Groundwater is a hidden global keystone ecosystem.

Groundwater is a vital ecosystem of the global water cycle, hosting unique biodiversity and providing essential services to societies. Despite being the largest unfrozen freshwater resource, in a period of depletion by extraction and pollution, groundwater environments have been repeatedly overlooked in global biodiversity conservation agendas. Disregarding the importance of groundwater as an ecosystem ignores its critical role in preserving surface biomes. To foster timely global conservation of groundwater, we propose elevating the concept of keystone species into the realm of ecosystems, claiming groundwater as a keystone ecosystem that influences the integrity of many dependent ecosystems. Our global analysis shows that over half of land surface areas (52.6%) has a medium-to-high interaction with groundwater, reaching up to 74.9% when deserts and high mountains are excluded. We postulate that the intrinsic transboundary features of groundwater are critical for shifting perspectives towards more holistic approaches in aquatic ecology and beyond. Furthermore, we propose eight key themes to develop a science-policy integrated groundwater conservation agenda. Given ecosystems above and below the ground intersect at many levels, considering groundwater as an essential component of planetary health is pivotal to reduce biodiversity loss and buffer against climate change.

Anthropogenic petroleum signatures and biodegradation in subantarctic Macquarie Island soils.

Special Antarctic Blend (SAB) diesel is the main fuel used on Macquarie Island and has been identified as the primary contaminant in several past spill events. This study evaluates the environmental impact of petroleum spills at high latitudes, in the soils of subantarctic Macquarie Island. Soil samples were collected from seven locations, including the "fuel farm" and main powerhouse that have been contaminated by petroleum in the past, and five reference locations, away from station infrastructure and from any obvious signs of contamination. Soils were solvent extracted and analysed using gas chromatography-mass spectrometry. The results show that both contaminated and uncontaminated sites contained a suite of different chain-length hydrocarbons. The more contaminated samples from the fuel farm and main powerhouse contained higher concentrations and a greater range of hydrocarbons that typically indicate numerous spills of varying ages. The hydrocarbon signature of samples collected near the fuel farm and at some of the main powerhouse sites was typical of SAB diesel. However, the hydrocarbon signature at other main powerhouse sites suggest contamination with a heavier fuel with different characteristics, including lower pristane/phytane ratios. Traces of C21-C35 cyclic biomarkers in the spill sites may be derived from additional heavier fuels, and include a signature characteristic of crude oil derived from marine carbonate source rocks. Reference samples had lower concentrations of hydrocarbons, and these were dominated by high molecular weight n-alkanes with an odd-carbon-number predominance, typical of higher-plant derived lipids. Some reference samples also contained geochemical signatures that suggest that they too were contaminated by fuel oil. Variable levels of biodegradation of fuels in soils are consistent with a heterogenous site and a relatively slow rate of biodegradation. The occurrence of fresh spilled fuel overprinting biodegraded fuel from earlier spills is compelling evidence of multiple spills and complex mixing in the environment.

Anxiety, Cognitive Availability, and the Talisman Effect of Insurance.

Across four experiments (N = 1,923), this research provides converging evidence of a talisman effect of insurance-consumers who have an insurance policy feel that the covered mishap is less likely to occur. Although such an effect has previously been proposed, empirical evidence for it is limited, in part because the talisman effect has often been conflated with a related but distinct magical-thinking phenomenon, the tempting-fate effect. By disentangling these two effects, we are better able to isolate the talisman effect and show that it is a robust phenomenon in its own right. We also provide support for a mechanism underlying the talisman effect: Insurance reduces anxiety and repetitious thoughts related to the mishap; with fewer thoughts about the mishap, its cognitive availability is lower and so it seems less likely to occur.

Effects of Weight Cutting on Exercise Performance in Combat Athletes: A Meta-Analysis.

