Facial recognition lock technology for social care settings: A qualitative evaluation of implementation of facial recognition locks at two residential care sites.

Background: There is limited literature on security and access for social care settings despite policy highlighting importance, and no published research exploring facial recognition lock technology (FRLT) for potential improvements. This study explored FRLT device implementation, use, barriers and benefits. Methods: One residential care home with 43 older adults and 68 staff members (Site A), and one supported living facility caring for six individuals with mental health issues with 18 staff members (Site B) were provided with FRLT for six months. Nine pre-implementation staff interviews explored existing access and security perceptions. Ten post-implementation staff interviews and one staff focus group were conducted; all were analysed using content analysis to understand, alongside process mapping, the use and impact of the FRLT. Interview participants included site care staff and other visiting healthcare professionals. We additionally report feedback from the technology developers to demonstrate impact of industry-academia collaboration. Results: Pre-implementation interviews highlighted issues with current pin-pad or lock-box systems, including; code sharing; code visibility, ineffective code changes, security issues following high staff turnover, lack of efficiency for visitors including NHS staff and lack of infection control suggesting requirement for innovation and improvement. Pre-implementation interviews showed openness and interest in FRLT, although initial queries were raised around cost effectiveness and staff skills. Following implementation, good levels of adoption were achieved with 72% and 100% (49/68 and 18/18) of staff members uploading their face at the two sites, and 100% of residents at Site B using the system (6/6). Additionally, Site B made a positive procurement decision and continues to discuss wider rollout. Post implementation interviews suggested FRLT was useful and acceptable for improving security and access. Benefits identified included staff/visitor time saving, enhanced security, team ease of access, resident autonomy and fewer shared touch points. Integration was suggested including with fire alarm systems, staff clocking in/out, and Covid monitoring to improve usefulness. The developers have since responded to feedback with design iterations. Conclusion: We identified concerns on security and access in social care settings, which warrant further exploration and research. FRLT could increase resident autonomy and reduce staff burden, particularly considering frequent multi-agency health and care visits.

Determining the neurocognitive profile of children with tuberous sclerosis complex within the Western Cape region of South Africa.

BACKGROUND: Tuberous sclerosis complex (TSC) is a multisystem genetic disorder associated with a wide spectrum of cognitive impairments that can often result in impaired academic, social and adaptive functioning. However, studies investigating TSC have found it difficult to determine whether TSC is associated with a distinct cognitive phenotype and more specifically which aspects of functioning are impaired. Furthermore, children with TSC living in low-income and middle-income countries, like South Africa, experience additional burdens due to low socio-economic status, high mortality rates and poor access to health care and education. Hence, the clinical population of South Africa may vary considerably from those populations from high-income countries discussed in the literature. METHODS: A comprehensive neuropsychological battery composed of internationally recognised measures examining attention, working memory, language comprehension, learning and memory, areas of executive function and general intellectual functioning was administered to 17 children clinically diagnosed with TSC. RESULTS: The exploration of descriptive data indicated generalised cognitive difficulties in most cognitive domains, aside from memory. With only two participants performing in the average to above-average ranges, the rest of the sample showed poor verbal comprehension, perceptual reasoning, working memory, processing speed, disinhibition, and problems with spatial planning, problem solving, frustration tolerance, set shifting and maintaining a set of rules. Furthermore, correlational findings indicated several associations between socio-demographic and cognitive variables. CONCLUSIONS: Importantly, this is the first study to comprehensively examine multiple domains of neurocognitive functioning in a low-resource setting sample of children with TSC. Current study findings showed that children with TSC have generalised impairments across several cognitive domains, rather than domain-specific impairments. Therefore, although examining individual aspects of cognition, such as those found in previous literature, is important, this approach is limiting. With a comprehensive assessment, including understanding the associations between domains, appropriate and directed support can be provided to ensure all aspects of development are addressed and considered.

