Falmouth Hospital

PURPOSE: This study aimed to investigate the effectiveness (speed of cooling and survival rates) of cold water immersion (CWI) in the treatment of patients with exertional heat stroke (EHS). Secondly, this study aimed to compare cooling rates on the basis of gender, age, and initial rectal temperature (Tr). METHODS: Eighteen years of finish line medical tent patient records were obtained from the exertional heat illness treatment area at the Falmouth Road Race. Study participants included patients with EHS who were treated with CWI in the medical tent. The number of EHS cases was recorded for each year, and incidence was established on the basis of the number of finishers. Overall cooling rate and differences between initial Tr, age, and sex were evaluated. RESULTS: A total of 274 cases of EHS was observed over the 18 yr of collected data. A mean of 15.2 ± 13.0 EHS cases per year was recorded, with an overall incidence of 2.13 ± 1.62 EHS cases per 1000 finishers. The average initial Tr was 41.44°C ± 0.63°C, and the average cooling rate for patients with EHS was 0.22°C·min ± 0.11°C·min. CWI resulted in a 100% survival rate for all patients with EHS. No significant interactions between cooling rate and initial Tr (P = 0.778), sex (P = 0.89), or age (P = 0.70) were observed. CONCLUSIONS: CWI was found to effectively treat all cases of EHS observed in this study. CWI provided similar treatment outcomes in all patients, with no significant differences noted on the basis of initial Tr, age, or sex. On the basis of the 100% survival rate from EHS in this large cohort, it is recommended that immediate (on site) CWI be implemented for the treatment of EHS.

This paper presents an overview of the state of measurement and monitoring capabilities for forests in the context of REDD+ needs, with a focus on what is currently possible, where improvements are needed, and what capabilities will be advanced in the near-term with new technologies already under development. We summarize the role of remote sensing (both satellite and aircraft) for observational monitoring of forests, including measuring changes in their current and past extent for setting baselines, their carbon stock density for estimating emissions in areas that are deforested or degraded, and their regrowth dynamics following disturbance. We emphasize the synergistic role of integrating field inventory measurements with remote sensing for best practices in monitoring, reporting and verification. We also address the potential of remote sensing for enforcing safeguards on conservation of natural forests and biodiversity. We argue that capabilities exist now to meet operational needs for REDD+ measurement, reporting, and verification and reference levels. For some other areas of importance for REDD+, such as safeguards for natural forests and biodiversity, monitoring capabilities are approaching operational in the near term. For all REDD+ needs, measurement capabilities will rapidly advance in the next few years as a result of new technology as well as advances in capacity building both within and outside of the tropical forest nations on which REDD+ is primarily focused.

BACKGROUND: Globally, medical cannabis legalization has increased in recent years and medical cannabis is commonly used to treat chronic pain. However, there are few randomized control trials studying medical cannabis indicating expert guidance on how to dose and administer medical cannabis safely and effectively is needed. METHODS: Using a multistage modified Delphi process, twenty global experts across nine countries developed consensus-based recommendations on how to dose and administer medical cannabis in patients with chronic pain. RESULTS: There was consensus that medical cannabis may be considered for patients experiencing neuropathic, inflammatory, nociplastic, and mixed pain. Three treatment protocols were developed. A routine protocol where the clinician initiates the patient on a CBD-predominant variety at a dose of 5 mg CBD twice daily and titrates the CBD-predominant dose by 10 mg every 2 to 3 days until the patient reaches their goals, or up to 40 mg/day. At a CBD-predominant dose of 40 mg/day, clinicians may consider adding THC at 2.5 mg and titrate by 2.5 mg every 2 to 7 days until a maximum daily dose of 40 mg/day of THC. A conservative protocol where the clinician initiates the patient on a CBD-predominant variety at a dose of 5 mg once daily and titrates the CBD-predominant dose by 10 mg every 2 to 3 days until the patient reaches their goals, or up to 40 mg/day. At a CBD-predominant dose of 40 mg/day, clinicians may consider adding THC at 1 mg/day and titrate by 1 mg every 7 days until a maximum daily dose of 40 mg/day of THC. A rapid protocol where the clinician initiates the patient on a balanced THC:CBD variety at 2.5-5 mg of each cannabinoid once or twice daily and titrates by 2.5-5 mg of each cannabinoid every 2 to 3 days until the patient reaches his/her goals or to a maximum THC dose of 40 mg/day. CONCLUSIONS: In summary, using a modified Delphi process, expert consensus-based recommendations were developed on how to dose and administer medical cannabis for the treatment of patients with chronic pain.

