Men's involvement in maternal health in sub-Saharan Africa: A scoping review of enablers and barriers.

BACKGROUND: Globally, there are about 800 maternal deaths every day, with low-to-middle-income countries accounting for most of these deaths. A lack of access to maternal healthcare services is one of the main causes of these deaths. In sub-Saharan Africa (SSA), one of the barriers to accessing maternal healthcare services by women is a lack of their male partners' involvement. This scoping review aimed to assess the enablers and barriers to men's involvement in maternal healthcare services. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist was used as a guide for this review. We searched for peer-reviewed articles published between 2013 and 2023 in the English language from SCOPUS, ScienceDirect, PubMed, Africa Journals Online (AJOL), and Google Scholar databases. Two reviewers independently conducted the data extraction and article selection. All of the authors discussed and decided on the codes and categories for enablers and barriers after using NVivo to generate them. RESULTS: Twenty-seven articles were used in this review. Of these, seventeen were qualitative studies, six were quantitative studies, and four were mixed-methods studies. The enablers of men's involvement in maternal healthcare were grouped into sociodemographic factors, health system factors, and policy factors, while barriers were grouped into sociodemographic, cultural, economic, and health system barriers. The lack of maternal health knowledge, insufficient economic resources, and unfriendly staff at healthcare facilities all contributed to a lack of involvement by men. CONCLUSION: To improve men's involvement in maternal healthcare in SSA, there should be economic empowerment of both men and women, health education, and the provision of adequate infrastructure in healthcare facilities to accommodate men.

Prospective diagnostic accuracy study of history taking and physical examination for adults with vertigo in general practice: study protocol.

INTRODUCTION: Vertigo is a prevalent and burdensome symptom. More than 80% of patients with vertigo are primarily treated by their general practitioner (GP) and are never referred to a medical specialist. Despite this therapeutic responsibility, the GP's diagnostic toolkit has serious limitations. All recommended tests lack empirical evidence, because a diagnostic accuracy study on vestibular disorders ('How well does test x discriminate between patients with or without target condition y?') has never been performed in general practice. The VERtigo DIagnosis study aims to fill this gap. METHODS AND ANALYSIS: We will perform a diagnostic accuracy study on vertigo of primary vestibular origin in general practice to assess the discriminative ability of history taking and physical examination. We will compare all index tests with a respective reference standard. We will focus on five target conditions that account for more than 95% of vertigo diagnoses in general practice: (1) benign paroxysmal positional vertigo, (2) vestibular neuritis, (3) Ménière's disease, (4) vestibular migraine (VM) and (5) central causes other than VM. As these five target conditions have a different pathophysiology and lack one generally accepted gold standard, we will use consensus diagnosis as a construct reference standard. Data for each patient, including history, physical examination and additional tests as recommended by experts in an international Delphi procedure, will be recorded on a standardised form and independently reviewed by a neurologist and otorhinolaryngologist. For each patient, the reviewers have to decide about the presence/absence of each target condition. We will calculate sensitivity, specificity, predictive values, likelihood ratios and diagnostic ORs, followed by decision rules for each target condition. ETHICS AND DISSEMINATION: The study obtained approval from the Vrije Universiteit Medical Center Medical Ethical Review Committee (reference: 2022.0817-NL83111.029.22). We will publish our findings in peer-reviewed international journals. TRIAL REGISTRATION NUMBER: ISRCTN97250704.

Mastering your fellowship: Part 2, 2024.

The 'Mastering your Fellowship' series provides examples of the question format encountered in the written and clinical examinations, Part A of the Fellowship of the College of Family Physicians of South Africa (FCFP [SA]) examination. The series is aimed at helping family medicine registrars prepare for this examination.

From the President's Desk: Part 1, 2024.

No abstract available.

Health budget cuts will be paid for by the most vulnerable.

No abstract available.

Turbulence causes kinematic and behavioural adjustments in a flapping flier.