Venous thromboembolism risk and prophylaxis prescription in surgical patients at a tertiary hospital in Eastern Cape Province, South Africa.

BACKGROUND: Venous thromboembolism (VTE) is a common complication during and after hospitalisation, and is regarded as the most common cause of preventable death in hospitalised patients worldwide. Despite its importance, there are few data on VTE risk and adherence to prophylaxis prescription guidelines in surgical patients from the South African (SA) public sector, especially from low-resource environments such as Eastern Cape Province. OBJECTIVES: To evaluate the risk and prescription of VTE prophylaxis to surgical patients at a tertiary government hospital in the Eastern Cape. METHODS: A cross-sectional clinical audit of general surgical inpatients was performed on two dates during July and August 2017. Patients' VTE risk was calculated by using the Caprini risk assessment model (RAM) and thromboprophylaxis prescription evaluated accordingly. RESULTS: A total of 179 patients were included in the study, of whom 56% were male and 44% female. The average age was 45 (range 18 - 83) years. Of the total number of participants, 33% were elective cases and 67% were emergency admissions. With application of RAM, 77% of patients were at risk of VTE (Caprini score ≥2), with 81% of elective and 74% of emergency patients being at risk. The most prevalent risk factors for VTE were major surgery (34%), age 41 - 60 years (30%), age 61 - 74 years (20%) and sepsis during the previous month (27%). A contraindication to chemoprophylaxis was recorded in 30% of patients, with the most prevalent being renal dysfunction (40%), peptic ulcer disease (34%), active bleeding (17%), liver dysfunction (17%), coagulopathy (6%) and recent cerebral haemorrhage (6%). With regard to VTE risk profile and contraindications to chemoprophylaxis, the correct thromboprophylactic treatment was prescribed to 26% of at-risk patients, with 21% of elective and 27% of emergency admission patients receiving the correct therapy. CONCLUSIONS: Despite a high proportion of patients being at risk of VTE, the rate of adequate thromboprophylaxis prescription for surgical inpatients at Frere Hospital, East London, SA is very low. Increased availability of mechanical prophylaxis, as well as interventions to improve the rate of adequate prophylaxis prescription, needs to be evaluated for feasibility and effect in this hospital and other SA public hospitals.

Venous thromboembolism risk and prophylaxis prescription in surgical patients at a tertiary hospital in Eastern Cape Province, South Africa

Background. Venous thromboembolism (VTE) is a common complication during and after hospitalisation, and is regarded as the most common cause of preventable death in hospitalised patients worldwide. Despite its importance, there are few data on VTE risk and adherence to prophylaxis prescription guidelines in surgical patients from the South African (SA) public sector, especially from low-resource environments such as Eastern Cape Province.Objectives. To evaluate the risk and prescription of VTE prophylaxis to surgical patients at a tertiary government hospital in the Eastern Cape.Methods. A cross-sectional clinical audit of general surgical inpatients was performed on two dates during July and August 2017. Patients' VTE risk was calculated by using the Caprini risk assessment model (RAM) and thromboprophylaxis prescription evaluated accordingly. Results. A total of 179 patients were included in the study, of whom 56% were male and 44% female. The average age was 45 (range 18 - 83) years. Of the total number of participants, 33% were elective cases and 67% were emergency admissions. With application of RAM, 77% of patients were at risk of VTE (Caprini score ≥2), with 81% of elective and 74% of emergency patients being at risk. The most prevalent risk factors for VTE were major surgery (34%), age 41 - 60 years (30%), age 61 - 74 years (20%) and sepsis during the previous month (27%). A contraindication to chemoprophylaxis was recorded in 30% of patients, with the most prevalent being renal dysfunction (40%), peptic ulcer disease (34%), active bleeding (17%), liver dysfunction (17%), coagulopathy (6%) and recent cerebral haemorrhage (6%). With regard to VTE risk profile and contraindications to chemoprophylaxis, the correct thromboprophylactic treatment was prescribed to 26% of at-risk patients, with 21% of elective and 27% of emergency admission patients receiving the correct therapy.Conclusions. Despite a high proportion of patients being at risk of VTE, the rate of adequate thromboprophylaxis prescription for surgical inpatients at Frere Hospital, East London, SA is very low. Increased availability of mechanical prophylaxis, as well as interventions to improve the rate of adequate prophylaxis prescription, needs to be evaluated for feasibility and effect in this hospital and other SA public hospitals

MRI artefact in the rectum caused by ingested orthodontic brackets.

