Spatial and temporal variability in the otolith chemistry of the Brazilian snapper Lutjanus alexandrei from estuarine and coastal environments.

Otolith chemistry of juvenile and adult individuals of the Brazilian snapper Lutjanus alexandrei was measured to assess the utility of natural markers for investigating individual movements. Individuals were collected over a 3-year period (2010-2012) along the north-eastern coast of Brazil from both estuarine (juvenile to sub-adult stages) and coastal (sub-adult to adult stages) areas. Six elements ((7) Li, (24) Mg, (55) Mn, (59) Co, (88) Sr and (137) Ba) were measured in sectioned otoliths of L. alexandrei using laser ablation inductively coupled plasma mass spectrometry (LA-ICPMS). Edge composition analysis indicated that element:Ca ratios in the otoliths of juvenile and sub-adult L. alexandrei from estuaries were not significantly different among the three consecutive years (2010, 2011 and 2012), suggesting that physicochemical conditions within the nursery area investigated were temporally stable. Similarly, apart from two elements (Ba and Co), element:Ca ratios for larger L. alexandrei inhabiting coastal waters were also similar. In contrast, otolith chemistry of similar sized L. alexandrei from estuarine and coastal areas was significantly different (based on recently accreted material). Otolith Mn:Ca and Ba:Ca were both significantly higher for L. alexandrei collected in estuaries compared to fish from adjacent coastal reefs, while the opposite trend was observed for Sr:Ca. Given the pronounced differences in otolith chemistry between estuarine and coastal areas, element:Ca transects were constructed from the core to margin of the otoliths for adults (age 7+ years) collected on reefs to determine the timing of movement (ontogenetic migration) from estuarine to coastal areas. Based on observed patterns of decline for both Mn:Ca and Ba:Ca, it appears that L. alexandrei begin the move to more coastal habitats (i.e. lower element:Ca ratios) after age 2 years. The patterns observed for this species highlight the importance of conserving connectivity between coastal habitats to maintain sustainable fish stocks exploited by artisanal fisheries.

Depressed resilience of bluefin tuna in the western atlantic and age truncation.

Following intense overfishing in the 1970s, the western stock of Atlantic bluefin tuna (Thunnus thynnus) experienced a long period of depressed abundance, which has been attributed to failure of the population to periodically produce large numbers of juveniles, the western stock mixing with the more highly exploited eastern stock (fisheries in the Northeast Atlantic Ocean and Mediterranean Sea), and regime shift in the population's ecosystem resulting in lower replacement rates. To evaluate the presence of relatively strong years of juvenile production, we analyzed age structure from a recent sample of otoliths (ear stones) collected from the western stock (2011-2013, North Carolina, U.S.A., winter fishery). Mixing levels for the recent sample were analyzed using otolith stable isotopes to test whether age structure might be biased through immigration of eastern stock bluefin tuna. Age structure from historical samples collected from United States and Canadian fisheries (1975-1981) was compared with more recent samples (1996-2007) to examine whether demographic changes had occurred to the western stock that might have disrupted juvenile production. Relatively high juvenile production occurred in 2003, 2005, and 2006. Otolith stable isotope analysis showed that these recruitments were mostly of western stock origin. However, these high recruitments were >2-fold less than historical recruitment. We found substantial age truncation in the sampled fisheries. Half the historical sample was >20 years old (mean age = 20.1 [SD 3.7]; skewness = -0.3), whereas <5% of the recent sample was >20 years old (mean age = 13.4 [SD 3.8]; skewness = 1.3). Loss of age structure is consistent with changes in fishing selectivity and trends in the stock assessment used for management. We propose that fishing, as a forcing variable, brought about a threshold shift in the western stock toward lower biomass and production, a shift that emulates the regime shift hypothesis. An abbreviated reproductive life span compromised resilience by reducing the period over which adults spawn and thereby curtailing the stock's ability to sample year-to-year variability in conditions that favor offspring survival (i.e., storage effect). Because recruitment dynamics by the western stock exhibit threshold dynamics, returning it to a higher production state will entail greater reductions in exploitation rates.

