Search

Foreword The first notion of a native police corps was brought forward in the 1830s, by the penal reformer Alexander Maconochie. Its primary objective was to "give the native race an institution of which it could be proud, a means of raising Aboriginal morale." A similar idea had been applied and had proved successful in India. But in the Eastern Colonies of Australia and particularly later in Queensland, this initial concept did not become a reality. This thesis is an attempt to explore the theme that the Native Mounted Police Force which developed in Queensland, was really a part of what could be seen as a "tradition of violent expansion" in the nineteenth century colony. In view of the fact that the Corps played a major role in the frontier conflict, and the consequent destruction of a large percentage of the Aboriginal population, it is important to see how and why these actions were motivated. This inevitably must shed light upon the whole social context within which the Native Police operated. The thread of these ideas is followed through with respect to the organization of the Force, its activities, its justifications and the reactions it produced within the colonial community. The decade of the 1870's was chosen as the limitations of this study for two reasons. Firstly, the 70's displayed all the characteristics of the Force and its interaction with the society as well as having another important factor. This second point, was that by the end of the 70's the Native Police organization and its supporting ideas were showing some sign of change. Up to this time, the Force had undergone no reform, no revision. ………………………

OBJECTIVE: To evaluate the effects of early treatment with CPAP on nutritional intake and in-hospital growth rates of extremely preterm (EPT) infants. STUDY DESIGN: EPT infants (24–0/7 to 27–6/7 weeks of gestation) enrolled in the Surfactant Positive Airway Pressure and Pulse Oximetry Trial (SUPPORT) were included. EPT infants who died before 36 weeks’ postmenstrual age (PMA) were excluded. The growth rates from birth to 36 weeks’ PMA and follow-up outcomes at 18–22 months’ corrected age of EPT infants randomized at birth to either early CPAP (intervention group) or early intubation for surfactant administration (control group) were analyzed. RESULTS: 810 of 1316 infants enrolled in SUPPORT (414 in intervention group, 396 in control group) had growth data analyzed. Median gestational age was 26 weeks and mean birthweight was 839 grams. Baseline characteristics, total nutritional intake, and in-hospital comorbidities were not significantly different between groups. In a regression model, growth rates between birth and 36 weeks’ PMA as well as growth rates during multiple intervals from birth to day 7, day 7 to14, day 14 to 21, day 21 to 28, day 28 to 32 weeks’ PMA, and 32 weeks’ PMA to 36 weeks’ PMA did not differ between treatment groups. Independent of treatment group, higher growth rates from day 21 to day 28 were associated with a lower risk of Bayley III cognitive score

Symptomatic cytomegalovirus (CMV) disease has been the standard endpoint for clinical trials in organ transplant recipients. Viral load may be a more relevant endpoint due to low frequency of disease. We performed a meta-analysis and systematic review of the literature. We found several lines of evidence to support the validity of viral load as an appropriate surrogate end-point, including the following: (1) viral loads in CMV disease are significantly greater than in asymptomatic viremia (odds ratio, 9.3 95% confidence interval, 4.6-19.3); (2) kinetics of viral replication are strongly associated with progression to disease; (3) pooled incidence of CMV viremia and disease is significantly lower during prophylaxis compared with the full patient follow-up period (viremia incidence: 3.2% vs 34.3%; P < .001) (disease incidence: 1.1% vs 13.0%; P < .001); (4) treatment of viremia prevented disease; and (5) viral load decline correlated with symptom resolution. Based on the analysis, we conclude that CMV load is an appropriate surrogate endpoint for CMV trials in organ transplant recipients.

