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During 2021-22 High Pathogenicity Avian Influenza (HPAI) killed thousands of wild birds across Europe and North America, suggesting a change in infection dynamics and a shift to new hosts, including seabirds. Northern Gannets (Morus bassanus) appeared especially severely impacted, but limited understanding of how the virus spread across the metapopulation, or the demographic consequences of mass mortality limit our understanding of its severity. Accordingly, we collate information on HPAIV outbreaks across most North Atlantic gannet colonies and for the largest colony (Bass Rock, UK), provide impacts on population size, breeding success, adult survival, and preliminary results on serology. Unusually high numbers of dead gannets were first noted in Iceland during April 2022. Outbreaks in May occurred in many Scottish colonies, followed by colonies in Canada, Germany and Norway. By the end of June, outbreaks had occurred in five Canadian colonies and in the Channel Islands. Outbreaks in 12 UK and Ireland colonies appeared to follow a clockwise pattern with the last infected colonies recorded in late August/September. Unusually high mortality was recorded at 40 colonies (75% of global total colonies). Dead birds testing positive for HPAIV H5N1 were associated with 58% of these colonies. At Bass Rock, the number of occupied sites decreased by at least 71%, breeding success declined by ∼66% compared to the long-term UK mean and adult survival between 2021 and 2022 was 42% lower than the preceding 10-year average. Serological investigation detected antibodies specific to H5 in apparently healthy birds indicating that some gannets recover from HPAIV infection. Further, most of these recovered birds had black irises, suggestive of a phenotypic indicator of previous infection. Untangling the impacts of HPAIV infection from other key pressures faced by seabirds is key to establishing effective conservation strategies for threatened seabird populations, HPAIV being a novel and pandemic threat.

Introduction Ankle fractures in sport are common. Their optimal management is unclear, as is when patients can return to their sports activities. This systematic review provides a contemporary assessment of the literature on return to sports following acute traumatic ankle fractures managed both operatively and non-operatively. Sources of data We systematically searched Pubmed, Google Scholar, the Cochrane Library, EMBASE and CINAHL using the terms ‘ankle fractures’, ‘ankle injuries’, ‘athletes’, ‘sports’, ‘return to sport’, ‘return to activity’, ‘operative management’, ‘non-operative management’. Areas of agreement Thirteen retrospective studies fulfilled the inclusion criteria. The methodological quality of the studies was generally poor. The proportion of patients returning to sporting activity was high. In some studies, a quicker return to sporting activity was demonstrated in patients managed non-operatively. Areas of controversy The time to return to sporting activity and level of performance post-treatment are not universally recorded, and the optimal time to return to sport remains to be confirmed. Growing points Conservative management for stable or undisplaced fracture may result in a higher proportion of patients returning to sport more quickly. Areas timely for developing research Randomized controlled trials should compare conservative to surgical treatment for appropriately chosen fracture patterns. Future studies should routinely report the timing of return to sport, the level of performance reached, and the time to achieve this.

Tubo-ovarian high-grade serous carcinomas (HGSC) are highly proliferative neoplasms that generally respond well to platinum/taxane chemotherapy. We recently identified minichromosome maintenance complex component 3 (MCM3), which is involved in the initiation of DNA replication and proliferation, as a favorable prognostic marker in HGSC. Our objective was to further validate whether MCM3 mRNA expression and possibly MCM3 protein levels are associated with survival in patients with HGSC. MCM3 mRNA expression was measured using NanoString expression profiling on formalin-fixed and paraffin-embedded tissue (N = 2355 HGSC) and MCM3 protein expression was assessed by immunohistochemistry (N = 522 HGSC) and compared with Ki-67. Kaplan–Meier curves and the Cox proportional hazards model were used to estimate associations with survival. Among chemotherapy-naïve HGSC, higher MCM3 mRNA expression (one standard deviation increase in the score) was associated with longer overall survival (HR = 0.87, 95% CI 0.81–0.92, p < 0.0001, N = 1840) in multivariable analysis. MCM3 mRNA expression was highest in the HGSC C5.PRO molecular subtype, although no interaction was observed between MCM3, survival and molecular subtypes. MCM3 and Ki-67 protein levels were significantly lower after exposure to neoadjuvant chemotherapy compared to chemotherapy-naïve tumors: 37.0% versus 46.4% and 22.9% versus 34.2%, respectively. Among chemotherapy-naïve HGSC, high MCM3 protein levels were also associated with significantly longer disease-specific survival (HR = 0.52, 95% CI 0.36–0.74, p = 0.0003, N = 392) compared to cases with low MCM3 protein levels in multivariable analysis. MCM3 immunohistochemistry is a promising surrogate marker of proliferation in HGSC.

Canis lupus (Gray Wolf) have been suspected as natural predators of Cygnus buccinator (Trumpeter Swan), but detailed descriptions of such predation events are lacking from the peer-reviewed literature. Herein, we document a Trumpeter Swan that was killed by a Gray Wolf fitted with a GPS collar in northern Minnesota, thus confirming that wolves are natural predators of Trumpeter Swans.

Background Though carotid artery stenting (CS) has gained popularity as an alternative to carotid endarterectomy, studies examining long-term results are limited. Methods All consecutive patients who underwent unilateral CS between 7/1993 and 8/2005 with no or non-significant contralateral stenosis were included. Follow-up with duplex sonography and/or angiography and neurological assessment was performed at 6 and/or 12 months. Thereafter, annually, a questionnaire was sent to the patients and their referring physicians. Results Two-hundred and seventy-nine patients underwent CS. In 99% of procedures stent delivery was successful. The periprocedural major and minor stroke rates were 2.2%, respectively. The periprocedural major stroke or death rate was 2.9%. Median clinical follow-up was 49 ± 32 months (range: 30 days–12.1 years). Excluding perioperative (

