Coupled social and ecological change drove the historical extinction of the California grizzly bear (Ursus arctos californicus).

Large carnivores (order Carnivora) are among the world's most threatened mammals due to a confluence of ecological and social forces that have unfolded over centuries. Combining specimens from natural history collections with documents from archival records, we reconstructed the factors surrounding the extinction of the California grizzly bear (Ursus arctos californicus), a once-abundant brown bear subspecies last seen in 1924. Historical documents portrayed California grizzlies as massive hypercarnivores that endangered public safety. Yet, morphological measurements on skulls and teeth generate smaller body size estimates in alignment with extant North American grizzly populations (approx. 200 kg). Stable isotope analysis (δ13C, δ15N) of pelts and bones (n = 57) revealed that grizzlies derived less than 10% of their nutrition from terrestrial animal sources and were therefore largely herbivorous for millennia prior to the first European arrival in this region in 1542. Later colonial land uses, beginning in 1769 with the Mission era, led grizzlies to moderately increase animal protein consumption (up to 26% of diet), but grizzlies still consumed far less livestock than otherwise claimed by contemporary accounts. We show how human activities can provoke short-term behavioural shifts, such as heightened levels of carnivory, that in turn can lead to exaggerated predation narratives and incentivize persecution, triggering rapid loss of an otherwise widespread and ecologically flexible animal.

Positive predictive value of an elevated cardiac troponin for type I myocardial infarction in ED patients based on the chief complaint.

BACKGROUND: Cardiac troponin testing is used to aid the diagnosis of myocardial infarction (MI) in the emergency department (ED) for patients who present with a range of symptoms. From a clinical perspective, the distinction between MI due to acute coronary artery thrombosis (type I MI) and other forms of direct and secondary myocardial injury (type II MI) is very important. However, the positive predictive value (PPV) of an elevated troponin for diagnosing type I MI, based on clinical history, has not been described. The objective of this study was to determine the PPV of an elevated troponin for type I MI based on the ED chief complaint. METHODS: We retrospectively reviewed the medical records of 1772 consecutive patients who had a troponin ordered in the ED at a tertiary care center over the period of March 1, 2013, to April 30, 2013. The chief complaint was based on official ED coding. For patients with a positive troponin, 2 authors independently reviewed the electronic medical record pertaining to the index encounter and subsequent hospitalization to adjudicate the cause. RESULTS: There was a significant association between the PPV of an elevated troponin for type I MI and the chief complaint. Patients with a chief complaint of chest pain were significantly more likely to have a type I MI compared to those without (PPV 84% vs 20%; Adjusted Odds Ratio (AOR), 14.31; P < .0001). There was also a significant association between the rate of type I MI and the chief complaint in all patients who had a troponin drawn. Patients with a chief complaint of chest pain were significantly more likely to have a type I MI compared to those without (PPV 9.8% vs 1.3%; AOR, 7.34; P < .0001). CONCLUSION: Applying information on the PPV of troponin for type I MI based on the clinical history could improve troponin utilization and clinical decision making.

The circadian pattern of cardiac autonomic modulation in a middle-aged population.

OBJECTIVES: To examine the circadian pattern of cardiac autonomic modulation (CAM) and its attributes in general population. METHODS: We obtained 24-h beat-to-beat RR data using a high resolution 12-lead Holter ECG in a community-dwelling sample of 115 non-smokers. We performed heart rate variability (HRV) analysis on the normal RRs from each 5-min segment to obtain time-specific HRV indices: high (HF; 0.15-0.40 Hz) and low (LF; 0.04-0.15 Hz) frequency powers, standard deviation of RR intervals (SDNN), and the square root of the mean of the sum of the squared differences of the adjacent RR intervals (RMSSD). For each individual, we fit the segment-specific HRV data to a cosine periodic function, and estimated 3 individual-level cosine function parameters to quantify the circadian variation: the mean (M), amplitude (A), and acrophase (θ). We then used a random-effects meta-analysis to summarize the M, A, and θ, and their 95% confidence intervals (CI). RESULTS: The mean age was 56 (SD 8) years, with 63% female and 76% white. The averages of M, A and θ (95%CI) of log HF were 3.59 (3.43-3.76) ms(2), 0.61 (0.54-0.68) ms(2), and 3:10 (2:25-3:55) AM, respectively, and that of RMSSD were 22.3 (20.5-24.1) ms, 6.5 (5.4-7.5) ms, 3:45 (2:55-4:35) AM, respectively. Older age is associated with lower mean of HRV. Males have higher oscillation amplitude than females. The acrophase of LF/HF was earlier in females than in males, and in younger individuals than in older individuals. CONCLUSIONS: The circadian pattern of CAM can be quantified by 3 cosine parameters of HRV, which are correlated with age and gender.

