Prioritizing conservation actions in urbanizing landscapes.

Urbanization-driven landscape changes are harmful to many species. Negative effects can be mitigated through habitat preservation and restoration, but it is often difficult to prioritize these conservation actions. This is due, in part, to the scarcity of species response data, which limit the predictive accuracy of modeling to estimate critical thresholds for biological decline and recovery. To address these challenges, we quantify effort required for restoration, in combination with a clear conservation objective and associated metric (e.g., habitat for focal organisms). We develop and apply this framework to coho salmon (Oncorhynchus kisutch), a highly migratory and culturally iconic species in western North America that is particularly sensitive to urbanization. We examine how uncertainty in biological parameters may alter locations prioritized for conservation action and compare this to the effect of shifting to a different conservation metric (e.g., a different focal salmon species). Our approach prioritized suburban areas (those with intermediate urbanization effects) for preservation and restoration action to benefit coho. We found that prioritization was most sensitive to the selected metric, rather than the level of uncertainty or critical threshold values. Our analyses highlight the importance of identifying metrics that are well-aligned with intended outcomes.

Procalcitonin in hemodialysis patients presenting with fever or chills to the emergency department.

We sought to assess the role of procalcitonin in discriminating severe bacterial infections requiring antibiotic treatment from non-bacterial causes of fever or chills in chronic dialysis patients. Chronic hemodialysis patients who were admitted to the emergency room due to fever and/or chills were recruited to the study. The presence or absence of bacterial infection was defined after recruitment conclusion by an infectious disease specialist who was blinded to procalcitonin results. Procalcitonin levels were compared between infected and non-infected patients. Out of 54 patients recruited, 22 (41%) patients eventually diagnosed with infection. Mean (± SD) procalcitonin values were 4.3 (± 5.5) ng/ml among cases, 1.0 (± 2.0) ng/ml among controls with no infection (p = 0.02). A cutoff PCT value of 1 ng/ml or higher had 77% sensitivity and 59% specificity for the diagnosis of severe infection. Procalcitonin cannot usefully identify hemodialysis patient with bacterial infection.

Community health needs assessment: a nurses' global health project in Vietnam.

BACKGROUND: Global health has been directed to providing solutions to various health issues cross-nations, and nurses have received wide recognition as a key health workforce to reduce health disparities globally. Nurses involved in global health research are required to implement evidence-based global nursing practices based on the assessments of local health needs. AIM: To assess health needs and to suggest future interventions in rural communities of Vietnam. METHODS: A multifaceted rapid participatory appraisal with information pyramid was used applying mixed methods from six sources: existing record review, surveys of community residents, surveys of healthcare providers, focus group discussions with community leaders, informal discussions with governmental health administrators and observations of community health station (CHS) facilities. RESULTS: The majority used the CHSs as primary health facilities with high satisfaction for services currently provided. However, there were needs for the stations to provide more comprehensive services including chronic diseases, and for healthcare providers to improve their competences. Community leaders showed high interest in health information for chronic diseases and strong commitment to involvement in the activities for health of their communities. The findings suggest future interventions in the areas of the enhancement of CHS' functions, human resources and the self-care capacity of community residents. CONCLUSION AND POLICY IMPLICATIONS: The rapid participatory appraisal approach emphasizing community participation and partnership was a useful tool to compile accurate information about the current needs of the community on health, the preparedness of healthcare services to meet community's demands and about community capacity. This process is fundamental to nurses, who initiate global health projects in resource-limited international countries, to generate evidences regarding practice, research and policy for taking responsibilities in promoting the sustainable development goals.

Not so bad after all: retroviruses and long terminal repeat retrotransposons as a source of new genes in vertebrates.

Viruses and transposable elements, once considered as purely junk and selfish sequences, have repeatedly been used as a source of novel protein-coding genes during the evolution of most eukaryotic lineages, a phenomenon called 'molecular domestication'. This is exemplified perfectly in mammals and other vertebrates, where many genes derived from long terminal repeat (LTR) retroelements (retroviruses and LTR retrotransposons) have been identified through comparative genomics and functional analyses. In particular, genes derived from gag structural protein and envelope (env) genes, as well as from the integrase-coding and protease-coding sequences, have been identified in humans and other vertebrates. Retroelement-derived genes are involved in many important biological processes including placenta formation, cognitive functions in the brain and immunity against retroelements, as well as in cell proliferation, apoptosis and cancer. These observations support an important role of retroelement-derived genes in the evolution and diversification of the vertebrate lineage.

