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The emergence of pathogens that are resistant to first-line antibiotics has made managing common bacterial infections more complex. The authors guide you to help minimize resistance. [ABSTRACT FROM AUTHOR]

Bacterial resistance is seen in patients with such common, community-acquired infections as acute otitis media, pneumonia, and cystitis.Resistance is the result of antibiotic use of all kinds and is exacerbated by overuse, particularly of broad-spectrum drugs.Hospital care paths strike a balance between a complex, nuanced document and a simpler, more useful type of guidance.Although the 1990s saw a 40% decline in antibiotic prescribing, there was an increase in prescribing of broad-spectrum drugs. [ABSTRACT FROM AUTHOR]

As tourists continue to enter remote areas, you need to prepare them with the most up-to-date information on vaccinations, malaria prophylaxis, and other vital precautions. The job may not be over until long after the patient returns home. [ABSTRACT FROM AUTHOR]

The possibilities for food contamination seem endless, and the symptoms of illness are often vague. How reliably can you identify foodborne disease? [ABSTRACT FROM AUTHOR]

A new classification system for prostatitis can help focus treatment for patients with chronic symptoms. While a cure is out of reach for some, significant improvement is certainly attainable. [ABSTRACT FROM AUTHOR]

When choosing a newer quinolone, macrolide, or other broad-spectrum agent, pay careful attention to local antimicrobial resistance patterns. Also consider the special pharmacologic properties of newer versus old antibiotics. [ABSTRACT FROM AUTHOR]

Insidious in onset and often characterized by various extrapulmonary symptoms, the atypical pneumonias can be easy to miss clinically and hard to confirm in the lab. Treatment is not the same as for pneumococcal pneumonia, though, so keep the index of suspicion high. [ABSTRACT FROM AUTHOR]

When choosing a newer quinolone, macrolide, or other broad-spectrum agent, pay careful attention to local antimicrobial resistance patterns. Also consider the special pharmacologic properties of newer versus old antibiotics. [ABSTRACT FROM AUTHOR]

While single UTI episodes are easily treated, reinfection requires more inventive measures. Antimicrobial resistance by uropathogens challenges your management approach to recurrent infection. [ABSTRACT FROM AUTHOR]

As tourists continue to enter remote areas, you need to prepare them with the most up-to-date information on vaccinations, malaria prophylaxis, and other vital precautions. The job may not be over until long after the patient returns home. [ABSTRACT FROM AUTHOR]

The fate of natural populations is mediated by complex interactions among vital rates, which can vary within and among years. Although the effects of random, among-year variation in vital rates have been studied extensively, relatively little is known about how periodic, nonrandom variation in vital rates affects populations. This knowledge gap is potentially alarming as global environmental change is projected to alter common periodic variations, such as seasonality. We investigated the effects of changes in vital-rate periodicity on populations of three species representing different forms of adaptation to periodic environments: the yellow-bellied marmot (Marmota flaviventer), adapted to strong seasonality in snowfall; the meerkat (Suricata suricatta), adapted to inter-annual stochasticity as well as seasonal patterns in rainfall; and the dewy pine (Drosophyllum lusitanicum), adapted to fire regimes and periodic post-fire habitat succession. To assess how changes in periodicity affect population growth, we parameterized periodic matrix population models and projected population dynamics under different scenarios of perturbations in the strength of vital-rate periodicity. We assessed the effects of such perturbations on various metrics describing population dynamics, including the stochastic growth rate, log λ S . Overall, perturbing the strength of periodicity had strong effects on population dynamics in all three study species. For the marmots, log λ S decreased with increased seasonal differences in adult survival. For the meerkats, density dependence buffered the effects of perturbations of periodicity on log λ S . Finally, dewy pines were negatively affected by changes in natural post-fire succession under stochastic or periodic fire regimes with fires occurring every 30 years, but were buffered by density dependence from such changes under presumed more frequent fires or large-scale disturbances. We show that changes in the strength of vital-rate periodicity can have diverse but strong effects on population dynamics across different life histories. Populations buffered from inter-annual vital-rate variation can be affected substantially by changes in environmentally driven vital-rate periodic patterns; however, the effects of such changes can be masked in analyses focusing on inter-annual variation. As most ecosystems are affected by periodic variations in the environment such as seasonality, assessing their contributions to population viability for future global-change research is crucial., (© 2022 The Ecological Society of America.)

