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Objectives: To examine management and outcomes of patients presenting to EDs with symptoms suggestive of acute coronary syndrome, who have mild non‐dynamically elevated high‐sensitivity troponin T (HsTnT) levels, not meeting the fourth universal definition of myocardial infarction (MI) criteria (observation group). Methods: Consecutive patients presenting to the ED with symptoms suggestive of acute coronary syndrome at Liverpool Hospital, Sydney, Australia, those having ≥2 HsTnT levels after initial assessment were adjudicated according to the fourth universal definition of MI, as MI ruled‐in, MI ruled‐out, or myocardial injury in whom MI is neither ruled‐in nor ruled‐out (>1 level ≥15 ng/L, called observation group); follow‐up was 5 years. Results: Of 2738 patients, 547 were in the observation group, of whom 62% were admitted to hospital, 52% to cardiac services, whereas 97% of MI ruled‐in patients and 21% of MI ruled‐out patients were admitted; P < 0.001. Non‐invasive testing occurred in 42% of observation group patients (36% had echo‐cardiography), and 16% had coronary angiography. Of observation group patients, MI rates were 1.5% during hospitalisation and 4% during the following year, similar to that in those with MI ruled‐in, among those with MI ruled‐out, the MI rate was 0.2%. The 1‐year death rate was 13% among observation group patients and 11% MI ruled‐in patients (P = 0.624), whereas at 5 years among observation group patients, type 1 MI and type 2 MI were 48%, 26% and 58%, respectively (P = 0.001). Conclusion: Very few unselected consecutive patients attending ED, with minor stable HsTnT elevation, had MI, although most had chronic myocardial injury. Late mortality rates among observation group patients were higher than those with confirmed type 1 MI but lower than those with type 2 MI. [ABSTRACT FROM AUTHOR]

Summary: Chest pain is the second most common reason for adult emergency department presentations.Most patients have low or intermediate risk chest pain, which historically has led to inpatient admission for further evaluation.Rapid access chest pain clinics represent an innovative outpatient pathway for these low and intermediate risk patients, and have been shown to be safe and reduce hospital costs.Despite variations in rapid access chest pain clinic models, there are limited data to determine the most effective approach. Developing a national framework could be beneficial to provide sites with evidence, possible models, and business cases. Multicentre data analysis could enhance understanding and monitoring of the service. [ABSTRACT FROM AUTHOR]

This consensus statement is designed to provide a standard of care document and describes the ACVR and ECVDI definition for performing a standard abdominal ultrasound examination in dogs and cats. The ACVR and ECVDI define a standard abdominal ultrasonographic examination as a complete exam of the abdominal organs which is appropriately documented. The consensus statement intends to provide guidance to veterinary sonographers and veterinarians for the performance and documentation of high‐quality diagnostic ultrasound examination. The document may also serve as a teaching aid for veterinary students, veterinarians, and residents in diagnostic imaging who seek proficiency in diagnostic ultrasound. Finally, it may serve an additional role in educating the public as to what a high‐quality abdominal ultrasound examination should entail. [ABSTRACT FROM AUTHOR]

Few studies have investigated the diagnostic performance of fluorine‐18‐fluorodeoxyglucose (18F‐FDG) positron emission tomography/computed tomography (PET/CT) for staging veterinary patients with appendicular osteosarcoma. The purpose of this study was to evaluate the efficacy of 18F‐FDG‐PET/CT compared to whole‐body CT (WBCT) for staging canine patients with appendicular osteosarcoma. The 18F‐FDG‐PET/CT imaging studies of 66 dogs with appendicular osteosarcoma were anonymized and separated into two detached studies (one with whole body pre‐ and post‐contrast CT images and the other with the whole body pre‐ and post‐contrast CT images with the associated 18F‐FDG‐PET overlay). Image assessment was performed retrospectively by five board‐certified veterinary radiologists. The radiologists were instructed to assign a predefined categorical score (1–4) to each pre‐designated anatomic region based on a devised lesional scoring system. A score of 1 was normal, 2 abnormal but not neoplastic, 3 abnormal and concerning for neoplasia, and 4 abnormal, most likely neoplastic. Overall, the likelihood of detection of '3 or 4' was found to be significantly higher with 18F‐FDG PET/CT when compared to WBCT after adjusting for the effect of evaluator and the subject. Most significantly, 13 osseous lesions concerning for metastasis (scored 3–4) were identified in 10/66 dogs by at least one reviewer on 18F‐FDG PET/CT, which were not identified by any reviewer on WBCT. Additionally, four comorbid neoplastic lesions were identified with 18F‐FDG PET/CT and not with WBCT. The results of this study suggest that 18F‐FDG PET/CT is more efficacious in detecting metastatic and comorbid neoplastic lesions compared to WBCT in dogs with appendicular osteosarcoma. [ABSTRACT FROM AUTHOR]