Therapeutically interchangeable? A study of real-world outcomes associated with switching basal insulin analogues among US patients with type 2 diabetes mellitus using electronic medical records data.

AIMS: To evaluate real-world clinical outcomes for switching basal insulin analogues [insulin glargine (GLA) and insulin detemir (DET)] among US patients with type 2 diabetes mellitus (T2DM). METHODS: Using the GE Centricity Electronic Medical Records database, this retrospective study examined two cohorts: cohort 1, comprising patients previously on GLA and then either switching to DET (DET-S) or continuing with GLA (GLA-C); and cohort 2, comprising patients previously on DET and then either switching to GLA (GLA-S) or continuing with DET (DET-C). Within each cohort, treatment groups were propensity-score-matched on baseline characteristics. At 1-year follow-up, insulin treatment patterns, glycated haemoglobin (HbA1c) levels, hypoglycaemic events, weight and body mass index (BMI) were evaluated. RESULTS: The analysis included 13 942 patients: cohort 1: n = 10 657 (DET-S, n = 1797 matched to GLA-C, n = 8860) and cohort 2: n = 3285 (GLA-S, n = 858 matched to DET-C, n = 2427). Baseline characteristics were similar between the treatment groups in each cohort. At 1-year follow-up, in cohort 1, patients in the DET-S subgroup were significantly less persistent with treatment, more likely to use a rapid-acting insulin analogue, had higher HbA1c values, lower HbA1c reductions and lower proportions of patients achieving HbA1c <7.0 or <8.0% compared with patients in the GLA-C subgroup, while hypoglycaemia rates and BMI/weight values and change from baseline were similar in the two subgroups. In cohort 2, overall, there were contrasting findings between patients in the GLA-S and those in the DET-C subgroup. CONCLUSIONS: This study showed contrasting results when patients with T2DM switched between basal insulin analogues, although these preliminary results may be subject to limitations in the analysis. Nevertheless, this study calls into question the therapeutic interchangeability of GLA and DET, and this merits further investigation.

Evaluation of a prospectively administered written questionnaire to reduce the incidence of suspected latex anaphylaxis during elective cesarean delivery.

BACKGROUND: Life-threatening anaphylaxis has been reported in women exposed to latex during surgery. We compared a written screening questionnaire to identify suspected latex sensitivity with a verbal inquiry used previously in a historical control group of women undergoing cesarean delivery to determine if the incidence of suspected latex anaphylaxis could be reduced. METHODS: To identify suspected latex sensitivity among women undergoing elective cesarean delivery in a single-site tertiary unit, a nine-item written screening questionnaire was compared to historical use of a standard verbal inquiry "Are you allergic to medications or latex?". Women who had suspected latex sensitivity risk factors, or who had known latex allergy, underwent latex-free surgery. Women with suspected anaphylaxis during cesarean delivery were recommended to undergo allergen testing. The primary study outcome was suspected anaphylaxis incidence during the two periods: historical control January to December 2008, questionnaire March 2010 to April 2011. RESULTS: The questionnaire identified suspected latex sensitivity in 66 of 453 women (14.6%) who completed the questionnaire. The standard verbal inquiry group had identified 12 of 460 women (2.6%) with self-reported latex sensitivity. The incidence of suspected anaphylaxis during cesarean delivery was significantly lower during the questionnaire period when compared to historical controls (3/516, 0.6% vs. 11/460, 2.4%, P=0.015). For both groups, 13 of 14 women (92.9%) with suspected latex anaphylaxis were contactable; five of 13 (38.5%) had undergone allergen testing and all were positive for latex. CONCLUSIONS: Use of the written screening questionnaire was associated with fewer cases of suspected anaphylaxis during cesarean delivery compared with the historical control. Most women with suspected anaphylaxis did not perform allergy testing; however, all who did were positive for latex.

