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In this third article in the series, two further hypothetical scenarios are used to provide guidance on supporting breastfeeding mothers when the baby has a craniofacial anomaly or a cardiac defect. Successful breastfeeding in such circumstances has a positive effect on maternal confidence and attachment, and appears in itself to have healing potential. Unexpected benefits of breastfeeding critically ill babies include enhanced immunity and feeding tolerance in babies undergoing chemotherapy. A structured breastfeeding support service can assist staff in promoting successful breastfeeding in the paediatric environment. Expert, experiential knowledge of overcoming challenges in breastfeeding for mothers of critically ill babies can be applied in the absence of research evidence.

The first article in this series highlighted the challenges that mothers face in establishing breastfeeding (Wallis and Harper 2007). Breastfeeding a sick infant in hospital presents additional challenges such as small, sleepy babies, babies who may be nil by mouth for prolonged periods and babies who may find breastfeeding difficult due to mechanical problems. There is very little published abut the needs of babies with complex medical or surgical conditions who may have had significant delays in their feeding or numerous starts and stops along the way. This article and Part 2b in the November issue illustrate some of the common challenges and propose principles of care that are transferable to caring for other sick babies with similar problems.

Breastfeeding makes a vital contribution to the health and development of babies, as well as to long term health. Establishing breastfeeding may not be easy even for mothers with healthy full-term babies. Mothers in the paediatric environment experience additional challenges: sick babies, delayed onset of breastfeeding and having to establish and maintain breastfeeding in situations where privacy may be limited and anxiety levels high. This first part of a two-part article describes the development of a breastfeeding support service in a tertiary children's hospital. Institutional support, a dedicated post and a planned programme of training and education, with the development of specific resource materials, have resulted in a service that closely matches the expressed needs of mothers.

Therian mammals (marsupials and placentals) have an XX female: XY male sex chromosome system, which is homologous to autosomes in other vertebrates. The testis-determining gene, SRY, is conserved on the Y throughout therians, but is absent in other vertebrates, suggesting that the mammal system evolved about 310 million years ago (MYA). However, recent work on the basal monotreme mammals has completely changed our conception of how and when this change occurred. Platypus and echidna lack SRY, and the therian X and Y are represented by autosomes, implying that SRY evolved in therians after their divergence from monotremes only 166 MYA. Clues to the ancestral mechanism usurped by SRY in therians are provided by the monotremes, whose sex chromosomes are homologous to the ZW of birds. This suggests that the therian X and Y, and the SRY gene, evolved from an ancient bird-like sex chromosome system which predates the divergence of mammals and reptiles 310 MYA.

In eutherian ('placental') mammals, sex is determined by the presence or absence of the Y chromosome-borne gene SRY, which triggers testis determination. Marsupials also have a Y-borne SRY gene, implying that this mechanism is ancestral to therians, the SRY gene having diverged from its X-borne homologue SOX3 at least 180 million years ago. The rare exceptions have clearly lost and replaced the SRY mechanism recently. Other vertebrate classes have a variety of sex-determining mechanisms, but none shares the therian SRY-driven XX female:XY male system. In monotreme mammals (platypus and echidna), which branched from the therian lineage 210 million years ago, no orthologue of SRY has been found. In this study we show that its partner SOX3 is autosomal in platypus and echidna, mapping among human X chromosome orthologues to platypus chromosome 6, and to the homologous chromosome 16 in echidna. The autosomal localization of SOX3 in monotreme mammals, as well as non-mammal vertebrates, implies that SRY is absent in Prototheria and evolved later in the therian lineage 210-180 million years ago. Sex determination in platypus and echidna must therefore depend on another male-determining gene(s) on the Y chromosomes, or on the different dosage of a gene(s) on the X chromosomes.

The duck-billed platypus has five pairs of sex chromosomes, but there is no information about the primary sex-determining switch in this species. As there is no apparent SRY orthologue in platypus, another gene must acquire the function of a key regulator of the gonadal male or female fate. SOX9 was ruled out from being this key regulator as it maps to an autosome in platypus. To check whether other genes in mammalian gonadogenesis could be the primary switch in monotremes, we have mapped a number of candidates in platypus. We report here the autosomal location of WT1, SF1, LHX1, LHX9, FGF9, WNT4 and RSPO1 in platypus, thus excluding these from being key regulators of sex determination in this species. We found that GATA4 maps to sex chromosomes Y1 and X2; however, it lies in the pairing region shown by chromosome painting to be homologous, so is unlikely to be either male-specific or differentially dosed in male and female.

Sex determination in vertebrates is accomplished through a highly conserved genetic pathway. But surprisingly, the downstream events may be activated by a variety of triggers, including sex determining genes and environmental cues. Amongst species with genetic sex determination, the sex determining gene is anything but conserved, and the chromosomes that bear this master switch subscribe to special rules of evolution and function. In mammals, with a few notable exceptions, female are homogametic (XX) and males have a single X and a small, heterochromatic and gene poor Y that bears a male dominant sex determining gene SRY. The bird sex chromosome system is the converse in that females are the heterogametic sex (ZW) and males the homogametic sex (ZZ). There is no SRY in birds, and the dosage-sensitive Z-borne DMRT1 gene is a credible candidate sex determining gene. Different sex determining switches seem therefore to have evolved independently in different lineages, although the complex sex chromosomes of the platypus offer us tantalizing clues that the mammal XY system may have evolved directly from an ancient reptile ZW system. In this review we will discuss the organization and evolution of the sex chromosomes across a broad range of mammals, and speculate on how the Y chromosome, and SRY, evolved.

In the absence of an SRY orthologue the platypus sex determining gene is unknown, so genes in the human testis determining pathway are of particular interest as candidates. SOX9 is an attractive choice because SOX9 deletions cause male-to-female sex reversal in humans and mice, and SOX9 duplications cause female-to-male sex reversal. We have localized platypus SOX9, as well as the related SOX10, to platypus chromosomes 15 and 10, respectively, the first assignments to these platypus chromosomes, and the first comparative mapping markers from human chromosomes 17 and 22. The autosomal localization of platypus SOX9 in this study contradicts the hypothesis that SOX9 acts as the sex determining switch in platypus.

A survey of some 12,000 research scientists and engineers in Canada unexpectedly shows widespread pessimism about our future prospects in science and technology. Closer analysis, however, suggests that the negativity of responses only partly reflects the real situation. Instead, it appears that many researchers have been influenced by a fairly consistent set of values and beliefs that perpetuates a negative national self-image. This paper makes an exploratory, interdisciplinary study of Canada’s “cultural mythology” and its implications for future industrial development.