Major conservation policy issues for biodiversity in Oceania.

Oceania is a diverse region encompassing Australia, Melanesia, Micronesia, New Zealand, and Polynesia, and it contains six of the world's 39 hotspots of diversity. It has a poor record for extinctions, particularly for birds on islands and mammals. Major causes include habitat loss and degradation, invasive species, and overexploitation. We identified six major threatening processes (habitat loss and degradation, invasive species, climate change, overexploitation, pollution, and disease) based on a comprehensive review of the literature and for each developed a set of conservation policies. Many policies reflect the urgent need to deal with the effects of burgeoning human populations (expected to increase significantly in the region) on biodiversity. There is considerable difference in resources for conservation, including people and available scientific information, which are heavily biased toward more developed countries in Oceania. Most scientific publications analyzed for four threats (habitat loss, invasive species, overexploitation, and pollution) are from developed countries: 88.6% of Web of Science publications were from Australia (53.7%), New Zealand (24.3%), and Hawaiian Islands (10.5%). Many island states have limited resources or expertise. Even countries that do (e.g., Australia, New Zealand) have ongoing and emerging significant challenges, particularly with the interactive effects of climate change. Oceania will require the implementation of effective policies for conservation if the region's poor record on extinctions is not to continue.

Comparison of closed chamber and open chamber evaporimetry.

BACKGROUND: Recently it has been asserted that a closed chamber evaporimeter, the VapoMeter, offers advantages over standard open chamber devices in measuring transepidermal water loss (TEWL). Purported improvements include the ability to take measurements at any angle, short reading times and insensitivity to external air currents. These claims are compelling, considering that measuring TEWL at diverse skin sites can be tedious, especially with children. The primary aim of this study was to compare the performance of closed and open chamber instruments when they were held at various angles and, secondly to evaluate the ability of the devices to discriminate between test conditions. METHODS: The performance of closed chamber (VapoMeter) and open chamber (DermaLab) evaporimeters were compared by measuring water vapor emitted from IMS Vitro-skin that had been hydrated to a predetermined level. Measurements were taken at three angles from vertical - 0 degrees, 45 degrees, and 90 degrees. Vitro-skin samples were weighed periodically throughout the experimental phase to verify water loss rates. RESULTS: Both the VapoMeter and the DermaLab yielded significantly lower water loss values when held at angles that varied from the vertical (0 degrees) position, indicating that the closed chamber device is no more capable of accurately measuring TEWL at any angle than an open chamber instrument. The DermaLab provided better discrimination than the VapoMeter when the instruments were held vertically, as is the only prescribed testing position for open-chamber instruments. The VapoMeter was easier to use than the DermaLab; however, there was evidence that the sealed chamber could become saturated under high water loss conditions. CONCLUSIONS: Previous assertions that the VapoMeter closed chamber evaporimeter is capable of measuring TEWL regardless of angle were not validated. Each device appeared capable of accurately estimating water loss rates only in the vertical position. Although the VapoMeter was easier to use than the open chamber device, its tendency to become saturated under high water loss conditions could be a disadvantage when assessing dynamic TEWL.

Maternal depression and anxiety effects on the human fetus: Preliminary findings and clinical implications.

Newborns of depressed and anxious mothers show biobehavioral abnormalities suggesting that maternal psychological distress has negative effects on the fetus. Two studies examined the fetuses of depressed and nondepressed mothers: (a) a cross-sectional investigation of fetal activity during the second and third trimesters and (b) an examination of behavioral and heart rate response to vibratory stimulation in late-gestation fetuses. Fetuses of depressed mothers were more active during the fifth, sixth, and seventh gestational months. Assessment of late-term fetuses consisted of a baseline, trials of vibratory stimulation directed towards measuring habituation, and a poststimulation period. During baseline, the fetuses of depressed mothers exhibited a lower heart rate. During stimulation trials, they showed less total movement and appeared to habituate more often. Approximately 35% of the variance in fetal behavior was accounted for by the mothers' depression and anxiety symptoms. Maternal depression may be linked to greater fetal activity during the second and third trimesters and decreased behavioral responsivity during late gestation. The response of late-term fetuses of depressed mothers to vibratory stimulation may reflect "receptor adaptation/effector fatigue" and not true habitation. Future studies should examine the value of clinical interventions provided to the pregnant mother.

