Effects of congressional modernization laws on public access to innovative medical device technologies

The Federal Food and Drug Administration (FDA) and the Centers for Medicare and Medicaid (CMS) play key roles in making Class III, medical devices available to the public, and they are required by law to meet statutory deadlines for applications under review. Historically, both agencies have failed to meet their respective statutory requirements. Since these failures affect patient access and may adversely impact public health, Congress has enacted several “modernization” laws. However, the effectiveness of these modernization laws has not been adequately studied or established for Class III medical devices. ^ The aim of this research study was, therefore, to analyze how these modernization laws may have affected public access to medical devices. Two questions were addressed: (1) How have the FDA modernization laws affected the time to approval for medical device premarket approval applications (PMAs)? (2) How has the CMS modernization law affected the time to approval for national coverage decisions (NCDs)? The data for this research study were collected from publicly available databases for the period January 1, 1995, through December 31, 2008. These dates were selected to ensure that a sufficient period of time was captured to measure pre- and post-modernization effects on time to approval. All records containing original PMAs were obtained from the FDA database, and all records containing NCDs were obtained from the CMS database. Source documents, including FDA premarket approval letters and CMS national coverage decision memoranda, were reviewed to obtain additional data not found in the search results. Analyses were conducted to determine the effects of the pre- and post-modernization laws on time to approval. Secondary analyses of FDA subcategories were conducted to uncover any causal factors that might explain differences in time to approval and to compare with the primary trends. The primary analysis showed that the FDA modernization laws of 1997 and 2002 initially reduced PMA time to approval; after the 2002 modernization law, the time to approval began increasing and continued to increase through December 2008. The non-combined, subcategory approval trends were similar to the primary analysis trends. The combined, subcategory analysis showed no clear trends with the exception of non-implantable devices, for which time to approval trended down after 1997. The CMS modernization law of 2003 reduced NCD time to approval, a trend that continued through December 2008. This study also showed that approximately 86% of PMA devices do not receive NCDs. ^ As a result of this research study, recommendations are offered to help resolve statutory non-compliance and access issues, as follows: (1) Authorities should examine underlying causal factors for the observed trends; (2) Process improvements should be made to better coordinate FDA and CMS activities to include sharing data, reducing duplication, and establishing clear criteria for “safe and effective” and “reasonable and necessary”; (3) A common identifier should be established to allow tracking and trending of applications between FDA and CMS databases; (4) Statutory requirements may need to be revised; and (5) An investigation should be undertaken to determine why NCDs are not issued for the majority of PMAs. Any process improvements should be made without creating additional safety risks and adversely impacting public health. Finally, additional studies are needed to fully characterize and better understand the trends identified in this research study.^

Ozone and fine particulate matter association with CVD and COPD emergency room visits in Harris County, Texas: Spatiotemporal analysis

