Public's perceptions of marine bioinvasive risks and responsible parties - Implications for social acceptability and better-informed communication in the marine biosecurity context

Using the survey data on a representative sample of the New Zealand population, our study presents a process of understanding citizens' perceptions, identifying patterns in the perceptions, and recognising the knowledge gaps existing in the citizenry in the marine biosecurity context. While our findings show a healthy sign of the public accepting their own responsibility and the devolved responsibility of business/industry, there are considerable gaps between the general public's perceptions and (marine) biosecurity current practices and expectations. There is a moderately strong signal from survey respondents that suggest the need of significantly more effort and improved transparency in marine biosecurity communication. Our outcomes indicate an anthropocentric tendency, with influences of gender, age, education, income, frequency of beach visitation upon societal perceptions in terms of awareness, concern, perceived non-indigenous marine species impacts, and accountability in marine biosecurity management. The recognised socio-demographic patterns in societal perceptions would inform marine biosecurity communication strategies.

Trends in the detection of aquatic non-indigenous species across global marine, estuarine and freshwater ecosystems: A 50-year perspective

Aim:

The introduction of aquatic non-indigenous species (ANS) has become a major driver for global changes in species biogeography. We examined spatial patterns and temporal trends of ANS detections since 1965 to inform conservation policy and management.

Location:

Global.

Methods:

We assembled an extensive dataset of first records of detection of ANS (1965–2015) across 49 aquatic ecosystems, including the (a) year of first collection, (b) population status and (c) potential pathway(s) of introduction. Data were analysed at global and regional levels to assess patterns of detection rate, richness and transport pathways.

Results:

An annual mean of 43 (±16 SD) primary detections of ANS occurred–one new detection every 8.4 days for 50 years. The global rate of detections was relatively stable during 1965–1995, but increased rapidly after this time, peaking at roughly 66 primary detections per year during 2005–2010 and then declining marginally. Detection rates were variable within and across regions through time. Arthropods, molluscs and fishes were the most frequently reported ANS. Most ANS were likely introduced as stowaways in ships’ ballast water or biofouling, although direct evidence is typically absent.

Main conclusions:

This synthesis highlights the magnitude of recent ANS detections, yet almost certainly represents an underestimate as many ANS go unreported due to limited search effort and diminishing taxonomic expertise. Temporal rates of detection are also confounded by reporting lags, likely contributing to the lower detection rate observed in recent years. There is a critical need to implement standardized, repeated methods across regions and taxa to improve the quality of global-scale comparisons and sustain core measures over longer time-scales. It will be fundamental to fill in knowledge gaps given that invasion data representing broad regions of the world's oceans are not yet readily available and to maintain knowledge pipelines for adaptive management.

Are our beaches safe? Quantifying the human health impact of anthropogenic beach litter on people in New Zealand

The environmental, social and cultural importance of beaches permeates human society, yet the risk of human injury associated with increasing exposure to anthropogenic beach litter remains an unknown. While the impact of marine debris and beach litter on marine and coastal fauna and flora is a widely reported global issue, we investigate the impact on human health in New Zealand. Anthropogenic beach litter is ubiquitous, few beaches remain pristine, which consequently influences tourist choices and potentially negatively interacts with humans. Human impacts are not well-investigated, with no quantitative studies of impact but many studies qualitatively inferring impact. New Zealand has a socialised medical system allowing a quantitative, decadal assessment of medical insurance claims to determine patterns and trends across ecosystems and causes. We demonstrate for the first time that anthropogenic beach litter poses a common and pervasive exposure hazard to all ages, with specific risk posed to young children. The New Zealand system allows these hazards to be investigated to determine the true effects and costs across a nation, providing an evidence base for decision-makers to address this ubiquitous environmental issue.

Seabirds and plastics don't mix: Examining the differences in marine plastic ingestion in wedge-tailed shearwater chicks at near-shore and offshore locations

Plastic ingestion by wedge-tailed shearwaters (WTS) nesting at near-shore and offshore sites along the east coast of Australia were investigated. Ingestion rates were at 20% in near-shore lavaged WTS, where the beaches were significantly more polluted, compared to 8% in birds at offshore sites. The material and colour of recovered plastics at offshore sites differed significantly between beach surveys and that ingested by seabirds in the same area. This pattern was not evident near-shore. Hence, in near-shore environments birds may feed locally and are influenced by nearby plastics, compared to birds offshore. The origins of marine debris between near-shore and offshore beaches differed; with land-based sources unsurprisingly having more influence on near-shore sites. The findings of this study indicate the need for localised data to address and manage this pollutant, with nesting seabirds at greater risk in near-shore environments. A preliminary modified ecological quality objective for WTS is presented.