Magnetic susceptibility artefacts, caused by metallic objects, present a challenge in magnetic resonance imaging (MRI). In this case, MRI showed metal-induced artefact in the rectum of a 14-year-old girl who presented with pain in the coccyx after a snowboarding accident. Previous radiographs showed no evidence of metal in the area. After the identification of the artefact and upon discussion with the patient, she disclosed that two orthodontic brackets had been swallowed two days prior to the MRI examination, likely the source of artefact. Following the passage of the brackets, subsequent MRI was artefact-free. A similar artefact was recreated by scanning a potato with and without an orthodontic bracket, highlighting the impact of the resulting artefact on MRI.

Identification of SNPs located on BTA 6 and BTA 20 significantly associated with bovine respiratory disease in crossbred cattle.

The objective of the present study was to evaluate single nucleotide polymorphisms (SNPs) located in two quantitative trait locus (QTL) regions (BTA 6 and BTA 20) that are associated with bovine respiratory disease (BRD). A population of 323 crossbred steers sired by five purebred sire breeds during 2010-2013 (Angus, Braford, Braunvieh, Charolais, and Simmental) were evaluated for BRD susceptibility during the finishing process at a commercial feedlot. A total of 21 animals representing all sire breeds were affected with BRD at some time during the finishing process over the 4-year period. Although multiple sire breeds were evaluated in the present study, no sire breed effects were detected. A total of 82 SNPs were evaluated (58 on BTA 6 and 24 on BTA 20) in the present study for potential associations with BRD incidence. When evaluating the previously described QTL regions on BTA 6, three SNPs (rs42968895, rs42823614, and rs43448463) were significantly (P < 0.05) associated with BRD incidence. Another three SNPs (rs42477340, rs42512588, and rs42524468) were identified as significantly associated with BRD on the previously described BTA 6 QTL region. For both of these regions, animals inheriting different genotypes differed in BRD incidence during the finishing period. Although multiple SNPs were identified as being significantly associated with BRD incidence in the present study, these SNP associations should be validated in larger and more diverse populations.

Placing ecosystem services at the heart of urban water systems management.

Current approaches have failed to deliver a truly integrated management of the different elements of the urban water system, such as freshwater ecosystems, drinking water treatment plants, distribution networks, sewer systems and wastewater treatment plants. Because the different parts of urban water have not been well integrated, poor decisions have been made for society in general, leading to the misuse of water resources, the degradation of freshwater ecosystems and increased overall treatment costs. Some attempts to solve environmental issues have adopted the ecosystem services concept in a more integrated approach, however this has rarely strayed far away from pure policy, and has made little impact in on-the-ground operational matters. Here, we present an improved decision-making framework to integrate the management of urban water systems. This framework uses the ecosystem service concept in a practical way to make a better use of both financial and water resources, while continuing to preserve the environment.

CD14 expression is increased on monocytes in patients with anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis and correlates with the expression of ANCA autoantigens.

