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The availability of electronic health records and access to a large number of routine measurements of serum creatinine and urinary albumin enhance the possibilities for epidemiologic research in kidney disease. However, the frequency of health care use and laboratory testing is determined by health status and indication, imposing certain challenges when identifying patients with kidney injury or disease, when using markers of kidney function as covariates, or when evaluating kidney outcomes. Depending on the specific research question, this may influence the interpretation, generalizability, and/or validity of study results. This review illustrates the heterogeneity of working definitions of kidney disease in the scientific literature and discusses advantages and limitations of the most commonly used approaches using 3 examples. We summarize ways to identify and overcome possible biases and conclude by proposing a framework for reporting definitions of exposures and outcomes in studies of kidney disease using routinely collected health care data.

We report on detailed multi-wavelength observations and analysis of the very bright and long GRB 210619B, detected by the Atmosphere-Space Interactions Monitor (ASIM) installed on the International Space Station (ISS) and the Gamma-ray Burst Monitor (GBM) on-board the Fermi mission. Our main goal is to understand the radiation mechanisms and jet composition of GRB 210619B. With a measured redshift of $z$ = 1.937, we find that GRB 210619B falls within the 10 most luminous bursts observed by Fermi so far. The energy-resolved prompt emission light curve of GRB 210619B exhibits an extremely bright hard emission pulse followed by softer/longer emission pulses. The low-energy photon indices ($\alpha_{\rm pt}$) values obtained using the time-resolved spectral analysis of the burst suggest a transition between the thermal (during harder pulse) to non-thermal (during softer pulse) outflow. We examine the correlation between spectral parameters and find that both peak energy and $\alpha_{\rm pt}$ exhibit the flux tracking pattern. The late time broadband photometric dataset can be explained within the framework of the external forward shock model with $\nu_m$ $< \nu_c$ $< \nu_{x}$ (where $\nu_m$, $\nu_c$, and $\nu_{x}$ are the synchrotron peak, cooling-break, and X-ray frequencies, respectively) spectral regime supporting a rarely observed hard electron energy index ($p, Comment: 24 pages, 18 figures, 10 tables, accepted for publication in MNRAS

Suboptimal nutrition may contribute to lionfish (Pterois volitans and Pterois miles) health issues in managed care environments. This study’s objective was to establish and compare whole blood fatty acid profiles in wild and aquarium lionfish. Whole blood samples were dried onto specialized high-quality paper cards from wild, invasive lionfish harvested off the North Carolina coast (n = 16) and lionfish managed by the North Carolina Aquariums (n = 12). Blood fatty acid profiles were analyzed from dried blood spots. Aquarium lionfish had significantly (p < 0.05) higher linoleic (18:2ω6) and eicosapentaenoic (20:5ω3) acid levels than wild lionfish. Similarly, aquarium lionfish had significantly (p < 0.05) lower saturated fatty acids and arachidonic (20:4ω6) to eicosapentaenoic acid (20:5ω3) ratios than wild lionfish. Total omega-3 and omega-6 fatty acids, as well as the ratio of these two fatty acid groups, were similar between wild and aquarium lionfish. Gut content analysis of wild lionfish diets included reef-dependent and schooling fish while aquarium lionfish diets were pelagic fish, crustaceans, mollusks, and commercial gel diets with nutrient supplements. This study reports whole blood fatty acid profiles in lionfish, providing comparative macronutrient data that may be useful for improving their nutrition and welfare in aquariums.

Background Despite a high prevalence of mental health problems among physicians, the rate of help-seeking behaviour is low. Instead, physicians tend to self-treat. This can have a negative impact on individual physicians and society. Aims The aim was to explore the relationship between self-rated depression, the use of psychotropic medication, and the extent of self-treatment across gender and hierarchical position among Swedish physicians. In addition, the aim was to investigate whether social support can buffer against self-treatment. Methods This study draws on data from the Longitudinal Occupational Health for Health Care in Sweden 2021 study, comprising a representative sample of physicians. Descriptive statistics and logistic regressions were carried out. Results The present study showed that approximately 60% of the physicians using narcotic or non-narcotic psychotropic medication were self-prescribing. Male and more senior physicians self-treated to a greater extent. Physicians without depression were self-treating to a greater extent than those with depression. Those who used non-narcotic psychotropic medication intermittently were more likely to self-treat than those who used these medications regularly. The frequency of use was insignificant in relation to self-treatment with narcotic psychotropic medication. No buffering effect from social support at work was found. Conclusions Self-treatment was common among physicians in Sweden, particularly among those who reported mild or no symptoms of depression. This may have negative long-term effects on an individual level and for Swedish health care at large.

Objectives To develop and test the performance of computerized ultrasound image analysis using deep neural networks (DNNs) in discriminating between benign and malignant ovarian tumors and to compare its diagnostic accuracy with that of subjective assessment (SA) by an ultrasound expert. Methods We included 3077 (grayscale, n = 1927; power Doppler, n = 1150) ultrasound images from 758 women with ovarian tumors, who were classified prospectively by expert ultrasound examiners according to IOTA (International Ovarian Tumor Analysis) terms and definitions. Histological outcome from surgery (n = 634) or long‐term (≥ 3 years) follow‐up (n = 124) served as the gold standard. The dataset was split into a training set (n = 508; 314 benign and 194 malignant), a validation set (n = 100; 60 benign and 40 malignant) and a test set (n = 150; 75 benign and 75 malignant). We used transfer learning on three pre‐trained DNNs: VGG16, ResNet50 and MobileNet. Each model was trained, and the outputs calibrated, using temperature scaling. An ensemble of the three models was then used to estimate the probability of malignancy based on all images from a given case. The DNN ensemble classified the tumors as benign or malignant (Ovry‐Dx1 model); or as benign, inconclusive or malignant (Ovry‐Dx2 model). The diagnostic performance of the DNN models, in terms of sensitivity and specificity, was compared to that of SA for classifying ovarian tumors in the test set. Results At a sensitivity of 96.0%, Ovry‐Dx1 had a specificity similar to that of SA (86.7% vs 88.0%; P = 1.0). Ovry‐Dx2 had a sensitivity of 97.1% and a specificity of 93.7%, when designating 12.7% of the lesions as inconclusive. By complimenting Ovry‐Dx2 with SA in inconclusive cases, the overall sensitivity (96.0%) and specificity (89.3%) were not significantly different from using SA in all cases (P = 1.0). Conclusion Ultrasound image analysis using DNNs can predict ovarian malignancy with a diagnostic accuracy comparable to that of human expert examiners, indicating that these models may have a role in the triage of women with an ovarian tumor. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology., This article's abstract has been translated into Spanish and Chinese. Follow the links from the abstract to view the translations.

Briefly considered extinct in the wild, the future of the wild population of the Wyoming toad (Anaxyrus baxteri) continues to rely on captive breeding to supplement the wild population. Given its small natural geographic range and history of rapid population decline at least partly due to fungal disease, investigation of the diversity of key receptor families involved in the host immune response represents an important conservation need. Population decline may have reduced immunogenetic diversity sufficiently to increase the vulnerability of the species to infectious diseases. Here we use comparative transcriptomics to examine the diversity of toll-like receptors and major histocompatibility complex (MHC) sequences across three individual Wyoming toads. We find reduced diversity at MHC genes compared to bufonid species with a similar history of bottleneck events. Our data provide a foundation for future studies that seek to evaluate the genetic diversity of Wyoming toads, identify biomarkers for infectious disease outcomes, and guide breeding strategies to increase genomic variability and wild release successes.

