Does training affect growth? - answers to common questions

Adolescent athletes may be at risk of restricted growth and delayed maturation when intense training is combined with insufficient energy intake. Because catch-up growth commonly occurs when training is reduced or ceases, final adult stature is unlikely to be compromised. However, in athletes who have long-term, clinically delayed maturation, catch-up growth may be incomplete. By charting individual growth patterns, physicians, coaches, and athletic trainers can detect vulnerable periods when the training intensity should be reduced and energy intake may need to be increased.

Are unilateral and bilateral patellar tendinopathy distinguished by differences in anthropometry, body composition, or muscle strength in elite female basketball players?

Background: Overuse injury to the patellar tendon (patellar tendinopathy) is a major reason for interrupted training and competition for elite athletes. In both sexes, the prevalence of unilateral and bilateral tendinopathy has been shown to differ. It has been proposed that bilateral pathology may have a different aetiology from unilateral pathology. Investigation of risk factors that may be unique to unilateral and bilateral patellar tendinopathy in female athletes may reveal insights into the aetiology of this condition.
Objectives: To examine whether anthropometry, body composition, or muscle strength distinguished elite female basketball players with unilateral or bilateral patellar tendinopathy.
Methods: Body composition, anthropometry, and muscle strength were compared in elite female basketball players with unilateral (n = 8), bilateral (n = 7), or no (n = 24) patellar tendinopathy. Body composition was analysed using a dual energy x ray absorptiometer. Anthropometric measures were assessed using standard techniques. Knee extensor strength was measured at 180°/s using an isokinetic dynamometer. z scores were calculated for the unilateral and bilateral groups (using the no tendinopathy group as controls). z scores were tested against zero.
Results: The tibia length to stature ratio was approximately 1.3 (1.3) SDs above zero in both the affected and non-affected legs in the unilateral group (p<0.05). The waist to hip ratio was 0.66 (0.78) SD above zero in the unilateral group (p<0.05). In the unilateral group, leg lean to total lean ratio was 0.42 (0.55) SD above zero (p<0.07), the trunk lean to total lean ratio was 0.63 (0.68) SD below zero (p<0.05), and leg fat relative to total fat was 0.47 (0.65) SD below zero (p<0.09). In the unilateral group, the leg with pathology was 0.78 (1.03) SD weaker during eccentric contractions (p<0.07).
Conclusions: Unilateral patellar tendinopathy has identifiable risk factors whereas bilateral patellar tendinopathy may not. This suggests that the aetiology of these conditions may be different. However, interpretation must respect the limitation of small subject numbers.

Does elite competition inhibit growth and delay maturation in some gymnasts? quite possibly

Today, elite young gymnasts undertake training programs of progressive volume and intensity from an early age. For example, talented young female gymnasts often commence training at age 5 or 6 and train more than 20 to 30 hours per week year-round throughout childhood and adolescence. Despite the "normal" short stature of top-level gymnasts and the obvious health benefits of physical activity during growth, there is concern that elite level or those gymnasts involved in heavy training regimens may be at risk for adverse effects on growth and maturation. This concern has been the source of much debate in the literature and is complicated by the difficulties in distinguishing between the genetic predisposition to short stature and late or delayed maturation, and the effect of environmental factors such as nutrition and exercise that may influence growth and maturation. The effect of gymnastics training on growth and maturation is often reported as averaged data: an approach that does not identify individual growth patterns. Finding no difference between groups is not proof that there is "in fact" no difference. Accepting the null hypothesis without the appropriate critical review of both the methodological and statistical power to detect differences is a flawed endeavor. We believe there is compelling "circumstantial" evidence to build a case that preparation for advanced gymnastics competition may place some children and youth at risk of reduced growth and delayed maturation.

T.S. Eliot`s idea of the clerisy, and its discussion by Karl Mannheim and Michael Polanyi in the context of J.H. Oldham`s moot

In 1938, Joseph Oldham, a leading British Christian ecumenist, formed a discussion group that came to be known as the Moot. The Moot met in a retreat setting for several long weekends each year until early 1947, its discussions carefully organized and convened by Oldham. More than anything else, the discussions of the Moot revolved around the topic of order and, more particularly, around the problem of how order might be restored in British society and culture in the context of a ‘world turned upside down’. Oldham and most members of the group sought a central place for Christian ideas and ideals in British social life.

