MouseMine: a new data warehouse for MGI

MouseMine (www.mousemine.org) is a new data warehouse for accessing mouse data from Mouse Genome Informatics (MGI). Based on the InterMine software framework, MouseMine supports powerful query, reporting, and analysis capabilities, the ability to save and combine results from different queries, easy integration into larger workflows, and a comprehensive Web Services layer. Through MouseMine, users can access a significant portion of MGI data in new and useful ways. Importantly, MouseMine is also a member of a growing community of online data resources based on InterMine, including those established by other model organism databases. Adopting common interfaces and collaborating on data representation standards are critical to fostering cross-species data analysis. This paper presents a general introduction to MouseMine, presents examples of its use, and discusses the potential for further integration into the MGI interface.

Hemispheric Differences in Leukoaraiosis in Patients with Carotid Artery Stenosis: A Systematic Review

PURPOSE

Despite the prevalence of leukoaraiosis in neuroimaging and its link to dementia, stroke, and death, the exact pathogenesis is still unclear. While some have postulated a link between carotid artery disease and leukoaraiosis, the exact relationship between the two common clinical findings is unknown. To determine the link between carotid disease and leukoaraiosis, we performed a systematic review of interhemispheric differences in white matter disease in patients with carotid artery disease.

METHODS

We performed a comprehensive literature search in multiple electronic databases evaluating the association of carotid artery and white matter disease using both subjective and volumetric assessment of white matter burden. The included studies examined patients with at least 30 % carotid artery stenosis for white matter burden both ipsilateral and contralateral to the site of carotid artery disease.

RESULTS

Of the 2920 manuscripts screened, five were included in the systematic review. One study used a volumetric analysis of the white matter burden and the others used various subjective methods. Four studies found no statistically significant relationship between carotid artery disease and ipsilateral white matter burden and one study found a significantly higher amount of white matter disease ipsilateral to carotid artery stenosis.

CONCLUSIONS

The mixed results in degree of hemispheric leukoaraiosis in patients with carotid artery disease indicate that no definite relationship can be established based on the existing literature. Given the complex nature of carotid artery disease, including increased risk with certain plaque components, the exact relationship requires further investigation with more rigorous research design.

A case report in health information exchange for inter-organizational patient transfers

OBJECTIVE

To provide a case report of barriers and promoters to implementing a health information exchange (HIE) tool that supports patient transfers between hospitals and skilled nursing facilities.

METHODS

A multi-disciplinary team conducted semi-structured telephone and in-person interviews in a purposive sample of HIE organizational informants and providers in New York City who implemented HIE to share patient transfer information. The researchers conducted grounded theory analysis to identify themes of barriers and promoters and took steps to improve the trustworthiness of the results including vetting from a knowledgeable study participant.

RESULTS

Between May and October 2011, researchers recruited 18 participants: informaticians, healthcare administrators, software engineers, and providers from a skilled nursing facility. Subjects perceived the HIE tool's development a success in that it brought together stakeholders who had traditionally not partnered for informatics work, and that they could successfully share patient transfer information between a hospital and a skilled nursing facility. Perceived barriers included lack of hospital stakeholder buy-in and misalignment with clinical workflows that inhibited use of HIE-based patient transfer data. Participants described barriers and promoters in themes related to organizational, technical, and user-oriented issues. The investigation revealed that stakeholders could develop and implement health information technology that technically enables clinicians in both hospitals and skilled nursing facilities to exchange real-time information in support of patient transfers. User level barriers, particularly in the emergency department, should give pause to developers and implementers who plan to use HIE in support of patient transfers.

CONCLUSIONS

Participants' experiences demonstrate how stakeholders may succeed in developing and piloting an electronic transfer form that relies on HIE to aggregate, communicate, and display relevant patient transfer data across health care organizations. Their experiences also provide insights for others seeking to develop HIE applications to improve patient transfers between emergency departments and skilled nursing facilities.

The Mouse Tumor Biology Database (MTB): a central electronic resource for locating and integrating mouse tumor pathology data

The Mouse Tumor Biology Database (MTB) is designed to provide an electronic data storage, search, and analysis system for information on mouse models of human cancer. The MTB includes data on tumor frequency and latency, strain, germ line, and somatic genetics, pathologic notations, and photomicrographs. The MTB collects data from the primary literature, other public databases, and direct submissions from the scientific community. The MTB is a community resource that provides integrated access to mouse tumor data from different scientific research areas and facilitates integration of molecular, genetic, and pathologic data. Current status of MTB, search capabilities, data types, and future enhancements are described in this article.