Fine-scale movements and habitat use of juvenile southern flounder Paralichthys lethostigma in an estuarine seascape.

Habitat use of juvenile southern flounder Paralichthys lethostigma was examined within a shallow estuarine seascape during June and July 2011 using acoustic telemetry. Fine-scale movement and habitat use of P. lethostigma was investigated with an acoustic positioning system placed in a seascape that varied in habitat type, physicochemical conditions and bathymetry. The use of different habitat types was examined with Euclidean distance-based analyses, and generalized additive models were used to determine the relative importance of habitat type relative to physicochemical conditions and bathymetry. Tracks of P. lethostigma ranged in distance between 1477 and 8582 m and speed was 4·2 ± 1·1 m min⁻¹ (mean ± s.e.) for all P. lethostigma combined. Depth, slope and habitat type had the most influence on P. lethostigma occurrence and deep sandy areas with shallow slopes were used most frequently. In addition, depth use by P. lethostigma was influenced by tidal cycles, indicating habitat use varies temporally and is dynamic. Finally, temperatures <30·5° C were used more than warmer waters within the study area. The results successfully identify movements by juvenile P. lethostigma, and indicate that definitions of essential habitats need to account for dynamics in habitat use.

Total hip replacement and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck: a seven- to ten-year follow-up report of a prospective randomised controlled trial.

We reviewed the seven- to ten-year results of our previously reported prospective randomised controlled trial comparing total hip replacement and hemiarthroplasty for the treatment of displaced intracapsular fracture of the femoral neck. Of our original study group of 81 patients, 47 were still alive. After a mean follow up of nine years (7 to 10) overall mortality was 32.5% and 51.2% after total hip replacement and hemiarthroplasty, respectively (p = 0.09). At 100 months postoperatively a significantly greater proportion of hemiarthroplasty patients had died (p = 0.026). Three hips dislocated following total hip replacement and none after hemiarthroplasty. In both the total hip replacement and hemiarthroplasty groups a deterioration had occurred in walking distance (p = 0.02 and p < 0.001, respectively). One total hip replacement required revision compared with four hemiarthroplasties which were revised to total hip replacements. All surviving patients with a total hip replacement demonstrated wear of the cemented polyethylene component and all hemiarthroplasties had produced acetabular erosion. There was lower mortality (p = 0.013) and a trend towards superior function in patients with a total hip replacement in the medium term.

Acute postoperative pain at rest after hip and knee arthroplasty: severity, sensory qualities and impact on sleep.

INTRODUCTION: The management of acute postoperative pain poses a significant challenge in surgical specialities. Despite the prevalence and impact of acute postoperative pain, there is a paucity of published data regarding its occurrence and sensory qualities after joint replacement. HYPOTHESIS: That a proportion of patients would experience severe acute postoperative pain at rest after total hip replacement (THR) and total knee replacement (TKR). MATERIALS AND METHODS: Pain was assessed preoperatively, and then five times daily for the first three postoperative days in 105 THR and TKR patients. Pain severity was assessed using a pain Visual Analogue Scale and the sensory qualities of pain were assessed using the pain descriptors from the Short-Form McGill Pain Questionnaire. RESULTS: Median acute pain scores peaked on the first postoperative day, with 58% of TKR patients and 47% of THR patients reporting moderate-severe pain. Preoperative pain was most frequently described as aching, stabbing and sharp, whereas acute postoperative pain was described as aching, heavy and tender. Night pain disturbed between 44-57% of TKR patients and 21-52% of THR patients on postoperative nights 1-3. DISCUSSION: These findings demonstrate that acute postoperative pain at rest after joint replacement, particularly TKR, is poorly managed, although it does not reach the severity of preoperative pain. LEVEL OF EVIDENCE: Level IV (observational cohort study).

