Associations between perfluoroalkyl compounds and immune and clinical chemistry parameters in highly exposed bottlenose dolphins (Tursiops truncatus).

Perfluoroalkyl compounds (PFCs) are ubiquitous, persistent chemical contaminants found in the environment, wildlife, and humans. Despite the widespread occurrence of PFCs, little is known about the impact these contaminants have on the health of wildlife populations. The authors investigated the relationship between PFCs (including ∑perfluorocarboxylates, ∑perfluoroalkyl sulfonates, perfluorooctane sulfonate, perfluorooctanoic acid, and perfluorodecanoic acid) and the clinocopathologic and immune parameters in a highly exposed population (n = 79) of Atlantic bottlenose dolphins (mean ∑PFCs = 1970 ng/ml; range 574-8670 ng/ml) sampled from 2003 to 2005 near Charleston, South Carolina, USA. Age-adjusted linear regression models showed statistically significant positive associations between exposure to one or more of the PFC totals and/or individual analytes and the following immunological parameters: absolute numbers of CD2+ T cells, CD4+ helper T cells, CD19+ immature B cells, CD21+ mature B cells, CD2/CD21 ratio, MHCII+ cells, B cell proliferation, serum IgG1, granulocytic, and monocytic phagocytosis. Several PFC analyte groups were also positively associated with serum alanine aminotransferase, gamma-glutamyltransferase, creatinine, phosphorus, amylase, and anion gap and negatively associated with cholesterol levels, creatinine phosphokinase, eosinophils, and monocytes. Based on these relationships, the authors suggest that the PFC concentrations found in Charleston dolphins may have effects on immune, hematopoietic, kidney, and liver function. The results contribute to the emerging data on PFC health effects in this first study to describe associations between PFCs and health parameters in dolphins.

Left ventricular rupture with resulting cardiac tamponade due to blast force trauma from gunshot wound.

BACKGROUND: Acute cardiac tamponade can rapidly become a surgical emergency requiring prompt diagnosis and intervention. Common etiologies of acute cardiac tamponade include blunt or penetrating trauma, surgical complications, sequelae from myocardial infarction and effusion. OBJECTIVES: This case report illustrates an instance where penetrating trauma mimics non-penetrating blunt force trauma. CASE REPORT: The following is a report of a woman who died from cardiac tamponade secondary to a self-inflicted gunshot wound to the chest. This case is unique because the pericardium was not perforated; the left ventricle sustained numerous lacerations from the blast forces upon discharge of the weapon, resulting in a hemopericardium. CONCLUSION: This article defines cardiac tamponade, presents the case, and discusses shotgun ballistics, wounding mechanisms, and blunt force trauma.

Assessment of perfluorinated compounds (PFCs) in plasma of bottlenose dolphins from two southeast US estuarine areas: relationship with age, sex and geographic locations.

Plasma PFCs were measured in 157 bottlenose dolphins (Tursiops truncatus) sampled from two US southeast Atlantic sites (Charleston (CHS), SC and Indian River Lagoon (IRL), FL) during 2003-2005. ∑PFCs, perfluoroalkyl carboxylates (∑PFCAs), perfluoroalkyl sulfonates (∑PFSAs) and individual compounds were significantly higher in CHS dolphins for all age/sex categories compared to IRL dolphins. Highest ∑PFCs concentrations occurred in CHS juvenile dolphins (2340 ng/g w.w.); significantly higher than found in adults (1570 ng/g w.w. males; 1330 ng/g w.w. females). ∑PFCAs were much greater in CHS dolphins (≈ 21%) compared to IRL dolphins (≈ 7%); ∑PFSAs were 79% in CHS dolphins versus 93% in IRL dolphins. PFOS, the dominant compound, averaged 72% and 84%, respectively, in CHS and IRL dolphins. Decreasing PFC levels occurred with age on the bioaccumulation of PFCs in both sites. These observations suggest PFC accumulation in these two dolphin populations are influenced by site-specific exposures with significantly higher levels in CHS dolphins.