Background: Cardiac troponin assays are very widely requested tests, particularly in emergency departments. Thus, many seriously ill patients who may not have heart disease as their primary discharge diagnosis have undergone troponin testing during hospitalisation. Aims: To determine associations between cardiac troponin levels and mortality, including from cardiovascular and non‐cardiovascular causes, among patients hospitalised in New South Wales, Australia over a 2‐year period. Methods: Over a 2‐year period (2006–2008), 172 753 hospitalised patients had a quantitative or qualitative troponin assay performed in New South Wales (Australia). The associations were examined, using data linked to late outcomes, between elevations in levels of troponins T or I and 1‐year mortality. Mortality was determined for International Statistical Classification of Diseases 10th Revision diagnostic groups. Results: Of 172 753 patients undergoing troponin testing, 44 357 (25%) had a cardiovascular diagnosis of whom (7% had myocardial infarction) 47 827 (28%) had a probable ischaemic heart disease diagnosis if the 23 873 (14%) of patients coded with 'chest pain' were included. In patients with a cardiovascular diagnosis and elevated troponin 3060 (1.8%) died in 12 months in comparison to 6262 (3.6%) in those with a non‐cardiovascular disease diagnoses and elevated troponin. The 1‐year mortality hazard with respect to a troponin elevation was 2.5 (95% confidence interval 2.3–2.7) and 2.0 (95% confidence interval 1.99–2.01) for those with a cardiovascular and non‐cardiovascular diagnosis respectively. Conclusion: In a very large state‐wide hospitalised patient cohort, among patients with elevated troponin levels and non‐cardiac diagnoses, mortality was higher than in those with cardiovascular diagnoses, including MI. [ABSTRACT FROM AUTHOR]

Positron emission tomography (PET) imaging utilizing fluorine‐18 labeled fluorodeoxyglucose is a relatively new imaging modality in veterinary medicine that is becoming more common for oncological staging and for musculoskeletal imaging. Thus, it is important to identify the normal variations on PET imaging that may be mistaken for pathology. Variation in standardized uptake values (SUVmax) have been anecdotally identified in the spinal cord of dogs undergoing fluorodeoxyglucose (FDG) PET–CT examinations for oncological staging, with notable increase in SUVmax values identified in the region of the cervical and lumbar spinal intumescences. The aim of this retrospective, analytical study was to compare the SUVmax values at four different locations throughout the spinal cord (C3, C5‐T1, T13, and L3‐S1) of a group of dogs with no evidence of neurologic disease and compare those findings to histologic specimens from dogs euthanized for unrelated disease. SUVmax values were significantly higher at the cervical and lumbar intumescences in comparison to the control regions (P <.0001 and P <.0001, respectively). Neuronal count and spinal cord gray matter area were also significantly greater at the cervical and lumbar intumescences (neuronal count P =.0025 and P =.0001; area P =.0004 and P =.0009, respectively) while overall neuronal density was lower (P =.003 and P =.028, respectively). We presume the increased SUVmax values at the spinal cord intumescences are the result of overall increased neuron count, increased proportion of gray matter, and increased spinal cord gray matter area. These findings will aid in the interpretation of future PET–CT studies and hopefully prevent the misdiagnosis of spinal cord disease in normal canines. [ABSTRACT FROM AUTHOR]

Computed tomographic angiography (CTA) has recently been shown to be a useful tool in the diagnosis of acute canine pancreatitis, the identification of pancreatic necrosis, and the detection of sequelae. Evidence of pancreatic necrosis on CTA has been shown to be correlated with a poorer outcome in both humans and dogs and early diagnosis and intervention may improve outcomes. In humans, pancreatic necrosis is typically evident on CTA within 48 h of clinical signs, thus, repeat CTA examinations are often performed to identify pancreatic necrosis that may not have been evident on CTA examinations performed early in the course of disease. Published information investigating the timing of CTA examinations and the use of serial CTA in dogs with acute pancreatitis is lacking. In this prospective, longitudinal study, CTA examinations were performed at the time of hospitalization and repeated 3‐5 days later in 11 dogs suffering from acute canine pancreatitis to determine if pancreatic necrosis or sequelae are under diagnosed on examinations performed at the time of hospitalization. Computed tomographic angiography studies were evaluated for changes in pancreatic size, pancreatic contrast enhancement, and peri‐pancreatic tissues and vessels. The only statistically significant difference between the initial and repeat CTA examinations was the improvement of fat stranding on the repeat CTA examinations (P <.045). Based on these results, CTA performed at the time of admission is likely adequate in the diagnosis and evaluation of dogs with acute pancreatitis. Repeat CTA examinations are unlikely to add additional information in the absence of worsening clinical signs. [ABSTRACT FROM AUTHOR]

Background: Acute pancreatitis in dogs is an under‐diagnosed disease. Current diagnostic methods are insufficient at identifying sequelae and lack prognostic capability. Computed tomographic angiography (CTA) is accurate for diagnosis and prognostication of pancreatitis in humans. Objectives: In comparison to ultrasound (US), CTA will (1) better diagnose more severe pancreatitis and sequelae and (2) provide assessment of patient outcome by identification of pancreatic contrast enhancement patterns. Animals: Twenty‐six client‐owned dogs suspected to have acute pancreatitis. Methods: US and CTA examinations performed at time of admission were compared to determine the detection of pancreatic changes and sequelae. CTA findings also were compared to outcome indicators for prognosis of dogs with acute pancreatitis. Specific canine pancreatic lipase (cPL) samples were obtained and compared with CTA findings. Results: Ten of 26 dogs had heterogeneous contrast enhancement of the pancreas. Compared to US, CTA better identified portal vein thrombosis (P = .003). Patients with heterogeneous contrast enhancement had longer hospitalization (P = .01), including hospital stays for >5 days (P = .02), had more relapses, and were more likely to have portal vein thrombosis (P = .002). Patients with heterogeneous contrast enhancement had increased spec cPL (P = .006). Conclusions and Clinical Importance: In comparison to US, CTA better identified dogs with more severe acute pancreatitis and those with portal vein thrombosis, factors that may predict longer hospitalization and increased risk of relapse. The presence of heterogeneous contrast enhancement and portal vein thrombosis may change therapy for patients with acute pancreatitis. [ABSTRACT FROM AUTHOR]