Analogies for a No-Analog World: Tackling Uncertainties in Reintroduction Planning.

Species reintroductions involve considerable uncertainty, especially in highly altered landscapes. Historical, geographic, and taxonomic analogies can help reduce this uncertainty by enabling conservationists to better assess habitat suitability in proposed reintroduction sites. We illustrate this approach using the example of the California grizzly, an iconic species proposed for reintroduction.

Achieving Guideline-Driven High-Intensity Statin Dose in Cardiac Rehabilitation Patients With Coronary Artery Disease.

PURPOSE: The 2013 American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults recommends high-intensity statin therapy in patients aged ≤75 y with clinical coronary artery disease (CAD). The effectiveness of cardiac rehabilitation (CR) in lipid management and guideline adherence is unknown. The purpose of this study is to determine whether CR participation affects guideline-driven achievement for statin use. METHODS: This multicenter retrospective study evaluated statin utilization in patients pre- and post-CR between January 1, 2014, and August 31, 2015. Records for patients with known CAD who completed 18 or more CR sessions were reviewed for statin-drug use and dose before and after CR and documented statin intolerance. RESULTS: Of the total 468 patients, 76% were male with mean age ± SD = 66.0 ± 10.8 y and range of 32 to 89 y. Patients aged ≤75 y (n = 375) showed a modest but statistically significant increase (P = .0006) in high-intensity statin use post-CR (56.3%-61.1%). Males demonstrated a significant increase in high-intensity statin use (P = .0005). Of the 146 patients aged ≤75 y not on high-intensity statins post-CR, only 21 had history of statin intolerance. Of the subjects aged >75 y (n = 93), 91% were already on high- or moderate-intensity statins with no significant change during CR. CONCLUSIONS: Patients aged ≤75 y following CR completion increased high-intensity statin use but only by 4.8% and 33% of subjects were inadequately treated. The updated 2013 treatment recommendations simplified statin use, yet substantial data continue to reveal that guideline achievement even post-CR remains limited.

The Benefits and Risks of Oral Antiplatelet Therapy in Patients with Acute Coronary Syndrome.

This newsletter aims to provide an overview of the currently available evidence pertaining to the benefits and risks of oral antiplatelet therapies, with a focus on balancing ischemic and bleeding risk to optimize patient outcomes.

Species Complex: Classification and Conservation in American Environmental History.

How does the classification of biological organisms shape efforts to conserve them? This essay addresses this key question through the scientific, administrative, and legal histories of steelhead and rainbow trout. Members of the diverse salmon family, these two fish have different life histories and physical appearances, but since the 1930s scientists have considered them the same species. Over the past 150 years, however, their histories diverged. Today, rainbow trout are bred by the millions in hatcheries and are among the world's most common and widespread fish, while steelhead are listed as threatened or endangered all along the West Coast of the United States. Their remarkable story shows that conservation is not merely a political struggle over things that exist in nature; it is a perennial competition to prove the existence and define the very nature of those things that are the focus of such struggles. Biological taxonomy and classification are central to these debates, as they are to environmental history and the history of science more generally.

Cardiovascular disease risk assessment and prevention: current guidelines and limitations.

