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Studies in parts of Europe, New Zealand, and North America indicate uptake of anticoagulant rodenticides (ARs) by predatory mammals to be widespread and common, with proximity to urban and agricultural areas being an important driver of exposure. Yet, little is known regarding the patterns and drivers of AR exposure in predatory mammals within more forest-dominated landscapes. Across the forest-dominated northeastern United States (US), a region spanning Pennsylvania to Maine, we tested livers from 597 fisher (Pekania pennanti) obtained from the legal harvest for 11 anticoagulant rodenticide compounds. We used kriging to determine potential hot zones (within or among states) and used regression models to test agricultural land use, developed landscapes, and protected areas as potential drivers of exposure patterns. We detected 8 AR compounds, with 78.6% of sampled individuals testing positive for ≥1 compound. The highest rate of exposure was observed in New Hampshire and Vermont at 93.3 and 100.0% and the lowest in Maine at 52.8%. The majority of individuals (55.3%) tested positive for 2-6 different compounds rather than a single compound (23.3%) or none (21.4%), indicating repeated and chronic levels of exposure among fisher. Spatial interpolation revealed a hot region of exposure spanning southern New Hampshire, Vermont, and southeastern New York. Regression models indicated the proportion of wildland-urban intermix (low density buildings within a largely forest-dominated landscape) as a consistent and strong predictor of AR exposure, with marginal and inconsistent relationships observed between AR exposure and the amount of agricultural land use, and with no apparent benefit conferred by protected areas in the region. Given that northeastern states support the highest rural human population density in the nation, with individual homes interspersed throughout a forested matrix, residential use of ARs is implicated as potentially the main driver of exposure for forest carnivores in this region. However, surveillance of a broader suite of species, and greater knowledge of AR use in commercial forestry operations, will be necessary to understand the generality of our observations.

One free-ranging Gray fox (Urocyon cinereoargenteus) underwent autopsy following neurologic disease, with findings including morbilliviral inclusions and associated lesions in numerous tissues, adenoviral intranuclear inclusions in bronchial epithelial cells, and septic pleuropneumonia, hepatitis, splenitis, and meningoencephalitis. Molecular diagnostics on fresh lung identified a strain within a distinct clade of canine distemper that is currently unique to wildlife in New England, as well as the emerging multi-host viral pathogen skunk adenovirus-1. Bacterial culture of fresh liver resulted in a pure growth of Listeria monocytogenes, with whole genome sequencing indicating that the isolate had a vast array of antimicrobial resistance and virulence-associated genes. One year later, a second fox was euthanized for inappropriate behavior in a residential area, and diagnostic workup revealed canine distemper and septic L. monocytogenes, with the former closely related to the distemper virus found in the previous fox and the latter divergent from the L. monocytogenes from the previous fox.

Objectives: We describe the parotidectomy experience at a single rural institution over 17 years. Methods: We retrieved the records of all patients who underwent parotidectomy for any nontrauma indication (current procedural terminology codes 42410,42415,42420,42425, and 42426) from January 1990 to June 2007 at Dartmouth-Hitchcock Medical Center, a rural medical center that provides both primary and tertiary care to a local population of 14,000, with a catchment area of 600,000 people. Information was collected on initial patient presentation, use of fine- needle aspiration, extent of surgery, final pathologic diagnosis, and complications. Results: We performed 341 parotidectomy procedures in 334 patients. The largest number of malignancies came from metastatic tumors; squamous cell carcinoma was the most common (37% of malignancies). The most common presenting complaint overall was a painless mass. The most common complication was facial weakness in 17% (57 of 341); 36 of the 57 cases of facial weakness (63%) were associated with surgery for malignancy. The most common benign tumor was pleomorphic adenoma (114 of 186; 61%). Mucoepidermoid carcinoma was the most common primary parotid malignancy (12%). Conclusions: In this 17-year rural case series of all parotidectomy procedures done for nontrauma indications, the largest number of malignancies came from metastatic tumors. Although facial nerve paralysis is not a common complication, it occurs most often when surgery is performed for either primary or metastatic malignancy. Surgeons will benefit from this information as they counsel patients who are considering parotidectomy. [ABSTRACT FROM AUTHOR]

Objective: To describe time trends in total laryngectomy health services utilization across the United States, such as rates of surgery, cost, length of stay, and insurance payer, and to compare this to important milestones in recommendations for laryngeal cancer treatment., Study Design: Population-based cohort study., Setting: Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) 1997-2008: stratified sample of all US hospital discharges., Subjects and Methods: All patients with the principal procedure of complete laryngectomy. The unit of analysis was the discharge., Results: Between 1997 and 2008, the number of laryngectomies done in the United States decreased by 48%. New cases of laryngeal cancer decreased 33% during the same time. The proportion of patients older than 65 years decreased from 48% to 43%. Mortality for the procedure was 1.4% in 1997 and 1.1% in 2008. Mean length of stay over the study period increased from 13 days to 14 days. Mean hospital charges rose from $58,000 in 1997 to $109,000 in 2008, consistent with the overall rise in US health care costs. Medicare was the dominant insurer throughout. Home health was ordered in 50% of 2008 discharges but only 32% in 1997., Conclusions: The rate of total laryngectomy has dropped more than the incidence of laryngeal cancer has dropped, consistent with the trend toward nonsurgical treatment. Lower surgical volumes and/or salvage laryngectomy surgeries are hypothesized to play a role in longer length of stay, stable mortality rates despite younger patient age, and increased need for home services after discharge.