Applying science to pressing conservation needs for penguins.

More than half of the world's 18 penguin species are declining. We, the Steering Committee of the International Union for Conservation of Nature Species Survival Commission Penguin Specialist Group, determined that the penguin species in most critical need of conservation action are African penguin (Spheniscus demersus), Galápagos penguin (Spheniscus mendiculus), and Yellow-eyed penguin (Megadyptes antipodes). Due to small or rapidly declining populations, these species require immediate scientific collaboration and policy intervention. We also used a pairwise-ranking approach to prioritize research and conservation needs for all penguins. Among the 12 cross-taxa research areas we identified, we ranked quantifying population trends, estimating demographic rates, forecasting environmental patterns of change, and improving the knowledge of fisheries interactions as the highest priorities. The highest ranked conservation needs were to enhance marine spatial planning, improve stakeholder engagement, and develop disaster-management and species-specific action plans. We concurred that, to improve the translation of science into effective conservation for penguins, the scientific community and funding bodies must recognize the importance of and support long-term research; research on and conservation of penguins must expand its focus to include the nonbreeding season and juvenile stage; marine reserves must be designed at ecologically appropriate spatial and temporal scales; and communication between scientists and decision makers must be improved with the help of individual scientists and interdisciplinary working groups.

Aplicación de Ciencia en las Necesidades de Conservación Urgentes para los Pingüinos. Resumen Más de la mitad de las 18 especies de pingüinos del mundo están disminuyendo. Nosotros, el Comité Directivo de la Unión Internacional para la Conservación de la Naturaleza, Grupo de Especialistas en Pingüinos, determinamos que las especies de pingüinos con necesidades críticas de conservación son el pingüino africano (Spheniscus demersus), el pingüino de las Galápagos (Spheniscus mendiculus) y el pingüino de ojos amarillos (Megadyptes antipodes). Debido a que sus poblaciones son pequeñas o están declinando rápidamente, estos pingüinos requieren colaboración científica e intervención política inmediatas. También utilizamos un método de clasificación por pares para priorizar las necesidades de investigación y conservación para todas las especies de pingüinos. Entre las 12 áreas de investigación que identificamos, las más prioritarias fueron: cuantificación de las tendencias poblacionales, estimación de las tasas demográficas, predicción de las patrones de cambio ambiental y mejora del conocimiento de las interacciones con pesquerías. Las mayores necesidades de conservación fueron: optimizar la planificación marina espacial, mejorar la colaboración de las partes interesadas y desarrollar planes de manejo de desastres y de acción para cada especie. Coincidimos en que, para mejorar la traducción de la ciencia en la conservación efectiva de los pingüinos, la comunidad científica y los organismos financiadores deben reconocer la importancia de la investigación a largo plazo y apoyarla; la investigación sobre pingüinos y su conservación debe expandir su enfoque para incluir la época no reproductiva y la etapa juvenil; las reservas marinas deben ser diseñadas a escalas espaciotemporales ecológicamente apropiadas; y la comunicación entre científicos y tomadores de decisiones debe mejorar con la ayuda de científicos individuales y grupos de trabajo interdisciplinario.

The feasibility of home monitoring of young people with cystic fibrosis: Results from CLIMB-CF.

BACKGROUND: CF is traditionally assessed in clinic. It is unclear if home monitoring of young people with CF is feasible or acceptable. The COVID-19 pandemic has made home monitoring more of a necessity. We report the results of CLIMB-CF, exploring home monitoring's feasibility and potential obstacles. METHODS: We designed a mobile app and enrolled participants with CF aged 2-17 years and their parents for six months. They were asked to complete a variety of measures either daily or twice a week. During the study, participants and their parents completed questionnaires exploring depression, anxiety and quality of life. At the end of the study parents and participants completed acceptability questionnaires. RESULTS: 148 participants were recruited, 4 withdrew prior to starting the study. 82 participants were female with median (IQR) age 7.9 (5.2-12 years). Median data completeness was 40.1% (13.6-69.9%) for the whole cohort; when assessed by age participants aged ≥ 12 years contributed significantly less (15.6% [9.8-30%]). Data completeness decreased over time. There was no significant difference between parental depression and anxiety scores at the start and the end of the study nor in CFQ-R respiratory domain scores for participants ≥ 14 years. The majority of participants did not feel the introduction of home monitoring impacted their daily lives. CONCLUSIONS: Most participants felt home monitoring did not negatively impact their lives and it did not increase depression, anxiety or decrease quality of life. However, uptake was variable, and not well sustained. The teenage years pose a particular challenge and further work is required.