Effects of sheep digoxin-specific antibodies and their Fab fragments on digoxin pharmacokinetics in dogs.

Intact sheep antidigoxin antibodies and their Fab fragments have both been found to exert profound effects on digoxin pharmacokinetics in [3H] digoxin-treated dogs. Both classes of molecule remove digoxin from the extravascular space and sequester it in the circulation in protein-bound form, a form in which the digoxin is presumably inactive. These two classes of molecule differ, however, in that the intact antibody molecules interfere with digoxin excretion, thereby promoting the retention of the glycoside; this retained digoxin is eventually released in free, active form when the administered antibody is metabolically degraded. In contrast, urinary excretion of digoxin continues in Fab-treated dogs, with significant quantities of digoxin being excreted promptly in the urine in complex with Fab fragments. These differences in urinary excretion, together with the probable decreased immunogenicity of sheep antidigoxin Fab fragments, suggest that such fragments possess potential advantages over intact antibody molecules for use in the therapy of life-threatening digoxin intoxication in man.

Umbilical cord blood screening for cytomegalovirus DNA by quantitative PCR.

BACKGROUND: Cytomegalovirus (CMV) infection, which is the most common congenitally transmitted infection, affects approximately 1% of neonates worldwide. Despite its prevalence, no convenient screening test for neonatal CMV infection has been implemented. OBJECTIVE: The purpose of this pilot study was to evaluate the feasibility and yield of screening umbilical cord blood for CMV DNA emiaby quantitative PCR. STUDY DESIGN: Umbilical cord blood was tested for CMV DNAemia using a commercial quantitative PCR assay. Maternal CMV serostatus at the time of delivery was assessed by testing for CMV IgG and IgM antibodies in serum. CONCLUSIONS: Screening for congenital CMV infection with PCR is easily incorporated into routine labor and delivery care using discarded cord blood specimens to identify neonates whose infection is otherwise undiagnosed. Among 433 infants tested, two (0.5%) had DNAemia detected in cord blood, one of whom was symptomatic, and both of whose mothers were CMV IgG positive and IgM negative. Viremic neonates identified by screening with PCR may be at high risk of developing long-term neurological complications of CMV infection and cannot reliably be identified using clinical presentation or maternal serology. Because of its convenience, cord blood CMV screening with PCR should be further investigated for incorporation into neonatal screening protocols.

Prenatal diagnosis of fetal disseminated intravascular coagulation associated with umbilical cord arteriovenous malformation.

BACKGROUND: Congenital disseminated intravascular coagulation (DIC) has been reported in a variety of clinical settings, but to our knowledge, it has never been documented before birth. We describe prenatal identification of an umbilical cord vascular tumor and echogenic foci in the fetal liver leading to the diagnosis of fetal DIC by funipuncture. CASE: A large vascular tumor of the umbilical cord was identified using prenatal sonography. At 31 weeks' gestation, echogenic areas, which were thought to represent infarcts or thrombi, were seen in the liver. When funipuncture revealed florid fetal DIC, delivery was accomplished by cesarean to prevent intracranial bleeding. Pathologic examination of the umbilical cord tumor showed it to be a large arteriovenous malformation. CONCLUSION: Arteriovenous malformations may cause fetal coagulopathy. This case illustrates that funipuncture may be used to diagnose this condition and that timely cesarean delivery may contribute to a favorable outcome.

Cytomegalovirus infection in pregnancy.