Management of open tibial fractures - a regional experience.

INTRODUCTION: The treatment of soft-tissue injuries associated with tibial diaphyseal fractures presents a clinical challenge that is best managed by a combined plastic and orthopaedic surgery approach. The current study was undertaken to assess early treatment outcomes and burden of service provision across five regional plastic surgery units in the South-West of England. SUBJECTS AND METHODS: We conducted a prospective 6-month audit of open tibial diaphyseal fracture management in five plastic surgery units (Bristol, Exeter, Plymouth, Salisbury, Swansea) with a collective catchment of 9.2 million people. Detailed data were collected on patient demographics, injury pattern, surgical management and outcome followed to discharge. RESULTS: The study group consisted of 55 patients (40 male, 15 female). Twenty-two patients presented directly to the emergency department at the specialist hospital (primary group), 33 patients were initially managed at a local hospital (tertiary group). The mean time from injury to soft tissue cover was significantly less (P < 0.001) in the primary group (3.6 ± 0.8 days) than the tertiary group (10.8 ± 2.2 days), principally due to a delay in referral in the latter group (5.4 ± 1.7 days). Cover was achieved with 39 flaps (19 free, 20 local), eight split skin grafts. Nine wounds closed directly or by secondary intention. There were 11 early complications (20%) including one flap failure and four infections. The overall mean length of stay was 17.5 ± 2.8 days. CONCLUSIONS: Multidisciplinary management of severe open tibial diaphyseal may not be feasible at presentation of injury depending on local hospital specialist services available. Our results highlight the need for robust assessment, triage and senior orthopaedic review in the early post-injury phase. However, broader improvements in the management of lower limb trauma will additionally require further development of combined specialist trauma centres.

Whiplash injury: 30-year follow-up of a single series.

We have reviewed 22 patients at a mean of 30 years (28 to 31) after a whiplash injury. A complete recovery had been made in ten (45.5%) while one continued to describe severe symptoms. Persistent disability was associated with psychological distress but both improved in the period between 15 and 30 years after injury. After 30 years, ten patients (45.5%) were more disabled by knee than by neck pain.

Feeding ecology of pelagic fish larvae and juveniles in slope waters of the Gulf of Mexico.

Stable isotope ratios of carbon (delta13C) and nitrogen (delta15N) were used to investigate feeding patterns of larval and early juvenile pelagic fishes in slope waters of the Gulf of Mexico. Contribution of organic matter supplied to fishes and trophic position within this pelagic food web was estimated in 2007 and 2008 by comparing dietary signatures of the two main producers in this ecosystem: phytoplankton [based on particulate organic matter (POM)] and Sargassum spp. Stable isotope ratios of POM and pelagic Sargassum spp. were significantly different from one another with delta13C values of POM depleted by 3-6 per thousand and delta15N values enriched by 2 relative to Sargassum spp. Stable isotope ratios were significantly different among the five pelagic fishes examined: blue marlin Makaira nigricans, dolphinfish Coryphaena hippurus, pompano dolphinfish Coryphaena equiselis, sailfish Istiophorus platypterus and swordfish Xiphias gladius. Mean delta13C values ranged almost 2 among fishes and were most depleted in I. platypterus. In addition, mean delta15N values ranged 4-5 with highest mean values found for both C. hippurus and C. equiselis and the lowest mean value for M. nigricans during both years. Increasing delta13C or delta15N with standard length suggested that shifts in trophic position and diet occurred during early life for several species examined. Results of a two-source mixing model suggest approximately an equal contribution of organic matter by both sources (POM=55%; pelagic Sargassum spp.=45%) to the early life stages of pelagic fishes examined. Contribution of organic matter, however, varied among species, and sensitivity analyses indicated that organic source estimates changed from 2 to 13% for a delta(13)C fractionation change of +/-0.25 per thousand or a delta15N fractionation change of +/-1.0 per thousand relative to original fractionation values.

Managing patients with carotid stenosis.