Full list of authors: Castro-Tirado, A. J.; Østgaard, N.; Göǧüş, E.; Sánchez-Gil, C.; Pascual-Granado, J.; Reglero, V.; Mezentsev, A.; Gabler, M.; Marisaldi, M.; Neubert, T.; Budtz-Jørgensen, C.; Lindanger, A. Sarria, D.; Kuvvetli, I.; Cerdá-Durán, P.; Navarro-González, J.; Font, J. A.; Zhang, B. -B.; Lund, N.; Oxborrow, C. A.; Brandt, S.; Caballero-García, M. D.; Carrasco-García, I. M.; Castellón, A.; Castro Tirado, M. A.; Christiansen, F.; Eyles, C. J.; Fernández-García, E.; Genov, G.; Guziy, S.; Hu, Y. -D.; Nicuesa Guelbenzu, A.; Pandey, S. B.; Peng, Z. -K.; Pérez del Pulgar, C.; Reina Terol, A. J.; Rodríguez, E.; Sánchez-Ramírez, R.; Sun, T.; Ullaland, K.; Yang, S., Magnetars are strongly magnetized, isolated neutron stars1–3 with magnetic fields up to around 1015 gauss, luminosities of approximately 1031–1036 ergs per second and rotation periods of about 0.3–12.0 s. Very energetic giant flares from galactic magnetars (peak luminosities of 1044–1047 ergs per second, lasting approximately 0.1 s) have been detected in hard X-rays and soft γ-rays4, and only one has been detected from outside our galaxy5. During such giant flares, quasi-periodic oscillations (QPOs) with low (less than 150 hertz) and high (greater than 500 hertz) frequencies have been observed6–9, but their statistical significance has been questioned10. High-frequency QPOs have been seen only during the tail phase of the flare9. Here we report the observation of two broad QPOs at approximately 2,132 hertz and 4,250 hertz in the main peak of a giant γ-ray flare11 in the direction of the NGC 253 galaxy12–17, disappearing after 3.5 milliseconds. The flare was detected on 15 April 2020 by the Atmosphere–Space Interactions Monitor instrument18,19 aboard the International Space Station, which was the only instrument that recorded the main burst phase (0.8–3.2 milliseconds) in the full energy range (50 × 103 to 40 × 106 electronvolts) without suffering from saturation effects such as deadtime and pile-up. Along with sudden spectral variations, these extremely high-frequency oscillations in the burst peak are a crucial component that will aid our understanding of magnetar giant flares. © 2021, The Author(s), under exclusive licence to Springer Nature Limited., This work made use of data from ASIM. ASIM is an international experiment aboard the International Space Station. ASIM is a mission of the European Space Agency (ESA), funded by ESA and national grants from Denmark, Norway and Spain. ESA PRODEX contracts C 4000115884 (DTU) and 4000123438 (Bergen) support the ASIM Science Data Centre. The science analysis is supported by ESA Topical Team contract 4200019920/06/NL/VJ; European Research Council grant AdG-FP7/2007-2013: n 320839; Research Council of Norway contract 223252/F50 (CoE/BCSS); and Ministerio de Ciencia, Innovación y Universidades grants ESP 2017-86263-C4 and ESP2017-87676-C5-5-R. J.A.F. and P.C.-D. acknowledge support by the Spanish Agencia Estatal de Investigación (grant PGC2018-095984-B-I00) and by the Generalitat Valenciana (PROMETEO/2019/071). P.C.-D. acknowledges the Ramon y Cajal funding (RYC-2015-19074) for supporting his research. M.G. acknowledges support through the Generalitat Valenciana via the grant CIDEGENT/2019/031. A.J.C.-T., J.P.-G., M.D.C.-G. and E.R. acknowledge financial support from the State Agency for Research of the Spanish MCIU through the “Center of Excellence Severo Ochoa” award to the Instituto de Astrofísica de Andalucía (SEV-2017-0709). This work is partly based on observations made with the Gran Telescopio Canarias (GTC), installed at the Spanish Observatorio del Roque de los Muchachos of the Instituto de Astrofísica de Canarias, on the island of La Palma. We thank J. D. Scargle for his help with the preliminary time-series analysis and his comments. J.P.-G. also acknowledges funding support from Spanish public funds for research from project PID2019-107061GB-C63 from the ‘Programas Estatales de Generación de Conocimiento y Fortalecimiento Científico y Tecnológico del Sistema de I+D+i y de I+D+i Orientada a los Retos de la Sociedad’ from the Spanish Ministry of Science, Innovation and Universities (MCIU).

Background: Systematic reviews suggest that preschool environmental/organizational changes may be effective in increasing physical activity (PA) levels of preschool children, but evidence is scarce regarding feasible, effective, and equitable interventions that can be scaled up. Specifically, it is essential to understand whether introducing a multicomponent organizational change in terms of policy in the preschool context may be beneficial for children’s PA levels and concomitant health outcomes. To bridge this knowledge gap, our main aim is to examine the feasibility and effectiveness of a policy package in increasing PA levels in preschool children, using a large-scale pragmatic cluster-randomized controlled trial. Methods: This proposed study is a pragmatic cluster-randomized controlled trial with two conditions (intervention and control with a 1:1 ratio) with preschools as clusters and the unit of randomization. We aim to recruit approximately 4000 3–5-year-old children from 90 preschools and retain more than 2800 children from 85 preschools to provide adequate statistical power for the analyses. The intervention to implement is a co-created, multicomponent policy package running for 6 months in preschools randomized to intervention. Change in accelerometer measured PA levels in children between intervention and control from pre- and post-intervention will be the primary outcome of the study, while secondary outcomes include health outcomes such as musculoskeletal fitness, psychosocial functioning, and absence due to illness in children among others. Implementation will be studied carefully using both quantitative (dose, fidelity) and qualitative (interview) methodologies. The change in primary and secondary outcomes, from pre- to post-intervention, will be analyzed with linear mixed-effect models (to allow both fixed and random effects) nested on a preschool level. Discussion: This is a large-scale co-creation project involving the City of Stockholm, childcare stakeholders, preschool staff, and the research group with the potential to influence more than 30,000 preschool children within the Stockholm area. The study will add reliable evidence for the implementation of PA policies at the organizational level of preschools and clarify its potential effect on objectively measured PA and health markers in children., Karolinska Institutet, Health and Medical Care Administration (Halso-och sjukvardsforvaltningen, Region Stockholm), Swedish Research Council for Sport Science

Objective To document ocular lesions present in cold-stunned sea turtles and determine the impact of these lesions on their release. Animals All sea turtles (Caretta caretta, Chelonia mydas, and Lepidochelys kempii) presenting to rehabilitation centers in North Carolina over two cold stun seasons. Procedures Complete ophthalmic examination using slit-lamp biomicroscopy, fluorescein stain, rebound tonometry, and occasionally binocular indirect funduscopy was performed within 1 week of presenting to the rehabilitation centers. A second examination was performed 2 weeks after the first examination in animals with ocular lesions and still present at the center. Results One hundred and sixty-four turtles (121 Chelonia mydas, 26 Lepidochelys kempii, 17 Caretta caretta) were evaluated over two cold stun seasons (2016-2017 and 2017-2018). Ocular or periocular lesions were identified in 78 of 164 (47.5%) turtles examined with 37 of 164 (22.5%) having bilateral disease. The most common ocular lesion was superficial corneal ulceration, accounting for 21.3% of all lesions. Adnexal lesions were also common, while intraocular abnormalities were overall rare. Most resolved uneventfully. Though some blinding lesions were noted, these were not present bilaterally in any one turtle, and thus, ocular findings did not affect release. Conclusion Ocular lesions in cold-stunned sea turtles are common. Some of these lesions are potentially blinding or require appropriate care, so evaluation of cold-stunned turtles should include a complete ophthalmic examination.

