Ecosystem-based management for military training, biodiversity, carbon storage and climate resiliency on a complex coastal land/water-scape.

The Defense Coastal/Estuarine Research Program (DCERP) was a 10-year multi-investigator project funded by the Department of Defense to improve understanding of ecosystem processes and their interactions with natural and anthropogenic stressors at the Marine Corps Base Camp Lejeune (MCBCL) located in coastal North Carolina. The project was aimed at facilitating ecosystem-based management (EBM) at the MCBCL and other coastal military installations. Because of its scope, interdisciplinary character, and duration, DCERP embodied many of the opportunities and challenges associated with EBM, including the need for explicit goals, system models, long-term perspectives, systems complexity, change inevitability, consideration of humans as ecosystem components, and program adaptability and accountability. We describe key elements of this program, its contributions to coastal EBM, and its relevance as an exemplar of EBM.

Acute Toxoplasmosis among Canadian Deer Hunters Associated with Consumption of Undercooked Deer Meat Hunted in the United States.

We conducted a recent investigation in Quebec, Canada, concerning Canadian deer hunters who went to the United States to hunt deer and returned with symptoms of fever, severe headache, myalgia, and articular pain of undetermined etiology. Further investigation identified that a group of 10 hunters from Quebec attended a hunting retreat in Illinois (USA) during November 22-December 4, 2018. Six of the 10 hunters had similar symptoms and illness onset dates. Serologic tests indicated a recent toxoplasmosis infection for all symptomatic hunters, and the risk factor identified was consumption of undercooked deer meat. Among asymptomatic hunters, 2 were already immune to toxoplasmosis, 1 was not immune, and the immune status of 1 remains unknown. Outbreaks of acute toxoplasmosis infection are rare in North America, but physicians should be aware that such outbreaks could become more common.

Assessment of metal contamination in Arabian/Persian Gulf fish: A review.

Metal contamination in fish is a concern worldwide, including in the Arabian/Persian Gulf region. This review summarizes the findings from 55 papers about metal concentrations in Gulf fish. Metal concentrations in muscle tissue were screened against the most recent maximum allowable levels (MALs) for fish in international commerce. We identified metals, fish species, and locations where concentrations exceeded the MALs. For some metals, recent MALs have been set to lower concentrations as more toxicological data have become available. Mean fish tissue concentrations exceeded the MAL in 13% (arsenic), 76% (cadmium), 56% (lead), and 10% (mercury) of species means. We identified 13 fish species with the potential to serve as bioindicators of metal contamination for use in four Gulf habitats: pelagic, benthopelagic, demersal, and coral reefs. Recommendations are provided for a regional approach to improve consistency of sampling, data analysis and reporting of metal concentrations in Gulf fish.

Whole-body MRI of bone marrow: A review.

Technical advances in the last two decades have allowed rapid, high-resolution whole-body magnetic resonance imaging (WBMRI). MRI allows unparalleled visualization and detail in the imaging of bone marrow and surrounding soft tissues. The properties of nuclear magnetic resonance allow superb characterization of bone marrow constituents. WBMRI allows superb characterization of the different types of bone marrow and their natural evolution during the life cycle. Diffusion-weighted WBMRI is an exciting development that adds functional information to anatomical detail. The mainstay of WBMRI for bone marrow abnormalities to date has centered upon staging multiple myeloma and other hematologic bone marrow conditions, and as a valuable tool in quantifying skeletal metastases. Increasingly, WBMRI is being utilized in a variety of additional malignant and nonmalignant conditions. Due to the absence of ionizing radiation, WBMRI represents a valuable screening tool in areas such as malignant transformation in hereditary multifocal exostoses or for the development of ischemic marrow insult in at-risk patients. An additional novel area of use includes postmortem WBMRI for characterization of skeletal injuries. This article provides a state-of-the-art and current review of WBMRI of the bone marrow and highlights potential future areas of development. Level of Evidence: 5 Technical Efficacy Stage: 3 J. MAGN. RESON. IMAGING 2019. J. Magn. Reson. Imaging 2019;50:1687-1701.

