ABSTRACT
The National Academy of Medicine (NAM) in the recently issued report Improving Diagnosis in Health Care outlined eight major recommendations to improve the quality and safety of diagnosis. The #1 recommendation was to improve teamwork in the diagnostic process. This is a major departure from the classical approach, where the physician is solely responsible for diagnosis. In the new, patient-centric vision, the core team encompasses the patient, the physician and the associated nursing staff, with each playing an active role in the process. The expanded diagnostic team includes pathologists, radiologists, allied health professionals, medical librarians, and others. We review the roles that each of these team members will need to assume, and suggest "first steps" that each new team member can take to achieve this new dynamic.
Subject(s)
Nurse's Role , Patient Care Team/organization & administration , Patient-Centered Care/methods , Physician's Role , Cooperative Behavior , Delivery of Health Care/standards , Diagnostic Errors/prevention & control , HumansABSTRACT
Cottus specus, a new species, is described from the karst regions of the Bois Brule drainage in eastern Missouri, USA. Cottus specus is distinguishable from all members of the genus Cottus using both genetic and morphological characters, including eye size and cephalic pore size. Cottus specus represents the first description of a cave species within Cottus. The addition of C. specus brings the total number of recognized species of Cottus to 33 in North American fresh waters.
Subject(s)
Perciformes/anatomy & histology , Perciformes/classification , Animals , Caves , Eye/anatomy & histology , Female , Male , Missouri , Perciformes/geneticsABSTRACT
Nitrate is one of the most commonly detected contaminants found in aquatic systems with other pesticides such as atrazine. The current study examined potential combined effects of nitrate and atrazine on adults of the freshwater amphipod Hyalella azteca, using survival and precopulatory guarding behavior as toxic endpoints. Although significant differences in acute toxicity with nitrate alone and in binary combination with atrazine (200 µg/L) in water-only tests were not consistently observed for each time point, potential biologically relevant trends in the data were observed. Posttest growth and behavioral observations (10-day period) conducted after 96-hour exposure suggested that atrazine and nitrate at these concentrations did not result in delayed effects on H. azteca. However, when test conditions were modified from standard toxicity tests by feeding amphipods, nitrate was found to be more toxic, with a reduction in median lethal concentration (LC50) values of approximately 80%. We also demonstrated that nitrate exhibits a dose-response effect on precopulatory guarding behavior of H. azteca, suggesting that reproductive effects may occur at environmentally relevant concentrations.
Subject(s)
Amphipoda/drug effects , Atrazine/toxicity , Behavior, Animal/drug effects , Nitrates/toxicity , Water Pollutants, Chemical/toxicity , Animals , Atrazine/chemistry , Drug Synergism , Female , Herbicides/chemistry , Herbicides/toxicity , Male , Nitrates/chemistry , Water Pollutants, Chemical/chemistryABSTRACT
Two types of passive samplers--semipermeable membrane devices (SPMDs) and polar organic chemical integrative samplers (POCIS)--were deployed in spring 2008 to assess bioavailable concentrations of aquatic contaminants in five cave streams and resurgences in Perry County, Missouri. Study sites represent areas of high cave biodiversity and the only known habitat for grotto sculpin (Cottus carolinae). Time-weighted average (TWA) water concentrations were calculated for 20 compounds (n = 9 SPMDs; n = 11 POCIS) originating primarily from agricultural sources, including two organochlorine insecticides, dieldrin and heptachlor epoxide, which were found at levels exceeding U.S. EPA criteria for the protection of aquatic life. GIS data were used to quantify and map sinkhole distribution and density within the study area. Infiltration of storm runoff and its influence on contaminant transport were also evaluated using land cover and hydrological data. This work provides evidence of cave stream contamination by a mix of organic chemicals and demonstrates the applicability of passive samplers for monitoring water quality in dynamic karst environments where rapid transmission of storm runoff makes instantaneous water sampling difficult.