Weight cutting in combat sports is a prevalent practice whereby athletes voluntarily dehydrate themselves via various methods to induce rapid weight loss (RWL) to qualify for a lower weight category than that of their usual training body weight. The intention behind this practice is to regain the lost body mass and compete at a heavier mass than permitted by the designated weight category. The purpose of this study was to quantitatively synthesize the available evidence examining the effects of weight cutting on exercise performance in combat-sport athletes. Following a systematic search of the literature, meta-analyses were performed to compare maximal strength, maximal power, anaerobic capacity, and/or repeated high-intensity-effort performance before rapid weight loss (pre-RWL), immediately following RWL (post-RWL), and 3 to 36 hours after RWL following recovery and rapid weight gain (post-RWG). Overall, exercise performance was unchanged between pre-RWL and post-RWG (g = 0.22; 95% CI, -0.18 to 0.62). Between pre-RWL and post-RWL analyses revealed small reductions in maximal strength and repeated high-intensity-effort performance (g = -0.29; 95% CI, -0.54 to -0.03 and g = -0.37; 95% CI, -0.59 to -0.16, respectively; both P ≤ .03). Qualitative analysis indicates that maximal strength and power remained comparable between post-RWL and post-RWG. These data suggest that weight cutting in combat-sport athletes does not alter short-duration, repeated high-intensity-effort performance; however, there is evidence to suggest that select exercise performance outcomes may decline as a product of RWL. It remains unclear whether these are restored by RWG.

Enhancing rhizoremediation of petroleum hydrocarbons through bioaugmentation with a plant growth-promoting bacterial consortium.

The slow rate of natural attenuation of organic pollutants, together with unwanted environmental impacts of traditional remediation strategies, has necessitated the exploration of plant-microbe systems for enhanced bioremediation applications. The identification of microorganisms capable of promoting rhizoremediation through both plant growth-promoting and hydrocarbon-degrading processes is crucial to the success and adoption of plant-based remediation techniques. In this study, through successive enrichments of soil samples from a historic oil-contaminated site in Wietze, Germany, we isolated a plant growth-promoting and hydrocarbon-degrading bacterial consortium dominated by Alphaproteobacteria. In microcosm experiments involving Medicago sativa L. and the isolated bacterial consortium, we examined the ability of the consortium to enhance rhizoremediation of petroleum hydrocarbons. The inoculation of M. sativa with the consortium resulted in 66% increase in plant biomass, and achieved a 91% reduction in diesel fuel hydrocarbon concentrations in the soil within 60 days. Metagenome analysis led to the identification of genes and taxa putatively involved in these processes. The majority of the coding DNA sequences associated with plant growth promotion and hydrocarbon degradation in this study were affiliated to Acidocella aminolytica and Acidobacterium capsulatum indicating their potential for biotechnological applications in the rhizoremediation of sites contaminated by petroleum-derived organic pollutants.

Weight-Cutting Implications for Competition Outcomes in Mixed Martial Arts Cage Fighting.

ABSTRACT: Brechney, GC, Chia, E, and Moreland, AT. Weight-cutting implications for competition outcomes in mixed martial arts cage fighting. J Strength Cond Res 35(12): 3420-3424, 2021-Weight cutting is common among amateur and professional mixed martial arts (MMA) competitors because of the belief that it provides an advantage in combat sports. This study aimed to identify whether fight outcome (win vs. loss vs. type of loss) was influenced by magnitudes of body mass (BM) lost through weight cutting and BM regained before the fight after official weigh-in in amateur and professional MMA athletes with previous weight-cutting experience. Body mass data were collected using self-report from 75 MMA athletes (59 amateur and 16 professional) before commencing weight-cutting practices 7 days before weigh-in, by the regulating body at their official weigh-in 24 hours before the fight and through direct measurement immediately before competition. Data were analyzed according to win; loss by technical knockout or knockout (KO); loss by submission; or loss by the judge's decision. Athletes who lost their fight cut significantly more BM (10.6%) compared with athletes who won (8.6%) (p = 0.04, d = 0.48, 95% confidence interval [CI] = 0.02-0.93), but there were no differences between types of loss. There were no significant differences in recovered BM between athletes who won (6.8%) vs. lost (7.4%), or type of loss. Furthermore, there was a significant relationship between greater magnitudes of BM cut and greater likelihood of losing the fight (B = -0.12, P = 0.048), odd ratio 0.89 (95% CI: 0.79-1.00). This study provides the first line of evidence that excessive weight cutting may be detrimental to fight outcome in MMA.

Virtual discovery of melatonin receptor ligands to modulate circadian rhythms.