Niche partitioning of intertidal seagrasses: evidence of the influence of substrate temperature

The influence of soil temperature on rhizome depths of four intertidal seagrass species was investigated in central Queensland, Australia. We postulated that certain intertidal seagrass species are soil temperature-sensitive and vertically stratify rhizome depths. Below-ground vertical stratification of intertidal seagrass rhizome depths was analysed based upon microclimate (soil temperature) and microhabitat (soil type). Soil temperature profiles exhibited heat transfer from surface layers to depth that varied by microhabitat, with vertical stratification of rhizome depths between species. Halodule uninervis rhizomes maintain a narrow median soil temperature envelope; compensating for high surface temperatures by occupying deeper, cooler soil substrates. Halophila decipiens, Halophila ovalis and Zostera muelleri rhizomes are shallow-rooted and exposed to fluctuating temperatures, with broader median temperature envelopes. Halodule uninervis appears to be a niche specialist, with the two Halophila species considered as generalist niche usage species. The implications of niche use based upon soil temperature profiles and rhizome rooting depths are discussed in the context of species' thermal tolerances and below-ground biomass O₂ demand associated with respiration and maintenance of oxic microshields. This preliminary evidence suggests that soil temperature interaction with rhizome rooting depths may be a factor that influences the distribution of intertidal seagrasses.

Aquaculture and urban marine structures facilitate native and non-indigenous species transfer through generation and accumulation of marine debris

Both the invasion of non-indigenous marine species (NIMS) and the generation and accumulation of anthropogenic marine debris (AMD) are pervasive problems in coastal urban ecosystems. The biosecurity risks associated with AMD rafting NIMS have been described, but the role of aquaculture derived AMD has not yet been investigated as a biosecurity vector and pathway. This preliminary study targeted 27 beaches along the Coromandel Peninsula, New Zealand, collecting debris from belt transects. Plastic (specifically plastic rope) was the dominant AMD present on beaches. The most common biofouling taxa were hydroids, bryozoans, algae and polychaetes, with one NIMS pest species, Sabella spallanzanii, detected fouling plastic rope. Our findings demonstrate that aquaculture is an AMD (plastic rope) generating activity that creates biosecurity risk by enhancing the spread of NIMS. The rafting of S. spallanzanii on AMD generated at aquaculture facilities is currently an unmanaged pathway within New Zealand that needs attention.

Epibiotic pressure contributes to biofouling invader success

Reduced competition is a frequent explanation for the success of many introduced species. In benthic marine biofouling communities, space limitation leads to high rates of overgrowth competition. Some species can utilise other living organisms as substrate (epibiosis), proffering a competitive advantage for the epibiont. Additionally, some species can prevent or reduce epibiotic settlement on their surfaces and avoid being basibionts. To test whether epibiotic pressure differs between native and introduced species, we undertook ex situ experiments comparing bryozoan larval settlement to determine if introduced species demonstrate a greater propensity to settle as epibionts, and a reduced propensity to be basibionts, than native species. Here we report that introduced species opportunistically settle on any space (bare, native, or introduced), whereas native species exhibit a strong tendency to settle on and near other natives, but avoid settling on or near introduced basibionts. In addition, larvae of native species experience greater larval wastage (mortality) than introduced species, both in the presence and absence of living substrates. Introduced species’ ability to settle on natives as epibionts, and in turn avoid epibiosis as basibionts, combined with significantly enhanced native larval wastage, provides a comprehensive suite of competitive advantages contributing to the invasion success of these biofouling species.

Biosecurity messages are lost in translation to citizens: Implications for devolving management to citizens

The increasing focus of marine biosecurity agencies on transferring management responsibilities to citizens and industry begs the question whether devolved responsibility is a viable option for creating biosecurity outcomes. We examined recreational marine users’ self-declared awareness of non-indigenous marine species (NIMS) at six locations in Tasmania, Australia and evaluated the accuracy of their awareness through recognition of four well-known NIMS with active awareness campaigns. We also investigated whether the activities of recreational marine users influence the accuracy of their NIMS recognition skills. We generally found that respondents declare NIMS awareness (70.45%), yet we found their recognition accuracy was variable ranging from low to fair (<10% to 54.95%) and recreational activity did not influence accuracy. Based on our results, we conclude that marine users’ awareness does not predict accuracy and therefore devolved management of biosecurity without additional resources may pose a risky biosecurity management strategy.

Burial Duration and Frequency Influences Resilience of Differing Propagule Types in a Subtidal Seagrass, Posidonia australis

Sedimentation that leads to periodic, and often prolonged, burial events is becoming more common on the world's coastlines as human populations expand and create urbanised marine environments. Different seagrass species react differently to sediment burial but many species in the southern hemisphere are yet to be examined. How seagrasses react to burial has restoration implications. There is a need to critically assess seagrass transplant propagule responses to periodic (pulse) and prolonged (press) burial events before selecting the most appropriate species, transplant propagule, and transplant site. In my study, mesocosm experiments, coupled with field measurements were used to assess how sexual (seedlings) and vegetative (sprigs) propagules of Posidonia australis responded to pulse and press burial events. Seedlings were highly susceptible to burial (both pulse and press), with no survival at the end of the experimental period. In contrast, rhizome growth in vegetative propagules was stimulated by pulse burial, although press burial events resulted in mortality. The implication for Posidonia australis restoration efforts in areas where burial is periodic, was that vegetative propagules are optimal transplant units, in comparison to seedlings. Press burial however, renders a transplant site sub-optimal for both seedling and sprig transplants.