Paediatrics in Berlin.

The aim of this report is to describe the highlights of the European Respiratory Society annual congress in Berlin, Germany. The best abstracts in asthma and allergy, cystic fibrosis, respiratory infection, paediatric and neonatal intensive care, paediatric investigative techniques (in particular respiratory physiology and bronchoscopy) and respiratory epidemiology are presented and set in the context of the current literature.

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach.

There is poor agreement on definitions of different phenotypes of preschool wheezing disorders. The present Task Force proposes to use the terms episodic (viral) wheeze to describe children who wheeze intermittently and are well between episodes, and multiple-trigger wheeze for children who wheeze both during and outside discrete episodes. Investigations are only needed when in doubt about the diagnosis. Based on the limited evidence available, inhaled short-acting beta(2)-agonists by metered-dose inhaler/spacer combination are recommended for symptomatic relief. Educating parents regarding causative factors and treatment is useful. Exposure to tobacco smoke should be avoided; allergen avoidance may be considered when sensitisation has been established. Maintenance treatment with inhaled corticosteroids is recommended for multiple-trigger wheeze; benefits are often small. Montelukast is recommended for the treatment of episodic (viral) wheeze and can be started when symptoms of a viral cold develop. Given the large overlap in phenotypes, and the fact that patients can move from one phenotype to another, inhaled corticosteroids and montelukast may be considered on a trial basis in almost any preschool child with recurrent wheeze, but should be discontinued if there is no clear clinical benefit. Large well-designed randomised controlled trials with clear descriptions of patients are needed to improve the present recommendations on the treatment of these common syndromes.

How should we estimate driving pressure to measure interrupter resistance in children?

Interrupter resistance (R(int)) is a widely used measure of airway caliber, but concerns remain about repeatability and sensitivity. Some R(int) variability may derive from the linear back-extrapolation algorithm (LBE 30/70) usually used to estimate driving pressure. To investigate whether other methods of estimating driving pressure could improve repeatability and sensitivity, we studied 39 children with asthma. Two measurements of R(int)-each the median of 10 interruptions-were made 5 min apart, and 14 children had a third measurement after bronchodilator (R(int)BD). Mouth pressure transients were analyzed using several algorithms, to compare the magnitude, repeatability, and sensitivity to bronchodilator change of R(int) values yielded. Algorithms taking driving pressure from later in the transient, predictably, yielded higher values of R(int) than those which back-extrapolated to time of valve closure. Algorithms which did not rely on back-extrapolation, including mean oscillation pressure (MOP) and mean plateau pressure (MP 30/70) had better repeatability. Sensitivity to detect change, calculated as ratio of bronchodilator response to repeatability coefficient (DeltaR(int)/CR), was also better for non-extrapolating algorithms: MP 30/70 1.67, LBE 30/70 1.28 (P = 0.0004). Measuring R(int) using techniques other than conventional back-extrapolation may give more consistent and clinically useful results, and these approaches merit further exploration.

Oral xanthines as maintenance treatment for asthma in children.