Introduction: To report a series of patients with osteoid osteoma treated by radiofrequency ablation in whom no complications or recurrences occurred.Methods: Over a 13-year period, 32 consecutive patients with osteoid osteoma were treated by radiofrequency ablation in an Australasian teaching centre.Results: All patients had resolution of symptoms with no complication or recurrence.Conclusions: This series is further evidence for the use of radiofrequency ablation as the primary treatment for osteoid osteoma. [ABSTRACT FROM AUTHOR]

Background: Inflammatory breast cancer (IBC) is associated with a poor prognosis and high risk of central nervous system (CNS) metastases.Methods: We retrospectively reviewed stage III-IBC patients compared with noninflammatory invasive ductal carcinoma (NI-IDC) patients treated between January 1, 1984, and December 31, 2011, who began primary treatment within 1 year of diagnosis and had been followed up for at least 1 year before the development of CNS metastasis or death. Cumulative CNS metastasis incidence and post-CNS metastasis overall survival (OS) estimates were computed. Multivariable Cox proportional hazard models explored factors for post-CNS metastasis survival.Results: A total of 2323 patients were identified (589-IBC/1734-NI-IDC). Eighty-one IBC patients developed CNS metastasis, versus 154 NI-IDC patients. The 2-, 5-, and 10-year cumulative CNS metastasis incidence rates in IBC and NI-IDC were 9.8%, 15.8%, 17.4% and 6.5%, 10.1%, and 12.7%, respectively. This was significantly different between IBC and NI-IDC patients (P = .0037). Multicovariate competing risk regression models in IBC and NI-IDC patients showed no statistically significant associations with the risk of developing CNS metastasis, except neoadjuvant taxane use in NI-IDC patients (hazard ratio, 0.45; 95% confidence interval, 0.24-0.83; P = .011). The median follow-up was 7.2 years, and the median post-CNS metastasis OS was not significantly different between IBC (7.6 months) and NI-IDC (5.6 months) patients. One hundred ninety patients with CNS metastasis died. HER2-positive patients had better OS, with a median 14.1 versus 4.3 months (P < .0001). Age >50 years (P = .012) but not IBC status was a significant predictor of post-CNS metastasis survival.Conclusion: IBC patients demonstrated higher CNS metastasis incidence rates but OS following CNS metastases is similar in both groups. HER2 status and age may play prognostic roles. Cancer 2018;124:2299-305. © 2018 American Cancer Society. [ABSTRACT FROM AUTHOR]

The submission rates of feline uroliths to laboratories and the composition of uroliths have been reported in studies. The prevalence of uroliths reported on imaging findings has not been published. The objective of this retrospective study was to use imaging data to investigate the anatomical location and the prevalence of macroscopic in situ uroliths in cats. Radiographs, sonograms and imaging reports from two cohorts of cats (from New Zealand ( n = 497) and the United States ( n = 693)) from 2004-2013 were reviewed for the presence of in situ uroliths. Uroliths were categorized by their location in the lower or upper urinary tract. Radiographic studies were performed on 43% (212/497) of the cats from New Zealand and 50% (349/693) of the cats from the USA. Sonographic studies were performed on 57% (285/497) of the cats from New Zealand and 50% (344/693) of the cats from the USA. The total prevalence of uroliths was 3% in the New Zealand cohort and 13% in the USA cohort. Lower tract urolith prevalence in the New Zealand cohort was 2.4% (5/212) in cats ≤ 6y and 1.1% (3/285) in cats >6y. Upper tract urolith prevalence in the New Zealand cohort was 0.5% (1/212) in cats ≤ 6y and 1.8% (5/285) in cats >6y. Lower tract urolith prevalence in the United States cohort was 6.0% (11/183) in cats ≤ 6y and 2.9% (15/510) in cats >6y. Upper tract urolith prevalence in the United States cohort was 2.7% (5/183) in cats ≤ 6y and 10.2% (52/510) in cats >6y. The prevalence of uroliths in the upper tract or lower tract was low in the New Zealand cohort compared to that of cats in the USA cohort, irrespective of age category. Geographical location may be important when evaluating risk factors for feline urolithiasis. [ABSTRACT FROM AUTHOR]

The authors reflect on the issues involving the use of aspirin for the prevention of primary cardiovascular diseases, like myocardial infarction, stroke and cardiovascular death. Also cited are the major studies on the effects of aspirin in the late 1970s and early 1980s, namely, the British Doctors Study and the Physicians Health Study in the U.S., respectively, and the possible adverse effects like gastrointestinal bleeding and intracranial bleeding.