To examine the outcome for patients with stage IB2 cervical cancer treated primarily with radical hysterectomy, and to determine the need for adjuvant therapy, the sites of recurrence, and the morbidity of the treatment.We reviewed our experience with 93 patients with stage IB2 cervical cancer treated with primary surgery at the Royal Hospital for Women in Sydney from 1988 to 2008. All patients underwent radical hysterectomy and pelvic lymphadenectomy. If bulky positive nodes were encountered, they were resected without complete lymphadenectomy. Postoperative radiation was tailored to the histologic findings.The mean age of the patients was 46 years, and 70% had squamous cell carcinomas. Tumor invaded into the outer third of the cervical stroma in 73 cases (78.5%), occult parametrial extension occurred in 15 cases (16.1%), and vascular space invasion occurred in 65 cases (69.9%). Positive pelvic nodes were present in 42 patients (45.2%) and bulky positive para-aortic nodes were present in 5 patients (5.4%). Some type of postoperative adjuvant (chemoradiation) radiation was given to 74 patients (79.6%). With a median follow-up of 96 months, the overall 5-year survival was 80.7%, being 85% for patients with negative nodes and 75% for those with positive nodes (hazard ratio 2.63, 95% confidence interval 1--5.6; P=.045). The major long-term surgical morbidity was lymphedema, which occurred in eight patients (8.6%). Serious long-term radiation morbidity (Radiation Therapy Oncology Group grade 3) occurred in three patients (3.2%).Primary radical hysterectomy with tailored postoperative adjuvant radiation for patients with stage IB2 cervical cancer provides good survival with acceptably low morbidity.III.

Higher education institutions all over the world have been increasing their student intake due to higher demands for education, creating larger and larger classes. The problems of teaching a large class are widely recognized and various solutions have been suggested. The pedagogy literature establishes that learning outcomes and engagement for students in large classes are improved when students feel that they belong to small groups within the classes. This article describes recent changes to a second year statistics unit with large practicals aimed initially at promoting group work, and more generally at conferring some of the benefits of smaller classes. Specifically, we aimed to increase students’ interaction with tutors and each other, and to develop students' verbal communication skills and confidence through short unrehearsed presentations. Results of preliminary analysis of students’ responses to survey questions on their learning habits and learning environment showed that students are generally happy with the new learning space regardless of their age, gender and whether they were local or international students. Although students felt less comfortable presenting their solutions to the class, they found it worthwhile to listen to peers’ solution presentations. Overall, students found their peers and teaching staff to be supportive of their learning.

This study was designed to investigate a novel device that was developed to direct emboli away from the internal carotid artery to the external carotid artery to prevent embolic stroke while avoiding the necessity for anticoagulation with warfarin. A stent-like, self-expandable filter was developed consisting of fine cobalt alloy mesh. After promising preclinical animal testing, the device was implanted into the common carotid artery extending into the external carotid artery in three patients with atrial fibrillation, each of whom were at high-risk for cerebral emboli and were suboptimal candidates for anticoagulation. Follow-up was performed clinically and with carotid duplex ultrasound. The implantation was successful in all three patients. Unrestricted flow through the filter was demonstrated in each patient at 6 months by duplex sonography. However, at 7 months ultrasound demonstrated occlusion of the internal carotid artery filter in one patient, which was subsequently confirmed by angiography. Subtotal filter occlusion occurred in a second patient at 14 months. Neither patient had clinical symptoms. Both internal carotid arteries were successfully recanalized using standard angioplasty techniques without complication. The third patient had completely normal carotid blood flow at 29 months follow-up. Implantation of a novel device intended to divert emboli away from the internal carotid artery was feasible, but resulted in occlusive neointimal proliferation in two of three patients. These results demonstrate a discrepancy from the findings of preclinical animal studies and human investigation.

Advanced and recurrent ovarian cancer results in extensive spread of tumor on the peritoneal surfaces of the abdomen and pelvis. We collectively review studies in the literature that report the efficacy of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for ovarian cancer peritoneal carcinomatosis. An electronic search of all relevant studies published in peer-reviewed journals before May 2009 was performed on three databases. The quality of each study was independently assessed and classified according to the time point of HIPEC use in various setting of ovarian cancer from the consensus statement of the Peritoneal Surface Oncology Group. Clinical efficacy was synthesized through a narrative review with full tabulation of the results of each included study. Nineteen studies each of more than ten patients reporting treatment results of HIPEC of patients with both advanced and recurrent ovarian cancer were included and data were extracted. All studies were observational case series. The overall rate of severe perioperative morbidity ranged from 0 to 40% and mortality rate varied from 0 to 10%. The overall median survival following treatment with HIPEC ranged from 22 to 64 months with a median disease-free survival ranging from 10 to 57 months. In patients with optimal cytoreduction, a 5-year survival rate ranging from 12 to 66% could be achieved. Despite the heterogeneity of the studies reviewed, current evidence suggest that complete CRS and HIPEC may be a feasible option with potential benefits that are comparable with the current standard of care. A randomized trial is required to establish the role of HIPEC in ovarian cancer.

OBJECTIVE To study patterns of recurrence, to evaluate pathologic features correlating with recurrence, and to estimate the prognostic implications for each different pattern of recurrence in the International Federation of Gynecology and Obstetrics (FIGO) stages I and II squamous cell vulvar cancer. METHODS This was a retrospective study of 121 cases of vulvar cancer managed at our institution from 1987 to 2005. Time to recurrence, sites of local and distant recurrence, and the type of surgery were recorded. Relapse-free and overall survival were calculated. RESULTS There was no difference in recurrence rates, time to recurrence, or survival between patients with FIGO stages I or II disease. The 5-year actuarial survival (corrected for competing risks) for stage I disease was 97% compared with 95% for stage II (P=.83). Progression-free survival at 5 years was 86% for stage I and 94% for stage II.In this study, 95.9% of patients were treated with vulvar-conserving surgery without detriment with respect to recurrence or survival. CONCLUSION Vulvar-conserving surgery, even for large tumors, results in excellent outcomes. Vulvar recurrences have an excellent prognosis, but primary site and remote site vulvar recurrences are biologically different. There is no justification for the FIGO differentiation of node-negative cancers confined to the vulva on the basis of tumor size. LEVEL OF EVIDENCE III.

