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Green Sturgeon ( GRS) Acipenser medirostris is one of the most marine-oriented of all sturgeons. It primarily spawns in the Sacramento, Klamath, and Rogue Rivers, yet lives most of its life in estuarine and coastal waters along the West Coast of North America. Spawning is only known to occur in the Rogue, Klamath and Sacramento rivers and optimal temperatures for egg incubation and larval growth are not always maintained in these dammed and highly-regulated systems. Genetic analysis and acoustic telemetry have confirmed the presence of two genetically distinct populations; the southern population is listed as 'threatened' under the ESA. Adults only enter natal rivers to spawn every 1-4 years. They make extensive coastal migrations in depths <80 m and move between estuaries where they aggregate in summer. The long marine occupancy of GRS potentially exposes them to mortality from various marine activities such as bottom trawl fishing, dredging, and ocean energy projects, but also provides a theoretical reservoir of fish to support viable populations. Critically-needed information for protection of this species includes: accurate annual population size estimates, data on distribution and habitat requirements for larvae and juveniles, and assessment of mortality due to bycatch, poaching and marine mammal predation. [ABSTRACT FROM AUTHOR]

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White sturgeon ( Acipenser transmontanus) ≥95 cm TL were monitored using acoustic and radio telemetry at a large hydroelectric dam (the Dalles Dam) on the Columbia River, during March 2004 through November 2005 to determine timing and routes of passage and to characterize general movements. Transmitters were surgically implanted into 148 fish during the study; 90 were released into the tailrace and 58 into the forebay. We documented 26 passage events by 19 tagged fish: eight upstream via fish ladders and 18 downstream, mostly through open spill gates. During the study 17 fish entered the two ladders one or more times; 11 entered only the east ladder, three entered only the north ladder, and three entered both ladders at sometime. Residence time within the ladders by individual fish was variable, ranging from about 1 min to nearly 6 months (median = 7.7 h). Only six fish successfully ascended the east ladder, one fish twice. We could not unequivocally determine which fish ladder one fish used to pass upstream. Differences in construction between the north and east fish ladders may account for the greater success of the east fish ladder in passing sturgeon upstream. Changes to operations at hydroelectric dams to benefit migrating anadromous salmonids may influence upstream or downstream passage by white sturgeon. Altering patterns and timing of spill discharge, altering fish ladder entrance attraction flows, and the use of lights, sound, and partial barriers to direct other species of fish to preferred passage routes have unknown effects on sturgeon passage. A better understanding of the consequences to the metapopulation of increasing or precluding upstream or downstream passage is needed. [ABSTRACT FROM AUTHOR]

Presents a debate concerning the proposed Model Rules of Professional Conduct in the United States. Overview of the model rules; Reasons for rejecting the model rules; Reasons for adopting the rules.

Focuses on the proposed Model Rules of Professional Conduct in the United States as of December 1981. Similarity of the proposed draft to the African Law Institute's restatements and modern codes; Alternative draft published by the American Bar Association Commission on Evaluation of Professional Standards; Reason behind lawyers' support of the modern code format of the proposed rules.

Presents comments about articles on nursing issues and problems in the U.S. as of January 1977. Need for extensive orientation to basic nursing skills; Criticisms on mandatory continuing education for nurses.

Focuses on containing the cost of hypertension management. Estimate on the annual cost of hypertension management in the U.S.; Reason for the high cost of hypertension management; Studies conducted on the subject; Solutions to the cost problem.

Abstract Oral health is a fundamental component in the overall well-being and quality of life for elders living in long-term care facilities. Effective oral care interventions must not only involve recognising the importance of oral health in this population, but giving oral hygiene the same priority as other care practices in long-term care settings. [ABSTRACT FROM AUTHOR]

