Small-scale Arctic charr Salvelinus alpinus fisheries in Canada's Nunavut: management challenges and options.

The Arctic charr Salvelinus alpinus is a diverse and abundant resource in Canada's Nunavut. The anadromous form is primarily targeted by exploitation in small-scale fisheries. The continued importance of subsistence fisheries and growing interest in further developing commercial fisheries underline the need for proper management of S. alpinus in northern Canada. This paper presents the current state of S. alpinus fisheries in Nunavut and related management challenges. An alternate framework for assessment using life-history information as it determines stock productivity and resilience to harvesting is presented. This framework combines (1) a risk assessment tool [productivity-susceptibility analysis (PSA)] to evaluate the relative vulnerability of S. alpinus stocks to harvest and (2) a conceptual model for quantitative assessment to determine sustainable harvest levels. Diversity in S. alpinus life history and contrast in vulnerability scores derived from PSA assessment are demonstrated for a sample of 86 anadromous stocks from throughout Nunavut. These data provide evidence in support of an alternate strategy for assessment permitting to integrate diversity in S. alpinus life history for improved generalization and representativeness. Salvelinus alpinus fisheries in Arctic regions exemplify the need for stock assessment and management alternatives to ensure fish conservation in remote, sensitive ecosystems and in data-poor circumstances.

Patterns in Pediatric Dental Surgery under General Anesthesia across 7 State Medicaid Programs.

OBJECTIVES: Children's access to dental general anesthesia (DGA) is limited, with highly variable wait times. Access factors occur at the levels of facility, dental provider, and anesthesia provider. It is unknown if these factors also influence utilization of dental surgery. We characterized patterns in DGA utilization by system, provider, population, and individual disease levels to explain variation. METHODS: We conducted a cross-sectional analysis of Medicaid-enrolled children (≤9 y) who received DGA in Massachusetts, Maryland, Texas, Connecticut, Washington, Illinois, and Florida from 2011 to 2012. DGA events were characterized by the place of service, measures of disease burden, average reimbursements for dental provider and anesthesia provider, and average total expenditures. RESULTS: A total of 10,149,793 children met study eligibility criteria. States with similar patterns of caries-related visits, such as Illinois (16% of Medicaid enrollees had a caries-related claim) and Washington (22%), had different DGA rates (1% and 17%, respectively). Reimbursement rates for dental providers, DGA services, and nonhospital places of services did not consistently align in states with higher DGA rates. Surgical extraction rates, as a proxy for the most severe disease, exceeded 75% in Maryland, which had the lowest DGA rate (0.3%). CONCLUSIONS: Variation in DGA rates across states was not explained by reimbursements rates (provider, DGA services, place of service) or population or individual level of caries burden. Efforts to evaluate and alter utilization of DGA should consider factors such as dental and anesthesia provider capacity, health facility capacity (hospital vs. ambulatory surgery center vs. office), and population- and individual-level disease burden. Our negative findings suggest the presence of other social determinants of oral health that influence utilization of services (e.g., race/ethnicity, language preference, immigration status, policy and budget goals), which should be explored. Our findings also raise the specter that variation in surgical rates may represent instances of unmet needs or overtreatment. KNOWLEDGE TRANSFER STATEMENT: The results of this study can be used by clinicians and policy makers as they address policy and clinical interventions to influence children with severe caries. Interventions to change utilization of surgical services on a population level may need to include state-specific factors that extend beyond reimbursement, disease burden, anesthesia provider type, or facility type.

Disparities in Emergency Department Pain Treatment for Toothache.

Racial disparities in how pain is treated in the emergency department (ED) for toothache have not been reported. Due to increasing reliance on EDs for dental care, the authors investigated whether race/ethnicity and insurance type are associated with treatment for toothache pain. The authors conducted a nationally representative cross-sectional study of ED toothache visits by adults (19 to 64 y old), using the 2008-2010 National Hospital Ambulatory Medical Care Survey. Multinomial regression models accounted for the complex survey design. Outcomes were pain medicines received: none, nonopioid only, or opioids. After adjusting for sociodemographic factors, black patients had 1.99 greater odds (P < 0.005) than white patients of receiving only a nonopioid pain medicine for toothache. Visits made by patients on Medicare, Medicaid, uninsured, or "other" insurance status had greater odds than the privately insured of receiving only a nonopioid pain medicine rather than an opioid (odds ratios, respectively: 4.8, P < 0.001; 2.1, P ≤ 0.001; 2.3, P < 0.01; and 4.1, P < 0.001). Blacks are less likely than whites to receive opioids in the ED for a toothache, even with similar levels of pain. Nonprivately insured patients have lower odds than the privately insured to receive opioids for toothache pain. A better understanding of the etiology of these disparities could lead to directed interventions. Knowledge Transfer Statement: This study presents findings novel to the body of pain and oral health care literature. Because there is an increasing reliance on the emergency department to address dental pain, disparities in how toothache pain is treated will be of great interest to a growing number of Americans, clinicians, and policy makers.