Turbulence is a widespread phenomenon in the natural world, but its influence on flapping fliers remains little studied. We assessed how freestream turbulence affected the kinematics, flight effort and track properties of homing pigeons (Columba livia), using the fine-scale variations in flight height as a proxy for turbulence levels. Birds showed a small increase in their wingbeat amplitude with increasing turbulence (similar to laboratory studies), but this was accompanied by a reduction in mean wingbeat frequency, such that their flapping wing speed remained the same. Mean kinematic responses to turbulence may therefore enable birds to increase their stability without a reduction in propulsive efficiency. Nonetheless, the most marked response to turbulence was an increase in the variability of wingbeat frequency and amplitude. These stroke-to-stroke changes in kinematics provide instantaneous compensation for turbulence. They will also increase flight costs. Yet pigeons only made small adjustments to their flight altitude, likely resulting in little change in exposure to strong convective turbulence. Responses to turbulence were therefore distinct from responses to wind, with the costs of high turbulence being levied through an increase in the variability of their kinematics and airspeed. This highlights the value of investigating the variability in flight parameters in free-living animals.

Translating musculoskeletal radiology reports into patient-friendly summaries using ChatGPT-4.

OBJECTIVE: To assess the feasibility of using large language models (LLMs), specifically ChatGPT-4, to generate concise and accurate layperson summaries of musculoskeletal radiology reports. METHODS: Sixty radiology reports, comprising 20 MR shoulder, 20 MR knee, and 20 MR lumbar spine reports, were obtained via PACS. The reports were deidentified and then submitted to ChatGPT-4, with the prompt "Produce an organized and concise layperson summary of the findings of the following radiology report. Target a reading level of 8-9th grade and word count <300 words." Three (two primary and one later added for validation) independent readers evaluated the summaries for completeness and accuracy compared to the original reports. Summaries were rated on a scale of 1 to 3: 1) summaries that were incorrect or incomplete, potentially providing harmful or confusing information; 2) summaries that were mostly correct and complete, unlikely to cause confusion or harm; and 3) summaries that were entirely correct and complete. RESULTS: All 60 responses met the criteria for word count and readability. Mean ratings for accuracy were 2.58 for reader 1, 2.71 for reader 2, and 2.77 for reader 3. Mean ratings for completeness were 2.87 for reader 1 and 2.73 for reader 2 and 2.87 for reader 3. For accuracy, reader 1 identified three summaries as a 1, reader 2 identified one, and reader 3 identified none. For the two primary readers, inter-reader agreement was low for accuracy (kappa 0.33) and completeness (kappa 0.29). There were no statistically significant changes in inter-reader agreement when the third reader's ratings were included in analysis. CONCLUSION: Overall ratings for accuracy and completeness of the AI-generated layperson report summaries were high with only a small minority likely to be confusing or inaccurate. This study illustrates the potential for leveraging generative AI, such as ChatGPT-4, to automate the production of patient-friendly summaries for musculoskeletal MR imaging.

Arthrocentesis of suspected septic sternoclavicular arthritis: microbial yield and predictors of culture positivity.

OBJECTIVE: Evaluate the microbial yield and factors predicting culture positivity for image-guided arthrocentesis of suspected septic sternoclavicular (SC) arthritis. MATERIALS AND METHODS: An electronic health record search identified image-guided SC joint aspirations for suspected septic arthritis. Data was extracted by retrospective chart review including patient demographics, procedure characteristics, pre-procedure lab testing, joint culture results, final SC joint diagnoses and any effect of positive synovial cultures on subsequent antibiotic therapy. Factors associated with positive joint fluid cultures were assessed using a Chi-squared test for categorical predictors and logistic regression for continuous predictors. RESULTS: A total of 31 SC arthrocenteses met inclusion criteria with most (81%) performed using ultrasound guidance. Synovial fluid was successfully aspirated in 19/31 (61%) of cases, and in all other cases lavage fluid was successfully obtained. Synovial cultures were positive in 9/31 (29%) of cases. A final diagnosis of septic arthritis was assigned to 20/31 cases (65%) in which 9/20 (45%) had positive synovial cultures. There was no statistically significant association between synovial culture positivity and risk factors for septic arthritis, positive blood cultures, pre-aspiration antibiotics and whether synovial fluid or lavage fluid was cultured. Serum white blood cell count (WBC) and erythrocyte sedimentation rate (ESR) demonstrated statistically significant positive correlation with positive synovial cultures. CONCLUSION: Arthrocentesis is effective for microbial speciation in SC septic arthritis, and diagnostic yield may be increased with lavage when encountering a dry tap. Normal serum WBC and ESR values indicate an extremely low likelihood of positive synovial cultures.