A striking feature of the Moot was the intellectual stature and the diversity of interests of its members. Among its 16 or so regular members were Oldham (1874-1969), his close friend T.S. Eliot (1888-1963) and Karl Mannheim (1893-1947). Among the later ‘visitors’ to Moot meetings was Michael Polanyi (1891-1976), who first came to the 20th Moot meeting in June of 1944.1

This article presents several papers that were produced for the Moot discussion of 15-18 December 1944 by Eliot, Mannheim and Polanyi. These papers have intrinsic and historical interest, and are published together for the first time here. The initial paper, written by Eliot, treats the role in society of ‘the clerisy’2 - a term borrowed from Samuel Taylor Coleridge that points to an intellectual elite or vanguard. Eliot requested that Oldham solicit responses to his paper from Mannheim and Polanyi. Mannheim’s response was a set of detailed answers to four questions that Eliot posed at the end of his essay. Polanyi’s response was a short, coherent essay, which he identified as ‘my own position with respect’ to Eliot’s discussion; his essay outlines a brief account of the role of the clerisy in science.3 Eliot wrote short comments on the responses of both Mannheim and Polanyi. These five pieces, which have a natural unity, should be of interest to anyone working in the history of social thought. We have abridged only Mannheim’s lengthy response and have eliminated a few lines of illustrative material from Eliot’s reply to Mannheim, but these excisions in no way detract from the clarity of the authors’ perspectives in this rich trilogue.

Conservation ecology and breeding biology of the white-browed treecreeper, Climacteris affinis