Evolution of syncarpy and other morphological characters in African Annonaceae: a posterior mapping approach

The congenital fusion of carpels, or syncarpy, is considered a key innovation as it is found in more than 80% of angiosperms. Within the magnoliids however, syncarpy has rarely evolved. Two alternative evolutionary origins of syncarpy were suggested in order to explain the evolution of this feature: multiplication of a single carpel vs. fusion of a moderate number of carpels. The magnoliid family Annonaceae provides an ideal situation to test these hypotheses as two African genera, Isolona and Monodora, are syncarpous in an otherwise apocarpous family with multicarpellate and unicarpellate genera. In addition to syncarpy, the evolution of six other morphological characters was studied. Well-supported phylogenetic relationships of African Annonaceae and in particular those of Isolona and Monodora were reconstructed. Six plastid regions were sequenced and analyzed using maximum parsimony and Bayesian inference methods. The Bayesian posterior mapping approach to study character evolution was used as it accounts for both mapping and phylogenetic uncertainty, and also allows multiple state changes along the branches. Our phylogenetic analyses recovered a fully resolved clade comprising twelve genera endemic to Africa, including Isolona and Monodora, which was nested within the so-called long-branch clade. This is the largest and most species-rich clade of African genera identified to date within Annonaceae. The two syncarpous genera were inferred with maximum support to be sister to a clade characterized by genera with multicarpellate apocarpous gynoecia, supporting the hypothesis that syncarpy arose by fusion of a moderate number of carpels. This hypothesis was also favoured when studying the floral anatomy of both genera. Annonaceae provide the only case of a clear evolution of syncarpy within an otherwise apocarpous magnoliid family. The results presented here offer a better understanding of the evolution of syncarpy in Annonaceae and within angiosperms in general.

Deep Impact: Excavating Comet Tempel 1

Deep Impact collided with comet Tempel 1, excavating a crater controlled by gravity. The comet's outer layer is composed of 1- to 100-micrometer fine particles with negligible strength (<65 pascals). Local gravitational field and average nucleus density (600 kilograms per cubic meter) are estimated from ejecta fallback. Initial ejecta were hot (>1000 kelvins). A large increase in organic material occurred during and after the event, with smaller changes in carbon dioxide relative to water. On approach, the spacecraft observed frequent natural outbursts, a mean radius of 3.0 +/- 0.1 kilometers, smooth and rough terrain, scarps, and impact craters. A thermal map indicates a surface in equilibrium with sunlight.

Do farmers reduce genetic diversity when they domesticate tropical trees? A case study from Amazonia

Agroforestry ecosystems may be an important resource for conservation and sustainable use of tropical trees, but little is known of the genetic diversity they contain. Inga edulis, a widespread indigenous fruit tree in South America, is used as a model to assess the maintenance of genetic diversity in five planted vs. five natural stands in the Peruvian Amazon. Analysis of five SSR (simple sequence repeat) loci indicated lower allelic variation in planted stands [mean corrected allelic richness 31.3 (planted) and 39.3 (natural), P = 0.009]. Concerns regarding genetic erosion in planted Amazonian tree stands appear valid, although allelic variation on-farm is still relatively high.

Historical biogeography of two cosmopolitan families of flowering plants: Annonaceae and Rhamnaceae

Annonaceae are a pantropically distributed family found predominantly in rainforests, so they are megathermal taxa, whereas Rhamnaceae are a cosmopolitan family that tend to be found in xeric regions and may be classified as mesothermal. Phylogenetic analyses of these families are presented based on rbcL and trnL-F plastid DNA sequences. Likelihood ratio tests revealed rate heterogeneity in both phylogenetic trees and they were therefore made ultrametric using non-parametric rate smoothing and penalized likelihood. Divergence times were then estimated using fossil calibration points. The historical biogeography of these families that are species rich in different biomes is discussed and compared with other published reconstructions. Rhamnaceae and most lineages within Annonaceae are too young to have had their distribution patterns influenced by break-up of previously connected Gondwanan landmasses. Contrasts in the degree of geographical structure between these two families may be explained by differences in age and dispersal capability. In both groups, long-distance dispersal appears to have played a more significant role in establishing modern patterns than had previously been assumed. Both families also contain examples of recent diversification of species-rich lineages. An understanding of the processes responsible for shaping the distribution patterns of these families has contributed to our understanding of the historical assembly of the biomes that they occupy.