The effects of various retention factors on the choice of where rural origin Umthombo Youth Development Foundation health science graduates work.

INTRODUCTION: South Africa has an inequitable distribution of health workers between the public and private sector, with rural areas being historically underserved. As rural background of health workers has been advocated as the strongest predictor of rural practice, the Umthombo Youth Development Foundation (UYDF) has invested in recruiting and training rural-origin health science students since 1999 as a way of addressing staff shortages at 15 district hospitals in northern KwaZulu-Natal Province, South Africa. UYDF's intervention is to support students to overcome their academic, social, and economic challenges and expose them annually to rural health practice. This study investigated the effects of various retention factors on the choice of where rural-origin UYDF graduates worked, namely in rural or urban, public or private settings. METHODS: An online survey was developed containing questions relevant to the retention of health workers and included: personal satisfaction; hospital resources and employment factors; professional development and support; and community integration, as well as the reasons for working where they do. Of the 317 eligible health science graduates invited to participate, 139 (44%) responded. Descriptive statistics were compiled. RESULTS: Forty-nine percent of graduates were working at a rural public healthcare facility (PHCF), followed by 34% at an urban PHCF, and 11% in the private sector. All the respondents, wherever they worked, reported positively on their work, management support, colleagues, and ability to practise their skills. Graduates working at rural PHCFs reported that patient care was sometimes compromised due to lack of equipment or medicines, with staff shortages being greater than at urban PHCFs. All the graduates reported that they had insufficient time to interact with peers regarding difficult cases, while those at rural PHCFs lacked access to senior staff or specialists compared to those working at urban PHCFs or urban private practice. Lack of professional development opportunities was reported by graduates at rural PHCFs as a reason they may leave, while those at urban PHCFs cited the intention to specialise. Graduates no longer working at a rural hospital reported that the lack of funded posts at rural PHCFs was the main reason (39%), followed by the desire to specialise (29.6%). Graduates working at rural PHCFs cited the 'ability to serve their community' and being 'close to family and friends' as the main reason for working where they do, whereas those working at urban PHCFs cited 'good work experience'. CONCLUSION: While nearly half of the rural-origin UYDF graduates surveyed continue to work in rural areas, this is considerably less than previously reported, indicating that rural-origin health workers are affected by retention factors. The lack of funded posts at rural PHCFs is a major barrier to the employment and retention of health workers, and to addressing the unequal distribution of health workers between urban and rural PHCFs. This requires commitment from government and other role players to increase the attraction and retention of health workers in rural areas. Focusing on the recruitment of rural students to become health workers, in the absence of adequate retention policies, is insufficient to adequately address shortages of staff at rural PHCFs, as rural-origin graduates will move from rural PHCFs to facilities where they can access these benefits.

Indomethacin with or without prophylactic pancreatic stent placement to prevent pancreatitis after ERCP: a randomised non-inferiority trial.