The White-browed Treecreeper Climacteris affinis is one of many woodland-dependent birds that are at risk from the encroachment of human-dominated land-uses into natural landscapes. The White-browed Treecreeper inhabits semi-arid woodlands in north-west Victoria, Australia, a vegetation community that has undergone extreme modification in the last century due to the expansion of agriculture in the region. Extant woodlands represent only 10% of the original woodland cover in the region, and are highly fragmented and disturbed in many districts. Thus, the survival of the White-browed Treecreeper may depend on active management. However, current knowledge of the ecology and biology of this species is virtually non-existent, and inadequate for informed and effective conservation actions. The aim of this thesis is to redress this situation and provide the ecological basis for sound conservation management of the species. The thesis consists of two parts: an investigation of habitat use at three spatial scales and a study of the social organization, nesting requirements, breeding behaviour and reproductive success of a population of White-browed Treecreepers. Fifty-six patches of remnant woodland in north-west Victoria were surveyed to determine the factors affecting the occurrence of the White-browed Treecreeper at the regional scale. It was detected in 16 patches, and was largely confined to two core districts - Yarrara and, Wyperfeld (Pine Plains). The floristic composition of the dominant tree species was an important determinant of patch occupancy, with the results providing quantitative support for the previously suspected affinity for Belah Casuarina pauper and Slender Cypress-pine Callitris gracilis — Buloke Allocasuarina luehmannii woodlands. However, the absence of the White-browed Treecreeper from several districts was due to factors other than a lack of appropriate habitat. Demographic isolation - the distance from the focal patch to the nearest population of the White-browed Treecreeper - was the most important variable in explaining variation in patch occupancy. Patches isolated from other treecreeper populations by more than 8.3 km in landscapes of non-preferred native vegetation, and 3 km in agricultural landscapes, were unlikely to support the White-browed Treecreeper. The impact of habitat loss and fragmentation on the capacity of individuals to move through the landscape (i.e. functional connectivity) is considered in relation to disruption to dispersal and migration, and the potential collapse of local metapopulations. Habitat use was then examined in a network of patches and linear strips of Belah woodland embedded in a predominantly cultivated landscape. A minimum area of 18.5 ha of Belah woodland was identified as the most important criterion for patch occupancy at the local scale. This landscape appeared to be permeable to movement by the White-browed Treecreeper, facilitated by the extensive network of linear habitat, and clusters of small to medium fragments. The third scale of habitat use investigated the frequency of use of 1-ha plots within tracts of occupied woodland. It is important to discriminate between habitat traits that operate at the population level, and those that act as proximate cues for habitat selection by individuals. Woodlands that have high tree density, extensive cover of low-stature shrubs, abundant lichen, a complex vertical structure, and relatively low cover of grass and herbs are likely to support larger populations of the White-browed Treecreeper. However, individuals appeared to be using tree dominance (positive) and tall shrub cover (negative) as proximate environmental stimuli for habitat selectivity. A relatively high cover of ground lichen, which probably reflects a ground layer with low disturbance and high structural complexity, was also a reliable indicator of habitat use. Predictive models were developed which could be used to plan vegetation management to enhance habitat for the White-browed Treecreeper. The results of the regional, landscape and patch-scale investigations emphasise that factors operating at multiple spatial scales influence the suitability of remnant vegetation as habitat for the White-browed Treecreeper. The White-browed Treecreeper is typical of many small Australian passerines in that it has high annual survival, small clutches, a long breeding season, multiple broods and relatively low reproductive rates. Reproductive effort is adjusted through the number of clutches laid rather than clutch size. They occupy relatively large, all-purpose territories throughout the year. However, unlike many group territorial birds, territory size was not related to the number of occupants. The White-browed Treecreeper nests in tree hollows. They select hollows with a southerly orientation where possible, and prefer hollows that were higher from the ground. At Yarrara, there was considerable spatial variation in hollow abundance that, in concert with territorial constraints, restricted the actual availability of hollows to less than the absolute abundance of hollows. Thus, the availability of suitable hollows may limit reproductive productivity in some territories, although the magnitude of this constraint on overall population growth is predicted to be small. However, lack of recruitment of hollow-bearing trees would increase the potential for hollow availability to limit population growth. This prospect is particularly relevant in grazed remnants and those outside the reserve system. Facultative cooperative breeding was confirmed, with groups formed through male philopatry. Consequently, natal dispersal is female-biased, although there was no skew in the sex ratio of the fledglings or the general adult population. Helpers were observed performing all activities associated with parenting except copulation and brooding. Cooperatively breeding groups enjoyed higher fledgling productivity than simple pairs, after statistically accounting for territory and parental quality. However, the difference reflected increased productivity in the 1999-breeding season only, when climatic conditions were more favourable than in 1998. Breeding commenced earlier in 1999, and all breeding units were more likely to attempt a second brood. However, only breeders with helpers were successful in fledging second brood young, and it was this difference that accounted for the overall discrepancy in productivity. The key mechanism for increased success in cooperative groups was a reduction hi the interval between first and second broods, facilitated by compensatory reductions in the level of care to the first brood. Thus, females with helpers probably achieved significant energetic savings during this period, which enabled them to re-lay sooner. Furthermore, they were able to recommence nesting when the fledglings from the first brood were younger because there were more adults to feed the dependent juveniles. The current utility, and possible evolutionary pathways, of cooperative breeding is examined from the perspective of both breeders and helpers. Breeders benefit through enhanced fledgling productivity in good breeding conditions and a reduction in the burden of parental care, which may impart significant energetic savings. Further, breeders may facilitate philopatry as a means for ensuring a minimum level of reproductive success. Helpers benefit through an increase in their inclusive fitness in the absence of opportunities for independent breeding (i.e. ecological constraints) and access to breeding vacancies in the natal or adjacent territories (i.e. benefits of philopatry). However, the majority of breeding unit-years comprised unassisted breeders, which suggests that pairs are selectively favoured under certain environmental or demographic conditions.

Importance of the contribution of Australians to the penetration of China by the China Inland Mission in the period 1888-1953, with particular reference to the work of Australian women missionaries

