Phytoplankton in the Damariscotta River Estuary

This research project examined the distribution of phytoplankton in the Damariscotta River, as well as environmental factors, such as nutrients, light, and physical conditions, in order to assess the estuary’s ability to sustain additional farms

Managing menopausal symptoms and associated clinical issues in breast cancer survivors

Objective: Review evidence to guide management of menopausal signs and symptoms in women after breast cancer and make recommendations accordingly. Evidence: Randomized controlled clinical trials, observational studies, evidence-based guidelines, and expert opinion from professional societies. Background: Symptoms and clinical problems associated with estrogen depletion—sleep disorders, vulvovaginal atrophy (VVA), vasomotor symptoms (VMS), mood changes, depressive symptoms, cardiovascular disease, osteopenia, and osteoporosis—confront the estimated 9.3 million breast cancer survivors globally. Recommendations: Following breast cancer, women should not generally be treated with menopausal hormone therapy or tibolone but should optimize lifestyle. Women with moderate to severe symptoms may benefit from mind–brain behavior or nonhormone, pharmacologic therapy. The selective serotonin/noradrenaline reuptake inhibitors and gabapentenoid agents improve VMS and quality of life. For osteoporosis, nonhormonal agents are available. Treatment of VVA remains an area of unmet need. Low-dose vaginal estrogen is absorbed in small amounts with blood levels remaining within the normal postmenopausal range but could potentially stimulate occult breast cancer cells, and although poorly studied, is not generally advised, particularly for those on aromatase inhibitors. Intravaginal dehydroepiandrosterone and oral ospemiphene have been approved to treat dyspareunia, but safety after breast cancer has not been established. Vaginal laser therapy is being used for VVA but efficacy from sham-controlled studies is lacking. Therapies undergoing development include lasofoxifene, neurokinin B inhibitors, stellate ganglion blockade, vaginal testosterone, and estetrol. Conclusions: Nonhormone options and therapies are available for treatment of estrogen depletion symptoms and clinical problems after a diagnosis of breast cancer. Individualization of treatment is essential

Measuring Changes in Local Surveillance and Investigation Capacity

Background: The outbreak of Ebola virus disease in West Africa and confirmation of the first cases in the United States highlight the need for robust and responsive public health surveillance system. With a 25% decline in funding since 2007, the impact on local surveillance capacities has not previously been described. Purpose: The Surveillance & Investigation domain of the Local Health Department Preparedness Capacities Survey (PCAS) was reweighted to reflect the national profile of LHDs. Changes in subdomain performance of capacities and the effect of population size on subdomain capacity performance were examined over time. Methods: Participating LHDs (n=208) from the PCAS sample were reweighted according to characteristics from the 2010 National Association of County and City Health Officials (NACCHO) Profile. Overall changes in preparedness capacity across four subdomains from 2010 to 2012 were tested for significant differences using a weighted t-test. A series of weighted least squares regression models were used to determine whether population size may have modified the temporal changes in preparedness capacity. Results: Significant declines were observed in the preparedness capacity in three of the four subdomains of Surveillance & Investigation. Results suggest that surveillance inputs from various sources, including hospitals, urgent care, poison control, pharmacies, and schools absentee reporting, especially for larger LHDs, may be more sensitive to changes or shifts over time versus others. Implications: Declines in preparedness capacity may have affected the ability of LHDs, particularly larger ones, to effectively respond to community preparedness needs and, specifically, the detection of highly communicable and novel disease events

Temporal Trends in Local Public Health Preparedness Capacity

Local health departments (LHDs) are essential to emergency preparedness and response activities. Since 2005, LHD resources for preparedness, including personnel, are declining in the face of continuing gaps and variation in the performance of preparedness activities. The effect of these funding decreases on LHD preparedness performance is not well understood. This study examines the performance of preparedness capacities among NC LHDs and a matched national comparison group of LHDs over three years. We observe significant decreases in five of eight preparedness domains from three years of survey data collected from 2010 through 2012. Most notably, we observe significant decreases in the Surveillance & Investigation domain. Performance decreases may be a result of continued, compounding declines in preparedness funding

Treatment of symptoms of the menopause: an endocrine society clinical practice guideline

Objective: The objective of this document is to generate a practice guideline for the management and treatment of symptoms of the menopause. Participants: The Treatment of Symptoms of the Menopause Task Force included six experts, a methodologist, and a medical writer, all appointed by The Endocrine Society. Evidence: The Task Force developed this evidenced-based guideline using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe the strength of recommendations and the quality of evidence. The Task Force commissioned three systematic reviews of published data and considered several other existing meta-analyses and trials. Consensus Process: Multiple e-mail communications, conference calls, and one face-to-face meeting determined consensus. Committees of The Endocrine Society, representatives from endorsing societies, and members of The Endocrine Society reviewed and commented on the drafts of the guidelines. The Australasian Menopause Society, the British Menopause Society, European Menopause and Andropause Society, the European Society of Endocrinology, and the International Menopause Society (co-sponsors of the guideline) reviewed and commented on the draft. Conclusions: Menopausal hormone therapy (MHT) is the most effective treatment for vasomotor symptoms and other symptoms of the climacteric. Benefits may exceed risks for the majority of symptomatic postmenopausal women who are under age 60 or under 10 years since the onset of menopause. Health care professionals should individualize therapy based on clinical factors and patient preference. They should screen women before initiating MHT for cardiovascular and breast cancer risk and recommend the most appropriate therapy depending on risk/benefit considerations. Current evidence does not justify the use of MHT to prevent coronary heart disease, breast cancer, or dementia. Other options are available for those with vasomotor symptoms who prefer not to use MHT or who have contraindications because these patients should not use MHT. Low-dose vaginal estrogen and ospemifene provide effective therapy for the genitourinary syndrome of menopause, and vaginal moisturizers and lubricants are available for those not choosing hormonal therapy. All postmenopausal women should embrace appropriate lifestyle measures