BACKGROUND: The combination of rectally administered indomethacin and placement of a prophylactic pancreatic stent is recommended to prevent pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) in high-risk patients. Preliminary evidence suggests that the use of indomethacin might eliminate or substantially reduce the need for stent placement, a technically complex, costly, and potentially harmful intervention. METHODS: In this randomised, non-inferiority trial conducted at 20 referral centres in the USA and Canada, patients (aged ≥18 years) at high risk for post-ERCP pancreatitis were randomly assigned (1:1) to receive rectal indomethacin alone or the combination of indomethacin plus a prophylactic pancreatic stent. Patients, treating clinicians, and outcomes assessors were masked to study group assignment. The primary outcome was post-ERCP pancreatitis. To declare non-inferiority, the upper bound of the two-sided 95% CI for the difference in post-ERCP pancreatitis (indomethacin alone minus indomethacin plus stent) would have to be less than 5% (non-inferiority margin) in both the intention-to-treat and per-protocol populations. This trial is registered with ClinicalTrials.gov (NCT02476279), and is complete. FINDINGS: Between Sept 17, 2015, and Jan 25, 2023, a total of 1950 patients were randomly assigned. Post-ERCP pancreatitis occurred in 145 (14·9%) of 975 patients in the indomethacin alone group and in 110 (11·3%) of 975 in the indomethacin plus stent group (risk difference 3·6%; 95% CI 0·6-6·6; p=0·18 for non-inferiority). A post-hoc intention-to-treat analysis of the risk difference between groups showed that indomethacin alone was inferior to the combination of indomethacin plus prophylactic stent (p=0·011). The relative benefit of stent placement was generally consistent across study subgroups but appeared more prominent among patients at highest risk for pancreatitis. Safety outcomes (serious adverse events, intensive care unit admission, and hospital length of stay) did not differ between groups. INTERPRETATION: For preventing post-ERCP pancreatitis in high-risk patients, a strategy of indomethacin alone was not as effective as a strategy of indomethacin plus prophylactic pancreatic stent placement. These results support prophylactic pancreatic stent placement in addition to rectal indomethacin administration in high-risk patients, in accordance with clinical practice guidelines. FUNDING: US National Institutes of Health.

TARGET: A Phase II, Open-Label, Single-Arm Study of 5-Year Adjuvant Osimertinib in Completely Resected EGFR-Mutated Stage II to IIIB NSCLC Post Complete Surgical Resection.

INTRODUCTION: Osimertinib is a central nervous system (CNS)-active, third generation, irreversible, epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) that potently and selectively inhibits EGFR-TKI sensitizing and EGFR T790M resistance mutations, with demonstrated efficacy in EGFR-mutated (EGFRm) non-small cell lung cancer (NSCLC). We present the rationale and design for TARGET (NCT05526755), which will evaluate the efficacy and safety of 5 years of adjuvant osimertinib in patients with completely resected EGFRm stage II to IIIB NSCLC. MATERIALS AND METHODS: TARGET is a phase II, multinational, open-label, single-arm study. Adults aged ≥18 years (Taiwan ≥20 years), with resected stage II to IIIB NSCLC are eligible; prior adjuvant chemotherapy is allowed. Eligible patients must have locally confirmed common (exon 19 deletion or L858R) or uncommon (G719X, L861Q, and/or S768I) EGFR-TKI sensitizing mutations, alone or in combination. Patients will receive osimertinib 80 mg once daily for 5 years or until disease recurrence, discontinuation or death. The primary endpoint is investigator-assessed disease-free survival (DFS) at 5 years (common EGFR mutations cohort). Secondary endpoints include: investigator-assessed DFS at 3 and 4 years; overall survival at 3, 4, and 5 years (common EGFR mutations cohort); DFS at 3, 4, and 5 years (uncommon EGFR mutations cohort); safety and tolerability, type of recurrence and CNS metastases (both cohorts). Exploratory endpoints include: tissue/plasma concordance; analysis of circulating molecules in plasma samples using different profiling approaches to detect minimal residual disease; incidence and change over time of incidental pulmonary nodules. RESULTS: TARGET is currently recruiting, and completion is expected in 2029.

Prevalence and Impact of Workplace Sexual Harassment Experienced by Medical Sonographers.