Australians, in the main, are unaware of the role which Australia played in the evangelization of China in the late nineteenth and the first half of the twentieth century. Most would never have heard of the China Inland Mission (CIM), the largest of the Protestant bodies which penetrated the Middle Kingdom, and few would know of the contribution that its Australian contingent, which consistently comprised about a tenth of the CIM's numbers, made towards the Christianization of that vast country. This thesis aims to raise the level of awareness in this area. Academic researchers have not totally neglected to examine the proselytization of China, and historians of the stature of Latourette have not let it escape their attention. However, most of the studies which have not merely fleetingly focused on the subject while viewing a larger canvas, have been North American, singling out the efforts of United States and Canadian bodies in introducing Christianity to the Chinese. Here, authors like Amerding, Bacon, Creighton, Gates, Hawkes, Ho, Ko, Mensendiek, Michell and Quale have left their mark. In the case of the present thesis, the outlook from which events played out in China are viewed is firmly based in Australia rather than North America. Earlier Australian research has been scarce, and is dominated by Loane and Dixon. Loane, evidently primarily working from Australasian Council minutes, mainly concentrates on the efforts of the CIM's Home Council, examining its endeavours decade by decade against a backdrop of contemporaneous events in China, and briefly referring to aspects of the lives of a cross-section of Australasian missionaries, without providing much idea about what they actually did in the field or what they achieved there. Because of its preoccupation with the Home Council, which never admitted women into its ranks, Loane's treatise is systemically biased towards men, though the more prominent of the women, like Mary Reed and Susie Garland, are given due recognition. The current thesis looks in detail at what Australians did in the field, the level of success they achieved, and at the particular contribution of Australian women towards the evangelization of China. Dixon took upon herself the formidable task of examining the endeavours of all missions in China which contained Australian missionaries. Because of the magnitude of her task, she could not focus to any great extent on particular missions, nor pursue in any detail the work of individual Australian missionaries. Like Loane, she was unable to explore what they actually did in the field or what they achieved there. Neither could she delve to any depth into the work of Australian women missionaries, though on the basis of the information she had accumulated, she drew the conclusion that Australian women had largely only brought about some unintended feminist consequences amongst Chinese women. This sweeping generalization failed to take into account the other very real social changes for Chinese women the Australian female missionaries quite purposely helped to bring about, and this thesis makes good that omission. This thesis studies aspects of the Australian missionary endeavour which both Loane and Dixon have neglected, thereby breaking new ground, and sets out to correct erroneous impressions which Dixon's dissertation has left on the historical record. One of these impressions concerned the longevity of the effect of the Australian effort in China. She had the View, writing in 1978, that the Chinese Church was moribund (a view shared by Varg and Lacy) , and that therefore the effects attributable to the endeavours of any nationality had proved fruitless, whereas the author is able to show, using modern-day sources, that the church has burgeoned in recent years thanks to earlier missionary endeavours and later neo-evangelistic efforts like Gospel radio, and now has a complement of perhaps 50 million adherents, making it second only to the United States in the size of its Protestant evangelical population. Another impression she left was that the Australian input into the evangelization of China can be largely dismissed because no totally Australian organization emerged, leaving the direction of Australia's effort in other hands. Contrary to that impression, the author shows that the Australian impact in China was significant and that Australians enjoyed more power than Dixon ever imagined. The author also shows that Australians were accepted as the equal of other nationalities in the CIM once they had acquired the necessary field expertise, a factor which doubtless also applied in respect of other missions with Australian components in China. Marchant has suggested that it is a fiction perpetuated by mission periodicals that Christianity spread and progressed in a determined manner in China. This thesis establishes that within the CIM's bailiwick, though there was some patchiness, Christianity progressed steadily and inexorably. One mission alone, the CIM, is concentrated upon, firstly in order to render the data manageable, secondly because it was the largest mission in China and had a sizeable Australian (including female) contingent, and thirdly because it exemplified many of the problems which would have been faced by missions in that country and their Australian components. The methodology employed is multifaceted. The written testimony of the missionaries themselves, contained in CIM periodicals, Field Bulletins, Monthly Notes, Annual Reports, autobiographies, personal files, diaries and letters is used to illustrate various aspects of the CIM's work in which Australians were engaged. This approach is augmented by other sources such as China and Australasian Home Council Minutes, missionary conference reports, Candidates' Books, biographies, and other selected material from archival holdings in Australia, Singapore, the United Kingdom, America and Canada. Statistics, especially ratio analyses and growth rate comparisons are used to demonstrate the relative success of different missions, missionaries and genders. Also employed are reminiscences of missionaries and descendants obtained by personal interview, and these are aggregated to provide some general conclusions. Data from these various sources have been synthesized to serve the central objective of demonstrating the importance of the contribution of Australians to the penetration of China by the CIM in the period 1888-1953 with particular reference to the work of Australian women missionaries.