Marine invasive species: establishing pathways, their presence and potential threats in the Galapagos Marine Reserve

Worldwide, marine biological invasions of non-native species have increased significantly in recent years due to a rapid rise in global trade, transport and tourism. Invasions occur when non-native species are transported from one region to another and establish, often resulting in competition displacing native species and changing ecosystems. Historic literature searches were conducted along with dive surveys of the main ports and in sites around the archipelago in order to produce a baseline of which non-native species are present in the Galapagos Marine Reserve at this time. Confounding processes of anthropogenic and natural activities are increasing the potential spread of marine invasive species in the Eastern Tropical Pacific and the Galapagos Marine Reserve. We discuss the potential vectors facilitating marine invasions with the suggestion that marine traffic could be the most influential vector in the transport of marine non-natives to the Galapagos Marine Reserve. The challenge for marine park authorities is to identify those species that are likely to cause negative impacts on native biodiversity and ecosystems before they establish in the Galapagos, and to develop pre-emptive strategies that would likely include prevention as well as risk-based management strategies to remove them or to mitigate their harmful effects.

Marine debris is selected as nesting material by the brown booby (Sula leucogaster) within the Swain Reefs, Great Barrier Reef, Australia

Many seabirds are impacted by marine debris through its presence in foraging and nesting areas. To determine the extent of this problem, marine debris use in nest material of the brown booby (Sula leucogaster) in the Great Barrier Reef, Australia, was investigated. Nine cays were examined using beach and nest surveys. On average, four marine debris items were found per nest (n=96) with 58.3% of surveyed nests containing marine debris. The source of marine debris in nests and transects were primarily oceanic. Hard plastic items dominated both nest (56.8%) and surveyed beaches (72.8%), however only two item types were significantly correlated between these surveys. Nest surveys indicated higher levels of black and green items compared to beach transects. This selectivity for colours and items suggest these nests are not good indicators of environmental loads. This is the first study to examine S. leucogaster nests for marine debris in this location.

Littering dynamics in a coastal industrial setting: the influence of non-resident populations

We examined if there is truth to the preconceptions that non-resident workers (including FIFO/DIDO's) detract from communities. We used marine debris to test this, specifically focussing on littering behaviour and evidence of awareness of local environmental programs that focus on marine debris. Littering was most common at recreational areas, then beaches and whilst boating. Twenty-five percent of respondents that admit to littering, reported no associated guilt with their actions. Younger respondents litter more frequently. Thus, non-resident workers litter at the same rate as permanent residents, visitors and tourists in this region, within this study. Few respondents are aware of the environmental programs that operate in their local region. Awareness was influenced by a respondent's residency (non-residents are less aware), age, and level of education. To address this failure we recommend that industries, that use non-resident workers, should develop inductions that expose new workers to the environmental programs in their region.

The role of uncertainty and subjective influences on consequence assessment by aquatic biosecurity experts

Expert judgement is often used to mitigate the knowledge gaps that limit understanding of aquatic non-indigenous species (ANS) impacts (consequences) to environmental, economic, social, cultural and human health values. To understand how this uncertainty may affect expert decision making, we explored the presence and effects of uncertainty on consequence assessment for 10 ANS by scientists and managers. We hypothesized species' distribution, taxonomy and impact type will affect assessment magnitude. These hypotheses were partially supported. We also hypothesized a difference in the relationship between consequence magnitude and uncertainty, based on assessor group. This set of hypotheses was not supported, as all group assessments had a significant negative correlation between consequence and uncertainty. Both scientists and managers assigned lower consequence when faced with knowledge gaps and other forms of uncertainty. This aligns with an "innocent until proven guilty" or hindsight approach, as opposed to a "guilty until proven innocent" or precaution approach. Based on these outcomes, the experts appeared to make decisions in violation of both the maximin principle and precaution, instead using a heuristic approach. We suggest several management strategies to prevent biases against environmental protection that occur due to use of the hindsight approach.

Ingestion of marine debris plastic by the wedge-tailed shearwater Ardenna pacifica in the Great Barrier Reef, Australia

We present the first evidence of ingestion of plastic by seabirds from the southern Great Barrier Reef (GBR), Australia. The occurrence of marine debris ingestion in the wedge-tailed shearwater, Ardenna pacifica, on Heron Island was the focus of this preliminary research. Our findings indicate that 21% of surveyed chicks are fed plastic fragments by their parents, having ingested 3.2 fragments on average. The most common colours of ingested plastic fragments were off/white (37.5%) and green (31.3%). Ingested fragments had a mean size of 10.17±4.55 mm and a mean weight of 0.056±0.051 g. Our results indicate that further research is critical to understanding the extent of ingestion, colour preferences, and what impacts ingestion may have on these and other seabird populations in the GBR.

Linking social drivers of marine debris with actual marine debris on beaches

The drivers (social) and pressures (physical) of marine debris have typically been examined separately. We redress this by using social and beach surveys at nine Tasmanian beaches, across three coastlines and within three categories of urbanisation, to examine whether people acknowledge that their actions contribute to the issue of marine debris, and whether these social drivers are reflected in the amount of marine debris detected on beaches. A large proportion (75%) of survey participants do not litter at beaches; with age, gender, income and residency influencing littering behaviour. Thus, participants recognise that littering at beaches is a problem. This social trend was reflected in the small amounts of debris that were detected. Furthermore, the amount of debris was not statistically influenced by the degree of beach urbanisation, the coastline sampled, or the proximity to beach access points. By linking social and physical aspects of this issue, management outcomes can be improved.