This study represents a secondary analysis of the merging of emergency room visits and daily ozone and PM2.5. Although the adverse health effects of ozone and fine particulate matter have been documented in the literature, evidence regarding the health risks of these two pollutants in Harris County, Texas, is limited. Harris County (Houston) has sufficiently unique characteristics that analysis of these relationships in this setting and with the ozone and industry issues in Houston is informative. The objective of this study was to investigate the association between the joint exposure to ozone and fine particulate matter, and emergency room diagnoses of chronic obstructive pulmonary disease and cardiovascular disease in Harris County, Texas, from 2004 to 2009, with zero and one day lags. ^ The study variables were daily emergency room visits for Harris County, Texas, from 2004 to 2009, temperature, relative humidity, east wind component, north wind component, ozone, and fine particulate matter. Information about each patient's age, race, and gender was also included. The two dichotomous outcomes were emergency room visits diagnoses for chronic obstructive pulmonary disease and cardiovascular disease. Estimates of ozone and PM2.5 were interpolated using kriging, in which estimates of the two pollutants were predicted from monitoring data for every case residence zip code for every day of the six years, over 3 million estimates (one of each pollutant for each case in the database). ^ Logistic regressions were conducted to estimate odds ratios of the two outcomes. Three analyses were conducted: one for all records, another for visits during the four months of April and September of 2005 and 2009, and a third one for visits from zip codes that are close to PM2.5 monitoring stations (east area of Harris County). The last two analyses were designed to investigate special temporal and spatial characteristics of the associations. ^ The dataset included all ER visits surveyed by Safety Net from 2004 to 2009, exceeding 3 million visits for all causes. There were 95,765 COPD and 96,596 CVD cases during this six year period. A 1-μg/m3 increase in PM2.5 on the same day was associated with a 1.0% increase in the odds of chronic obstructive pulmonary disease emergency room diagnoses, a 0.4% increase in the odds of cardiovascular disease emergency room diagnoses, and a 0.2% increase in the odds of cardiovascular disease emergency room diagnoses on the following day. A 1-ppb increase in ozone was associated with a 0.1% increase in the odds of chronic obstructive pulmonary disease emergency room diagnoses on the same day. These four percentages add up to 1.7% of ER visits. That is, over the period of six years, one unit increase for both ozone and PM2.5 (joint increase), resulted in about 55,286 (3,252,102 * 0.017) extra ER visits for CVD or COPD, or 9,214 extra ER visits per year. ^ After adjustment for age, race, gender, day of the week, temperature, relative humidity, east wind component, north wind component, and wind speed, there were statistically significant associations between emergency room chronic obstructive pulmonary disease diagnosis in Harris County, Texas, with joint exposure to ozone and fine particulate matter for the same day; and between emergency room cardiovascular disease diagnosis and exposure to PM2.5 of the same day and the previous day. ^ Despite the small association between the two air pollutants and the health outcomes, this study points to important findings. Namely, the need to identify reasons for the increase of CVD and COPD ER visits over the course of the project, the statistical association between humidity (or whatever other variables for which it may serve as a surrogate) and CVD and COPD cases, and the confirmatory finding that males and blacks have higher odds for the two outcomes, as consistent with other studies. ^ An important finding of this research suggests that the number and distribution of PM2.5 monitors in Harris County - although not evenly spaced geographically—are adequate to detect significant association between exposure and the two outcomes. In addition, this study points to other potential factors that contribute to the rising incidence rates of CVD and COPD ER visits in Harris County such as population increases, patient history, life style, and other pollutants. Finally, results of validation, using a subset of the data demonstrate the robustness of the models.^

Sea surface temperatures during Marine Isotope Stage (MIS) 11

The Marine Isotope Stage (MIS) 11 (424-374 ka) was characterized by a protracted deglaciation and an unusually long climatic optimum. It remains unclear to what degree the climate development during this interglacial reflects the unusually weak orbital forcing or greenhouse gas trends. Previously, arguments about the duration and timing of the MIS11 climatic optimum and about the pace of the deglacial warming were based on a small number of key records, which appear to show regional differences. In order to obtain a global signal of climate evolution during MIS11, we compiled a database of 78 sea surface temperature (SST) records from 57 sites spanning MIS11, aligned these individually on the basis of benthic (N = 28) or planktonic (N = 31) stable oxygen isotope curves to a common time frame and subjected 48 of them to an empirical orthogonal function (EOF) analysis. The analysis revealed a high commonality among all records, with the principal SST trend explaining almost 49% of the variability. This trend indicates that on the global scale, the surface ocean underwent rapid deglacial warming during Termination V, in pace with carbon dioxide rise, followed by a broad SST optimum centered at ~410 kyr. The second EOF, which explained ~18% of the variability, revealed the existence of a different SST trend, characterized by a delayed onset of the temperature optimum during MIS11 at ~398 kyr, followed by a prolonged warm period lasting beyond 380 kyr. This trend is most consistently manifested in the mid-latitude North Atlantic and Mediterranean Sea and is here attributed to the strength of the Atlantic meridional overturning circulation. A sensitivity analysis indicates that these results are robust to record selection and to age-model uncertainties of up to 3-6 kyr, but more sensitive to SST seasonal attribution and SST uncertainties >1 °C. In order to validate the CCSM3 (Community Climate System Model, version 3) predictive potential, the annual and seasonal SST anomalies recorded in a total of 74 proxy records were compared with runs for three time slices representing orbital configuration extremes during the peak interglacial of MIS11. The modeled SST anomalies are characterized by a significantly lower variance compared to the reconstructions. Nevertheless, significant correlations between proxy and model data are found in comparisons on the seasonal basis, indicating that the model captures part of the long-term variability induced by astronomical forcing, which appears to have left a detectable signature in SST trends.