Isolation of culturable microorganisms from free-ranging bottlenose dolphins (Tursiops truncatus) from the southeastern United States.

Reports of diseases in marine mammals are increasing worldwide, however our understanding of the microorganisms associated with marine mammals is still limited. In this study, we cultured bacteria and fungi isolated from the upper respiratory tract (blowhole), gastric fluid and anus of 180 wild bottlenose dolphins (Tursiops truncatus) from two estuarine locations along the southeastern Atlantic Coast of the United States. A total of 339 and 491 isolates from Charleston, SC (CHS) and Indian River Lagoon, FL (IRL) dolphins, respectively, were cultured from gastric (70 CHS/82 IRL), fecal (141 CHS/184 IRL), and blowhole (128 CHS/225 IRL) swabs on selective media used for routine clinical microorganisms of human concern. The most frequently cultured Gram-negative bacteria from all sample and study types were Plesiomonas shigelloides, Aeromonas hydrophila, Escherichia coli, and Pseudomonas fluorescens. Among the Gram-positive bacteria, Clostridium perfringens, Bacillus sp., and Staphylococcus Coag. Neg were the predominant organisms. For fungi, the most abundant species were Candida glabrata, budding yeasts, and Candida tropicalis. Of concern, the MRSA strain of Staphylococcus aureus was detected in the blowhole and gastric swabs from CHS dolphins. In general, a greater prevalence of bacteria and fungi (four-fold increase) were cultured from IRL than CHS animals. Together, these culture-dependent studies, coupled to on-going culture-independent approaches, should help establish a baseline of microorganisms associated with bottlenose dolphins and aid in the identification of organisms responsible for infectious diseases(s) in these animals.

Contaminant blubber burdens in Atlantic bottlenose dolphins (Tursiops truncatus) from two southeastern US estuarine areas: concentrations and patterns of PCBs, pesticides, PBDEs, PFCs, and PAHs.

Polychlorinated biphenyls (PCBs), chlorinated pesticides (i.e., dichlorodiphenyltrichloroethane (DDT) and its metabolites, chlordanes (CHLs), dieldrin, hexachlorobenzene (HCB), and mirex), polybrominated diphenyl ethers (PBDEs), perfluorinated chemicals (PFCs), and polyaromatic hydrocarbons (PAHs) were measured in blubber biopsy samples collected from 139 wild bottlenose dolphins (Tursiops truncatus) during 2003-2005 in Charleston (CHS), SC and the Indian River Lagoon (IRL), FL. Dolphins accumulated a similar suite of contaminants with summation operatorPCB dominating (CHS 64%, IRL 72%), followed by summation operatorDDT (CHS 20%, IRL 17%), summation operatorCHLs (CHS 7%; IRL 7%), summation operatorPBDE (CHS 4%, IRL 2%), PAH at 2%, and dieldrin, PFCs and mirex each 1% or less. Together summation operatorPCB and summation operatorDDT concentrations contributed approximately 87% of the total POCs measured in blubber of adult males. summation operatorPCBs in adult male dolphins exceed the established PCB threshold of 17mg/kg by a 5-fold order of magnitude with a 15-fold increase for many animals; 88% of the dolphins exceed this threshold. For male dolphins, CHS (93,980ng/g lipid) had a higher summation operatorPCBs geomean compared to the IRL (79,752ng/g lipid) although not statistically different. In adult males, the PBDE geometric mean concentration was significantly higher in CHS (5920ng/g lipid) than the IRL (1487ng/g). Blubber summation operatorPFCs concentrations were significantly higher in CHS dolphins. In addition to differences in concentration of PCB congeners, summation operatorPBDE, TEQ, summation operatorCHLs, mirex, dieldrin, and the ratios summation operatorDDE/ summation operatorDDT and trans-nonachlor/cis-nonachlor were the most informative for discriminating contaminant loads in these two dolphin populations. Collectively, the current summation operatorPCB, summation operatorDDT, and summation operatorPBDEs blubber concentrations found in CHS dolphins are among the highest reported values in marine mammals. Both dolphin populations, particularly those in CHS, carry a suite of organic chemicals at or above the level where adverse effects have been reported in wildlife, humans, and laboratory animals warranting further examination of the potential adverse effects of these exposures.