Cytotoxic fungal spores in the indoor atmosphere of the damp domestic environment.

Eight-three fungal isolates collected and cultured from the air spora of damp public sector Scottish housing have been screened for cytotoxic properties. A bioassay procedure has been utilised for this purpose involving cytotoxic effects on human embryonic diploid fibroblast lung cells grown as monolayer cultures within the wells of microtitre plates. The MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] biochemical assay system employed has revealed that 39 (47%) of the moulds investigated possessed spore-associated cytotoxic properties; a value which emphasises the potential health hazards of the continual inhalation of toxigenic fungal propagules by occupants of mouldy houses. Penicillia, the most prevalent fungi found in the internal atmosphere of the domestic environment, accounted for the great majority of cytotoxic strains identified.

Intracardiac transplantation of skeletal myoblasts yields two populations of striated cells in situ.

BACKGROUND: Adult heart lacks stem cells and cannot effectively regenerate. In contrast, skeletal muscle is constantly undergoing repair. We proposed to transplant immature skeletal myoblasts into injured myocardium. METHODS: Approximately 7x10(6) soleus skeletal myoblasts were expanded in vitro from adult New Zealand White rabbits (n = 23) whose posterior left ventricle was cryoinjured to create a transmural lesion. Autologous myoblasts (n = 18) or saline (n = 5) was transplanted into the central cryolesion at the time of injury (n = 6) or 1 week later (n = 12). Hearts were harvested 2 weeks after injection. RESULTS: Myoblast transfer did not incur further morbidity. After cryolesion, grossly, a 1.6-cm epicardial hemorrhagic lesion could be seen. Histologically, the transmural lesion contained inflammatory cells and active scarring but no viable cardiomyocytes. Electron microscopy demonstrated a predominance of collagen and fibroblasts. Nine hearts contained multinucleated cells within the cryolesion that covered approximately 75% of the central cryolesion in 17% of animals. Immunohistochemical analysis confirmed their skeletal muscle origin. At the periphery of the lesion, isolated clusters of nonskeletal muscle cells could be visualized (n = 12) that resembled immature cardiocytes. CONCLUSIONS: Autologous skeletal myoblasts can regenerate viable striated tissue within damaged myocardium. Myoblast transfer warrants further investigation as a new method for improving myocardial performance within infarcted myocardium.

Tinea nigra palmaris. Treatment with thiabendazole topically.

A patient had tinea nigra palmaris that had not responed to toinaftate or salicylic acid ointment during a period of seven years. Thiabendazole suspension, 10 percent applied twice daily, cleared the lesion in two weeks.

Contact dermatitis to homomenthyl salicylate.

Two patients with follicular dermatitis were found to have a contact sensitivity to homomenthyl salicylate, a sunscreening chemical present in a commercially available suntan lotion. One patient did not use the product, but her boyfriend did, and contact between the two individuals resulted in a follicular dermatitis developing in her. A second patient with contact dermatitis to homomenthyl salicylate also had a follicular eruption. Both patients appear to represent true allergic sensitivities.

Hereditary hemorrhagic telangiectasia with cerebrovascular malformations.

Three cases of hereditary hemorrhagic telanglectasia (HHT) with cerebrovascular malformation are presented. Previous reports of HHT have given little attention to its association with cerebrovascular malformation, despite frequent neurological symptoms in patients with HHT. Eleven other cases of HHT with neuropathologic or radiographic evidence of cerebrovascular malformation have been reported in the literature. We think that this association may be more frequent than previously suspected. The subtlety of the symptoms in HHT is stressed, and it is suggested that patients with cerebrovascular malformation be examined carefully for HHT, and vice versa.

Skin lesions in paroxysmal nocturnal hemoglobinuria.

Paroxysmal nocturnal hemoglobinuria (PNH) is an uncommon hemolytic anemia that rarely manifests skin lesions. Leg ulcers and purpura similar to the manifestation of thrombotic thrombocytopenic purpura (TTP); disseminated intravascular coagulation, and Henoch-Schönlein purpura do occur. This is the second known case report of PNH with histopathologic features of TTP. Clinically, our patient's condition resembled TTP with disseminated intravascular platelet aggregation, and she followed a nonfulminant course. She improved on a regimen of systemic steroids, dipyridamole, and cessation of antibiotics.