This article extends current understandings of sources of job (dis)satisfaction for childcare staff by investigating the hypothesis that early childhood professionals’ satisfaction with regulatory requirements is a predictor of job satisfaction. Findings show that for early childhood professionals in New South Wales, Australia, satisfaction with the regulatory environment is related to the extent these requirements are perceived to support autonomous professional practices conducive to quality care. Considerable dissatisfaction with regulatory requirements was found among study participants. Nonetheless, this level of dissatisfaction did not predict job (dis)satisfaction. The lack of correlation may be indicative of the study’s sample, however, and does not preclude a greater connection between the two constructs. Implications of a possible nexus between job satisfaction and satisfaction with regulatory requirements are discussed, and further research is called for.

Autopsy studies have demonstrated a very high incidence of positive retroperitoneal lymph nodes in patients with advanced ovarian cancer, but the clinical management of these nodes has only recently been investigated. Several institutional studies had suggested an advantage to systematic removal of pelvic and paraaortic nodes in patients whose tumor was optimally cytoreduced in the peritoneal cavity. However, the only randomized prospective study revealed a 7-month benefit in progression-free survival for patients having systematic lymphadenectomy, but no benefit in terms of overall survival. Unless a future randomized trial shows evidence to the contrary, removal of clinically normal nodes should not be considered part of the standard care for patients with advanced ovarian cancer. Bulky nodes should be removed as part of the surgical aim of removing all macroscopic residual disease

Aims: False aneurysms can be treated surgically or by ultrasound guided manual compression. Another method is to inject thrombin into the aneurysm under ultrasound guidance. We evaluated safety and efficacy of this approach in a multicentre registry. Methods and results: In 595 consecutive patients a pseudoaneurysm (593 femoral arteries, 2 brachial arteries) was diagnosed 0 to 250 days (median 3 days) after a catheter procedure. The diameter of the aneurysm -anged from 0.5×0.5×0.5 (L×W×D) to 8×11×16 cm (median 2×2×1.6 cm). 20 U lo 4000 U (median 400 U) of thrombin solution were injected into the aneurysm under ultrasound guidance. The procedure was technically successful in 587/595 (99%) patients. The aneurysms were thrombosed after the first injection in 531 (89%) patients. Thirty-eight (6%) patients needed a second injection and eight (1%) patients, a third injection because residual flow in the aneurysm was visible at follow-up. In four (0.7%) additional patients the thrombosis of the aneurysms was delayed and occurred only after 24 hours to sever days. Six (1%) patients surgery was performed after successful closure of the aneurysm lo remove the resulting haematoma. The overall technical success rate was 99% and clinical success was achieved in 96% Eight (1%) other patients underwent surgery due to thrombin injection failure. Complications occurred in nine patients (1,5%). Intravascular thrombus formation, deep venous thrombosis, pulmonary embolism due to deep venous thrombosis, transient paresthesia in the leg during injection Conclusions: Ultrasound guided thrombin injection is a safe, effective and rapid treatment of false aneurysms. Complications and recurrent pseudoanetrysms are rare.

The regulatory environment in which long daycare centres are required to operate plays a key role in determining what early childhood professionals do and how they go about doing it. This paper reports findings from a state‐wide survey undertaken in New South Wales, Australia, which shows how early childhood professionals position themselves on four key aspects of the regulatory environment: the premises underlying regulatory requirements; its perceived support of them as professionals to provide quality care; how state regulations and the national accreditation system impact upon their daily practice; and the way these audit systems affect their professional esteem. Implications for job satisfaction are discussed. The paper concludes by asserting that regulatory requirements need to be evaluated in terms of their contribution to structural, process, contextual and work environment dimensions of quality.

Seven patients seen between January 1995 and December 1998 developed symptomatic lymphatic ascites following either pelvic or para-aortic lymph node dissection. The incidence of symptomatic lymphatic ascites during this 4-year period was 2.7% (7 of 263 cases). The accumulation of ascites postoperatively was associated with a prolonged postoperative ileus, abdominal pain, and extended postoperative hospitalization. Once the condition was recognized, abdominal paracentesis resulted in rapid improvement of symptoms in two patients but repeated paracenteses were required for a further two patients who had significant complications as a result of these procedures. Two patients improved following spontaneous drainage of a large amount of ascites per vagina and did not require further intervention. The final patient settled with observation only. This condition can be difficult to recognize and is a potential cause of significant postoperative morbidity.

BACKGROUND After radical hysterectomy and pelvic lymph node dissection, an identifiable subgroup of patients with International Federation of Gynecology and Obstetrics Stage IB lymph node negative cervix carcinoma remains at high risk of pelvic recurrence. This study attempted to determine whether postoperative small field of pelvic radiation can improve the disease free survival (DFS) of this high risk group of patients without producing significant morbidity. METHODS Between 1991 and 1995, after radical surgery, 25 patients with Stage IB lymph node negative cervix carcinoma were considered to be at high risk of pelvic recurrence on the basis of tumor dimension, depth of stromal invasion, and the presence of lymph-vascular space invasion. All had a score ≥ 120 as determined by the Gynecologic Oncology Group (GOG) study. These patients received 50.4 gray of adjuvant radiation to a small central pelvic field and were followed prospectively. A Kaplan–Meier 5-year DFS curve was generated. A log rank analysis produced an estimated log rank P value (est P value) by comparing the 5-year DFS of the patients in the current study with the 5-year DFS of the corresponding high risk group of the GOG study (observation only). The morbidity of small field pelvic radiation was recorded. RESULTS Among the 25 patients who received small field pelvic radiation, the mean GOG score was 166 (range, 120–263) and the mean follow-up was 32 months (range, 12–64 months). There was 1 recurrence (4%) recorded at 16 months. The log rank analysis demonstrated a significant improvement in the 5-year DFS for the group who received adjuvant small field pelvic radiation (est P value = 0.005) when compared with the DFS of the high risk GOG patients who were observed postoperatively. Four cases of minor morbidity were recorded: lymphedema (three cases) and mild rectal incontinence (one case). No major morbidity was reported. CONCLUSIONS With low morbidity, adjuvant small field pelvic radiation appears to improve significantly the 5-year DFS of patients with high risk, lymph node negative Stage IB cervical carcinoma. However, this pilot study requires verification. Cancer 1999;86:2059–65. © 1999 American Cancer Society.

