An assessment of temporal, spatial and taxonomic trends in harmful algal toxin exposure in stranded marine mammals from the U.S. New England coast.

Despite a long-documented history of severe harmful algal blooms (HABs) in New England coastal waters, corresponding HAB-associated marine mammal mortality events in this region are far less frequent or severe relative to other regions where HABs are common. This long-term survey of the HAB toxins saxitoxin (STX) and domoic acid (DA) demonstrates significant and widespread exposure of these toxins in New England marine mammals, across multiple geographic, temporal and taxonomic groups. Overall, 19% of the 458 animals tested positive for one or more toxins, with 15% and 7% testing positive for STX and DA, respectively.

Evidence-based Care of the Human Trafficking Patient.

Human trafficking is the intentional exploitation of vulnerable individuals for the personal gain of the exploiter and is now recognized as an emerging public health care priority. Health care providers are well positioned to identify and assist trafficked individuals as well as those who may be at risk for exploitation. Trauma informed care is essential to identify victims and evaluate the impact of traumatic stress while highlighting survivors' strengths and supporting their resiliency.

Motivational Interviewing and Home Visits to Improve Health Behaviors and Reduce Childhood Obesity: A Pilot Study.

Introduction: Childhood obesity prevalence is highest among low-income, Hispanic, and Black children. The purpose of this study was to examine the feasibility of using motivational interviewing (MI) with home visits and the 5-2-1-0 program to improve health behaviors in children. Desirable health behaviors include daily consuming five servings of fruits or vegetables, limiting recreational screen time to 2 hours, exercising for 1 hour, and avoiding sugar-sweetened beverages.

Discrimination between bycatch and other causes of cetacean and pinniped stranding.

The challenge of identifying cause of death in discarded bycaught marine mammals stems from a combination of the non-specific nature of the lesions of drowning, the complex physiologic adaptations unique to breath-holding marine mammals, lack of case histories, and the diverse nature of fishing gear. While no pathognomonic lesions are recognized, signs of acute external entanglement, bulging or reddened eyes, recently ingested gastric contents, pulmonary changes, and decompression-associated gas bubbles have been identified in the condition of peracute underwater entrapment (PUE) syndrome in previous studies of marine mammals. We reviewed the gross necropsy and histopathology reports of 36 cetaceans and pinnipeds including 20 directly observed bycaught and 16 live stranded animals that were euthanized between 2005 and 2011 for lesions consistent with PUE.

Vitamin D Deficiency and Association With Body Mass Index and Lipid Levels in Hispanic American Adolescents.

In this retrospective study, vitamin D deficiency was examined with body mass index (BMI) and lipid levels in a sample of Hispanic American adolescents. The prevalence of vitamin D deficiency among 234 subjects aged 13 to 19 years was 27.8%.

Ten-year outcome of intraoperative treatment of atrial fibrillation using radiofrequency ablation.

Background: Intraoperative radiofrequency ablation (RFA) has been advocated to treat atrial fibrillation (AF). This report examines the long-term effects of intraoperative RFA in the prevention of recurrence of AF when used as an adjunctive treatment in patients undergoing cardiac procedures for primary indications unrelated to their arrhythmia.

Methods: The study reviewed the records of patients from a tertiary medical center which had 2 cardiac surgeons performing an intraoperative adjunctive RFA procedure.

Working With Socially and Medically Complex Patients: When Care Transitions Are Circular, Overlapping, and Continual Rather Than Linear and Finite.

The care coordination program described here evolved from 5 years of trial and learning related to how to best serve our high-cost, high-utilizing, chronically ill, urban core patient population. In addition to medical complexity, they have daily challenges characteristic of persons served by Safety-Net health systems. Many have unstable health insurance status.

Phocine distemper virus: current knowledge and future directions.

Phocine distemper virus (PDV) was first recognized in 1988 following a massive epidemic in harbor and grey seals in north-western Europe. Since then, the epidemiology of infection in North Atlantic and Arctic pinnipeds has been investigated. In the western North Atlantic endemic infection in harp and grey seals predates the European epidemic, with relatively small, localized mortality events occurring primarily in harbor seals.

Addressing social determinants to improve healthcare quality and reduce cost.

Unlabelled: Most healthcare quality improvement and cost reduction efforts currently focus on care processes, or transitions-for example, the hospital discharge process. While identification and adoption of best practices to address these aspects of healthcare are essential, more is needed for systems that serve vulnerable populations: to account for social factors that often inhibit patients' ability to take full advantage of available healthcare. Our urban safety net healthcare system developed and implemented an innovative quality improvement approach.

Intra-abdominal hypertension and abdominal compartment syndrome.

Abdominal compartment syndrome (ACS) is seen with increasing frequency in the critically-ill. Elevated intraabdominal pressures interfere with vital organ function and contribute to mortality. Prevention, when possible and early recognition of occurrence with timely therapy will improve survival.

Acute respiratory distress syndrome.