The neuromodulator melatonin synchronizes circadian rhythms and related physiological functions through the actions of two G-protein-coupled receptors: MT1 and MT2. Circadian release of melatonin at night from the pineal gland activates melatonin receptors in the suprachiasmatic nucleus of the hypothalamus, synchronizing the physiology and behaviour of animals to the light-dark cycle1-4. The two receptors are established drug targets for aligning circadian phase to this cycle in disorders of sleep5,6 and depression1-4,7-9. Despite their importance, few in vivo active MT1-selective ligands have been reported2,8,10-12, hampering both the understanding of circadian biology and the development of targeted therapeutics. Here we docked more than 150 million virtual molecules to an MT1 crystal structure, prioritizing structural fit and chemical novelty. Of these compounds, 38 high-ranking molecules were synthesized and tested, revealing ligands with potencies ranging from 470 picomolar to 6 micromolar. Structure-based optimization led to two selective MT1 inverse agonists-which were topologically unrelated to previously explored chemotypes-that acted as inverse agonists in a mouse model of circadian re-entrainment. Notably, we found that these MT1-selective inverse agonists advanced the phase of the mouse circadian clock by 1.3-1.5 h when given at subjective dusk, an agonist-like effect that was eliminated in MT1- but not in MT2-knockout mice. This study illustrates the opportunities for modulating melatonin receptor biology through MT1-selective ligands and for the discovery of previously undescribed, in vivo active chemotypes from structure-based screens of diverse, ultralarge libraries.

STARx Hottpad for smoldering treatment of waste oil sludge: Proof of concept and sensitivity to key design parameters.

Growing stockpiles of waste oil sludge (WOS) are an outstanding problem worldwide. Self-sustaining Treatment for Active Remediation applied ex situ (STARx) is a treatment technology based on smoldering combustion. Pilot-scale experiments for the STARx Hottpad prove this new concept for the mobile treatment of WOS mixed intentionally with sand or contaminated soil. The experiments also allowed for the calibration and validation of a smoldering propagation numerical model. The model was used to systematically explore the sensitivity of Hottpad performance to system design, operational parameters, and environmental factors. Pilot-scale (~1.5 m width) simulations investigated sensitivity to injected air flux, WOS saturation, heterogeneity of intrinsic permeability, and heterogeneity of WOS saturation. Results reveal that Hottpad design is predicted to be successful for WOS treatment across a wide range of scenarios. The operator can control the rate of WOS destruction and extent of treatment by increasing the air flux injected into the bed. The potential for smoldering channeling to develop was demonstrated for the first time. Under certain conditions, such as WOS saturations of 80%, high heterogeneity of WOS saturations, or moderate to high heterogeneity of soil permeability, smoldering channeling was predicted to accelerate to the point that remedial performance was degraded. Field-scale simulations (~10 m width) predicted successful treatment, with WOS destruction rates an order of magnitude higher than the pilot-scale and treatment times increasing only linearly with bed height. This work is a key step toward the design and effective operation of field STARx Hottpad systems for eliminating WOS.

Insights from the Genomes of Microbes Thriving in Uranium-Enriched Sediments.

Elevated uranium dose (4 g kg-1) causes a shift in billabong sediment communities that result in the enrichment of five bacterial species. These taxa include Geobacter, Geothrix and Dyella species, as well as a novel-potentially predatory-Bacteroidetes species, and a new member of class Anaerolineae (Chloroflexi). Additionally, a population of methanogenic Methanocella species was also identified. Genomic reconstruction and metabolic examination of these taxa reveal a host of divergent life strategies and putative niche partitioning. Resistance-nodulation-division heavy metal efflux (RND-HME) transporters are implicated as potential uranium tolerance strategies among the bacterial taxa. Potential interactions, uranium tolerance and ecologically relevant catabolism are presented in a conceptual model of life in this environment.

Ecosystem effects and the management of petroleum-contaminated soils on subantarctic islands.