Scale and pattern of broadnose sevengill shark Notorynchus cepedianus movement in estuarine embayments.

The detailed movements of 32 acoustically tagged broadnose sevengill shark Notorynchus cepedianus were documented in and around north-east Pacific Ocean estuarine embayments from 2005 to 2007. Arrangements of passive acoustic receivers allowed analysis of movement at several spatial scales, with sex and size examined as possible factors influencing the pattern and timing of these movements. Notorynchus cepedianus exhibited a distinctly seasonal pattern of estuary use over three consecutive years, entering Willapa Bay in the spring, residing therein for extended periods of time during the summer and dispersing into nearshore coastal habitats and over the continental shelf during the autumn. Notorynchus cepedianus within Willapa Bay showed spatio-temporal patterns of segregation by size and sex, with males and small females using peripheral southern estuary channels early in the season before joining large females, who remained concentrated in central estuary channels for the entire season. Individuals displayed a high degree of fidelity not only to Willapa Bay (63% were documented returning over three consecutive seasons), but also to specific areas within the estuary, showing consistent patterns of site use from year to year. Cross-estuary movement was common during the summer, with most fish also moving into an adjacent estuarine embayment for some extent of time. Most winter and autumn coastal detections of N. cepedianus were made over the continental shelf near Oregon and Washington, U.S.A., but there were also examples of individuals moving into nearshore coastal habitats further south into California, suggesting the feasibility of broad-scale coastal movements to known birthing and nursery grounds for the species. These findings contribute to a better understanding of N. cepedianus movement ecology, which can be used to improve the holistic management of this highly mobile apex predator in regional ecosystems.

Trade-offs between species conservation and the size of marine protected areas.

Moving from single-species- to ecosystem-based management requires an understanding of how community-level attributes such as diversity change with area. We used survey data from bottom trawls to examine spatial patterns of species richness in U.S. Pacific coastal fishes. Specifically, we generated and compared species-area relationships (SARs) for species classified into several groups on the basis of maximum body size, trophic level, diet, maximum depth, geographic affinity, and taxonomic order. Because SARs among groups were not parallel and z values varied significantly for several groups, groups of species were under- or overrepresented (depending on the size of the area) relative to their proportions in the entire community (i.e., entire U.S. Pacific coast). In this way, differences in SARs help demonstrate trade-offs between species representation and coastal area and suggest strategies (such as targeting the protection of habitats and locations where a particular species or groups of species are maximized) that may minimize the size of marine protected areas (MPAs) but protect diversity at the level of the community and functional group.

A brief review of potential mechanisms of immune reconstitution inflammatory syndrome in HIV following antiretroviral therapy.

A subset of HIV-infected individuals who receive antiretroviral therapy (ART) develop a paradoxical pathological response that significantly increases morbidity and sometimes mortality. Following the induction of highly active ART, a rapid decline in the viral load results within weeks and coincides with a steep rise in the CD4(+) T-cell counts and immune hyperactivation. Although no mechanistic pathway has been elucidated for the development of immune reconstitution inflammatory syndrome (IRIS), it is thought that change in the nature of the immune response is a predominant factor in the development of reconstitution disease. In this article, we review the current state of knowledge in this field and provide a model for the development of IRIS.

The cost-effectiveness of insulin glargine vs. neutral protamine Hagedorn insulin in type 2 diabetes: a focus on health economics.

Diabetes mellitus is a major public health problem, in particular because of long-term complications affecting essential organs, such as the eyes and kidneys, which can lead to a reduction in life expectancy and high healthcare costs. The number of individuals with diabetes mellitus is projected to rise worldwide from 171 million people in 2000 to 366 million people in 2030. With the number of patients with diabetes continually growing, the burden of pressure on worldwide health systems is huge. Accordingly, regulatory and marketing approvals of new medicines are beginning to incorporate economic evaluation techniques to determine their cost-effectiveness. Overall, the studies included in this review show that the initiation of insulin glargine is cost-effective and is expected to lead to substantial improvements in both life years (LYs) and quality-adjusted LYs compared with neutral protamine Hagedorn insulin.