Among etiologies of hyperammonemic emergencies, infection must be considered in certain clinical contexts, particularly among immunocompromised individuals. Although Cryptococcus neoformans is known to be urease-producing, to our knowledge it has not previously been described as a cause of hyperammonemia in patients. We report an immunocompromised man with acute on chronic kidney disease with hyperammonemic crisis due to Cryptococcal meningitis and fungemia. It is important to be aware of C. neoformans as a possible cause of hyperammonemia., Competing Interests: No authors have a conflict of interest to disclose or funding source., (© 2021 The Authors.)

Left ventricular assist devices (LVADs) are surgically implanted mechanical devices indicated for patients with advanced heart failure and are known to come with several complications. Here we present a case series, and review 1 documented report, of LVAD vasculitis, a presumed new LVAD immune/humoral related phenomenon. ( Level of Difficulty: Advanced. )., Competing Interests: Dr Garcia is supported by the National Heart, Lung, and Blood Institute, Institutes of Health, under Aware Number 5T32HL110837. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2021 Published by Elsevier on behalf of the American College of Cardiology Foundation.)

Seasonal environmental conditions shape the behavior and life history of virtually all organisms. Climate change is modifying these seasonal environmental conditions, which threatens to disrupt population dynamics. It is conceivable that climatic changes may be beneficial in one season but result in detrimental conditions in another because life-history strategies vary between these time periods. We analyzed the temporal trends in seasonal survival of yellow-bellied marmots ( Marmota flaviventer ) and explored the environmental drivers using a 40-y dataset from the Colorado Rocky Mountains (USA). Trends in survival revealed divergent seasonal patterns, which were similar across age-classes. Marmot survival declined during winter but generally increased during summer. Interestingly, different environmental factors appeared to drive survival trends across age-classes. Winter survival was largely driven by conditions during the preceding summer and the effect of continued climate change was likely to be mainly negative, whereas the likely outcome of continued climate change on summer survival was generally positive. This study illustrates that seasonal demographic responses need disentangling to accurately forecast the impacts of climate change on animal population dynamics., Competing Interests: The authors declare no competing interest.

Annual reproductive success and senescence patterns vary substantially among individuals in the wild. However, it is still seldom considered that senescence may not only affect an individual but also affect age-specific reproductive success in its offspring, generating transgenerational reproductive senescence. We used long-term data from wild yellow-bellied marmots ( Marmota flaviventer ) living in two different elevational environments to quantify age-specific reproductive success of daughters born to mothers differing in age. Contrary to prediction, daughters born to older mothers had greater annual reproductive success on average than daughters born to younger mothers, and this translated into greater lifetime reproductive success. However, in the favorable lower elevation environment, daughters born to older mothers also had greater age-specific decreases in annual reproductive success. In the harsher higher elevation environment on the other hand, daughters born to older mothers tended to die before reaching ages at which such senescent decreases could be observed. Our study highlights the importance of incorporating environment-specific transgenerational parent age effects on adult offspring age-specific life-history traits to fully understand the substantial variation observed in senescence patterns in wild populations., Competing Interests: The authors declare no competing interest.

Background: We aimed to assess the knowledge, attitudes, and perceptions of resident physicians regarding sepsis in general and the Surviving Sepsis Campaign Guidelines in particular., Methods: After institutional review board approval, we surveyed internal medicine (IM) and emergency medicine (EM) house staff from 3 separate institutions. House staff were notified of the survey via e-mail from their residency director or chief resident. The survey was Internet-based (using http://www.surveymonkey.com ), voluntary, and anonymous. The Surviving Sepsis Campaign Guidelines were used to develop the survey. The survey was open between December 2015 and April 2016. No incentives for participation were given. Reminder e-mails were sent approximately every 3 to 4 weeks to all eligible participants. Comparisons of responses were evaluated using the N-1 2-proportion test., Results: A total of 133 responses were received. These included 84 from IM house staff, 27 from EM house staff, and 22 who selected "other." Eighty (101/126) percent reported managing at least 1 patient with sepsis in the preceding 30 days, 85% (97/114) rated their knowledge of the Surviving Sepsis Guidelines as "very familiar" or at least "somewhat familiar," and 84% (91/108) believed their training in the diagnosis and management of sepsis was "excellent" or at least "good." However, 43% (47/108) reported not receiving any feedback on their treatment of patients with sepsis in the last 30 days, while 24% (26/108) received feedback once. Both IM and EM house staff received comparable rates of feedback (62% vs 48%, respectively; P = .21). For the 3 questions that directly tested knowledge of the guidelines, the scores of the IM and EM house staff were similar. Notably, <20% of both groups correctly identified diagnostic criteria for sepsis., Conclusion: Additional education of IM and EM house staff on the Surviving Sepsis Campaign Guidelines is warranted, along with more consistent feedback regarding their diagnosis and management of sepsis.

