Search

This retrospective study aimed to determine the prevalence of preoperative anaemia, hypochromia and microcytosis in cardiac surgery patients. Data was analysed for 943 patients (over a two-year period) undergoing coronary artery bypass graft, valve or combined coronary artery bypass graft and valve surgery at a tertiary hospital in South Australia. Overall prevalence of preoperative anaemia was 25.2%, greater in males than females (27.6 vs 19.9%, P0.01). Of patients with preoperative anaemia, 19.3% had reduced red cell indices (mean corpuscular haemoglobin and/or mean corpuscular volume) compared to 4% of patients without anaemia. The proportion of anaemic patients with low red cell indices was significantly higher in women50 years and 50-65 years, compared to those65 years of age (P=0.003). Anaemic patients with low red cell indices had lower preoperative haemoglobin than anaemic patients without low red cell indices (median haemoglobin 112 vs 120 g/l, P=0.008). Compared to non-anaemic patients, anaemic patients had higher transfusion rates (79.8 vs 46.4%, P0.0001), which were greater in those with reduced red cell indices compared to those with normal red cell indices (93.5 vs 76.6%, P=0.01). This study demonstrated a high prevalence of preoperative anaemia, microcytosis and hypochromia in cardiac surgical patients.

Asia is increasingly entering into the Australian imaginary as the nation grapples with the issue of ‘Australian identity’. This article examines two instances in which the idea of Asia has been taken up in debates about marriage and relations between men and women. Asia is a site of fantasy for men in an era when they feel that ‘traditional’ values of male pre-eminence in the family are being undermined. In this fantasy, ‘Asia’ is known through stereotypic representations, the stereotypes underlying the nature of the response in the popular media.

Rationale: Myocardial infarction (MI) is a leading cause of death worldwide. Because endogenous cardiac repair mechanisms are not sufficient for meaningful tissue regeneration, MI results in loss of cardiac tissue and detrimental remodeling events. MicroRNAs (miRNAs) are small, noncoding RNAs that regulate gene expression in a sequence dependent manner. Our previous data indicate that miRNAs are dysregulated in response to ischemic injury of the heart and actively contribute to cardiac remodeling after MI. Objective: This study was designed to determine whether miRNAs are dysregulated on ischemic damage in porcine cardiac tissues and whether locked nucleic acid (LNA)-modified anti-miR chemistries can target cardiac expressed miRNAs to therapeutically inhibit miR-15 on ischemic injury. Methods and Results: Our data indicate that the miR-15 family, which includes 6 closely related miRNAs, is regulated in the infarcted region of the heart in response to ischemia-reperfusion injury in mice and pigs. LNA-modified chemistries can effectively silence miR-15 family members in vitro and render cardiomyocytes resistant to hypoxia-induced cardiomyocyte cell death. Correspondingly, systemic delivery of miR-15 anti-miRs dose-dependently represses miR-15 in cardiac tissue of both mice and pigs, whereas therapeutic targeting of miR-15 in mice reduces infarct size and cardiac remodeling and enhances cardiac function in response to MI. Conclusions: Oligonucleotide-based therapies using LNA-modified chemistries for modulating cardiac miRNAs in the setting of heart disease are efficacious and validate miR-15 as a potential therapeutic target for the manipulation of cardiac remodeling and function in the setting of ischemic injury.