Occurrence of triclosan in plasma of wild Atlantic bottlenose dolphins (Tursiops truncatus) and in their environment.

The presence of triclosan, a widely-used antibacterial chemical, is currently unknown in higher trophic-level species such as marine mammals. Blood plasma collected from wild bottlenose dolphins (Tursiops truncatus) in Charleston, SC (CHS) (n = 13) and Indian River Lagoon, FL (IRL) (n = 13) in 2005 was analyzed for triclosan. Plasma concentrations in CHS dolphins ranged from 0.12 to 0.27 ng/g wet weight (mean 0.18 ng/g), with 31% of the sampled individuals having detectable triclosan. The mean IRL dolphin plasma concentrations were 0.072 ng/g wet weight (range 0.025-0.11 ng/g); 23% of the samples having detectable triclosan. In the CHS area, triclosan effluent values from two WWTP were both 190 ng/L and primary influents were 2800 ng/L and 3400 ng/L. Triclosan values in CHS estuarine surface water samples averaged 7.5 ng/L (n = 18) ranging from 4.9 to 14 ng/L. This is the first study to report bioaccumulation of anthropogenic triclosan in a marine mammal highlighting the need for further monitoring and assessment.

One state's effort to improve recruitment, retention, and practice through multifaceted clinical supervision interventions.

The professional literature has described the critical role child welfare supervisors play in the recruitment and retention (R&R) of a competent workforce and in practice enhancement to produce positive outcomes for children and families. Building on findings from a federally funded demonstration project related to implementation of clinical supervision in the child welfare setting, this article provides a description of a comprehensive approach to achievement of these outcomes: an integrated implementation of an employee selection protocol, 360-degree evaluation and employee development planning, and peer consultation and support groups for supervisors. An outline of the evaluation designed to assess relative effectiveness of each component on organizational culture, staff R&R, and practice is provided.

Early introduction to pregnancy care and delivery for medical students.

BACKGROUND AND OBJECTIVES: We developed a curriculum designed to expose first-year medical students to the longitudinal experience of prenatal care and delivery. The curriculum included reinforcement throughout clinical training to increase their knowledge of pregnancy care and to encourage inclusion of pregnancy care in their future family practice. METHODS: The program was implemented at the University of Minnesota Medical School Duluth, and titled the Obstetric Longitudinal Program (OLP). It provided continuity care experiences among medical students, family physician preceptors, and obstetric patients. Students were enrolled by lottery. Students who were not selected in the lottery to participate in the program served as a control group. All students completed knowledge and attitude tests before and after the program. RESULTS: Compared to the control group, OLP participants had higher knowledge scores at the end of the program and expressed greater likelihood to include deliveries in their future practice. The OLP was well received by all participants. CONCLUSIONS: The OLP provided a continuity of care experience for first-year medical students. Further studies are needed to determine if such early medical education experiences actually change the future practice of family physicians.

Polybrominated diphenyl ethers (PBDEs) in blubber of free-ranging bottlenose dolphins (Tursiops truncatus) from two southeast Atlantic estuarine areas.

Blubber tissue samples from bottlenose dolphins collected during the summers of 2003 and 2004 were screened for 13 (17, 28, 47, 66, 71, 85, 99, 100, 138, 154, 153, 183, 190) polybrominated diphenyl ethers (PBDEs) from dolphin populations in the Indian River Lagoon, FL (n = 58) and the Charleston Harbor estuary, SC (n = 53). Within each population, we investigated contaminant levels of PBDEs and the effects of factors including age, sex, the interaction of age and sex, and location. Six PBDE congeners (28, 47, 99, 100, 153, and 154) were routinely detected in all samples using gas chromatography/mass spectometry methods. Significantly higher (p

An interprofessional activity using standardized patients.