Assessing biosecurity risk associated with the importation of non-indigenous microalgae

The importation and use of microalgae as live feeds for aquaculture and research poses significant marine biosecurity risks as it represents a poorly or unregulated mechanism for the introduction of non-native species. In many jurisdictions, the importation of a good is controlled by an Import Health Standard (IHS); however within New Zealand, no IHS explicitly exists for microalgae and no import risk assessments have occurred. This represents an unregulated pathway that requires urgent management attention. To address this problem, an 8-step decision-tree (based on non-probabilistic if/then statements) was developed. The decision-tree applies the same set of criteria to all species and strains, ensuring that future importation of microalgae could be assessed in a consistent, robust, transparent, and defensible manner. To assess the validity of the decision-tree, all New Zealand microalgae imports from 1998 to 2005 were assessed using the decision-tree and then compared against a derived risk assessment for the same dataset. Microalgae imports that pose a risk to New Zealand have been imported and released into the environment, indicating that this unregulated pathway needs improved biosecurity management. Both aquaculture and research agencies are responsible for releasing microalgae imports. The decision-tree was a more conservative method than a derived risk assessment process.

Assessing the port to port risk of vessel movements vectoring non-indigenous marine species within and across domestic Australian borders

Biofouling of vessels is implicated as a high risk transfer mechanism of non-indigenous marine species (NIMS). Biofouling on international vessels is managed through stringent border control policies, however, domestic biofouling transfers are managed under different policies and legislative arrangements as they cross internal borders. As comprehensive guidelines are developed and increased compliance of international vessels with 'clean hull' expectations increase, vessel movements from port to port will become the focus of biosecurity management. A semi-quantitative port to port biofouling risk assessment is presented that evaluates the presence of known NIMS in the source port and determines the likelihood of transfer based on the NIMS association with biofouling and environmental match between source and receiving ports. This risk assessment method was used to assess the risk profile of a single dredge vessel during three anticipated voyages within Australia, resulting in negligible to low risk outcomes. This finding is contrasted with expectations in the literature, specifically those that suggest slow moving vessels pose a high to extreme risk of transferring NIMS species.

Evaluating vegetative transplant success in Posidonia australis: a field trial with habitat enhancement

Seagrasses in Western Australia grow on open coastlines that are wave and surge exposed, which are known to reduce transplant success. This study investigated the use of habitat enhancement procedures to improve the survival and expansion of Posidonia australis transplants. Limited success transplanting P. australis vegetative propagules (plugs) was achieved after habitat enhancement was implemented, using artificial seagrass (ASG) mats to emulate a "surrogate" seagrass meadow. The ASG mats enhanced one aspect of the habitat (stabilised sediment grain size) but did not suitably stabilise erosion and accretion. Transplant survival was significantly increased (up to 50% survival) in 60% of the sites where ASG mats were present. However, only 8% of the total transplant population exhibited rhizome extension (3.2+/-0.11 mmd(-1)).

Pharmacologic options for the treatment of obesity

Past and current drug therapies for weight loss are discussed. More than 50% of Americans can be categorized as overweight or obese. Obesity is associated with increased mortality and with comorbidities such as hypertension, hyperglycemia, dyslipidemia, coronary artery disease, and certain cancers. According to guidelines for identification, evaluation, and treatment of obesity, patients with a body mass index (BMI) of > or = 30 kg/m2 should attempt to lose weight. Patients with a BMI of > or = 25 kg/m2 plus two or more risk factors or patients with an excessive waist circumference plus two or more risk factors should also attempt to lose weight. The initial goal is a 10% weight reduction in six months achieved through lifestyle changes. If lifestyle changes alone are not effective, then drug therapy may be indicated. Pharmacotherapeutic options for obesity have decreased over the past few years. Fenfluramine, dexfenfluramine, and phenylpropanolamine have been withdrawn because of severe adverse effects, leaving only sympathomimetics, sibutramine, and orlistat as anorectics with FDA-approved labeling. Phentermine has been shown to cause a 5-15% weight loss if given daily or intermittently. Compared with sibutramine and orlistat, phentermine is cheaper, and specific formulations allow once-daily administration. However, phentermine is indicated only for short-term treatment, and tolerance often develops. Common adverse effects associated with phentermine are dry mouth, insomnia, increased blood pressure, and constipation. Sibutramine increases norepinephrine and serotonin levels in the CNS and should not be taken with many antidepressants because of the risk of increased norepinephrine and serotonin levels. Its use is also contraindicated in patients with cardiovascular disease. Orlistat is not systemically absorbed; therefore, it does not cause the systemic adverse effects or drug interactions of phentermine and sibutramine. Orlistat has a cholesterol-lowering effect not seen with other diet medications. However, the three-times-daily administration and frequent gastrointestinal effects limit its use. Sibutramine, phentermine, and orlistat have both positive and negative properties. Choosing among the medications will depend on concurrent disease states and medications, ease of administration, and cost.

The synthesis of phosphopeptides

Phosphorylation and dephosphorylation are key events in protein expression and regulation and in signal transduction. Phosphopeptides are very useful reagents for the study of these processes, and have been used to great advantage in the study of phosphatase substrate specificity, SH2 domain ligand specificity, and protein-protein interactions. Furthermore, the advent of cell-permeable peptide carriers, such as those from the antennapedia homeodomain and the HIV TAT transcription factor, has allowed the study of intracellular events, thus underscoring the utility of these reagents. In this paper we review methods for the synthesis of phosphopeptides with the emphasis on the preparation of phosphoamino acid building blocks.