Monocyte subsets with differing functional properties have been defined by their expression of CD14 and CD16. We investigated these subsets in anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) and determined their surface expression of ANCA autoantigens. Flow cytometry was performed on blood from 14 patients with active AAV, 46 patients with AAV in remission and 21 controls. The proportion of classical (CD14(high) CD16(neg/low)), intermediate (CD14(high) CD16(high)) and non-classical (CD14(low) CD16(high)) monocytes and surface expression levels of CD14 and CD16 were determined, as well as surface expression of proteinase 3 (PR3) and myeloperoxidase (MPO) on monocyte subsets. There was no change in the proportion of monocytes in each subset in patients with AAV compared with healthy controls. The expression of CD14 on monocytes from patients with active AAV was increased, compared with patients in remission and healthy controls (P < 0.01). Patients with PR3-ANCA disease in remission also had increased monocyte expression of CD14 compared with controls (P < 0.01); however, levels in patients with MPO-ANCA disease in remission were lower than active MPO-ANCA patients, and not significantly different from controls. There was a correlation between CD14 and both PR3 and MPO expression on classical monocytes in AAV patients (r = 0.79, P < 0.0001 and r = 0.42, P < 0.005, respectively). In conclusion, there was an increase in monocyte CD14 expression in active AAV and PR3-ANCA disease in remission. The correlation of CD14 expression with ANCA autoantigen expression in AAV may reflect cell activation, and warrants further investigation into the potential for increased CD14 expression to trigger disease induction or relapse.

An impedance-based process analytical technology for monitoring the lyophilisation process.

The aim of this work was to develop a minimally invasive, impedance spectroscopy method as a novel process analytical technology for monitoring the freeze drying process. This involved the application of planar electrodes, mounted externally to a conventional glass freeze-drying vial, coupled to a high-impedance analyser. The pseudo-relaxation process arising from the composite impedance of the glass wall and product interface was recorded over a frequency range 10(1)-10(6)Hz for a surrogate formulation comprising 2.5% sucrose. Features of the process (i.e. the peak amplitude, C"(peak) and characteristic peak frequency, fpeak) were monitored along with the product temperature data during the entire cycle. It was demonstrated that fpeak is strongly coupled to the temperature of the product (through the dependence of the product temperature on the electrical resistance of the product) whereas C"(peak) is dependent on the extent of ice sublimation and hence can be used to measure the rate of drying and end point of primary drying. This feature provides a distinct advantage over thermocouple measurements which are restricted to end point detection only. The potential to predict the end point of a cycle from C"(peak) vs. time profiles is highlighted in this work.

Systematic review and meta-analysis of wound dressings in the prevention of surgical-site infections in surgical wounds healing by primary intention.

BACKGROUND: Postoperative surgical-site infections are a major source of morbidity and cost. This study aimed to identify and present all randomized controlled trial evidence evaluating the effects of dressings on surgical-site infection rates in surgical wounds healing by primary intention; the secondary outcomes included comparisons of pain, scar and acceptability between dressings. METHODS: Randomized controlled trials comparing alternative wound dressings, or wound dressings with leaving wounds exposed for postoperative management of surgical wounds were included in the review regardless of their language. Databases searched included the Cochrane Wounds Group Specialised Register and Central Register of Controlled Trials, Ovid MEDLINE, Ovid Embase and EBSCO CINAHL from inception to May 2011. Two authors performed study selection, risk of bias assessment and data extraction, including an assessment of surgical contamination according to the surgical procedure. Where levels of clinical and statistical heterogeneity permitted, data were pooled for meta-analysis. RESULTS: Sixteen controlled trials with 2594 participants examining a range of wound contamination levels were included. They were all unclear or at high risk of bias. There was no evidence that any dressing significantly reduced surgical-site infection rates compared with any other dressing or leaving the wound exposed. Furthermore, no significant differences in pain, scarring or acceptability were seen between the dressings. CONCLUSION: No difference in surgical-site infection rates was demonstrated between surgical wounds covered with different dressings and those left uncovered. No difference was seen in pain, scar or acceptability between dressings.

The Impact of Medicare's lifetime immunosuppression coverage on racial disparities in kidney graft survival.