BACKGROUND: Xanthines have been used in the treatment of asthma as a bronchodilator, though they may also have anti-inflammatory effects. The current role of xanthines in the long-term treatment of childhood asthma needs to be reassessed. OBJECTIVES: To determine the efficacy of xanthines (e.g. theophylline) in the maintenance treatment of paediatric asthma. SEARCH STRATEGY: A search of the Cochrane Airways Group Specialised Register was undertaken with predefined search terms. Searches are current to May 2005. SELECTION CRITERIA: Randomised controlled trials,lasting at least four weeks comparing a xanthine with placebo, regular short-acting beta-agonist (SABA), inhaled corticosteroids (ICS), cromoglycate (SCG), ketotifen (KET) or leukotriene antagonist, in children with diagnosed with chronic asthma between 18 months and 18 years old. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected each study for inclusion in the review and extracted data. Primary outcome was percentage of symptom-free days. MAIN RESULTS: Thirty-four studies (2734 participants) of adequate quality were included. Xanthine versus placebo (17 studies): The proportion of symptom free days was larger with xanthine compared with placebo (7.97% [95% CI 3.41, 12.53]). Rescue medication usage was lower with xanthine, with no significant difference in symptom scores or hospitalisations. FEV1 , and PEF were better with xanthine. Xanthine was associated with non - specific side-effects. Data from behavioural scores were inconclusive. Xanthine versus ICS (four studies) : Exacerbations were less frequent with ICS, but no significant difference on lung function was observed. Individual studies reported significant improvements in symptom measures in favour of steroids, and one study reported a difference in growth rate in favour of xanthine. No difference was observed for study withdrawal or tremor. Xanthine was associated with more frequent headache and nausea. Xanthine versus regular SABA (10 studies): No significant difference in symptoms, rescue medication usage and spirometry. Individual studies reported improvement in PEF with beta-agonist. Beta-agonist treatment led to fewer hospitalisations and headaches. Xanthine was associated with less tremor. Xanthine versus SCG (six studies ): No significant difference in symptoms, exacerbations and rescue medication. Sodium cromoglycate was associated with fewer gastro-intestinal side-effects than xanthine. Xanthine versus KET (one study): No statistical tests of significance between xanthine and ketotifen were reported. Xanthine + ICS versus placebo + same dose ICS (three studies) : Results were conflicting due to clinical/methodological differences, and could not be aggregated. AUTHORS' CONCLUSIONS: Xanthines as first-line preventer alleviate symptoms and reduce requirement for rescue medication in children with mild to moderate asthma. When compared with ICS they were less effective in preventing exacerbations. Xanthines had similar efficacy as single preventative agent compared with regular SABA and SCG. Evidence on AEs (adverse effects) was equivocal: there was evidence for increased AEs overall, but no evidence that any specific AE (including effects on behaviour and attention) occurred more frequently than with placebo. There is insufficient evidence from available studies to make firm conclusions about the effectiveness of xanthines as add-on preventative treatment to ICS, and there are no published paediatric studies comparing xanthines with alternatives in this role. Our data suggest that xanthines are only suitable as first-line preventative asthma therapy in children when ICS are not available. They may have a role as add-on therapy in more severe asthma not controlled by ICS, but further studies are needed to examine this, and to define the risk-benefit ratio compared with other agents.

A simple comorbidity scale predicts clinical outcomes and costs in dialysis patients.

PURPOSE: In a university-based dialysis program, we found that 25% of the patients accounted for 50% of the costs and 42% of the deaths. We determined whether the Charlson Comorbidity Index, a simple measure of comorbid conditions, could predict clinical outcomes and costs in these patients. METHODS: Patients on hemodialysis or peritoneal dialysis from July 1996 to June 1998 at the University of Pittsburgh outpatient dialysis unit were studied. Comorbidity scores and outcomes were determined by reviewing the Medical Archival Retrieval System database and outpatient records. RESULTS: Two hundred sixty-eight patients were observed for 293 patient-years. The Comorbidity Index strongly predicted admission rate (relative risk per each unit increase = 1.20; 95% confidence interval [CI]: 1.16 to 1.23, P = 0.0001), hospital days and inpatient costs (both P <0.0001), and mortality (relative risk per unit increase = 1.24, 95% CI: 1.11 to 1.39, P = 0.0002.). Age and diabetes, used in the Health Care Financing Administration dialysis capitation model, correlated poorly with outcomes. CONCLUSIONS: The modified Charlson Comorbidity Index predicts outcomes and costs in dialysis patients. This index may be useful in determining appropriate payment for care of dialysis patients under capitated payment schemes and as a research tool to stratify dialysis patients in order to compare the outcomes of various interventions.

Pulmonary impedance as an index of severity and mechanisms of neonatal lung disease.