Educational intervention to increase detection of metabolic syndrome in patients at community mental health centers.

The prevalence of metabolic syndrome and associated illness is approximately double in individuals with mental illness compared with the general public. An educational intervention on metabolic syndrome was provided to mental health counselors, who performed intake assessments of patients newly admitted to two outpatient mental health facilities. Researchers of the current study first measured mastery of metabolic syndrome content following the educational intervention; they then conducted a chart audit on new admissions to measure changes in clinician behavior. Prior to the intervention, neither facility screened for metabolic syndrome at intake or referred patients with a body mass index (BMI) >25 for medical evaluation. A paired t test showed no significant difference in the educational pre-posttest scores; however, following the intervention, 53 of 132 patients had a documented BMI >25, and 47 of 53 patients were referred to a primary care provider for evaluation. The current study's findings suggest that mental health counselors who screen for metabolic syndrome and associated illnesses will increase the rate of detection of these chronic conditions.

Fixation of ankle syndesmotic injuries: comparison of tightrope fixation and syndesmotic screw fixation for accuracy of syndesmotic reduction.

BACKGROUND: Ankle syndesmotic injuries are complex and require anatomic reduction and fixation to restore the normal biomechanics of the ankle joint and prevent long-term complications. PURPOSE: The aim of this study is to compare the accuracy and maintenance of syndesmotic reduction using TightRope versus syndesmotic screw fixation. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: This cohort study included consecutive patients treated for ankle syndesmotic diastases between July 2007 and June 2009. Single slice axial computed tomography (CT) scans of both the ankles together were performed at the level of syndesmosis, 1 cm above the tibial plafond. A greater than 2-mm widening of syndesmosis compared with the untreated contralateral ankle was considered significant malreduction. Clinical outcomes were measured using the American Orthopaedics Foot and Ankle Society (AOFAS) and Foot and Ankle Disability Index (FADI) scores. RESULTS: Forty-six of 55 eligible patients participated in the study; 23 patients were in the TightRope group and 23 in the syndesmotic screw group. The average age was 42 years in the TightRope and 40 years in the syndesmotic screw group, and the mean follow-up time was 2.5 years (range, 1.5-3.5 years). The average width of normal syndesmosis was 4.03 ± 0.89 mm. In the TightRope group, the mean width of syndesmosis was 4.37 mm (SD, ±1.12 mm) (P = .30, t test) compared with 5.16 mm (SD, ±1.92 mm) in the syndesmotic screw group (P = .01, t test). Five of 23 ankles (21.7%) in the syndesmotic screw group had syndesmotic malreduction, whereas none of the TightRope group showed malreduction on CT scans (P = .04, Fisher exact test). Average time to full weightbearing was 8 weeks in the TightRope group and 9.1 weeks in the syndesmotic screw group. There was no significant difference between the TightRope and syndesmotic screw groups in mean postoperative AOFAS score (89.56 and 86.52, respectively) or FADI score (82.42 and 81.22, respectively). Regression analysis confirmed malreduction of syndesmosis as the only independent variable that affected the clinical outcome (regression coefficient, -12.39; t = -2.43; P = .02). CONCLUSION: The results of this study indicate that fixation with TightRope provides a more accurate method of syndesmotic stabilization compared with screw fixation. Syndesmotic malreduction is the most important independent predictor of clinical outcomes; therefore, care should be taken to reduce the syndesmosis accurately.

A comparison of suboxone and clonidine treatment outcomes in opiate detoxification.

PURPOSE: This retrospective quality improvement study was to evaluate if Suboxone therapy reduced the risk of terminating treatment against medical advice compared with the use clonidine in men aged 18--55 years. METHODS: Data were collected through chart review for all opioid-addicted male clients admitted voluntarily to a community-based treatment center between July 1, 2009, and December 30, 2009. FINDINGS: The chi-square test of independence between treatment completion and treatment noncompletion was found to be significant at the 5% critical level (P = .027) for Suboxone therapy. CONCLUSIONS: Suboxone treatment decreased premature termination of opioid detoxification completion when compared with clonidine.