Beginning January 1, 2000, Medicare effectively extended its coverage of immunosuppression medications from 3 years to lifetime for patients eligible for Medicare on the basis of age or disability status. We examined the impact of this policy on racial disparities in kidney transplant outcomes at 5 years. Using data from the US Renal Data System, we identified cohorts of Medicare-insured kidney transplant recipients according to patient characteristics defining eligibility for lifetime immunosuppression coverage according to the year 2000 policy. We compared racial disparities in graft survival among those eligible for lifetime coverage with the Kaplan-Meier method. We modeled adjusted associations of patient race, patient income, benefits eligibility category and policy exposure with graft loss by multivariable Cox's regression. The racial disparity in graft survival between African American and non-African American among transplant recipients eligible for the lifetime benefit persisted. The graft survival disparity between high- and low-income African American recipients was insignificantly reduced among those eligible for the lifetime benefit. The results of the study suggest that insurance coverage of medication did not eliminate or reduce the racial disparity in graft survival.

Comparing the performance of multiple mitochondrial genes in the analysis of Australian freshwater fishes.

In this study, four mitochondrial genes (cytochrome oxidase I, ATPase, cytochrome b and control region) were amplified from most of the fish species found in the fresh waters of south-eastern Queensland, Australia. The performance of these different gene regions was compared in terms of their ability to cluster fish families together in a neighbour-joining tree, both individually by gene and in all combinations. The relative divergence rates of each of these genes were also calculated. The three coding genes (cytochrome oxidase I, ATPase and cytochrome b) recovered similar number of families and had broadly similar divergence rates. ATPase diverged a little more quickly than cytochrome oxidase I and cytochrome b slightly more slowly than cytochrome oxidase I. All two-gene combinations recovered the same number of families. Results from the control region were much more variable, and, although generally possessing more diversity than the other regions, were sometimes less variable.

Breeding behaviour of Kunzea pomifera (Myrtaceae): self-incompatibility, intraspecific and interspecific cross-compatibility.

To examine breeding system characteristics of the endemic Australian prostrate shrub Kunzea pomifera, artificial hybridisations were undertaken using thirteen different genotypes of K. pomifera, to elucidate: (1) self-incompatibility, (2) intraspecific cross-compatibility in the species and (3) interspecific cross-compatibility with each of K. ambigua and K. ericoides. K. pomifera exhibited very low self-compatibility, with the barrier to self-fertilisation being prevention of pollen-tube growth in the style or ovary. Following intraspecific pollination amongst a number of different genotypes of K. pomifera, 38.4% of pollinated flowers developed fruit; arrest of compatible pollen-tubes in the style, preventing fertilisation, contributes to the low fruit set in this species. Interspecific compatibility was examined between K. pomifera (pistillate parent) and K. ambigua (staminate parent) where seed set per pollinated flower (4.47) was not significantly different from intraspecific crosses (4.66). In crosses between K. pomifera (pistillate parent) and K. ericoides as staminate plant, 0.037% of pollinated flowers produced fruit, with 0.0075 seeds per pollinated flower. Reproductive barriers between these two species were evident in the style of K. pomifera, where the growing tips of the K. ericoides pollen-tubes swelled and ceased to grow.

Income-related disparities in kidney transplant graft failures are eliminated by Medicare's immunosuppression coverage.

Beginning January 1, 2000, Medicare extended coverage of immunosuppression medications from 3 years to lifetime based on age >65 years or disability. Using United States Renal Data System (USRDS) data for Medicare-insured recipients of kidney transplants between July 1995 and December 2000, we identified four cohorts of Medicare-insured kidney transplant recipients. Patients in cohort 1 were individuals who were both eligible and received lifetime coverage. Patients in cohort 2 would have been eligible, but their 3-year coverage expired before lifetime coverage was available. Patients in cohort 3 were ineligible for lifetime coverage because of youth or lack of disability. Patients in cohort 4 were transplanted between 1995 and 1996 and were ineligible for lifetime coverage. Incomes were categorized by ZIP code median household income from census data. Lifetime extension of Medicare immunosuppression was associated with improved allograft survival among low-income transplant recipients in the sense that the previously existing income-related disparities in graft survival in cohort 2 were not apparent in cohort 1. Ineligible individuals served as a control group; the income-related disparities in graft survival observed in the early cohort 4 persisted in more recent cohort 3. Multivariate proportional hazards models confirmed these findings. Future work should evaluate the cost effectiveness of these coverage increases, as well as that of benefits extensions to broader patient groups.