CMV is the most common cause of intrauterine infection in this country, affecting approximately 1% of newborns. As such, CMV infection is a leading cause of deafness and an important contributor to learning disabilities. The virus is transmitted through close contact with infected secretions as well as transplacentally, through sexual contact, and through blood transfusion and organ transplantation. CMV has a high prevalence in the population; antibody to the virus can be detected in 50% to 85% of individuals. Like herpes simplex, the virus can be reactivated and cause recurrent infection. Congenital disease occurs in about 30% to 40% of women with primary infection. Ten percent of infants with congenital infection will have clinical disease at birth. Of these, as many as 30% die. Ninety percent of survivors have sequelae such has deafness, mental retardation, chorioretinitis, and motor deficits. The other 90% of infants with congenital infection are asymptomatic at birth, but 5% to 17% develop long-term sequelae. Congenital disease also occurs with recurrent maternal infection in about 0.2% to 1% of immune women. Congenital infection due to recurrent disease is far less severe, and less than 10% of affected infants have long-term sequelae (Fig 3). The diagnosis of congenital infection can be established using a combination of ultrasound, amniocentesis, and cordocentesis. Viral culture of neonatal urine can confirm the diagnosis after birth. Routine screening of the pregnant population is not currently recommended because present laboratory methods limit the ability to differentiate primary from recurrent infection. Preventive efforts at this time must focus on good hygiene, limited intimate contact with infected children, and responsible sexual practices.

Maternal serum vascular cell adhesion molecule concentration during pregnancy.

OBJECTIVE: Vascular cell adhesion molecule (VCAM-1), a transmembrane glycoprotein known primarily as a mediator of white blood cell adhesion and extravasation from the intravascular space, is synthesized by vascular endothelial cells, macrophages, epithelial cells, and placental trophoblasts. Vascular cell adhesion molecule has also been identified as an angiogenic agent, and it appears to play an important role in early placental development. The expression of VCAM-1 is stimulated by cytokines, such as tumor necrosis factor, interleukin-1, and interferon gamma, as well as by oxidatively modified lipoproteins. Our objective was to determine the concentration of soluble VCAM-1 normally present throughout gestation. METHODS: Maternal serum soluble VCAM-1 concentrations were measured by enzyme-linked immunosorbent assay in healthy pregnant women. RESULTS: In 78 patients, soluble VCAM concentrations ranged from 128.02 to 728.6 ng/mL between 5 and 39 weeks of gestation. Maternal soluble VCAM concentrations showed a negative correlation with gestational age. The mean concentration (+/-standard deviation) was significantly higher before 20 weeks (406.76 +/- 134.41 ng/mL) than at or after 20 weeks (346.04 +/- 111.20 ng/mL). CONCLUSION: These findings are consistent with the hypothesis that VCAM-1 may play an important role in the normal process of placentation during early pregnancy.

Triggered electromyographic threshold for accuracy of thoracic pedicle screw placement in a porcine model.

STUDY DESIGN: A porcine model of thoracic pedicle screw insertion was used to determine the effect of screw position on triggered electromyographic response. OBJECTIVE: To develop a model of intraoperative detection of misplaced thoracic pedicle screws. SUMMARY OF BACKGROUND DATA: Triggered electromyographic stimulation has been a valuable aid in determining appropriate placement of lumbar pedicle screws. The use of pedicle screws is increasing in the thoracic spine. Misplaced thoracic pedicle screws may have significant implications if the spinal cord is injured. This study was an attempt to determine whether the established lumbar model can be used for thoracic pedicle screws. METHODS: Five 120- to 150-lb domestic pigs had 85 pedicle screws placed bilaterally in the thoracic spine at each level from T6 to T15. Screws were inserted entirely in the pedicle (Group A). After removal of the medial pedicle wall, the screws were reinserted in the pedicle with no neural contact (Group B). The screws were then placed with purposeful contact with the neural elements (Group C). The screws were stimulated, eliciting an electromyographic response in the intercostal muscles for each instrumented level. The type of response noted was classified as either primary (response from appropriate nerve root), secondary (response at different root) or no response (response at different root, no response at appropriate root). RESULTS: Two hundred fifty responses were recorded. A primary response was noted in 72% of recordings. There was a relatively consistent decrease in the triggered electromyographic response from Group A (mean 4.15 +/- 1.80 mA) to Group C (mean 3.02 +/- 2.53 mA) screws (P = 0.0003). There was little difference in the response obtained from Group A to Group B (mean 4.37 +/- 2.48 mA) screws (P > 0.05). When a primary response was recorded, the mean threshold electromyographic response recorded was significantly lower than recordings with secondary and no response recordings (P < 0.05). CONCLUSION: Even though there was a consistent decrease between the A and C screws that was more definitively separated when a primary response was elicited, it was not possible to determine a cutoff trigger electromyographic level that would consistently differentiate intraosseous from epidural pedicle screw placement. Furthermore, this method could not differentiate screws clearly in the pedicle from screws with medial pedicle wall breakthrough. A more direct method of spinal cord monitoring must be established to provide the surgeon with early warning of the potential of neural injury in the placement of thoracic pedicle screws.