Background Recent single-center and retrospective studies suggest that acute myocardial infarction ( AMI) could be immediately excluded without serial sampling in patients with initial high-sensitivity cardiac troponin T (hs- cTnT) levels below the limit of detection (LoD) of the assay and no electrocardiogram ( ECG) ischemia. Objective We aimed to determine the external validity of those findings in a multicenter study at 12 sites in nine countries. Methods TRAPID- AMI was a prospective diagnostic cohort study including patients with suspected cardiac chest pain within 6 hours of peak symptoms. Blood drawn on arrival was centrally tested for hs- cTnT (Roche; 99th percentile = 14 ng/L, LoD = 5 ng/L). All patients underwent serial troponin sampling over 4-14 hours. The primary outcome, prevalent AMI, was adjudicated based on sensitive troponin I (Siemens Ultra) levels. Major adverse cardiac events ( MACE) including AMI, death, or rehospitalization for acute coronary syndrome with coronary revascularization were determined after 30 days. Results We included 1,282 patients, of whom 213 (16.6%) had AMI and 231 (18.0%) developed MACE. Of 560 (43.7%) patients with initial hs- cTnT levels below the LoD, four (0.7%) had AMI. In total, 471 (36.7%) patients had both initial hs- cTnT levels below the LoD and no ECG ischemia. These patients had a 0.4% ( n = 2) probability of AMI, giving 99.1% (95% confidence interval [ CI] = 96.7% to 99.9%) sensitivity and 99.6% (95% CI = 98.5% to 100.0%) negative predictive value. The incidence of MACE in this group was 1.3% (95% CI = 0.5% to 2.8%). Conclusions In the absence of ECG ischemia, the detection of very low concentrations of hs- cTnT at admission seems to allow rapid, safe exclusion of AMI in one-third of patients without serial sampling. This could be used alongside careful clinical assessment to help reduce unnecessary hospital admissions. [ABSTRACT FROM AUTHOR]

Introduction: The modern care of suspected and confirmed acute coronary syndrome (ACS) is informed by an extensive and evolving evidence base. This clinical practice guideline focuses on key components of management associated with improved clinical outcomes for patients with chest pain or ACS. These are presented as recommendations that have been graded on both the strength of evidence and the likely absolute benefit versus harm. Additional considerations influencing the delivery of specific therapies and management strategies are presented as practice points.Main Recommendations: This guideline provides advice on the standardised assessment and management of patients with suspected ACS, including the implementation of clinical assessment pathways and subsequent functional and anatomical testing. It provides guidance on the: diagnosis and risk stratification of ACS; provision of acute reperfusion therapy and immediate post-fibrinolysis care for patients with ST segment elevation myocardial infarction; risk stratification informing the use of routine versus selective invasive management for patients with non-ST segment elevation ACS; administration of antithrombotic therapies in the acute setting and considerations affecting their long term use; and implementation of an individualised secondary prevention plan that includes both pharmacotherapies and cardiac rehabilitation. Changes in management as a result of the guideline: This guideline has been designed to facilitate the systematic integration of the recommendations into a standardised approach to ACS care, while also allowing for contextual adaptation of the recommendations in response to the individual's needs and preferences. The provision of ACS care should be subject to continuous monitoring, feedback and improvement of quality and patient outcomes. [ABSTRACT FROM AUTHOR]

Objective We examined the disposition and outcomes of patients presenting to the ED with symptoms suggestive of acute coronary syndrome undergoing measurement of troponin T using a highly sensitive assay. Methods Troponin T (TnT) was measured in 204 consecutive patients (mean age = 65 [±18] years, 55% men) presenting to the ED with symptoms suggestive of acute coronary syndrome. Results Ninety-four patients predominantly had chest pain, 34 had dyspnoea and the remainder had various symptoms. Overall, 96 patients had TnT >14 ng/L (upper reference limit), of whom 31 were admitted to the cardiology service (26 had final cardiac diagnosis [five ST-elevation MI, 10 non- ST-elevation MI, one unstable angina and 10 other cardiac]). Among these 96 patients, 41 had chronic kidney disease, 17 had heart failure and seven had sepsis. At 30 days, death rates among patients who had TnT >14 ng/L with non-cardiac diagnoses and in patients who had TnT >14 ng/L with a cardiac diagnosis were 6.6% and 2.9% ( P = 0.652); no death and/or MI occurred in patients with normal TnT levels. At late follow up (median 6.8 months) that was obtained in 189 (93% of 204) patients, four had MI and 14 died (three cardiac deaths). Conclusions Despite high-sensitivity TnT assay having a high sensitivity and specificity for myocardial necrosis, the majority of unselected consecutive patients attending ED in whom TnT levels were elevated did not have an acute coronary syndrome. Our pilot study suggests that a larger study is needed to provide evidence to modify management algorithms. [ABSTRACT FROM AUTHOR]

The article discusses a SNAPSHOT study which examines the differences in care and inhospital course of acute coronary syndrome (ACS) patients in Australia and New Zealand based on the use of highly sensitive (hs) troponin assay. Topics include measuring the rates of adverse cardiac events and the averages of the patients' predicted outcome, the results showing a lower rate inhospital events, and the use of percutaneous coronary intervention (PCI).