Age models of five ice cores from the Dronning Maud Land, Antarctica

For the first time, annually resolved accumulation rates have been determined in central Antarctica by means of counting seasonal signals of ammonium, calcium, and sodium. All records, obtained from three intermediate depth ice cores from Dronning Maud Land, East Antarctica, show rather constant accumulation rates throughout the last 9 centuries with mean values of 63, 61, and 44 mm H2O yr**-1 and a typical year-to-year variation of about 30%. For the last few decades, no trend was detected accounting for the high natural variability of all records. A significant weak intersite correlation is apparent only between two cores when the high-frequency part with periods less than 30 years is removed. By analyzing the records in the frequency domain, no persistent periods were found. This suggests that the snow accumulation in this area is mainly influenced by local deposition patterns and may be additionally masked by redistribution of snow due to wind. By comparing accumulation rates over the last 2 millennia a distinct change in the layer thickness in one of the three cores was found, which might be attributed either to an area upstream of the drilling site with lower accumulation rates, or to deposition processes influenced by surface undulations. The missing of a clear correlation between the accumulation rate histories at the three locations is also important for the interpretation of small, short time variations of past precipitation records obtained from deep ice cores.

Stable isotopes and calcium carbonate at DSDP Holes 85-574 and 85-574A

Detailed stable isotopic and calcium carbonate records (with a sampling resolution of 3000 yr.) from the middle Miocene section of hydraulic piston corer (HPC) Hole 574A provide a sequence that records the major shift in the oxygen isotopic composition of the world's oceans that occurred at about 14 Ma. The data suggest that this transition was rapid and spans about 30,000 yr. of sediment deposition. In intervals before and after the shift, the mean d18O values are characterized by a constant mean with a high degree of variability. The degree of variability in both the d18O and d13C records is comparable to that observed for the Pliocene and earliest Pleistocene and does not show a significant change before or after the major shift in the d18O record. Whereas the oxygen isotopic record is characterized by relatively stable mean values before and after the middle Miocene event, the d13C record shows a number of significant offsets in the mean value separated by intervals of high-frequency variations. Time and frequency domain analysis of all records from Hole 574A indicate that the frequency components shown to be related to orbital changes in the Pleistocene record are also present in the middle Miocene. The high variability observed in the Site 574 isotopic records places important constraints on models describing the role of formation of the Antarctic ice sheet during the middle Miocene climatic transitions. Thus, HPC Hole 574A provides a valuable sequence for detailed study of climatic variability during an important time in the Earth's history, although we cannot provide a definitive explanation of the major oxygen isotopic event of the middle Miocene.

Age profiles and isotopes d18O and d13C in Globigerina angiporoides and Oridorsalis umbonatus at DSDP Site 90-593 and Holes 12-111, 29-277 and 90-592

