improve with both knowledge and experience, but no diagnostic method, including this one, can be 100% sensitive in diagnosing malignancy, in particular, melanoma. Taking these limitations into account, any non-pigmented lesion, regardless of pattern analysis, which is raised and firm (nodular) and for which a confident, specific benign diagnosis cannot be made, should be excised to exclude the nodular variant of amelanotic melanoma.

Background Whether the fetus can experience pain remains controversial. During the last half of pregnancy, the neuroanatomic connections for nociception are in place, and the human fetus mounts sizable stress responses to physical insults. Analgesia has been recommended for intrauterine procedures or late termination, but without evidence that it works. The authors investigated whether fentanyl ablates the fetal stress response to needling using the model of delayed interval sampling during intrahepatic vein blood sampling and transfusion in alloimmunized fetuses undergoing intravascular transfusion between 20 and 35 weeks. Methods Intravenous fentanyl (10 microg/kg estimated fetal weight x 1.25 placental correction) was given once at intrahepatic vein transfusion in 16 fetuses, and changes (posttransfusion - pretransfusion) in beta endorphin, cortisol, and middle cerebral artery pulsatility index were compared with intrahepatic vein transfusions without fentanyl and with control transfusions at the placental cord insertion. Results Fentanyl reduced the beta endorphin (mean difference in changes, -70.3 pg/ml; 95% confidence interval, -121 to -19.2; P = 0.02) and middle cerebral artery pulsatility index response (mean difference, 0.65; 95% confidence interval, 0.26-1.04; P = 0.03), but not the cortisol response (mean difference, -10.9 ng/ml, 95% confidence interval, -24.7 to 2.9; P = 0.11) in fetuses who had paired intrahepatic vein transfusions with and without fentanyl. Comparison with control fetuses transfused without fentanyl indicated that the beta endorphin and cerebral Doppler response to intrahepatic vein transfusion with fentanyl approached that of nonstressful placental cord transfusions. Conclusions The authors conclude that intravenous fentanyl attenuates the fetal stress response to intrahepatic vein needling.

Objective: To describe and compare the information obstetricians and geneticists in five European countries report they would give following the prenatal diagnosis of Klinefelter syndrome. Methods: 388 obstetricians and 269 geneticists from Germany, the Netherlands, Portugal, Spain and the UK completed a brief questionnaire assessing two variables: the information they reported providing to parents following the prenatal diagnosis of Klinefelter syndrome (categorized as positive or negative); and their perceptions of the quality of life with the condition. Results: Geneticists were more likely than obstetricians to report providing more positive than negative information about Klinefelter syndrome than equal amounts of positive and negative information or more negative than positive information about the condition (excess positive information). Regardless of specialty, the information that health professionals reported providing was predicted by their perceptions of the quality of life with the condition, and the country from which they came. Those perceiving quality of life as greater were more likely to provide an excess positive information, as were health professionals from Germany and the UK. Conclusions: These results suggest that the information parents across Europe receive after the prenatal diagnosis of Klinefelter syndrome varies according to the specialty and country of the health professionals consulted, and their perceptions of quality of life with the condition. This variation seems to reflect personal, cultural and professional differences between health professionals.

A 21-year-old woman presented in her first pregnancy with an asymptomatic vaginal mass which increased significantly in size during the pregnancy. The appearance of the vaginal mass and lack of specific radiological features clouded the diagnosis. The diagnosis of vaginal leiomyoma could only be obtained by histological examination after excision of the mass. We describe the clinical course, difficulty in diagnosis, and management of the case. The dilemma remains as to how to follow up such patients, especially with regard to future pregnancies.

The behavioural responses of flying western flower thrips (Frankliniella occidentalis Pergande) (Thysanoptera: Thripidae) to the colour yellow and the odour anisaldehyde were examined. In a wind tunnel, upwind flight by female thrips was common in an airflow of 0.11 m s−1 but was impeded at 0.22 m s−1. In the absence of anisaldehyde, flying female thrips exhibited an oriented response towards a yellow cue in the wind tunnel at a wind speed of 0.11 m s−1. The main response of females to anisaldehyde in the wind tunnel was flight inhibition. There was no evidence of an odour-induced visual response, an odour-induced anemotactic response or chemotaxis by female thrips to anisaldehyde in wind tunnel bioassays, but chemokinesis was implicated. With a matrix of yellow or black water traps with and without anisaldehyde in a greenhouse sweet pepper crop, yellow traps with anisaldehyde caught more thrips adults than yellow traps without anisaldehyde, black traps with anisaldehyde and black traps without anisaldehyde (1.3, 28 and 721 times for males respectively and 2.4, 9 and 117 times for females, respectively). Differences between respective traps were statistically significant in almost all cases. Trapping experiments using a centre-baited trap design to reduce the interaction of anisaldehyde between baited and unbaited traps were undertaken in tomato and sweet pepper greenhouse crops. When the spatial distribution of the thrips adult population within the greenhouse was taken into account, yellow water traps with anisaldehyde caught between 11 and 15 times more female and 3 and 20 times more male F. occidentalis adults than yellow traps without anisaldehyde.