The cumulative cost of reproduction hypothesis predicts that reproductive costs accumulate over an individual's reproductive life span. While short-term costs have been extensively explored, the prevalence of cumulative long-term costs and the circumstances under which such costs occur alongside or instead of short-term costs, are far from clear. Indeed, few studies have simultaneously tested for both short-term and cumulative long-term reproductive costs in natural populations. Even in mammals, comparatively little is known about cumulative effects of previous reproduction, especially in species with high variation in offspring numbers, where costs could vary among successful reproductive events. Here, we quantify effects of previous short-term and cumulative long-term reproduction on current reproduction probability and litter size in wild female yellow-bellied marmots ( Marmota flaviventer ) and test how these effects vary with age and between two contrasting environments. We provide evidence for cumulative long-term effects: females that had both reproduced frequently and weaned large litters on average in previous years had decreased current reproduction probability. We found no evidence for short-term reproductive costs between reproductive bouts. However, females weaned larger litters when they had weaned larger litters on average in previous years and had lower current reproduction probability when their previous reproductive success was low. Together these results suggest that, alongside persistent among-individual variation, long-term reproductive history affects current reproductive success.

Temporal variation in environmental conditions affects population growth directly via its impact on vital rates, and indirectly through induced variation in demographic structure and phenotypic trait distributions. We currently know very little about how these processes jointly mediate population responses to their environment. To address this gap, we develop a general transient life table response experiment (LTRE) which partitions the contributions to population growth arising from variation in (1) survival and reproduction, (2) demographic structure, (3) trait values and (4) climatic drivers. We apply the LTRE to a population of yellow-bellied marmots (Marmota flaviventer) to demonstrate the impact of demographic and trait-mediated processes. Our analysis provides a new perspective on demographic buffering, which may be a more subtle phenomena than is currently assumed. The new LTRE framework presents opportunities to improve our understanding of how trait variation influences population dynamics and adaptation in stochastic environments., (© 2018 The Authors Ecology Letters published by CNRS and John Wiley & Sons Ltd.)

Senescence is a highly variable process that comprises both age-dependent and state-dependent components and can be greatly affected by environmental conditions. However, few studies have quantified the magnitude of age-dependent and state-dependent senescence in key life-history traits across individuals inhabiting different spatially structured and seasonal environments. We used longitudinal data from wild female yellow-bellied marmots ( Marmota flaviventer ), living in two adjacent environments that differ in elevation and associated phenology, to quantify how age and individual state, measured as "time to death," affect body mass senescence in different environments. Further, we quantified how patterns of senescence differed between two biologically distinct seasons, spring, and late summer. Body mass senescence had an age-dependent component, expressed as a decrease in mass in old age. Overall, estimated age-dependent senescence was greater in females living in the more favorable lower elevation environment, than in the harsher higher elevation environment, and greater in late summer than in spring. Body mass senescence also had a state-dependent component, captured by effects of time to death, but only in the more favorable lower elevation environment. In spring, body mass gradually decreased from 2 years before death, whereas in late summer, state-dependent effects were expressed as a terminal decrease in body mass in the last year of life. Contrary to expectations, we found that senescence was more likely to be observed under more favorable environmental conditions, rather than under harsher conditions. By further demonstrating that senescence patterns differ among seasons, our results imply that within-year temporal environmental variation must be considered alongside spatial environmental variation in order to characterize and understand the pattern and magnitude of senescence in wild populations.

The rapid expansion of minimally invasive image-guided procedures has led to their extensive use in the interdisciplinary management of patients with vascular, hepatobiliary, genitourinary, and oncologic diseases. Given the increased availability and breadth of these procedures, it is important for physicians to be aware of common complications and their management. In this article, the authors describe management of select common complications from interventional radiology procedures including tumor lysis syndrome, acute on chronic postprocedural pain, and venous thromboembolism. These complications are discussed in detail and their medical management is outlined according to generally accepted practice and evidence from the literature.

