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Every fall, juvenile sea turtles in the Northwest Atlantic Ocean are threatened by rapidly declining water temperatures. When sea turtles become hypothermic, or cold-stunned, they lose mobility--either at the surface, subsurface, or the bottom of the water column--and eventually strand at the shoreline where rescue teams associated with the Sea Turtle Stranding and Salvage Network may search for them. Understanding the effects of ocean currents on the potential stranding locations of cold-stunned sea turtles is essential to better understand stranding hotspots and increase the probability of successful discovery and recovery of turtles before they die in the cold temperatures. Traditional oceanographic drifters--instruments used to track currents--have been used to examine relationships between current and stranding locations in Cape Cod Bay, but these drifters are not representative of sea turtle morphology and do not assess how bottom currents affect stranding locations. To address these knowledge gaps, we designed new drifters that represent the shape and dimensions of sea turtles--one that can float at the surface and one that sinks to the bottom--to track both surface and bottom currents in Cape Cod Bay. We found a marked difference between the trajectories of our new drifter models and those that were previously used for similar research. These findings bring us one step closer to identifying the transport pathways for cold-stunned sea turtles and optimizing cold-stunned sea turtle search and rescue efforts in Cape Cod. [ABSTRACT FROM AUTHOR]

Aims: Remote monitoring of patients with physiological data derived from cardiac implanted electronic devices (CIEDs) offers potential to reconfigure clinical services. The 'Heart Failure Risk Score' (HFRS) uses input from integrated device physiological monitoring to risk‐stratify patients as low‐risk, medium‐risk, or high‐risk of a heart failure event in the next 30 days. This study aimed to evaluate a novel clinical pathway utilizing a combination of CIED risk‐stratification and telephone triage to identify patients with worsening heart failure (WHF). Methods and results: A prospective, single‐centre, real‐world evaluation of the 'Triage‐HF Plus' clinical pathway (HFRS in combination with telephone triage) over a 27 month period. One hundred and fifty‐seven high‐risk HFRS transmissions were referred for telephone triage assessment. Interventions were at the discretion of the clinical assessor acting in accordance with clinical guidelines. An additional 3month consecutive sample of low and medium HFRS transmissions (control group) were also contacted for telephone triage assessment (n = 98). Successful telephone contact was made in 127 (81%) of referred high‐risk HFRS cases: 71 (55.9%) were confirmed to have WHF requiring intervention; 19 (14.9%) had an alternative acute medical problem; one patient had been recently discharged from hospital with WHF; and 36 (28.0%) had no apparent cause for the high score. In the control group, only one patient had symptoms of WHF. The sensitivity and specificity of CIED‐based remote monitoring to identify WHF 98.6% (92.5–100.0%) and 63.4% (55.2–71.0%), respectively. Conclusions: The Triage‐HF Plus clinical pathway is a potentially useful remote monitoring tool for patients with heart failure and in situ CIEDs. [ABSTRACT FROM AUTHOR]

The article discusses land use planning in the U.S. According to the author, a key component in natural and build environment is control over the way in which land is used and requires professionally-trained individuals in various fields, including policy, architecture, and transportation design. The author notes that planning commissions are generally composed of unpaid citizen volunteers who may or may not have formal training, but are nonetheless important organizational entities that make land use recommendations to local governments. Topics include an overview of how the capacities of commissioners and their ability to interact with each other and the general public affects how land and resources are used.

Spinal cord injured patients are highly prone to urinary tract infections. The high frequency of recurrences, the problems with drug resistance and the difficulties associated with diagnosis complicate the management. In a preliminary retrospective study of 30 patient files, we discovered that prophylactic antimicrobial therapy with trimethoprim-sulfamethoxazole, significantly reduced the incidence of symptomatic urinary tract infections. The prevention of infection resulted in cheaper healthcare expenses than treatment. One problematic outcome was that antibiotic therapy resulted in a dramatic change in the population of uropathogens infecting the host, from a predominantly Gram negative type to one dominated by Enterococcus faecalis. [ABSTRACT FROM AUTHOR]

Background: Elevated total homocysteine (tHcy) levels are associated with an increased risk of cerebrovascular disease. It is uncertain whether tHcy is also an independent risk factor for cognitive impairment., Methods: We examined 95 stroke subjects 3 months after their strokes, and 55 healthy comparison subjects, with a detailed neuropsychological assessment, and MRI brain scans in a proportion (n = 97). Baseline measurements of tHcy, serum folate and B(12), creatinine and plasma fibrinogen levels were obtained., Results: tHcy levels were higher in the stroke subjects by a mean 34%. These levels were significantly correlated with the first factor of a principal component analysis of the neuropsychological data, after controlling for age, folate, B(12) and creatinine levels. The correlation of Hcy levels was particularly significant with frontal-executive functioning and attention. tHcy levels were significantly correlated with number of infarcts and total stroke volume in the stroke group, but not with T(2)-weighted deep white matter hyperintensity scores, after correction for age. In the control group, tHcy levels were significantly correlated with ventricle-to-brain ratios as measures of brain atrophy., Conclusion: This study provides evidence that high tHcy levels are associated with cognitive impairment, in particular that of frontal-executive function. The major component of this association is accounted for by small and large strokes, but non-vascular neurotoxic effects of tHcy also appear to play a role. tHcy must receive greater attention as a risk factor for cognitive impairment., (Copyright 2003 S. Karger AG, Basel)