Objective: The objective of this study was to explore osteopathy students' perceptions of occupational stress and clinical practice competence, and how these perceptions changed after six months of osteopathic practice. Participants: Students who graduated in 2010 from Victoria University's osteopathy program. Method: Participants completed one survey as final year osteopathy students in November 2010 and one survey as registered osteopaths in July 2011. The surveys were developed by drawing on previous work investigating health professional capabilities and also graduates transition to practice. Key areas of exploration were work related stressors and self-perceived clinical competence. Results: Job related stressors experienced were different from those expected by students, however, the overall level of stress as a new practitioner was accurately anticipated by students. New graduates were found to experience high levels of stress caused by: managing tricky patients; feeling like they should know everything; medico-legal issues; time management; and, overwork. Students in their final months of the osteopathy program felt more competent than after six months in practice. However, they perceived a lack of competence in: establishing a prognosis and using appropriate outcome measures; managing risks; maintaining * Corresponding author. College

A 3-month-old female baby brought for cleft lip repair was referred to the Department of Pediatrics. On physical examination, her weight was 4.2 kg, head circumference 39 cm, and length 53 cm; she revealed pallor, cleft lip, hepatomegaly (span 8 cm), and grade II splenomegaly (palpable 6 cm below left costal margin from midclavicular line). With the detailed history, we found that this girl was born by a full-term normal delivery to a consanguineously married couple. Her birth weight was 2.7 kg, and she was the third in birth order. The first sibling, a male child, showed failure to thrive, pallor, macrocephaly, global developmental delay, hepatosplenomegaly, recurrent history of lower respiratory tract infections, and expired at 3 years of age with sepsis. The second sibling, a female child, is thriving well. Laboratory investigations showed anemia (Hb, 8.1 gm/dL), thrombocytopenia (80,000) with normal WBC count (8,500/mm 3). Peripheral blood smear showed microcytic, hypochromic red blood corpuscles with immature white blood cells (WBCs; myleocytes, metamyleocytes, and bandforms) and normoblasts (3-4/100 WBC). Bone marrow aspiration revealed erythroid hyperplasia. Hemoglobin electrophoresis was normal. Inborn error of metabolism workup was normal. Malignant infantile osteopetrosis (MIOP), a rare congenital disorder of bone resorption, is caused by the failure of osteoclasts to reabsorb immature bones. We report a 3-month-old female child with cleft lip who was referred to the pediatric department for consultation. She was born to consanguineous parents, and the elder sibling expired at the age of 3 years owing to recurrent respiratory tract infections and hydrocephalus. On examination, we found pallor and hepatosplenomegaly. On follow-up, we came to know that she exhibited delayed developmental history and bilateral optic atrophy. Skeletal radiographs showed dense bones with "bone-in-bone" appearance. The overall clinical features and radiological findings of these patients were sufficient to arrive at the diagnosis of MIOP.