The late Eocene through earliest Miocene stable-isotope composition of southwest Pacific microfossils has been examined in a traverse of high-quality sedimentary sequences ranging from subantarctic (DSDP Site 277) through temperate regions (DSDP Sites 592 and 593). Changes in oxygen-isotope values, measured in benthic and planktonic foraminifers, document the Oligocene development and strengthening of latitudinal thermal zonation from water masses with broad temperature gradients during the Eocene to the steeper gradients and more distinct latitudinally distributed surface water-mass belts of the Neogene. The oxygen-isotope records can be divided into three intervals: late Eocene, early Oligocene, and middle to late Oligocene. Each interval represents a successive stage in the evolution of latitudinal thermal gradients between subantarctic and temperate regions in the Southern Hemisphere. During the late Eocene, oxygen-isotope values at subantarctic Site 277 were similar to those at temperate Sites 592 and 593. The isotope values suggest that, although the inferred paleotemperatures at Site 277 are slightly cooler on average than those at the temperate sites, there is no evidence for a major thermal boundary between the regions at this time. All three sites record the well-known oxygen-isotope enrichment of about 1 per mil in both planktonic and benthic foraminifers in close association with the Eocene/Oligocene boundary. In contrast to the earliest Oligocene enrichments in the planktonic and benthic oxygen-isotope composition at Site 277, more northern Sites 592 and 593 exhibit a depletion through the early-middle Oligocene. This documents the beginning of thermal segregation as subantarctic waters cooled relative to those at temperate latitudes. During the Oligocene, this surface-water differentiation continued, as measured by planktonic d18O values. The oxygen-isotope records of the benthic foraminifers also began to diverge in the earliest Oligocene. The most enriched oxygen-isotope values in all records cluster in the middle Oligocene, marked by oscillating episodes of enrichments >0.5 per mil occurring most prominently in the subantarctic record of Site 277. These values can be interpreted as recording either the coldest oceanic temperatures of the Paleogene and/or accumulations of Antarctic ice. After this interval, latitudinal thermal differentiation developed rapidly during the middle Oligocene, especially in the surface waters which actually warmed in temperate areas. If the enriched Oligocene oxygen-isotope values indicate that ice had accumulated, this ice must have disappeared by the early Miocene, when depleted oxygen-isotope values suggest very warm conditions. The data presented in this chapter document the progressive increase of latitudinal temperature gradients from the late Eocene through the late Oligocene. This pattern of increasing isotopic offset between latitudinally distributed southwest Pacific sites is linked to the establishment and strengthening of the Circum-Antarctic Current, previously considered to have developed during the middle to late Oligocene. The intensification of this current system progressively decoupled the warm subtropical gyres from cool polar circulation, in turn leading to increased Antarctic glaciation.

Stable carbon and oxygen isotope compositions of bulk rock samples analyzed from the Zumaia section

Astronomical tuning of sedimentary records to precise orbital solutions has led to unprecedented resolution in the geological time scale. However, the construction of a consistent astronomical time scale for the Paleocene is controversial due to uncertainties in the recognition of the exact number of 405-kyr eccentricity cycles and accurate correlation between key records. Here, we present a new Danian integrated stratigraphic framework using the land-based Zumaia and Sopelana hemipelagic sections from the Basque Basin and deep-sea records drilled during Ocean Drilling Program (ODP) Legs 198 (Shatsky Rise, North Pacific) and 208 (Walvis Ridge, South Atlantic) that solves previous discrepancies. The new coherent stratigraphy utilises composite images from ODP cores, a new whole-rock d13C isotope record at Zumaia and new magnetostratigraphic data from Sopelana. We consistently observe 11 405-kyr eccentricity cycles in all studied Danian successions. We achieve a robust correlation of bioevents and stable isotope events between all studied sections at the ~100-kyr short-eccentricity level, a prerequisite for paleoclimatic interpretations. Comparison with and subsequent tuning of the records to the latest orbital solution La2011 provides astronomically calibrated ages of 66.022 ± 0.040 Ma and 61.607 ± 0.040 Ma for the Cretaceous-Paleogene (K-Pg) and Danian-Selandian 105 (D-S) boundaries respectively. Low sedimentation rates appear common in all records in the mid-Danian interval, including conspicuous condensed intervals in the oceanic records that in the past have hampered the proper identification of cycles. The comprehensive interbasinal approach applied here reveals pitfalls in time scale construction, filtering techniques in particular, and indicates that some caution and scrutiny has to be applied when building orbital chronologies. Finally, the Zumaia section, already hosting the Selandian Global Boundary Stratotype Section and Point (GSSP), could serve as the global Danian unit stratotype in the future.