Author Posting. © The Author(s), 2014]. This is the author's version of the work. It is posted here by permission of Geological Society of America for personal use, not for 
\nredistribution. The definitive version was published in Geology 43 (2015): 7-10, doi: 10.1130/G36147.1.

Plastic marine debris is a global problem, but due to its widespread and patchy distribution, gathering sufficient samples for scientific research is challenging with limited ship time and human resources.

The scientific merit of decadal climate projections can only be established by means of comparisons with observations. Testing of models that are used to predict climate change is of such importance that no single approach will provide the necessary basis to analyze systematic errors and to withstand critical analysis. Appropriate observing systems must be relevant, global, precise, and calibratable against absolute standards. This paper describes two systems that satisfy these criteria: spectrometers that can measure thermal brightness temperatures with an absolute accuracy of 0.1 K and a spectral resolution of 1 cm−1 , and radio occultation measurements of refractivity using satellites of the GPS positioning system, which give data of similar accuracy. Comparison between observations and model predictions requires an array of carefully posed tests. There are at least two ways in which either of these data systems can be used to provide strict, objective tests of climate models. The first looks for the emergence from the natural variability of a predicted climate “fingerprint” in data taken on different occasions. The second involves the use of high-order statistics to test those interactions that drive the climate system toward a steady state. A correct representation of these interactions is essential for a credible climate model. A set of climate model tests is presented based upon these observational and theoretical ideas. It is an approach that emphasizes accuracy, exposes systematic errors, and is focused and of low cost. It offers a realistic hope for resolving some of the contentious arguments about global change.

Abstract In some regions underlain by ice‐rich permafrost, a consistent, long‐term increase in ALT under changing climatic conditions is not supported by observations. The apparent lack of ALT may be attributed to soil consolidation from thawing of the uppermost ice‐rich permafrost and subsidence of the ground surface. Four plots established in 1962 at Barrow, Alaska, were re‐instrumented in 2003 and surveyed annually using differential GPS technology, accompanied by active‐layer probing. Elevation change from 1962 to 2003 was within the interannual variability of the 2003–15 period, indicating net stability in the area. Over the 2003–15 period, however, all four plots experienced subsidence trends of 0.4–1.0 cm/year, resulting in a net elevation change of 8–15 cm. Warmer winters and increased snow depth during this period decreased the potential for frost heave. Warmer summers resulted in thaw penetration into the ice‐rich transient layer and ice wedges, leading to the net subsidence in recent years. Copyright © 2016 John Wiley & Sons, Ltd.

1 Remnants from oil spills can persist for decades within anoxic coastal sediments affecting local flora and fauna, but few studies have examined the long-term impacts of the residual petroleum on these valuable coastal ecosystems. 2 The Wild Harbor salt marsh (Buzzards Bay, Massachusetts, USA) still harbours residual petroleum from a 1969 oil spill, which released 700 000 L of No. 2 fuel oil. Previous effects have been noted in fiddler crabs and ribbed mussels inhabiting the oiled marsh. 3 Spartina alterniflora biomass was sampled above- and below-ground in elevational transects through areas with different total petroleum hydrocarbon (TPH) content. Further, elevational differences were mapped in oiled and non-oiled locations. 4 Stem density and above- and below-ground biomass decreased in oiled areas. The decreased vegetation biomass led to unconsolidated sediments, increased topographical variation and, ultimately, loss of salt marsh habitat. 5 Four decades after the Florida spill, with only 100 kg of the original 595 000 kg of spilt oil persisting in salt marsh sediment, the effects on large-scale ecosystem functions are still evident. 6 Synthesis and applications. Our results demonstrate specific impacts of residual petroleum on S. alterniflora biomass and coastal erosion. Further, we have defined TPH content thresholds at which to expect long-term ecosystem impacts. The recalcitrant nature of these contaminants and their chronic large-scale ecosystem effects leads to the potential demand for alternative compensation, such as preservation of coastal systems at risk elsewhere.