Preeclampsia and Chlamydia pneumoniae: is there a link?

Several parallels exist between preeclampsia and atherosclerosis. Both are multifactorial diseases that share risk factors such as obesity, insulin resistance, lipid abnormalities, and elevated serum homocysteine. There are also similarities in the biochemical changes seen in both diseases, including elevated serum triglycerides, decreased HDL cholesterol and enhanced formation of small, dense LDL particles as well as vascular atherosclerotic lesions. Chronic infection with Chlamydia pneumoniae has been linked to coronary artery disease. This study evaluated a possible link between the incidence of preeclampsia and infection with C. pneumoniae by examining the rate of seropositivity in 81 women with preeclampsia, and 206 women with normal pregnancies. Although our data confirmed well-known risk factors for preeclampsia such as obesity, diabetes, and hypertension, we found no difference in the rate of seropositivity between preeclampsia and normal pregnancy. On the contrary, the presence of chlamydial antibodies was lower in preeclampsia. Multiparous women with preeclampsia showed a significantly lower rate of seropositivity than multiparous normal women and nulliparous preeclamptics. In addition, women with a history of preeclampsia who developed preeclampsia in the current pregnancy also had a significantly lower rate of seropositivity.

Interpregnancy primary care and social support for African-American women at risk for recurrent very-low-birthweight delivery: a pilot evaluation.

OBJECTIVES: Very-low-birthweight (VLBW) delivery accounts for the majority of neonatal mortality and the black-white disparity in infant mortality. The risk of recurrent VLBW is highest for African-Americans of lower socioeconomic status. This study explores whether the provision of primary health care and social support following a VLBW delivery improves subsequent child spacing and pregnancy outcomes for low-income, African-American women. METHODS: This pilot study of mixed prospective-retrospective cohort design enrolled African-American women who qualified for indigent care and delivered a VLBW infant at a public hospital in Atlanta from November 2003 through March 2004 into the intervention cohort (n (1) = 29). The intervention consisted of coordinated primary health care and social support for 24 months following the VLBW delivery. A retrospective cohort was assembled from consecutive women meeting the same eligibility criteria who delivered a VLBW infant during July 2001 through June 2002 (n (2) = 58). The number of pregnancies conceived within 18 months of the index VLBW delivery and the number of adverse pregnancy outcomes for each cohort was compared with Poisson regression. RESULTS: Women in the control cohort had, on average, 2.6 (95% CI: 1.1-5.8) times as many pregnancies within 18 months of the index VLBW delivery and 3.5 (95% CI: 1.0-11.7) times as many adverse pregnancy outcomes as women in the intervention cohort. CONCLUSIONS: This small, pilot study suggests that primary health care and social support for low-income, African-American women following a VLBW delivery may enhance achievement of a subsequent 18-month interpregnancy interval and reduce adverse pregnancy outcomes.

The experience with vaginal birth after cesarean delivery in a small rural community practice.

OBJECTIVE: The purpose of this study was to determine if the success and safety of vaginal birth after cesarean delivery in a small, isolated, rural hospital compare with those seen in larger centers. STUDY DESIGN: As part of a continuing study, the prenatal and hospital records of all patients with previous cesarean delivered by the Rural Health Group between October 1988 and January 1991 were reviewed. Patients were allowed a trial of labor with one or more previous cesarean sections, unknown scar, and breech presentation but not for other malpresentation or a vertical scar. RESULTS: A total of 67 patients were studied; 76.1% of these had a trial of labor, and 60.8% of them were delivered vaginally, whereas 39.2% underwent repeat cesarean delivery. Of the 67 patients 11.9% were not candidates for vaginal birth after cesarean delivery, and the same percentage refused. Forty-nine percent received oxytocin; of these, 56% were delivered vaginally. Overall, maternal complications were similar between the groups. Two uterine ruptures occurred; neither was associated with labor. The major maternal complications occurred in the vaginal birth after cesarean delivery group, but all were associated with antepartum conditions and not related to labor and delivery. There were no maternal deaths. The only neonatal death resulted from a congenital anomaly. CONCLUSION: We concluded that vaginal birth after cesarean delivery can be performed safely in an isolated small community hospital with success rates similar to those of larger centers and with no increased maternal or neonatal morbidity or mortality.