Even after decades of progress in understanding atherosclerotic cardiovascular disease (ASCVD) and improved cardiovascular event prevention, the incidence, consequences and cost of cardiovascular disease (CVD) remain a significant public health issue. Observational studies have identified major ASCVD risk factors and lead to the development of a number of risk assessment systems/scores now in use. However many patients who will develop clinically important CVD are not identified by current systems or approaches and significant numbers of recurrent cardiovascular events continue to occur even after aggressive secondary prevention treatment strategies are utilized. Some now term this residual risk. The statin era revolutionized clinical practice with effective outcome-driven risk reduction. As a result there are now numerous clinical recommendations or guidelines for ASCVD risk stratification and treatment. Further disease and event prevention may rely on improved patient-centered risk stratification using novel biomarkers, imaging techniques, and new treatment approaches including emerging pharmacologic therapies.

A Sanctuary for Science: The Hastings Natural History Reservation and the Origins of the University of California's Natural Reserve System.

In 1937 Joseph Grinnell founded the University of California's (U.C.) first biological field station, the Hastings Natural History Reservation. Hastings became a center for field biology on the West Coast, and by 1960 it was serving as a model for the creation of additional U.C. reserves. Today, the U.C. Natural Reserve System (NRS) is the largest and most diverse network of university-based biological field stations in the world, with 36 sites covering more than 135,000 acres. This essay examines the founding of the Hastings Reservation, and asks how it managed to grow and develop, in the 1940s and 1950s, during a time of declining support for natural history research. It shows how faculty and staff courted the support of key institutional allies, presented themselves as the guardians of a venerable tradition in nature study, and emphasized the station's capacity to document ecological change and inform environmental policy and management. In the years since, Hastings and other U.C. reserves have played crucial roles in California environmental politics. Biological field stations in the post-war era deserve more attention not only from historians of biology, but also from environmental historians and other scholars interested in the role of science in society.

The worldwide environment of cardiovascular disease: prevalence, diagnosis, therapy, and policy issues: a report from the American College of Cardiology.

The environment in which the field of cardiology finds itself has been rapidly changing. This supplement, an expansion of a report created for the Board of Trustees, is intended to provide a timely snapshot of the socio-economic, political, and scientific aspects of this environment as it applies to practice both in the United States and internationally. This publication should assist healthcare professionals looking for the most recent statistics on cardiovascular disease and the risk factors that contribute to it, drug and device trends affecting the industry, and how the practice of cardiology is changing in the United States.

Relation of atrial and/or ventricular premature complexes on a two-minute rhythm strip to the risk of sudden cardiac death (the Atherosclerosis Risk in Communities [ARIC] study).

Ventricular premature complexes (VPCs) and atrial premature complexes (APCs) are common findings on routinely obtained electrocardiograms. Despite their common occurrence, the significance of these irregular beats is unclear, especially with regard to risk of sudden cardiac death (SCD). In this study, we examined the prospective relation between baseline VPCs or APCs and SCD, myocardial infarction, and fatal coronary heart disease (CHD) in a population-based sample of subjects from the Atherosclerosis Risk in Communities (ARIC) study excluding participants with known history of CHD or stroke. Baseline examination was conducted from 1987 to 1989, with follow-up data regarding clinical cardiac events collected until December 2002. The total study population was 14,574 subjects. Kaplan-Meier curves and computed univariate and multivariate Cox proportional hazard models were employed to estimate the effect of VPC and APC occurrences on incident cardiac events. During the follow-up period, there were 130 incident cases of SCD, 1,657 incident cases of CHD cases, and 288 cases of fatal CHD. Participants with VPC were 2 times as likely to have SCD (hazard ratio [HR] 2.09, 95% confidence interval [CI] 1.22 to 3.56) compared to those without VPC. Presence of APC was not significantly associated with SCD (HR 1.15, 95% CI 0.56 to 2.39). Compared to subjects without VPC and APC, risk of SCD in subjects with VPC and APC was significantly increased (HR 6.39, 95% CI 2.58 to 15.84). In conclusion, our study shows that subjects with VPCs are significantly more likely to die from SCD, despite not having any known history of cardiovascular disease. This effect appears to be additive when APCs occur concurrently.

Pitavastatin: evidence for its place in treatment of hypercholesterolemia.