In Brief PURPOSE: Most eligible patients do not participate in traditional clinic-based cardiac rehabilitation (CR) despite well-established benefits. Novel approaches to overcome logistic obstacles and increase efficiencies of learning, behavior modification, and exercise surveillance may increase CR participation. In an observational study, the feasibility and utility of a mobile smartphone application for CR, Heart Coach (HC), were assessed as part of standard care. Ultimately, innovative CR models incorporating HC may facilitate better CR usage and value. METHODS: Twenty-six patients enrolled in CR installed HC. Over the next 30 days, they were prompted by HC to complete a daily “task list” that included medications, walking, education (text and videos), and surveys. Cardiac rehabilitation providers monitored each patient's progress through a HC-based Web dashboard and also sent them personalized feedback and support. Completion of the tasks and feedback (qualitative and quantitative) from patients and clinicians were tracked. RESULTS: Patients engaged with HC 90% of days during the study period, with uniformly favorable impact on compliance and adherence. Eighty-three percent of patients reported a positive/very positive HC experience. Providers reported that HC enhanced their provision of therapy by improving communication, clinical insight, patient participation, and program efficiency. CONCLUSIONS: Integrating a mobile care delivery platform into CR was feasible, safe, and agreeable to patients and clinicians. It enhanced patient perceptions of CR care and physician perceptions of the CR caregiving process. Mobile-enabled technologies hold promise to extend the quality and reach of CR, and to better achieve contemporary accountable care goals. To assess feasibility and utility of a novel smartphone application for cardiac rehabilitation (CR) and its usability and impact (task completion and qualitative feedback) over 30 days on a phase 2 program. Patients and providers reported positive experiences; it was feasible, enhancing, and agreeable to CR patients and clinicians.

A summary of molecular and visualization techniques to characterize life in the Plastisphere and compare corresponding datasets through the VAMPS website.

Abstract Over the past 5 years, massive accumulations of holopelagic species of the brown macroalga Sargassum in coastal areas of the Caribbean have created “golden tides” that threaten local biodiversity and trigger economic losses associated with beach deterioration and impact on fisheries and tourism. In 2015, the first report identifying the cause of these extreme events implicated a rare form of the holopelagic species Sargassum natans (form VIII ). However, since the first mention of S. natans VIII in the 1930s, based solely on morphological characters, no molecular data have confirmed this identification. We generated full‐length mitogenomes and partial chloroplast genomes of all representative holopelagic Sargassum species, S. fluitans III and S. natans I alongside the putatively rare S. natans VIII , to demonstrate small but consistent differences between S. natans I and VIII (7 bp differences out of the 34,727). Our comparative analyses also revealed that both S. natans I and S. natans VIII share a very close phylogenetic relationship with S. fluitans III (94‐ and 96‐bp differences of 34,727). We designed novel primers that amplified regions of the cox2 and cox3 marker genes with consistent polymorphic sites that enabled differentiation between the two S. natans forms ( I and VIII ) from each other and both from S. fluitans III in over 150 Sargassum samples including those from the 2014 golden tide event. Despite remarkable gene synteny and sequence conservation, the three Sargassum forms differ in morphology, ecology, and distribution patterns, warranting more extensive interrogation of holopelagic Sargassum genomes as a whole.

Abstract In one of my communications to the Cornwall Geological Society on the high temperature of the interior of the earth, I ventured to express a belief that mineral veins, and the internal heat, are connected with electrical action. This opinion, founded as it was on the curious arrangement of the veins, &c. in pri­mitive rocks, I have had the satisfaction to find confirmed by experiments made in some of the mines of Cornwall; and, I doubt not that the existence of electricity in metalliferous veins similarly circumstanced, and capable of con­ducting it, will prove to be as universal a fact, as the progressive increase of temperature under the earth’s surface is now admitted to be, much as my conclusions on this point were at one time controverted. In my first experiment I did not succeed in detecting any electricity; but in my second I had the gratification to observe considerable electrical action.