A major question in ecology is how age-specific variation in demographic parameters influences population dynamics. Based on long-term studies of growing populations of birds and mammals, we analyze population dynamics by using fluctuations in the total reproductive value of the population. This enables us to account for random fluctuations in age distribution. The influence of demographic and environmental stochasticity on the population dynamics of a species decreased with generation time. Variation in age-specific contributions to total reproductive value and to stochastic components of population dynamics was correlated with the position of the species along the slow-fast continuum of life-history variation. Younger age classes relative to the generation time accounted for larger contributions to the total reproductive value and to demographic stochasticity in "slow" than in "fast" species, in which many age classes contributed more equally. In contrast, fluctuations in population growth rate attributable to stochastic environmental variation involved a larger proportion of all age classes independent of life history. Thus, changes in population growth rates can be surprisingly well explained by basic species-specific life-history characteristics.

Social behaviour was proposed as a density-dependent intrinsic mechanism that could regulate an animal population by affecting reproduction and dispersal. Populations of the polygynous yellow-bellied marmot (Marmota flaviventris) fluctuate widely from year to year primarily driven by the number of weaned young. The temporal variation in projected population growth rate was driven mainly by changes in the age of first reproduction and fertility, which are affected by reproductive suppression. Dispersal is unrelated to population density, or the presence of the father; hence, neither of these limits population growth or acts as an intrinsic mechanism of population regulation; overall, intrinsic regulation seems unlikely. Sociality affects the likelihood of reproduction in that the annual probability of reproducing and the lifetime number of offspring are decreased by the number of older females and by the number of same-aged females present, but are increased by the number of younger adult females present. Recruitment of a yearling female is most likely when her mother is present; recruitment of philopatric females is much more important than immigration for increasing the number of adult female residents. Predation and overwinter mortality are the major factors limiting the number of resident adults. Social behaviour is not directed towards population regulation, but is best interpreted as functioning to maximize direct fitness., (© 2011 Blackwell Publishing Ltd.)

We investigated factors influencing natal dispersal in 231 female yearling yellow-bellied marmots (Marmota flaviventris) using comprehensive analysis of 10 years (1983-1993) of radiotelemetry and 37 years (1963-1999) of capture-mark-recapture data. Only individuals whose dispersal status was verified, primarily by radiotelemetry, were considered. Univariate analyses revealed that six of the 24 variables we studied significantly influenced dispersal: dispersal was less likely when the mother was present, amicable behavior with the mother and play behavior were more frequent, and spatial overlap was greater with the mother, with matriline females, and with other yearling females. Using both univariate and multivariate analyses, we tested several hypotheses proposed as proximate causes of dispersal. We rejected inbreeding avoidance, population density, body size, social intolerance, and kin competition as factors influencing dispersal. Instead, our results indicate that kin cooperation, expressed via cohesive behaviors and with a focus on the mother, influenced dispersal by promoting philopatry. Kin cooperation may be an underappreciated factor influencing dispersal in both social and nonsocial species.

Environmental change has altered the phenology, morphological traits and population dynamics of many species. However, the links underlying these joint responses remain largely unknown owing to a paucity of long-term data and the lack of an appropriate analytical framework. Here we investigate the link between phenotypic and demographic responses to environmental change using a new methodology and a long-term (1976-2008) data set from a hibernating mammal (the yellow-bellied marmot) inhabiting a dynamic subalpine habitat. We demonstrate how earlier emergence from hibernation and earlier weaning of young has led to a longer growing season and larger body masses before hibernation. The resulting shift in both the phenotype and the relationship between phenotype and fitness components led to a decline in adult mortality, which in turn triggered an abrupt increase in population size in recent years. Direct and trait-mediated effects of environmental change made comparable contributions to the observed marked increase in population growth. Our results help explain how a shift in phenology can cause simultaneous phenotypic and demographic changes, and highlight the need for a theory integrating ecological and evolutionary dynamics in stochastic environments.

Despite recent advances in biodemography and metapopulation ecology, we still have limited understanding of how local demographic parameters influence short- and long-term metapopulation dynamics. We used long-term data from 17 local populations, along with the recently developed methods of matrix metapopulation modeling and transient sensitivity analysis, to investigate the influence of local demography on long-term (asymptotic) versus short-term (transient) dynamics of a yellow-bellied marmot metapopulation in Colorado. Both long- and short-term dynamics depended primarily on a few colony sites and were highly sensitive to changes in demography at these sites, particularly in survival of reproductive adult females. Interestingly, the relative importance of sites differed between long- and short-term dynamics; the spatial structure and local population sizes, while insignificant for asymptotic dynamics, were influential on transient dynamics. However, considering the spatial structure was uninformative about the relative influence of local demography on metapopulation dynamics. The vital rates that were the most influential on local dynamics were also the most influential on both long- and short-term metapopulation dynamics. Our results show that an explicit consideration of local demography is essential for a complete understanding of the dynamics and persistence of spatially structured populations.