Secondary health conditions among middle-aged individuals with chronic physical disabilities: implications for unmet needs for services

Data from the Aging with Disability (AwD) Study are used to examine variations in the types and frequency of secondary conditions experienced by 301 middle-aged individuals living with the effects of three disabling conditions: polio (n = 124), rheumatoid arthritis (RA) (n = 103), and stroke (n = 75). All respondents were randomly selected from a county rehabilitation hospital or a community-based subject pool. Secondary conditions are operationalized as (1) the number of new health problems diagnosed or treated since the onset of the primary disability and (2) the amount of change/decline in basic and instrumental daily activities since a previous reference period in the disability trajectory. Also analyzed are changes in use of assistive devices and unmet needs for services. Differences in secondary conditions are examined within the AwD sample by impairment group and between samples by comparing AwD rates to national estimates for the same cohort. Results reveal significant differences in the types of new health problems reported by persons living with polio, RA, and stroke and document marked disparities, or accelerated aging, between disabled and nondisabled adults. Findings are discussed in terms of the changing health care needs of persons aging with disability and the importance of improving access to preventive services, ongoing rehabilitation, and assistive technology.

Construction of a BAC contig map of chromosome 16q by two-dimensional overgo hybridization

We have used sequence-based markers from an integrated YAC STS-content/somatic cell hybrid breakpoint physical map and radiation hybrid maps of human chromosome 16 to construct a new sequence-ready BAC map of the long arm of this chromosome. The integrated physical map was generated previously in our laboratory and contains 1150 STSs, providing a marker on average every 78 kb on the euchromatic arms of chromosome 16. The other two maps used for this effort were the radiation hybrid maps of chromosome 16 from Whitehead Institute and Stanford University. To create large sequenceable targets of this chromosome, we used a systematic approach to screen high-density BAC filters with probes generated from overlapping oligonucleotides (overgos). We first identified all available sequences in the three maps. These include sequences from genes, ESTs, STSs, and cosmid end sequences. We then used BLASTto identify 36-bp unique fragments of DNA for overgo probes. A total of 906 overgos were selected from the long arm of chromosome 16. Hybridizations occurred in three stages: (1) superpool hybridizations against the 12x coverage human BAC library (RPCI-11); (2) two-dimensional hybridizations against rearrayed positive BACs identified in the superpool hybridizations; and (3) pooled tertiary hybridizations for those overgos that had ambiguous positives remaining after the two-dimensional hybridization. For the superpool hybridizations, up to 236 overgos have been pooled in a single hybridization against the 12x BAC library. A total of 5187 positive BACs from chromosome 16q were identified as a result of five superpool hybridizations. These positive clones were rearrayed on membranes and hybridized with 161 two-dimensional subpools of overgos to determine which BAC clones were positive for individual overgos. An additional 46 tertiary hybridizations were required to resolve ambiguous overgo-BAC relationships. Thus, after a total of 212 hybridizations, we have constructed an initial probe-content BAC map of chromosome 16q consisting of 828 overgo markers and 3363 BACs providing >85% coverage of the long arm of this chromosome. The map has been confirmed by the fingerprinting data and BAC end PCR screening.

Patient responses during rapid terminal weaning from mechanical ventilation: a prospective study

OBJECTIVE

To describe and analyze patient responses to rapid terminal weaning from mechanical ventilation.

DESIGN

A prospective, descriptive, correlational study.

SETTING

An urban, university-affiliated, trauma/emergency hospital.

PATIENTS

A convenience sample of 31 adult patients experiencing withdrawal of mechanical ventilation.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Physiologic (peripheral oxygen saturation, end-tidal CO2, heart rate, and respiratory rate) and comfort (electroencephalogram [EEG], Bizek Agitation Scale, and the COMFORT scale) measures were collected at baseline, during, and after the terminal weaning procedure. Clinical status was measured using the Acute Physiology and Chronic Health Evaluation score, Glasgow Coma Scale, and PaO2/F(IO2). Duration of survival after the wean inversely correlated with illness severity but did not correlate with consciousness, use of analgesia/sedation, or pulmonary function. Respiratory rate and oxygen saturation changed significantly during the wean but not end-tidal CO2. Patients remained comfortable with little or no analgesia/sedation, in a predominantly comatose sample. Subjective measures of comfort strongly correlated with objective data from bispectral analysis of EEG.

CONCLUSIONS

Patients with altered consciousness or coma can be kept comfortable during a rapid terminal weaning procedure with morphine and benzodiazepines in low doses. Comfort can be reliably evaluated using subjective scales.

Spatial and temporal expression of AP-1 responsive rod photoreceptor genes and bZIP transcription factors during development of the rat retina

PURPOSE

The promoter region of the rod-specific beta subunit of cGMP PDE (beta-PDE) and opsin genes contains highly conserved cis-acting elements, which include an AP-1 and/or Nrl response element (NRE: An extended AP-1 like sequence). Transactivation of AP-1 or NRE appears necessary to drive expression of these rod-specific genes during adulthood, however, their role during development is relatively unknown. Therefore, we determined the spatial and temporal relationships between rod morphological and functional development, rod-specific gene expression, and expression of the bZIP transcription factors c-fos, junD and Nrl.

