A Dataset of Amphibian Species in U.S. National Parks.

National parks and other protected areas are important for preserving landscapes and biodiversity worldwide. An essential component of the mission of the United States (U.S.) National Park Service (NPS) requires understanding and maintaining accurate inventories of species on protected lands. We describe a new, national-scale synthesis of amphibian species occurrence in the NPS system. Many park units have a list of amphibian species observed within their borders compiled from various sources and available publicly through the NPSpecies platform. However, many of the observations in NPSpecies remain unverified and the lists are often outdated. We updated the amphibian dataset for each park unit by collating old and new park-level records and had them verified by regional experts. The new dataset contains occurrence records for 292 of the 424 NPS units and includes updated taxonomy, international and state conservation rankings, hyperlinks to a supporting reference for each record, specific notes, and related fields which can be used to better understand and manage amphibian biodiversity within a single park or group of parks.

Infectious Disease: Mosquito-Borne Viral Illnesses.

Due to rapid globalization and ease of travel, mosquito-borne viral infections are now a concern for family physicians throughout the United States. Zika virus infection is one such concern. It is spread via mosquito bites or by sexual contact with an infected individual. Most patients are asymptomatic, and when symptoms occur, they are mild and nonspecific. The main concern is the potential of the infection to cause fetal anomalies. Dengue is another mosquito-borne viral infection. Symptoms of initial infection are mild, and may include arthralgias. Subsequent infection with a different serotype can cause life-threatening hemorrhagic fever or shock. Chikungunya virus infection is widespread in the Americas and symptoms are similar to those of dengue. However, it can cause a postviral chronic inflammatory rheumatism in up to half of patients. Yellow fever occurs mostly in sub-Saharan Africa and can cause hepatic failure. Encephalitis viruses, most commonly West Nile in the United States and others such as Japanese encephalitis virus, can cause neuroinvasive disease, most often in older adults. Vaccines are available for yellow fever and Japanese encephalitis viruses but the keys to prevention are insect avoidance, mosquito eradication, and use of mosquito repellants.

Infectious Disease: Health Care-Associated Infections.

Health care-associated infections (HAIs) are a major cause of morbidity and mortality, with 2 million US patients per year developing HAIs. This results in 90,000 deaths and billions of dollars in preventable expenses annually. Common HAIs include central line-associated bloodstream infection, catheter-related urinary tract infection, surgical site infection, hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), methicillin-resistant Staphylococcus aureus (MRSA) infection, Clostridium difficile infection (CDI), and others. Many factors contribute to HAIs, including inadequate hand hygiene by health care workers, inappropriate antibiotic use, increasing prevalence of multidrug-resistant organisms (MDROs), suboptimal disinfection and cleaning of hospital rooms and equipment, and use of invasive medical devices. HAP and VAP together represent the most common HAIs. Control of HAIs involves high- and low-tech solutions, including pulsed xenon light as a room disinfection adjunct, improving health care worker adherence to hand hygiene and standard precautions, as well as regular cleaning of cell phones and stethoscopes. Antibiotic stewardship programs have been shown to reduce inappropriate prescribing of antibiotics, a significant contributor to MDROs and CDI. Bundled interventions to control MRSA and CDI have been effective. Artificial intelligence applications likely will be involved in identification of patients at risk of HAIs in the future.

Infectious Disease: Bedbugs, Lice, and Mites.

Bedbugs, mites, and scabies are ectoparasites that commonly affect humans. Bedbugs (Cimex species) were once rare in the United States but are now common. They cause intensely pruritic lesions on areas of exposed skin. The bites are highly allergenic and can cause asthma exacerbations or anaphylaxis. Management of bedbug bites involves symptomatic relief of itching and dealing with patient anxiety. Identification and elimination of infestation are most important. Another ectoparasite of concern is lice (Pediculus and Pthirus species), which causes head, body, and pubic infestations. Patients can experience hypersensitivity to the saliva of lice, but such symptoms often do not develop until several weeks after infestation. Diagnosis involves identification of nits (ie, eggs) or lice on the skin or hair. Several pediculicides are used for management but wet combing without use of pediculicides may be more effective. A third common ectoparasitic infestation, scabies (ie, infestation with the mite Sarcoptes scabiei), affects 5% of the world's population. Patients present with pruritic lesions in skin folds, finger webs, and areas in which clothing is tight. The diagnosis can be confirmed with dermatoscopy or microscopy. Management involves use of permethrin cream, oral ivermectin, or benzyl benzoate.