Objective To investigate associations in toddlers born extremely preterm ( Study design Cohort analysis from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network Surfactant Positive Airway Pressure and Pulse Oximetry Trial Neuroimaging and Neurodevelopmental Outcomes Study of infants born extremely preterm. Subjects underwent cranial ultrasonography and near-term magnetic resonance imaging (MRI). At 18-22 months of corrected age, the assessment included the Brief Infant Toddler Social Emotional Assessment (BITSEA) Problem and Competence Scale scores and the Bayley Scales of Infant Development, Third Edition (Bayley-III). The BITSEA Problem Scale assesses dysregulation; the Competence Scale assesses social-emotional competence. We examined associations of Problem and Competence scores and positive screen rates with cranial ultrasonography and near-term MRI. Mean BITSEA and Bayley-III scores were compared using ANOVA and positive screen rates with the χ2 test. We computed correlations between BITSEA and Bayley-III scores. Results Of the 397 children, positive BITSEA screens were found in 34% for the Problem score and 26% for the Competence score. Presence of lesions on near-term MRI that included cerebellar lesions were significantly associated with lower BITSEA Competence but not with Problem scores; Competence scores were inversely related to the presence/significance of lesions. Positive screens on Competence scores and on both Competence and Problem scores were significantly associated with Bayley-III cognitive and language scores Conclusions Social–emotional competence contributes to deficits in cognitive and language development. Presence of injury on near-term MRI that includes cerebellar lesions is associated with later social–emotional competence and may be a useful predictor to guide early assessment and intervention. Trial registration ClinicalTrials.gov : NCT00063063 and NCT00233324 .

Objectives To identify variables associated with successful elective extubation, and to determine neonatal morbidities associated with extubation failure in extremely preterm neonates. Study design This study was a secondary analysis of the National Institute of Child Health and Human Development Neonatal Research Network's Surfactant, Positive Pressure, and Oxygenation Randomized Trial that included extremely preterm infants born at 240/7 to 276/7 weeks' gestation. Patients were randomized either to a permissive ventilatory strategy (continuous positive airway pressure group) or intubation followed by early surfactant (surfactant group). There were prespecified intubation and extubation criteria. Extubation failure was defined as reintubation within 5 days of extubation. Results Of 1316 infants in the trial, 1071 were eligible; 926 infants had data available on extubation status; 538 were successful and 388 failed extubation. The rate of successful extubation was 50% (188/374) in the continuous positive airway pressure group and 63% (350/552) in the surfactant group. Successful extubation was associated with higher 5-minute Apgar score, and pH prior to extubation, lower peak fraction of inspired oxygen within the first 24 hours of age and prior to extubation, lower partial pressure of carbon dioxide prior to extubation, and non-small for gestational age status after adjustment for the randomization group assignment. Infants who failed extubation had higher adjusted rates of mortality (OR 2.89), bronchopulmonary dysplasia (OR 3.06), and death/ bronchopulmonary dysplasia (OR 3.27). Conclusions Higher 5-minute Apgar score, and pH prior to extubation, lower peak fraction of inspired oxygen within first 24 hours of age, lower partial pressure of carbon dioxide and fraction of inspired oxygen prior to extubation, and nonsmall for gestational age status were associated with successful extubation. Failed extubation was associated with significantly higher likelihood of mortality and morbidities. Trial registration ClinicalTrials.gov : NCT00233324 .

Objective To characterize actual achieved patterns of oxygenation in infants born appropriate vs small for gestational age (SGA) randomized to a lower (85-89%) vs higher (91%-95%) oxygen saturation target in the Surfactant Positive Pressure and Oxygen Trial. To determine the association between achieved oxygen saturation levels and survival in infants born appropriate vs SGA enrolled in the Surfactant Positive Pressure and Oxygen Trial. Study design Median oxygen saturation and intermittent hypoxemia events ( 0/7 -27 6/7 weeks of gestation while receiving supplemental oxygen during the first 3 days of life. Results Lower target infants who were small for gestational age had the lowest oxygen saturation and highest incidence of intermittent hypoxemia during the first 3 days of life. The lowest quartile of oxygen saturation (≤92%) during the first 3 days of life was associated with lower 90-day survival for both infants born appropriate and SGA. An increased incidence of intermittent hypoxemia events during the first 3 days of life was associated with lower 90-day survival only in infants born SGA. Conclusion Lower achieved oxygen saturation during the first 3 days of life was associated with lower 90-day survival in extremely preterm infants. Infants born SGA had enhanced vulnerability to lower oxygen saturation targets as evidenced by lower achieved oxygen saturation and an association between increased intermittent hypoxemia events and lower survival. Trial registration ClinicalTrials.gov: NCT00233324.