The measurement of resistive and elastic components of the respiratory system in neonates has been used to define disease severity and the response to therapy. The lung resistance (RL) and dynamic lung compliance (CLdyn) partition the impediment to gas flow into two components, each of which may be altered independently. The concept of lung impedance (ZLdyn) is the combined effect of the elastic and resistive loads presented to the respiratory muscles, which determines the gas flow that will result from the pressures generated by the respiratory muscles. In a first order system where RL and CLdyn are single values (independent of volume or respiratory rate), ZLdyn is the vector sum of the reactive [1/2 pi fb x CLdyn)] and resistive (RL) components at the infant's breathing rate (fb), if the transpulmonary pressure (Ptp) generated by the respiratory muscles during spontaneous respiration can be modeled mathematically by a sinusoidal function. Furthermore, the phase angle (theta) between the impedance and the resistive component will represent the relative magnitude of the resistive and reactive components. The validity of this model can be establishing by comparing the calculated theta to the observed temporal difference (measured theta) between the Ptp and flow derived from the polygraph tracing. This hypothesis was tested in 10 spontaneously breathing neonates with lung disease of differing etiology and severity. No significant difference was found between the measured and calculated theta values (mean difference, 1.2 +/- 3.9 degrees).(ABSTRACT TRUNCATED AT 250 WORDS)

Branhamella catarrhalis colonization in preschool asthmatics.

Branhamella catarrhalis has been associated with exacerbations of chronic bronchitis and asthma in adults. To investigate the possible role of B. catarrhalis in asthma of early childhood, we took posterior pharyngeal swabs from 24 normal children, 20 well asthmatics, and 20 acutely wheezy asthmatics, all between 1 and 4 years of age. On culture, 33% of the normal children were colonized with B. catarrhalis; colonization rates in the well asthmatics (70%) and in the wheezy asthmatics (75%) were significantly higher than in normals. The nature of this association requires further study.

Short acting beta agonists for recurrent wheeze in children under 2 years of age.

BACKGROUND: Wheeze is a common symptom in infancy and is a common cause for both primary care consultations and hospital admission. Beta2-adrenoceptor agonists (b2-agonists) are the most frequently used as bronchodilator but their efficacy is questionable. OBJECTIVES: To determine the effectiveness of b2-agonist for the treatment of infants with recurrent and persistent wheeze. SEARCH STRATEGY: Relevant trials were identified using the Cochrane Airways Group database (CENTRAL), Medline and Pubmed. The database search used the following terms: Wheeze or asthma and Infant or Child and Short acting beta-agonist or Salbutamol (variants), Albuterol, Terbutaline (variants), Orciprenaline, Fenoterol SELECTION CRITERIA: Randomised controlled trials comparing the effect of b2-agonist against placebo in children under 2 years of age who had had two or more previous episodes of wheeze, not related to another form of chronic lung disease. DATA COLLECTION AND ANALYSIS: Eight studies met the criteria for inclusion in this meta-analysis. The studies investigated patients in three settings: at home (3 studies), in hospital (2 studies) and in the pulmonary function laboratory (3 studies). The main outcome measure was change in respiratory rate except for community based studies where symptom scores were used. MAIN RESULTS: The studies were markedly heterogeneous and between study comparisons were limited. Improvement in respiratory rate, symptom score and oxygen saturation were noted in one study in the emergency department following two salbutamol nebulisers but this had no impact on hospital admission. There was a reduction in bronchial reactivity following salbutamol. There was no significant benefit from taking regular inhaled salbutamol on symptom scores recorded at home. REVIEWER'S CONCLUSIONS: There is no clear benefit of using b2-agonists in the management of recurrent wheeze in the first two years of life although there is conflicting evidence. At present, further studies should only be performed if the patient group can be clearly defined and there is a suitable outcome parameter capable of measuring a response.

Effectiveness of low dose urokinase on dialysis catheter thrombolysis.

Thrombosis, a major cause of hemodialysis catheter dysfunction, can be treated with urokinase. We compared protocols using full strength urokinase to the volume of the catheter with low dose therapy. Clotting episodes and successful declottings (blood flow > 200 ml/min) were tracked for 6 months. One hundred four clotting episodes were treated with 5,000 U/ml urokinase to the volume of the catheter lumen for a 1 hr dwell. If unsuccessful, a second dose of 5,000 U/ml was administered and, if needed, a third dose of 125,000 U/lumen. Post treatment, catheters were locked with 5,000 U/ml heparin to the volume of the lumen. Using new protocols, clotting episodes were treated with 2,500 U/lumen urokinase, followed by saline to the volume of the lumen for a 1 hr dwell. A mid dwell injection of 0.2 ml/lumen saline was added to advance the front of active urokinase. If unsuccessful, a second 2,500 U/lumen dose was administered. Heparin lock was 10,000 U/ml heparin to the volume of the lumen. Revised protocols decreased clotting episodes 60% and urokinase charges 81%, while maintaining successful declottings at 74%. Low dose urokinase was as effective as full strength when the active front was advanced mid dwell.