Jeffrey B. Gibson, The Temptations of Jesus in Early Christianity, reviewed by Colleen Shantz Norman C. Habel, The Land Is Mine: Six Biblical Land Ideologies, reviewed by Marvin L. Anderson Thomas W. Gillespie, The First Theologians: A Study in Early Christian Prophecy, reviewed by Michael P. Knowles Richard A. Horsley, Galilee: History, Politics, People, reviewed by William E. Arnal Gareth Schmeling, ed., The Novel in the Ancient World, reviewed by Richard S. Ascough David C. Sim, Apocalyptic Eschatology in the Gospel of Matthew., reviewed by John S. Kloppenborg Jeffrey L. Staley, Reading with a Passion: Rhetoric, Autobiography, and the American West in the Gospel of John, reviewed by Willi Braun Carsten P. Thiede, Re-Kindling the Word: Jesus, Qumran and the Papyri, reviewed by Jean-Fran~ois Racine Lauri Thuren, The Motivation of the Paraenesis: Discovering Argumentation and Theology in 1 Peter, reviewed by Robert L. Webb Renita J. Weems, Battered Love: Marriage, Sex, and Violence in the Hebrew Prophets, reviewed by John L. McLaughlin Brad H. Young, Jesus the Jewish Theologian, reviewed by Robert Derrenbacker John M. Badertscher, Gordon Harland and Roland E. Miller, Religious Studies in Manitoba and Saskatchewan: A State-of-the-Art Review, reviewed by Bryan Hills Brian J. Fraser, The Study of Religion in British Columbia: A State-of-the-Art Review, reviewed by Robert K. Burkinshaw R.D. Gidney and W.P.I. Millar, Professional Gentlemen: The Professions in Nineteenth-Century Ontario, reviewed by Sharon Anne Cook Carmel McEnroy, Guests in Their Own House: The Women of Vatican II., reviewed by Ellen M. Leonard Mark A. Noll, David W. Bebbington and George A. Rawlyk, eds., Evangelicalism: Comparative Studies in Popular Protestantism in North America. the British Isles, and Beyond 1700-1990, reviewed by John W. Stephenson Elizabeth Alvilda Petroff, Body and Soul: Essays on Medieval Women and Mysticism, reviewed by Kate Galea Kim Power, Veiled Desire: Augustine on Women, reviewed by Richard Valantasis Scott L. Waugh and Peter D. Diehl, eds., Christendom and Its Discontents: Exclusion, Persecution, and Rebellion 1000-1500, reviewed by Evelyn A. Mackie Earle H. Waugh, Dissonant Worlds: Roger Vandersteene Among the Cree, reviewed by David Nazar Peter Wyatt, Jesus Christ and Creation in· the Theology of John Calvin, reviewed by Anna Case-Winters John Fenwick and Bryan Spinks, Worship in Transition: The Liturgical Movement in the Twentieth Century, reviewed by Alan L. Hayes Margaret Eletta Guider, Daughters of Rahab: Prostitution and the Church of Liberation in Brazil, reviewed by Helen-May Eaton-Ramirez Howard Clark Kee and Irvin Borowski, eds., Removing Anti-Judaism from the Pulpit, reviewed by Dow Marmur Bill McKibben, The Comforting Whirlwind: God, Job, and the Scale of Creation, reviewed by Michael Kolarcik Mercy Amba Oduyoye, Daughters of Anowa: African Women and Patriarchy, reviewed by Diana L. Hayes Marjorie Procter-Smith, Praying with Our Eyes Open: Engendering Feminist Liturgical Prayer, reviewed by Pamela Ann Moeller Ted A. Campbell, Christian Confessions: A Historical Introduction, reviewed by Philip G. Ziegler Anne E. Carr, Transforming Grace: Christian Tradition and Women' s Experience, reviewed by Grace Kim Gary David Comstock, Unrepentant, Self-Affirming, Practicing: Lesbian/Bisexual! Gay People within Organized Religion, reviewed by Donald C. Smith Dawn De Vries, Jesus Christ in the Preaching of Calvin and Schleiermacher, reviewed by lain G. Nicol Willem B. Drees, Religion, Science and Naturalism, reviewed by Donald Wiebe David J. Gouwens, Kierkegaard as Religious Thinker, reviewed by Abrahim H. Khan Colin Grant, A Salvation Audit, reviewed by Nancy L. Cocks Moshe Idel and Bernard McGinn, eds., Mystical Union in Judaism, Christianity and Islam: An Ecumenical Dialogue, reviewed by Dow Marmur Gordon D. Kaufman, God-Mystery-Diversity; Christian Theology in a Pluralistic World, reviewed by DarylCulp Julian Kunnie, Models of Black Theology: Issues in Class, Culture and Gender, reviewed by Ogbu U. Kalu Geiko Miiller-Fahrenholz, God's Spirit: Transforming a World in Crisis, reviewed by Philip G. Ziegler Mark I. Wallace. Fragments, of the Spirit: Nature, Violence, and the Renewal of Creation, reviewed by Philip G. Ziegler Anne E. Patrick, Liberating Conscience: Feminist Explorations in Catholic Moral Theology, reviewed by Bridget Campion Terence Penelhum, Reason and Religious Faith, reviewed by Abrahim H. Khan John Polkinghorne, The Faith of a Physicist, reviewed by Donald Wiebe Jung Suk Rhee, Secularization and Sanctification: A Study of Karl Barth's Doctrine of Sanctification and Its Contextual Application to the Korean Church, reviewed by Carl F. Starkloff John J. Robertson, Jr., The Loss and Recovery of Transcendence: The Will to Power and the Light of Heaven, reviewed by Brian J. Walsh Christoph Schwabel, ed., Trinitarian Theology Today: Essays on Divine Being and Act, reviewed by Myroslaw Tataryn Thomas F. Torrance., The Christian Doctrine of God: One Being, Three Persons, reviewed by Myroslaw Tataryn Harold Wells, A Future for Socialism? Political Theology and the "Triumph of Capitalism", reviewed by Donald C. Smith Stephen N. Williams, Revelation and Reconciliation: A Window on Modernity, reviewed by Greg Robertson Pamela Dickey Young, Christ in a Post-Christian World, reviewed by Cora Twohig-Moengangongo