Sea turtles are frequently presented for rehabilitation with injuries for which analgesic treatment is warranted. Ketoprofen is a nonsteroidal anti-inflammatory drug (NSAID) widely used in clinical veterinary medicine for musculoskeletal pain relief. Pharmacokinetics of 2 mg/kg IM have been studied in loggerhead sea turtles (Caretta caretta) as a single and a repeated dose q24hr for 3 days. Safety of longer term administration has not been performed, however, and NSAID use carries a risk of potential complications, including gastrointestinal ulceration, kidney damage, and bleeding. The objective of the current study was to determine the effects of a 5-day course of ketoprofen on thromboelastography (TEG) and hematological (including thrombocytes) and plasma biochemical analytes in loggerheads. A secondary objective was to determine 24-hr trough concentrations of ketoprofen after 5 days of treatment. Eight loggerheads were treated with ketoprofen 2 mg/kg IM q24hr for 5 days, and TEG, hematology, and plasma biochemistry panels were performed before and at the conclusion of treatment. Eight controls were treated with an equivalent volume of saline intramuscularly. Virtually no changes were detected before and after treatment or between treatment and control groups in any of the 24 endpoints evaluated, and marginal differences were not considered clinically relevant. Plasma ketoprofen concentrations after 5 days of treatment indicated no accumulation over that duration. Ketoprofen at 2 mg/kg IM q24hr for up to 5 days in loggerheads appears safe with respect to blood clotting and blood data, although other potential effects were not evaluated.

Objective: QMAC-dRASTTM is a phenotypic automatized Antibiotic Susceptibility Testing (AST) system based on microfluidic chip technology enabling observation of changes in a single bacterial cell under antibiotic treatment conditions. The 96 wells plate with dried antibiotics comprises 19 and 17 antibiotics for the Gram-Negatives (GNs) and Gram-Positives (GPs), respectively. Categorical (Sensitive, Intermediate or Resistant) results were compared to results obtained by our laboratory standard susceptibility testing procedure and given as Categorical Agreement (CA). Methods: In a 3-month period (2019/2020), blood cultures detected positive were included. Excluded were known off-panel strains of QMAC-dRASTTM, such as Gram-positive bacilli, Streptococcus and Candida species. Percentages of CA (CA, %) between QMAC-dRASTTM and routine testing methods used in the laboratory (EUCAST disc diffusion and/or etest/Broth Micro Dilution MIC), were calculated. Results: 255 positive blood cultures from as many patients were examined. Of the positive blood culture strains, 144 were GNs, and 111 were GPs. An overall combined CA,% of 96.3 (2410 of 2502 determinations) was obtained, and discrepancies were noted in 92 of 2502 test results (3.7%). The percentage of very major errors (VMEs) was 0.7% for GNs and 2.2% for GPs. For 87% of blood culture specimens examined, susceptibility reports were available within 6-7 hours. Conclusion: The high CA,% for as well GNs as GPs are promising. The presented time to report data obtained by QMAC-dRASTTM in this study being of 3-8 hours for blood culture specimens examined strongly support a further possible improvement in the workflow for handling blood stream infections.

Sea turtles are frequently presented for rehabilitation with injuries for which analgesic treatment is warranted. Ketoprofen is a nonsteroidal anti-inflammatory drug (NSAID) widely used in clinical veterinary medicine for musculoskeletal pain relief. Pharmacokinetics of 2 mg/kg IM have been studied in loggerhead sea turtles (

Fibropapillomatosis is associated with chelonid alphaherpesvirus 5 (ChHV5) and tumor formation in sea turtles. We collected blood samples from 113 green (Chelonia mydas) and 112 loggerhead (Caretta caretta) turtles without fibropapillomatosis, including 46 free-ranging turtles (20 green turtles, 26 loggerheads), captured in Core Sound, North Carolina, and 179 turtles (93 green turtles, 86 loggerheads) in rehabilitative care in North Carolina. Blood samples were analyzed for ChHV5 DNA using quantitative polymerase chain reaction (qPCR), and for antibodies to ChHV5 peptides using an enzyme-linked immunosorbent assay (ELISA). None of the samples from foraging turtles tested positive for ChHV5 by qPCR, ELISA was not used for foraging turtles. Samples from 18/179 (10.1%) rehabilitating turtles tested positive for ChHV5 using qPCR, and 32/56 (57.1%) rehabilitating turtles tested positive for antibodies to ChHV5 using ELISA. Five turtles that tested positive by qPCR or ELISA at admission converted to being undetectable during rehabilitation, and five that initially tested negative converted to being positive. Both sea turtle species were significantly more likely to test positive for ChHV5 using ELISA than with qPCR (p &lt, 0.001). There was no difference in the proportions of green turtles versus loggerheads that tested positive for ChHV5 using qPCR, but loggerheads were significantly more likely than green turtles to test positive for ChHV5 using ELISA. This finding suggests that loggerheads infected with ChHV5 at some point in their life may be more able than green turtles to mount an effective immune response against recrudescent infection, pointing to species-specific genetic differences in the two species&rsquo, immune response to ChHV5 infection. This is the first study to analyze antibodies to ChHV5 in loggerhead turtles and represents the most complete dataset on ChHV5 DNA detection in sea turtles encountered in the more northern latitudes of their western Atlantic habitat.

Simple Summary Fibropapillomatosis is a debilitating tumor disease of sea turtles that is sometimes fatal. This disease is a key concern for sea turtle rehabilitation facilities due to its infectious nature, as it is associated with a virus called chelonid alphaherpesvirus 5. This is the first study to analyze antibodies to this virus in loggerhead sea turtles and represents the most complete dataset on viral detection in sea turtles encountered in the more northern latitudes of their habitat in the western Atlantic. Abstract Fibropapillomatosis is associated with chelonid alphaherpesvirus 5 (ChHV5) and tumor formation in sea turtles. We collected blood samples from 113 green (Chelonia mydas) and 112 loggerhead (Caretta caretta) turtles without fibropapillomatosis, including 46 free-ranging turtles (20 green turtles, 26 loggerheads), captured in Core Sound, North Carolina, and 179 turtles (93 green turtles, 86 loggerheads) in rehabilitative care in North Carolina. Blood samples were analyzed for ChHV5 DNA using quantitative polymerase chain reaction (qPCR), and for antibodies to ChHV5 peptides using an enzyme-linked immunosorbent assay (ELISA). None of the samples from foraging turtles tested positive for ChHV5 by qPCR; ELISA was not used for foraging turtles. Samples from 18/179 (10.1%) rehabilitating turtles tested positive for ChHV5 using qPCR, and 32/56 (57.1%) rehabilitating turtles tested positive for antibodies to ChHV5 using ELISA. Five turtles that tested positive by qPCR or ELISA at admission converted to being undetectable during rehabilitation, and five that initially tested negative converted to being positive. Both sea turtle species were significantly more likely to test positive for ChHV5 using ELISA than with qPCR (p < 0.001). There was no difference in the proportions of green turtles versus loggerheads that tested positive for ChHV5 using qPCR, but loggerheads were significantly more likely than green turtles to test positive for ChHV5 using ELISA. This finding suggests that loggerheads infected with ChHV5 at some point in their life may be more able than green turtles to mount an effective immune response against recrudescent infection, pointing to species-specific genetic differences in the two species’ immune response to ChHV5 infection. This is the first study to analyze antibodies to ChHV5 in loggerhead turtles and represents the most complete dataset on ChHV5 DNA detection in sea turtles encountered in the more northern latitudes of their western Atlantic habitat.