A potential role for free radical-mediated skeletal muscle soreness in the pathophysiology of acute mountain sickness.

BACKGROUND: It has been suggested that free radicals may be implicated in the pathophysiology of acute mountain sickness (AMS) due to their ability to initiate and propagate cell membrane damage (3). Therefore, the present study was designed to: a) investigate the effects of an expedition to high altitude on metabolic indices of free radical-mediated oxidative stress and assess subsequent implications for skeletal/cardiac muscle damage; and b) determine whether these parameters were different in subjects who developed AMS after gradual ascent to 5100 m (base camp, BC) compared with those who remained healthy. METHODS: There were 19 male volunteers who were examined at rest and after a standardized maximal exercise test at sea level before and after an expedition (SL1/SL2) and during the first morning of arrival at BC. The trek to BC lasted 20+/-5 d. RESULTS: A mild increase in the Lake Louise AMS score was observed by the end of day 1 at BC (p < 0.05 vs. SL1/SL2). Four subjects developed AMS, which in one subject later progressed to high altitude pulmonary and cerebral edema. The serum concentration of lipid hydroperoxides (LH) increased markedly at rest and after maximal exercise at BC (p < 0.05 vs. SL1/SL2) whereas no changes were observed for plasma malondialdehyde (MDA). Resting serum total phosphocreatine kinase activity (CPK) and myoglobin also increased at BC (p < 0.05 vs. SL1/SL2) whereas cardiac troponin I (cTnI) remained stable. The resting pain threshold decreased and exercise-induced muscle soreness subsequently increased at BC (p < 0.05 vs. SL1/SL2). An association was observed between resting LH and myoglobin at BC (r = 0.45, p < 0.05) and the increase in LH was related to the increase in exercise-induced muscle soreness at BC (r = 0.96, p < 0.05). Further correlations were identified between the AMS score on day 1 at BC and: a) resting/exercise LH (r = 0.63, p < 0.05/r = 0.51, p < 0.05); and b) resting pain threshold at BC (r = -0.58, p < 0.05). Furthermore, subjects with AMS on day 1 at BC were characterized by a greater decrease in the resting pain threshold and greater increase in resting LH, CPK and myoglobin compared with subjects without AMS (p < 0.05). Headache, fatigue, insomnia and general apathy were the most frequently reported symptoms of AMS. CONCLUSIONS: Localized free radical-mediated vascular damage of the blood-brain barrier in addition to systemic tissue damage causing overt skeletal muscle soreness may have contributed to the pathophysiology of AMS, the latter through its indirect effects on other non-specific constitutional symptoms such as fatigue and insomnia causing a deterioration in physical performance.

Diagnosis of cystic fibrosis in London and South East England before and after the introduction of newborn screening.

INTRODUCTION: Newborn screening (NBS) for cystic fibrosis (CF) was introduced to London and South East England in 2007. We wished to assess the details of missed cases, and to compare the age at diagnosis and other clinical parameters, prescreening and postscreening. METHODS: Retrospective and prospective case notes and database review of all newly diagnosed CF patients in our 7 CF centres, for 18 months before and 4 years after NBS started. RESULTS: 347 patients were diagnosed with CF. 126 patients were not screened (born before or abroad), and had a median age at diagnosis of 2.4 years, excluding those with meconium ileus (MI). Their median time to diagnosis from initial symptoms was 1 year, and in 10% it was >6 years. After NBS started, 170 were diagnosed by NBS (48% were already symptomatic); 7 moved into the region after NBS elsewhere; 34 presented with MI (6 were negative on NBS); and 10 screened children were missed (false negative cases). Median age of diagnosis was 3 weeks. Prevalence was 1 in 3991 live births. By 2 years of age (with data on 104 patients), 49 children (47%) had their first isolation of Pseudomonas aeruginosa, while 37 (36%) had their first growth of Staphylococcus aureus from respiratory cultures. CONCLUSIONS: NBS has significantly reduced the age of diagnosis, although many were symptomatic even at 3 weeks of age. A small number of patients with CF can still be missed by the screening programme, and the diagnosis should be considered even with a negative screen result.