Infectious Disease: Community Response to Emerging Infectious Diseases.

Emerging infectious diseases are those that are newly discovered, recently have increased in prevalence, or are expected to increase in prevalence in the future. Family physicians play an important role in leading community response to emerging infectious diseases. As with other types of disasters, the general approach to outbreaks has four stages: preparedness, response, recovery, and mitigation. Preparedness includes promotion of community health, maintenance of high vaccination rates, development of protocols for hospitals and family medicine practices, preparation of patients for international travel, and consideration of volunteering in case of disasters. Response includes treatment of infected patients, minimization of the risk of transmission to other individuals, education of the public, and disease reporting to local health departments. Recovery can be physical and emotional. Mitigation efforts attempt to minimize long-term effects of the outbreak and apply lessons learned to prevent or minimize the effects of similar events in the future.

Female gonadal hormones and reproductive behaviors as key determinants of successful reproductive output of breeding whooping cranes (Grus americana).

Reproductive success of endangered whooping cranes (Grus americana) maintained ex situ is poor. As part of an effort to identify potential causes of poor reproductive success in a captive colony, we used non-invasive endocrine monitoring to assess gonadal and adrenal steroids of bird pairs with various reproductive outcomes and evaluated the relationships of hormones and behaviors to reproductive performance. Overall, reproductively successful (i.e., egg laying) females had significantly higher mean estrogen levels but lower mean progestogen concentrations than did unsuccessful females. Other hormones, including glucocorticoids and androgens, were not significantly different between successful and unsuccessful individuals. Observations of specific behaviors such as unison calling, marching, and the number of copulation attempts, along with overall time spent performing reproductive behaviors, were significantly higher in successful pairs. Our findings indicate that overall reproductive performance of whooping crane pairs is linked to female gonadal hormone excretion and reproductive behaviors, but not to altered adrenal hormone production.

Managing H*V in Pregnancy.

A number of chronic viral infections require special attention during pregnancy in the prenatal, perinatal and postnatal periods. In many rural areas of South Dakota, these conditions are present, but readily-accessible subspecialty consultation is not. Fortunately, most aspects of management of these conditions in pregnancy are easily within the scope of practice of primary care physicians. This paper presents a review of the management of pregnancies complicated by HBV, HCV, HIV, HPV and HSV, offering a quick-reference guide for physicians who may infrequently encounter these patients as a part of their practices.

Prevalence of vitamin D deficiency among immigrants to South Dakota.

INTRODUCTION: Vitamin D deficiency is gaining increased attention nationally. Recent clinical cases suggest that this condition is a significant problem in local refugee populations. The Sioux Falls Health Department recently implemented a policy of screening and treating all new refugees as part of the new refugee examinations at Falls Community Health Center. METHODS: Data from this screening during the first nine months of 2009 were reviewed and analyzed for prevalence of hypovitaminosis D in this population. Results from a total of 157 individuals were included in this study. RESULTS: Two percent of this population had initial calcidiol levels below the detection threshold. Six percent were severely deficient, defined as <15 ng/mL, and 58 percent were mildly deficient (15-32 ng/mL). Only 36 percent had levels above 32 ng/mL, considered adequate for bone health, with a mere 1 percent showing optimal levels of > 50 ng/mL. CONCLUSIONS: Hypovitaminosis D represents a significant public health issue among recent immigrants in Minnehaha County, S.D., and warrants aggressive attention by both primary care and public health professionals.

The new South Dakotans: caring for recent immigrants.

South Dakota is the home of many new immigrants. In addition to brightening the cultural tapestry of the state with their traditions and customs, these newest residents broaden the perspective of their physicians by presenting them with medical conditions uncommon in the Midwest. This article reviews some of the special infectious, nutritional, psychological, women's health and cultural conditions that might be encountered while caring for new immigrants.