The economic reforms that have taken place in New Zealand since 1984 were based on the rationale that governments can best help the economy by creating an environment free of inhibiting regulations. The conceptual shift from government intervention to reliance on the free market has been accompanied by significant changes in SME assistance. Successive New Zealand governments have decreased the level of direct funding, and this has created a need for other sectors of the economy to increase their activity.This paper examines government assistance to SMEs in New Zealand in relation to the economic reforms. These reforms have created a situation where direct assistance has become increasingly politically inappropriate. However, the most recent changes to SME assistance only reflect this ideological position to a limited degree. The fact that SME assistance still exists suggests that there are other factors at work, and implies that ideological purity is tempered with political pragmatism.

The philosophical work of the Dutch Christian intellectual Hernum Dooyeweerd is notinternationally well known. His major jurisprudential work is even less well known owing to the fact that it has not been published either in his native language or in English. The author of this article, who is involved in the editing of the English translation of Dooyeweerd's jurisprudence for publication, briefly expounds the main themes and some of the basic concepts of his legal philosophy with reference to the general problem of the relationship between law and morality and then attempts to apply these insights towards a theoretical elucidation of the relationship between law and legal ethics. Central to the Dooyeweerdian jurisprudential perspective is a highly original theory of the modal aspects. ln particular, the notions of the jural and ethical aspects provide the baszs of his unique account of the relationshzp between law and morality and of this article's application of Dooyeweerd's theoretical framework to the topic of legal ethics.

DISTINGUISHING HOMONYMS is a problem in any society, and it is not perhaps surprising that the same simple devices recur over long periods of time and in different parts of the ancient (and modern) world. P. Amh. LXII.6-7 lists two Ptolemaic soldiers called Apollonios, distinguishing them as I¤IAE˜ and IÂoofi˜. Some years ago Frank M. Snowden suggested that the first of the pair was actually black- skinned.1 A. M. Devine raised two different objections to this hypothe- sis.2 First, he finds "little hard evidence to suggest that general colour- terms like I¤IAE˜ by themselves carried any specific racial connotations in antiquity." Yet it depends what is meant by hard evidence. There is certainly some evidence, for which reference may now be made to Lloyd A. Thompson's useful book Romans and Blacks (1989). But "ra- cial connotations" are not really the point at issue. The question is rather, did the writer intend to indicate the color of the first Apollonios' skin? Personal descriptions in Egyptian documents do in fact very fre- quently specify skin color as an identifying characteristic. But they nor- mally use a more subtle vocabulary than just black/white: IÂoofiUˆ˜, IÂI›Uˆ˜, â﷿›﷿oUUO˜, n﷿fi﷿oUUO˜, IÂI?AUˆ˜, ﷿oUUAEo‹˜, âUoiU›AE˜. 3 I do not recall seeing plain I¤IAE˜ and IÂoofiused for this purpose. If skin color were the explanation here, we should have to assume that two men described bluntly as black and white one after another on the same document stood at opposite ends of the spectrum in skin color. That this should happen in the case of men who were in addition homo- nyms would surely be an improbable coincidence. The explanation must

A laboratory bioassay was conducted to test the effects of temperature and the availability of Acer saccharum Marshall pollen on adult female Taeniothrips inconsequens (Uzel) longevity and oviposition. Over a range of temperatures (8-20°C), a diet that included pollen significantly increased T. inconsequens adult longevity, total oviposition, and oviposition rate compared with diets that included no pollen. For diets with and without pollen, adult longevity significantly decreased with increasing temperature. However, the decrease in total oviposition and oviposition rate with increasing temperatures was only marginally significant. The importance of these 3 factors in determining the population dynamics of T. inconsequens in sugar maple stands is discussed.