Comparative analyses of survival senescence by using life tables have identified generalizations including the observation that mammals senesce faster than similar-sized birds. These generalizations have been challenged because of limitations of life-table approaches and the growing appreciation that senescence is more than an increasing probability of death. Without using life tables, we examine senescence rates in annual individual fitness using 20 individual-based data sets of terrestrial vertebrates with contrasting life histories and body size. We find that senescence is widespread in the wild and equally likely to occur in survival and reproduction. Additionally, mammals senesce faster than birds because they have a faster life history for a given body size. By allowing us to disentangle the effects of two major fitness components our methods allow an assessment of the robustness of the prevalent life-table approach. Focusing on one aspect of life history - survival or recruitment - can provide reliable information on overall senescence.

Spatiotemporal variation in reproductive rates is a common phenomenon in many wildlife populations, but the population dynamic consequences of spatial and temporal variability in different components of reproduction remain poorly understood. We used 43 years (1962-2004) of data from 17 locations and a capture-mark-recapture (CMR) modeling framework to investigate the spatiotemporal variation in reproductive parameters of yellow-bellied marmots (Marmota flaviventris), and its influence on the realized population growth rate. Specifically, we estimated and modeled breeding probabilities of two-year-old females (earliest age of first reproduction), >2-year-old females that have not reproduced before (subadults), and >2-year-old females that have reproduced before (adults), as well as the litter sizes of two-year old and >2-year-old females. Most reproductive parameters exhibited spatial and/or temporal variation. However, reproductive parameters differed with respect to their relative influence on the realized population growth rate (lambda). Litter size had a stronger influence than did breeding probabilities on both spatial and temporal variations in lambda. Our analysis indicated that lambda was proportionately more sensitive to survival than recruitment. However, the annual fluctuation in litter size, abetted by the breeding probabilities, accounted for most of the temporal variation in lambda.

Spatiotemporal variation in age-specific survival rates can profoundly influence population dynamics, but few studies of vertebrates have thoroughly investigated both spatial and temporal variability in age-specific survival rates. We used 28 years (1976-2003) of capture-mark-recapture (CMR) data from 17 locations to parameterize an age-structured Cormack-Jolly-Seber model, and investigated spatial and temporal variation in age-specific annual survival rates of yellow-bellied marmots (Marmota flaviventris). Survival rates varied both spatially and temporally, with survival of younger animals exhibiting the highest degree of variation. Juvenile survival rates varied from 0.52 +/- 0.05 to 0.78 +/- 0.10 among sites and from 0.15 +/- 0.14 to 0.89 +/- 0.06 over time. Adult survival rates varied from 0.62 +/- 0.09 to 0.80 +/- 0.03 among sites, but did not vary significantly over time. We used reverse-time CMR models to estimate the realized population growth rate (lamda), and to investigate the influence of the observed variation in age-specific survival rates on lamda. The realized growth rate of the population closely covaried with, and was significantly influenced by, spatiotemporal variation in juvenile survival rate. High variability in juvenile survival rates over space and time clearly influenced the dynamics of our study population and is also likely to be an important determinant of the spatiotemporal variation in the population dynamics of other mammals with similar life history characteristics.

1. The presence/absence of a species at a particular site is the simplest form of data that can be collected during ecological field studies. We used 13 years (1990-2002) of survey data to parameterize a stochastic patch occupancy model for a metapopulation of the yellow-bellied marmot in Colorado, and investigated the significance of particular patches and the influence of site quality, network characteristics and regional stochasticity on the metapopulation persistence. 2. Persistence of the yellow-bellied marmot metapopulation was strongly dependent on the high quality colony sites, and persistence probability was highly sensitive to small changes in the quality of these sites. 3. A relatively small number of colony sites was ultimately responsible for the regional persistence. However, lower quality satellite sites also made a significant contribution to long-term metapopulation persistence, especially when regional stochasticity was high. 4. The northern network of the marmot metapopulation was more stable compared to the southern network, and the persistence of the southern network depended heavily on the northern network. 5. Although complex models of metapopulation dynamics may provide a more accurate description of metapopulation dynamics, such models are data-intensive. Our study, one of the very few applications of stochastic patch occupancy models to a mammalian species, suggests that stochastic patch occupancy models can provide important insights into metapopulation dynamics using data that are easy to collect.