Anthropogenic contaminants in the marine environment often biodegrade slowly, bioaccumulate in organisms, and can have deleterious effects on wildlife immunity, health, reproduction, and development. In this study, we evaluated tissue toxicant concentrations and pathology data from 83 odontocetes that stranded in the southeastern United States during 2012–2018. Mass spectrometry was used to analyze blubber samples for five organic toxicants (atrazine, bisphenol-A, diethyl phthalates, nonylphenol monoethoxylate [NPE], triclosan), and liver samples were analyzed for five non-essential elements (arsenic, cadmium, lead, mercury, thallium), six essential elements (cobalt, copper, manganese, iron, selenium, zinc) and one toxicant mixture class (Aroclor1268). Resultant data considerably improve upon the existing knowledge base regarding toxicant concentrations in stranded odontocetes. Toxicant and element concentrations varied based on animal demographic factors including species, sex, age, and location. Samples from bottlenose dolphins had significantly higher average concentrations of lead, manganese, mercury, selenium, thallium, and zinc, and lower average concentrations of NPE, arsenic, cadmium, cobalt, and iron than samples from pygmy sperm whales. In adult female bottlenose dolphins, average arsenic concentrations were significantly higher and iron concentrations were significantly lower than in adult males. Adult bottlenose dolphins had significantly higher average concentrations of lead, mercury, and selenium, and significantly lower average manganese concentrations compared to juveniles. Dolphins that stranded in Florida had significantly higher average concentrations of lead, mercury, and selenium, and lower concentrations of iron than dolphins that stranded in North Carolina. Histopathological data are presented for 72 animals, including microscopic evidence of Campula spp. and Sarcocystis spp. infections, and results of Morbillivirus and Brucella spp. molecular diagnostic testing. Sublethal cellular changes related to toxicant exposure in free-ranging odontocetes may lead to health declines and, in combination with other factors, may contribute to stranding.

Ketoprofen is a nonsteroidal anti-inflammatory and analgesic agent that nonselectively inhibits cyclooxygenase, with both COX-1 and COX-2 inhibition. Recent studies on COX receptor expression in reptiles suggest that nonselective COX inhibitors may be more appropriate than more selective inhibitors in some reptiles, but few pharmacokinetic studies are available. The goal of this study was to determine single- and multidose (three consecutive days) pharmacokinetics of racemic ketoprofen administered intravenously and intramuscularly at 2 mg/kg in healthy juvenile loggerhead turtles (Caretta caretta). The S-isomer is the predominant isomer in loggerhead sea turtles, similar to most mammals, despite administration of a 50:50 racemic mixture. Multidose ketoprofen administration demonstrated no bioaccumulation; therefore, once-daily dosing will not require dose adjustment over time. S-isomer pharmacokinetic parameters determined in this study were Cmax of 10.1 μg/ml by IM injection, C0 of 13.4 μg/ml by IV injection, AUC of 44.7 or 69.4 μg*hr/ml by IM or IV injection, respectively, and T½ of 2.8 or 3.6 hr by IM or IV injection, respectively. Total ketoprofen plasma concentrations were maintained for at least 12 hr above concentrations determined to be effective for rats and humans. A dose of 2 mg/kg either IM or IV every 24 hr is likely appropriate for loggerhead turtles.

OBJECTIVE To compare physiologic and anesthetic effects of alfaxalone administered IV to yearling loggerhead sea turtles (Caretta caretta) at 3 different doses. DESIGN Randomized crossover study. ANIMALS 9 healthy yearling loggerhead sea turtles. PROCEDURES Animals received each of 3 doses of alfaxalone (3 mg/kg [1.4 mg/lb], 5 mg/kg [2.3 mg/lb], or 10 mg/kg [4.5 mg/lb]) administered IV in randomly assigned order, with a minimum 7-day washout period between doses. Endotracheal intubation was attempted following anesthetic induction, and heart rate, sedation depth, cloacal temperature, and respirations were monitored. Times to first effect, induction, first voluntary muscle movement, first respiration, and recovery were recorded. Venous blood gas analysis was performed at 0 and 30 minutes. Assisted ventilation was performed if apnea persisted 30 minutes following induction. RESULTS Median anesthetic induction time for all 3 doses was 2 minutes. Endotracheal intubation was accomplished in all turtles following induction. Heart rate significantly increased after the 3- and 5-mg/kg doses were administered. Median intervals from alfaxalone administration to first spontaneous respiration were 16, 22, and 54 minutes for the 3-, 5-, and 10-mg/kg doses, respectively, and median intervals to recovery were 28, 46, and 90 minutes, respectively. Assisted ventilation was required for 1 turtle after receiving the 5-mg/kg dose and for 5 turtles after receiving the 10-mg/kg dose. The 10-mg/kg dose resulted in respiratory acidosis and marked hypoxemia at 30 minutes. CONCLUSIONS AND CLINICAL RELEVANCE IV alfaxalone administration to loggerhead sea turtles resulted in a rapid anesthetic induction and dose-dependent duration of sedation. Assisted ventilation is recommended if the 10 mg/kg dose is administered.

Four captive raptors, an American kestrel ( Falco sparverius ), peregrine falcon ( Falco peregrinus ), golden eagle ( Aquila chrysaetos ), and barn owl ( Tyto alba ), were diagnosed with ventricular and/or proventricular foreign material impactions consisting of artificial turf substrate, paper and plastic substrate, grass, and newspaper. Partial or total anorexia was reported in all birds and decreased casting in 2 birds. Survey radiographs confirmed presence of gastric enlargement in all 4 birds. The kestrel and eagle were treated unsuccessfully with gastroscopy and gastric lavage, respectively, followed by surgical intervention to remove the ventricular impactions. Both birds died of undetermined causes after surgery. The peregrine falcon died before medical or surgical intervention was started, and the owl was managed successfully with oral mineral oil and liquid diet to facilitate egestion of the foreign material as a pellet. Lead poisoning was suspected as the predisposing cause for foreign body ingestion in the eagle, but underlying causes for pica in the other birds were not determined. Radiographs can provide useful diagnostic information in sick raptors that exhibit vomiting or changes in appetite or casting frequency, and may help guide treatment decisions of impacted birds. Careful consideration of substrate, enrichment items, and access to potential foreign material that could be ingested may be the best pre-emptive management strategy in captive raptors.