Physiological responses of firefighters wearing level 3 chemical protective suits while working in controlled hot environments

Firefighters in Queensland are exposed to hot, humid weather conditions that contribute to the overall workload encountered during emergency operations. Responding to certain hazardous material incidents requires firefighters to wear fully encapsulated chemical protective suits for a maximum period of 20 minutes. The nature of these suits, combined with workload and environmental conditions, poses a potential heat stress problem for firefighters. This study evaluates the heat-induced physiological responses of firefighters while wearing fully encapsulated chemical protective suits in a series of controlled thermal environments. Heart rate, body (aural) temperature, blood pressure, fluid loss, and a rating of perceived exertion were measured to evaluate the effect of increasing ambient air temperature during the performance of standard tasks. The results of the study indicated that the significant increase in heart rate, body temperature, and blood pressure was directly related to the increase in air temperature. The research indicates that the recommended suit wearing time of 20 minutes provided adequate physiological protection under the research conditions.

Rapid diversification of a species-rich genus of neotropical rain forest trees

Species richness in the tropics has been attributed to the gradual accumulation of species over a long geological period in stable equatorial climates or, conversely, to speciation in response to late Tertiary geological events and unstable Pleistocene climates. DNA sequence data are consistent with recent diversification in Inga, a species-rich neotropical tree genus. We estimate that speciation was concentrated in the past 10 million years, with many species arising as recently as 2 million years ago. This coincides with the more recent major uplifts of the Andes, the bridging of the Isthmus of Panama, and Quaternary glacial cycles. Inga may be representative of other species-rich neotropical genera with rapid growth and reproduction, which contribute substantially to species numbers in the world's most diverse flora.

Rapid and recent origin of species richness in the Cape flora of South Africa

The Cape flora of South Africa grows in a continental area with many diverse and endemic species. We need to understand the evolutionary origins and ages of such 'hotspots' to conserve them effectively. In volcanic islands the timing of diversification can be precisely measured with potassium-argon dating. In contrast, the history of these continental species is based upon an incomplete fossil record and relatively imprecise isotopic palaeotemperature signatures. Here we use molecular phylogenetics and precise dating of two island species within the same clade as the continental taxa to show recent speciation in a species-rich genus characteristic of the Cape flora. The results indicate that diversification began approximately 7-8 Myr ago, coincident with extensive aridification caused by changes in ocean currents. The recent origin of endemic species diversity in the Cape flora shows that large continental bursts of speciation can occur rapidly over timescales comparable to those previously associated with oceanic island radiations.

The Mouse Gene Expression Database (GXD)

The Gene Expression Database (GXD) is a community resource of gene expression information for the laboratory mouse. By combining the different types of expression data, GXD aims to provide increasingly complete information about the expression profiles of genes in different mouse strains and mutants, thus enabling valuable insights into the molecular networks that underlie normal development and disease. GXD is integrated with the Mouse Genome Database (MGD). Extensive interconnections with sequence databases and with databases from other species, and the development and use of shared controlled vocabularies extend GXD's utility for the analysis of gene expression information. GXD is accessible through the Mouse Genome Informatics web site at http://www.informatics.jax.org/ or directly at http://www.informatics.jax.org/menus/expression_menu. shtml.

The Mouse Genome Database (MGD): integration nexus for the laboratory mouse

The Mouse Genome Database (MGD) is the community database resource for the laboratory mouse, a key model organism for interpreting the human genome and for understanding human biology and disease (http://www.informatics.jax.org). MGD provides standard nomenclature and consensus map positions for mouse genes and genetic markers; it provides a curated set of mammalian homology records, user-defined chromosomal maps, experimental data sets and the definitive mouse 'gene to sequence' reference set for the research community. The integration and standardization of these data sets facilitates the transition between mouse DNA sequence, gene and phenotype annotations. A recent focus on allele and phenotype representations enhances the ability of MGD to organize and present data for exploring the relationship between genotype and phenotype. This link between the genome and the biology of the mouse is especially important as phenotype information grows from large mutagenesis projects and genotype information grows from large-scale sequencing projects.