In writing this article, we wanted to provide advisors practical means with which to optimize their relationships with advisees. First, we describe behavioral microskills that can be used by advisors to enhance advising sessions. Attending behaviors (eye contact, vocal cadence and tone, verbal tracking, body language) and listening skills (asking questions, observing, guiding discussion, reflecting feelings) are two core microskills that advisors can practice. Use of these microskills has been shown to improve session effectiveness and strengthen the advisee-advisor relationship. Second, we present the results of a small-scale experiment that suggests that even modest training in microskills can benefit advising sessions. Relative emphasis: * practice, theory, research

OBJECTIVE—Alström syndrome, with type 2 diabetes, and blindness could confer a high risk of foot ulceration. Clinical testing for neuropathy in Alström syndrome and matched young-onset type 2 diabetic subjects was therefore undertaken. RESEARCH DESIGN AND METHODS—Fifty-eight subjects with Alström syndrome (18 insulin-resistant nondiabetic and 40 diabetic; aged 8–43 years) and 30 young-onset diabetic subjects (aged 13–35 years) were studied. Neuropathy symptom questionnaires were administered. Graded monofilament and 128-MHz tuning fork vibration perception were assessed in both feet. RESULTS—Neuropathic symptoms, loss of monofilament, and/or vibration perception were reported by 12 of the 30 young-onset type 2 diabetic subjects (6 had neuropathic ulceration) but none of the subjects with Alström syndrome. CONCLUSIONS—The striking preservation of protective foot sensation in Alström syndrome may provide a clue to the causes of differential susceptibility to neuropathy in the wider diabetic population.

Developing a vaccine that overcomes the diversity of HIV-1 is likely to require a strategy that directs antibody (Ab) responses toward conserved regions of the viral Envelope (Env). However, the generation of neutralizing Abs (NAbs) targeting these regions through vaccination has proven to be difficult. One conserved region of particular interest is the membrane proximal external region (MPER) of Env located within the gp41 ectodomain. In order to direct the immune response to this region, the MPER and gp41 ectodomain were expressed separately as N-terminal fusions to the E2 protein of Geobacillus stearothermophilus. The E2 protein acts as a scaffold by self-assembling into 60-mer particles, displaying up to 60 copies of the fused target on the surface. Rabbits were immunized with E2 particles displaying MPER and/or the gp41 ectodomain in conjunction with DNA encoding full-length gp160. Only vaccines including E2 particles displaying MPER elicited MPER-specific Ab responses. NAbs were elicited after two immunizations that largely targeted the V3 loop. To overcome V3 immunodominance in the DNA component, E2 particles displaying MPER were used in conjunction with gp160 DNA lacking hypervariable regions V2, V3, or combined V1V2V3. All rabbits had HIV binding Ab responses and NAbs following the second vaccination. Using HIV-2/HIV-1 MPER chimeric viruses as targets, NAbs were detected in 12/16 rabbits after three immunizations. Low levels of NAbs specific for Tier 1 and 2 viruses were observed in all groups. This study provides evidence that co-immunizing E2 particles displaying MPER and gp160 DNA can focus Ab responses toward conserved regions of Env.