BACKGROUND: Maternal domestic violence (MDV) screening by pediatricians is not well-studied. Objectives. To determine the practicality and dynamics of routine MDV screening in a private pediatric office and to determine the rate of MDV in Upper Cape Cod, Massachusetts. SETTING: A 3-pediatrician, private pediatric office in Falmouth, Massachusetts. PARTICIPANTS: Mothers of children aged 1 month to 10 years scheduled to undergo a well-child visit between February 7 and July 7, 2000. INTERVENTION: Completion of an 11-item questionnaire related to violence. RESULTS: Seven hundred sixty-six families were scheduled for well visits. Five hundred ninety-two eligible mothers presented to the office. Five hundred fifty-three completed questionnaires were returned (71.2%). The rate of MDV was 2.5% in current relationships (95% confidence interval [CI]: 1.4-4.3), 14.7% in past relationships (95% CI: 11.9-18.0), and 16.5% overall (95% CI: 13.5-19.9). Increased incidence of MDV was associated with the following variables: 1) harm to a child (odds ratio [OR]: 57.3, 95% CI: 7.3-1232.4), 2) being in a relationship other than a first marriage (OR: 4.6, 95% CI: 2.7-7.8), 3) having been previously asked about MDV (OR: 3.5, 95% CI: 2.1-6.1), 4) having 4 or more children (OR: 3.1, 95% CI: 1.6-6.1), 5) Women, Infants, and Children's program eligibility (OR: 3.0, 95% CI: 1.8-5.0), 6) having public insurance (ie, Medicaid or Children's Medical Security Plan) (OR: 2.2, 95% CI: 1.3-3.7), 7) a history of failure to present for a scheduled well-child visit (no-show; OR: 2.0, 95% CI: 1.0-4.2) and 8) anonymous questionnaire completion (OR: 1.7, 95% CI: 1.0-2.9). Thirty-two and one-half percent (32/91, 95% CI: 25.6-46.0) of mothers with a history of MDV recall having previously been asked about this by a health professional, compared with 16.9% overall (93/551, 95% CI: 13.9-20.3). Eighty-two and eight tenths (82.8) percent (457/552, 95% CI: 79.3-85.8) of mothers favored pediatricians asking about MDV. DISCUSSION: This information was gathered within the context of normal work hours in a busy office. No additional staff were required. Hence, routine MDV screening appears feasible. The results suggest that a documented history of child abuse in a family makes it very likely that the mother has also been abused. However, child abuse among abused mothers is probably underreported. Furthermore, because most mothers favor domestic violence screening, concerns about lack of acceptance of maternal screening at pediatric visits seem to be unfounded. Screening may actually increase satisfaction with care. In addition, families who do not show up for appointments are at higher risk. Therefore, screening only at well visits will miss an important group. CONCLUSIONS: Maternal domestic violence screening at well-child visits is practical in a private pediatric office setting. Current rates of screening are low; however, most mothers favor such screening. Furthermore, MDV screening should also be offered on a catch-up basis for those who miss well-child visits, as is currently recommended for immunizations.

In 1999, we compared demographic and biological parameters in Common Terns (Sterna hirundo) among three colonies located 10-26 km apart in Buzzards Bay, Massachusetts, USA. The three colony sites differed primarily in size, number of pairs, and length of occupancy by terns: Penikese Island (8 ha, 132 pairs, 3 yr), Ram Island (1.1 ha, 1,900 pairs, 8 yr), Bird Island (0.6 ha, 1,800 pairs, >65 yr). This study compared parental ages and origins, nesting phenology, clutch-size, chick growth rates, productivity, chick diets, feeding rates and foraging trip times among the three colonies. Common Terns breeding at the new colony on Penikese Island were significantly younger (mean age 6.8 yr) and laid later (mean laying date 25 May), had higher productivity (2.2 fledged chicks/pair) and higher chick growth rates than those at the old colony on Bird Island (means 11.7 yr, 20 May, 0.8 chicks/pair, respectively). Feeding rates were highest and foraging trip times for all types of prey were shortest at Penikese Island. Birds at Ram Island were intermediate in all these respects. Although productivity of Common Terns at Bird Island was relatively low during the period in which the other two colonies were established (1992-1999), both breeding adults at Bird Island and chicks raised there have been very slow to move to the other colonies, which were colonized mainly by immigrants from outside the region.