OBJECTIVE: To assess the prevalence and impact of sexual harassment among a nationwide sample of medical sonographers. METHODS: A survey was distributed anonymously to a convenience sample of medical sonographers via email contacts and sonographer-specific social media pages. Data were analyzed to determine respondent demographics, the prevalence of sexual harassment in the last 2 years, the type and severity of harassment experienced, demographics of perpetrators, personal and institutional responses to such experiences, and the impact of sexual harassment on sonographer physical and mental health and job satisfaction. RESULTS: Of the 220 sonographers (83% female) most (45%) were between 18 and 34 years and identified as white (81%). A total of 192 (87%) reported experiencing at least 1 incident of harassment within the last 2 years. Female respondents experienced higher harassment rates (76%) compared to males (50%, P = .02). The most common forms of harassment were verbal, including suggestive or sexist jokes (69%) and offensive sexist remarks (61%). Perpetrators were predominantly male (78%) and most commonly patients (89%) or their friends/family members (46%). The majority of respondents either ignored the harassing behavior (70%) or treated it like a joke (50%), with only a minority (12%) officially reporting incidents. Of those who reported, 44% were unsatisfied with their institution's response. Among respondents, 34% reported negative impacts of workplace sexual harassment, such as anxiety, depression, sleep loss, or adverse workplace consequences. DISCUSSION: Workplace sexual harassment is a common occurrence for sonographers and often leads to negative health and career outcomes. Further institutional policies to prevent harassment and mitigate its effects are needed.

Assessing AI-Powered Patient Education: A Case Study in Radiology.

RATIONALE AND OBJECTIVES: With recent advancements in the power and accessibility of artificial intelligence (AI) Large Language Models (LLMs) patients might increasingly turn to these platforms to answer questions regarding radiologic examinations and procedures, despite valid concerns about the accuracy of information provided. This study aimed to assess the accuracy and completeness of information provided by the Bing Chatbot-a LLM powered by ChatGPT-on patient education for common radiologic exams. MATERIALS AND METHODS: We selected three common radiologic examinations and procedures: computed tomography (CT) abdomen, magnetic resonance imaging (MRI) spine, and bone biopsy. For each, ten questions were tested on the chatbot in two trials using three different chatbot settings. Two reviewers independently assessed the chatbot's responses for accuracy and completeness compared to an accepted online resource, radiologyinfo.org. RESULTS: Of the 360 reviews performed, 336 (93%) were rated "entirely correct" and 24 (7%) were "mostly correct," indicating a high level of reliability. Completeness ratings showed that 65% were "complete" and 35% were "mostly complete." The "More Creative" chatbot setting produced a higher proportion of responses rated "entirely correct" but there were otherwise no significant difference in ratings based on chatbot settings or exam types. The readability level was rated eighth-grade level. CONCLUSION: The Bing Chatbot provided accurate responses answering all or most aspects of the question asked of it, with responses tending to err on the side of caution for nuanced questions. Importantly, no responses were inaccurate or had potential to cause harm or confusion for the user. Thus, LLM chatbots demonstrate potential to enhance patient education in radiology and could be integrated into patient portals for various purposes, including exam preparation and results interpretation.

Secondary Postoperative Hemorrhage in the Pediatric Tonsillectomy Patient- is there a correlation between hemorrhage and tonsilloliths?

INTRODUCTION: Tonsillectomy with or without adenoidectomy is one of the most common ambulatory procedures performed in children under 15. One rare yet serious complication of tonsillectomy is postoperative hemorrhage. Chronic tonsillitis, which is an indication for tonsillectomy, has been shown to have an increased risk for postoperative hemorrhage. Tonsilloliths or tonsil stones have been associated with cryptic tonsillitis. This 2020-2021 study examined whether tonsilloliths were a risk factor for post-tonsillectomy hemorrhage in a convenience sample of 187 pediatric patients. METHODS: This was a cross-institutional 12-month retrospective cohort study investigating pediatric patients who had undergone tonsillectomy. Exclusion criteria included patients who had received prior airway surgeries (e.g., supraglottoplasty), patients with significant comorbidities such as chromosomal abnormalities or congenital disorders, and patients with pre-existing bleeding disorders. Demographic, clinical, and operative data was extracted from each chart. Postoperative adverse events and bleeding were also recorded. These factors were then compared between the tonsillolith and no tonsillolith patient groups. RESULTS: A total of 187 pediatric patients met the inclusion criteria. Seventy-three (39%) of the patients had tonsilloliths and 114 (61%) did not have tonsilloliths at the time of surgery. The tonsillolith subgroup had a higher median age (10 vs 3, P < 0.001) when compared to the no tonsillolith subgroup. The most common indication for tonsillectomy was obstructive sleep apnea/sleep disordered breathing (N= 148, 79.1%). There was no statistical difference found between presence of tonsillolith and indication for surgery (P = 0.06). Only five (2.7%) of sample patients experienced postoperative bleeding and there was no association found between postoperative bleeding and presence of tonsilloliths (P = 0.38). CONCLUSION: In the current study there was no association found between the presence of tonsilloliths (indicating low grade chronic inflammation) and hemorrhage after tonsillectomy. Continued larger sample evaluations of possible risk factors for post-tonsillectomy hemorrhage patterns are encouraged.

