Evidence-Based Approach to Palpitations.

Palpitations are a common presenting symptom in primary care, yet their cause can be difficult to diagnose due to their intermittent and sometimes infrequent nature. All patients presenting with a chief complaint of palpitations should undergo a detailed history, physical examination, and electrocardiogram (ECG). This alone can yield a probable diagnosis. Limited laboratory testing, ambulatory ECG monitoring, and cardiology referral are sometimes indicated. This article reviews current data and guidelines on how to evaluate palpitations in the primary care setting.

The Cost-Effective Evaluation of Uncomplicated Headache.

Headaches remain one of the most common reasons for patients to seek acute care. It is important to assess whether the headache meets criteria for a primary (uncomplicated) versus a secondary headache, due to an underlying condition. A thorough history and physical examination are imperative when assessing the nature of the headache and to rule out red-flag features, which are signs and symptoms of dangerous causes. This will help determine if imaging studies are warranted. Management of uncomplicated headache should include treatment of the acute headache and an action plan for reducing the frequency and severity of future headaches.

Modeling the impacts of the European green crab on commercial shellfisheries.

Coastal resource managers are often tasked with managing coastal ecosystems that are stressed by overexploitation, climate change, contaminants, and habitat loss, as well as biological invasions. Therefore, managers increasingly need better economic data to help them prioritize their management strategies and distribute their increasingly limited resources to those strategies. Despite frequent pronouncements about the substantial ecological and economic impacts of invasive species, there have been few if any rigorous analyses of the economic impacts of invasive species in coastal systems. Here we present a bioeconomic analysis of the impacts of the European green crab, Carcinus maenas, on commercial shellfisheries along the West Coast of the United States. Green crabs are among the most comprehensively studied and widely distributed invasive species in coastal systems, with established populations on every continent except Antarctica. Their impacts on commercial bivalve fisheries have been alleged or substantiated to varying degrees, but no formal analysis of the economic impacts of the green crab has been conducted. We assess economic impacts using a combination of ecological and economic models. The ecological models incorporate green crab dispersal and description of estuarine habitat and the relationship between green crab abundance and predation on prey populations. The economic analysis focuses on the green crab impacts on commercial shellfisheries, including both historical and present impacts of green crabs on several important shellfisheries, including soft-shell clams, blue mussels, scallops, hard-shell clams, and Manila clams. We conclude that the past and present economic impacts on the West Coast shellfisheries are minor, although losses could increase significantly if densities increase or with northward range expansion into Alaska.

Melanoma prognostic factors found in the dermatopathology report.

Significant prognostic information is available in a routine melanoma dermatopathology report. Features that are enumerated in the pathology report and that portend a potentially poorer prognosis are older age, site (acral, head, neck), male sex, increasing Breslow tumor thickness, increasing Clark's level, ulceration, increasing number of mitoses, vertical growth phase, regression, absence of a host inflammatory response, increased tumor vascularity, angiotropism, vascular invasion, neurotropism, marked atypia, and satellite metastasis.