Karabouta Z, Barnett S, Shield JPH, Ryan FJ, Crowne EC. Peripheralneuropathy is an early complication of type 2 diabetes in adolescence.Pediatric Diabetes 2008: 9: 110–114.Objective: To screen for microvascular complications in adolescents withtype 2 diabetes mellitus (T2DM).Subjects and methods: Seven adolescents with T2DM were assessedfor early secondary complications. Median duration of diabetes was 1.8(0.8–3.0) yr. All were assessed as follows: blood pressure, ophthalmologicexamination for diabetic retinopathy, renal function, full blood count andvitamin B12 levels (to exclude B12 malabsorption – a side effect ofmetformin), random urine for microalbuminuria, an electrocardiogram(ECG) rhythm strip and podiatry performed by an experienced podiatrist.Testing for peripheral neuropathy included foot pulse palpation, tendo-Achilles reflexes, plantar callus test, large nerve fibre function (vibrationand threshold for light touch/pressure) assessed by a 128-Hz tuning fork,and by the standard 10-g Semmes–Weinstein monofilament test, andsmall nerve fibre function (pain) assessed by pinprick neurotip.Results: Four adolescents had evidence of peripheral neuropathy onclinical examination, with abnormal large and small nerve fibre function.Six had plantar callus present, and four had weak but palpable posteriortibial pulses. All had normal tendo-Achilles reflex and normal response tovibration. None had diabetic retinopathy or hypertension. Renalfunction, full blood count (FBC), B12 levels and ECGs were normal.None of 120 adolescents with type 1 diabetes mellitus (T1DM) assessedby the same podiatrist had any signs of peripheral neuropathy.Conclusions: Unlike T1DM, peripheral neuropathy can be present soonafter diagnosis in those with T2DM. Children with T2DM needsurveillance for complications from the time of diagnosis.

During the past 20 years, the pendulum of opinion in the HIV-1 vaccine field has swung between two extremes, initially favoring the induction of antibodies only, and subsequently favoring the induction of cell-mediated immune responses only. At present, the consensus seems to be that induction of both humoral and cellular immunity by an HIV-1 vaccine will be required to achieve maximum protection. One obstacle to the development of an effective HIV-1 vaccine has been the difficulty in inducing broadly reactive, potent antibodies with protective functions. Defining epitopes and designing immunogens that will induce these antibodies is one of the main challenges that currently confronts the HIV-1 vaccine field.

Vaccination strategies that can block or limit heterosexual HIV transmissions to local and systemic tissues are much sought for. Herein, in a mouse model, we aimed to determine whether the enhancement of antibody responses through mucosal and systemic immunizations, previously observed with protein-based vaccines, applies to immunizations with DNA- or RNA-based vectors. Intra-nasal (i.n.) followed by intra-muscular (i.m.) immunizations (i.n./i.m.) with PLG-DNA microparticles encoding HIV-gag (PLG-DNA-gag) significantly enhanced serum antibody responses, compared i.m., i.n. or i.m. followed by i.n. (i.m./i.n.), immunizations. Moreover, while i.n./i.m., i.n. or i.m./i.n. immunizations with PLG-DNA-gag resulted in genital tract antibody responses, i.m. immunizations alone failed to do so. Importantly, β7-deficient mice developed local and systemic antibody responses following i.n./i.m., or any other routes of immunization similar to wild type mice. To compare the DNA with an RNA delivery system, immunizations were performed with VEE/SIN-gag replicon particles, composed of Venezuelan Equine Encephalitis virus (VEE) replicon RNA and Sindbis surface structure (SIN). i.n./i.m., as compared to any other immunizations, with VEE/SIN-gag resulted in enhanced genital tract, but not serum antibody responses. These data show for the first time that mucosal followed by systemic immunizations with gene delivery systems enhance B cell responses independent of the mucosal homing receptors α4β7 or αEβ7.

In patients with acute severe ankle sprain, are mechanical supports more effective than double-layer tubular compression bandages (Tubigrip) for enhancing recovery? ### Design: randomised controlled trial. ### Allocation: concealed. ### Blinding: blinded (outcome assessors). ### Follow-up period: 1, 3, and 9 months. ### Setting: 8 emergency departments in the UK. ### Patients: 584 patients >16 years of age (mean age 30 y, 58% men) who were unable to bear weight for ⩾3 days after sprain. Exclusion criteria were contraindications to immobilisation, injury date >7 days ago, or recent fracture (except flake fracture