Purpose: We sought to characterize trends in demographics, comorbidities, and postoperative complications among patients undergoing primary and revision cervical disc replacement (pCDR/rCDR) procedures., Methods: In this retrospective database study, the Premier Healthcare database was queried from 2006 to 2019. Annual proportions or medians were calculated for patient and hospital characteristics, comorbidities, and postoperative complications associated with CDR surgery. Trends were assessed using linear regression analyses with year of service as the sole predictor., Results: A total of 16,178 pCDR and 758 rCDR cases were identified, with a median (IQR) age of 46 (39; 53) and 51 (43; 60) years among patients, respectively. The annual number of both procedures increased between 2006 and 2019, from 135 to 2220 for pCDR (p < 0.001), and from 17 to 49 for rCDR procedures (p < 0.001), with radiculopathy being the main indication for surgery in both groups. Mechanical failure was identified as a major indication for rCDR procedures with an increase over time (p = 0.002). Baseline patient comorbidity burden (p = 0.045) and complication rates (p < 0.001) showed an increase. For both procedures, an increase in outpatient surgeries and procedures performed in rural hospitals was seen (pCDR: p = 0.045; p = 0.006; rCDR: p = 0.028; p = 0.034)., Conclusion: PCDR and rCDR procedures significantly increased from 2006 to 2019. At the same time, comorbidity burden and complication rates increased, while procedures were more often performed in an outpatient and rural setting. The identification of these trends can help guide future practice and lead to further areas of research., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Balamuthia mandrillaris is a free-living ameba that causes rare, nearly always fatal disease in humans and animals worldwide. B. mandrillaris has been isolated from soil, dust, and water. Initial entry of Balamuthia into the body is likely via the skin or lungs. To date, only individual case reports and small case series have been published., Methods: The Centers for Disease Control and Prevention (CDC) maintains a free-living ameba (FLA) registry and laboratory. To be entered into the registry, a Balamuthia case must be laboratory-confirmed. Several sources were used to complete entries in the registry, including case report forms, CDC laboratory results, published case reports, and media information. SAS© version 9.3 software was used to calculate descriptive statistics and frequencies., Results: We identified 109 case reports of Balamuthia disease between 1974 and 2016. Most (99%) had encephalitis. The median age was 36 years (range 4 months to 91 years). Males accounted for 68% of the case patients. California had the highest number of case reports, followed by Texas and Arizona. Hispanics constituted 55% for those with documented ethnicity. Exposure to soil was commonly reported. Among those with a known outcome, 90% of patients died., Conclusions: Balamuthia disease in the United States is characterized by a highly fatal encephalitis that affects patients of all ages. Hispanics were disproportionately affected. The southwest region of the United States reported the most cases. Clinician awareness of Balamuthia as a cause of encephalitis might lead to earlier diagnosis and initiation of treatment, resulting in better outcomes., (Published by Oxford University Press for the Infectious Diseases Society of America 2018. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

One of the most successful public health programs in the past century provides an example of what can be accomplished when the government, the private sector, academia, and community organizations work together. The results of 4 decades of activities of the National High Blood Pressure Education Program (NHBPEP) can be measured in several ways. The publics' awareness, treatment, and control have increased remarkably. Hypertension is the primary reason adults visit physicians. Age-adjusted mortality for heart disease and stroke has declined by 70% and 80%, respectively, since the beginning of the program. The decline in heart and stroke deaths is seen in both sexes and blacks and whites, and is particularly evident in people who reside in the southeastern portion of the United States, which once had the highest mortality rates of stroke in the United States. This dramatic decrease in strokes and heart disease has occurred despite the substantial increase in obesity and diabetes in the United States., (© 2012 Wiley Periodicals, Inc.)

Introduction: Although more than 30 million patients in the United States undergo ambulatory surgery each year, it remains unclear what percentage of these patients receive a perioperative nerve block. We reviewed data from the 2006 National Survey of Ambulatory Surgery to determine the demographic, socioeconomic, geographic, and clinical factors associated with the likelihood of nerve block placement for ambulatory orthopedic surgery. The primary outcome of interest was the association between primary method of payment and likelihood of nerve block placement. In addition, we examined the association between type of surgical procedures, patient demographics, and hospital characteristics with the likelihood of receiving a nerve block., Methods: This cross-sectional study reviewed 6000 orthopedic anesthetics from the 2006 National Survey of Ambulatory Surgery data set, which accounted for more than 3.9 million orthopedic anesthetics when weighted. The primary outcome of this study addressed the likelihood of receiving a nerve block for orthopedic ambulatory surgery according to the patient's primary method of payment. Secondary end points included differences in demographics, surgical procedures, adverse effects, complications, recovery profile, anesthesia staffing model, and total perioperative charges in those with and without nerve block., Results: Overall, 14.9% of anesthetics in this sample involved a peripheral nerve block. Length of time in postoperative recovery, total perioperative time, and total charges were less for those receiving nerve blocks. Patients were more likely to receive a nerve block if their procedures were performed in metropolitan service areas (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.19-2.91; P = 0.007) or in freestanding surgical facilities (OR, 2.27; 95% CI, 1.74-2.96; P < 0.0001) and if payment for their surgery was supported by government programs (OR, 2.5; 95% CI, 1.01-6.21; P = 0.048) or private insurance (OR, 2.62; 95% CI, 1.12-6.13; P = 0.03) versus self-pay or charity care., Conclusions: For patients receiving ambulatory orthopedic surgery in the United States, our results suggest that geographic and socioeconomic factors are associated with different likelihoods of perioperative peripheral nerve block placement.