Garden & landscape heritage:a crisis of tangible & intangible comprehension and curatorship

The cultural landscape of George Town, Penang, Malaysia, embraces the historic enclave of George Town as well as a range of other significant colonial vestiges adjacent to the entrépôt. Many of these landscapes cannot be isolated from the énclave as they are integral to and part of its cultural mosaic and character. Perhaps the most important are the Penang Hill hill-station landscape and the 'Waterfall‘ Botanic Gardens. The latter is an under-valued 'garden of the empire‘—a garden that significantly underpinned the development and historical and botanical stature of the Singapore Botanic Gardens.This paper reviews the cultural significance of colonial botanic gardens as they were established around the world during the scientific explosion of the late 1800s. It addresses their position within World Heritage listings, and considers the role, significance and importance of the 'Waterfall‘ Botanic Gardens within this context, within the concept of 'cultural landscapes‘, and critiques its absence from the recent World Heritage Listing of the colonial enclaves of Georgetown and Meleka in Malaysia.

An interview with Archie Weller

Interviews writer Archie Weller about Australian literature. Assessment of the value of his own work; View on criticism of Aboriginal writing; Weller's efforts to depict the plight of Nyoongahs in the white power system; Stature of black Australian writers; Comments on literary style; Shift in focus and emphasis in writing.

Femoral neck dimensions are unlikely to be associated with age at menarche

Hip axis length (HAL) has been reported as an independent risk factor for hip fracture. Later puberty may increase bone size because of delayed epiphyseal fusion. We sought to identify associations between bone size at the proximal femur with age at menarche and other indices of growth such as stature. Femoral neck dimensions were measured from dual-energy X-ray absorptiometry scans of the proximal femur in a random sample of 203 premenopausal Caucasian women (age 20–30 years). There were no associations between age at menarche and HAL, femoral axis length (FAL) or femoral neck width (FNW). Age at menarche was associated with height (r= 0.2, p= 0.02). Variations in HAL, FAL and FNW do not appear to be related to age at menarche.

The influence of body build on estimates of body composition from anthropometric measurements in premenopausal women

Objective: To assess the influence of body build on the bias and limits of agreement for estimates of body fat obtained from anthropometric prediction equations when compared with the same data obtained by dual energy X-ray absorptiometry (DEXA).

Survey design and subjects: Ninety-one premenopausal women, aged between 20 and 54 years, were chosen to represent a range of skeletal body build (relative silting height 0.50-0.56) and body fatness [body mass index (BMI) 18-34 kg/m²]. Measurements of weight, sitting height, stature, skinfold thickness, waist, umbilical and hip circumference and total body resistance and reactance were made on all subjects by standard techniques after an overnight fast. A DEXA measurement of total body fat, fat-free soft tissue and total body bone mineral mass was also obtained within 2 weeks of the anthropometric assessment.

Results: At the group level the mean difference (bias) between DEXA and the anthropometric estimates of body fat was similar for all three anthropometric estimates ranging from 2.7 kg with impedance to 1.8 kg with skinfold thickness. The 95% limits of agreement were also similar, ranging from ±5.3 kg with body mass index to ±4.1 kg with impedance. Umbilical circumference, BMI and the amount of bone mineral expressed as a proportion of the fat-free soft-tissue mass were all significantly (P < 0.01) correlated with the level of bias between DEXA and the anthropometric estimates of body fat. This was not the case for relative sitting height or measures of body fat distribution. Regression equations which included BMI or umbilical circumference in combination with the predicted estimates of body fat essentially eliminated the association between the level of bias in predicted body fat and the level of body fatness. They also reduced the 95% limits of agreement between DEXA and the anthropometric estimates of body fat.

Conclusions: Using DEXA estimates of body fat as the standard of reference our results suggest that the comparability and precision of body fat estimates derived from age- and/or sex-specific anthropometric prediction equations based on skinfolds and BMI, but not impedance, can be improved by adjusting for differences in BMI and umbilical circumference respectively.