Transcriptional regulation of plant senescence: from functional genomics to systems biology.

Leaf senescence is an active process that involves the increased expression of many hundreds of genes. Many putative transcription factors show enhanced transcription during leaf senescence in Arabidopsis and functional analysis of these should help to indicate their role in controlling gene expression during leaf senescence. In this paper, we describe the analysis of knockout insertion mutants in two different senescence-enhanced genes, one encodes a heat shock transcription factor and the other a zinc finger protein. Plants mutated in these genes show accelerated leaf senescence and reduced tolerance to drought stress, indicating that expression of these genes during senescence has a protective role to maintain viability during this essential developmental process. Analysis of gene expression changes in both mutants compared to the wild-type plants indicates an increased rate of senescence but does not show clearly the pathway that is dependent on these genes for expression. The complexities of signalling networks in plant stress and the plasticity of plant responses mean that the direct consequences of mutation are very difficult to define. The usefulness of this type of approach to address the burning question of how senescence is regulated is discussed, and an alternative approach aimed at a more global analysis of gene regulation using systems biology methods is described.

Characteristics of HIV-1-associated Kaposi's sarcoma among women and men in South Africa.

Despite the increase of HIV-1-associated Kaposi's sarcoma (KS), little is known about HIV-associated KS in the African setting, particularly among women. A descriptive study of the demographic, clinical, immunological and virological features of AIDS-associated KS from KwaZulu-Natal, South Africa was undertaken. Consecutively, recruited patients were clinically staged; CD4/CD8 cell counts, HIV-1 viral loads and clinical parameters were evaluated. Of the 152 patients (77 male and 75 female) 99% were black. Females were significantly younger (P = 0.02) and had poorer disease prognosis (odds ratio [OR] = 2.7, 95% confidence interval [CI] = 1.4-5.4, P = 0.003) and were more likely to have extensive cutaneous KS when compared with males (OR = 3.1, 95% CI = 1.4-6.7, P = 0.003). One-third of patients had coexisting HIV-related disease, most commonly tuberculosis, and these were more frequent in females (56.7 vs. 43.3%). In conclusion, HIV-associated KS in South Africans has an equal female-to-male ratio. Females are younger and have more severe disease than males.

Assessment of uncertainties in a long range atmospheric transport model: Methodology, application and implications in a UK context.

Acid deposition models are inherently simplified representations of real world behaviour and their performance is best evaluated by comparison with observations. National and international acid rain policy assessments handle observed and modelled deposition fields in different ways. Here, both the observed and modelled deposition fields are seen as uncertain and the Generalised Likelihood Uncertainty Estimation (GLUE) framework is used to choose acceptable sets of model input parameters that minimise the differences between them. These acceptable sets of model parameters are then used to estimate deposition budgets to the UK and to provide a probabilistic treatment of excess deposition over environmental quality standards (critical loads).

Phylogeographic structure in an Australian freshwater shrimp largely pre-dates the geological origins of its landscape.