Eighteen cases of bladder outlet obstruction were diagnosed at Queen Mother's Hospital, Glasgow, over a period of 6 years. Commonest cause was posterior urethral valve in 11 cases (61%). Oligohydramnios was present in 78% of cases with a mortality of 67% mainly due to pulmonary hypoplasia. The 6 surviving infants (33%) underwent early postnatal surgery. Two of these have chronic renal failure on follow-up.

We report on structurally modified dodecapeptide amides (KYKLFKKILKFL-NH2) and two analogs of a hexapeptide amide (WRWYCR-NH2) with antibacterial activity against the Gram negative pathogens Pseudomonas syringae pv. actinidiae (Psa) and Erwinia amylovora (Ea). Dodecapeptide minimal inhibitory concentrations (MICs) ranged from 3.2 to 15.4 µM, with the unmodified peptide being the most potent against both pathogens. The unmodified dodecapeptide also had 32-58% α-helicity in membrane mimetic environments (50% v/v trifluoroethanol and 30 mM SDS micelles). Structural modifications which included branching, acylation, and conjugation with 5-nitro-2-furaldehyde (NFA) proved detrimental to both antimicrobial activity and α-helicity. Scanning electron microscopy (SEM) revealed distinct morphological changes to bacterial cells treated with the different peptides, leading to blistering of the membrane and cell lysis. MICs of the hexapeptide amide were 3.9-7.7 µM against both pathogens. The hexapeptide acid did not show anti-bacterial activity against either pathogen. However, the NFA conjugated hexapeptide acid was more active than the parent peptide or NFA alone with MICs of 1.6-3.2 µM against the pathogens. SEM analysis revealed shriveling and collapse of bacterial cells treated with the hexapeptide, whereas shortening and compactness on exposure to streptomycin. A colorimetric assay demonstrated that the dodecapeptides were likely to act by targeting the bacterial membrane, whereas the hexapeptides, streptomycin, and NFA were not, thereby supporting the morphological changes observed during SEM. To the best of our knowledge, this appears to be the first report of antimicrobial peptide activity against Psa, a pathogen that is currently devastating the kiwifruit industry internationally.

The social, moral and marital status of the ladies of the Roman love elegists has been long and solemnly debated — if to little avail. 1 By contrast, no attention at all has been paid to the women of a genre that is known to have exerted considerable influence on the elegists, hellenistic love epigram 2 .

Objective: The incidence of gastroschisis, a congenital anomaly where the infant abdominal wall is defective and intestines protrude from the abdominal cavity, is increasing in many countries. The role of maternal stress in some adverse birth outcomes is now well established. We tested the hypothesis that major stressful life events in the first trimester are risk factors for gastroschisis, and social support protective, in a case-control study in the United Kingdom.\ud Methods: Gastroschisis cases and three controls per case (matched for maternal age) were identified at routine 18-20 week fetal anomaly ultrasound scan, in 2007-2010. Face to face questionnaire interviews were carried out during the antenatal period (median 24 weeks gestation) asking about serious stressful events and social support in the first trimester. Data were analysed using conditional logistic regression.\ud Results: Two or more stressful life events in the first trimester (adjusted OR 4.9; 95% CI 1.2-19.4), and moving address in the first trimester (aOR 4.9; 95% CI 1.7-13.9) were strongly associated with risk of gastroschisis, independent of behavioural risk factors including smoking, alcohol, and poor diet. Perceived availability of social support was not associated with reduced risk of gastroschisis (aOR 0.8; 95% CI 0.2-3.1).\ud Conclusions: Stressful maternal life events in the first trimester of pregnancy including change of address were strongly associated with a substantial increase in the risk of gastroschisis, independent of stress related high risk behaviours such as smoking, alcohol consumption and poor diet. This suggests that stress pathways are involved in the aetiology of gastroschisis.

Within–tree distribution of pear thrips, Taeniothrips inconsequens (Uzel), in Sugar maple, Acer saccharum Marsh., was determined in six nonflowering trees in 1990 and six flowering trees in 1992. During budburst, vegetative (1990) and flower (1992) buds were sampled from four cardinal quadrants, two canopy positions (inside and outside), and three crown levels (upper, middle, and lower) of sugar maples in a plantation in central Pennsylvania and examined for thrips eggs and adults. Almost all thrips adults were identified as T. inconsequens (94.9% in 1990 and 97.0% in 1992) and all eggs were likely to be from T. inconsequens because of their position in bud tissues and their morphology. Few larvae were present. Thrips eggs and adults were found in vegetative and flower buds throughout all levels, positions and quadrants. There were few significant differences in relation to any part of the tree in either year. In 1990 significantly more eggs (but not adults) were found in the middle level, compared with the lower and the upper levels. There was a significant interaction between height and quadrant for eggs (but not adults) in 1992. Within–tree distribution of pear thrips is likely to be affected by the synchrony between thrips emergence from ovelwintering sites and the timing of budburst in a particular position within the tree, and the distribution and density of flowers.