Objectives. In 2006 South Australia had a red cell issue rate, measured as product issues per 1000 population, 22.4% higher than the national average. A pilot study was undertaken to investigate the disparity in issue rates between SA and the national average with a secondary aim of establishing information on SA red cell use. Methods. A linked electronic database was developed using clinical, epidemiological and red cell transfusion data within hospitals in the SA public sector. Aggregated red cell use across the SA public health sector was analysed by clinical variables such as Diagnosis Related Group (DRG), including speciality related groups (SRGs) and major diagnostic categories (MDCs). The DRGs that were associated with blood use were identified and applied to national hospital separations data in order to derive comparative blood utilisation rates for SA and Australia. Results. Although blood issue and usage by population measure showed a significant difference of 22.4 and 22.0% respectively between SA and Australia, when measured against weighted separations the differences reduced to 7.4 and 7.1% respectively. Conclusion. This study showed the importance of analysing blood issues and utilisation on an activity adjusted basis rather than a raw per capita basis. What is known about the topic? Transfusion practice can be monitored by various methods such as retrospective review of medical records and blood orders, prospective audits and analysis of blood usage by DRG classification. Blood utilisation studies have been used to describe the use of blood for a whole population or hospitals in order to understand the clinical reasons for transfusion. These studies also help to describe current practice, assess variability in practice and suggest areas where improvements in transfusion practice could be achieved. What does this paper add? This study enabled an analysis of red cell usage in South Australia and the factors that can influence blood utilisation rates. This study also emphasised the fact that blood usage is better represented on a hospital activity basis rather than by raw population. What are the implications for practitioners? The major implications for health practitioners would be the key findings related to red cell usage patterns. Firstly, older patients (>65 years) represented 36.5% of admissions and received 56.9% of the total red cells transfused. This has huge implications for future red cell use as an ageing population will both drive up demand and also result in a decreasing red cell donor pool. Secondly, high use of red cells in medical diagnoses such as haematology, medical oncology and gastroenterology confirms the current trend towards increasing use of red cells in medical diagnoses. This implies the need to focus on reducing reliance on blood use for medical patients and improve transfusion practice by regular audits, dissemination of guidelines and education.

Iron deficiency anaemia (IDA) remains prevalent in Australia and worldwide, especially among high-risk groups. IDA may be effectively diagnosed in most cases by full blood examination and serum ferritin level. Serum iron levels should not be used to diagnose iron deficiency. Although iron deficiency may be due to physiological demands in growing children, adolescents and pregnant women, the underlying cause(s) should be sought. Patients without a clear physiological explanation for iron deficiency (especially men and postmenopausal women) should be evaluated by gastroscopy/colonoscopy to exclude a source of gastrointestinal bleeding, particularly a malignant lesion. Patients with IDA should be assessed for coeliac disease. Oral iron therapy, in appropriate doses and for a sufficient duration, is an effective first-line strategy for most patients. In selected patients for whom intravenous (IV) iron therapy is indicated, current formulations can be safely administered in outpatient treatment centres and are relatively inexpensive. Red cell transfusion is inappropriate therapy for IDA unless an immediate increase in oxygen delivery is required, such as when the patient is experiencing end-organ compromise (eg, angina pectoris or cardiac failure), or IDA is complicated by serious, acute ongoing bleeding. Consensus methods for administration of available IV iron products are needed to improve the utilisation of these formulations in Australia and reduce inappropriate transfusion. New-generation IV products, supported by high-quality evidence of safety and efficacy, may facilitate rapid administration of higher doses of iron, and may make it easier to integrate IV iron replacement into routine care.

Notes on Contributors Introduction: Asian and Pacific Cosmopolitans: Self and Subject in Motion K.Robinson PART 1: REPRESENTATION, SELF-RECOGNITION AND SELF-DISCOVERY 'Self' and 'Subject' in Southeast Asian Literature in the Global Age T.Day Art and Identity Politics: Nation, Religion, Ethnicity, Elsewhere K.M.George Moving Stories: Beyond the Local in Ethnography and Fiction K.Narayan Wounds in Our Heart: Identity and Social Justice in the Art of Dadang Christanto C.Turner PART 2: RELIGION, COSMOPOLITANISM AND SUBJECTIFICATION Billy Graham in the South Seas R.Eves A Cultural Revival and the Custom of Christianity in Papua New Guinea A.Dundon Sufi Regional Cults in South Asia and Indonesia: Towards a Comparative Analysis P.Werbner PART 3: IDENTITY AND DISPLACEMENT The Dragon Dance: Shifting Meanings of Chineseness in Indonesia M.Budianta Identities in a Culture of Circulation: Performing Selves in Filipina Migration D.Mckay Transporting Culture Across Borders - The Hmong N.Tapp Index

