We have shown that an assessment of both atrial and PDA shunt size can be derived from the respective colour Doppler shunt diameter.89 We used this and other echocardiographic measures to highlight the complexity of early preterm cardiac haemodynamics in a cohort of 120 ventilated preterm infants.10 Low ventricular outputs are a common early finding and are associated with high ventilatory pressures and large left to right PDA and atrial shunts which "steal" blood from the systemic circulation, even in the early postnatal period. 10 We hypothesised that there is an association between these early cardiovascular changes and IVH. The aim of this analysis was to examine if there were any significant associations, in this same group of preterm infants, between our early echocardiographic measures, other perinatal variables, and the occurrence of IVH. MethodsPreterm infants with a birthweight of less than 1500 g and respiratory problems likely to require mechanical ventilation for more than 24 hours were selected for echocardiographic study. The infants were studied over two 12 month periods which began, respectively, in February 1992 and June 1993. Echocardiography was performed at a mean of 19 hours of age (range 7-31 hours).Echocardiographic data collection was done using an Acuson 128/XP10 ultrasound machine with a 7 MHz transducer incorporating colour flow, pulsed wave, and continuous wave Doppler. Structural normality of the heart was established on the initial scan. A videotape of the scan was made and measurements were done later. Echocardiographic measures included: right ventricular output (RVO); colour Doppler diameter and pulsed Doppler direction of any ductus arteriosus shunt; left ventricular output (LVO); colour Doppler diameter and pulsed Doppler direction of any interatrial shunt. The echocardiographic procedure and measurement protocol have been described before.'0 Cerebral ultrasound scans were performed with a 7 MHz transducer. All infants were scanned between the fourth and seventh postnatal day and then again on day 28. These scans were recorded on to x-ray film and reported by a paediatric radiologist who was unaware of either the echocardiographic or clinical findings. These scans were used as the

Among preterm infants, delayed cord clamping did not result in a lower incidence of the combined outcome of death or major morbidity at 36 weeks of gestation than immediate cord clamping. (Funded by the Australian National Health and Medical Research Council [NHMRC] and the NHMRC Clinical Trials Centre; APTS Australian and New Zealand Clinical Trials Registry number, ACTRN12610000633088 .).

Few studies have evaluated the impact of childhood cancer on parents' occupational/financial status. This study explored parents' occupational/financial experiences posttreatment. Semistructured interviews were administered to 78 parents (44 mothers) of childhood cancer survivors diagnosed in the preceding 5 years. Transcripts were organized into themes using QSR NVivo8. Parents reported familial, psychological, and practical factors affecting their ability to return to work. Prioritizing family, reinstigating career progression, and negative workplace attitudes were particularly challenging. Parents of children with cancer experience substantial work-family conflict after their child's physical recovery from cancer. Family friendly policies and further research are recommended.

IntroductionActivity-monitoring devices may increase activity, but their effectiveness in sedentary, diseased, and less-motivated populations is unknown.MethodsSubjects with diabetes or pre-diabetes were given a Fitbit and randomized into three groups: Fitbit only, Fitbit with reminders, and Fitbit with both reminders and goal setting. Subjects in the reminders group were sent text-message reminders to wear their Fitbit. The goal-setting group was sent a daily text message asking for a step goal. All subjects had three in-person visits (baseline, 3 and 6 months). We modelled daily steps and goal setting using linear mixed-effects models.Results138 subjects participated with 48 in the Fitbit-only, 44 in the reminders, and 46 in the goal-setting groups. Daily steps decreased for all groups during the study. Average daily steps were 7123, 6906, and 6854 for the Fitbit-only, the goal-setting, and the reminders groups, respectively. The reminders group was 17.2 percentage points more likely to wear their Fitbit than the Fitbit-only group. Setting a goal was associated with a significant increase of 791 daily steps, but setting more goals did not lead to step increases.ConclusionIn a population of patients with diabetes or pre-diabetes, individualized reminders to wear their Fitbit and elicit personal step goals did not lead to increases in daily steps, although daily steps were higher on days when goals were set. Our intervention improved engagement and data collection, important goals for activity surveillance. This study demonstrates that new, more-effective interventions for increasing activity in patients with pre-diabetes and diabetes are needed.