Age models, ostracods and trace elements of five gravity cores from the NW Black Sea

New Mg/Ca, Sr/Ca, and published stable oxygen isotope and 87Sr/86Sr data obtained on ostracods from gravity cores located on the northwestern Black Sea slope were used to infer changes in the Black Sea hydrology and water chemistry for the period between 30 to 8 ka B.P. (calibrated radiocarbon years). The period prior to 16.5 ka B.P. was characterized by stable conditions in all records until a distinct drop in d18O values combined with a sharp increase in 87Sr/86Sr occurred between 16.5 and 14.8 ka B.P. This event is attributed to an increased runoff from the northern drainage area of the Black Sea between Heinrich Event 1 and the onset of the Bølling warm period. While the Mg/Ca and Sr/Ca records remained rather unaffected by this inflow; they show an abrupt rise with the onset of the Bølling/Allerød warm period. This rise was caused by calcite precipitation in the surface water, which led to a sudden increase of the Sr/Ca and Mg/Ca ratios of the Black Sea water. The stable oxygen isotopes also start to increase around 15 ka B.P., although in a more gradual manner, due to isotopically enriched meteoric precipitation. While Sr/Ca remains constant during the following interval of the Younger Dryas cold period, a decrease in the Mg/Ca ratio implies that the intermediate water masses of the Black Sea temporarily cooled by 1-2°C during the Younger Dryas. The 87Sr/86Sr values drop after the cessation of the water inflow at 15 ka B.P. to a lower level until the Younger Dryas, where they reach values similar to those observed during the Last Glacial Maximum. This might point to a potential outflow to the Mediterranean Sea via the Sea of Marmara during this period. The inflow of Mediterranean water started around 9.3 ka B.P., which is clearly detectable in the abruptly increasing Mg/Ca, Sr/Ca, and 87Sr/86Sr values. The accompanying increase in the d18O record is less pronounced and would fit to an inflow lasting ~100 a.

Revised calibration of the MBT-CBT paleotemperature proxy

The MBT-CBT proxy for the reconstruction of paleotemperatures and past soil pH is based on the distribution of branched glycerol dialkyl glycerol tetraether (brGDGT) membrane lipids. The Methylation of Branched Tetraether (MBT) and the Cyclisation of Branched Tetraether (CBT) indices were developed to quantify these distributions, and significant empirical relations between these indices and annual mean air temperature (MAT) and/or soil pH were found in a large data set of soils. In this study, we extended this soil dataset to 278 globally distributed surface soils. Of these soils, 26% contains all nine brGDGTs, while in 63% of the soils the seven most common brGDGTs were detected, and the latter were selected for calibration purposes. This resulted in new transfer functions for the reconstruction of pH based on the CBT index: pH = 7.90-1.97 × CBT (r**2 = 0.70; RMSE = 0.8; n = 176), as well as for MAT based on the CBT index and methylation index based on the seven most abundant GDGTs (defined as MBT'): MAT = 0.81-5.67 × CBT + 31.0 × MBT' (r**2 = 0.59; RMSE = 5.0 °C; n = 176). The new transfer function for MAT has a substantially lower correlation coefficient than the original equation (r**2 = 0.77). To investigate possible improvement of the correlation, we used our extended global surface soil dataset to statistically derive the indices that best describe the relations of brGDGT composition with MAT and soil pH. These new indices, however, resulted in only a relatively minor increase in correlation coefficients, while they cannot be explained straightforwardly by physiological mechanisms. The large scatter in the calibration cannot be fully explained by local factors or by seasonality, but MAT for soils from arid regions are generally substantially (up to 20 °C) underestimated, suggesting that absolute brGDGT-based temperature records for these areas should be interpreted with caution. The applicability of the new MBT'-CBT calibration function was tested using previously published MBT-CBT-derived paleotemperature records covering the last deglaciation in Central Africa and East Asia, the Eocene-Oligocene boundary and the Paleocene-Eocene thermal maximum. The results show that trends remain similar in all records, but that absolute temperature estimates and the amplitude of temperature changes are lower for most records, and generally in better agreement with independent proxy data.

