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Background: The global spread of the highly pathogenic avian influenza H5N1 virus has stimulated interest in a better understanding of the mechanisms of H5N1 dispersal, including the potential role of migratory birds as carriers. Although wild birds have been found dead during H5N1 outbreaks, evidence suggests that others have survived natural infections, and recent studies have shown several species of ducks capable of surviving experimental inoculations of H5N1 and shedding virus. To investigate the possibility of migratory birds as a means of H5N1 dispersal into North America, we monitored for the virus in a surveillance program based on the risk that wild birds may carry the virus from Asia., Results: Of 16,797 birds sampled in Alaska between May 2006 and March 2007, low pathogenic avian influenza viruses were detected in 1.7% by rRT-PCR but no highly pathogenic viruses were found. Our data suggest that prevalence varied among sampling locations, species (highest in waterfowl, lowest in passerines), ages (juveniles higher than adults), sexes (males higher than females), date (highest in autumn), and analytical technique (rRT-PCR prevalence = 1.7%; virus isolation prevalence = 1.5%)., Conclusion: The prevalence of low pathogenic avian influenza viruses isolated from wild birds depends on biological, temporal, and geographical factors, as well as testing methods. Future studies should control for, or sample across, these sources of variation to allow direct comparison of prevalence rates.

Quartz Hill, in Misty Fjords National Monument near Ketchikan, Alaska, is the site of a proposed molybdenum-producing mine. To provide baseline data for use in post-development comparisons, we analyzed tissues of Barrow's goldeneyes (Bucephala islandica), common mergansers (Mergus merganser), and blue mussels (Mytilus edulis) for seven heavy metals that could potentially be released into the environment as a result of mining operations. Specimens were collected in 1980, 1981, and 1982 from two fjords likely to be used for discharge of tailings from the proposed mine and from two control fjords. Concentrations of arsenic, cadmium, copper, chromium, molybdenum, lead, and zinc were measured in soft tissues of mussels and in kidney, liver, and muscle of birds. The highest mean concentrations of metals found in bird tissues were 55.7 ppm dry weight cadmium in kidneys and 154 ppm dry weight zinc in livers of Barrow's goldeneyes. Concentrations of several metals in blue mussels differed among seasons and locations, but the most significant finding in mussels was a maximum mean cadmium concentration of 9.6 ppm dry weight, a level higher than normally found in undisturbed areas. With the exception of 104 ppm dry weight cadmium in the kidney of one common merganser and 12.7 ppm dry weight lead in the kidney of another, concentrations of other metals in seaduck and mussel tissues were low, consistent with what would be expected for a pre-development environment. Molybdenum was found in low concentrations (<10 ppm dry weight) in all avian kidney samples and most liver samples, but was not detected in blue mussels.

Two hundred and fifty patients at a university hospital teaching clinic and 200 patients in a small private medical office were questioned about their expectations for confidentiality. It was found that in general, subjects in both groups had similar expectations of how physicians handle confidential information. This included physician behavior in situations such as discussing cases with other physicians for second opinions, submitting cases to medical journals, and discussing cases at parties or with spouses and friends. The similarity existed despite demographic differences between the two groups and despite marked differences in the two practice settings. A few differences between the groups were noted, however. University clinic patients were more likely than private office patients (54.5% vs 38.5%) to expect that cases are discussed at large physicians' meetings. Private office patients were more likely (77.8% vs 67%) to expect physicians to discuss cases with nurses. Men in both practice settings were more likely than women to believe that physicians commonly submit cases to medical journals (75.8% vs 59.9%), or discuss cases with nurses (81% vs 67%), non-medical friends (10.9% vs 4.4%), spouses (53% vs 36.4%), and at parties with physicians (56.4% vs 39.6%).