Introduction Treatment options for peritoneal metastases (PM) from colorectal cancer (CRC) have increased, their efficiency should be monitored. For this purpose, register-based data on PM can be used, if valid. Purpose We aimed to evaluate the completeness and positive predictive value (PPV) of synchronous peritoneal metastases (S-PM) registered among CRC patients in the Danish National Patient Register (DNPR) and/or the Danish National Pathology Register (the DNPatR) using the Danish Colorectal Cancer Group database (DCCG) as a reference. Patients and Methods We identified Danish patients with newly diagnosed primary CRC in the DCCG during 2014–2015. S-PM were routinely registered in the DCCG. We excluded patients with non-CRC cancers and identified S-PM using all three registries. We estimated the completeness and the PPV of registered S-PM in the DNPR, the DNPatR and the DNPR and/or the DNPatR (DNPR/DNPatR) in combination using the DCCG as the reference. We stratified by age, gender, WHO performance status, tumour location and distant metastases to liver and/or lungs. Results We identified 9142 patients with CRC in DCCG. In DCCG, 366 patients were registered with S-PM, among whom 213 in DCCG only, whereas 153 in DCCG and in at least one of DNPR and/or DNPatR. In DNPR/DNPatR, S-PM was registered with a completeness of 42% [95% CI: 37–47] and a PPV of 60% [95% CI: 54–66]. In the DNPR only, the completeness was 32% [95% CI: 27–37] and the PPV 57% [95% CI: 50–64]. The completeness in the DNPatR was 19% [95% CI: 15–23] and the PPV was 76% [95% CI: 68–85]. In the DNPR/DNPatR patients aged

We examine the impact of black hole jet feedback on the properties of the low-redshift intergalactic medium (IGM) in the SIMBA simulation, with a focus on the Ly$\alpha$ forest mean flux decrement $D_A$. Without jet feedback, we confirm the Photon Underproduction Crisis (PUC) in which $\Gamma_{\rm HI}$ at $z=0$ must be increased by $\times6$ over the Haardt & Madau value in order to match the observed $D_{A}$. Turning on jet feedback lowers this discrepancy to $\sim\times 2.5$, and additionally using the recent Faucher-Gigu\`ere background mostly resolves the PUC, along with producing a flux probability distribution function in accord with observations. The PUC becomes apparent at late epochs ($z \lesssim 1$) where the jet and no-jet simulations diverge; at higher redshifts SIMBA reproduces the observed $D_{A}$ with no adjustment, with or without jets. The main impact of jet feedback is to lower the cosmic baryon fraction in the diffuse IGM from 39% to 16% at $z=0$, while increasing the warm-hot intergalactic medium (WHIM) baryon fraction from 30% to 70%; the lowering of the diffuse IGM content directly translates into a lowering of $D_{A}$ by a similar factor. Comparing to the older MUFASA simulation that employs different quenching feedback but is otherwise similar to SIMBA, MUFASA matches $D_{A}$ less well than SIMBA, suggesting that low-redshift measurements of $D_{A}$ and $\Gamma_{\rm HI}$ could provide constraints on feedback mechanisms. Our results suggest that widespread IGM heating at late times is a plausible solution to the PUC, and that SIMBA's jet AGN feedback model, included to quench massive galaxies, approximately yields this required heating., Comment: 19 pages, 11 Figures, accepted to MNRAS

Following the explosion of the Deepwater Horizon MC252 oil rig in 2010, 319 live sea turtles exposed to crude oil and oil-dispersant (Corexit) combinations were admitted to rehabilitation centers for decontamination and treatment. Treatment of oiled sea turtles was guided by expected physiological and pathological effects of crude oil exposure extrapolated from studies in other species and from a single loggerhead sea turtle (Caretta caretta) study. While invaluable starting points, inherent limitations to extrapolation, and small sample size of the experimental exposure study, reduce their utility for clinical guidance and for assessing oil spill impacts. Effects of dispersants were not included in the previous experimental exposure study, and cannot be effectively isolated in the analysis of field data from actual spills. A terminal study of pivotal temperature of sex determination using eggs salvaged from doomed loggerhead nests provided an opportunity for an ancillary exposure study to investigate the acute effects of crude oil, dispersant, and a crude oil/dispersant combination in sea turtle hatchlings. Eggs were incubated at 27.2 – 30.8 °C, and hatchlings were randomly assigned to control, oil, dispersant, and combined oil/dispersant exposures for 1 day or 4 days. Contaminant exposures were started after a 3 day post-hatching period simulating nest emergence. Turtles were placed in individual glass bowls containing aged seawater and exposed to oil (Gulf Coast – Mixed Crude Oil Sweet, CAS #8002-05-9, 0.833 mL/L) and/or dispersant (Corexit 9500A, 0.083 mL/L), replicating concentrations encountered during oil spills and subsequent response. Statistically significant differences between treatments and non-exposed controls were detected for PCV, AST, uric acid, glucose, calcium, phosphorus, total protein, albumin, globulin, potassium and sodium. The principal dyscrasias reflected acute osmolar, electrolyte and hydration challenges that were more numerous and greater in combined oil/dispersant exposures at 4 days. Clinicopathological findings were supported by a failure to gain weight (associated with normal hatchling hydration in seawater) in dispersant and combination exposed hatchlings. These findings can help guide clinical response for sea turtles exposed to crude oil and crude oil/dispersant combinations, and indicate potential impacts on wildlife to consider when deploying dispersants in an oil spill response.

Enrofloxacin is a fluoroquinolone widely used in animals including fish. Intramuscular (IM) injection of enrofloxacin is a feasible and efficacious option for drug delivery. In many species IM injection has been associated with injection site reactions and increases in serum muscle enzymes. Injection site reactions have not been well characterized in fish. Three groups of striped bass (

Following the explosion of the Deepwater Horizon MC252 oil rig in 2010, 319 live sea turtles exposed to crude oil and oil-dispersant (Corexit) combinations were admitted to rehabilitation centers for decontamination and treatment. Treatment of oiled sea turtles was guided by expected physiological and pathological effects of crude oil exposure extrapolated from studies in other species and from a single loggerhead sea turtle (Caretta caretta) study. While invaluable starting points, inherent limitations to extrapolation, and small sample size of the experimental exposure study, reduce their utility for clinical guidance and for assessing oil spill impacts. Effects of dispersants were not included in the previous experimental exposure study, and cannot be effectively isolated in the analysis of field data from actual spills. A terminal study of pivotal temperature of sex determination using eggs salvaged from doomed loggerhead nests provided an opportunity for an ancillary exposure study to investigate the acute effects of crude oil, dispersant, and a crude oil/dispersant combination in sea turtle hatchlings. Eggs were incubated at 27.2–30.8°C, and hatchlings were randomly assigned to control, oil, dispersant, and combined oil/dispersant exposures for 1 or 4 days. Contaminant exposures were started after a 3 day post-hatching period simulating nest emergence. Turtles were placed in individual glass bowls containing aged seawater and exposed to oil (Gulf Coast—Mixed Crude Oil Sweet, CAS #8002-05-9, 0.833 mL/L) and/or dispersant (Corexit 9500A, 0.083 mL/L), replicating concentrations encountered during oil spills and subsequent response. Statistically significant differences between treatments and non-exposed controls were detected for PCV, AST, uric acid, glucose, calcium, phosphorus, total protein, albumin, globulin, potassium, and sodium. The principal dyscrasias reflected acute osmolar, electrolyte and hydration challenges that were more numerous and greater in combined oil/dispersant exposures at 4 days. Clinicopathological findings were supported by a failure to gain weight (associated with normal hatchling hydration in seawater) in dispersant and combination exposed hatchlings. These findings can help guide clinical response for sea turtles exposed to crude oil and crude oil/dispersant combinations, and indicate potential impacts on wildlife to consider when deploying dispersants in an oil spill response.