The contemporary Asia-Pacific is a region characterized by contested identities and emergent subjectivities. As in other parts of the world, over the past two decades, ‘the acceleration of global economic restructuring … new transnational media, increasing flows of migrants, and proliferations of civil wars and humanitarian crises in the wake of the cold war’ have ‘set the stage for the revitalization of cosmopolitanism’ (Calhoun 2002, pp. 885–886). The migrant figures as the quintessential image of the new cosmopolitan, and this is reflected in the immense scholarly interest in diasporas and cultural hybridity. Cosmopolitanism can have diverse meanings — as political discourse and cultural practices — ‘Yet it recognizes something important: worldly productive sites of crossing; complex, unfinished paths between local and global attachments’ (Clifford 1998, p. 362). The authors in this book take up questions of subjectification and selfhood in the context of ‘sites of crossing’, exploring the consequences for processes of identification in parts of the world beyond the West. These sites exemplify the ‘sticky materiality’ (Tsing 2005) of the ‘friction’ of local/global encounters. Such encounters can be revealed in the context of globalization, the ‘designs to manage the world’ and the realm of ‘planetary conviviality’ and human compassion in which cosmopolitanism is given expression as political discourse (Mignolo 2000, p. 721).

Introduction: Anemia is one of the commonest presenting features of MDS and approximately 30-40% of patients require regular RBC-transfusion. RBC-transfusion dependency (RBC-TD) is a poor-prognostic factor independent of revised International Prognostic Scoring System (IPSS-R) (Hiwase et al ASH 2014). Although RBC transfusion increases the risk of alloimmunization, there is limited literature characterizing this risk in MDS patients as compared to other hematological disorders (such as thalassemia). Methods: This retrospective study assessed the alloimmunization rate in 784 MDS and AML (20-30% blasts) patients registered in the South Australian-MDS registry (SA-MDS registry) between 1991 and 2015. RBC-TD was defined as ≥1 unit of RBC transfused every eight weeks for four months according to WHO based Prognostic Scoring System. The cumulative incidence of RBC-alloimmunization was calculated using competing risk analysis (death being the competing risk). Factors associated with increased rate of RBC antibody formation were investigated by Cox regression analysis. Results: The median age of the 784 patients at diagnosis was 75 years with 66% males. The estimated median follow up time was 7.3 years. 70% of patients (549/784) were diagnosed with primary MDS, while the remaining patients were diagnosed with AML (20-30% blasts; n=57), CMML (n=91) or therapy-related myeloid neoplasm (T-MN; n=87). At last follow-up 30% patients were alive, 67% were deceased and 3% were lost to follow-up. During the study period, 658 (84%) patients required ≥1 unit of RBC transfusion and median RBC units transfused were 29 (range 0-708). The WPSS definition of RBC-TD was met in 47% (366/784 patients), while 36% (282/784) patients required intermittent RBC-transfusions (RBC-TI). During follow up, 83 (13%) patients formed 155 RBC-alloantibodies and 50% of these cases (42/83) developed >1 RBC-alloantibody. Autoantibodies were also detected in 31 cases, mainly in association with RBC-alloantibodies (n=27; complex alloimmunization) while 4 cases had only autoantibodies. Interestingly, in 19/27 of cases autoantibodies were detected only after alloimmunization. The pathophysiologic mechanism of this remains unclear. The most common alloantibody specificities were Rh (57%) and Kell (21%) (Table 1). The median interval between 1st RBC transfusion and antibody detection was 10 (0.2-225) months. In 9 cases (6 females) alloantibodies were detected prior to the 1st unit of RBC-transfused. The incidence of RBC alloimmunization reached a plateau at 16% by 100 units of RBC (Fig. 1A), however 80% of antibodies were detectable by 30-40 RBC units transfused. It indicates that most "responders" will form antibodies during the first 30-40 units of RBC transfused. Since most chronically transfused MDS patients do not form RBC alloantibodies it is important from a clinical and resource-utilization standpoint to identify who is at greatest risk of RBC alloimmunization. Multivariate analysis using Cox-regression model was performed. The only factor which was associated with significantly higher risk of RBC alloimmunization was RBC-TD (HR 2.52; p=0.0005). Age, sex, IPSS-R category and number of RBC units transfused did not independently predict alloimmunization rate. Using competing risk analysis, the cumulative incidence of RBC-alloimmunization was significantly higher in RBC-TD group compared to RBC-TI group (p=0.0004; Fig. 1B). Conclusion: RBC-alloimmunization is a substantial risk in MDS patients, especially in RBC-transfusion dependent cases. Extended phenotype matching (D,C,c,E,e and Kell) could have prevented alloantibody formation in 79% of alloimmunized MDS patients. Table 1. Specificity of 155 RBC-alloantibodies Table 1. Specificity of 155 RBC-alloantibodies Disclosures Yeung: Ariad: Honoraria, Membership on an entity's Board of Directors or advisory committees; BMS: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding.