Though carotid artery stenting (CS) has gained popularity as an alternative to carotid endarterectomy, studies examining long-term results are limited.All consecutive patients who underwent unilateral CS between 7/1993 and 8/2005 with no or non-significant contralateral stenosis were included. Follow-up with duplex sonography and/or angiography and neurological assessment was performed at 6 and/or 12 months. Thereafter, annually, a questionnaire was sent to the patients and their referring physicians.Two-hundred and seventy-nine patients underwent CS. In 99% of procedures stent delivery was successful. The periprocedural major and minor stroke rates were 2.2%, respectively. The periprocedural major stroke or death rate was 2.9%. Median clinical follow-up was 49 ± 32 months (range: 30 days-12.1 years). Excluding perioperative (30 days) events, the annual major and minor stroke rate was 1.3% and the annual ipsilateral major and minor stroke rate was 0.6%. In symptomatic and asymptomatic patients, the annual major and minor stroke rates were 2.2% and 0.8%, respectively, and the ipsilateral major and minor stroke rates were 1.1% and 0.3%, respectively. There was no significant difference between ipsilateral and contralateral major or minor strokes at long-term follow-up. At last sonographic follow-up (median 36 ± 32 months), restenosis rates for symptomatic and asymptomatic stenoses were 5% and 3%, respectively.The results of our study demonstrate very low long-term cerebral event rates after CS supporting the long-term safety of CS. Importantly, there was no significant difference in long-term ipsilateral versus contralateral cerebral events lending support to the hypothesis of plaque stabilization.

Gosta W. Ahlstrom with Gary O. Rollefson, The History of Ancient Palestine, reviewed by Brian Peckham Rainer Albertz, A History of Israelite Religion in the Old Testament Period. Vol. I: From the Beginnings to the End of the Monarchy. Vol. 2: From the Exile to the Maccabees, reviewed by John L. McLaughlin Samuel E. Balentine, Prayer in the Hebrew Bible: The Drama of Divine-Human Dialogue, reviewed by William H. Irwin Mervin Breneman, Ezra, Nehemiah, Esther., reviewed by Gordon Davies Athalya Brenner, ed., A Feminist Companion to Genesis, reviewed by Dennis Becker Walter Brueggemann, Texts Under Negotiation: The BibLe and Postmodern Imagination, reviewed by John E. Harvey Johannes C. de Moor and Wilfred O.E. Watson, eds., Verse in Ancient Near Eastern Prose, reviewed by Tyler F. Williams Cheryl J. Exum and David J. Clines, eds., The New Literary Criticism and the Hebrew Bible, reviewed by Marion Ann Taylor J.P. Fokkelman, Narrative Art and Poetry in the Books of Samuel. Vol. 4: Vow and Desire (J Sam. 1-12), reviewed by John E. Harvey Philip J. King, Jeremiah: An Archaeological Companion, reviewed by Donald E. Burke Jon D. Levenson, The Hebrew Bible, the Old Testament, and Historical Criticism, reviewed by Dennis Becker Kim Ian Parker, Wisdom and Law in the Reign of Solomon, reviewed by John E. Harvey Leo G. Perdue, Bernard Brandon Scott and William J. Wiseman, eds., In Search ofWisdom: Essays in Memory of John G. Gammie, reviewed by John L. McLaughlin Glen Taylor, Yahweh and the Sun: The Biblical and Archaeological Evidence, reviewed by Patrick D. Miller and Andrew G. Vaughn Wesley I. Toews, Monarchy and Religious Institution in Israel Under Jeroboam I., reviewed by John L. McLaughlin Benton J. White, Taking the Bible Seriously: Honest Differences about Biblical lnterpretation, reviewed by Brian P. Irwin Schuyler Brown, The Origins of Christianity: A Historical Introduction to the New Testament., reviewed by William E. Arnal Timothy B. Cargal, Restoring the Diaspora: Discursive Structure and Purpose in the Epistle of James, reviewed by Patrick J. Hartin Robert W. Funk and Roy W. Hoover, eds., The Five Gospels: The Search for the Authentic Words of Jesus, reviewed by William E. Amal Wilfrid J. Harrington, Revelation, reviewed by Kenneth Fox Robert Jewett, Saint Paul at the Movies: The Apostle's Dialogue with American Culture., reviewed by Susan Lochrie Graham Bradley H. McLean, ed., Origins and Method: Towards a New Understanding of Judaism and Christianity. Essays in Honour of John C. Hurd, reviewed by Daniel A. Smith Hajo Uden Meijboom, A History and Critique of the Origin of the Marean Hypothesis 1835-1866: A Contemporary Report Rediscovered, reviewed by John S. Kloppenborg Walter Wink, Cracking the Gnostic Code: The Powers in Gnosticism, reviewed by Schuyler Brown Paul R. Dekar, For the Healing of the Nations: Baptist Peacemakers, reviewed by John W. Sabean John G. Stackhouse, Canadian Evangelicalism in the Twentieth Century: An Introduction to Its Character, reviewed by Douglas Jacobsen George E. Tinker, Missionary Conquest: The Gospel and Native American Cultural Genocide, reviewed by David Nazar Takeuchi Yoshinori, ed., Buddhist Spirituality: Indian, Southeast Asian, Tibetan, Early Chinese, reviewed by Ovey N. Mohammed Jorge Garcia Antezana, ed., Liberation Theology and Sociopolitical Transformation, reviewed by Rivkah Vaage Frank T. Birtel, ed., Reasoned Faith: Essays on the Interplay of Faith and Reason, reviewed by Daryl Culp Adina Davidovich, Religion as a Province of Meaning: The Kantian Foundations of Modern Theology, reviewed by Donald Wiebe Philip Hefner, The Human Factor: Evolution, Culture and Religion, reviewed by Donald Wiebe Alfred T. Hennelly, ed., Santo Domingo and Beyond: Documents and Commentaries from the Historic Meeting of the Latin American Bishops' Conference, reviewed by LeeCormie Benjamin Ish-Shalom, Rav Avraham Itzhak HaCohen Kook: Between Rationalism and Mysticism, reviewed by Dow Marmur Karl-Josef Kuschel and Hermann Haring, eds., Hans Küng: New Horizons for Faith and Thought, reviewed by Daniel Donovan Philip J. Lee, Against the Protestant Gnostics, reviewed by Douglas K. Harink Jacob K. Olupona and Sulayman S. Nyang, eds., Religious Plurality in Africa: Essays in Honour of John S. Mbiti, reviewed by Grant LeMarquand Raimon Panikkar, The Cosmotheandric Experience: Emerging Religious Consciousness., reviewed by John F. Duggan Thomas L. Schubeck, Liberation Ethics: Sources, Models, and Norms, reviewed by Ronald Mercier Wilfred Cantwell Smith, What Is Scripture? A Comparative Approach, reviewed by Laetitia van Stekelenburg Leonard Swidler, The Meaning of Life at the Edge of the Third Millennium, reviewed by Ovey N. Mohammed Brian Swimme and Thomas Berry, The Universe Story: From the Primordial Flaring Forth to the Ecozoic Era: A Celebration of the Unfolding of the Cosmos, reviewed by John F. Duggan Emilie M. Townes, ed., A Troubling in My Soul: Womanist Perspectives on Evil and Suffering, reviewed by Barbara Paleczny Charles M. Wood, The Formation of Christian Understanding: Theological Hermeneutics., reviewed by Greg Robertson Delores S. Williams, Sisters in the Wilderness: The Challenge of Womanist God-Talk, reviewed by Barbara Paleczny Daniel F. Rice, Reinhold Niebuhr and John Dewey; An American Odyssey., reviewed by Gordon Harland