Interventions to improve young men's utilisation of HIV-testing services in KwaZulu-Natal, South Africa: perspectives of young men and health care providers.

Introduction: HIV-testing services (HTS) are an important point of entry to prevention and treatment of HIV in South Africa. Despite the availability of HTS across the region and in SA, the uptake among men remains low, especially young men residing in rural and peri-urban communities. This study aimed to explore interventions that could improve the uptake of HTS among young men in KwaZulu-Natal.Methods: A descriptive exploratory qualitative study was conducted in which 17 young men and two health care providers in Ladysmith were purposively and conveniently sampled. Data were collected through semi-structured interviews using WhatsApp and landline audio calls between September and December 2021 and thematically analysed.Results: An improvement in the health care provider attitudes and service delivery, establishment of adherence clubs for young people living with HIV, ensuring a diverse and balanced health care provider staff composition at primary health care facilities, and increased demand creation in spaces frequented by men are vital for enhancing access and utilisation of HTS among young men. Additionally, health care providers believe that the presence of male health care providers, investment in health education, prioritising men in the morning at the primary health care facilities, and the establishment of male clinics within communities as key factors in improving the uptake of HTS among young men.Conclusion: To attract and retain young men in HTS and in HIV treatment and care, several improvements at primary health care facilities need to be implemented. These should focus on addressing the specific needs and preferences of young men, ensuring their comfort and engagement in health care.

Interpersonal Mechanisms Between Child Maltreatment Timing and Young Adult Internalizing and Externalizing Symptomatology.

OBJECTIVE: Children who experience maltreatment are prone to exhibit interpersonal deficits and lack secure attachment, which can lead to internalizing and externalizing symptomatology. This study investigated timing and chronicity of maltreatment and its impacts on psychopathology outcomes in young adulthood. Two interpersonal mediators were examined: problems with peers and childhood attachment security. METHOD: Children with and without maltreatment exposure were recruited to take part in a 1-week research summer camp (N = 697; mean [SD] age = 11.29 [0.97] years; 71.3% Black or African American; 50.5% male). Participants were recontacted in young adulthood to complete a second wave of assessments (n = 427; mean [SD] age = 19.67 [1.16] years; 78.0% Black or African American; 48.9% male). Structural equation modeling was used to estimate indirect effects from child maltreatment timing to young adult internalizing and externalizing symptomatology via childhood attachment security and peer problems. RESULTS: Findings highlighted the detrimental impact of chronic maltreatment, which was associated with higher levels of peer problems (ß = .24, p < .001) and less secure attachment (ß = -.13, p < .01) in childhood. Also, lower attachment quality in childhood mediated the association between chronic maltreatment and self-reported internalizing (a × b = 0.02, p < .05) and externalizing symptomatology (a × b = 0.02, p < .05). Additionally, childhood peer problems mediated the association between chronic maltreatment and caregiver-reported internalizing problems (a × b = 0.04, p < .05). CONCLUSION: Chronic maltreatment is particularly harmful for interpersonal outcomes of children. Mediation findings differed by who reported on psychopathology, showing the importance of considering multireporter measures of psychopathology.

Domoic acid in Canadian Pacific waters, from 2016 to 2021, and relationships with physical and chemical conditions.