After a trip to Zambia, a previously healthy adult traveler presented with a prolonged illness characterized by low-grade fevers and fatigue. Although malaria smears and antibody tests results for Plasmodium species were negative, a diagnosis of malaria was ultimately determined by polymerase chain reaction (PCR) amplification and species-specific nucleic acid hybridization techniques. The patient was successfully treated and cured. Clinical use of PCR technology may facilitate the identification of cases of smear-negative malaria, which up to the present time, have been difficult to diagnose.

We investigated mechanisms of energy conservation during hibernation. The amount of time torpid was significantly less for groups of three young marmots than for marmots hibernating singly. Mean daily mass loss (DML; as mg d(-1) g(-1) immergence mass) averaged 1.33 for single marmots and 1.46 for grouped young. Animals were active 17.3% of the time, which used 82.4% of the energy, and were torpid 82.7% of the time, which used 17.6% of the energy expenditure. During longer torpor bouts, more time was spent in deep torpor, which decreased the hourly cost of a complete bout. Bout oxygen consumption V dot o2, percent time in deep torpor, and body temperature (T(B)) during deep torpor changed seasonally and were curvilinearly related to when in the hibernation period the measurements were made and probably represent a stage in the circannual metabolic cycle. The decrease of environmental temperature (T(E)) to 2 degrees C significantly increased metabolism. Potential costs of low T(E) were reduced by allowing T(B) to decrease, thereby reducing the T(B) to T(E) gradient. Average monthly metabolic rate was high early and late in the hibernation period when time spent euthermic was greater and when VO2 was higher. Over the hibernation period, energy saved averaged 77.1% and 88.0% of the costs for winter and summer euthermic metabolism, respectively. Hibernation costs were reduced by the seasonal changes, the high percentage of time in torpor, the rapid decline in V dot o2 following arousal, and allowing T(B) to decline at lower T(E). Asynchrony in the torpor cycles increased energy expenditures in group hibernators, which negated possible beneficial effects of group hibernation.

Theoretical and empirical studies suggest that the age of first reproduction (the age at which reproduction begins) can have a substantial influence on population dynamics and individual fitness. Using complete survival and reproductive histories of 428 female yellow-bellied marmots (Marmota flaviventris) from a 40-year study (1962-2001), we investigated causes and fitness consequences of delayed maturity. Most females (86%) died without reproducing. The age of first reproduction of females that survived to reproduce at least once (n=60) ranged from 2 to 6 years. Females maturing later did not have a larger lifetime number of successful reproductive events or offspring production, nor did they experience improved survival. Females reproducing earlier had a higher fitness than those that delayed maturity. These results suggest that the net cost of early maturity was less than fitness benefits associated with early onset of reproduction, and that age of first reproduction in our study population is under substantial directional selection favoring early maturity. We conclude that female yellow-bellied marmots delay onset of reproduction not because of fitness benefits of foregoing reproduction at an earlier age, but due to the social suppression of reproduction by older, reproductive females, which enhances their own fitness to the detriment of the fitness of young females. Our results indicate that female yellow-bellied marmots that survive to reproduce may act to increase their own direct fitness, and that social suppression of reproduction of young females is a part of that strategy.

Yellow-bellied marmots (Rodentia: Sciuridae) typically hibernate for eight months. This study explored energetic costs of hibernation in young and adults at 10 and 6 degrees C. Age significantly affected the percent time torpid, total and mass-specific VO(2), use of energy during torpor, and daily mass loss at 6 degrees C. Thus young had a higher mass-specific VO(2) during a torpor bout, which was attributed to higher metabolism during deep torpor. Total VO(2) during a bout was higher in young and there were significant temperature/age interactions; young had a higher VO(2) during torpor and deep torpor at 6 degrees C than at 10 degrees C. VO(2) increased at T(E)s below 6 degrees C. Young had a higher daily mass loss than adults at 6 degrees C. Euthermy increased energetic costs 19.3 times over those of torpor and 23.5 times over those of deep torpor. Energy costs are minimized by spending 88.6% of the hibernation period in torpor, by the rapid decline of VO(2) from euthermy to torpor and by allowing T(B) to decline at low T(E). Torpidity results in average energy savings during winter of 83.3% of the costs of maintaining euthermy. Energy savings are greater than those reported for Marmota marmota and M. monax.

Osteoarticular tuberculosis rarely occurs in developed countries. Initial symptoms are often overlooked and the diagnosis is frequently delayed for several months. Thus, despite available diagnostic tools and accessible treatment, destruction of affected joints remains a complication of non-vertebral osteoarticular tuberculosis even in industrialized countries. We report a patient from Cleveland, Ohio, USA, in whom the delayed diagnosis of tuberculous osteoarthritis led to severe destruction of the left knee and finally, after superinfection with Staphylococcus aureus, to an above-the-knee amputation. The epidemiology, presentation, diagnosis and treatment of nonvertebral tuberculous osteoarthritis are discussed.

