Sentinel California sea lions provide insight into legacy organochlorine exposure trends and their association with cancer and infectious disease.

BackgroundOrganochlorine contaminants (OCs), like polychlorinated biphenyls (PCBs) and dichlorodiphenyltrichloroethanes (DDTs), are widespread marine pollutants resulting from massive historical use and environmental persistence. Exposure to and health effects of these OCs in the marine environment may be examined by studying California sea lions (Zalophus californianus), which are long lived, apex predators capable of accumulating OCs.MethodsWe evaluated PCB and DDT levels in 310 sea lions sampled between 1992 and 2007: 204 individuals stranded along the coast of central California, 60 healthy males from Washington State, and 46 healthy females from southern California. Lipid-normalized contaminant concentrations were analyzed using general linear models and logistic regression to ascertain temporal trends; differences between stranded and healthy sea lions; and association of organochlorines with sex, age, and presence of cancer or fatal infectious disease.ResultsConcentrations of the contaminants in stranded adults decreased over time in the study period (adjusted for sex, as adult males had higher mean blubber concentrations than adult females and juveniles). Cancer was almost eight and six times more likely in animals with higher summed PCBs and DDTs, compared to those with lower levels (95% CI 5.55-10.51 and 4.54-7.99, respectively). Fatal infectious diseases were similarly seven and five times more likely in animals with higher contaminant burdens (95% CI 4.20-10.89 and 3.27-7.86, respectively). Mean contaminant loads were significantly higher in stranded sea lions than in healthy live captured animals (p < 0.001).ConclusionOrganochlorine contamination has significant associations with health outcomes in California sea lions, raising concerns for humans and other animals eating tainted seafood. While environmental exposure to these organochlorines appears to be decreasing over time based on levels in sea lion tissues, their persistence in the environment and food web for all predators, including humans, and the associated serious health risks, warrant monitoring, possibly through sentinel species like marine mammals

Young people's use of NHS Direct: a national study of symptoms and outcome of calls for children aged 0-15

Objectives National Health Service (NHS) Direct provides 24/7 expert telephone-based healthcare information and advice to the public in England. However, limited research has explored the reasons to why calls are made on behalf of young people, as such this study aimed to examine call rate (CR) patterns in younger people to enable a better understanding of the needs of this population in England. Setting NHS Direct, England, UK. Participants and methods CRs (expressed as calls/100 persons/annum) were calculated for all calls (N=358 503) made to NHS Direct by, or on behalf of, children aged 0–15 during the combined four ‘1-month’ periods within a year (July 2010, October 2010, January 2011 and April 2011). χ² Analysis was used to determine the differences between symptom, outcome and date/time of call. Results For infants aged <1, highest CRs were found for ‘crying’ for male (n=14, 440, CR=13.61) and female (n=13 654, CR=13.46) babies, which is used as a universal assessment applied to all babies. High CRs were also found for symptoms relating to ‘skin/hair/nails’ and ‘colds/flu/sickness’ for all age groups, whereby NHS Direct was able to support patients to self-manage and provide health information for these symptoms for 59.7% and 51.4% of all cases, respectively. Variations in CRs were found for time and age, with highest peaks found for children aged 4–15 in the 15:00–23:00 period and in children aged <1 in the 7:00–15:00 period. Conclusions This is the first study to examine the symptoms and outcome of calls made to NHS Direct for and on behalf of young children. The findings revealed how NHS Direct has supported a range of symptoms through the provision of health information and self-care support which provides important information about service planning and support for similar telephone-based services