OBJECTIVES: To describe the development and implementation of an interprofessional activity using standardized patients. METHODS: In the interprofessional standardized patient experience (ISPE), pharmacy students are teamed with medical and nursing students. This team completes an assessment of a standardized patient. During this assessment, each student has time to interview the patient according to his/her own skills and patient care perspective. After the assessment is completed, the team collaborates to develop a patient care plan. Pre-experience and post-experience surveys were conducted. RESULTS: Pharmacy students' appreciation for each profession's role in patient care increased. CONCLUSIONS: Despite multiple challenges, an interprofessional activity involving multiple health professionals from multiple institutions can be successfully implemented. Feedback from pharmacy students indicated that this activity increased students' awareness and ability to work as members of the health professional team.

Microwave-assisted synthesis of new polysubstituted dienaminoesters and their cyclization to 3-bromo-2(1H)-pyridinones.

A microwave-assisted, telescoped synthesis, involving a Michael-type addition followed by intramolecular cyclization, provides an effective entry to the polysubstituted 3-bromo-2(1H)-pyridinone core.

Fatal apnea in piglets by way of laryngeal chemoreflex: postmortem findings as anatomic correlates of sudden infant death syndrome in the human infant.

OBJECTIVES/HYPOTHESIS: Intrathoracic petechiae are a prominent diagnostic finding in sudden infant death syndrome (SIDS) victims. In this study, the laryngeal chemoreflex (LCR) was elicited experimentally to discover whether intrathoracic petechiae would be produced by way of the LCR. The hypothesis was that water stimulation of the larynx in piglets, leading to death by prolonged apnea, would produce postmortem findings similar to those found in SIDS victims. STUDY DESIGN: Using the piglet as an animal model, the LCR was initiated by way of water stimulation of the larynx, resulting in death. Normoxic and hypoxic conditions were established before the stimulation. The piglets were studied postmortem to determine the relationship between the physiologic mechanisms of the LCR and characteristic pathologic findings in SIDS. METHODS: Using protocols approved by animal care, 14 mixed-breed piglets aged 7 to 14 days were sedated with a ketamine/xylazine mixture. Respiratory and pressure-monitoring devices were affixed and light anesthesia maintained with Surital infusion. In 10 of the piglets, a small catheter was placed between the arytenoid cartilages, and 5 mL of tap water was introduced over 1 second. The LCR ensued, producing periods of central apnea bordered by gasping efforts and resulting in hypoxemia and death in all cases. Four piglets underwent this manipulation in normoxic conditions. Six breathed a hypoxic gas mixture for 1 hour to bring their Po2 down to below 50 torr before water was introduced into the larynx. Four control piglets breathed the hypoxic gas mixture for 1 hour (without water stimulation or LCR) before Surital overdose. Within 24 hours of death, all piglets underwent thoracoabdominal autopsy by a blinded evaluator experienced in SIDS pathology. RESULTS: The autopsies revealed nothing remarkable in the abdominal viscera of any of the experimental animals. Thymus, heart, and lungs were graded 0 to 4 to indicate the degree of petechiae on external surfaces. Average cumulative scores (ACS) were applied to each animal. The control (hypoxic) piglets had no petechiae (ACS 0.0). The normoxic experimental piglets had moderate petechiae (ACS 3.5). The hypoxic experimental piglets had more prominent petechiae (ACS 6.3). CONCLUSIONS: Stimulation of the LCR, leading to death by prolonged apnea, produces postmortem findings in piglets similar to those found in SIDS victims. Petechiae were more severe among piglets pretreated with a hypoxic mixture of gases. This study supports the hypothesis that initiation of the LCR may produce pathologic features often prominent in SIDS.