Reliability testing of the dermatology index of disease severity (DIDS). An index for staging the severity of cutaneous inflammatory disease.

OBJECTIVES: To describe a new severity of illness index for inflammatory skin disease called the Dermatology Index of Disease Severity (DIDS), and to show its preliminary use and reliability in staging disease in patients with psoriasis and dermatitis. DESIGN: Interobserver rating study using the DIDS with as many as 10 observers independently rating the same patient at a single point in time. SETTING: Ambulatory care clinics at an academic medical center with patients from various socioeconomic backgrounds. PATIENTS: Thirty-four patients with psoriasis and 15 patients with dermatitis were included in the study. MAIN OUTCOME MEASURES: The severity of illness for each patient was rated as 1 of 5 stages: 0, no evidence of clinical disease; I, limited disease; II, mild disease; III, moderate disease; and IV, severe disease. The degree of interobserver concordance was measured by the Cohen kappa statistic. RESULTS: All 5 stages were represented in the study of patients with psoriasis. The overall kappa statistic was 0.76, which is defined as substantial interobserver concordance. The use of the instrument in dermatitis showed good consensus in staging, where the kappa statistic was 0.41. CONCLUSION: We introduce an easy and efficient instrument for staging the severity of illness in inflammatory cutaneous diseases. The reliability of the DIDS is demonstrated in patients with psoriasis and in patients with dermatitis.

Assessment of the Frank-Starling relationship by two-dimensional echocardiography.

The Frank-Starling relationship between left ventricular stroke work and end-diastolic minor-axis cross-sectional area was evaluated as a load-insensitive measure of inotropic state by two-dimensional echocardiography in 10 conscious dogs. Stroke work was calculated as the product of systolic change in cross-sectional area and either (1) beat-to-beat mean arterial pressure or (2) initial systolic blood pressure. Both Frank-Starling relationships were highly linear during preload variation (mean r = 0.96), sensitive to the inotropic state (slope increase with calcium 51% +/- 43% and 62% +/- 53%, respectively), and insensitive to afterload (r < 0.4, slope or x intercept versus afterload). Thus the Frank-Starling relationships derived from two-dimensional echocardiographic images and peripheral arterial pressure may be a useful and practical means of assessing inotropic state with minimally invasive measurements.

Drug-nutrient interactions in three long-term-care facilities.

OBJECTIVE: To assess the risk of drug-nutrient interactions (DNIs) in three long-term-care facilities. DESIGN: Retrospective audit of charts. SETTING: Three long-term-care facilities in central New York State. SUBJECTS: Fifty-three patients selected randomly from each facility. MEASUREMENT: Data were collected from the medical record of each patient for a period of 6 months. A computerized algorithm was used to assess the risk for DNIs. Mean drug use, most frequently consumed drugs, incidence of potential DNIs, and the most commonly observed potential DNIs are reported. RESULTS: In facilities A, B, and C, respectively, patients consumed a mean of 4.86, 4.04, and 5.27 drugs per patient per month and were at risk for a mean of 1.43, 2.69, and 1.43 potential DNIs per patient per month. The most commonly observed potential DNIs were gastrointestinal interactions affecting drug bioavailability and interactions affecting electrolyte status. CONCLUSIONS: Patients in long-term-care facilities, who are primarily elderly and chronically ill and who consume multiple medications, are at notable risk for certain DNIs. Efforts need to be made to ensure appropriate pharmacologic and nutrition therapies as well as adequate and timely monitoring of patients in these facilities. Dietitians can play an important role in training other health professionals and in designing policies to prevent DNIs.

Sources of air pollutants indoors: VOC and fine particulate species.

The average concentrations of a large number of fine particle aerosol and VOC species measured in ten Boise, Idaho, residences in wintertime have been apportioned according to their contributions from all inside sources and all outside sources, regarded as two composite source categories. Air change rates for the residences were in the range 0.2-0.8 hr-1. None of the residences had obvious major indoor sources (smokers, woodburning appliances, etc.). The two category apportionment was accomplished through use of the single chamber mass balance indoor air quality model given by Dockery and Spengler. The method depends on the availability of average concentrations measured outside each residence during the same sampling periods used for the inside measurements, and on the ability to identify one or more species that have negligible indoor sources. Calculated infiltration factors (the indoor/outdoor ratio in the absence of indoor sources) for fine particle species averaged 0.5, and varied in a reasonably way with measured air change rates, essentially independent of species. Infiltration factors for the VOCs were indistinguishable from unity. The relative importance of indoor and outdoor sources to measured indoor concentrations showed great variation between species and between residences. In most homes the indoor source contribution was dominant for fine particle Si, Ca, and Fe, while the infiltration contribution was dominant for S, K, Pb, Zn, mass, and extractable organic matter. Indoor contributions to individual VOCs were frequently very large at a few residences and negligible at the others.