A fat lot of good: balance and trends in fat intake in children with cystic fibrosis.

BACKGROUND: The fundamental nutritional treatment of a high fat diet for cystic fibrosis (CF) is established and essentially unchanged in the last 25 years. However, recent concerns have emerged regarding the potential risks of such a diet. We investigated the diets of children with CF to determine the source of energy, energy imbalance, and changing trends of fat intake. METHOD: In a prospective longitudinal study over 8 years at a single paediatric CF clinic three-day food diaries that included supplementary nutrition (SN) either as enteral feeds or oral nutritional supplements (ONS), were analysed annually. Influence of year on percent energy by type (fat, carbohydrate and protein) and on fat component: saturated (SFA); monounsaturated (MUFA) and polyunsaturated fatty acids (PUFA) was examined. RESULTS: 136 food diaries were analysed in 27 children (age range 1-18 years). 51 (37%) food diaries included SN (enteral feeds n=15 and ONS n=36). Mean energy intake was 1726 Kcals (oral diet alone) and 2245 Kcals (including SN). Percent energy from macronutrients did not change significantly over time (protein p=0.06; carbohydrate p=0.44; fat p=0.07) and remained within recommended levels. Mean caloric contribution from fat was 38.7% from oral diet alone and 37.8% including SN. Percent energy derived from SFA remained statistically unchanged (SFA p=0.57) but fell from MUFA (p=0.05) and PUFA (p=0.004). Mean SFA consistently contributed >134% (mean 158%) of reference nutrient intake and mean PUFA intake <100% (92%). CONCLUSION: Macronutrient intakes did not change significantly in our population of CF children, but there was a consistent imbalance of fat-sources with over-dependence on saturated fats which, in the context of increased survival in CF may potentially increase risk of cardiovascular disease. Further studies are needed to confirm our findings, investigate consequences of fat imbalance and guide clearer advice regarding appropriate proportions of sources of fat for CF patients.

Measuring tidal breathing parameters using a volumetric vest in neonates with and without lung disease.

Lung function measurement is difficult in unsedated infants; tidal breathing parameters are a useful non-invasive surrogate, but even these measurements cause disturbance from applying a facemask. We investigated a novel volumetric vest system (FloRight), which measures volume changes of the respiratory system from changes in the magnetic fields induced by current-carrying coils around the entire chest and abdomen. Using a facemask and ultrasonic flowmeter as comparator, we assessed the validity and repeatability of tidal breathing parameters measured by FloRight in 10 healthy newborn infants during natural sleep. We also assessed the effect of a facemask on tidal volume and tidal expiratory flow parameters. To assess the ability of the FloRight system to detect disease, we compared the healthy infants with 11 infants suffering from bronchopulmonary dysplasia. Tidal parameters with the FloRight vest corresponded closely with facemask measurements. Mean difference, mask minus vest, for tidal volume was 0.096 ml (P < 0.05), with limits of agreement +4.5 to -4.3 ml. Coefficient of repeatability was similar for mask and vest measurements. Tidal volume measured by FloRight with mask in place (20.6 ml) was significantly higher than without mask (16.1 ml), but tidal expiratory flow parameters were not altered. FloRight measurements of tidal parameters were markedly different between the two groups of infants, with tidal volume per Kg significantly higher and tidal expiratory flow parameters significantly lower. Our findings suggest that the FloRight system is able to measure tidal breathing parameters accurately, in healthy newborn infants, without prior calibration on the infant. It appears to have at least sufficient sensitivity to detect severe respiratory disease.

Extracting respiratory data from pulse oximeter plethysmogram traces in newborn infants.