Occurrence (presence-only) of living Lophelia pertusa reefs in the Irish continental margin

The present data set was used as a training set for a Habitat Suitability Model. It contains occurrence (presence-only) of living Lophelia pertusa reefs in the Irish continental margin, which were assembled from databases, cruise reports and publications. A total of 4423 records were inspected and quality assessed to ensure that they (1) represented confirmed living L. pertusa reefs (so excluding 2900 records of dead and isolated coral colony records); (2) were derived from sampling equipment that allows for accurate (<200 m) geo-referencing (so excluding 620 records derived mainly from trawling and dredging activities); and (3) were not duplicated. A total of 245 occurrences were retained for the analysis. Coral observations are highly clustered in regions targeted by research expeditions, which might lead to falsely inflated model evaluation measures (Veloz, 2009). Therefore, we coarsened the distribution data by deleting all but one record within grid cells of 0.02° resolution (Davies & Guinotte 2011). The remaining 53 points were subject to a spatial cross-validation process: a random presence point was chosen, grouped with its 12 closest neighbour presence points based on Euclidean distance and withheld from model training. This process was repeated for all records, resulting in 53 replicates of spatially non-overlapping sets of test (n=13) and training (n=40) data. The final 53 occurrence records were used for model training.

Ptolemaiida, a new order of Mammalia--with description of the cranium of Ptolemaia grangeri.

All records of the exotic mammalian family Ptolemaiidae are known from 182 m of section in the lower to middle parts of the upper Eocene and lower Oligocene Jebel Qatrani Formation, Fayum Depression, Egypt. Previous tentative assignments of ptolemaiid affinity have suggested that these animals are allied with the primitive suborder Pantolesta (currently placed in the order Cimolesta). Though perhaps ultimately derived from an unknown member of that group, the likelihood that ptolemaiids constitute a distinct group is considered, and analysis of all known materials of Ptolemaia, Qarunavus, and Cleopatrodon demonstrates that these genera belong in their own order, the Ptolemaiida, described here. The morphologically unique dentition and only known ptolemaiid cranium, that of Ptolemaia grangeri, is described. Although Qarunavus and Cleopatrodon show some similarities in primitive characters to European merialine Paroxyclaenidae (suborder Pantolesta), their affinities clearly lie with Ptolemaia and the Ptolemaiida.

Descrição de um fóssil de Eira barbara (Carnivora, Mustelidae) do Pleistoceno final (Bacia do Acre) e morfologia comparada do sincrânio de E. barbara recente: implicações paleobiogeográficas, geográficas e taxonômicas

A espécie recente Eira barbara (Mustelidae, Carnivora) possui uma distribuição geográfica desde o México até o norte da Argentina. É um importante táxon a ser estudado como modelo anatômico dentre os mustelídeos, assim como um importante modelo para uma melhor compreensão e entendimento sobre a diversificação dos Mustelidae. Atualmente, os registros fósseis de E. barbara na América do Sul são bastante escassos e restritos às idades pleistocênicas, sendo que os estudos destes fósseis são frequentemente desprovidos de maiores esforços para realização de descrições morfológicas detalhadas e de estudos paleobiogeográficos. Assim como os estudos dos fósseis de E. barbara são limitados, constatou-se que o mesmo cenário é observado quanto aos estudos sobre a morfologia e biogeografia da espécie. Desta forma, o presente trabalho se propôs a: realizar uma revisão de todos os registros da espécie e de uma forma geral, contribuir para um melhor conhecimento sobre a morfologia sincraniana e sobre a história biogeográfica e paleobiogeográfica de E. barbara. Para tanto, os seguintes objetivos foram propostos: estudo e redescrição detalhada do fóssil UFAC-PV 036, proveniente do Pleistoceno final do Alto Rio Juruá do sudoeste da Amazônia Brasileira; descrição sincraniana comparada de estruturas morfológicas externas e internas, analisando caracteres intraespecíficos da espécie E. barbara; realização de análises multivariadas a fim de investigar variações geográficas sob o uso de caracteres craniométricos de E. barbara entre os diferentes biomas brasileiros. A revisão dos registros fósseis foi de grande importância para o estabelecimento dos verdadeiros registros de Eira na América do Sul e a redescrição de UFAC-PV 36 contribui para o melhor conhecimento morfológico e paleobiogeográfico da espécie. A descrição morfológica comparada do sincrânio de E. barbara contribui de forma significativa para o conhecimento sobre a morfologia da espécie bem como, a descrição de caracteres intraespecíficos proporcionam caracteres mais apropriados em matrizes morfológicas, fornecendo maior robustez nas análises filogenéticas futuras. Este trabalho propõe que E. barbara não possui diferenças craniométricas estatisticamente significativas entre os biomas brasileiros, porém, E. barbara caracteriza-se aqui como uma espécie dimórfica, na qual os machos possuem estruturas cranianas relativamente maiores do que as fêmeas.