Type-II myocardial infarction and chronic myocardial injury rates, invasive management, and 4-year mortality among consecutive patients undergoing high-sensitivity troponin T testing in the emergency department. Keywords: Myocardial infarction EN Myocardial infarction 512 513 2 06/23/21 20210615 NES 210615 Improving systems of care can achieve earlier treatment and increase survival The report by Nadlacki and colleagues1 on long term outcomes for patients after myocardial infarction provides much needed clarity about progress in care in Australia and New Zealand during 2009-2015. [Extracted from the article]

Evidence from the randomized studies of coronary surgery suggests that patients who benefit from surgery in terms of improved survival are those with left main stem stenosis, triple vessel coronary artery disease, impaired left ventricular function or higher angina class. Patients currently undergoing surgery are in general older, with more severe angina, more comorbidity and more extensive coronary disease as compared with the population randomized in the earlier studies. Angioplasty has been shown to improve symptoms and to reduce the need for surgery in certain patients. Recent changes in procedural techniques and adjunctive therapies have reduced the number of acute complications and the rate of restenosis. However, recent evidence suggests that some patients with mild angina (< class 2) or good exercise tolerance may not benefit as much from angioplasty as other patients with more severe angina. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) is associated with increased cardiovascular morbidity and mortality; hence detection of early cardiovascular involvement in CKD is important to prevent future adverse cardiovascular events. Left atrial (LA) enlargement and dysfunction has been reported in end stage renal disease. However, there is a paucity of published data regarding the evaluation of LA function in CKD using noninvasive imaging parameters. In this study, we evaluated biplane LA volume as well as LA function (LA global systolic strain (GS) and strain rate [SR]) in stage 3 CKD patients (eGFR 30- 59 mL/min per 1.73 m2) to determine if LA function parameters are more significantly altered by the presence of CKD in addition to changes due to hypertension alone. Methods: Thirty-three CKD patients (eGFR 30-59 mL/min per 1.73 m2) with hypertension were compared to 33 normal controls and 34 hypertensive (HT) subjects with normal renal function; all participants underwent a detailed transthoracic echocardiogram. Indexed biplane LA volume (LAVI), LA segmental function, and GS and SR (systolic, early, and late diastole) derived from tissue Doppler imaging (TDI) were measured. Univariate predictors of LA strain were determined. Multiple logistic regression analysis was used to examine the effect of patient group (i.e. CKD) on GS and SR as well as LAVI. Results: Left atrial volume indexed was significantly increased in both the HT and CKD with HT group compared to normal controls (28 ± 9 mL/m2 vs. 28 ± 9 mL/m2 vs. 23 ± 5 mL/m2, respectively, P = 0.02). However, LAVI was similar in the HT and CKD with HT group (28 ± 9 mL/m2 vs. 28 ± 9 mL/m2; P = NS). LA GS and SR were reduced in both the CKD with HT and HT group, compared to controls. However, a significantly lower LA GS was present in the CKD with HT group (Controls vs. HT vs. CKD with HT: 54.9 ± 14.5% vs. 34.5 ± 6.2% vs. 25.7 ± 9.3%, respectively; P = 0.001). To examine the effect of group, (i.e. presence of CKD) multiple logistic regression analysis was performed with univariate predictors including indexed left ventricular mass (LVMI), LV diastolic grade, LAVI, peak A-wave velocity, β-blocker therapy, GS and SR; this demonstrated that CKD had an independent effect on LA GS and SR (systolic, early, and late diastole). GS demonstrated moderate correlation with systolic blood pressure (r = -0.5, P = 0.01), diastolic grade (r = -0.5, P = 0.01), E′ velocity (r = 0.6, P = 0.0001), peak A velocity (r = -0.5, P = 0.004), and LAVI (r = -0.6, P = 0.002). Conclusions: Left atrial dysfunction is evident in stage 3 CKD with associated LA enlargement. This study demonstrates that LA GS and SR were reduced in the CKD group despite similar LAVI in the CKD with HT and HT group. Hence LA GS and SR may be a more sensitive noninvasive tool to detect cardiovascular involvement in CKD. [ABSTRACT FROM AUTHOR]

The article presents a study which aims to qualify acute coronary syndrome (ACS) management in New Zealand and Australia and evaluate the use of recommended treatment. It says that the study involved hospitalised patients with confirmed or suspected ACS, whose records were assessed using logistic regression and descriptive analyses. The study determined variations in the use of ACS evidence base and differing levels of inhospital events.