A sophistic rhetorical approach to public relations

This article introduces a thesis that understanding rhetoric properly will lead to the best way of understanding public relations properly. It acknowledges but then critiques Robert Heath’s advocacy of the rhetorical paradigm. It also acknowledges the more critical contributions to the rhetorical theory of public relations of Jacquie L’Etang, Øyvind Ihlen, Andrej Skerlap and Lee Edwards. However in declining to favour the approaches of any of these authors it argues that no writers have so far revealed the true significance of a proper application of the notion ‘rhetoric’ to the field of public relations. The claim will be that if the true relevance of the fields of public relations and rhetoric to each other is fully recognised the stature of public relations would be raised to a considerable extent beyond current thinking.

Role of intensive training in the growth and maturation of artistic gymnasts

Short stature and later maturation of youth artistic gymnasts are often attributed to the effects of intensive training from a young age. Given limitations of available data, inadequate specification of training, failure to consider other factors affecting growth and maturation, and failure to address epidemiological criteria for causality, it has not been possible thus far to establish cause–effect relationships between training and the growth and maturation of young artistic gymnasts. In response to this ongoing debate, the Scientific Commission of the International Gymnastics Federation (FIG) convened a committee to review the current literature and address four questions: (1) Is there a negative effect of training on attained adult stature? (2) Is there a negative effect of training on growth of body segments? (3) Does training attenuate pubertal growth and maturation, specifically, the rate of growth and/or the timing and tempo of maturation? (4) Does training negatively influence the endocrine system, specifically hormones related to growth and pubertal maturation? The basic information for the review was derived from the active involvement of committee members in research on normal variation and clinical aspects of growth and maturation, and on the growth and maturation of artistic gymnasts and other youth athletes. The committee was thus thoroughly familiar with the literature on growth and maturation in general and of gymnasts and young athletes. Relevant data were more available for females than males. Youth who persisted in the sport were a highly select sample, who tended to be shorter for chronological age but who had appropriate weight-for-height. Data for secondary sex characteristics, skeletal age and age at peak height velocity indicated later maturation, but the maturity status of gymnasts overlapped the normal range of variability observed in the general population. Gymnasts as a group demonstrated a pattern of growth and maturation similar to that observed among short-, normal-, late-maturing individuals who were not athletes. Evidence for endocrine changes in gymnasts was inadequate for inferences relative to potential training effects. Allowing for noted limitations, the following conclusions were deemed acceptable: (1) Adult height or near adult height of female and male artistic gymnasts is not compromised by intensive gymnastics training. (2) Gymnastics training does not appear to attenuate growth of upper (sitting height) or lower (legs) body segment lengths. (3) Gymnastics training does not appear to attenuate pubertal growth and maturation, neither rate of growth nor the timing and tempo of the growth spurt. (4) Available data are inadequate to address the issue of intensive gymnastics training and alterations within the endocrine system.

Height, aging and cognitive abilities across Europe

Previous research has found that as a marker of childhood circumstances, height is correlated with cognitive functioning at older ages. Using data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) and about 17,000 respondents from 11 countries, we find that height is positively and significantly associated with cognitive functioning in later life despite controlling for a myriad of possible confounding factors. A 10 cm increase in height is associated with a 0.04 standard deviation increase in a summary cognitive score (mean 0.02, std. dev. 0.77). We find that being born in a country where the infant mortality rate at the time of birth is high has a negative and significant influence on cognitive functioning in later life. A 10% increase in the infant mortality rate is associated with a 0.1 standard deviation decrease in the summary cognitive score. We also find some evidence that height serves as a protective factor against age related deterioration in cognitive functioning. For persons of average stature, age related decreases in cognition scores are 3–5 percentage points smaller if they move up a quartile in the height distribution. Our results also suggest that there is a significant positive association between height and cognitive abilities across countries for this pre-1950 birth cohort of respondents, with correlations ranging from 0.4 to 0.8.