Human activity in the Polar Regions has resulted in petroleum contamination of soils. In this context, subantarctic islands are a unique management challenge for climatic, biological and logistical reasons. In this review we identify the main abiotic factors affecting petroleum-contaminated soils in the subantarctic environment, the primary effects of such contamination on biota, and lessons learned with regards to remediation techniques in this region. The sensitivity of biota to contamination depends on organism life stage, on soil properties, and on the degree of contaminant weathering. Initial studies using species endemic to subantarctic islands suggest that for fresh diesel fuel, sensitivities may range between 103 and 20 000 mg total petroleum hydrocarbons (TPH) kg -1 soil. Diesel that has undergone a short period of weathering is generally more toxic, with sensitivities ranging between 52 and 13 000 mg TPH kg-1 soil for an earthworm and a grass respectively (based on EC20 and IC50 values). A sufficient body of data from which to develop remediation targets for existing spills in the region does not yet exist for the region, but there has been a recent increase in research attention to address this data gap. A range of remediation methods have also now been trialled, and techniques such as in-ground aeration and nutrient addition have achieved some success. Passive management techniques such as permeable reactive barriers and phytoremediation are in preliminary stages of investigation for the region and show promise, not least because they cause less collateral disturbance than other methods.

Effects of uranium concentration on microbial community structure and functional potential.

Located in the Northern Territory of Australia, Ranger uranium mine is directly adjacent to the UNESCO World Heritage listed Kakadu National Park, with rehabilitation targets needed to ensure the site can be incorporated into the park following the mine's closure in 2026. This study aimed to understand the impact of uranium concentration on microbial communities, in order to identify and describe potential breakpoints in microbial ecosystem services. This is the first study to report in situ deployment of uranium-spiked sediments along a concentration gradient (0-4000 mg U kg-1 ), with the study design maximising the advantages of both field surveys and laboratory manipulative studies. Changes to microbial communities were characterised through the use of amplicon and shotgun metagenomic next-generation sequencing. Significant changes to taxonomic and functional community assembly occurred at a concentration of 1500 mg U kg-1 sediment and above. At uranium concentrations of ≥ 1500 mg U kg-1 , genes associated with methanogenic consortia and processes increased in relative abundance, while numerous significant changes were also seen in the relative abundances of genes involved in nitrogen cycling. Such alterations in carbon and nitrogen cycling pathways suggest that taxonomic and functional changes to microbial communities may result in changes in ecosystem processes and resilience.

Predictors of vitamin D status in New Zealand preschool children.

Vitamin D deficiency has adverse health effects in young children. Our aims were to determine predictors of vitamin D status and then to use these factors to develop a practical tool to predict low 25(OH)D concentrations in preschool New Zealand children. A cross-sectional sample of 1329 children aged 2 to <5 years were enrolled from throughout New Zealand in late-winter to spring 2012. 25-Hydroxyvitamin D (25(OH)D) was measured on dried blood spot (DBS) samples collected using finger-prick sampling. Caregivers completed a questionnaire. Mean (SD) DBS 25(OH)D concentration was 52(19)nmol/L. 25(OH)D < 25 nmol/L was present in 86(7%), 25(OH)D < 50 nmol/L in 642(48%), 25(OH)D 50- < 75 nmol/L in 541(41%) and 25(OH)D > 75 nmol/L in 146(11%) of children. Factors independently associated with the risk of 25(OH)D < 25 nmol/L were female gender (OR 1.92,95%CI 1.17-3.14), other non-European ethnicities (not including Maori or Pacific) (3.51,1.89-6.50), had olive-dark skin colour (4.52,2.22-9.16), did not take vitamin D supplements (2.56,1.06-6.18), had mothers with less than secondary-school qualifications (5.00,2.44-10.21) and lived in more deprived households (1.27,1.06-1.53). Children who drank toddler milk (vitamin D fortified cow's milk formula marketed to young children) had a zero risk of 25(OH)D < 25 nmol/L. The predictive tool identified children at risk of 25(OH)D < 25 nmol/L with sensitivity 42%, specificity 97% and ROC area-under-curve 0.76(95%CI 0.67-0.86, p < 0.001). Predictors of low vitamin D status were consistent with those identified in previous studies of New Zealand children. The tool had insufficient predictive ability for use in clinical situations, and suggests a need to promote safe, inexpensive testing to determine vitamin D status in preschool children.

Vitamin D supplementation during pregnancy and infancy reduces aeroallergen sensitization: a randomized controlled trial.