A phylogenetic analysis of Rhamnaceae using rbcL and trnL-F plastid DNA sequences

Previous tribal classifications of Rhamnaceae have been based on fruit characters, resulting in the delimitation of large and otherwise heterogeneous groups. We evaluated the most recent classification with DNA sequences of two regions of the plastid genome, rbcL and trnL-F, from 42 genera of Rhamnaceae and representatives of the related families Elaeagnaceae, Barbeyaceae, Dirachmaceae, Urticaceae, Ulmaceae, Moraceae, and Rosaceae. The trnL-F trees have higher consistency and retention indices than the rbcL trees, and patterns of change in rbcL and trnL-F are compared. The closest relatives of Rhamnaceae are Dirachmaceae and Barbeyaceae, followed by the urticalean families. The plastid trees support the monophyly of the family and provide the basis for a new tribal classification. Three strongly supported clades are identified, but morphological characters could not be found to underpin a formal taxonomic description of these three clades as subfamilies. We therefore only recognize groups that are also defined by morphological characters. The biogeography of Rhamnaceae is discussed with reference to the molecular trees.

Gene ontology: tool for the unification of biology. The Gene Ontology Consortium

Genomic sequencing has made it clear that a large fraction of the genes specifying the core biological functions are shared by all eukaryotes. Knowledge of the biological role of such shared proteins in one organism can often be transferred to other organisms. The goal of the Gene Ontology Consortium is to produce a dynamic, controlled vocabulary that can be applied to all eukaryotes even as knowledge of gene and protein roles in cells is accumulating and changing. To this end, three independent ontologies accessible on the World-Wide Web (http://www.geneontology.org) are being constructed: biological process, molecular function and cellular component.

Gene ontology: tool for the unification of biology. The Gene Ontology Consortium

Genomic sequencing has made it clear that a large fraction of the genes specifying the core biological functions are shared by all eukaryotes. Knowledge of the biological role of such shared proteins in one organism can often be transferred to other organisms. The goal of the Gene Ontology Consortium is to produce a dynamic, controlled vocabulary that can be applied to all eukaryotes even as knowledge of gene and protein roles in cells is accumulating and changing. To this end, three independent ontologies accessible on the World-Wide Web (http://www.geneontology.org) are being constructed: biological process, molecular function and cellular component.

The Mouse Genome Database (MGD): expanding genetic and genomic resources for the laboratory mouse. The Mouse Genome Database Group

The Mouse Genome Database (MGD) is a comprehensive public database of mouse genomic, genetic and phenotypic information (http://www. informatics.jax.org). This community database provides information about genes, serves as a mapping resource of the mouse genome, details mammalian orthologs, integrates experimental data, represents standardized mouse nomenclature for genes and alleles, incorporates links to other genomic resources such as sequence data, and includes a variety of additional information about the laboratory mouse. MGD scientists and annotators work cooperatively with the research community to provide an integrated, consensus view of the mouse genome while also providing experimental data including data conflicting with the consensus representation. Recent improvements focus on the representation of phenotypic information and the enhancement of gene and allele descriptions.

GXD: a Gene Expression Database for the laboratory mouse: current status and recent enhancements. The Gene Expresison Database group

The Gene Expression Database (GXD) is a community resource of gene expression information for the laboratory mouse. The database is designed as an open-ended system that can integrate different types of expression data. New expression data are made available on a daily basis. Thus, GXD provides increasingly complete information about what transcripts and proteins are produced by what genes; where, when and in what amounts these gene products are expressed; and how their expression varies in different mouse strains and mutants. GXD is integrated with the Mouse Genome Database (MGD). Continuously refined interconnections with sequence databases and with databases from other species place the gene expression information in the larger biological and analytical context. GXD is accessible through the Mouse Genome Informatics Web site at http://www.informatics.jax.org/ or directly at http://www.informatics.jax.org/menus/expression_menu.shtm l

The Mouse Genome Database (MGD): genetic and genomic information about the laboratory mouse. The Mouse Genome Database Group

