Seabird stress and breeding: Endocrine and hematological stress biomarkers differ between gray-faced petrel (Pterodroma gouldi) colonies.

Seabird breeding success is known to reflect oceanic conditions. Gray-faced petrels (Pterodroma gouldi) breeding on the east coast of Auckland, New Zealand, exhibit poor reproductive success and slow chick development compared to west coast conspecifics. This study mapped changes in physiological traits (corticosterone [CORT] and hematological parameters) indicative of sublethal stress in this Procellariiform species between the west coast (Ihumoana) and east coast (Hawere) island colonies. We found adult gray-faced petrels on the east coast to be lighter and, unlike west coast birds, exhibited an attenuation of response CORT levels between incubation and chick-rearing phases. Such responses were also reflected in east coast chicks that were lighter and had higher feather CORT titers than west coast chicks. Measures of adult hematology and plasma biochemistry revealed significantly lower glucose levels in east coast birds and indicated that chick rearing is the most stressful phase of breeding for this species Combined; these results suggest that east coast birds are under greater nutritional stress and that parents appear to transfer the costs of poor foraging to their chicks to preserve their own condition, consequently increasing chick developmental stress. Our results suggest that any long-term decrease in ocean conditions and/or climatic shifts would be more acutely felt by east coast chicks and potentially their parents, resulting in years of poor breeding success rates on a local scale.

Process and outcomes of patient-centered medical care with Alaska Native people at Southcentral Foundation.

PURPOSE: This study describes key elements of the transition to a patient-centered medical home (PCMH) model at Southcentral Foundation (SCF), a tribally owned and managed primary care system, and evaluates changes in emergency care use for any reason, for asthma, and for unintentional injuries, during and after the transition. METHODS: We conducted a time series analyses of emergency care use from medical record data. We also conducted 45 individual, in-depth interviews with PCMH patients (customer-owners), primary care clinicians, health system employees, and tribal leaders. RESULTS: Emergency care use for all causes was increasing before the PCMH implementation, dropped during and immediately after the implementation, and subsequently leveled off. Emergency care use for adult asthma dropped before, during, and immediately after implementation, subsequently leveling off approximately 5 years after implementation. Emergency care use for unintentional injuries, a comparison variable, showed an increasing trend before and during implementation and decreasing trends after implementation. Interview participants observed improved access to primary care services after the transition to the PCMH tempered by increased staff fatigue. Additional themes of PCMH transformation included the building of relationships for coordinated, team-based care, and the important role of leadership in PCMH implementation. CONCLUSIONS: All reported measures of emergency care use show a decreasing trend after the PCMH implementation. Before the implementation, overall use and use for unintentional injuries had been increasing. The combined quantitative and qualitative results are consistent with decreased emergency care use resulting from a decreased need for emergency care services due to increased availability of primary care services and same-day appointments.