METHODS

Retinas from 0-45 day old (PN0-45) dark- and light-adapted Long-Evans rats were used. Morphological development was monitored by light and electron microscopy. Whole retinal trypsin-activated cGMP-PDE activity and rhodopsin content were measured biochemically. The expression of opsin, beta-PDE, c-fos, junD and Nrl mRNAs were determined by Northern blot analysis. The cellular localization of Nrl was examined with in situ hybridization.

RESULTS

The mRNAs for opsin, beta-PDE and c-fos were observed at PN0-2, while cGMP-PDE activity and rhodopsin were detected first at PN5: coincident with rod outer segment development. The developmental pattern of cGMP-PDE activity and rhodopsin accumulation paralleled the expression of beta-PDE and opsin mRNA and all reached their maximal levels by PN45. Nrl expression, for all three transcripts found in the rat retina, was low on PN2 and reached its maximal level at PN14. The c-fos and Nrl expression preceded beta-PDE and opsin mRNA expression by 1-2 days. Nrl expression was detected first in the distal post-mitotic retina at PN5 and then in all nuclear layers during retinal development. Maximal expression shifted from the ganglion cells to the outer nuclear layer as the neural retina matured. In contrast, junD expression was highest at PN0 and declined to a stable level by PN10.

CONCLUSIONS

Colocalization of Nrl and c-Fos suggests that expression of rod-specific genes, which utilize AP-1 or NRE sites in their promoter, could be regulated through the formation of Nrl-Fos dimers. We hypothesize that Nrl and c-Fos play a fundamental role in the initiation and regulation of the rod-specific gene expression in developing and adult rod photoreceptors.

A survey of hantavirus antibody in small-mammal populations in selected United States National Parks

Hantavirus activity in 39 National Parks in the eastern and central United States was surveyed by testing 1,815 small mammals of 38 species for antibody reactive to Sin Nombre virus. Antibody-positive rodents were found throughout the area sampled, and in most biotic communities. Antibody was detected in 7% of 647 deer mice (Peromyscus maniculatus), 2% of 590 white-footed mice (P. leucopus), 17% of 12 rice rats (Oryzomys palustris), 3% of 31 cotton rats (Sigmodon hispidus), and 33% of 18 western harvest mice (Reithrodontomys megalotis). Antibody was also found in three of six species of voles, and in one of 33 chipmunks (Tamias minimus). Prevalence among Peromyscus was highest in the northeast. Although few cases of hantavirus pulmonary syndrome have been identified from the eastern and central regions, widespread infection in reservoir populations indicates that potential exists for human infection throughout much of the United States.

Integrating technology with compassionate care: withdrawal of ventilation in a conscious patient with apnea

This case was atypical because the patient was conscious and apneic. The usual responses that indicate a patient's distress during terminal weaning would not have been evident in this patient. Introducing noninvasive monitoring of end-tidal CO2 and SpO2 and using BIS allowed the weaning to progress with confidence that the patient was as comfortable as possible. We think we kept our commitment to HD to honor his wishes by using the most humane method we could devise, and to address his family's needs at the same time.

Integrating technology with compassionate care: withdrawal of ventilation in a conscious patient with apnea

This case was atypical because the patient was conscious and apneic. The usual responses that indicate a patient's distress during terminal weaning would not have been evident in this patient. Introducing noninvasive monitoring of end-tidal CO2 and SpO2 and using BIS allowed the weaning to progress with confidence that the patient was as comfortable as possible. We think we kept our commitment to HD to honor his wishes by using the most humane method we could devise, and to address his family's needs at the same time.

Small mammal survival and trapability in mark-recapture monitoring programs for hantavirus

Following the 1993 hantavirus pulmonary syndrome (HPS) epidemic in the south-western United States, mammalogists and epidemiologists instituted long-term studies to monitor population density and prevalence of infection in rodents which constitute the reservoir for Sin Nombre virus (SNV). In this study, field techniques used in sampling small mammals for SNV infection were evaluated to determine if trapping and handling protocols were having significant effects on future trapability or mortality of animals. We compared rodent mark-recapture control plots, on which all rodents were simply measured, marked, and released on site, with experimental plots on which all animals were anesthetized with methoxyflurane, sampled for blood and saliva, measured, marked, and released. Blood samples were obtained from anesthetized animals on the experimental plots via a retro-orbital sinus puncture using a heparinized capillary tube. Dacron tipped oral swabs were used to collect buccal cells and saliva from the rodent's oral cavity. Field data were collected monthly from August 1994 to August 1996 at two sites in New Mexico (USA). Analyses were based on 3,661 captures of 1,513 individuals representing 21 species from three rodent families (Rodentia: Muridae, Heteromyidae, Sciuridae) and two species of rabbits (Lagomorpha: Leporidae). Overall, for most murid rodents (including five Peromyscus spp., Neotoma albigula, and Onychomys leucogaster) and one rabbit species (Sylvilagus floridanus), the handling/bleeding procedures had no significant effects on recapture rates or mortality. In contrast, several species of heteromyids (Dipodomys ordii and Perognathus flavus), one murid (Reithrodontomys megalotis) and one leporid (S. auduboni) suffered higher mortality rates, and heteromyid kangaroo rats (D. ordii and D. merriami) exhibited lower trapability as a result of the anesthesia and sampling procedures. In view of the overall non-significant influence of the sampling procedures on murid rodents, the anesthesia and blood/saliva sampling protocols described herein appear to be appropriate for hantavirus research, and may serve as a model for environmental monitoring of other zoonotic agents and their reservoirs.