The Mouse Genome Database (MGD) focuses on the integration of mapping, homology, polymorphism and molecular data about the laboratory mouse. Detailed descriptions of genes including their chromosomal location, gene function, disease associations, mutant phenotypes, molecular polymorphisms and links to representative sequences including ESTs are integrated within MGD. The association of information from experiment to gene to genome requires careful coordination and implementation of standardized vocabularies, unique nomenclature constructions, and detailed information derived from multiple sources. This information is linked to other public databases that focus on additional information such as expression patterns, sequences, bibliographic details and large mapping panel data. Scientists participate in the curation of MGD data by generating the Chromosome Committee Reports, consulting on gene family nomenclature revisions, and providing descriptions of mouse strain characteristics and of new mutant phenotypes. MGD is accessible at http://www.informatics.jax.org

GXD: a gene expression database for the laboratory mouse. The Gene Expression Database Group

The Gene Expression Database (GXD) is a community resource that stores and integrates expression information for the laboratory mouse, with a particular emphasis on mouse development, and makes these data freely available in formats appropriate for comprehensive analysis. GXD is implemented as a relational database and integrated with the Mouse Genome Database (MGD) to enable global analysis of genotype, expression and phenotype information. Interconnections with sequence databases and with databases from other species further extend GXD's utility for the analysis of gene expression data. GXD is available through the Mouse Genome Informatics Web Site at http://www.informatics.jax.org/

Informatics for mouse genetics and genome mapping

Bioinformatics has become an essential part of biological research. The rapid pace of technology development and the ability to carry out biological experimentation in large scale require computerized systems for data management, analysis, and display. Experimentation with the mouse, a major model organism of the Human Genome Initiative, has intensified the need for bioinformatics tools for mouse mapping and genome analysis. This article describes the Mouse Genome Database in the United States, a primary resource for mouse genomic data, as well as resources at the Mammalian Genetics Unit in the United Kingdom and the Animal Genome Database of Japan. Internet addresses are provided for major genetic and physical mapping resources, major genome data sites, and resources of molecular information.

The Mouse Genome Database (MGD): a community resource. Status and enhancements. The Mouse Genome Informatics Group

The Mouse Genome Database (MGD) is a comprehensive community database that integrates genetic, genomic and phenotypic information about the laboratory mouse. MGD provides detailed information about genes and genetic markers, elemental data from mapping experiments, descriptions of molecular segments including ESTs, probes, and cDNA clones, homology information between mouse and many other mammalian genomes, and phenotypic descriptions of gene mutations, gene function and mouse strains. All data are supported by citations. Interactive graphical displays of cytogenetic, genetic and physical maps are available. User support is provided through dedicated staff, bulletin boards, and user documentation. MGD can be accessed at http://www.informatics.jax.org

The mouse gene expression database GXD

The gene expression database (GXD) is being developed to store and integrate expression information for mouse development. GXD addresses many issues that apply to gene expression databases in general, and its data structures and supporting software tools are generalized in design and thus readily adaptable to other life stages and species. Integration of GXD with the mouse genome database (MGD) and interconnections with other relevant databases will place the gene expression data into the larger biological and analytical context. Here, we describe the design and implementation of GXD and illustrate, in particular, the gene expression annotator, an electronic system for submitting expression data to the database.Copyright 1997 Academic Press Limited Copyright 1997Academic Press Limited

The Mouse Genome Database (MGD). A comprehensive public resource of genetic, phenotypic and genomic data. The Mouse Genome Informatics Group

The Mouse Genome Database (MGD) is a comprehensive community resource of mouse genetic and biological information populated both with data from published literature and with data electronically submitted from the research community. MGD stores genetic, physical and comparative mapping data, clones/probes/PCR information, and phenotype descriptions for genes, mutations and mouse strains. Supporting software for importation, analysis, display and distribution of mouse genetic data have been developed. User support is provided through dedicated staff providing documentation, training, and response to individual user queries. MGD is accessible over the Internet at URL http://www.informatics.jax.org.

A Rosetta stone of mammalian genetics

The Mammalian Comparative Database provides genetic maps of mammalian species. Comparative maps are valuable aids for predicting linkages, developing animal models and studying genome organization and evolution.