Ecological stability in the Laurentian Great Lakes has been altered by nonindigenous species, such as the Round GobyNeogobius melanostomusand dreissenid mussels, and by declines in native amphipodsDiporeiaspp. We evaluated whether these changes could influence diet overlap between three benthivorous fishes (Slimy SculpinCottus cognatus, Deepwater SculpinMyoxocephalus thompsonii, and Round Goby) and whether predation on eggs of native species was occurring. We examined diets of fish collected at depths of 69–128 m in Lake Michigan offshore of Frankfort and Muskegon, Michigan, and Two Rivers and Sturgeon Bay, Wisconsin, during January–May 2009 and 2010. Important prey (by dry weight proportion and by percent frequency of occurrence) for Slimy Sculpin wereMysis(0.34; 45%),Diporeia(0.16; 34%), andLimnocalanus macrurus(0.22; 68%); important prey for Deepwater Sculpin wereMysis(0.74; 92%) andDiporeia(0.16; 54%). Round Goby consumed mainly bivalves (i.e., dreissenids: 0.68; 95%) andMysis(0.15; 37%). The two sculpin species consumed the eggs of BloatersCoregonus hoyi(Slimy Sculpin: 0.04, 11%; Deepwater Sculpin: 0.02, 7%) and the eggs of Deepwater Sculpin (Slimy Sculpin: 0.03, 13%; Deepwater Sculpin: 0.05, 16%) during February–May at all sites. Round Goby also consumed eggs of these species but at lower levels (≤0.01; <1%). Diet overlap was identified between sculpin species at Frankfort and Sturgeon Bay, suggesting possible interspecific competition, but their diets did not overlap at Two Rivers; diet overlap was never observed between Round Goby and either sculpin species. Given that (1) diet overlap varied by site and (2) diet proportions varied spatially more than temporally, benthivores appear to be exhibiting localized responses to recent ecological changes. Overall, these results reveal that egg predation and interspecific competition could be important interactions to consider in future examinations of the population dynamics of these species or in ecosystem models that forecast how fisheries will respond to possible perturbations or management scenarios. Received April 24, 2012; accepted November 23, 2012 [ABSTRACT FROM AUTHOR]

This study evaluated the effects of dietary methylmercury (MeHg) on immune system development in captive-reared nestling American kestrels ( Falco sparverius) to determine whether T cell-mediated and antibody-mediated adaptive immunity are targets for MeHg toxicity at environmentally relevant concentrations. Nestlings received various diets, including 0 (control), 0.6, and 3.9 µg/g (dry wt) MeHg for up to 18 d posthatch. Immunotoxicity endpoints included cell-mediated immunity (CMI) using the phytohemagglutinin (PHA) skin-swelling assay and antibody-mediated immune response via the sheep red blood cell (SRBC) hemagglutination assay. T cell- and B cell-dependent histological parameters in the spleen, thymus, and bursa of Fabricius were correlated with the functional assays. For nestlings in the 0.6 and 3.9 µg/g MeHg groups, CMI was suppressed by 73 and 62%, respectively, at 11 d of age. Results of this functional assay were correlated with T cell-dependent components of the spleen and thymus. Dose-dependent lymphoid depletion in spleen tissue directly affected the proliferation of T-lymphocyte populations, insofar as lower stimulation indexes from the PHA assay occurred in nestlings with lower proportions of splenic white pulp and higher THg concentrations. Nestlings in the 3.9 µg/g group also exhibited lymphoid depletion and a lack of macrophage activity in the thymus. Methylmercury did not have a noticeable effect on antibody-mediated immune function or B cell-dependent histological correlates. We conclude that T cell-mediated immunosuppression is the primary target of MeHg toward adaptive immunity in developing kestrels. This study provides evidence that environmentally relevant concentrations of MeHg may compromise immunocompetence in a developing terrestrial predator and raises concern regarding the long-term health effects of kestrels that were exposed to dietary MeHg during early avian development. Environ. Toxicol. Chem. 2011; 30:1328-1337. © 2011 SETAC [ABSTRACT FROM AUTHOR]

Fifty-nine adult male American kestrels ( Falco sparverius) were assigned to one of three diet formulations including 0 (control), 0.6, and 3.9 µg/g (dry wt) methylmercury (MeHg). Kestrels received their diets daily for 13 weeks to assess the effects of dietary MeHg on immunocompetence. Immunotoxic endpoints included assessment of cell-mediated immunity (CMI) using the phytohemagglutinin (PHA) skin-swelling assay and primary and secondary antibody-mediated immune responses (IR) via the sheep red blood cell (SRBC) hemagglutination assay. Select hematology and histology parameters were evaluated to corroborate the results of functional assays and to assess immunosuppression of T and B cell-dependent components in spleen tissue. Kestrels in the 0.6 and 3.9 µg/g MeHg groups exhibited suppression of CMI, including lower PHA stimulation indexes ( p = 0.019) and a 42 to 45% depletion of T cell-dependent splenic lymphoid tissue ( p = 0.006). Kestrels in the 0.6 µg/g group exhibited suppression of the primary IR to SRBCs ( p = 0.014). MeHg did not have a noticeable effect on the secondary IR ( p = 0.166). Elevation of absolute heterophil counts ( p < 0.001), the heterophil to lymphocyte ratio ( p < 0.001), and total white blood cell counts ( p = 0.003) was apparent in the 3.9 µg/g group at week 12. Heterophilia, or the excess of heterophils in peripheral blood above normal ranges, was apparent in seven of 17 (41%) kestrels in the 3.9 µg/g group and was indicative of an acute inflammatory response or physiological stress. This study revealed that adult kestrels were more sensitive to immunotoxic effects of MeHg at environmentally relevant dietary concentrations than they were to reproductive effects as previously reported. Environ. Toxicol. Chem. 2011; 30:1320-1327. © 2011 SETAC [ABSTRACT FROM AUTHOR]