The yellow-bellied marmot (Marmota flaviventris) is a social, ground-dwelling squirrel that lives either individually or in kin groups of from two to five adult females. Philopatry and daughter recruitment lead to the formation and persistence of matrilines at habitat sites. By using 37 years of demographic data for 12 habitat sites, we could determine long-term trends in the effects of group size on two measures of fitness, survivorship and net reproductive rate, which otherwise are obscured by annual fluctuations in these measures. Both size and number of matrilines varied among sites and survivorship and net reproductive rate varied among sites and among matriline sizes. The role of social organization was explored further by examining the effect of matriline size, averaged over all years and sites, on fitness. For both survivorship and net reproductive rate the relationship with matriline size was curvilinear. Fitness increased with the increase in matriline size and then decreased in the largest groups. Decreased fitness in matrilines of four or five was associated with agonistic behavior, a large number of 2-year-old females in the social group, and reproductive suppression. There is no evidence that females acted to increase their fitness by increasing indirect fitness; i.e., by assisting relatives, but attempted to increase direct fitness. Direct fitness increased when mortality and fission of large matrilines reduced group size and the surviving females increased reproduction.

Objective: To describe the development and implementation of an inpatient disease management program., Study Design: Prospective observational study., Patients and Methods: On the basis of opportunities for improving quality or efficiency of inpatient and emergency department care, 4 diagnoses, including congestive heart failure (CHF), gastrointestinal hemorrhage, community-acquired pneumonia and sickle-cell crisis were selected for implementation of a disease management program. For each diagnosis, a task force assembled a disease management team led by a "physician champion" and nurse care manager and identified opportunities for improvement through medical literature review and interviews with caregivers. A limited number of disease-specific guidelines and corresponding interventions were selected with consensus of the team and disseminated to caregivers. Physician and nurse team leaders were actively involved in patient care to facilitate adherence to guidelines., Results: For quarter 2 to 4 of 1997, there were improvements in angiotensin-converting enzyme inhibitor use, daily weight compliance, assessment of left ventricular function, hospital costs, and length of stay for care-managed patients with CHF. Differences in utilization-related outcomes persisted even after adjustment for severity of illness. For the other 3 diagnoses, the observational period was shorter (quarter 4 only), and hence preliminary data showed similar hospital costs and length of stay for care-managed and noncare-managed patients., Conclusions: An interdisciplinary approach to inpatient disease management resulted in substantial improvements in both quality and efficiency of care for patients with CHF. Additional data are needed to determine the program's impact on outcomes of other targeted diagnoses.

Calendar date of the beginning of the growing season at high altitude in the Colorado Rocky Mountains is variable but has not changed significantly over the past 25 years. This result differs from growing evidence from low altitudes that climate change is resulting in a longer growing season, earlier migrations, and earlier reproduction in a variety of taxa. At our study site, the beginning of the growing season is controlled by melting of the previous winter's snowpack. Despite a trend for warmer spring temperatures the average date of snowmelt has not changed, perhaps because of the trend for increased winter precipitation. This disjunction between phenology at low and high altitudes may create problems for species, such as many birds, that migrate over altitudinal gradients. We present data indicating that this already may be true for American robins, which are arriving 14 days earlier than they did in 1981; the interval between arrival date and the first date of bare ground has grown by 18 days. We also report evidence for an effect of climate change on hibernation behavior; yellow-bellied marmots are emerging 38 days earlier than 23 years ago, apparently in response to warmer spring air temperatures. Migrants and hibernators may experience problems as a consequence of these changes in phenology, which may be exacerbated if climate models are correct in their predictions of increased winter snowfall in our study area. The trends we report for earlier formation of permanent snowpack and for a longer period of snow cover also have implications for hibernating species.