Although recent microarray studies have provided evidence of RNA interference (RNAi)-mediated off-target gene modulation, little is known about whether these changes induce observable phenotypic outcomes. Here we show that a fraction of randomly selected small inhibitory RNAs (siRNAs) can induce changes in cell viability in a target-independent fashion. The observed toxicity requires an intact RNAi pathway and can be eliminated by the addition of chemical modifications that reduce off-target effects. Furthermore, an analysis of toxic and nontoxic duplexes identifies a strong correlation between the toxicity and the presence of a 4-base-pair motif (UGGC) in the RISC-entering strand of toxic siRNA. This article provides further evidence of siRNA-induced off-target effects generating a measurable phenotype and also provides an example of how such undesirable phenotypes can be mitigated by addition of chemical modifications to the siRNA.

In imagining Indonesia's future, its character as a country with the world's larg est Islamic population emerges as a critical issue. In the post-Suharto period, some commentators have seen the emergence of Islamist politics as a threat to newly attained freedoms. No sooner had women been freed from the constraints of 'state ibuism', i.e., the official policy promoting the role of wife and mother [ibu] of the New Order (see Suryakusuma 1996), which endorsed patriarchal familism as a cornerstone of authoritarian politics, than they faced a new kind of patriarchal authority in the demands for the enactment of shari'a as state law. For example, during her 2005 visit to Australia, Indonesian feminist com mentator Julia Suryakusuma raised the specter of Islam as the greatest current threat to gender equity and to women as social actors in civic life, whose rights in the domestic sphere are now protected by the state. The growing influence of Middle Eastern Islam in Indonesia, evidenced by funding for organizations, translations of publications, and the increase in Islamist rhetoric, has caused alarm among many observers. This apprehension draws on the stereotype of the Middle East as the source of all that is 'bad' about Islam, taken as an undif ferentiated whole. But this view of Islam fails to acknowledge debates within Islam and diversity in Islamic practice, not the least of which are the varieties of Islam that can be found throughout the Indonesian archipelago. These diverse practices have emerged as local communities and indigenous polities responded in distinctive and often unique ways during the long period of Islamic conver sion, beginning from the thirteenth century.

There are many challenging problems related to bleeding and anticoagulation in cardiac surgery. Practical guidelines, which are based on available evidence, can help to direct management issues of post-bypass bleeding, perioperative anticoagulation and the use of haemostatic agents. The patient's bleeding history is the most useful preoperative screening test of haemostasis. The input of a haematologist is often valuable in a number of areas, such as preoperative assessment of patients with a significant history of bleeding, or past history of heparin-induced thrombocytopenia, a lupus anticoagulant, or recent venous thromboembolism. Cardiothoracic surgeons, anaesthetists, perfusionists and haematologists can ensure ‘best practice’ by being actively involved in the development of ‘local’ transfusion and anticoagulation guidelines, hospital transfusion committee policies, and audits.