Since the fall of communism, democracy has come to be seen as the 'only game in town'- the only legitimate form of political system. Democracy is considered legitimate because it provides for individual rights and allows the people access to the resources of the state. If 'we the people' defines the limits of these entitlements, the next logical question is who are 'the people'? In contemporary developed states, the problem of diversity is most often framed as a problem of immigration; the arrival of new groups threatens both the presumed homogeneity of established nations and their democracy. We argue for a new conception of democracy, which takes into account the constructed nature of 'the people' that democracy empowers. This paper attempts to provide such an account by advocating a new understanding of the relationship between nationalism, citizenship, and democracy. [ABSTRACT FROM AUTHOR]

A physiologically based toxicokinetic (PBTK) model was developed to describe the uptake, distribution, and elimination of methylmercury (CH3Hg) in female American kestrels. The model consists of six tissue compartments corresponding to the brain, liver, kidney, gut, red blood cells, and remaining carcass. Additional compartments describe the elimination of CH3Hg to eggs and growing feathers. Dietary uptake of CH3Hg was modeled as a diffusion-limited process, and the distribution of CH3Hg among compartments was assumed to be mediated by the flow of blood plasma. To the extent possible, model parameters were developed using information from American kestrels. Additional parameters were based on measured values for closely related species and allometric relationships for birds. The model was calibrated using data from dietary dosing studies with American kestrels. Good agreement between model simulations and measured CH3Hg concentrations in blood and tissues during the loading phase of these studies was obtained by fitting model parameters that control dietary uptake of CH3Hg and possible hepatic demethylation. Modeled results tended to underestimate the observed effect of egg production on circulating levels of CH3Hg. In general, however, simulations were consistent with observed patterns of CH3Hg uptake and elimination in birds, including the dominant role of feather molt. This model could be used to extrapolate CH3Hg kinetics from American kestrels to other bird species by appropriate reassignment of parameter values. Alternatively, when combined with a bioenergetics-based description, the model could be used to simulate CH3Hg kinetics in a long-term environmental exposure. Environ. Toxicol. Chem. 2010; 29:1854–1867. © 2010 SETAC [ABSTRACT FROM AUTHOR]

The main aim of this paper is to present humanity and termites as design partners in the creation of a new dimension of ecosystem understanding. The paper by Turner and Soar, “Beyond biomimicry: What termites can tell us about realizing the living building” (2008) opens up a new era in how we think of human habitations, not only on earth, but perhaps on other planets, and using the termite model as the corner stone of innovative engineering. We know that termites are masters of constructing ‘buildings’ that meet all nutrition, energy, waste disposal needs, shelter, and food sources for many other animals and insects. We need to emulate the symbiotic abilities of termites to survive over time, for we all live on this symbiotic planet, and symbiosis is natural and common. [ABSTRACT FROM AUTHOR]

Sixty breeding pairs of captive American kestrels (Falco sparverius) were exposed to a range of sublethal dietary concentrations of mercury (Hg), in the form of methylmercuric chloride, and their subsequent reproduction was measured. Egg production, incubation performance, and the number and percent of eggs hatched decreased markedly between 3.3 and 4.6 mg/kg dry weight of Hg (1.2 and 1.7 mg/kg wet wt), in the diet. The number of fledglings and the percent of nestlings fledged were reduced markedly at 0.7 mg/kg dry weight (0.3 mg/kg wet wt) and declined further between 2 and 3.3 mg/kg dry weight (0.7 and 1.2 mg/kg wet wt). Dietary concentrations of ≥4.6 mg/kg dry weight (1.7 mg/kg wet wt) were associated with total fledging failure. The estimated decline in fledged young per pair (24%, Bayesian regression) for kestrels consuming 0.7 mg/kg dry weight (0.3 mg/ kg wet wt) raises concerns about population maintenance in areas subject to high inputs of anthropogenic Hg. Mercury concentrations in 20 second-laid eggs collected from all groups were related to dietary concentrations of Hg, and the Hg concentrations in 19 of these eggs were related to eggs laid and young fledged. Concentrations of Hg in eggs from the highest diet group (5.9 mg/kg dry wt; 2.2 mg/kg wet wt) were higher than egg concentrations reported for either wild birds or for captive birds (nonraptors) fed dry commercial food containing 5 mg/kg methylmercury. Accumulation ratios of Hg from diets to eggs were higher than those reported for feeding studies with other species. [ABSTRACT FROM AUTHOR]

This study assessed the influence of short-term changes in smoking habit on blood levels of inflammatory markers, which have been associated with increased cardiovascular risk. Five inflammatory markers were measured before and 6 weeks after attempting smoking cessation in 138 healthy women. In the 48 participants who stopped smoking, white blood cell count (−0.7±1.2 × 109/L; P <.001) and fibrinogen (−0.6±1.5µmol/L; P <.01) decreased, but there was no significant (P >.1) change in the plasma level of C-reactive protein (median change +0.1; interquartile range −0.2, 0.9 mg/L), intercellular adhesion molecule 1 (+17±75 ng/mL), or CD40 ligand (+0.4±2.1 ng/mL). Most of the individual variation in inflammatory marker levels was unrelated to changes in smoking habit. [ABSTRACT FROM AUTHOR]