Acute Respiratory Distress Syndrome (ARDS) is defined by bilateral diffuse infiltrates on chest radiography, a PO2/FiO2 ratio < 200, and noncardiogenic pulmonary edema. Pathophysiologically it is characterized by disruption of the alveolar lining and capillary endothelium, alveolar edema, protein exudation coupled with a marked inflammatory response and subsequent fibrosis and a resultant ventilation-perfusion mismatch. Effective treatment strategies include low tidal volume ventilation with positive end expiratory pressure, careful fluid management and good supportive care.

Risk factors for community-associated Staphylococcus aureus skin infection in children of Maui.

The prevalence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection, and Staphylococcus aureus (S. aureus) infection overall, has dramatically increased in the past 10 years. Children and Native Hawaiians and Pacific Islanders (NHPI) are disproportionately affected by CA-MRSA infection.

Congenital scoliosis of a bottlenose dolphin.

There are many reports of cetaceans with deformed and twisted bodies. Skeletal pathology descriptions have shown changes to axial skeletons because of injury, trauma, or disease. We present a bottlenose dolphin (Tursiops truncatus) that shows characteristic patterns of congenital skeletal deformity, including malformed vertebrae, ribs, and sternum.

Static inflation and deflation pressure-volume curves from excised lungs of marine mammals.

Excised lungs from eight marine mammal species [harp seal (Pagophilus groenlandicus), harbor seal (Phoca vitulina), gray seal (Halichoerus grypush), Atlantic white-sided dolphin (Lagenorhynchus acutus), common dolphin (Delphinus delphis), Risso's dolphin (Grampus griseus), long-finned pilot whale (Globicephala melas) and harbor porpoise (Phocoena phocoena)] were used to determine the minimum air volume of the relaxed lung (MAV, N=15), the elastic properties (pressure-volume curves, N=24) of the respiratory system and the total lung capacity (TLC). Our data indicate that mass-specific TLC (sTLC, l kg(-1)) does not differ between species or groups (odontocete vs phocid) and agree with that estimated (TLC(est)) from body mass (M(b)) by applying the equation: TLC(est)=0.135 M(b)(0.

When core measures fail: how often has the patient received the prescribed care?

Core measures were developed to assess the gap between recommended best medical practice and actual applied care using publicly-reported hospital results We found that 29+/-6% (p>0.001), of failed core measure cases actually received best medical practice care but failed documentation requirements.

The two worlds of race revisited: a meditation on race in the age of Obama.

Nearly fifty years ago, the American Academy organized a conference and two issues of its journal "Daedalus" on the topic of "The Negro American." The project engaged top intellectuals and policy-makers around the conflicts and limitations of mid-1960s liberalism in dealing with race. Specifically, they grappled with the persistent question of how to integrate a forced-worker population that had been needed but that was socially undesirable once its original purpose no longer existed.

Patient safety: a tool from Atul.

The 1999 Institute of Medicine (IOM) report estimated that as many as 98,000 medical error related deaths occur each year in the United States; and although some argued the accuracy of the number, few denied the gravity. Medical error produces more fatalities than motor vehicle accidents, or other more publicized nonmedical disasters, and is one of the leading causes of death.

Gas bubbles in seals, dolphins, and porpoises entangled and drowned at depth in gillnets.

Gas bubbles were found in 15 of 23 gillnet-drowned bycaught harp (Pagophilus groenlandicus), harbor (Phoca vitulina) and gray (Halichoerus grypus) seals, common (Delphinus delphis) and white-sided (Lagenorhyncus acutus) dolphins, and harbor porpoises (Phocaena phocaena) but in only 1 of 41 stranded marine mammals. Cases with minimal scavenging and bloating were chilled as practical and necropsied within 24 to 72 hours of collection. Bubbles were commonly visible grossly and histologically in bycaught cases.

Fungal sensitivity in the South Carolina Governor's Mansion: a descriptive study.

In 2004, significant mold growth was discovered in the SC Governor's Mansion; this provided an opportunity to test inhabitants and employees of the Mansion for relationships between airborne fungi and health effects. This descriptive study used site specific fungal testing for IgE pinprick testing to show that two exposed individuals had specific sensitivity to the most problematic molds. Follow up testing and self-reporting of symptoms after abatement indicated that most symptoms had resolved in the cases.

Spondylitic changes in long-finned pilot whales (Globicephala melas) stranded on Cape Cod, Massachusetts, USA, between 1982 and 2000.

The primary bone pathology diagnoses recognized in cetacea are osteomyelitis and spondylosis deformans. In this study, we determined the prevalence, type, and severity of vertebral pathology in 52 pilot whales, a mass stranding species that stranded on Cape Cod, Massachusetts, between 1982 and 2000. Eleven whales (21%) had hyperostosis and ossification of tendon insertion points on and between vertebrae, chevron bones, and costovertebral joints, with multiple fused blocks of vertebrae.

Cumulative sperm whale bone damage and the bends.

Diving mosasaurs, plesiosaurs, and humans develop dysbaric osteonecrosis from end-artery nitrogen embolism ("the bends") in certain bones. Sixteen sperm whales from calves to large adults showed a size-related development of osteonecrosis in chevron and rib bone articulations, deltoid crests, and nasal bones. Occurrence in animals from the Pacific and Atlantic oceans over 111 years made a pathophysiological diagnosis of dysbarism most likely.