Traumatic wound of the heart: value of intraoperative colour Doppler flow imaging

A patient who sustained a traumatic ventricular septal defect from a stab wound is presented. Intraoperative echo-Doppler imaging provided an additional diagnosis of avulsion of anterior papillary muscle of the tricuspid valve prior to cardiotomy. It was concluded that intraoperative echo-Doppler imaging proves a useful guide for cardiac surgery following penetrating trauma.

The incidence of childhood diabetes in certain parts of Scotland

The incidence of diabetes in children under 12 years of age has been studied in three regions of Scotland from 1976 to 1986. These areas represent more than half of the Scottish population of that age group. The overall annual incidence is 17.6 per 100,000, ranging from 16.8 in densely populated areas to 23.4 in more rural areas. Earlier studies have concerned the age group 0-18 years so the present results from a younger age group are, as expected, slightly lower but show the same trends. After a rise to 1983 there appears to have been a drop, but not in all areas. The danger of drawing conclusions from areas of low population or from short periods of time is stressed.

HLA-DR4 in giant cell arteritis: association with polymyalgia rheumatica syndrome

Forty-three patients with well-documented giant cell arteritis (GCA) were studied clinically and with HLA typing. All patients were over age 40. Twenty-two of the patients had coexistent polymyalgia rheumatica (PMR). No association with class I HLA antigens was detected. When compared with HLA findings in 243 healthy controls, HLA-DR4 was increased in patients with GCA and PMR, but not in patients with GCA alone. Pooled analysis of data from 4 published papers confirmed the association of DR4 with GCA and PMR (P much less than 0.00001). Patients with PMR but negative findings of temporal artery biopsies also showed an increased frequency of HLA-DR4, but this did not reach statistical significance, probably because of the small number of subjects. It is likely that the increased frequency of DR4 in GCA patients is related to its association with PMR.

Focus on: Biomedical Technology Department, Lutheran Medical Center

The Biomedical Technology Department (BTD) at Lutheran Medical Center, (LMC), Wheat Ridge, CO was started in an attempt to meet the challenges of advancing technology and the new requirements of accrediting agencies. LMC treats 92,000 inpatients and 50,000 outpatients per year. The role of the department technicians has changed since the inception of the BTD, in 1976. The most significant impact, on this role, has been the effective utilization of technical skills to generate income for the hospital. Eight technicians service over 4,200 pieces of equipment for 62 departments. The BTD, at present, has eight clinics under Quality Assurance Testing (QAT) contracts. The department is laying ground work for increase service responsibility to become as cost-effective as possible. Obtaining additional service contracts is essential in utilizing department expertise to generate income for the hospital.

Impact of worksite health promotion on health care costs and utilization. Evaluation of Johnson & Johnson's Live for Life program

This study explores the relationship between exposure to a comprehensive worksite health promotion program and health care costs and utilization. The experience of two groups of Johnson & Johnson employees (N = 5192 and N = 3259) exposed to Live for Life, a comprehensive program of health screens, life-style improvement programs, and worksite changes to support healthier life-styles, was compared with that of a control group (N = 2955) over a five-year period. To account for baseline differences, analyses of covariance produced adjusted means for inpatient hospital costs, admissions, hospital days, outpatient costs, and other health costs. Mean annual inpatient cost increases were $43 and $42 for two Live for Life groups vs $76 for the non-Live for Life group. Live for Life groups also had lower rates of increase in hospital days and admissions. No significant differences were found for outpatient or other health care costs.

Lymphocytotoxins in vasculitis. Correlation with clinical manifestations and laboratory variables

Twenty-eight of 53 patients with various types of vasculitis were found to have cold reacting lymphocytotoxins (LCT). LCT were cytotoxic to both peripheral blood B and T cells as well as to OKT4 and OKT8 subpopulations. The interaction with the B cells was more pronounced than with the T cells as shown by reactivity with the former at higher serum dilutions than with the latter. Similar results were obtained with eluates from the unseparated lymphocytes and from B or from T cells. Partial purification of LCT demonstrated that they belong to the IgM class. LCT correlated with the level of circulating immune complexes as determined by the fluid phase C1q binding assay, but they did not correlate with the level of immunoglobulins, complement or antinuclear factors. The presence of LCT correlated significantly with the activity but not with the disease duration or the number of involved organs. Correlation of LCT with the activity of vasculitis implies that these cytotoxins may have a pathogenetic role and perhaps may serve as a marker for disease activity.