Recombinant human growth hormone for the treatment of growth disorders in children: a systematic review and economic evaluation

Recombinant human growth hormone (rhGH) is licensed for short stature associated with growth hormone deficiency (GHD), Turner syndrome (TS), Prader-Willi syndrome (PWS), chronic renal insufficiency (CRI), short stature homeobox-containing gene deficiency (SHOX-D) and being born small for gestational age (SGA). To assess the clinical effectiveness and cost-effectiveness of rhGH compared with treatment strategies without rhGH for children with GHD, TS, PWS, CRI, SHOX-D and those born SGA. The systematic review used a priori methods. Key databases were searched (e.g. MEDLINE, EMBASE, NHS Economic Evaluation Database and eight others) for relevant studies from their inception to June 2009. A decision-analytical model was developed to determine cost-effectiveness in the UK. Two reviewers assessed titles and abstracts of studies identified by the search strategy, obtained the full text of relevant papers, and screened them against inclusion criteria. Data from included studies were extracted by one reviewer and checked by a second. Quality of included studies was assessed using standard criteria, applied by one reviewer and checked by a second. Clinical effectiveness studies were synthesised through a narrative review. Twenty-eight randomised controlled trials (RCTs) in 34 publications were included in the systematic review. GHD: Children in the rhGH group grew 2.7 cm/year faster than untreated children and had a statistically significantly higher height standard deviation score (HtSDS) after 1 year: -2.3 ± 0.45 versus -2.8 ± 0.45. TS: In one study, treated girls grew 9.3 cm more than untreated girls. In a study of younger children, the difference was 7.6 cm after 2 years. HtSDS values were statistically significantly higher in treated girls. PWS: Infants receiving rhGH for 1 year grew significantly taller (6.2 cm more) than those untreated. Two studies reported a statistically significant difference in HtSDS in favour of rhGH. CRI: rhGH-treated children in a 1-year study grew an average of 3.6 cm more than untreated children. HtSDS was statistically significantly higher in treated children in two studies. SGA: Criteria were amended to include children of 3+ years with no catch-up growth, with no reference to mid-parental height. Only one of the RCTs used the licensed dose; the others used higher doses. Adult height (AH) was approximately 4 cm higher in rhGH-treated patients in the one study to report this outcome, and AH-gain SDS was also statistically significantly higher in this group. Mean HtSDS was higher in treated than untreated patients in four other studies (significant in two). SHOX-D: After 2 years' treatment, children were approximately 6 cm taller than the control group and HtSDS was statistically significantly higher in treated children. The incremental cost per quality adjusted life-year (QALY) estimates of rhGH compared with no treatment were: 23,196 pounds for GHD, 39,460 pounds for TS, 135,311 pounds for PWS, 39,273 pounds for CRI, 33,079 pounds for SGA and 40,531 pounds for SHOX-D. The probability of treatment of each of the conditions being cost-effective at 30,000 pounds was: 95% for GHD, 19% for TS, 1% for PWS, 16% for CRI, 38% for SGA and 15% for SHOX-D.

Reassembling a lost lowland carabid beetle assemblage (Coleoptera) from Kauai, Hawaiian Islands

A late Holocene but prehistoric carabid beetle fauna from the lowland Makauwahi Cave, Kauai, is characterised. Seven extinct species - Blackburnia burneyi, B. cryptipes, B. godzilla, B. menehune, B. mothra, B. ovata and B. rugosa, spp. nov. (tribe Platynini) - represent the first Hawaiian insect species to be newly described from subfossil specimens. Four extant Blackburnia spp. - B. aterrima (Sharp), B. bryophila Liebherr, B. pavida (Sharp), and B. posticata (Sharp) - and three extant species of tribe Bembidiini - Bembidion ignicola Blackburn, B. pacificum Sharp and Tachys oahuensis Blackburn - are also represented. All subfossil fragments are disarticulated, with physical dimensions and cladistic analysis used to associate the major somites - head, prothorax and elytra - for description of the new species. The seven new Makauwahi Cave species support recognition of a lowland area of endemism adjoining Haupu, a low-stature 700m elevation ridgeline in southern Kauai. Four of the extinct Blackburnia are adelphotaxa to extant species currently found at higher elevations in Kauai. Addition of these lowland specialists to the phylogenetic hypothesis undercuts applicability of the taxon cycle for interpreting evolutionary history of these taxa. Two of the extinct species are Kauai representatives in clades that subsequently colonised younger Hawaiian Islands, enhancing support for the progressive biogeographic colonisation of the archipelago by this lineage. And three of the extinct Blackburnia species comprised larger beetles than those of any extant Kauai Blackburnia, consistent with the evolution of island gigantism in the lowland habitats of Kauai.