BACKGROUND: Vitamin D has immune-modulating effects. We determined whether vitamin D supplementation during pregnancy and infancy prevents aeroallergen sensitization and primary care respiratory illness presentations. METHODS: A randomized, double-blind, placebo-controlled parallel-group trial. We assigned pregnant women, from 27-week gestation to birth, and then their infants, from birth to 6 months, to placebo or one of two dosages of daily oral vitamin D. Woman/infant pairs were randomized to: placebo/placebo, 1000 IU/400 IU or 2000 IU/800 IU. When the children were 18 months old, we measured serum-specific IgE antibodies and identified acute primary care visits described by the doctor to be due to a cold, otitis media, an upper respiratory infection, croup, asthma, bronchitis, bronchiolitis, a wheezy lower respiratory infection or fever and cough. RESULTS: Specific IgE was measured on 185 of 260 (71%) enrolled children. The proportion of children sensitized differed by study group for four mite antigens: Dermatophagoides farinae (Der-f1, Der-f2) and Dermatophagoides pteronyssinus (Der-p1, Der-p2). With results presented for placebo, lower dose, and higher dose vitamin D, respectively (all P < 0.05): Der-f1 (18%, 10%, 2%), Der-f2 (14%, 3%, 2%), Der-p1 (19%, 14%, 3%) and Der-p2 (12%, 2%, 3%). There were study group differences in the proportion of children with primary care visits described by the doctor as being for asthma (11%, 0%, 4%, P = 0.002), but not for the other respiratory diagnoses. CONCLUSIONS: Vitamin D supplementation during pregnancy and infancy reduces the proportion of children sensitized to mites at age 18 months. Preliminary data indicate a possible effect on primary care visits where asthma is diagnosed.

Smoldering Remediation of Coal-Tar-Contaminated Soil: Pilot Field Tests of STAR.

Self-sustaining treatment for active remediation (STAR) is an emerging, smoldering-based technology for nonaqueous-phase liquid (NAPL) remediation. This work presents the first in situ field evaluation of STAR. Pilot field tests were performed at 3.0 m (shallow test) and 7.9 m (deep test) below ground surface within distinct lithological units contaminated with coal tar at a former industrial facility. Self-sustained smoldering (i.e., after the in-well ignition heater was terminated) was demonstrated below the water table for the first time. The outward propagation of a NAPL smoldering front was mapped, and the NAPL destruction rate was quantified in real time. A total of 3700 kg of coal tar over 12 days in the shallow test and 860 kg over 11 days in the deep test was destroyed; less than 2% of total mass removed was volatilized. Self-sustaining propagation was relatively uniform radially outward in the deep test, achieving a radius of influence of 3.7 m; strong permeability contrasts and installed barriers influenced the front propagation geometry in the shallow test. Reductions in soil hydrocarbon concentrations of 99.3% and 97.3% were achieved in the shallow and deep tests, respectively. Overall, this provides the first field evaluation of STAR and demonstrates that it is effective in situ and under a variety of conditions and provides the information necessary for designing the full-scale site treatment.

Phase III randomized, placebo-controlled, double-blind study of intravenous calcium and magnesium to prevent oxaliplatin-induced sensory neurotoxicity (N08CB/Alliance).

PURPOSE: Cumulative neurotoxicity is a prominent toxicity of oxaliplatin-based therapy. Intravenous calcium and magnesium have been extensively used to reduce oxaliplatin-induced neurotoxicity. This trial was designed to definitively test whether calcium/magnesium decreases oxaliplatin-related neurotoxicity. PATIENTS AND METHODS: In all, 353 patients with colon cancer undergoing adjuvant therapy with FOLFOX (fluorouracil, leucovorin, and oxaliplatin) were randomly assigned to intravenous calcium/magnesium before and after oxaliplatin, a placebo before and after, or calcium/magnesium before and placebo after. The primary end point was cumulative neurotoxicity measured by the sensory scale of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Chemotherapy-Induced Peripheral Neuropathy 20 tool. RESULTS: There were no statistically significant neuropathy differences among the study arms as measured by the primary end point or additional measures of neuropathy, including clinician-determined measurement of the time to grade 2 neuropathy by using the National Cancer Institute Common Terminology Criteria for Adverse Events scale or an oxaliplatin-specific neuropathy scale. In addition, calcium/magnesium did not substantially decrease oxaliplatin-induced acute neuropathy. CONCLUSION: This study does not support using calcium/magnesium to protect against oxaliplatin-induced neurotoxicity.

