Updated lemur species ranges in Madagascar's Corridor Forestier d'Ambositra Vondrozo (COFAV).

Madagascar's high rates of endemism, paired with its escalating deforestation rates, has made it one of the most important conservation priorities on the planet. In southeastern Madagascar, the Corridor Forestier d'Ambositra Vondrozo (COFAV) is an unprotected rainforest corridor that sustains ∼15 species of lemurs, most of which are endangered. The COFAV connects many protected areas and is therefore essential for gene flow, dispersal, and the long-term sustainability of animal populations in the area. The corridor has not been surveyed extensively since the 1990s, and even so, only a fraction of the sites have been sampled multiple times. The goal of our study was to survey the COFAV, from Ranomafana National Park to the Mananara River, to provide updated species occurrences and ranges. Combining data across multiple teams using different inventorying methods, we surveyed a total area of 227 km2 throughout an eight-month period. We recorded every lemur occurrence (sighting or vocalization) and noted the species, date, time, group size, and GPS coordinates. We found 11 lemur species and one putative hybrid species. The geographic ranges for three species (Hapalemur aureus, H. griseus, Propithecus edwardsi) were larger than previously thought. The range of Varecia variegata should be shortened and adjusted accordingly, as the species appears transient (at best) in the northern parts of Ranomafana National Park and was not found south of the Ambohimahamasina/Ikongo region. This study provides updated geographic ranges for lemur species in the COFAV, important information for future censuses, species assessments, and conservation measures for future implementation.

Olanzapine and Lorazepam Used in the Symptomatic Management of Excited Catatonia Secondary to Anti-N-Methyl-D-Aspartate Receptor Encephalitis.

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis has become one of the more well-known autoimmune diseases affecting the brain and it is characterized by a multitude of progressive neuropsychiatric symptoms. The following case describes the clinical course of an 18-year-old female with excited type catatonia secondary to anti-NMDA receptor encephalitis. The patient had been brought to the ED by her parents in an acutely psychotic state characterized by profound disorganization and vivid visual hallucinations. She was admitted to psychiatry and her hospital course was significant for both retarded and excited type catatonia, autonomic instability, and sensitivity to multiple neuroleptics. Given the atypicality of her symptoms and a family history of autoimmune disease, workup for autoimmune encephalitis was performed. MRI of the pelvis showed an indeterminate ovarian mass and laboratory studies were generally unremarkable. The catatonic symptoms resolved over the course of three weeks, eventually responding to a combination of lorazepam and olanzapine. Following discharge, a cerebrospinal fluid (CSF) panel resulted with positive titers for anti-NMDA receptor antibodies. This case illustrates the need to consider autoimmune encephalitis in cases of catatonia. It also presents a case in which symptoms of anti-NMDA receptor encephalitis potentially remitted without immunotherapy or mass resection.

Desert leaf litter decay: Coupling of microbial respiration, water-soluble fractions and photodegradation.

The mechanisms of plant litter decay in drylands are poorly understood, limiting the accuracy of nutrient-cycling models for these systems. We monitored the decay of 12 leaf litter types on the soil surface of the Sonoran Desert for 34 months and assessed what traits predicted mass loss and how exposure to different wavebands of sunlight influenced mass loss. Mass loss varied considerably among litter types, ranging from 42%-96% after 34 months in full sunlight. Traditional indices of litter quality (e.g., initial C:N or lignin:N ratios) failed to predict differences in mass loss among litter types. The strongest predictor of mass loss was the microbial respiration rate of initial litter, which explained 45%-54% of the variation in loss among litter types. Microbial respiration rates were not correlated with traditional indices of litter quality, but were positively correlated with the water-soluble fraction in litter and concentrations of dissolved organic C in this fraction. Traditional indices of litter quality failed to predict decay likely because they did a poor job of predicting microbial degradability of litter, not because microbial degradation was a minor driver of decay. In all radiation-exposure treatments, water-soluble fractions and respiration rates increased through decay and were several times higher after 34 months than initially. Hence, labile pools and microbial degradability of litter increased through decay in contrast to traditional views that labile pools decline and constrain microbes. Litter exposed to UV or UV through blue radiation wavelengths, lost on average 1.3 times or 1.5 times more mass, respectively, than litter not exposed to these wavebands. The magnitude of this photodegradation was greater in litter types that had higher initial concentrations of hemicellulose and cellulose per unit surface area. Litter exposed to full sun had higher water-soluble fractions and usually had higher respiration rates, illustrating that sunlight accelerated microbial degradation by increasing labile pools. The processes driving litter decay appeared to differ appreciably from mesic systems and involved strong couplings between abiotic and biotic drivers.

Medical exceptionalism.

How should we assess the historical development of health care? Many historians are deeply reluctant to endorse ideas involving progress in human affairs, including the evolution of modern medicine. We tend to think either that our present situation is little better than in the past, or that most kinds of value judgments about history are subjective and inappropriate. A laudatory approach to medical history commonly adopted by "amateur" medical historians in the tradition of Sir William Osler has often been eschewed by "professionals" as faulty, feel-good history. But Osler was right in his belief that, on balance, the progress of medicine has been spectacular, that modern health care offers one of the finest examples of the possibility of "man's redemption of man." Written objectively, medical history is about progress and achievement, and can properly seen as inspiring. If we mordantly or relativistically dismiss the unprecedentedly high quality of modern health care, we lose the ability to understand why citizens value it so highly, and this distorts our understanding of current issues. We also lose our sense of the wonders of human and medical achievement.

William Osler: slow pulse, stokes-adams disease, and sudden death in families.

In 1903, William Osler, then at Johns Hopkins University, published "On the So-Called Stokes-Adams Disease (Slow Pulse with Syncopal Attacks, etc.)" in The Lancet, classifying a syndrome in evolution. There are thinly disguised references to a brother and to himself in the article, suggesting that Osler was concerned about a family and personal predisposition. Osler's decision to move to Oxford was triggered in part by his personal concerns about cardiac disease. Then, in 1909, Osler contributed a chapter on Stokes-Adams disease to Allbutt and Rolleston's A System of Medicine, complemented by a brilliant pathologic section by the renowned anatomist-morphologist, Arthur Keith. Osler's original contributions involved his emphasis on the importance of family history, his careful clinical and natural history observations, and his recognition of the familial occurrence of bradycardia, Stokes-Adams disease, sudden death, and cardiomyopathy.

Resurrections in Toronto: the emergence of insulin.

The discovery of insulin remains the greatest and one of the most controversial events in the history of endocrinology. Hypotheses about the possible existence of an internal secretion of the pancreas date from the early 1890s and were steadily modified with the development of the concept of an endocrine system. In the spring of 1922, after many false starts and dead ends, a team of researchers at the University of Toronto provided conclusive evidence of the existence of the internal secretion of insulin. The discovery process was fraught with personal and scientific rivalries more striking than fiction. The early use of insulin on starved, dying diabetic children awed everyone involved in the process. With the discovery of insulin, endocrinology moved into the mainstream of medical science.