A dermatopathologist can only make a specific diagnosis based on the presence of defined histologic criteria. Most cases encountered in routine practice show enough criteria on standard examination to reach an unequivocal diagnosis. Sometimes further steps must be taken, such as cutting deeper levels or using special stains, to clarify uncertainties. Occasionally the final histologic diagnosis must remain uncertain or borderline. This most frequently occurs in the assessment of melanocytic lesions. There is no single diagnostic criterion for the histologic diagnosis of melanoma. “Criteria are evaluated differently by different observers. They are derived from typical, not difficult cases, and are seldom tested. In sum, none of the criteria useful for the diagnosis of melanoma are specific and diagnostic . . .” [1]. A series of architectural and cytological criteria are listed (Table 1) [2] and these criteria would apply to the majority of melanomas encountered in routine dermatopathology practice, but the quantity or quality required to make a diagnosis are not defined. It is accepted that melanomas, as with all malignant tumours, evolve over time and the rate of growth has been measured in one study [3]. Currently, few very small melanomas are diagnosed [4,5]. The increased use of dermatoscopy and digital monitoring should lead to more small melanomas being encountered [6]. What is not known is how commonly these very small melanomas, at the ‘infantile’ stage of Ackerman’s analogy, lack sufficient criteria to make the diagnosis of melanoma. It seems reasonable to speculate that such lesions exist. This leads us to pose the question, “Can melanomas be diagnosed earlier by adding information from history and dermatoscopy to the findings at histopathology?” and we present the case that led us to consider these matters. TABLE 1 Histologic criteria for the diagnosis of malignant melanoma (after Ackerman) (Table 32.4, Weedon’s Skin Pathology[2].)

Objectives To characterize dermoscopic criteria of squamous cell carcinoma (SCC) and keratoacanthoma and to compare them with other lesions. Design Observer-masked study of consecutive lesions performed from March 1 through December 31, 2011. Setting Primary care skin cancer practice in Brisbane, Australia. Participants A total of 186 patients with 206 lesions. Main Outcome Measures Sensitivity, specificity, predictive values, and odds ratios. Results In a retrospective analysis of 60 invasive SCC and 43 keratoacanthoma cases, keratin, surface scale, blood spots, white structureless zones, white circles, and coiled vessels were commonly found in both types of lesions. We reevaluated the significance of these criteria in 206 raised, nonpigmented lesions (32 SCCs, 29 keratoacanthomas, and 145 other lesions). Central keratin was more common in keratoacanthoma than in SCC (51.2% vs 30.0%, P = .03). Keratin had the highest sensitivity for keratoacanthoma and SCC (79%), and white circles had the highest specificity (87%). When keratoacanthoma and SCC were contrasted with basal cell carcinoma, the positive predictive values of keratin and white circles were 92% and 89%, respectively. When SCC and keratoacanthoma were contrasted with actinic keratosis and Bowen disease, the positive predictive value of keratin was 50% and that of white circles was 92%. In a multivariate model, white circles, keratin, and blood spots were independent predictors of SCC and keratoacanthoma. White circles had the highest odds ratio in favor of SCC and keratoacanthoma. The interobserver agreement for white circles was good (0.55; 95% CI, 0.44-0.65). Conclusions White circles, keratin, and blood spots are useful clues to differentiate SCC and keratoacanthoma from other raised nonpigmented skin lesions by dermoscopy. The significance of these criteria depends on the clinical context.

Skin cancer is a major cause of mortality and morbidity in Australia, and primary care doctors can, and should, treat most cases.In this article we outline one method for the effective use of dermatoscopy in diagnosing melanoma and other skin malignancies in general practice.The use of a dermatoscope in clinical practice has been shown to increase diagnostic accuracy and is considered the standard of care in assessing patients with pigmented skin lesions. Its use is also being increasingly applied to the diagnosis of nonpigmented skin lesions. Like any clinical tool, training is required for effective use. 'Chaos and clues' is a straightforward method of rapidly assessing suspicious pigmented skin lesions using a dermatoscope; its use can lead to improved diagnosis of melanoma and other skin malignancies.