The phylogeographic structure of cryptic lineages within the freshwater shrimp Caridina indistincta Calman, 1926 (Decapoda: Atyidae) was investigated in an attempt to unravel any potential genetic influences of Quaternary sea-level oscillations. The study was based on mitochondrial DNA sequences from specimens from lakes and creeks in the sand dune areas of southeast Queensland, eastern Australia. Four divergent lineages were identified, two of which were from Moreton and North (N.) Stradbroke Islands. Lineage 'C1' has been found only on Moreton Island and the western part of N. Stradbroke Island, whereas 'C2' was found on the eastern side of N. Stradbroke Island and a few locations on the mainland. These diverged from each other during the Late Miocene/Pliocene and so are older than the current landscape in which they are found. Small-scale phylogeographic analysis of C1 identified four separate geographic areas, within the two islands, whose divergences date to the Pleistocene (approximately 100-300 thousand years ago ('kya')). The N. Stradbroke Island population of C2 also diverged from the mainland during the Pleistocene, as did a sympatric freshwater fish Rhadinocentrus ornatus Regan, 1914 (Melanotaeniidae). This implies that the ice-age sea-level changes may have structured these populations, although there is little observable influence of the last glacial maximum (approximately 18 kya). Most estimates for the age of the landscape (dunes, lakes) also fall within the Pleistocene and so the effect of sea-level change may be seen both in biology and geology.

Biogeographic history of an Australian freshwater shrimp, Paratya australiensis (Atyidae): the role life history transition in phylogeographic diversification.

The widespread distribution of the freshwater shrimp Paratya australiensis in eastern Australia suggests that populations of this species have been connected in the past. Amphidromy is ancestral in these shrimps, although many extant populations are known to be restricted to freshwater habitats. In this study, we used a fragment of the cytochrome c oxidase I mitochondrial DNA (mtDNA) gene to examine diversity within P. australiensis and to assess the relative importance of amphidromy in its evolutionary history. We hypothesized that if transitions from an amphidromous to a freshwater life history were important, then we would find a number of divergent lineages restricted to single or groups of nearby drainages. Alternatively, if amphidromy was maintained within the species historically, we expected to find lineages distributed over many drainages. We assumed that the only way for divergence to occur within amphidromous lineages was if dispersal was limited to between nearby estuaries, which, during arid periods in the earth's history, became isolated from one another. We found nine highly divergent mtDNA lineages, estimated to have diverged from one another in the late Miocene/early Pliocene, when the climate was more arid than at present. Despite this, the geographic distribution of lineages and haplotypes within lineages did not support the notion of a stepping-stone model of dispersal between estuaries. We conclude that the extensive divergence has most likely arisen through a number of independent amphidromy-freshwater life history transitions, rather than via historical isolation of amphidromy populations. We also found evidence for extensive movement between coastal and inland drainages, supporting the notion that secondary contact between lineages may have occurred as a result of drainage rearrangements. Finally, our data indicate that P. australiensis is likely a complex of cryptic species, some of which are widely distributed, and others geographically restricted.

A novel polymorphism in the 5' flanking region of the glucose transporter (GLUT1) gene is strongly associated with diabetic nephropathy in patients with Type 1 diabetes mellitus.

Glucose transporter 1 (GLUT1) activity has been implicated in renal hypertrophy and extracellular matrix formation in mesangial cells. Recent studies have suggested that polymorphisms in the GLUT1 gene are associated with susceptibility to diabetic nephropathy (DN) in patients with diabetes mellitus. In this study, a novel polymorphism (A-2841T) in the 5' flanking region of GLUT1 was examined in 288 patients with Type 1 diabetes mellitus (T1DM) and 101 normal controls. The polymorphisms were amplified and the fragment digested with the enzyme HpyCH4V. There was a highly significant increase in the frequency of the TT-2841 genotype in patients with nephropathy (n=131) compared with those with either no microvascular complications after a 20-year duration of diabetes (uncomplicated; n=72; 54.5% vs. 2.7%, chi=79.4, P<.000001). There was no difference between the uncomplicated group and those who only had retinopathy (n=50; 2.7% vs. 4.0%, respectively). The frequency in recently diagnosed patients was 17.1% and only 2.0% in normal controls. In contrast, the AA genotype was found in 13.6% of the nephropaths, 76.3% of uncomplicated, 48.0% of retinopaths, and 65% of normal controls. These results confirm previous reports of an association between the GLUT1 gene and susceptibility to DN but not retinopathy. The localisation of this polymorphism suggests that it may be involved in the expression of the gene.