A new national online survey by Harris Interactive of 1245 hypertensive individuals indicates that >90% were aware that elevated blood pressure (BP) is a major risk factor for cardiovascular disease. The majority discovered that they had elevated BP levels as a result of a routine examination. More than two thirds of persons identified 120/80 mm Hg as an optimal BP level; only 6.0% stated that the Internet was their primary source of information about high BP. More than 60% of respondents had a body mass index >30 kg/m(2), and >50% had other cardiovascular risk factors. More than 50% were involved in some lifestyle change to control BP, and >90% were taking medication. More than 60% reported that BP was controlled (<140/90 mm Hg) at the last visit, although approximately 50% were told that their BP was high at some time. The survey results suggest that >90% of hypertensive patients are aware of the risks of elevated BP and that a high percentage of hypertensive patients are being treated with medication. Control rates as reported by respondents were >60% based on last BP recorded; however, between 31% and 40% of patients (based on differences in ethnic groups) were continued on the same therapy despite elevated BP levels. The survey suggests a high degree of risk awareness and treatment, and what appears to be an increase in control rates among hypertensive patients.

Following a hypertension symposium in Washington, DC, in November 2006, a panel was convened to discuss new data from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) and to revisit the significance of this trial in the management of hypertension. Based on these data and information from other trials, the expert panel also addressed the questions, "Is it time for a new Joint National Committee report?" and "Should the 2003 hypertension treatment recommendations be updated or are they still valid?" The panel was moderated by Marvin Moser, MD, Clinical Professor of Medicine, Yale University School of Medicine, New Haven, CT. On the panel were Suzanne Oparil, MD, Professor of Medicine at the University of Alabama in Birmingham, and President of the American Society of Hypertension (ASH); William Cushman, MD, Professor of Preventive Medicine and Medicine at the University of Tennessee in Memphis and attending physician at the Washington, DC, VA Medical Center; and Vasilios Papademetriou, MD, Professor of Medicine at Georgetown University in Washington, DC, and attending physician at the Washington, DC, VA Medical Center. This expert panel discussion was supported by Pfizer Inc and each author received an honorarium from Pfizer Inc for time and effort spent participating in the discussion and reviewing the transcript for important intellectual content prior to publication. The authors maintained full control of the discussion and the resulting content of this article; Pfizer had no input in the choice of topic, speakers, or content.

Guidelines in medicine have become useful instruments to improve outcomes for many diseases. The JNC-7 report puts the available data into perspective and provides suggestions to physicians and health plans for improving treatment. The JNC-7 guidelines are based on sound scientific evidence.

The JNC-7 treatment recommendations, if followed by a majority of physicians, should help to reduce the number of resistant hypertensive patients in the United States and should result in an improved proportion of patients with controlled blood pressure.

Hypertension affects approximately fifty million Americans. About 80% of hypertensive patients are aware that their blood pressure is elevated. While more than 50% are on medication, only about 20% of all hypertensive adults are controlled at normotensive levels. Ophthalmologists should be aware of the seriousness of hypertension because it affects many of their patients and is a risk factor for myocardial infarction, stroke, congestive heart failure, end-stage renal disease and peripheral vascular disease. As medically trained eye specialists, ophthalmologists should be knowledgeable about and take an interest in their patients' medical problems, thus playing an integral role on the health care team. As a primary health care provider, ophthalmologists should perform in-office blood pressure monitoring.