Background Seventy percent of women in Scotland have at least one baby, making pregnancy an opportunity to help most young women quit smoking before their own health is irreparably compromised. By quitting during pregnancy their infants will be protected from miscarriage and still birth as well as low birth weight, asthma, attention deficit disorder and adult cardiovascular disease. In the UK, the NICE guidelines: ‘How to stop smoking in pregnancy and following childbirth’ (June 2010) highlighted that little evidence exists in the literature to confirm the efficacy of financial incentives to help pregnant smokers to quit. Its first research recommendation was to determine: Within a UK context, are incentives an acceptable, effective and cost-effective way to help pregnant women who smoke to quit? Design and methods This study is a phase II exploratory individually randomized controlled trial comparing standard care for pregnant smokers with standard care plus the additional offer of financial voucher incentives to engage with specialist cessation services and/or to quit smoking during pregnancy. Participants (n = 600) will be pregnant smokers identified at maternity booking who, when contacted by specialist cessation services, agree to having their details passed to the NHS Smokefree Pregnancy Study Helpline to discuss the trial. The NHS Smokefree Pregnancy Study Helpline will be responsible for telephone consent and follow-up in late pregnancy. The primary outcome will be self reported smoking in late pregnancy verified by cotinine measurement. An economic evaluation will refine cost data collection and assess potential cost-effectiveness while qualitative research interviews with clients and health professionals will assess the level of acceptance of this form of incentive payment. The research questions are: What is the likely therapeutic efficacy? Are incentives potentially cost-effective? Is individual randomization an efficient trial design without introducing outcome bias? Can incentives be introduced in a way that is feasible and acceptable? Discussion This phase II trial will establish a workable design to reduce the risks associated with a future definitive phase III multicenter randomized controlled trial and establish a framework to assess the costs and benefits of financial incentives to help pregnant smokers to quit. Trial registration Current Controlled Trials ISRCTN87508788

Nail matrix melanoma, otherwise known as subungual melanoma, is unique in that the actual primary cutaneous melanoma is occult, being covered by the nail plate and the proximal nail fold. Fortunately, the concealed melanoma may produce melanin, which then appears as longitudinal pigmentation in the nail plate. Thus melanin-producing nail matrix melanoma has a distinctive ‘signature’ to the informed observer. Acral lentiginous melanoma was first described as a subgroup in 1976 by Reed [1]. Prior to that Clark had proposed three histologic sub-types: superficial spreading melanoma, lentigo maligna melanoma and nodular melanoma [2]. About half of all hand and foot melanomas are of the acral lentiginous subtype. A Scottish study restricted to subungual melanoma showed that 45% were acral lentiginous, 27% nodular and 20% superficial spreading in type [3]. We present two consecutive cases of nail matrix melanoma from a general practice. The first patient was referred to the practice and the second patient was recommended to the practice by the first.

Background: Deciding whether a skin lesion requires biopsy to exclude skin cancer is often challenging for primary care clinicians in Australia. There are several published algorithms designed to assist with the diagnosis of skin cancer but apart from the clinical ABCD rule, these algorithms only evaluate the dermatoscopic features of a lesion. Objectives: The BLINCK algorithm explores the effect of combining clinical history and examination with fundamental dermatoscopic assessment in primary care skin cancer practice. Patients/Methods: Clinical and dermatoscopic images of 50 skin lesions were collected and shown to four primary care practitioners. The cases were assessed by each participant and lesions requiring biopsy were determined on separate occasions using the 3-Point Checklist, the Menzies method, clinical assessment alone and the BLINCK algorithm. Results: The BLINCK algorithm had the highest sensitivity and found more melanomas than any of the other methods. However, BLINCK required more biopsies than the other methods. When comparing diagnostic accuracy, there was no difference between BLINCK, Menzies method and clinical assessment but all were better than the 3-Point checklist. Conclusions: These results suggest that the BLINK algorithm may be a useful skin cancer screening tool for Australian primary care practice.