To investigate whether valid respiratory data can be extracted from the pulse oximeter plethysmographic (pleth) trace in healthy newborn infants, pleth data were collected from the foot, and respiratory airflow was simultaneously measured using a facemask. The pleth waveform was analysed using fast Fourier transform (FFT), low-pass filtering (LPF), and by plotting the peak-to-peak amplitude variation (PtP). Using FFT in 14 term infants, the median (range) respiratory rate from the pleth signal was 43 (30-65) breaths/min, and from the flow signal it was 44 (30-67) breaths/min (median difference 0.01 breaths/min, p>0.05). Both LPF and PtP analysis yielded waveforms with a frequency similar to the respiratory rate. Respiratory information, including respiratory rate and a respiratory-like waveform, can reliably be extracted from the pleth trace of a standard pulse oximeter in newborn infants. Such analysis may be clinically useful for non-invasive assessment of respiratory problems in infants and young children.

Measurement and repeatability of interrupter resistance in unsedated newborn infants.

Interrupter resistance (R(int)) is a useful measure of airway caliber in young children, but has not been well characterized in infants-in whom there are concerns about the accurate measurement of driving pressure. This study aimed to assess the feasibility and repeatability of measuring R(int) in unsedated newborn infants, and to explore alternative algorithms for calculating driving pressure. R(int) measurement was attempted in 28 healthy term newborn infants during natural sleep using the MicroRint device. Paired R(int) measurements were achieved in 24 infants, but after screening of waveforms only 15 infants had at least 5 technically acceptable waveforms on both measurements. R(int) values obtained were comparable with reported values for airflow resistance in newborns using other methods. However, the repeatability coefficient (CR) was much higher than reported values in preschool children using standard back-extrapolation algorithms, with CR 2.47 KPa L(-1) sec (unscreened) and 2.93 KPa L(-1) sec (screened). Other algorithms gave only marginally better repeatability, with all CR values over 50% of the mean R(int) value. Using current commercially available equipment, R(int) is too poorly repeatable to be a reliable measurement of airflow resistance in newborn infants. Lower deadspace equipment is needed, but anatomical and physiological factors in the infant are also important.

Isolation and characterization of microsatellite loci from the yellow-eyed penguin (Megadyptes antipodes).

Twelve microsatellite loci were isolated and characterized in the endangered yellow-eyed penguin (Megadyptes antipodes) using enriched genomic libraries. Polymorphic loci revealed two to eight alleles per locus and observed heterozygosity ranged from 0.21 to 0.77. These loci will be suitable for assessing current and historical patterns of genetic variability in yellow-eyed penguins.

Early nebulized budesonide in the treatment of bronchiolitis and the prevention of postbronchiolitic wheezing.

OBJECTIVE: To determine the effectiveness of nebulized budesonide in the treatment of acute bronchiolitis and in the prevention of postbronchiolitic wheezing. STUDY DESIGN: A randomized, double-blind, placebo-controlled trial was performed. PATIENTS: Forty infants with bronchiolitis (83% RSV), mean age 13.5 weeks (range 4 to 41 weeks), were admitted to the Royal Alexandra Children's Hospital, Brighton, UK. METHODS: Twenty-one infants received nebulized budesonide 1 mg every 12 hours for 5 days, then 500 micrograms every 12 hours continuing to a total of 6 weeks. Nineteen received nebulized placebo (0.9% saline) for 6 weeks. A clinical scoring system was used to rate acute symptoms, and diary cards were used to assess persistent respiratory symptoms over a 6-month follow-up period. RESULTS: No significant differences were found between the budesonide and placebo groups in change in clinical score 48 hours after trial entry, mean oxygen requirements, or length of hospital stay during the acute illness. At 6-month follow-up, the two groups did not differ significantly in prevalence of wheeze, respiratory symptom scores, or proportion requiring bronchodilators or steroids. CONCLUSION: This study did not demonstrate that a 6-week course of nebulized budesonide reduced the symptoms of acute bronchiolitis or prevented postbronchiolitic wheezing.

Adolescent diabetic amyotrophy.

A 16-year-old boy with insulin-dependent diabetes mellitus since age five years was admitted with severe ketoacidosis, and suffered a cardiorespiratory arrest from which he made a full recovery. He subsequently developed the typical clinical picture of diabetic amyotrophy with painful asymmetrical weakness and wasting of proximal lower limb muscles. Cerebrospinal fluid protein was elevated, and electromyography showed typical changes. Diabetic amyotrophy has not previously been reported in this age group.