Summary 1.Decision support tools used for vegetation management require accurate information on the spatial array of different plant communities and a herbivore’s grazing location. We tested the accuracy and precision of locations derived using the satellite navigation global positioning system (GPS). 2.Before May 2000, the accuracy and precision of GPS-derived locations were degraded by a process known as selective availability (SA); after May 2000, SA was disabled. In this study we investigated how to handle and improve the quality of data generated both when SA was enabled and when SA was disabled using relative GPS (rGPS). rGPS entails the post-processed correction of the roving GPS module with simultaneously acquired positional errors recorded at a known stationary reference location. 3.With SA enabled, GPS data were obtained at a fixed known location to obtain baseline information, and from a roving module that essentially mimicked surveying techniques or the movement of a free-ranging animal. The mean accuracy of GPS with SA enabled was 21 m for the fixed module and 25 m for the roving module. Use of rGPS and further manipulation of the data improved the mean accuracy of the data to 7 m for the fixed module and 10 m for the roving module. With SA disabled, data were similarly recorded from the fixed known location and resulted in a mean location accuracy of 5 m. The use of rGPS resulted in a significant improvement of this value to 3·6 m and precision measured by the 95% quantile was < 10 m. For mapping and wildlife tracking, such quality in terms of location accuracy and precision is unprecedented and demonstrates that rGPS may still be useful in many applications. 4.GPS enables the world-wide collection of accurate and precise location information at 1-second intervals. Furthermore, by programming the GPS receiver to overdetermine location by using information from all visible satellites, many of the limitations that arise in habitats or... [ABSTRACT FROM AUTHOR]

Une étude antérieure, faite aux Etats-Unis, a montré que les étudiants en médecine sont en général les aǐnés de leur famille; cette tendance est spécialement marquée lorsque le père souffre ďun certain déséquilibre dans son statut professionnel, en ce sens que celui-ci est inférieur à ce à quoi il pouvait aspirer de par sa formation. Cette étude a été refaite et étendue en Suède; les conclusions sont les sui- vantes : (1) Les étudiants en médecine, filles et garçons sont en général les ainés de leur famille. (2) Cette tendance est plus marquee chez les filles dont le père a un statut déséquilibré. (3) Pour les étudiants des deux sexes, la proportion ďaǐnés est spécialement forte chez ceux qui relatent que leur père a été frustré dans ses aspirations professionnelles. On pourrait donc penser que le fils aǐné prend son père comme modèle de ròle professionnel quand le père est satisfait de son travail, tandis que, lorsque le père est frustré, le fils prend pour modèle le rôle que le père n'a pas réussi à atteindre. (4) Conformément aux prédictions basées sur la primogéniture, les effets du rang de naissance, pour les sujets masculins, sont plus marques dans les zones rurales que dans les villes, mais cette différence ne joue pas pour les filles. Plusieurs problèmes méthodologiques afférant aux recherches sur le rang de naissance sont discutés ici. [ABSTRACT FROM PUBLISHER]

A response from the authors of a retrospective observational study which selected the variable of English either as first language (EFL) or second language (ESL) and measured significant inferiority of care and outcome for people with ESL is presented.

Objectives: To assess the impact of the availability of a catheterisation laboratory and evidence-based care on the 18-month mortality rate in patients with suspected acute coronary syndromes (ACS).Design, Setting and Participants: Management and outcomes are described for patients enrolled in the 2012 Australian and New Zealand SNAPSHOT ACS audit. Patients were stratified according to their presentation to hospitals with or without cardiac catheterisation facilities. Data linkage ascertained patient vital status 18 months after admission. Descriptive and Cox proportional hazards analyses determined predictors of outcomes, and were used to estimate the numbers of deaths that could be averted by improved application of evidence-based care.Main Outcome Measures: Mortality for ACS patients from admission to 18 months after admission.Results: Definite ACS patients presenting to catheterisation-capable (CC) hospitals (n = 1326) were more likely to undergo coronary angiography than those presenting to non-CC hospitals (n = 1031) (61.5% v 50.8%; P = 0.0001), receive timely reperfusion (for ST elevation myocardial infarction (STEMI) patients: 45.2% v 19.2%; P < 0.001), and be referred for cardiac rehabilitation (57% v 53%; P = 0.05). All-cause mortality over 18 months was highest for STEMI (16.2%) and non-STEMI (16.3%) patients, and lowest for those presenting with unstable angina (6.8%) and non-cardiac chest pain (4.8%; P < 0.0001 for trend). After adjustment for patient propensity to present to a CC hospital and patient risk, presentation to a CC hospital was associated with 21% (95% CI, 2%-37%) lower mortality than presentation to a non-CC hospital. This mortality difference was attenuated after adjusting for delivery of evidence-based care.Conclusion: In Australia and New Zealand, the availability of a catheterisation laboratory appears to have a significant impact on long-term mortality in ACS patients, which is still substantial. This mortality may be reduced by improvements in evidence-based care in both CC and non-CC hospitals. [ABSTRACT FROM AUTHOR]