Determining the fetal scalp lactate level that indicates the need for intervention in labour

Background: Fetal scalp lactate testing has been shown to be as useful as pH with added benefits. One remaining question is What level of lactate should trigger intervention in the first stage of labour?' Aims: This study aimed to establish the lactate level in the first stage of labour that indicates the need for intervention to ensure satisfactory outcomes for both babies and mothers. Methods: A prospective study at Mater Mothers' Hospital, Brisbane, Australia, a tertiary referral centre. One hundred and forty women in labour, with non-reassuring fetal heart rate traces, were tested using fetal blood scalp sampling of 5 mu L of capillary blood tested on an Accusport (Boeringer, Mannheim, East Sussex, UK) lactate meter. Decision to intervene in labour was based on clinical assessment plus a predetermined cut off. Main outcome measures were APGAR scores, cord arterial pH, meconium stained liquor and Intensive Care Nursery admission. Results: Two-graph receiver operating characteristic (TG-ROC) analysis showed optimal specificity, and sensitivity for predicting adverse neonatal outcomes was a scalp lactate level above 4.2 mmol/L. Conclusions: Fetal blood sampling remains the standard for further investigating-non-reassuring cardiotocograph (CTG) traces. Even so, it is a poor predictor of fetal outcomes. Scalp lactate has been shown to be at least as good a predictor as scalp pH, with the advantages of being easier, cheaper and with a lower rate of technical failure. Our study, found that a cut off fetal scalp lactate level of 4.2 mmol/L, in combination with an assessment of the entire clinical picture, is a useful tool in identifying those women who need intervention.

To marry or not to marry: marital status and the household division of labour

Data from an Australian national survey (1996 to 1997) are used to examine domestic labor patterns among de facto and married men and women. The results show that women spend more time on housework and do a greater proportion of housework than men. However, the patterns are most traditional among married men and women. Women in de facto relationships spend less time doing housework and do a smaller proportion of indoor activities than married women. Men in de facto relationships do a larger proportion of indoor activities and a lower proportion of outdoor tasks than married men. The data also show that couples who have cohabited prior to marriage have more egalitarian divisions of labor than those who have not cohabited prior to marriage. This article concludes by arguing that the incompleteness of the de facto relationship provides a period of relative freedom in which to negotiate more equal roles.

Division of labour within cooperatively breeding groups

Within cooperative societies, group members share in caring for offspring. Although division of labour among group members has been relatively well studied in insects, less is known about vertebrates. Most studies of avian helping focus solely on the extent to which helpers provision the offspring, however, helpers can participate in everything from nest building to predator defence. Bad provisioners may, for example, not be as 'uncooperative' as they appear. if they are good defenders. Thus, the distribution of helping tasks between group members should have important implications for our interpretation of group dynamics. Here, we compare two distinct forms of helping behaviour in the cooperatively breeding noisy miner (Manorina melanocephala): chick provisioning and mobbing nest predators. We show that the way in which individual helpers invest in these two helping behaviours varies enormously across individuals and among social groups. Good provisioners often contributed relatively little to mobbing and vice versa. Indeed, (18%) of helpers only mobbed, 22% just provisioned, whereas 60% of helpers performed both forms of helping. Across nests, provisioning was significantly negatively correlated with mobbing effort. We suggest that small differences in the costs or benefits of different aspects of helping (due to differences in age, relatedness or social status) have a big impact on the division of labour within a group. Consequently, social groups can be made up from individuals who often specialise in one helping behaviour, and/or helpers who perform a number of behaviours to differing degrees. Division of labour within social groups will, therefore, have important consequences for the maintenance of cooperatively breeding in vertebrates.

Canadian heroin supply and the Australian 'heroin shortage'

No Abstract

Documenting the heroin shortage in New South Wales

Australian heroin markets have recently undergone dramatic change, sparking debate about the nature of such markets. This study aimed to determine the onset, peak and decline of the heroin shortage in New South Wales (NSW), using the most appropriate available methods to detect market level changes. The parameters of the heroin shortage were determined by reviewing: reports of heroin users about availability and price (derived from the existing literature and the Illicit Drug Reporting System); qualitative interviews with injecting drug users, and health and law enforcement professionals working in the illicit drug field; and examining data on heroin seizures over the past decade. There was a marked reduction in heroin supply in NSW in early 2001. An increase in the price of heroin occurred in 2001, whereas it had decreased steadily since 1996. A reduction in purity also occurred, as reported by drug users and heroin seizures. The peak period of the shortage appears to have been January to April 2001. The market appears to have stabilised since that time, although it has not returned to pre- 2001 levels: heroin prices have decreased in NSW for street grams, but not to former levels, and the price of `caps' (street deals) remain elevated. Heroin purity in NSW has remained low, with perhaps a 10% increase above the lowest recorded levels. These data support the notion that the heroin market in NSW underwent significant changes, which appear to have involved a lasting shift in the nature of the market.