Sea surface temperatures derived from alkenones from Late Quaternary sediments of the East Equatorial South Atlantic

Angola Basin and Walvis Ridge records of past sea surface temperatures (SST) derived from the alkenone Uk 37 index are used to reconstruct the surface circulation in the east equatorial South Atlantic for the last 200,000 years. Comparison of SST estimates from surface sediments between 5° and 20°S with modern SST data suggests that the alkenone temperatures represent annual mean values of the surface mixed layer. Alkenone-derived temperatures for the warm climatic maxima of the Holocene and the penultimate interglacial are 1 to 4°C higher than latest Holocene values. All records show glacial to interglacial differences of about 3.5°C in annual mean SST, which is about 1.5°C greater than the difference estimated by CLIMAP (1981) for the eastern Angola Basin. At the Walvis Ridge, significant SST variance is observed at all of the Earth's orbital periodicities. SST records from the Angola Basin vary predominantly at 23- and 100-kyr periodicities. For the precessional cycle, SST changes at the Walvis Ridge correspond to variations of boreal summer insolation over Africa and lead ice volume changes, suggesting that the east equatorial South Atlantic is sensitive to African monsoon intensity via trade-wind zonality. Angola Basin SST records lag those from the Walvis Ridge and the equatorial Atlantic by about 3 kyr. The comparison of Angola Basin and Walvis Ridge SST records implies that the Angola-Benguela Front (ABF) (currently at about 14-16°S) has remained fairly stationary between 12° and 20°S (the limits of our cores) during the last two glacial-interglacial cycles. The temperature contrast associated with the ABF exhibits a periodic 23-kyr variability which is coherent with changes in boreal summer insolation over Africa. These observations suggest that surface waters north of the present ABF have not directly responded to monsoon-modulated changes in the trade-wind vector, that the central field of zonally directed trades in the southern hemisphere was not shifted or extended northward by several degrees of latitude during glacials, and that a cyclonic gyre circulation has existed in the east equatorial South Atlantic over the last 200,000 years. This scenario contradicts former assumptions of glacial intensification of the Benguela Current into the eastern Angola Basin and increased coastal upwelling off Angola.

Ayrshire record, advanced registry.

Vol. 5, 1928 contains all records completed prior to Jan. 1, 1928.

Polioviruses and other enteroviruses isolated from faecal samples of patients with acute flaccid paralysis in Australia, 1996-2004

Background: Acute flaccid paralysis (AFP) is the most common clinical presentation of acute poliovirus infection, occurring in 0.1-1% of infected cases. AFP surveillance has been used world-wide to monitor the control and eradication of circulating wild poliovirus. This study aims to review the significance of all enteroviruses, including polioviruses, isolated from patients with AFP in Australia between 1996 and 2004. Methods: We undertook a retrospective review of all notified cases of AFP, aged 0-15 years and resident in Australia at the time of notification. We reviewed all available clinical and virological data for these cases and all records of the Polio Expert Committee, which determined the final classification for all cases. Results: There were 335 notified cases that satisfied the case definition for AFP, 162 (48%) of whom had at least one faecal sample tested. Enteroviruses isolated from the faeces of 26 (16%) of the 162 cases were Coxsackie A24, Coxsackie B5, enterovirus 71, enterovirus 75, echovirus 9, echovirus 11 and echovirus 18. In addition, one or more polioviruses were isolated from the faeces of seven patients. Six of seven polioviruses were characterised as Sabin-like, one was not characterised, but all were considered to be incidental isolates. Five of these cases were classified as infant botulism, one case as transverse myelitis and one as a focal mononeuropathy. Conclusion: With the eradication of circulating wild polioviruses, other enteroviruses are being more commonly identified as the cause of polio-like illnesses. In the polio end game, when there is increased testing for polioviruses, it is important to consider infant botulism as a differential diagnosis in cases presenting with AFP.