Statins, inhibitors of 3-hydroxy-3-methylglutaryl-coenzyme A reductase, are the most potent pharmacologic agents for lowering total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C). They have become an accepted standard of care in the treatment of patients with known atherosclerotic cardiovascular disease (secondary prevention) and also those at increased risk of cardiovascular events. There are currently six statin drugs commercially available in the US. Although they are chemically similar and have the same primary mechanisms of action in lowering TC and LDL-C, there are differences in their efficacy or potency, metabolism, drug-drug interactions, and individual tolerability. Considering the numbers of patients who need LDL-C-lowering therapy and questions of individual tolerance and therapeutic response, having a variety of agents to choose from is beneficial for patient care. This paper presents background information on statin treatment and reviews data regarding a new agent, pitavastatin, which has recently been approved for clinical use.

Fenofibric acid: a new fibrate approved for use in combination with statin for the treatment of mixed dyslipidemia.

The last two to three decades have seen an explosive growth in interest and information regarding cardiovascular disease (CVD) risk assessment and treatment. Evidence for the role of low-density lipoprotein (LDL) in risk has led to a series of clinical guidelines/recommendations on the importance of LDL lowering with statin treatment. There is also substantial evidence on a number of lipoproteins in the initiation and progression of atherosclerosis and CV events. Health care professionals have not embraced easily novel approaches to identifying those at increased risk and more aggressive treatment. This is especially true for non-LDL factors. The use of non-statin drugs such as fibrates has been modest and many health care professionals avoid consideration of combination therapy due to an inordinate fear of toxicity. This review will attempt to provide appropriate background information on lipids/lipoproteins, including non-high density lipoprotein and risk, as well as data available on fibrates and combination pharmacologic therapy. We will review a new agent, TriLipix((R)) (fenofibric acid), and its potential role in treatment.

Unresolved issues associated with early initiation of antiplatelet therapy in acute coronary syndromes.

Early initiation of antiplatelet therapy in addition to aspirin is critical for all patients with acute coronary syndrome (ACS) due to improved short- and long-term outcomes. Thus, evidence-based practice guidelines for ACS management recommend early and intensive initiation of antiplatelet therapy with aspirin, clopidogrel, and/or glycoprotein (GP) IIb/IIIa inhibitors. Despite the comprehensive nature of current guidelines, several important clinical issues concerning the optimal initiation of antiplatelet therapy remain. This review addresses four of these clinical issues: When should GP IIb/IIIa inhibitors be initiated? When should clopidogrel be initiated? What is the optimal clopidogrel loading dose? How should antiplatelet therapy be approached in chronically anticoagulated patients?

Beyond LDL cholesterol: the role of elevated triglycerides and low HDL cholesterol in residual CVD risk remaining after statin therapy.

Managed care initiatives to reduce cardiovascular disease (CVD) risk have, to date, focused almost exclusively on statins, which are primarily low-density lipoprotein cholesterol-lowering agents and have limited effects on triglycerides and high-density lipoprotein (HDL) cholesterol at commonly used doses. Significant residual CVD risk (ie, risk of recurrent CVD events) remains after treatment with statins and may stem, at least partially, from low HDL cholesterol and/or elevated triglycerides. Consequently, national treatment guidelines suggest that combination therapy may be necessary to address multiple lipid targets and adding niacin or a fibrate to a statin is a strategy to be considered. Recent clinical trial evidence has demonstrated the efficacy of niacin/statin and fenofibric acid/statin combination therapies in treating multiple lipid abnormalities.

The Coachella Valley Multiple Species Habitat Conservation Plan: a decade of delays.

This article describes the history of the Coachella Valley Multiple Species Habitat Conservation Plan (CVMSHCP), in the Riverside County region of Southern California. When this collaborative biodiversity conservation planning process began, in 1994, local participants and supporters had numerous factors working in their favor. Yet, as of April 2007, nearly 13 years had passed without an approved plan. This is a common problem. Many multiple species habitat conservation plans now take more than a decade to complete, and the long duration of these processes often results in negative consequences. The CVMSHCP process became bogged down-despite strong scientific input and many political advantages-due to problematic relationships between the Plan's local supporters, its municipal signatory parties, and officials from the state and federal wildlife agencies, particularly the regional office of the US Fish and Wildlife Service. This case study demonstrates the crucial importance of institutional structures and relationships, process management, and timeliness in habitat conservation planning. We conclude by offering several related recommendations for future HCP processes.