Ecological aspects of the surf-zone ichthyofauna of Itamambuca Beach, Ubatuba, SP / Aspectos ecológicos da ictiofauna da zona de arrebentação da praia de Itamambuca, Ubatuba, SP

Sandy beaches are among the most extensive environments in Brazil and are generally threatened by disorderly urban growth due to their location along the coast, where human populations tend to concentrate. This is especially true in southeastern Brazil, where the largest urban areas are located. Thus, better knowledge regarding these natural resources is of considerable importance. The surf zone of sandy beaches is inhabited by a number of fish species, including juveniles seeking both food and shelter from predators. An ecological survey was conducted in the surf zone of Itamambuca beach in the city of Ubatuba, São Paulo State, Brazil, in order to evaluate the composition, structure and dynamics of the fish fauna using community descriptors. Diurnal and nocturnal samples were taken with a beach seine at five oceanographic stations over a 12-month period. Water temperature and salinity were also recorded. A total of 2,147 individuals representing 34 species and 18 families were sampled. The main variation in fish fauna was detected on the diel level, followed by a spatial repartition possibly related to salinity. Seasonal variation was also observed. The five most important species in the overall context were Atherinella brasiliensis, Eucinostomus melanopterus, Mugil sp., Trachinotus goodei and Atherinella blackburni.

Praias arenosas estão entre os ecossistemas mais extensos do Brasil e, por serem próximas aos locais onde o Homem tende a se concentrar, são suscetíveis aos impactos negativos decorrentes do crescimento populacional desordenado. Isso é especialmente crítico na Região Sudeste do Brasil, onde uma das maiores populações humanas está instalada. Neste contexto, pesquisas no sentido de melhorar o conhecimento sobre os recursos naturais da região têm importante valor. A zona de arrebentação das praias arenosas é habitada por várias espécies de peixes, freqüentemente representadas por jovens, que buscam alimento e abrigo de predadores. Foi realizado levantamento ictiológico da zona de arrebentação da praia de Itamambuca, Ubatuba, São Paulo, com o intuito de se avaliar a composição, estrutura e dinâmica da fauna de peixes através de descritores da comunidade. Amostras foram coletadas com rede de picaré durante 12 meses, nos períodos diurno e noturno, ao longo de cinco estações oceanográficas na praia. Temperatura da água e salinidade também foram registradas. Foram amostrados 2.147 indivíduos de 34 espécies e 18 famílias. A variação mais marcante da ictiofauna foi a circadiana, seguida por repartição espacial relacionada principalmente à salinidade. Variação sazonal da assembléia também foi observada. As cinco espécies mais importantes no contexto geral foram Atherinella brasiliensis, Eucinostomus melanopterus, Mugil sp., Trachinotus goodei e Atherinella blackburni.

A nationally consistent framework for identifying interstate waters with applications for the national listing of fish advisories.

A 1988 survey, funded by the US Environmental Protection Agency (EPA) and conducted by the American Fisheries Society, identified the need to standardize the approaches for evaluating risks and developing fish consumption advisories that are comparable across different jurisdictions. A major tool for evaluating the progress in developing such nationally consistent information is EPA's web-based National Listing of Fish Advisories (NLFA) database, which has archived fish advisory information since 1993. The NLFA comprises both a database and Geographic Information System mapping components that are implemented using the National Hydrography Dataset (NHD). EPA and the US Geological Survey have developed an enhanced NHD product (NHDPlus) that is applied to define an interstate waters framework for the conterminous USA. This NHDPlus-based framework provides an efficient watershed-oriented approach for identifying interstate advisories from NLFA. We provide summaries of (1) the degree of consistency documented for inland waters where states have issued advisories for shared interstate NHD reaches and (2) the patterns for interstate advisories organized according to the ecoregions developed for EPA's Wadeable Streams Assessment. Approaches are also discussed for addressing interstate consistency issues for fish advisories in coastal waters making use of the NHDPlus combined with other nationally consistent frameworks, such as the 12-digit hydrologic unit code subwatersheds in the Watershed Boundary Dataset. Probability survey methods are recommended as a way to promote increased interjurisdictional consistency in the development of the monitoring and risk assessment conclusions reflected in NLFA, as well as in other EPA water quality-based programs.

