Pharmaceutical innovation, reference pricing and therapeutic classes

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Two mistletoes are too many?: Interspecific occurrence of mistletoes on the same host tree

Mistletoe can have a major impact on the fitness of the host plant. If there is more than one species of mistletoe on the same host tree, the overall impact might be amplified. We report the occurrence of more than one species of mistletoe on the same host tree. Although it is not a rule in the field, to our knowledge, there have been no studies of this topic. In most cases, two species of mistletoe were recorded on the same host tree, although we recorded three species of mistletoe on one occasion. This demonstrates that different species of mistletoe can be compatible with the same host species. Therefore, compatibility (structural and physiological) might be an important factor for the occurrence of mistletoe. Recent studies have shown that if the mistletoe does not recognize the host species, the deposited seeds will germinate but the haustorium will not penetrate the host branch. This is probably the primary mechanism in the establishment of more than one species of mistletoe on the same host, which can trigger a cascade of harmful effects for the host species.

Gluttonous predators: how to estimate prey size when there are too many prey

Prey size is an important factor in food consumption. In studies of feeding ecology, prey items are usually measured individually using calipers or ocular micrometers. Among amphibians and reptiles, there are species that feed on large numbers of small prey items (e.g. ants, termites). This high intake makes it difficult to estimate prey size consumed by these animals. We addressed this problem by developing and evaluating a procedure for subsampling the stomach contents of such predators in order to estimate prey size. Specifically, we developed a protocol based on a bootstrap procedure to obtain a subsample with a precision error of at the most 5%, with a confidence level of at least 95%. This guideline should reduce the sampling effort and facilitate future studies on the feeding habits of amphibians and reptiles, and also provide a means of obtaining precise estimates of prey size.

How rare is too rare to harvest? Management challenges posed by timber species occurring at low densities in the Brazilian Amazon

Tropical forests are characterized by diverse assemblages of plant and animal species compared to temperate forests. Corollary to this general rule is that most tree species, whether valued for timber or not, occur at low densities (<1 adult tree ha(-1)) or may be locally rare. In the Brazilian Amazon, many of the most highly valued timber species occur at extremely low densities yet are intensively harvested with little regard for impacts on population structures and dynamics. These include big-leaf mahogany (Swietenia macrophylla), ipe (Tabebuia serratifolia and Tabebuia impetiginosa), jatoba (Hymenaea courbaril), and freijo cinza (Cordia goeldiana). Brazilian forest regulations prohibit harvests of species that meet the legal definition of rare - fewer than three trees per 100 ha - but treat all species populations exceeding this density threshold equally. In this paper we simulate logging impacts on a group of timber species occurring at low densities that are widely distributed across eastern and southern Amazonia, based on field data collected at four research sites since 1997, asking: under current Brazilian forest legislation, what are the prospects for second harvests on 30-year cutting cycles given observed population structures, growth, and mortality rates? Ecologically `rare` species constitute majorities in commercial species assemblages in all but one of the seven large-scale inventories we analyzed from sites spanning the Amazon (range 49-100% of total commercial species). Although densities of only six of 37 study species populations met the Brazilian legal definition of a rare species, timber stocks of five of the six timber species declined substantially at all sites between first and second harvests in simulations based on legally allowable harvest intensities. Reducing species-level harvest intensity by increasing minimum felling diameters or increasing seed tree retention levels improved prospects for second harvests of those populations with a relatively high proportion of submerchantable stems, but did not dramatically improve projections for populations with relatively flat diameter distributions. We argue that restrictions on logging very low-density timber tree populations, such as the current Brazilian standard, provide inadequate minimum protection for vulnerable species. Population declines, even if reduced-impact logging (RIL) is eventually adopted uniformly, can be anticipated for a large pool of high-value timber species unless harvest intensities are adapted to timber species population ecology, and silvicultural treatments are adopted to remedy poor natural stocking in logged stands. (C) 2008 Elsevier B.V. All rights reserved.

Are we too busy to volunteer? The relationship between time and volunteering using the 1997 ABS Time Use Data

Time availability is a key concept in relation to volunteering, leading to organisations and governments targeting those outside paid work as a potential source of volunteers. It may be that factors such as a growth in female participation in the labour market and an increase in work hours will lead to more people saying they are simply too busy to volunteer This paper discusses how social and economic change, such as changing work patterns, are impacting on time availability. Using the 1997 ABS Time Use data, it identifies a predictive model of spare time by looking at demographic, life stage and employment related variables. Results confirm that those outside paid work, particularly the young, males and those without partners or children, are the groups most likely to have time to spare. These groups do not currently report high rates of volunteering. The paper concludes by questioning the premise that people will volunteer simply because they have time to spare. This is just one component of a range of motivations and factors that influence the decision to volunteer.