Domoic acid, a phycotoxin produced by species of the marine diatom Pseudo-nitzschia, can cause deleterious impacts to marine food webs and human health. Domoic acid and Pseudo-nitzschia spp. were surveyed from 2016 to 2021 in the Pacific waters of Canada to assess their occurrences, concentrations, and relationships with physical and chemical conditions. Domoic acid was common, occurring in measurable concentrations in 73 % of the 454 samples. It occurred in all regions (west coast of Vancouver Island, Salish Sea, Queen Charlotte Sound / Hecate Strait, deep oceanic NE Pacific), in all years and all seasons. Median concentrations were highest along the west coast of Vancouver Island, and lowest in the oceanic waters of the NE Pacific. Winter had the lowest concentrations; no significant differences occurred between spring, summer, and autumn. High domoic acid concentrations equal to or above 100 ng/L were not common, occurring in about 5 % of samples, but in all seasons and all years except 2019. All six Pseudo-nitzschia taxa identified had similar median concentrations, but different frequencies of occurrence. P. cf. australis appeared to be the major contributor to high concentrations of domoic acid. Physico-chemical conditions were described by ten variables: temperature, salinity, density difference between 30 m and the surface (a proxy for vertical stability), chlorophyll a, nitrate, phosphate, silicate, and the ratios nitrate:phosphate, nitrate:silicate, and silicate:phosphate. Statistical analyses, using general linear models, of their relationships with the absence/presence of Pseudo-nitzschia spp. found silicate (negative) to be the most influential variable common in both the west coast of Vancouver Island and Salish Sea regions. Temperature and chlorophyll a were the most influential variables which determined the log10 abundance of Pseudo-nitzschia spp. in both regions. Analyses of the absence/presence of particulate domoic acid per Pseudo-nitzschia cell (excluding P. americana) found chlorophyll a to be the most influential variable common in both regions, whereas no common influential variable determined the log10 concentration of particulate domoic acid per Pseudo-nitzschia cell (excluding P. americana). These results were generally similar to those of other studies from this area, although this study extends these findings to all seasons and all regions of Canada's Pacific waters. The results provide important background information against which major outbreaks and unusual events can be compared. A domoic acid surveillance program during synoptic oceanographic surveys can help to understand where and when it reaches high concentrations at sea and the potential impacts to the marine ecosystem.

Simultaneous determination of steroid hormones and pharmaceuticals in killer whale (Orcinus orca) faecal samples by liquid chromatography tandem mass spectrometry.

We describe a non-invasive method for profiling selected hormones, pharmaceuticals and personal care products (PPCPs) in killer whales (Orcinus orca) based on analysis of faecal samples by liquid chromatography tandem mass spectrometry (LC-MS/MS). The method targets 21 compounds of interest including glucocorticoids, mineralocorticoids, androgens, estrogens, progestogens, selective serotonin uptake inhibitors and an antibacterial/antifungal agent. This method is suitable for routine simultaneous determination of target compounds in killer whale faecal samples as well as validation of immunoassays for the detection and measurement of steroid hormones in faeces. The optimized method involves extraction of freeze-dried faecal material with reagent alcohol and water followed by isolation of the analytes using solid phase extraction with hydrophilic-lipophilic balance cartridges and liquid-liquid extraction with methyl tertiary-butyl ether. Reconstituted extracts were analysed by LC-MS/MS using an electrospray ionization interface. Method limit of quantification ranged from 0.06 to 45.2 ng/g in freeze-dried faecal samples. Except for sertraline, triclosan and estradiol (which was not recovered at the lowest spiked concentration), average intra- and inter-day precisions were within 10%, and average recoveries were between 89.3% and 129.3%, for faecal samples spiked with 5.3, 26.7 or 133 ng/g of each analyte. The method was applied successfully to the analysis of hormones and PPCPs in whale faeces during which 17α-hydroxyprogesterone, a common intermediate in steroid biosynthesis that cross-reacts with precursors and sulphated conjugates in immunoassays, was identified and quantified in all samples.