Evaluating Use of Custom Survey Reports by Local Health Departments

This report demonstrates how providing survey feedback, like comparative reports, to survey respondents can result in improvement activities. For each of the past three years (2010-2013), the North Carolina Institute for Public Health (NCIPH) has invited local health departments (LHDs) from 40 states to participate in a preparedness capacities survey. In addition, NCIPH fielded a six-question evaluation survey to a subset of LHDs (n=70) to determine how LHDs use these reports. LHDs that reported using their custom reports compared their preparedness capacities to other LHDs, conducted strategic planning (e.g., benchmarking, setting preparedness goals), planned staff trainings, and disseminated the report both internally and to external preparedness partners. Through evaluation of custom report use, we have found that survey feedback is a valuable part of a participatory research approach that promotes and encourages discussion, motivates improvement, and provides opportunities to identify potential solutions relevant to both researchers and LHDs

Ultrahigh-temperature granulite-facies metamorphism and exhumation of deep crust in a migmatite dome during late- to post-orogenic collapse and extension in the central Adirondack Highlands (New York, USA)

This study combines field observations, mineral and whole-rock geochemistry, phase equilibrium modeling, and U-Pb sensitive high-resolution ion microprobe (SHRIMP) zircon geochronology to investigate sillimanite-bearing felsic migmatites exposed on Ledge Mountain in the central Adirondack Highlands (New York, USA), part of an extensive belt of mid-crustal rocks comprising the hinterland of the Mesoproterozoic Grenville orogen. Phase equilibrium modeling suggests minimum peak metamorphic conditions of 960-1025 °C and 11-12.5 kbar during the Ottawan orogeny—sig-nificantly higher pressure-temperature conditions than previously determined—followed by a period of near-isothermal decompression, then isobaric cooling. Petrography reveals abundant melt-related microstructures, and pseudosection models show the presence of at least ~15%-30% melt during buoyancy-driven exhumation and decompression. New zircon data document late Ottawan (re)crys-tallization at ca. 1047 ± 5 to 1035 ± 2 Ma following ultrahigh-temperature (UHT) metamorphism and anatexis on the retrograde cooling path. Inherited zircon cores give a mean date of 1136 ± 5 Ma, which suggests derivation of these felsic granulites by partial melting of older igneous rocks. The ferroan, anhydrous character of the granulites is similar to that of the ca. 1050 Ma Lyon Mountain Granite and consistent with origin in a late- to post-Ottawan extensional environment. We present a model for development of a late Ottawan migmatitic gneiss dome in the central Adirondacks that exhumed deep crustal rocks including the Snowy Mountain and Oregon anorthosite massifs with UHT Ledge Mountain migmatites. Recognition of deep crustal meta-plutonic rocks recording UHT metamorphism in a migmatite gneiss dome has significant implications for crustal behavior in this formerly thickened orogen

Effects of Performance Improvement Programs on Preparedness Capacities

In response to public health systems and services research priorities, we examined the extent to which participation in accreditation and performance improvement programs can be expected to enhance preparedness capacities

Measuring Changes in Local Surveillance and Investigation Capacity

Background: The outbreak of Ebola virus disease in West Africa and confirmation of the first cases in the United States highlight the need for robust and responsive public health surveillance system. With a 25% decline in funding since 2007, the impact on local surveillance capacities has not previously been described. Purpose: The Surveillance & Investigation domain of the Local Health Department Preparedness Capacities Survey (PCAS) was reweighted to reflect the national profile of LHDs. Changes in subdomain performance of capacities and the effect of population size on subdomain capacity performance were examined over time. Methods: Participating LHDs (n=208) from the PCAS sample were reweighted according to characteristics from the 2010 National Association of County and City Health Officials (NACCHO) Profile. Overall changes in preparedness capacity across four subdomains from 2010 to 2012 were tested for significant differences using a weighted t-test. A series of weighted least squares regression models were used to determine whether population size may have modified the temporal changes in preparedness capacity. Results: Significant declines were observed in the preparedness capacity in three of the four subdomains of Surveillance & Investigation. Results suggest that surveillance inputs from various sources, including hospitals, urgent care, poison control, pharmacies, and schools absentee reporting, especially for larger LHDs, may be more sensitive to changes or shifts over time versus others. Implications: Declines in preparedness capacity may have affected the ability of LHDs, particularly larger ones, to effectively respond to community preparedness needs and, specifically, the detection of highly communicable and novel disease events

Temporal Trends in Preparedness Capacity

Local health departments (LHDs) are essential to emergency preparedness and response activities. Since 2005, LHD resources for preparedness, including personnel, are declining in the face of continuing gaps and variation in the performance of preparedness activities. The effect of these funding decreases on LHD preparedness performance is not well understood. This study examines the performance of preparedness capacities among NC LHDs and a matched national comparison group of LHDs over three years. We observe significant decreases in five of eight preparedness domains from three years of survey data collected from 2010 through 2012. Most notably, we observe significant decreases in the Surveillance & Investigation domain. Performance decreases may be a result of continued, compounding declines in preparedness funding