Obstetric outcomes associated with increase in BMI category during pregnancy.

OBJECTIVE: The purpose of this study was to investigate effect of increase in body mass index (BMI) category on obstetric outcomes. STUDY DESIGN: A cohort study was conducted from 1999 to 2002. Women with singleton pregnancies were placed in standard BMI categories. Increase in BMI was calculated as difference between initial BMI and delivery BMI. ANOVA was used to compare continuous variables, and chi-square test for categorical variables. RESULTS: This study included 5131 women: 49.8% had no change in BMI category, 43.9% increased by 1 BMI category, and 6.3% by >1 category. Increase in BMI category was associated with higher rates of gestational diabetes (P = .005), failed induction (P < .001), lacerations (P < .001), cesarean deliveries (P < .001), and postpartum infection (P = .007) in normal weight women. Overweight women also had increased rates of preeclampsia (P = .002) and operative vaginal deliveries (P < .001). Obese women had higher rates of chorioamnionitis (P = .003), failed induction (P < .001), and cesarean deliveries (P = .016). CONCLUSION: Increase in BMI category is associated with increased risk of complications.

Risk of uterine rupture in labor induction of patients with prior cesarean section: an inner city hospital experience.

OBJECTIVE: This study was undertaken to determine the risk of uterine rupture in patients induced with oxytocin or misoprostol after 1 or more previous cesarean sections. STUDY DESIGN: Patients with 1 or more previous cesarean sections who delivered after 28 weeks' gestation between 1996 and 2002 were identified by database. Among 3533 total patients, rates of uterine rupture were compared among 4 groups: oxytocin induction (n = 430), misoprostol induction (n = 142), spontaneous labor (n = 2523), and repeat cesarean section without labor (n = 438). Statistical analysis included chi(2) test, Fisher exact test, unpaired t test, and Mantel-Haenszel test. RESULTS: Rate of rupture was increased in all inductions compared with that of the spontaneous labor group. Among patients with 1 prior cesarean, rupture rates with misoprostol and oxytocin induction were 0.8% and 1.1%, respectively. CONCLUSION: Induction of labor with oxytocin or misoprostol is associated with a higher rate of uterine rupture compared with those who deliver after spontaneous labor. After 1 prior cesarean, rupture rate with misoprostol induction is not increased compared with oxytocin induction.

Misoprostol induction of labor among women with a history of cesarean delivery.

OBJECTIVE: Several reports have appeared of uterine rupture among women with a history of cesarean delivery who received misoprostol for induction of labor. A recent review suggested a uterine rupture rate of almost 6%, but the experience at our institution did not seem to reflect this high complication rate. This study was undertaken to compare complications of labor induction with misoprostol between women with a history of cesarean delivery and women without uterine scarring. STUDY DESIGN: A computerized database was used to select women with a viable fetus who underwent induction of labor with misoprostol during the period from January 1996 through December 1998. Patients were given 50 microg misoprostol every 4 hours. Women with a history of cesarean delivery were retrospectively compared with those without uterine scarring. RESULTS: A total of 425 women were given misoprostol for induction of labor: 48 had a history of cesarean delivery and 377 did not. Women with a history of cesarean delivery were more likely to be delivered abdominally (56% vs 28%; P <.04). Among women with a history of cesarean delivery, women who had a history of vaginal birth after cesarean were more likely to be delivered vaginally (92% vs 42%; P =.003). There was no difference in the overall rate of complications (2% with scarring vs 3% without scarring). There were no uterine ruptures. However, the previous cesarean group was more likely than the unscarred group to have blood loss >500 mL (38% vs 22%; P <.03). Although the incidences of fetal distress were similar, neonates born to women in the previous cesarean group were more likely to have an Apgar score <7 at 5 minutes (13% vs 5%; P <.04). CONCLUSION: Misoprostol induction of labor in women with a history of cesarean resulted in a higher rate of cesarean delivery than was seen among women without uterine scarring but was not associated with a higher incidence of complications. There were no uterine ruptures in either group.