Percutaneous Laser Ablation of Sacrococcygeal Teratoma in a Hydropic Fetus with Severe Heart Failure - Too Late for a Surgical Procedure?

Sacrococcygeal teratoma (SCT) is the commonest solid fetal tumor. Perinatal prognosis is usually favorable, but sometimes it can be complicated by fetal hydrops being responsible for high risk of mortality. Fetal therapy in such cases has so far not been established. We report a case with a giant solid SCT associated with fetal hydrops and severe heart failure. 2D- and 3D-Doppler ultrasonography revealed great vessels originated from the medial sacral artery. Percutaneous laser ablation of these vessels was performed at 24 weeks of gestation. During the procedure, severe anemia was also diagnosed (hemoglobin 4.3 g/dl). Two days later, the fetus died and pathological examination revealed local tumor necrosis and blood hemorrhage inside the mass. We suggest that in such cases, fetal surgery may not be enough, being too late, and perhaps fetal clinical therapy for anemia and heart failure could be the best option at a gestational age of less than 28 weeks. Copyright (C) 2009 S. Karger AG, Basel

Too wet to exercise? Leaking urine as a barrier to physical activity in women

Leaking urine Is frequently mentioned (anecdotally) by women as a barrier to physical activity. The aim of this paper was to use results from the Australian Longitudinal Study on Women's Health (ALSWH) to explore the prevalence of leaking urine in Australian women, and to ascertain whether leaking urine might be a barrier to participation for women. More than 41,000 women participated in the baseline surveys of the ALSWH in 1996. More than one third of the mid-age (45-50 years) and older (70-75) women and 13% of the young women (18-23) reported leaking urine. There was a cross-sectional association between leaking urine and physical activity, such that women with more frequent urinary leakage were also more likely to report low levels of physical activity. More than one thousand of those who reported leaking urine at baseline participated in a follow-up study in 1999. Of these, more than 40% of the mid-age women (who were aged 48-53 in 1999), and one in seven of the younger (21-26 years) and older (73-79 years) women reported leaking urine during sport or exercise. More than one third of the mid-age women and more than one quarter of the older women, but only 7% of the younger women said they avoided sporting activities because of leaking urine. The data are highly suggestive that leaking urine may be a barrier to physical activity, especially among mid-age women. As current estimates suggest that fewer than half of all Australian women are adequately active for health benefit, health professionals could be more proactive in raising this issue with women and offering help through non-invasive strategies such as pelvic floor muscle exercises.

Primary aldosteronism: Are we diagnosing and operating on too few patients?

Many cases of potentially curable primary aldosteronism are currently likely to be diagnosed as essential hypertension unless screening tests based on suppression of renin are tarried out in all hypertensive patients. More than half of the patients with primary aldosteronism detected in this way have normal circulating potassium levels, so measurement of potassium is not enough to exclude primary aldosteronism. When primary aldosteronism is diagnosed, fewer than one-third of patients are suitable for surgery as initial treatment, but this still represents a significant percentage of hypertensive patients. After excluding glucocorticoid-suppressible primary aldosteronism, adrenal venous sampling is essential to detect unilateral production of aldosterone and diagnose angiotensin-responsive aldosterone-producing adenoma. One cannot rely on the computed tomography scan. If all hypertensive patients are screened for primary aldosteronism and the workup is continued methodically in those with a positive screening test, patients with unilateral overproduction of aldosterone who potentially can be cured surgically are not denied the possibility of cure.

Sticks and stones will break my bones -- and words will harm too: Australia's provision of education for asylum seeker children in detention

No abstract

Short QT Syndrome Presenting As Syncope: How Short Is Too Short?

We report the case of a 52-year-old man who presented to our emergency department (ED) after three episodes of syncope in the seven hours before admission. During his stay in the ED he had recurrent ventricular tachycardia (VT) requiring external electrical cardioversion. A 12-lead electrocardiogram (ECG) showed a short QT (SQT) interval (270 ms, QTc 327 ms), with frequent R-on-T extrasystoles triggering sustained polymorphic VT. After exclusion of other precipitating causes, the patient was diagnosed as having SQT syndrome (SQTS) according to the Gollob criteria. To our knowledge, this is the first known documentation of an SQT-caused arrhythmic episode on a 12-lead ECG, as well as the first reported case of SQTS in Portugal. The patient received an implantable cardioverter-defibrillator and was discharged. At a follow-up assessment 14 months later he was symptom-free, interrogation of the device showed no arrhythmic events, and the ECG showed a QT interval of 320 ms (QTc 347 ms).