We summarise recent advances in transfusion medicine applicable to cardiac surgery and cardiac transplantation. It is important that clinicians know the risks of blood transfusion in Australia. They should also be aware of the different types of transfusion reaction so that there is early recognition and investigation. Blood conservation strategies including acceptance of normovolaemic anaemia in clinically stable patients are important in reducing the requirement for red cell transfusion. Cytomegalovirus (CMV) seronegative blood products are recommended for heart transplant recipients with no evidence of prior CMV infection. Leucodepletion of units of unknown CMV status reduces the risk of CMV infection and are an acceptable alternative when seronegative units are unavailable. Leucodepletion of cellular blood products has been shown to reduce infection rates postoperatively in a large trial involving cardiac surgical patients. Further studies are needed to confirm this promising finding. Irradiation of blood products eliminates the risk of transfusion-associated graft versus host disease. Routine preoperative screening for cold agglutinins is no longer recommended.

Off-target gene silencing can present a notable challenge in the interpretation of data from large-scale RNA interference (RNAi) screens. We performed a detailed analysis of off-targeted genes identified by expression profiling of human cells transfected with small interfering RNA (siRNA). Contrary to common assumption, analysis of the subsequent off-target gene database showed that overall identity makes little or no contribution to determining whether the expression of a particular gene will be affected by a given siRNA, except for near-perfect matches. Instead, off-targeting is associated with the presence of one or more perfect 3' untranslated region (UTR) matches with the hexamer or heptamer seed region (positions 2-7 or 2-8) of the antisense strand of the siRNA. These findings have strong implications for future siRNA design and the application of RNAi in high-throughput screening and therapeutic development.

In this article, we assemble and synthesize the available industrial hygiene data that describe exposure during the marine transport of benzene-containing products in the United States and abroad. A total of 25 studies were identified and summarized. The measured airborne concentrations of benzene on marine vessels were found to vary depending on several key factors, including the job task, vessel characteristics, cargo type, and sample type and duration. Despite the differences in sampling strategies and benzene content of the liquids being transported, personal time-weighted-average benzene air concentrations typically ranged from 0.2-2.0 ppm during closed loading and 2-10 ppm during open loading operations. Benzene exposures during these activities are likely due to specific short-term tasks, such as connecting and disconnecting hoses and tank gauging and sampling. Similar concentrations of benzene have been reported in the pump room during marine loading operations and during tank cleaning activities in various settings. When compared with contemporaneous occupational health standards, our review indicates that most activities performed on marine vessels from the 1970s to 1990s usually did not result in benzene exposures that exceeded these standards. The information and data presented here may be useful for quantitatively estimating or reconstructing historical exposures during the marine transport of benzene-containing cargo if details about individual's work histories in the maritime industry are available.

The Gbeta and Ggamma subunit of the heterotrimeric G proteins form a functional dimer that is stable once assembled in vivo or in vitro. The requirements, mechanism, and specificity of dimer formation are still incompletely understood, but represent important biochemical processes involved in the specificity of cellular signaling through G proteins. Here, seven Gbeta and 12 FLAG-epitope-tagged Ggamma subunits were separately synthesized in vitro using a rabbit reticulocyte lysate expression system. The translation products were combined and dimers isolated by immunoprecipitation. Gbeta1 and Gbeta4 formed dimers with all Ggamma subunit isoforms, generally with Gbeta/Ggamma stoichiometries between 0.2:1 and 0.5:1. Gbeta5, Gbeta5L, and Gbeta3s did not form significant amounts of dimer with any of the gamma subunit isoforms. Gbeta2 and Gbeta3 formed dimers with selected Ggamma isoforms to levels intermediate between that of Gbeta1/Gbeta4 and Gbeta3s/Gbeta5/Gbeta5L. We also expressed selected Gbetagamma in HEK293 cells and measured PLCbeta2 activity. Gbetagamma dimer-dependent increases in IP3 production were seen with most Gbeta1, Gbeta2, and Gbeta5 combinations, indicating functional dimer expression in intact cells. These results define the complete set of G protein betagamma dimers that are formed using a single biochemical assay method and suggest that there are Gbeta isoform-specific factors in rabbit reticulocyte lysates that determine the efficacy of Gbetagamma dimer formation.

