Syntenic organization of the mouse distal chromosome 7 imprinting cluster and the Beckwith-Wiedemann syndrome region in chromosome 11p15.5

In human and mouse, most imprinted genes are arranged in chromosomal clusters. Their linked organization suggests co-ordinated mechanisms controlling imprinting and gene expression. The identification of local and regional elements responsible for the epigenetic control of imprinted gene expression will be important in understanding the molecular basis of diseases associated with imprinting such as Beckwith- Wiedemann syndrome. We have established a complete contig of clones along the murine imprinting cluster on distal chromosome 7 syntenic with the human imprinting region at 11p15.5 associated with Beckwith- Wiedemann syndrome. The cluster comprises approximately 1 Mb of DNA, contains at least eight imprinted genes and is demarcated by the two maternally expressed genes Tssc3 (Ipl) and H19 which are directly flanked by the non-imprinted genes Nap1l4 (Nap2) and Rpl23l (L23mrp), respectively. We also localized Kcnq1 (Kvlqt1) and Cd81 (Tapa-1) between Cdkn1c (p57(Kip2)) and Mash2. The mouse Kcnq1 gene is maternally expressed in most fetal but biallelically transcribed in most neonatal tissues, suggesting relaxation of imprinting during development. Our findings indicate conserved control mechanisms between mouse and human, but also reveal some structural and functional differences. Our study opens the way for a systematic analysis of the cluster by genetic manipulation in the mouse which will lead to animal models of Beckwith-Wiedemann syndrome and childhood tumours.      

Hepatitis B in childhood: An update for the paediatrician

Hepatitis B virus (HBV) infection may lead to acute or chronic hepatitis, cirrhosis and hepatocellular carcinoma. The incidence rate of paediatric hepatitis B is 0.2/100,000 to 1.8/100,000 in Canada. Hepatitis B virus infection is acquired largely through mother-to-infant (vertical) or community-based (horizontal) transmission in early childhood, whereas older children are susceptible to HBV infection through exposure to contaminated blood during intravenous drug use or through sexual transmission. Immigrants from endemic areas and some Native Canadian populations are also at a higher risk for HBV infection. Infection with HBV may manifest in three forms: acute self-limited hepatitis, chronic hepatitis or massive hepatic necrosis causing acute liver failure. The identification of HBV infection and the characterization of the disease relies on serological and virological tests. The course of chronic hepatitis B may be classified into three phases: an immunotolerant phase, an active phase and an inactive phase. Current treatment options include interferon-alpha and lamivudine for individuals with elevated serum alanine aminotransferase levels and markers of persistent viral replication. Children with chronic hepatitis B require regular monitoring and age-appropriate lifestyle counselling. Paediatricians are well-positioned to promote vaccination and encourage testing of those who are at risk for hepatitis B. With effective universal vaccination against hepatitis B, this infection could be essentially eliminated in Canada.     

Lamp light on leadership: clinical leadership and Florence Nightingale

stanley d. & sherratt a. (2010) Journal of Nursing Management  18, 115–121
Lamp light on leadership: clinical leadership and Florence Nightingale Aims The purpose of the present study was to use the example of Florence Nightingales’ nursing experience to highlight the differences between nursing leadership and clinical leadership with a focus on Miss Nightingales’ clinical leadership attributes. Background 2010 marks the centenary of the death of Florence Nightingale. As this significant date approaches this paper reflects on her contribution to nursing in relation to more recent insights into clinical leadership. Evaluation Literature has been used to explore issues related to nursing leadership, clinical leadership and the life and characteristics of Florence Nightingale. Key issues There are a few parts of Florence’s character which fit the profile of a clinical leader. However, Miss Nightingale was not a clinical leader she was a powerful and successful role model for the academic, political and managerial domains of nursing. Conclusion There are other ways to lead and other types of leaders and leadership that nursing and the health service needs to foster, discover and recognize. Implications for nursing management Clinical leaders should be celebrated and recognized in their own right. Both clinical leaders and nursing leaders are important and need to work collaboratively to enhance patient care and to positively enhance the profession of nursing.     

Comparative Effectiveness of Group and Individual Prenatal Care on Gestational Weight Gain

This study examined differences in gestational weight gain for women in CenteringPregnancy (CP) group prenatal care versus individually delivered prenatal care. We conducted a retrospective chart review and used propensity scores to form a matched sample of 393 women (76 % African-American, 13 % Latina, 11 % White; average age 22 years) receiving prenatal care at a community health center in the South. Women were matched on a wide range of demographic and medical background characteristics. Compared to the matched group of women receiving standard individual prenatal care, CP participants were less likely to have excessive gestational weight gain, regardless of their pre-pregnancy weight (b = ?.99, 95 % CI [?1.92, ?.06], RRR = .37). CP reduced the risk of excessive weight gain during pregnancy to 54 % of what it would have been in the standard model of prenatal care (NNT = 5). The beneficial effect of CP was largest for women who were overweight or obese prior to their pregnancy. Effects did not vary by gestational age at delivery. Post-hoc analyses provided no evidence of adverse effects on newborn birth weight outcomes. Group prenatal care had statistically and clinically significant beneficial effects on reducing excessive gestational weight gain relative to traditional individual prenatal care.