Pretreatment values of squamous cell carcinoma antigen (SCC) were obtained in 100 consecutive patients with squamous cell carcinoma of the cervix presenting to the Regional Gynaecological Oncology Centre in Gateshead, UK. Nine patients deemed to have locally advanced disease not suitable for primary surgery had elevated levels. Ninety-one patients were suitable for primary surgery. Sixty-seven had normal SCC levels, two of which had lymph node metastases. Twenty-four had elevated SCC levels, 14 of which had lymph node metastases. Two early recurrences have been detected in the raised SCC group where no lymph node metastases were present. Elevated levels of SCC in the pretreatment assessment indicate a high risk of lymph node metastases and of developing recurrent disease after primary surgery.

Enhanced recovery after surgery (ERAS) programmes have been shown to improve outcomes after colonic surgery. However, there is less evidence supporting ERAS in rectal surgery. The aim of this study was to compare outcomes of conventional perioperative care with those of an ERAS pathway including both colonic and rectal surgery patients.Outcomes of patients undergoing elective colorectal surgery at Christchurch Hospital within the ERAS pathway were compared with patients receiving conventional perioperative care over a 2-year period. A retrospective analysis was conducted, including primary and total length of stay (LOS), readmission, complication and mortality rate.A total of 240 patients undergoing colorectal surgery were included; 160 patients received conventional perioperative care and 80 patients were managed within the ERAS pathway. Primary and total LOS were shorter in the ERAS group (6 versus 7 days, P = 0.0004, 7 versus 10 days, P = 0.0003, respectively). Re-admission and complication rates were not significantly different between the groups. There was one death (in the conventional care group) within 30 days. Patients undergoing rectal surgery within the ERAS pathway did not show any difference in primary LOS, readmission or complication rate although median total LOS was significantly reduced (7 versus 10 days, P = 0.0457).Patients undergoing elective colorectal surgery managed within the ERAS pathway had shorter hospital stays without increased morbidity or mortality. Differences were less pronounced in the rectal surgery subgroup and further research is needed to investigate the use of ERAS pathways for patients undergoing elective rectal surgery.

Background and aims: Ross River virus (RRV) is the most common and widespread mosquito-borne disease in Australia [1] and is predominantly identified and managed through passive surveillance. Here,...

The purpose of this study was to evaluate the feasibility and short-term efficacy of transcatheter paravalvular leak closure using different occlusion devices.Twenty-one patients underwent transcatheter closure of either aortic or mitral paravalvular leak from June 2002 to February 2006 using the Amplatzer PDA, ASD or VSD occluder. All patients had symptoms and signs of haemolysis and/or cardiac decompensation with dyspnoea.Implantation of a device was technically successful in twenty patients (95%). Immediate residual leak was found in seventeen patients (85%). Significant shunting persisted in nine cases during follow up (45%).Permanent leaflet obstruction was observed in one patient. Severe complications during follow up led to early death in one patient and surgical intervention in three. A successful second catheter treatment was performed in another three patients. The event-free survival from re-operation, death and stroke at the end of the observation period was 80%.Transcatheter closure of paravalvular leaks is a technically feasible, but demanding procedure. Residual leaks are common and may worsen pre-existing haemolysis. Due to the significant ongoing morbidity in this group of patients and the complexity of follow up individual patient results differ considerably. Nevertheless, it is possible to achieve some symptomatic relief, thus an interventional approach should be discussed as a potential treatment option for those patients with a limited defect and who are not deemed suitable for another operation.