Impact of ecosystem management on microbial community level physiological profiles of postmining forest rehabilitation.

We investigated the impacts of forest thinning, prescribed fire, and contour ripping on community level physiological profiles (CLPP) of the soil microbial population in postmining forest rehabilitation. We hypothesized that these management practices would affect CLPP via an influence on the quality and quantity of soil organic matter. The study site was an area of Jarrah (Eucalyptus marginata Donn ex Sm.) forest rehabilitation that had been mined for bauxite 12 years previously. Three replicate plots (20 x 20 m) were established in nontreated forest and in forest thinned from 3,000-8,000 stems ha(-1) to 600-800 stems ha(-1) in April (autumn) of 2003, followed either by a prescribed fire in September (spring) of 2003 or left nonburned. Soil samples were collected in August 2004 from two soil depths (0-5 cm and 5-10 cm) and from within mounds and furrows caused by postmining contour ripping. CLPP were not affected by prescribed fire, although the soil pH and organic carbon (C), total C and total nitrogen (N) contents were greater in burned compared with nonburned plots, and the coarse and fine litter mass lower. However, CLPP were affected by forest thinning, as were fine litter mass, soil C/N ratio, and soil pH, which were all higher in thinned than nonthinned plots. Furrow soil had greater coarse and fine litter mass, and inorganic phosphorous (P), organic P, organic C, total C, total N, ammonium, microbial biomass C contents, but lower soil pH and soil C/N ratio than mound soil. Soil pH, inorganic P, organic P, organic C, total C and N, ammonium, and microbial biomass C contents also decreased with depth, whereas soil C/N ratio increased. Differences in CLPP were largely (94%) associated with the relative utilization of gluconic, malic (greater in nonthinned than thinned soil and mound than furrow soil), L-tartaric, succinic, and uric acids (greater in thinned than nonthinned, mound than furrow, and 5-10 cm than 0-5 cm soil). The relative utilization of amino acids also tended to increase with increasing soil total C and organic C contents but decreased with increasing nitrate content, whereas the opposite was true for carboxylic acids. Only 45% of the variance in CLPP was explained using a multivariate multiple regression model, but soil C and N pools and litter mass were significant predictors of CLPP. Differences in soil textural components between treatments were also correlated with CLPP; likely causes of these differences are discussed. Our results suggest that 1 year after treatment, CLPP from this mined forest ecosystem are resilient to a spring prescribed fire but not forest thinning. We conclude that differences in CLPP are likely to result from complex interactions among soil properties that mediate substrate availability, microbial nutrient demand, and microbial community composition.

Estimating the unknown components of nutrient mass balances for forestry plantations in mine rehabilitation, upper Hunter Valley, New South Wales, Australia.

Commercial forestry plantations as a postmining land use in the Upper Hunter Valley of New South Wales, Australia are restricted by both the poor nutrient availability of mining substrates and low regional rainfall. An experiment was conducted to investigate whether municipal waste products and saline groundwater from coal mining operations could improve early tree growth without impacting on the environment through salt accumulation and/or nutrient enrichment and changes in groundwater quality. Potential impacts were investigated by quantifying the nutrient cycling dynamics within the plantation using an input-output mass balance approach for exchangeable calcium (Ca(2+)), exchangeable magnesium (Mg(2+)), exchangeable potassium (K(+)), exchangeable sodium (Na(+)), nitrogen (N), and phosphorus (P). Measured inputs to and outputs from the available nutrient pool in the 0-30 cm of the overburden subsystem were used to estimate the net effect of unmeasured inputs and outputs (termed "residuals"). Residual values in the mass balance of the irrigated treatments demonstrated large leaching losses of exchangeable Ca, Mg, K, and Na. Between 96% and 103% of Na applied in saline mine-water irrigation was leached below the 0-30-cm soil profile zone. The fate of these salts beyond 30 cm is unknown, but results suggest that irrigation with saline mine water had minimal impact on the substrate to 30 cm over the first 2 years since plantation establishment. Accumulations of N and P were detected for the substrate amendments, suggesting that organic amendments (particularly compost) retained the applied nutrients with very little associated losses, particularly through leaching.