Alcohol trait and transcriptional genomic analysis of C57BL/6 substrains.

C57BL/6 inbred mice have been widely used as research models; however, widespread demand has led to the creation of several B6 substrains with markedly different phenotypes. In this study, we report that two substrains of C57BL/6 mice, C57BL/6J (B6J) and C57BL/6NCrl (B6C), separated over 50 years ago at two different breeding facilities differ significantly in alcohol consumption and alcohol preference. The genomes of these two substrains are estimated to differ by only 1-2% of all gene loci, providing a unique opportunity to extract particular expression signatures between these substrains that are associated with quantifiable behavioral differences. Expression profiling of the cortex and striatum, hippocampus, cerebellum and the ventral brain region from alcohol-naïve B6C and B6J mice showed intervals on three chromosomes that are enriched in clusters of coregulated transcripts significantly divergent between the substrains. Additional analysis identified two genomic regions containing putative copy number differences between the substrains. One such region on chromosome 14 contained an estimated 3n copy number in the B6J genome compared with B6C. Within this interval, a gene of unknown function, D14Ertd449e, was found to be both associated with alcohol preference and vary in copy number across several inbred strain lineages. H2afz, Psen1, Wdfy1 and Clu were also identified as candidate genes that may be involved in influencing alcohol consumption.

Computerised tomography for the detection of pulmonary emboli in intensive care patients--a retrospective cohort study.

Pulmonary emboli are frequently considered as a cause for respiratory deterioration in intensive care unit (ICU) patients, however empirical observation suggests that computerised tomographic (CT) angiography is infrequently positive after the first 24 hours. This study aimed to determine the rate and risk factors for detection of pulmonary emboli by CT angiography in ICU patients. All patients undergoing CT angiography > 24 hours after ICU admission for respiratory deterioration from April 2000 until January 2004 were included. The positivity rate for pulmonary emboli was determined and risk factors analysed. Seven (6%) out of 113 CT angiograms were positive for pulmonary emboli. All were found in trauma patients. Comparing positive to negative scans, predefined risk factors including head injury (5/7 positive scans, 71% vs. 23/106 negative scans, 22%, P = 0.005), spine injury with neurological impairment (4/7, 57% vs. 9/106, 8%, P = 0.002) and lower limb injury (3/7, 43% vs. 12/106, 9%, P = 0.039) were significantly more frequent in patients with positive scans. Deep vein thrombosis prophylaxis was employed less frequently prior to a positive scan (in 3/7, 43% patients with positive scans vs. 91/106, 86% patients with negative scans P = 0.015). Only the predefined risk factors were independently associated with positive CT angiography on limited logistic regression (OR 24.7 per risk factor, 95% CI 2.38 to 255.1, P = 0.007). Pulmonary emboli were infrequently diagnosed using CT angiography in ICU patients admitted for more than 24 hours and found only in patients with recognised risk factors.

Medical aerosol propellant interference with infrared anaesthetic gas monitors.

BACKGROUND: 1,1,1,2 Tetrafluoroethane is a hydrofluoroalkane (HFA) that is replacing chlorofluorocarbons (CFC) as a medical aerosol propellant in an attempt to reduce damage to the ozone layer. This study compared the effects of HFA- and CFC-based inhalers on four anaesthetic gas monitoring systems. METHODS: The HFA- and CFC-based inhalers were activated in close proximity to the sample line of two Datex Ohmeda, an Agilent and a Siemens infrared anaesthetic agent monitoring systems. The effects were recorded on each system for five common anaesthetic agents. RESULTS: The HFA inhaler caused either maximal false positive readings (with the exception of desflurane) or transient measurement failure on all systems. The Datex Ohmeda AS/3 system misidentified the HFA inhaler as carbon dioxide at low concentration (2 +/- 0 mm Hg). The CFC-based inhaler caused a minor false-positive reading (0.4 +/- 0%) for halothane only on the Datex Ohmeda AS/3 system only and was misidentified as carbon dioxide at 33.3 (sd 2.1) mm x Hg and 22.4 (8.9) mm x Hg by the Agilent and Siemens systems. CONCLUSIONS: The HFA inhaler adversely affected all equipment tested. The infrared spectra of HFA and the common anaesthetic gases have considerable overlap at the 8-12 microm range that is not shared by the CFCs. The differences in spectral overlap explain the different effects of the HFA and CFC propellants. Anaesthetic gas concentration data may be erroneous using the HFA-based inhalers.