The impact of location of the uptake of telephone based healthcare

Telephone healthcare systems have been put forward as a key strategy to overcome geographical disadvantage, however, evidence has suggested that usage decreases with increasing rurality. This research aimed to identify geographical high and low areas of usage of NHS Direct, a leading telephone healthcare provider worldwide to determine if usage is influenced by rurality. National call data was collected (January, 2011) from the NHS Direct Clinical Assessment System for all 0845 4647 calls in England, UK (N=360,137). Data extracted for analysis included; unit postcode of patient, type of call, date of call, time of call and final disposition. Calls were mapped using GIS mapping software using full postcode, aggregated by population estimate by local authority to determine confidence intervals across two thresholds by call rate. Uptake rate Output Area Classification (OAC) group profiles was performed using the chi-square goodness of fit. The majority of calls were ‘symptomatic’ (N=280,055; 74.8%) i.e. calls that were triaged by an expert nurse, with the remaining 25.2% of calls health/ medicine information only (N=94,430). NHS Direct were able to manage through self-care advice and health information 43.5 of all calls made (N=99,367) with no onward referral needed. Geographical pattern of calls were highest for more urbanised areas with significant higher call usage found in larger cities. Lower observed usage was found in areas that are more rural of which were characterised by above average older populations. This was supported by geo-segmentation, which highlighted that rural and older communities had the lowest expected uptake rate. There is a variation of usage of NHS Direct relating to rurality, which suggests that this type of service has not been successful in reducing accessible barriers. However, geographical variations are likely to be influenced by age. There is a need for exploratory to determine the underlying factors that contribute to variation in uptake of these services particularly older people who reside in rural communities. This will have worldwide implications as to how telephone based healthcare is introduced

The Large-Scale, Authentic Assessment of Listening and Speaking as Interactive Communication: Issues in Reliability

In this article we discuss reliability issues in the large-scale assessment of speech communication through authentic or performance techniques used recently in Saskatchewan. New performance-based approaches enable educators to evaluate the integrated, interpersonal communication skills of large populations of students, thereby modeling best professional practice. We conclude, however, that decentralized teacher rating approaches do not yet demonstrate sufficient reliability to enable public officials to use the results for high-stakes testing purposes.Dans cet article, nous discutons de questions de fiabilité dans réévaluation à grande échelle de la communication verbale par le biais de techniques authentiques (ou basées sur la performance) employées en Saskatchewan. De nouvelles approches reposant sur la performance permettent aux enseignants d'évaluer les compétences communicatives intégrées et interpersonnelles de grandes populations d'élèves, reflétant ainsi les meilleures stratégies pédagogiques. Nous concluons toutefois que les approches impliquant une évaluation décentralisée ne s'avèrent pas encore suffisamment fiables pour que les fonctionnaires se servent des résultats dans des contextes ou l'enjeu est considérable

Inequalities and outcomes : end stage kidney disease in ethnic minorities

The international evidence about outcomes of End Stage Kidney Disease (ESKD) for ethnic minorities was reviewed to identify gaps and make recommendations for researchers and policy makers. Nine databases were searched systematically with 112 studies from 14 different countries included and analysed to produce a thematic map of the literature. Reviews (n = 26) highlighted different mortality rates and specific causes between ethnic groups and by stage of kidney disease associated with individual, genetic, social and environmental factors. Primary studies focussing on uptake of treatment modalities (n = 19) found ethnic differences in access. Research evaluating intermediate outcomes and quality of care in different treatment phases (n = 35) e.g. dialysis adequacy, transplant evaluation and immunosuppression showed ethnic minorities were disadvantaged. This is despite a survival paradox for some ethnic minorities on dialysis seen in studies of longer term outcomes (n = 29) e.g. in survival time post-transplant and mortality. There were few studies which focussed on end of life care (n = 3) and ethnicity. Gaps identified were: limited evidence from all stages of the ESKD pathway, particularly end of life care; a lack of system oriented studies with a reliance on national routine datasets which are limited in scope; a dearth of qualitative studies; and a lack studies from many countries with limited cross country comparison and learning. Differences between ethnic groups occur at various points and in a variety of outcomes throughout the kidney care system. The combination of individual factors and system related variables affect ethnic groups differently indicating a need for culturally intelligent policy informed by research to prevent disadvantage

Expression of Epstein–Barr Virus–Encoded Small RNA (by the EBER-1 Gene) in Liver Specimens from Transplant Recipients with Post-Transplantation Lymphoproliferative Disease