While sociality has been hypothesized to drive the evolution of communicative complexity, the relationship remains to be formally tested. We derive a continuous measure of social complexity from demographic data and use this variable to explain variation in alarm repertoire size in ground-dwelling sciurid rodents (marmots, Marmota spp.; prairie dogs, Cynomys spp.; and ground squirrels, Spermophilus spp.). About 40% of the variation in alarm call repertoire size was explained by social complexity in the raw data set. To determine the degree to which this relationship may have been influenced by historical relationships between species, we used five different phylogenetic hypotheses to calculate phylogenetically independent contrasts. Less variation was significantly explained in contrast-based analyses, but a general positive relationship remained. Social complexity explained more variation in alarm call repertoire size in marmots, while sociality explained no variation in repertoire size in prairie dogs and no variation in phylogenetically based analyses of squirrels. In most cases, substantial variation remained unexplained by social complexity. We acknowledge that factors other than social complexity, per se, may contribute to the evolution of alarm call repertoire size in sciurid rodents, and we discuss alternative hypotheses. Our measure of social complexity could be used by other researchers to test explicit evolutionary hypotheses that involve social complexity.

Resting metabolic rate (RMR) and field metabolic rate (FMR) of wild-caught males were estimated from oxygen consumption and the doubly-labeled water method, respectively. The average FMR:RMR ratio of 6.9 was much greater than ratios reported for other mammals. Total FMR (kJ/day) increased and specific RMR (kJ/kg/day) decreased with time. Neither total RMR nor specific FMR were significantly related to time. The decrease in specific RMR may result from a circannual decrease in maintenance expenditure and a seasonal increase in body mass. Total FMR may increase through the season as conditions for male activity become more favorable.

The waning of cell-mediated immunity during aging has been attributed primarily to defects in T lymphocyte properties and functions. We assessed the potential contribution of accessory dysfunction of monocytes from the elderly on responses of T cells to phytohemagglutinin (PHA) and to tetanus toxoid after in vivo boosting. Accessory function of monocytes from the elderly subjects for T lymphocyte responses to tetanus toxoid was comparable to the young. Expression of the cytokines interleukin-1, interleukin-6 and tumor necrosis factor, the cell adhesion molecules ICAM-1 and LFA-3 and the class II major histocompatibility molecule HLA-DR by monocytes from the elderly and young subjects was similar. T lymphocytes from the elderly responded poorly to PHA. Monocytes from the elderly had a decreased accessory function for PHA-stimulated T cells from young, third donors. Thus, although many accessory properties of monocytes from the elderly are normal, the monocyte and T lymphocyte defects in the elderly for mitogen may represent interactive factors in cell-mediated immunity during aging.

The diminished in vitro blastogenic response of lymphocytes from the elderly to mitogenic stimuli is cited as evidence of immunosenescence, but the response to specific microbial antigens has not been well characterized. We measured the response to tetanus toxoid before and after boosting in young and elderly subjects. Elderly subjects (age > or = 70) and young controls (age < 35) were subjected to clinical, laboratory, and nutritional evaluation to ensure a cohort of healthy subjects. Responses of lymphocytes from the elderly to the mitogens phytohemagglutinin and concanavalin A were markedly diminished compared to those from the young. For all subjects, the average in vitro blastogenic response to tetanus toxoid of lymphocytes from elderly subjects (n = 23) was significantly diminished compared to young controls (n = 23; 31,985 +/- 4502 vs 14,411 +/- 3714 cpm, p < .01). Following boosting with tetanus in those subjects in whom boosting with tetanus toxoid was indicated, blastogenesis was comparable between elderly (n = 17) and young subjects (n = 7; 38,078 +/- 11,451 vs 42,103 +/- 9247 cpm). The boosted response to tetanus apparently was not sustained, since in the subset of subjects with a history of tetanus immunization in the past 10 years, the response of the elderly was much less than that of the young. Thus, a cohort of healthy elderly with diminished blastogenic responses to mitogens was capable of at least a transiently normal response to tetanus post boosting.

1. All age groups gained mass during the active season, but mass-gain of adult females was delayed during lactation. 2. The relationship of body mass to metabolic rate varied widely; when the relationship was significant, R2 varied from 10.3 to 72.6%. Body mass affects VO2 more during lactation than at any other period. 3. Mean VO2 of adult males was higher in June than that of adult, non-lactating females. 4. VO2 of reproductive females was significantly higher during lactation than during gestation or postlactation because specific VO2 varied. Specific VO2 of non-reproductive females declined over the active season. 5. Specific VO2 of all age groups declined between the premolt and postmolt periods. The reduced maintenance costs can contribute 20-46% to daily growth. 6. Observed VO2 was lower than the value predicted from intraspecific or interspecific Bm:M regressions. 7. VO2 of wild-caught marmots was lower than that of marmots maintained in the laboratory, probably because of dietary differences. 8. Because basal metabolism is a stage on a food-deprivation curve, we suggest that basal metabolic rate is not an appropriate measure of the metabolic activity of free-ranging animals.