Background The Southern Stingray (Dasyatis americana) is a batoid elasmobranch frequently exhibited in zoological institutions. Blood is commonly collected from the caudal hemal arch at the tail base in stingrays for the purpose of health assessment and clinical pathology tests. An alternative site that allows a dorsal or ventral approach without necessitating puncture of a cartilaginous structure has been identified between the cartilaginous pectoral fin rays (ceratotrichia). Objectives The purpose of the study was to compare CBC, plasma biochemistry analytes, and blood gas variables between blood samples collected from the caudal and pectoral fin vasculature sites of the Southern Stingray. Methods Fifteen captive Southern Stingrays (10 females, 5 males) from 4 zoo and aquarium facilities were sampled. Lithium heparinized blood samples were collected from the caudal and pectoral venipuncture sites of each animal. Values from estimated total and differential leukocyte counts, plasma biochemistry analytes, and blood gas variables were compared. Results There were no statistically significant differences between venipuncture sites for the measured analytes except for CK activity, which was statistically significantly higher in the pectoral site samples. Levels of agreement between sites were good or moderate for 22 analytes and poor for ALT, AST, CK, pO2, lactate, monocytes, and eosinophils. Conclusions The good agreement between sampling sites for the majority of the measured analytes and the lack of differences that would alter clinical interpretation support the use of the pectoral site as an alternative to the traditional caudal fin venipuncture site in Southern Stingrays.

Biological dinitrogen (N2) fixation is the pathway making the large pool of atmospheric N2available to marine life. Besides direct rate measurements, a common approach to explore the potential for N2fixation in the ocean is a mining based on molecular genetic methods targeting the key functional genenifH, coding for a subunit of the nitrogenase reductase. As novel sequencing and single cell techniques improved, our knowledge on the diversity of marine N2fixers grew exponentially. However, to date one aspect of N2fixation in the ocean is commonly left aside. This is the existence of two alternative types of nitrogenases, which are besides the Mo-Fe nitrogenaseNif, the Fe-Fe nitrogenaseAnf, and the V-Fe nitrogenaseVnf, which differ with regard to their metal co-enzymes, as well as regarding their operon structure and composition.nifH-based studies may thus be biased, and alternative nitrogenases could not be recovered. Here, we screened a set of 6 metagenomes and -transcriptomes from a sulfidic water patch from the oxygen minimum zone off Peru for genes involved in N2fixation. We identified genes related to all three nitrogenases, and generally increased diversity as compared to our previousnifH-based study from the same waters. While we could not confirm gene expression of the alternative nitrogenases from our transcriptomes, we detected additional diazotrophs involved in N2fixation. We suggest that alternative nitrogenases may not be used under conditions present in those waters, however, depending on trace metal limitation in the future they may become active.Significance statementThis study addresses the important process of N2fixation, based on a whole-metagenome and –transcriptome screening, reports an increased diversity of N2fixing microbes in the sulfidic shelf water off Peru, as compared to previous target-gene based studies from the same waters. In addition to a generally higher diversity, genes encoding for alternative nitrogenases, which were previously not subject of any study on N2fixation in oxygen minimum zones, were detected. The ecological meaning and evolutionary history of those alternative nitrogenases is subject of ongoing debates, however, their presence in OMZ waters would allow for N2fixation at extreme anoxia, which may become important in a future ocean challenged by progressive deoxygenation.

OBJECTIVE: To determine the combined mydriatic effects of topical rocuronium bromide and phenylephrine in juvenile loggerhead turtles and identify any adverse effects associated with treatment. ANIMALS STUDIED: Eleven juvenile loggerhead turtles (Caretta caretta). PROCEDURES: Four 20 μL drops of rocuronium bromide and four 20 μL drops of 10% phenylephrine were placed into the right eye at 2‐minute intervals of 5 turtles, while the same volume of saline was administered to six control turtles. A pupilometer recorded pupil measurements at rest and following a light stimulus at 2, 15, 30, 60, 120, 150, 180, 210, 240, 300, and 360 minutes following delivery of the final drop to the ocular surface. Intraocular pressure (IOP) was also measured at similar time points. RESULTS: The nonilluminated and light‐stimulated pupillary diameter of the right eye of treated turtles was significantly greater than baseline starting at 120 and 15 minutes, respectively. Light‐stimulated pupillary diameter of treated eyes was greater than that of control eyes from time 15 minutes until the end of the treatment period. No systemic side effects were noted over a 24 hours period following treatment and all turtles showed normal behavior and appetite. No mydriasis was noted in either eye at 24 hours and the anterior segment was normal. CONCLUSIONS: A combination of topical ophthalmic rocuronium bromide and 10% phenylephrine is safe and effective for mydriasis in juvenile loggerhead turtles.

Intravascular access in batoid species is commonly achieved using the ventral coccygeal or radial wing vessels. However, these approaches can be difficult because of the presence of cartilage, lack of specific landmarks, species variation, and small vessel size in many species. This study used postmortem contrast radiography and gross dissection to develop landmarks for a new, dependable vascular access in three Myliobatiform species commonly maintained in captivity: Atlantic stingray (Hypanus sabinus), cownose ray (Rhinoptera bonasus), and smooth butterfly ray (Gymnura micrura). The mesopterygial vein provides quick vascular access and is suitable for administration of large fluid volumes and intravascular drugs. It is located immediately ventrolateral to the metapterygium cartilage, which sits adjacent to the coelomic cavity and supports the caudal half of the pectoral fin. Using the pectoral girdle and cranial third of the metapterygium cartilage as landmarks, vascular access can be achieved by directing a needle medially at approximately a 30° (adult cownose rays) or 45° angle (Atlantic stingrays, juvenile cownose rays, smooth butterfly rays) toward the metapterygium cartilage. Differences in the degree of needle direction are due to species and age-specific shapes of the metapterygium cartilage. The mesopterygial vein is an alternate site of quick and reliable venous access in batoid species.

Thromboelastography (TEG) provides a global evaluation of haemostasis. This diagnostic test is widely used in mammals but has not previously been performed in reptiles, mainly due to the limited availability of taxon-specific reagents. The objective of this pilot study was to establish a protocol to perform TEG in sea turtles. Pooled citrated plasma, stored at −80°C, from four green turtles (Chelonia mydas) was assayed on a TEG 5000. Several initiators were evaluated: kaolin (n=2), RapidTEG (n=2), fresh (n=2) and frozen (n=6) thromboplastin extracted from pooled brain tissue from several chelonian species, human recombinant tissue factor at 1:100 (n=1), Reptilase (n=2), and rabbit thromboplastin (n=1). Both fresh and frozen chelonian thromboplastin were superior in producing quantifiable TEG reaction time compared with all other reagents. These findings are consistent with the lack of an intrinsic pathway in turtles and confirmed a lack of coagulation in the turtle samples in response to mammalian thromboplastin. A TEG protocol was subsequently established for harvested species-specific frozen thromboplastin. The frozen thromboplastin reagent remained stable after one year of storage at −80°C. The developed protocol will be useful as a basis for future studies that aim to understand the pathophysiology of haemostatic disorders in various stranding conditions of sea turtles.