Epstein-Barr virus (EBV)—associated post-transplantation lymphoproliferative disease (PTLD) develops in 1 to 10 percent of transplant recipients, in whom it can be treated by a reduction in the level of immunosuppression. We postulated that the tissue expression of the small RNA transcribed by the EBER-1 gene during latent EBV infection would identify patients at risk for PTLD. We studied EBER-1 gene expression in liver specimens obtained from 24 patients 2 days to 22 months before the development of PTLD, using in situ hybridization with an oligonucleotide probe. Control specimens were obtained from 20 recipients of allografts with signs of injury due to organ retrieval, acute graft rejection, or viral hepatitis in whom PTLD had not developed 9 to 71 months after the biopsy. Of the 24 patients with PTLD, 17 (71 percent) had specimens in which 1 to 40 percent of mononuclear cells were positive for the EBER-1 gene. In addition, 10 of these 17 patients (59 percent) had specimens with histopathological changes suggestive of EBV hepatitis. In every case, EBER-1—positive cells were found within the lymphoproliferative lesions identified at autopsy. Only 2 of the 20 controls (10 percent) had specimens with EBER-1—positive cells (P<0.001), and such cells were rare. EBER-1 gene expression in liver tissue precedes the occurrence of clinical and histologic PTLD. The possibility of identifying patients at risk by the method we describe here and preventing the occurrence of PTLD by a timely reduction of immunosuppression needs to be addressed by future prospective studies. (N Engl J Med 1992;327:1710–4.), POST-TRANSPLANTATION lymphoproliferative disease (PTLD), either polyclonal or monoclonal, complicates the clinical course of 1 to 10 percent of organ-transplant recipients.123 Immunohistochemical studies have demonstrated that the lymphoid cells within the lesions of PTLD almost invariably contain Epstein–Barr virus (EBV), primarily in a state of latent infection.4,5 The EBER-1 gene is expressed early during latent EBV infection and codes for a small messenger RNA (mRNA) expressed at up to 107 copies per cell.6 We and others have previously demonstrated the value of the detection of EBER-1 RNA for identifying EBV-infected cells in formalin-fixed paraffin-embedded tissues.7,8 In the current investigation, we used… © 1992, Massachusetts Medical Society. All rights reserved

Doppler study of middle cerebral artery and umbilical artery in biometrically suspected intra uterine growth restricted pregnancies

Background: Intra uterine growth restricted (IUGR) is when the expected foetal weight is less than 10th percentile for gestational age. The hemodynamics of the feotus takes into account both the umbilical-placental and cerebral vascular beds. Underlying etiology that results in the failure of a foetus to attain its expected growth may vary. However the final infliction is via uteroplacental insufficiency. It is highlighted that inadequate uteroplacental perfusion is the main and primary pathology in growth restriction resulting in an increased umbilical artery impedance. Following this step are the changes in the middle cerebral artery (MCA) which categorically set in as a secondary phenomenon.Methods: Duplex Doppler Sonography is a reliable, non- invasive and rapid diagnostic technique in IUGR patients. Grey scale findings together with colour Doppler characteristics help in the qualitative as well as quantitative evaluation of the Uteroplacental and Fetoplacental circulation. Hence ultrasonography (USG) has become the most widely used, standard and simple way of detecting and confirming IUGR. Ultrasound biometry is the gold standard for assessment of foetal size. Various criteria are used to label a feotus growth restricted; foetal weight less than 10th percentile for gestational age is mostly widely accepted criterion. Others like elevated HC/AC ratio, elevated FL/AC ratio, and presence of oligohydramnios without ruptured membranes, presence of advanced placental grade can also be used for improving the accuracy of diagnosis. After establishing the diagnosis of IUGR, Doppler imaging becomes a valuable investigating method for monitoring the pregnancy because it provides information about the hemodynamic status of the feotus. Uteroplacental system evaluation takes into account the flow pattern of uterine artery, reflecting any underlying Uteroplacental vascular ischemia. Umbilical artery Doppler waveforms reflect the status of the fetoplacental circulation and any underlying placental insufficiency.Results: Fourteen cases showed absent umbilical artery end diastolic flow and four patients showed reversal of end diastolic flow.: Twenty two patients showed elevated PI. Adverse perinatal outcome was observed in all patients with absent and reversal of end diastolic flow. Out of the twenty two with elevated PI fifteen showed adverse outcome. Thirty six cases showed low MCA PI and six showed a pseudonormalization. A cerebro -placental ratio of < 1.08 was observed in 16 patients, it was calculated in only those pregnancies that showed forward diastolic flow in umbilical artery (n= 22). Fifteen of them showed adverse perinatal outcome.Conclusions: Doppler imaging is of value for monitoring pregnancies complicated with IUGR because it can provide indirect evidence of foetal compromise and is known to improve outcome of high risk pregnancies. Doppler evaluation is complementary to all other surveillance modalities. Because the changes in umbilical, uterine & MCA strongly correlate with pregnancy outcome in growth restricted foetuses the use of foetal biometry & Doppler examination is recommended in all cases of suspected IUGR cases