Evaluation of mood disorder patients in a primary care practice: measures of affective temperament, mental health risk factors, and functional health in a retrospective, descriptive study of 35 patients.

OBJECTIVE: THE PURPOSE OF THIS RETROSPECTIVE, DESCRIPTIVE STUDY WAS TO EVALUATE PRIMARY CARE PATIENTS DIAGNOSED WITH A MOOD DISORDER ON THE BASIS OF THE FOLLOWING: (1) comorbid medical illnesses, (2) risk factors for mood disorders and longitudinal presence of symptoms, (3) presence of affective temperament, and (4) functional status and quality of life. METHOD: Patients (N = 35) were a convenience sample diagnosed in the Mood Disorder Clinic (MDC), a family practice site-based mental health treatment consultation service. All study patients were assessed using a semistructured interview and diagnosed according to DSM-IV-TR criteria. Data were collected using both chart review and secondary analysis of a computerized touch-screen mood disorders database that included the 36-item Short-Form Medical Outcomes Study Health Survey (SF-36) and an affective temperament survey. The study was conducted from January 2000 through August 2000. RESULTS: A total of 62 comorbid medical illnesses were present in this group of patients; only 2 patients had no comorbid illnesses. Psychiatric diagnoses included 25 cases (78.1%) of bipolar depression, 5 cases (15.6%) of unipolar or dysthymic depression, and 2 cases (6.3%) of nonmood or anxiety disorders. All patients (100%) had a positive family history for mood disorders or substance abuse. Twenty-four patients (70.6%) had onset of their depressive symptoms prior to age 21, and 11 patients (35.5%) had a positive history of sexual abuse. Affective temperaments were positive in the 30 patients who completed this section. SF-36 scale scores were predominantly below national norms. CONCLUSION: The medical comorbidities in our study were expected; the positive family and individual histories for risk along with low SF-36 scores reflect the severity and chronicity of mood disorders in this population.

Improving patient safety: patient-focused, high-reliability team training.

Healthcare systems are recognizing "human factor" flaws that result in adverse outcomes. Nurses work around system failures, although increasing healthcare complexity makes this harder to do without risk of error. Aviation and military organizations achieve ultrasafe outcomes through high-reliability practice. We describe how reliability principles were used to teach nurses to improve patient safety at the front line of care. Outcomes include safety-oriented, teamwork communication competency; reflections on safety culture and clinical leadership are discussed.

Vulnerable populations: drug court program clients.

Substance abuse and addiction are chronic conditions characterized by an inability to control one's urge to use mood- or mind-altering drugs. Recognition of the association between addictions and crime to support the addiction, along with the relapsing nature of addictions, presents treatment and management challenges for clinicians and frustration for patients and their families. Pressures to reduce the burgeoning jail population have resulted in collaboration between the treatment community and the court--a diversion program called drug court. This article reviews the drug court programs, the clients, and the processes of accountability that direct the progress toward sobriety in the drug court clients. It also argues that the drug court clients have unique health needs requiring interventions best suited for the recovering addict enrolled in a diversion program within the criminal justice system. Nurses have the ability to influence these systems and provide safety-net clinics to drug court clients through outreach, case finding, and culturally and linguistically appropriate care that can ultimately help this population to reach a higher level of wellness.

Aesthetic practice of labial reduction.

As aesthetic labial reduction is becoming a more common practice, it is necessary to look at the state of the science, what we know, and, more importantly, what we do not know about this practice. This article reviews the literature to date on labial reduction and describes the concerns related to the lack of understanding of the outcomes associated with this procedure.