A 12 –yr-old female Goeldi's monkey (Callimico goeldii) in British Columbia, Canada was diagnosed with alveolar echinococcosis (AE) on postmortem examination. Echinococcus multilocularis has been identified in several species of nonhuman primates, most frequently Old World primates, in zoos and research facilities in Europe and Asia. The strain affecting this monkey was identified as a European haplotype, indistinguishable from E. multilocularis recently identified in several canids in British Columbia. The animal is suspected to have been exposed while living in a zoological institution in Alberta, where E. multilocularis has also been reported in urban coyotes. Alveolar echinococcosis is a zoonotic disease of increasing concern in the United States and Canada, and this disease should be considered on the differential list of any nonhuman primate exhibiting signs of abdominal pain or distension, along with diagnostic imaging consistent with cystic structures of the liver or other organs.

Measuring plasma protein electrophoresis fractions and plasma concentrations of acute phase proteins (APPs) is commonly used to monitor inflammation and illness in mammalian species, but its use is not widespread in fish species, despite the presence of similar proteins. This study aims to determine plasma protein electrophoresis values for koi carp ( Cyprinus carpio ) and to assess the use of plasma protein electrophoresis and commercially available assays for 3 primary APPs (C-reactive protein, serum amyloid A, and haptoglobin) as markers of inflammation in 13 koi following invasive surgery. Median packed cell volume decreased by nearly 50% but recovered to baseline by 14 days postsurgery. Plasma protein electrophoresis fractions were consistent across the experimental period and did not demonstrate an inflammatory pattern, but electrophoretograms exhibited variation between individual fish. No clinically meaningful changes were observed in the APPs of the test subjects 28 days following surgery. Despite grossly evident inflammation of the incision line, either this surgical procedure did not stimulate a marked systemic inflammatory response, or the available assays are not effective in detecting the acute phase inflammatory response in this fish species.

Leatherback sea turtles are globally distributed and endangered throughout their range. There are limited data available on disease in this species. Initial observations of solitary large intestinal diverticulitis in multiple leatherbacks led to a multi-institutional review of cases. Of 31 subadult and adult turtles for which complete records were available, all had a single exudate-filled diverticulum, as large as 9.0 cm in diameter, arising from the large intestine immediately distal to the ileocecal junction. All lesions were chronic and characterized by ongoing inflammation, numerous intralesional bacteria, marked attenuation of the muscularis, ulceration, and secondary mucosal changes. In three cases, Morganella morganii was isolated from lesions. Diverticulitis was unrelated to the cause of death in all cases, although risk of perforation and other complications are possible.

Cold-stunning in sea turtles is a frequent natural cause of mortality and is defined as a hypothermic state due to exposure to water temperatures

The objective of this study was to characterize the behavioral effects and changes in heart rate of four doses of alfaxalone delivered by intravascular injection to blue crabs (Callinectes sapidus). Thirty (male, n = 27; female, n = 3) blue crabs were randomly assigned to one of four treatment groups of alfaxalone: eight animals were assigned to each of the 5-, 10-, and 15-mg/kg treatment groups, and the remaining six animals were assigned to the 100-mg/kg group. Times for anesthetic induction and recovery periods were recorded. Righting reflex, defensive posturing, and heart rate were evaluated before, during, and after the anesthetic trial. Anesthesia was induced in all 14 animals consolidated into the high-dosage group (15 mg/kg [n = 8] and 100 mg/kg [n = 6]), which was significantly greater than 8 of 16 animals in the low-dosage group (5 mg/kg [n = 2] and 10 mg/kg [n = 6]). Median anesthesia induction time for all crabs was 0.4 min, with no significant difference in induction time between groups observed. Median recovery time was 9.4 min (n = 2), 6.1 min (n = 5), 11.3 min (n = 8), and 66.1 min (n = 5) for the 5-, 10-, 15-, and 100-mg/kg groups, respectively. Recovery times were significantly longer for crabs exposed to an induction dose of 100 mg/kg compared with the 10- and 15-mg/kg induction doses. A significant decrease in the median heart rate was observed between the baseline value and that observed at both induction and 5 min postinjection in the 100-mg/kg dose trial. Two mortalities were observed during the anesthesia trials (n = 1, 10 mg/kg; n = 1, 100 mg/kg), both associated with the autotomization of limbs. In summary, the intravascular administration of alfaxalone at 15 mg/kg provided rapid and reliable sedation, whereas alfaxalone administered at 100 mg/kg produced rapid and long lasting anesthesia.

Tricaine methanesulfonate (MS-222) solutions are used routinely for clinical and experimental anesthesia of a variety of aquatic organisms. It is commonly accepted that MS-222 alters pH when added to freshwater, and buffering freshwater anesthetic solutions is considered to be the standard of care. However, buffering saltwater solutions is considered by many to be unnecessary; some individuals question whether any water with high natural mineral hardness needs to be buffered when MS-222 is added. To assess the need for buffering, we studied the dynamics of pH change when adding clinically relevant amounts of MS-222 to artificial seawater and to freshwater of varying hardness. We found that artificial seawater does not possess adequate buffering capacity to prevent a physiologically significant drop in pH when MS-222 is added, and hardness does not accurately predict the reaction of water pH to the addition of MS-222 in clinically relevant concentrations. Our data for salt water suggest that MS-22...

For many acute care nursing units, such as the Burn Progressive Care Unit (BPCU) at the U.S. Army Burn center, staff stress and burnout is always a concern for leaders. Job stress not only contributes to nursing turnover, but can have a negative impact on patient care. The purpose of this project was to develop a training platform for nursing staff education and teambuilding with the intent of improving nurse satisfaction, increasing resiliency, building unit cohesion, enhancing morale, and increasing staff awareness of unit performance. All nursing staff were given an 8-hour training day, half of which was focused on education and the other half on teambuilding and resiliency. At the end of the staff development day (SDD), participants were encouraged to complete an evaluation; all activities were scored on a 10-point scale, with 10 representing the most informative. In total, 46 of 48 staff (96%) participated in the first two SDDs. During the first iteration (Spring 2015), participants scored all activities very high, with a total average score of 9.15 ± 0.26 (n = 246). In the Fall of 2015, the SDD program was again rated well, with an average score of 9.36 ± 0.13 (n = 276). The SDD program has been successful in supporting teamwork and resiliency among BPCU staff. Staff feedback supported success in meeting the objectives of building unit cohesion and increasing satisfaction and morale.

Today, modern pirates operate both in ports and on the open sea and use state-of-the-art equipment. Their crimes range from simple robbery to murder and hijacking of entire ships for ransom demand. It is the purpose of this paper to investigate the modern piracy trends and the effect of preventive actions taken by the crew of the attacked vessels. By analysing the available statistical material from the International Maritime Organization’s (IMO) monthly piracy reports during the period 2000–2009, it is shown that the attack rates on specific vessel segments and the recorded incidents for each geographical area develop their own trends. Incidents off and around the African continent have resulted to fewer deaths as compared to those in South China Sea and Malacca strait indicating that this area is dominated by more violent attacks against seafarers. However, the African attacks have bigger threatening potential in terms of the weapons used, whereas the inclusion of light weaponry in Asian attacks characterises them ancestors of historical piracy. Over the 10-year investigation period, a shift is observed from acts of robbery to acts of hostage taking and hijacking particularly around and off the East African coast. Estimates of the probability of an attack are provided through logistic regression modelling indicating that the success rate decreases with vessel size. It is also shown that the attacks are emphasised on specific vessel types for example chemical and oil tankers. The importance of a heightened vigilant crew in reducing the probability of a successful attack is pointed out by the analysis’ results. It is found that pirates are aiming at successful attacks regardless of their tactics and the success rate becomes higher as the pirates’ capability is improved. Additionally, the success probability of an attack is decreased as the act’s difficulty is increased, i.e. less success for hijacking rather than robbery.