The distribution and host plant associations of the pear thrips, Taeniothrips inconsequens (Uzel), were determined from published and unpublished data. T. inconsequens is found throughout Europe and much of North America as well as in some countries of Asia and South America; there is one record from North Africa. It is generally considered that T. inconseqyens is native to Europe, but we present good evidence to suggest that Asia is its area of origin. Breeding hosts for T. inconsequens were identified from 35 species, 17 genera and 12 families, with incidental records from at least 207 species, 138 genera and 54 families. Breeding hosts were mainly from the Rosaceae (5 genera, 16 species) and Aceraceae (1, 7) but also members of other plant families. Incidental collections were mostly from the Rosaceae (15 genera, 36 species) but also members of a wide range of plant families including the Compositae (10, 12), the Leguminosae (10, 11) and the Aceraceae (1, 9). Reports of economic damage to orchard and forest trees are listed. There is no evidence to suggest that recent outbreaks of T. inconsequens in northeastern hardwood forests of the United States and adjacent areas of Canada can be explained by recent changes in host plant preference.

The control of the woodwasp Sirex noctilio can be visualized as a three-legged stool. Silvicultural practices to reduce tree competition and stress and biological control using the nematode Deladenus siricidicola are two important legs. The third, and equally important, component of a total control program for this pest is the use of parasitoid wasps. Parasitoids were the first form of control used against S. noctilio in the Southern Hemisphere and remain important, especially as a constant repressor at low population levels. However, there is significant variation in the effect and application of the various parasitoid wasps in different regions. There is evidently scope for renewed efforts to better understand and optimize the use of parasitoids to achieve stable, long lasting population repression of invasive S. noctilio populations.

We present a case report of a naevoid lentigo maligna (World Health Organisation level 1 melanoma) on the nose of a 46-year-old man. He was under surveillance because of a past history of two melanomas and developed a new lesion. The visible lesion was 1.6 mm in maximum diameter as measured by the scale on the dermatoscope footplate. The dermatoscopic structures present were limited to dots arranged asymmetrically. We believe that the fact that some of these dots were grey provided a useful clue to the diagnosis of melanoma.

Introduction Antenatal screening identifies those pregnancies at ‘high risk’ of fetal complications, such as aneuploidy, intrauterine infection and fetal anaemia, but the diagnosis can only be confirmed or refuted by direct examination of fetal tissue or blood. Until recently, fetal cells could only be obtained by an invasive procedure: amniocentesis, chorionic villus sampling (CVS) or cordocentesis. While fetal cells can now be extracted from the maternal circulation and analysed for specific indications, this technique is not widely available and it clinical use remains limited. Invasive testing therefore remains the cornerstone of prenatal diagnosis. This chapter will focus on the prenatal diagnostic techniques used to determine fetal karyotype. Readers are referred to Chapters 5 and 10 for information on the role of prenatal diagnostic tests in the management of fetal anaemia and intrauterine infection. Who should be offered invasive prenatal testing? All pregnant women should be made aware that both diagnostic and screening tests for aneuploidy are available in pregnancy. The majority of women will choose to have a screening test, as this carries no innate risk to the pregnancy, and will not wish to discuss diagnostic testing in any form. For others, the consequences of having a child affected by aneuploidy are of such enormity that no screening test will give sufficient reassurance. If such concerns are expressed, the mother must have ample opportunity to discuss the full range of diagnostic tests that are available. It is for the woman to decide which risk is most acceptable.

Introduction The United Kingdom Abortion Act was passed in 1967 and amended in 1990 when the Human Fertilisation and Embryology Act was passed. The main changes were that an upper time limit of 24 weeks was introduced for the termination of pregnancy where fetal abnormality was not the indication for the procedure. There was also the removal of any time limit if a termination was being carried out for fetal abnormality, such that no offence was committed under either the law relating to abortion or the Infant Life Preservation Act 1929 if a medical practitioner was involved within the clauses of the Abortion Act in this work. The main clause concerning termination for fetal abnormality is found in Section I(d) of the Act and this states that termination is permitted when two registered medical practitioners are of an opinion formed in good faith that ‘there is substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped’. This, therefore, forms the basis of legal termination of pregnancy for fetal abnormality in the UK. The stage of pregnancy at which the diagnosis is made and the time of pregnancy when the decision to perform a termination is made are crucial in terms of how the procedure may be performed. The decision to terminate a pregnancy because of fetal abnormality is often extremely difficult and it is vital that a comprehensive counselling service is available to the couple concerned before undertaking the procedure. This should involve multidisciplinary teamwork from obstetricians, midwives, geneticists and paediatricians, where appropriate. This complex area is dealt with in detail by Fisher and Staham.