There is little reason to believe that patients with hypertension cannot be treated effectively without increasing the cost of care. Yet costs in the United States continue to increase. It is of interest to review some of the reasons for this and to emphasize that the management of hypertension has been successfully carried out over the past 20-30 years without the use of expensive technology or complicated treatment programs. This is an important message to non industrialized nations that are starting hypertension treatment programs. Hypertension costs can be controlled by: (1) limiting the complexities of the initial evaluation, avoiding the temptation to employ technologies which have not been shown to improve outcome, and (2) by selecting therapy based on data that have been collected over the past 20 years, and not on the latest promotional efforts. In addition, there is evidence that limiting physician visits to 2, 3 or at the most 4 per year is adequate to control the majority of hypertensive patients after initial blood pressure control is obtained--another important factor in the cost of care ($). There is no evidence that a more expensive approach to management will improve outcome compared to a less costly approach.

Introduction of striped bass to the west coast from the east coast of the U.S.A. provided the opportunity to study a recent host-parasite association in a marine system. An indigenous species of parasite was known to induce pathological changes in the introduced population. Because the west coast population has been in association with this pathogenic parasite more than 20 generations, we predicted that the host reaction of the west coast population would be less severe compared to that of the naive east coast stock of striped bass. This prediction was tested by conducting reciprocal infection experiments with east and west coast hosts and parasites. The group of west coast striped bass had a lower intensity of infection and exhibited less tissue damage compared to the group of east coast striped bass. We suggest that selection has acted only on the host and is driven by parasite-induced host mortality. This type of 1-sided selection is in contrast to present models of the evolution of host-parasite associations.

Extensive clinical trials have been carried out to test the effectiveness of antihypertensive therapy in controlling high blood pressure and in reducing the morbidity and mortality associated with hypertension and related cardiovascular and cerebrovascular disease. These trials have studied more than 40,000 individuals in programs worldwide. Although they answered many important questions, some of these trials have failed to produce conclusive results concerning certain issues, such as the results of treatment on coronary artery disease. The medical community has come to rely on clinical trials in evaluating the treatment of many different chronic diseases, and this methodology has become the accepted means of evaluating therapy. Analyses of the clinical trials on hypertension and their implications should review factors other than fatal and non-fatal end points if their results are to be useful for the practicing physician in making treatment decisions.

Data are presented that define the risks of elevated blood pressure, both systolic and diastolic, and support the recent recommendations of the Third Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure in the United States that a consistently elevated pressure level above 140/90 mm Hg in adults should be lowered if possible. A summary of the major clinical trials, as well as a review of extensive data reported over the past 15-20 years, supports conclusions that mortality and morbidity are reduced, even in the mild hypertensive (diastolic BPs of 90-104 mm Hg), following blood pressure lowering to normotensive levels (less than 140-90 mm Hg). Numerous observations in the 1960s and 70s had established the benefits of treatment in patients with severe hypertension (diastolic BPs more than 115 mm Hg). The Veterans Administration studies also demonstrated that blood pressure lowering in patients with diastolic BPs above 105 mm Hg reduced mortality. More recently the 7-10-year U.S. Public Health Service Study and the Hypertension Detection and Follow-Up Program Study (HDFP) in the United States, and the Australian Study in Mild Hypertension, have demonstrated a decrease in cerebrovascular and a trend of a statistically significant decrease in overall cardiovascular mortality with effective blood pressure lowering.(ABSTRACT TRUNCATED AT 250 WORDS)

Elevated blood pressure substantially increases mortality and requires, therefore, high premium payments for life insurance coverage. Most life insurance companies are willing to reduce the cost of yearly premiums when blood pressure is successfully treated and controlled for several years. Physicians should bring these facts to their patients' attention as a motivating factor to improve adherence to therapy.

Results of a survey of 90 medical schools in 44 states indicate that only 11 had specific hypertension sections, and that after completion of four years of medical school, students had received only 18 hours of instruction in the management of hypertension. Undergraduate students spent only an average of 1.5 weeks in clinics specifically designated for the treatment of hypertension, and small numbers of students were involved in each school at any one time. Specific instruction during residency training was also minimal. Even when ward round and general medical clinic teaching hours are included, instruction in the management of hypertension is limited for a disease that is the most common chronic illness in the United States and accounts for over 5 percent of all physician visits by adults. An increased emphasis should be placed on training for the management of hypertension within the undergraduate curriculum and within the existing general medical and hypertension clinics.