Objectives: To summarize our experiences with the first-in-man suture-based patent foramen ovale (PFO) closure technique. Background: PFO is often present with the occurrence of cryptogenic stroke and migraine with aura. Successful PFO closure can be performed percutaneously using catheter techniques with many different closure devices. The described novel closure system is intended to deliver, via endovascular access, a suture into the atrial septal wall tissue for closure of PFO. Methods: Eleven patients, between 22 and 58 years of age (mean 46.6 ± 9.6), who had a cryptogenic ischemic stroke, TIA, or a peripheral embolism and a PFO were considered for percutaneous closure with this technique. Results: The mean stretched diameter of the defect evaluated during balloon sizing was 8.8 ± 0.4 mm (range 7–12.5). Delivery of the suture was successful in all patients. No intraprocedural complications occurred. During the follow up, complete closure could be achieved in one patient. Six patients with significant residual shunting during follow-up had successful closure using a conventional device. One patient was lost for follow-up after the 3-month visit. The residual shunt in the remaining three patients was very small and they declined to be treated with a conventional device. No complications occurred during the follow up. Conclusions: Transcatheter application of a suture for closure of PFO is technically feasible and safe. However, despite successful suturing of the septum primum to the septum secundum, the PFO did not close in most of the patients. © 2008 Wiley-Liss, Inc.

Background: Triage of ovarian masses for appropriate management is important in ensuring the best outcome for patients. The Risk of Malignancy Indices (RMI) seem to represent a low cost and effective tool for triage and management of women with ovarian masses. Aim: To review patients with an ovarian mass referred to the Gynaecological Cancer Centre at the Royal Hospital for Women, and to assess the effectiveness of the RMI in differentiating benign from malignant tumours in this group of patients. Methods: A retrospective review of the case records of all patients with an ovarian mass referred to our centre from January 2003 to December 2005 was undertaken. Results: Two hundred and four patients were eligible for RMI calculation. An RMI of 200 correctly identified 11 of 19 (58%) borderline ovarian tumours and 70 of 77 (91%) invasive ovarian tumours. An RMI of > 200 had a sensitivity of 84%, specificity of 77%, positive predictive value of 76% and negative predictive value of 85% in detecting both borderline and invasive ovarian tumours. The false negative rate for invasive tumours was 9%. Conclusions: This study showed that using RMI at a cut-off of 200 for referral could have prevented 83 benign cases (41%) from being referred. We propose that the RMI could be utilised as a triage tool for referral of ovarian masses to gynaecological cancer centres.

In 2005 the National Screening Unit of the Ministry of Health appointed a Colorectal Screening Advisory Group to provide independent strategic advice and recommendations on population screening for colorectal cancer (CRC) in New Zealand.Evidence-based review of relevant literature and assessment of CRC screening using the New Zealand Criteria to Assess Screening Programmes.Guaiac faecal occult blood test (FOBTg), immunochemical FOBT (FOBTi), flexible sigmoidoscopy, colonoscopy, and CT colonography were considered. FOBTg is the only test supported by high quality evidence from randomised controlled trials but has limited sensitivity and achieves modest CRC mortality reduction over time. FOBTi has higher analytical sensitivity than FOBTg and would be assumed to achieve greater mortality reduction. A CRC screening programme requires substantial planning and resources. Currently public hospitals cannot deliver timely diagnostic or surveillance colonoscopy.The Advisory Group recommends that a feasibility study of CRC screening using FOBTi be undertaken. This would help determine the performance of the FOBTi in the New Zealand population and whether the New Zealand health system could support an acceptable, effective and economically efficient CRC screening programme. To optimise the diagnosis and treatment of colorectal cancer there is an immediate need to expand colonoscopy services and to ensure that throughout New Zealand the treatment outcomes for CRC, both surgical and oncological, meet international standards.

Objective. The purpose of this study was to define the incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE) in patients with clear cell carcinoma (CCC) of the ovary and to investigate the prognostic factors in such patients. Methods. Between January 1987 and December 2003, 641 women with primary invasive epithelial ovarian cancer underwent treatment at the Royal Hospital for Women in Sydney, Australia. Sixty-six patients (10.3%) with CCC were identified from the data bank, and their data were compared with a matched-control group of 132 patients with non-clear cell epithelial ovarian carcinoma. Results. A thromboembolic event (DVT or PE) was noted in 27.3% of patients with CCC, compared to 6.8% of patients with other epithelial ovarian cancers. PE was detected in 13.6% and 3.8% of patients, respectively. In patients with CCC, DVT was frequently observed before operation or at the time of recurrence. In a multivariate analysis of patients matched for age and stage, the occurrence of a DVT or the presence of endometriosis was significant predictors of clear cell histology. Within the clear cell group, no particular risk factor for DVT could be identified. Metastases of 50 mm or greater in diameter, ascites of 1000 ml or more, advanced FIGO stage, and the occurrence of DVT were poor prognostic factors for CCC in univariate analysis, but in a multivariate Cox regression analysis, only FIGO stage and occurrence of DVT remained significant. Conclusion. The incidence of venous thromboembolic events was found to be significantly higher in patients with CCC when compared to patients with other epithelial ovarian cancers.

Injury prevention at home is an important concern for parents of toddlers. This study investigated safety‐related intervention strategies of 40 middle‐class Australian mothers, and their relationship with three child characteristics: gender, temperament and language comprehension. In an interview at home, mothers reported frequency of use of 15 strategies and completed a child temperament questionnaire. Their two‐year‐olds were tested for language comprehension. Principal component analysis revealed three types of strategies: educate, control, and remove risk. Relationships were found between strategy type and two child characteristics: temperament and language comprehension. Control strategies were linked to active, intense children; and educate strategies were linked to persistent children and to children with higher language comprehension. Implications are discussed for safety‐related parenting strategies with toddlers.