Growth retardation in fetuses with gastroschisis.

This study was designed to determine the prevalence of intrauterine growth restriction in neonates with gastroschisis and to evaluate the accuracy of the ultrasonographic diagnosis of intrauterine growth restriction. Birth weight and gestational age were determined for 46 infants diagnosed prenatally as having gastroschisis. Biometric data were analysed for the 30 pregnancies in which an examination was conducted within 1 week of delivery. Fetal growth parameters were compared with norms for gestational age. The prevalence of intrauterine growth restriction in the entire study group was 24% with a mean birth weight of 2401 +/- 508 g. Ultrasonographic estimated fetal weight was significantly less than birth weight (mean, 2079 +/- 508 g versus 2331 +/- 512 g, respectively; P < 0.0001). Intrauterine growth restriction was predicted in 43% of infants but was present in only 23%. The percentage difference between measured abdominal circumference and gestational age norm was significantly more than for biparietal diameter and for femur length (P < 0.001). Of the three biometric measures, only the difference between measured abdominal circumference and gestational age norms and the difference between estimated fetal weight and birth weight showed a significant correlation. Both abdominal circumference and femur length correlated with the difference between estimated fetal weight and birth weight. We conclude that the prevalence of intrauterine growth restriction is increased in infants with gastroschisis but is overestimated with prenatal ultrasonography, primarily because of smaller than average abdominal circumference measurements.

Transvaginal ultrasonographic cervical measurement as a predictor of successful labor induction.

OBJECTIVE: Our purpose was to compare transvaginal cervical measurement and the Bishop score as indicators of duration of labor and successful induction of labor at term. STUDY DESIGN: This prospective observational study recruited women with singleton gestations scheduled for induction of labor at > or =37 weeks. Transvaginal ultrasonographic measurement of cervical length was performed and the Bishop score was determined, each by operators masked to the other measurement. Data were collected on parity, gestational age, mode of delivery, induction agent, induction-to-delivery interval, Bishop score, and cervical length measurement. RESULTS: A total of 77 women were analyzed. Vaginal delivery occurred in 69%. Both Bishop score and cervical length showed linear correlation with duration of labor (R(2) = 0.43, P <. 001; R(2) = 0.48, P <.001; respectively). Women with cervical length <3.0 cm had shorter labors (P <.001) and were more likely to be delivered vaginally (P <.001). Women with a Bishop score >4 also had shorter labors and were more likely to be delivered vaginally, with similar P values. A logistic regression model identified cervical length and parity as the only independent predictors of vaginal delivery. CONCLUSIONS: Both ultrasonographically measured cervical length and Bishop score predict duration of labor and likelihood of vaginal delivery. However, only cervical length and parity were independent predictors of mode of delivery.

Postoperative morbidity in the morbidly obese parturient woman: supraumbilical and low transverse abdominal approaches.

OBJECTIVE: Our purpose was to determine the differences in postoperative morbidity in obese women who had a supraumbilical or a Pfannenstiel incision at cesarean delivery. STUDY DESIGN: A case-control retrospective review was conducted of all patients who were at >150% ideal body weight when undergoing cesarean delivery between 1989 and 1995 by means of either a supraumbilical or a Pfannenstiel incision. Patients were excluded if medical records were unavailable. A total of 15 women who had a supraumbilical incision and 54 who had a low transverse incision were included in the analysis. Antenatal complications were examined, as were age, weight, and training level of the surgeon. Postoperative complications were then compared. RESULTS: The groups were similar in age and antepartum complications. However, mean weight and percentage of ideal body weight in the supraumbilical group were both higher (P <.00001 and P <.0001, respectively), with the supraumbilical group 83 lb heavier on average. No significant differences were seen in any postoperative complication. CONCLUSION: Postoperative morbidity in morbidly obese women undergoing cesarean delivery does not differ between a supraumbilical approach and the low transverse abdominal incision.