Milk versus medicine for the treatment of iron deficiency anaemia in hospitalised infants.

AIMS: To compare iron fortified follow-on milk (iron follow-on), iron fortified partially modified cows' milk (iron milk), and iron medicine for the treatment of iron deficiency anaemia (IDA) in hospitalised infants. METHODS: In a randomised controlled trial, infants aged 9-23 months with IDA and who were hospitalised with an acute illness received iron follow-on (12 mg/l ferrous iron), iron milk (12.9 mg/l ferrous iron), or iron medicine (ferrous gluconate at 3 mg/kg of elemental iron once daily). All interventions were given for three months. Changes in measures of iron status three months after hospital discharge were determined. RESULTS: A total of 234 infants were randomised. Iron status was measured at follow up in 59 (70%) iron medicine, 49 (66%) iron follow-on, and 54 (70%) iron milk treated infants. There was a significant (mean, 95% CI) increase in haemoglobin (15 g/l, 13 to 16) and iron saturation (9%, 8 to 10) and decrease in ferritin (-53 microg/l, -74 to -31) in all three groups. Mean cell volume increased in iron follow-on (2 fl, 1 to 3) and iron milk (1 fl, 0.1 to 3) treated infants, but not in the iron medicine group (1 fl, -1 to 2). The proportion with IDA decreased in all three groups: iron medicine 93% to 7%, iron follow-on 83% to 8%, and iron milk 96% to 30%. Adverse effects, primarily gastrointestinal, occurred in 23% of the iron medicine, 14% of the iron follow-on, and 13% of the iron milk group. CONCLUSIONS: Iron fortified follow-on milk, iron fortified partially modified cows' milk, and iron medicine all effectively treat IDA in infancy.

Treatable forms of retinitis pigmentosa associated with systemic neurological disorders.

In this chapter; we have described the role of nutritional supplements or selective dietary restriction (or both) on the maintenance and function of the retina and nervous system in some diseases. Oral vitamin A therapy has proven to be effective in the treatment of the common forms of retinitis pigmentosa. Bassen-Kornzweig disease can be treated with vitamin A and vitamin E and, in some cases, with vitamin K. Vitamin E therapy for Friedreich-like ataxia associated with retinitis pigmentosa has been shown to be effective in the short term. Classic Refsum's disease responds to a low phytol-low phytanic acid diet. Undoubtedly, future research will bring more insight into the biochemical pathways responsible for other diseases and, it is hoped, aid in developing treatments for additional retinal degenerations associated with systemic neurological disease.

Characteristics of children with florid vitamin D deficient rickets in the Auckland region in 1998.

AIM: To describe the characteristics of children with vitamin D deficiency rickets and identify common features and predisposing factors. METHODS: A review of the clinical notes of all children less than five years of age with radiological evidence of rickets and serum 25-hydroxyvitamin D levels of less than 10 micrograms/L. Patients were identified by searching all low vitamin D levels performed at the Endocrinology laboratory at Auckland Hospital and children presenting to the Starship Childrens' Hospital with rickets in 1998. RESULTS: In 1998, there were eighteen children (ten males and eight females) with vitamin D deficient rickets. The age range was 3 to 36 months with a median of 12 months. There were twelve children of Indian ethnic origin, one Maori, one Tongan, one Western Samoan, one Ethiopian, one Moroccan and one Indonesian. All children had an elevated alkaline phosphatase level and most had very low serum 25-hydroxyvitamin D levels (< or = 5 micrograms/L), and over half were hypocalcaemic. The common presenting features were delayed walking and bowed legs, swollen wrists or ankles, hypocalcaemic seizure, incidental radiological abnormalities and failure to thrive. CONCLUSIONS: There are a significant number of children in Auckland presenting with florid clinical rickets. The majority with vitamin D deficient rickets in this survey were of Indian ethnic origin. Strategies are needed to detect children at risk of vitamin D deficiency and supplement them with vitamin D.