Functional alterations and apoptotic cell death in the retina following developmental or adult lead exposure

Long-term visual system deficits occur in man and animals following developmental and occupational lead exposure. Recent experimental data suggests that the adult brain is not altered following lead exposure. Therefore, the aim of these studies was to use the retina as a CNS model to examine and compare the morphological, biochemical and electroretinographic (ERG) changes occurring in rats exposed to low or moderate levels of lead during development (0-21 days of age) with those occurring in adult rats with equivalent blood and retinal levels of lead for three or six weeks. Five main results were obtained. First, developmental and adult lead exposure for six weeks produced age- and dose-dependent retinal degeneration such that rods and bipolar cells were selectively lost. At the ultrastructural level, all dying cells exhibited the classical morphological features of apoptotic cell death. Second, in the lead-exposed groups, the decrease in the number of rods was correlated with the loss of rhodopsin content per eye confirming that rods were directly affected by lead. Third, single-flash rod ERGs and cone ERGs obtained from developmentally and adult lead-exposed rats demonstrated that there were age- and dose-dependent decreases in the rod a-wave and b-wave sensitivity and maximum amplitudes without any effect on cones. In adult rats exposed to lead for three weeks, qualitatively similar ERG changes occurred in the absence of cell loss or decrease in rhodopsin content. Fourth, developmental and adult lead exposure for three and six weeks produced age- and dose-dependent decreases in retinal cGMP phosphodiesterase (PDE) activity resulting in increased cGMP levels. Fifth, picomolar to micromolar concentration of free lead directly inhibited rat retinal and purified bovine rod cGMP PDE. In summary, there are three main conclusions. First, the retinas of developing and adult rats exposed to lead exhibit qualitatively similar rod-mediated ERG alterations as well as rod and bipolar apoptotic cell death. Thus, developing and mature retinas are both sensitive to the adverse effects of lead: albeit to significantly different extents. Second, a similar biochemical mechanism such as the inhibition of rod and bipolar cell cGMP PDE, varying only in degree and duration, underlies both the lead-induced ERG rod-mediated deficits and the rod and bipolar apoptotic cell death. Third, the composite results from our experiments and those of others suggest that the developing retina might be more sensitive to preweaning lead exposure than the hippocampus and thus may serve as a good model for studying the cellular and molecular mechanisms underlying developmental and adult lead neurotoxicity.

The contemporary food supply of three northern Manitoba Cree communities

A complex set of social, economic, cultural and environmental circumstances affecting native Canadians in northern regions has resulted in the dietary replacement of indigenous foods with marketed products not always of equivalent nutritional value. This article examines the current food supply in three northern Manitoba Cree communities by looking at the availability and preservation of traditional foods, the price of marketed foods and perceptions of the food supply. Data were obtained by questionnaire from older adults (over 55 years) and younger women (16-45 years) in each community. The food supply comprised a mix of traditional and marketed foods, with limited use of traditional methods of food preservation. Marketed food prices were high in communities without all-weather road access. Respondents expressed a desire for more traditional food. Promotion of traditional foods could increase nutrient intake, decrease food costs and contribute to a revival of interest in Cree culture.

The contemporary food supply of three northern Manitoba Cree communities

A complex set of social, economic, cultural and environmental circumstances affecting native Canadians in northern regions has resulted in the dietary replacement of indigenous foods with marketed products not always of equivalent nutritional value. This article examines the current food supply in three northern Manitoba Cree communities by looking at the availability and preservation of traditional foods, the price of marketed foods and perceptions of the food supply. Data were obtained by questionnaire from older adults (over 55 years) and younger women (16-45 years) in each community. The food supply comprised a mix of traditional and marketed foods, with limited use of traditional methods of food preservation. Marketed food prices were high in communities without all-weather road access. Respondents expressed a desire for more traditional food. Promotion of traditional foods could increase nutrient intake, decrease food costs and contribute to a revival of interest in Cree culture.

Depression and life satisfaction in aging polio survivors versus age-matched controls: relation to postpolio syndrome, family functioning, and attitude toward disability

OBJECTIVE

To compare depressive symptoms and life satisfaction in aging polio survivors with age-matched controls and to relate these outcomes to scores to psychosocial and disability-related variables.

DESIGN

A planned medical, functional, and psychosocial study with multivariate analyses.

SETTING

A large, urban rehabilitation center.

PARTICIPANTS

A volunteer sample of 121 polio survivors and an age-matched control group of 60 people with similar sociodemographic backgrounds.

MAIN OUTCOMES

Depression as measured by the Geriatric Depression Scale and an 11-item life satisfaction scale.

RESULTS

The prevalence of depressive disorders was not significantly different in the two groups, although the postpolio group tended to have more symptomatology and an overall depressive disorder prevalence of 28%. Some life satisfaction scale scores were significantly lower in the postpolio group, especially those concerned with health. People with postpolio syndrome scored significantly higher on depression scales and lower on some life satisfaction scales than people with a history of polio but without postpolio syndrome. Several psychosocial variables, most notably family functioning and attitude toward disability, helped to mediate this effect. Among people with significant depression, there was little, evidence of adequate treatment in the community.