A woman with tetra-X is presented together with a survey of the physical signs and the mental retardation in the 26 cases previously published.

Deletion of short arm 9 was found in a 61-year-old, mentally retarded male with few of the previously described signs typical of deletion of short arm 9 in children. A survey is given of the nine previously described cases of deletion of short arm 9.

Introduction: Non-shockable rhythm (NSR) is the most prevalent heart rhythm for both in- and out-of-hospital cardiac arrest (OHCA). While survival from OHCA patients with a shockable rhythm (SR) has increased over time, survival following NSR remains low. Thus, identification of risk factors for NSR is important to reduce mortality. We hypothesize that patients with NSR and SR are two disparate groups where patients with NSR are characterized by a high non-cardiac disease burden when compared to patients with SR. Methods: Using data from the nationwide Danish Cardiac Arrest Registry (2001–2012), we identified 33,617 OHCA patients ≥18 years old. The Danish National Registry of Patients was used to identify comorbidities while the National Prescription Registry was used to identify drug prescriptions (within 180 days). A multivariable logistic regression model was used to estimate odds ratios for risk factors associated with NSR. Results: Patients with NSR were characterized by a higher median age 71 years (IQR 60-81) vs. 67 years (IQR 58-77), higher proportion of women (38% vs. 21%), lower proportion of witnessed collapse (50% vs. 79%) and bystander CPR (27% vs. 50%) than patients with SR. A higher proportion of NSR occurred in private homes (77% vs. 58%) and time from recognition of OHCA to first rhythm analysis was longer: 13 min (IQR 7-22) vs. 9 min (IQR 6-14). In a fully adjusted model (patient-related and cardiac arrest-related characteristics included) a higher degree of comorbidity, psychiatric disease, chronic obstructive lung disease and the use of antidepressants, antipsychotics, anxiolytics, analgesics, corticosteroids, and antibiotics (within 14 days) where associated with NSR (Table). In contrast, the use of cardiovascular specific drugs and history of cardiovascular disease was associated with a lower risk of NSR. Conclusion: A history of non-cardiac disease and non-cardiac drug use are risk factors of NSR when compared to patients with SR.

Monogenean parasite infestations are common in captive marine teleosts, and are generally found on the skin and gills. This report describes an unusual pathological presentation of exuberant granulation tissue of the gills, suspected to be related to Neobenedenia infestation in two cobia housed together at a North Carolina aquarium.

Reactions between α-MoO3 or MoO3·0.43H2O and 65–95 wt% H2SO4 were studied from room temperature up to the boiling point of the acid. Four new compounds, MoO2(SO4), (modifications I, II and III) and MoO2(SO4)· H2SO4·H2O, have been isolated depending on the H2SO4 concentration, reaction temperature, reaction time and molybdenum source. The characterization of these phases was performed with powder X-ray diffraction, thermogravimetric analysis, differential thermal analysis, chemical analysis and density measurements. Both starting materials react with sulfuric acid and form MoO2(SO4) II at temperatures above ca. 75 °C. This compound is unstable in the reaction mixture and converts into MoO2(SO4) I or III depending on time and temperature. The three modifications of MoO2(SO4) are hygroscopic and decomposition in moist air is studied for the I and II modifications. On heating, all modifications of MoO2(SO4) decompose into α-MoO3 or a mixture of α-MoO3 and β-MoO3 depending on heating rate and sample size. The three-dimensional, open-framework structures of I and II, have been determined from single-crystal X-ray diffraction data. I crystallizes in the monoclinic space group C2/c and II in the orthorhombic space group Pna21. Both structures are made up of MoO6 octahedra and SO4 tetrahedra and contain layers of eight- and four-membered rings of alternating, corner-sharing octahedra and tetrahedra. These layers are linked (also via Mo–S bridges) to form a three-dimensional framework. The MoO6 octahedra are rather distorted, as demonstrated by large variations in the bonding Mo–O interatomic distances, which reflect the double-bond character of the binding between molybdenum and terminal oxygen atoms pointing into the eight-membered rings. The SO4 tetrahedra are quite regular. The structural relation to MoO2(SO4) III is briefly considered.

This study investigated whether the moderate observer agreement rate for lung scintigraphy, when using the PIOPED criteria, reflects significant variations in accuracy. In a prospective study, 170 patients were investigated with lung scintigraphy and pulmonary angiography. The lung scintigrams were read according to the PIOPED criteria by three skilled observers from different hospitals who had no experience of consensus interpretation. The scintigrams were reinterpreted 6 months later. The inter-observer agreement rates were moderate and fair, with kappa values of 0.49 (0.44-0.54) for the first reading and 0.36 (0.31-0.41) for the second reading. The intra-observer agreement rates were good and moderate, with kappa values of 0.62 (0.51-0.73), 0.52 (0.42-0.62) and 0.54 (0.44-0.64). There were no significant differences between the observers in the areas under the ROC curves. However, one observer showed a significant difference between his first and second reading (P = 0.02). All three observers showed good accuracy. Although there were substantial variations in the inter- and intra-observer agreeement rates, this was only reflected to a minor degree in the accuracy.

Spatiotemporally chaotic dynamics of a Kuramoto-Sivashinsky system is described by means of an infinite hierarchy of its unstable spatiotemporally periodic solutions. An intrinsic parametrization of the corresponding invariant set serves as accurate guide to the high-dimensional dynamics, and the periodic orbit theory yields several global averages characterizing the chaotic dynamics.

The population is aging. We examined changes in the proportion of elderly (≥ 80 years) intensive care unit (ICU) patients during 2005-2011 and the association between age and mortality controlling for preexisting morbidity.Through the Danish National Patient Registry, we identified a cohort of 49,938 ICU admissions (47,596 patients) in Northern Denmark from 2005 to 2011. Patients were subdivided in age groups (15-49, 50-64, 65-79 and ≥ 80 years) and calendar year. We estimated 30-day and 31-365-day mortality and mortality rate ratios (MRRs), stratified by admission type (medical and elective/acute surgical patients). Mortality was compared between age groups adjusting for sex and preexisting morbidity using 50-64-year-olds as reference.The proportion of elderly patients increased from 11.7% of all ICU patients in 2005 to 13.8% in 2011. Among the elderly, the 30-day mortality was 43.7% in medical, 39.6% in acute surgical, and 11.6% in elective surgical ICU patients. The corresponding adjusted 30-day MRRs compared with the 50-64-year-olds were 2.7 [95% confidence interval (CI) 2.5-3.0] in medical, 2.7 (95% CI 2.4-3.0) in acute surgical, and 5.2 (95% CI 4.1-6.6) in elective surgical ICU patients. The 31-365-day mortality among elderly patients was 25.4% in medical, 26.9% in acute, and 11.9% in elective surgical ICU patients, corresponding to adjusted MRRs of 2.5 (95% CI 2.1-2.9), 2.2 (95% CI 1.9-2.5), and 1.9 (95% CI 1.6-2.3), respectively.During 2005-2011, there was an 18% increase in the proportion of elderly ICU patients. Advancing age is associated with increased mortality even after controlling for preexisting morbidity.