Invisible dermatoses.

An invisible dermatosis is defined as a skin disease manifesting no clinically apparent lesion but histologic changes of a characteristic nature. An example of an invisible form of transient acantholytic dermatosis is presented. Invisible forms of pseudoxanthoma elasticum, sarcoidosis, lepromatous leprosy, and lichen planus are reviewed. Dermal deposits may also be found on biopsy of clinically normal skin in amyloidosis, Hunter's and Hurler's syndromes, and thyroid disease.

Candidiasis seminar.

This is a review of candidiasis from its historical, epidemiologic aspect through the laboratory diagnoses, precipitating factors and the more common diseases caused by Candida. Therapeutic modalities available are listed and specific guidelines for therapy are demonstrated.

An exploratory look at hydrocarbon data from the Photochemical Assessment Monitoring Stations network.

This paper describes some characteristics of speciated nonmethane organic compound (NMOC) data collected in 1994 at five Photochemical Assessment Monitoring Stations (PAMS) and archived in the U.S. Environmental Protection Agency's Aerometric Information Retrieval System (AIRS). Topics include data completeness, distribution of individual NMOCs in concentration categories relative to minimum detectable levels, percentage of total NMOC associated with the sum of the 55 PAMS target compounds, and use of scatterplots to diagnose chromatographic misidentification of compounds. This is an early examination of a database that is expanding rapidly, and the insights presented here may be useful to both the producers and future users of the data for establishing consistency and quality control.

A pityriasis rosea-like eruption secondary to bacillus Calmette-Guérin therapy for bladder cancer.

The use of bacillus Calmette-Guérin (BCG) for the treatment of bladder cancer has been followed by reports documenting adverse reactions. Eruptions of the skin have been included (although not well described) in the list of side effects. We report a pityriasis rosea-like rash secondary to BCG therapy for bladder cancer. Although the treatment was interrupted because of this reaction, the medication was restarted later with only a mild transient recurrence of the eruption.

Management of pseudofolliculitis barbae.

Pseudofolliculitis barbae is a common dermatologic conditions primarily affecting black men who shave closely on a regular basis. Figures cited in the literature indicate 10 to 83% of black men have some form of it. Commonly encountered in the military, pseudofolliculitis barbae has caused significant problems in all commands, both medically and administratively. This article will review the pathogenesis of pseudofolliculitis barbae and provide a variety of treatment modalities. Proper treatment is essential to avoid unnecessary scarring, pigmentation, and keloid formation.

Damp housing, mould growth, and symptomatic health state.

OBJECTIVE: To examine the relation between damp and mould growth and symptomatic ill health. DESIGN: Cross-sectional study of random sample of households containing children; separate and independent assessments of housing conditions (by surveyor) and health (structured interview by trained researcher). SETTING: Subjects' homes (in selected areas of public housing in Glasgow, Edinburgh, and London). SUBJECTS: Adult respondents (94% women) and 1169 children living in 597 households. END POINTS: Specific health symptoms and general evaluation of health among respondents and children over two weeks before interview; and score on general health questionnaire (only respondents). MEASUREMENTS AND MAIN RESULTS: Damp was found in 184 (30.8%) dwellings and actual mould growth in 274 (45.9%). Adult respondents living in damp and mouldy dwellings were likely to report more symptoms overall, including nausea and vomiting, blocked nose, breathlessness, backache, fainting, and bad nerves, than respondents in dry dwellings. Children living in damp and mouldy dwellings had a greater prevalence of respiratory symptoms (wheeze, sore throat, runny nose) and headaches and fever compared with those living in dry dwellings. The mean number of symptoms was higher in damp and mouldy houses and positively associated with increasing severity of dampness and mould (dose response relation). All these differences persisted after controlling for possible confounding factors such as household income, cigarette smoking, unemployment, and overcrowding. Other possible sources of bias that might invalidate the assumption of a causal link between housing conditions and ill health--namely, investigator bias, respondent bias, and selection bias--were also considered and ruled out. CONCLUSION: Damp and mouldy living conditions have an adverse effect on symptomatic health, particularly among children.