Patients with carotid stenosis present multiple challenges to the medical-surgical nurse case manager. Implementing a defined critical pathway for the patient undergoing a carotid endarterectomy can result in quality cost-effective care, fewer complications, and less possibility of future stroke.

Synergistic interaction between tirapazamine and cyclophosphamide in human breast cancer xenografts.

This study examined the efficacy of combining cyclophosphamide and the hypoxic cytotoxin, tirapazamine, in the treatment of human breast cancer xenografts grown in nude mice. A single dose of tirapazamine was followed 2 h later by a single dose of cyclophosphamide. As determined from tumor regrowth delay, the effectiveness of combined therapy was greater than the additive effects of each treatment given alone. Possible mechanisms of this synergistic interaction include enhancement of DNA damage, inhibition of repair of DNA damage, or induction of apoptosis. Apart from some loss in body weight, the only other toxicity of interest in mice treated with tirapazamine was necrosis of the skin on the distal tail, which appeared to be vascular in origin.

A whole-person sampler for assessing numbers of host-seeking adult mosquitoes.

The whole-person bag sampler (WPBS) is a human-baited drop-net mosquito trap for evaluating an individual's exposure to nuisance mosquitoes. A diagram of WPBS construction is given, with results from field tests. Trap operator exposures of 2, 4, and 8 min did not result in a corresponding increase in mosquitoes caught in the WPBS, although simultaneous captures using a sweep net or Nasci aspirator increased with the sample duration. The person baiting and operating the trap did not have a significant effect on number of mosquitoes captured. Taxonomic diversity of adult mosquitoes collected with WPBS and CO2-baited traps was similar, with Aedes vexans predominant in the study areas.

Public perception of mosquito annoyance measured by a survey and simultaneous mosquito sampling.

For randomly chosen residents of the Minneapolis-St. Paul, Minnesota, metropolitan area, survey responses, reported bites, and observed defensive behaviors (e.g., brushing, swatting) for a 5-min period in their yard were compared with simultaneous mosquito counts from a human-baited drop-net trap 6 m from the resident. When mosquitoes trapped, reported bites, or observed behaviors per 5 min were 3 or more, the majority of respondents described the mosquito levels as greater than "moderate" and anticipated reduced outdoor time and/or possible repellent use. At 25 or more mosquitoes trapped, 11 or more reported bites, or 16 or more observed behaviors per 5 min, response was "bad", with most people anticipating a major reduction in outdoor time (without repellent), "probably" or "definitely" planning to use repellent, and anticipating some outdoor time loss even if using repellent. Levels of less than 3 mosquitoes trapped per 5 min were related to moderate annoyance in 20-45% of the population. Individual response was highly variable, and the personal and environmental covariates measured did not account for more than half the variability.

Case management of the patient with pituitary tumor.

Many medical-surgical nurse case managers will care for patients with pituitary tumors at some point in their careers. These patients present multiple challenges throughout their courses of treatment. Using astute assessment and intervention skills, the nurse case manager can positively influence the outcomes of therapy for these patients, whether they are in the diagnostic, treatment, or follow-up phase of care. Nursing management can indeed make a difference in the costs of money, time, and functional disabilities experienced by patients with pituitary tumors.

Prevalence of glioblastoma multiforme subjects with prior herbicide exposure.

The charts of 100 patients with established diagnoses of glioblastoma multiforme (GBM) provided the data base for a descriptive study of patients' exposure to herbicides. The study focused on place of residence and occupation during the year prior to diagnosis of GBM. Although subjects reported residences in 33 of the 75 counties in Arkansas, more than one-third of the sample came from just 3 counties in which rice, cotton or wood products are produced. These industries were reported as the occupations of almost one-third of the sample for whom occupations involved a risk of herbicide exposure. The findings of this study add to the epidemiological profile of those at risk for GBM and underscore the need for assessment of residence and occupation on a consistent basis when counseling patients and providing health education.