CONCLUSIONS

Postpolio by itself does not relate to higher depression scores or lower life satisfaction. Postpolio syndrome has some relation to depression, but family functioning and attitude toward disability are more important. There is a need for better community-based psychological services.

Experience with an end-of-life practice at a university hospital

OBJECTIVE

To describe a 10-yr experience with an end-of-life practice in a hospital.

DESIGN

A nonexperimental, prospective, descriptive design was used to record variables from a convenience sample of patients transferred to the Comprehensive Supportive Care Team.

SETTING

Detroit Receiving Hospital is an urban, university-affiliated, Level I trauma/emergency hospital.

PATIENTS

Patients who are not expected to survive hospitalization, and for whom a decision has been made to focus care on palliative interventions, are candidates for care by this practice.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Patient demographics, including the following information: age, gender; diagnoses; illness severity; mortality rate; and disposition. Measures of resource utilization included: referral sources; Therapeutic intervention Scoring System values; bed costs; and length of hospital stay. Satisfactory patient/family care with a measurable reeducation in the use of resources can be achieved in the hospital setting.

CONCLUSIONS

A hands-on approach to the care of dying patients by this specialty, palliative care service has provided patients, families, and clinicians with the type of support needed for satisfactory end-of-life care. A summary of our experience may be useful to others.

Collection of surgical specimens in total joint arthroplasty. Is routine pathology cost effective?

A retrospective review of 715 consecutive cases of total joint arthroplasty (283 hips, 432 knees), performed for a variety of indications during 1992 and 1993, was undertaken to assess the cost effectiveness of routine pathologic examination. The charts were reviewed for preoperative, operative, and pathologic diagnosis, and any discrepancies in diagnosis were noted. Particular attention was paid to pathologic findings suggestive of neoplasia or rheumatoid arthritis that were not noted in the preoperative or operative diagnoses. Six of the 715 cases fit into this category, but all failed to have any clinical significance. No alteration in patient care resulted from routine pathologic examination. This paper questions the necessity of routinely submitting pathologic specimens in uncomplicated total hip and knee arthroplasty.

Impact of patient consciousness on the intensity of the do-not-resuscitate therapeutic plan

BACKGROUND: The nature and intensity of a do-not-resuscitate therapeutic plan varies by patient. Some do-not-resuscitate therapeutic plans may include interventions directed at the withdrawal of life-sustaining therapy. OBJECTIVE: The purpose of this study was to examine the impact of patient consciousness on the nature and intensity of the do-not-resuscitate plan, and on the decision to withdraw life-sustaining therapy. METHODS: This study represents a secondary analysis of data obtained in a previous study to evaluate patient care requirements under varying intensities of do-not-resuscitate plans. Data were collected retrospectively through record review. Patients were grouped as follows, according to the intensity of the do-not-resuscitate plan: (1) all but cardiopulmonary resuscitation, (2) conservative care without cardiopulmonary resuscitation, (3) comfort only, and (4) withdrawal of life-sustaining therapy. In addition to demographic data, consciousness and illness severity were measured. Data were analyzed using descriptive statistics. RESULTS: There was a significant decrease in consciousness from admission in all groups except conservative care. The withdrawal group had the lowest average Glasgow Coma Scale scores at the time of the do-not-resuscitate designation. Multiple regression analysis was used to demonstrate a significant impact of consciousness on type of do-not-resuscitate decision, but no significant impact from age or illness severity. CONCLUSIONS: These results support previous observations that decisions to withdraw life-sustaining therapy are prompted by diminished consciousness. These results may stimulate caregivers to offer withdrawal of life-sustaining therapy as an option in patients with severely decreased consciousness and a poor prognosis for functional recovery.

Impact of patient consciousness on the intensity of the do-not-resuscitate therapeutic plan

BACKGROUND

The nature and intensity of a do-not-resuscitate therapeutic plan varies by patient. Some do-not-resuscitate therapeutic plans may include interventions directed at the withdrawal of life-sustaining therapy.

OBJECTIVE

The purpose of this study was to examine the impact of patient consciousness on the nature and intensity of the do-not-resuscitate plan, and on the decision to withdraw life-sustaining therapy.

METHODS

This study represents a secondary analysis of data obtained in a previous study to evaluate patient care requirements under varying intensities of do-not-resuscitate plans. Data were collected retrospectively through record review. Patients were grouped as follows, according to the intensity of the do-not-resuscitate plan: (1) all but cardiopulmonary resuscitation, (2) conservative care without cardiopulmonary resuscitation, (3) comfort only, and (4) withdrawal of life-sustaining therapy. In addition to demographic data, consciousness and illness severity were measured. Data were analyzed using descriptive statistics.

RESULTS

There was a significant decrease in consciousness from admission in all groups except conservative care. The withdrawal group had the lowest average Glasgow Coma Scale scores at the time of the do-not-resuscitate designation. Multiple regression analysis was used to demonstrate a significant impact of consciousness on type of do-not-resuscitate decision, but no significant impact from age or illness severity.

CONCLUSIONS

These results support previous observations that decisions to withdraw life-sustaining therapy are prompted by diminished consciousness. These results may stimulate caregivers to offer withdrawal of life-sustaining therapy as an option in patients with severely decreased consciousness and a poor prognosis for functional recovery.