The nutritional status and feeding practices among sick urban pre-school children admitted to a major hospital in Accra, Ghana

In a prospective study of 652 sick pre-school children only 33% were found to be adequately nourished. Among the malnourished, 54.3% had first degree malnutrition while 32.3% and 13.4% had second and third degree malnutrition respectively. The majority of malnourished children (72.4%) had undernutrition: kwashiorkor (14.2%), marasmus 7.3%) and marasmic kwashiorkor (6.1%) was relatively less common. Furthermore, 58% of the underweight children were stunted, indicating malnutrition of some considerable duration. Malnutrition was essentially of postnatal origin and closely related to a high incidence of malnutrition-associated illnesses: diarrhoea (74%), measles (51%) and intestinal parasites (54%). Though breast feeding was universal and of adequate duration, milk production was mostly inadequate because of too early supplementation with low-energy cereal gruels with little or no protein-enrichment. The majority of children came from low socio-economic homes (61%) with mostly illiterate or semi-literate mothers. It is essential that newer methods of teaching be employed in the health education of these unfortunate mothers. Health institutions other than well-baby clinics need to have integrated units for nutritional and immunization surveillance and also for serving as avenues for the supply of free supplementary food items to children with poor weight gain, especially those from poor homes. Clinical Nutrition Units are needed to ensure that inpatients receive nutrients sufficient for continuing and catch-up growth.

Measles in Ghana--1973-1982

Admissions of children with measles constituted 8.8% of all admissions to the paediatric medical service of the Korle Bu Teaching Hospital, Accra, over the ten-year-period 1973-1982. Measles remains endemic in urban Accra as in the towns of other developing nations. The peak of admissions occurred in the age range seven to 12 months. Complications were frequent, with a high mortality (16.86%). Bronchopneumonia, the commonest complication (63.9%) was also the commonest cause of death in 51.5% of cases. Comparative national case-mortality rates were, however, surprisingly low and should be accepted with caution. There is an urgent need for intensification of immunization efforts through amalgamation of the preventive and curative services of Ghana, especially for children attending health centres for medical care. Vaccination should be administered before the peak age of admission, preferably at six months of age, with a second dose administered as soon after one year of age as possible.

Diabetes insipidus, diabetes mellitus, optic atrophy, and deafness. 3 cases of 'DIDMOAD' syndrome

Three children with diabetes insipidus, diabetes mellitus, optic atrophy, and high-tone deafness were shown to lack vasopressin, indicative of degeneration of the cells of the hypothalamic supraoptic nuclei. The syndrome being due to a single gene defect, inherited as an autosomal recessive, is therefore likely to be the result of an inborn error of metabolism with variable periods of latency in those affected.

Primary malignant tumours of the thyroid: the relationship between histological classification and clinical behaviour

One hundred and seventy-nine primary malignant tumours of the thyroid seen at The London Hospital between 1945 and 1972 were classified by the system of Woolner et al. (1961) and Hazard (1964). The distinct pathological and clinical features of the differentiated primary carcinomas and the similarities and differences between malignant lymphoma and anaplastic carcinoma were confirmed. This study showed the 'benign' behaviour of more than half the 'differentiated' papillary and follicular carcinomas when treated by thyroid lobectomy and the very malignant nature of anaplastic carcinomas and lymphomas whatever their treatment. The behaviour of medullary carcinoma was closer to that of the other differentiated tumours than to the undifferentiated varieties. Our patients were not thought to have been exposed to known goitrogens or previous thyroid irradiation.

Thyroid cancer in young patients in Great Britain

Recent collective experience with thyroid cancer in children in Britain is reported. Fifteen out of 16 patients with papillary carcinoma treated in the years 1962–7 are still living at least 5–10 years later; the sixteenth patient died of an unrelated cause. Two patients with follicular carcinoma also survived. Seven deaths between 1957 and 1970 were due to anaplastic or medullary carcinomas and 1 death was caused by a papillary carcinoma.

These data emphasize that in the treatment of papillary carcinoma we should take account of its prolonged natural history. Radical operations which have serious associated morbidity do not appear to be indicated.