Long-term results of irradiation for patients with progressive Graves' ophthalmopathy.

PURPOSE: To determine the long-term outcome of radiotherapy (RT) in patients with progressively symptomatic thyroid eye disease and to evaluate the potential long-term sequelae. METHODS AND MATERIALS: Four hundred fifty-three patients provided written informed consent and received retrobulbar RT for Graves' ophthalmopathy at Stanford University Medical Center; 197 with 1 year of follow-up were retrospectively analyzed. Of the 197 patients, 189 received RT to the bilateral retrobulbar regions, and 4 received unilateral RT. The technical information was unavailable for 4 patients. Patients were assessed by chart review, telephone interview, questionnaire, and multidisciplinary physician examination. Eye impairment was scored using the SPECS system. The end point review included the before and after treatment SPECS score, surgical intervention, and patient satisfaction. Potential complications, including cataract development, retinopathy, and tumor formation, were investigated. Multivariate analyses were performed to assess the prognostic variables. RESULTS: Improvement or resolution was 89% for soft-tissue findings; 70% for proptosis; 85% for extraocular muscle dysfunction; 96% for corneal abnormalities; and 67% for sight loss. The response to RT may take >6 months to stabilize. Factors predictive of response varied in the individual SPECS categories but included the initial SPECS score, pretreatment thyroid status, female gender, a 20-Gy RT dose, and a history of hypertension. Nonpredictive factors included a history of tobacco use, diabetes mellitus, steroids, and prior cataracts. Only 16% required surgical intervention to preserve their vision or restore binocular vision. Twenty-two patients (12%) developed cataracts after irradiation (median 11 years). No patient developed a tumor within the RT field during the follow-up period (range 1-29 years). Ninety-eight percent of patients were pleased with their results, and 2% believed their symptoms progressed despite RT. CONCLUSIONS: Retrobulbar irradiation (20 Gy) is safe and effective treatment for progressive Graves' ophthalmopathy, with a 96% overall response rate, 98% patient satisfaction rate, and no irreparable long-term sequelae, with follow-up extending 29 years. The most common late effect observed was cataract development, which occurred more frequently in older patients and was reversible with extraction. Elective surgical intervention after RT should be withheld until patients have demonstrated a plateau in response.

Polymer stability plays an important role in the positional regulation of FtsZ.

We conducted a series of experiments examining the effect of polymer stability on FtsZ localization dynamics in Bacillus subtilis. A loss-of-function mutation in ezrA, a putative polymer-destabilizing factor, suppresses the defects in FtsZ polymer stability associated with minCD overexpression. In addition, a mutation that is predicted to stabilize the FtsZ polymer leads to the formation of polar FtsZ rings. These data support the hypothesis that carefully balanced polymer stability is important for the assembly and localization of FtsZ during the bacterial cell cycle.

The road to extinction is paved with good intentions: negative association of fish hatcheries with threatened salmon.

Hatchery programmes for supplementing depleted populations of fish are undergoing a worldwide expansion and have provoked concern about their ramifications for populations of wild fish. In particular, Pacific salmon are artificially propagated in enormous numbers in order to compensate for numerous human insults to their populations, yet the ecological impacts of this massive hatchery effort are poorly understood. Here we test the hypothesis that massive numbers of hatchery-raised chinook salmon reduce the marine survival of wild Snake River spring chinook, a threatened species in the USA. Based on a unique 25-year time-series, we demonstrated a strong, negative relationship between the survival of chinook salmon and the number of hatchery fish released, particularly during years of poor ocean conditions. Our results suggest that hatchery programmes that produce increasingly higher numbers of fish may hinder the recovery of depleted wild populations.

The loyal treatment.

Despite employees' diminished loyalty to health care organizations, you can earn their devotion and transfer the benefits to the organization.