Objectives: Epithelial ovarian cancer is a common disease with a high mortality, the latter being frequently attributed to late diagnosis due to failure to recognise symptoms of early disease. This study was designed to determine any differences in symptomatology between patients with early and advanced stage disease. Design: A retrospective cohort study of 100 patients with stage 1 disease and 100 with stage 3 disease. Ten consecutive patients with stage 1 disease and 10 with stage 3 disease were identified from the database of patients treated each year from 1990 to 1999. Setting: A tertiary referral centre for gynecological malignancy. Outcome measures: The nature and duration of symptoms, age at presentation, and the size, histologic type and grade of tumour were determined by chart review, and the findings compared using logistic regression analysis. Results: Ninety percent of women with early, and 100% with advanced disease reported at least one symptom. With early disease, abdominal pain was reported by 51% and abdominal swelling by 32%, and with advanced disease abdominal swelling by 62% and abdominal pain by 44%. Seventy percent of the early stage and 69% of the advanced stage cohorts reported symptoms of less than 3 months duration. Tumours less than 5 cm diameter were three times more likely to have advanced disease (P = 0.02). Grade 1 tumours were 40 times more likely to be early stage than grade 3 tumours. Serous tumours occurred in 25% of patients with early disease, and 45% with advanced disease (P = 0.01). Conclusion: Patients with early stage ovarian cancer are likely to be younger and to have larger, better differentiated tumours that are more often non-serous histologically. Advanced disease is not invariably due to delayed diagnosis.

Objective To examine morbidity and survival among women treated by pelvic exenteration for gynaecological malignancy. Design Retrospective review by analysis of case records. Setting Department of Gynaecological Oncology, Queen Elizabeth Hospital, Gateshead, UK. Subjects Eighty-three consecutive patients referred from within the UK from 1974 to 1992 for initial treatment of advanced gynaecological malignancy or management of recurrent disease following unsuccessful initial therapy. Results Overall five year actuarial survival was 41%, falling to 36 % at 10 years. Serious morbidity was low, and there were only three perioperative deaths. Conclusions For patients with limited options for treatment of advanced primary or recurrent cancer, exenteration offers a reasonable prospect of survival with good quality of life.

SummarySummaryWith the introduction of large loop diathermy excision of the transformation zone in our department, we undertook a prospective study to assess the short term morbidity related to the procedure. Two thousand and eight loop diathermies were performed between 1988 and 1992 and 1696 women (84·5 per cent) returned the relevant ‘symptom’ chart at their subsequent visit. Discharge and bleeding were noted by 72 per cent of women lasting for a median duration of 12 and 7 days respectively. Discomfort or pain was noted in 41·1 per cent with a median duration of 3 days. Antibiotics were prescribed in 13·9 per cent of cases and in these women the duration of bleeding and discomfort was significantly prolonged (P < < 0·01) as was the incidence of bleeding (P< 0·01). The next menstrual period was delayed or early in 30 per cent, heavier in 39 per cent, lighter in 8 per cent and missed in 2 per cent.

asked about their recollection of post-operative bleeding three months after the event. Therefore, we stand by our claim that our study is the first to document prospectively blood loss following loop diathermy excision of the transformation zone. In the patients in the Monsel’s group we did find a lessening of blood loss in the first 2 days although this was not significant statistically or clinically. We are pleased to note that the unpublished observations mentioned by Lopes et al. concur with our own findings. Finally, we accept that there is inevitably some difficulty in describing post-operative loss, but it is surely a matter of semantics as to where blood loss ends and bloody discharge begins. Mark Doyle Adrian Warwick Charles Redman University of KeelelNorth Staffordshire Health Authority School of PostgraduateMedicine and Biological Sciences North Staffordshire Maternity Hospital Academic Department of Obstetrics and Gynaecology Hilton Road Stoke-on-Trent ST4 6SD Does application of Morsel’s solution after loop diathermy excision of the transformation zone reduce post-operative discharge?

SummaryAll men receiving hospital orders (Section 60) in the UK in the year 1963–64 (excluding those receiving restriction orders (Section 60/65)) were followed up over 15 years with regard to (1) subsequent offences and convictions, (2) hospital admissions, and (3) death. Nine per cent of the patients involved could not be traced. Sixteen per cent had died by 1978, a quarter of them by suicide.Of the mentally ill only 4 per cent subsequently committed serious offences (manslaughter, wounding, GBH, robbery, rape or arson), although a further 4 per cent committed assaults repeatedly. Sex crimes were uncommon. Among the mentally subnormal, 7 per cent committed serious sex crimes subsequent to committal. A further 9 per cent were considered to be persistent sex offenders and another 9 per cent were judged to be persistently violent. In general the mentally subnormal were much younger and were detained for much longer than the mentally ill. Since 1964 the use of hospital orders for the detention of such people has become much less frequent.The best predictor of subsequent offences was found by multiple regression analysis to be the number of previous offences: this was especially true for acquisitive offences committed by the young. The mentally ill were less often reconvicted than the mentally subnormal.

SummaryThe offenders committed to local hospitals in 1962 and 1964 under a hospital order with restriction of discharge were followed up for 15 years with regard to subsequent court appearances, hospital admissions, and death. One hundred and forty-six were traced. Of these, 49 per cent had been diagnosed as mentally ill: most of this group were committed for violent offences. Thirty-five per cent were mentally subnormal: they were frequently committed for sexual offences, arson and property offences. Twelve per cent were diagnosed psychopathic: this group had a wide variety of committal offences.Fourteen per cent of the mentally ill and 17 per cent of the mentally subnormal were still in hospital after 15 years, but 51 per cent of the mentally ill and 36 per cent of the mentally subnormal were released within three years. Sixty-one per cent of the psychopaths were released within two years. Few of the subsequent offences were serious in any of the diagnostic groups.Since 1973 there has been a dramatic fall in restriction orders, especially for mentally subnormal patients.