[Extract] The Asia Pacific Journal of Anthropology (TAPJA) is proud to celebrate the career of Douglas Miles, who pioneered Anthropological studies of Southeast Asia in Australia, through major fieldwork among the Ngadju Dayaks of Borneo (1959-60, 1961-63) and the Yao of Northern Thailand and Laos (1966-69, 1970, 1996-97).

Patient blood management (PBM) aims to improve patient outcomes by avoiding unnecessary exposure to transfusion through effective conservation and management of a patient’s own blood. PBM requires a proactive, multidisciplinary and team based approach. A review of the 2001 National Health and Medical Research Council (NHMRC)/Australasian Society of Blood Transfusion (ASBT) Clinical Practice Guidelines for the use of Blood Components is currently being undertaken by the National Blood Authority (NBA) on behalf of all governments. A series of six modules will compromise the new Patient Blood Management Guidelines. The Critical Bleeding, Perioperative and Medical modules have been released and are available at www.nba.gov.au/ guidelines/. The three pillars of PBM are optimisation of red cell mass, minimisation of blood loss and optimisation of the patient’s tolerance of anaemia. Preoperative anaemia should be identified, evaluated and managed to minimise RBC transfusion, which may be associated with an increased risk of morbidity, mortality, intensive care unit length of stay and hospital length of stay. Surgical patients should be evaluated as early as possible to coordinate scheduling of surgery with optimisation of haemoglobin and iron stores. Approaches to coordinating care prior to elective surgery will be reviewed.

After qualifying, John Warburton Lewis did his national service in the Royal Army Medical Corps and then he looked after his father’s practice in Newbury after his sudden death in 1949. In 1950 he took up an assistantship to the practice in Malmesbury and moved to Nailsworth in 1951 to run …

Nat. Methods 3, 199–204 (2006). In Figure 3 of the original article, the genes in panels a–c were incorrectly identified. The correct gene names are: (a) Ppyr/LUC siRNA A, (b) ALPPL2 and (c) Ppyr/LUC siRNA B. The figure legend should read: Figure 3 | Systematic single base pair–mismatch analysis of siRNA functionality.

Addendum: 3′ UTR seed matches, but not overall identity, are associated with RNAi off-targets

Editor—We read with interest the first in your series of articles on common problems in primary care, on the topic of management of menorrhagia.1 We would, however, like to draw attention to one important aspect that was overlooked, which we believe deserves wider recognition. Menorrhagia may be a manifestation of an underlying inherited disorder of coagulation. Such disorders are by no means rare. A recent British study found that as many of 17% of women with menorrhagia and no underlying pelvic disease had an inherited bleeding disorder, the most common of which was von Willebrand's disorder.2 An earlier study from Sweden also found the prevalence of von Willebrand's disorder among women with menorrhagia to be 20%.3 The history in the initial consultation should therefore include specific questions to elicit features suggestive of an underlying bleeding disorder. These include a history of menorrhagia since menarche, recurrent epistaxis, bleeding after dental extraction, operations, or parturition, and a family history. The Royal College of Obstetricians and Gynaecologists in the United Kingdom has recommended screening of selected women for bleeding disorders in their guidelines on the management of menorrhagia in secondary care.4 The identification of inherited bleeding disorders is important not only because these women may have invasive procedures but also for future pregnancies and family members. Women with inherited bleeding disorders may, however, not complain of menorrhagia (which is often socially limiting) because their bleeding is similar to what other family members have experienced. The primary care physician is in the unique position of identifying these patients when they attend for other problems. Referral of patients with suggestive histories to a haematologist should be considered.

The establishment of a nickel mine has greatly affected the lives of the inhabitants of a formerly remote rural community in Indonesia. The article examines some of the health consequences of the project for the local people. In particular, it discusses problems of water and sanitation in the mining town, the nutritional consequences of changing social relations with capitalist development, and problems in the delivery of health care. The conflicts generated by these issues indicate some of the shortcomings of a national development strategy which relies heavily on private foreign investment.