Introduction Mechanically assisted crevice corrosion (MACC) in metal-on-polyethylene (MOP) total hip arthroplasty (THA) is of concern, but its prevalence, etiology and natural history are incompletely understood. Methods From January 2003 to December 2012, 1356 consecutive THA surgeries using a titanium stem, cobalt chromium alloy femoral head, highly crosslinked polyethylene and a tantalum or titanium acetabular shell were performed. Patients were followed at 1 year, and 5 year intervals for surveillance, but also seen earlier if they had symptoms. Any patient with osteolysis or unexplained pain underwent exam, radiographs, CBC, ESR and CRP, as well as serum cobalt (Co) and chromium (Cr) level. MARS MRI was performed if the Co level was > 1 ppb. Results Symptomatic MACC was present in 39/1356 patients (2.9%). Yearly MACC prevalence ranged from 0 % (0/139, 2005) to 9.9 % (16/162, 2009). 22/39 (56%) patients have undergone revision surgery, and 17/39 (44%) have opted for ongoing surveillance. Of the surveillance patients, serial serum metal ion levels appear to increase over time. Time of symptoms is correlated with tissue necrosis at time of revision. Conclusions The prevalence of MACC in MOP hips is higher in this cross-sectional study than previously reported. The highest prevalence was found in 2009 with this vendor. Based on how common this finding is in symptomatic patients from 2009, we may consider asking asymptomatic patients to obtain baseline serum ion levels. The goal of our ongoing research is to understand how to avoid permanent soft tissue loss from adverse local tissue reactions caused by MACC.

Logghe, Heather J. MD; Boeck, Marissa A. MD, MPH; Gusani, Niraj J. MD, MS, FACS; Hardaway, John C. MD, PhD; Hughes, Kathryn A. MD, FACS; Mouawad, Nicolas J. MD, MPH, MBA, FACS; Kulaylat, Afif N. MD, MSc; Hoffman, Rebecca L. MD, MSCE; Turner, Patricia MD, FACS; Jones, Christian MD, MS, FACS; Leichtle, Stefan W. MD, FACS Author Information

Since the identification of the causative organism more than 30 years ago, there remain questions about the di-agnosis and treatment of Lyme Disease. In this article, what is known about the disease will be reviewed, and approaches to the successful diagnosis and treatment of Lyme disease described. In considering the diagnosis of Lyme disease, a major problem is the inability of documenting the existence and location of the bacteria. After the initial transfer of the bacteria from the Ixodes tick into the person, the spirochetes spread locally, but after an initial bacteremic phase, the organisms can no longer be reliably found in body fluids. The bacteria are proba-bly present in subcutaneous sites and intracellular loci. Currently, the use of circulating antibodies directed against spe-cific antigens of the Lyme borrelia are the standard means to diagnose the disease, but specific antibodies are not an ade-quate means to assess the presence or absence of the organism. What is needed is a more Lyme-specific antigen as a more definitive adjunct to the clinical diagnosis. As for the treatment of Lyme disease, the earliest phase is generally easily treated. But it is the more chronic form of the disease that is plagued with lack of information, frequently leading to erroneous recommendations about the type and du-ration of treatments. Hence, often cited recommendations about the duration of treatment, eg four weeks is adequate treatment, have no factual basis to support that recommendation, often leading to the conclusion that there is another, per-haps psychosomatic reason, for the continuing symptoms. B. burgdorferi is sensitive to various antibiotics, including pe-nicillins, tetracyclines, and macrolides, but there are a number of mitigating factors that affect the clinical efficacy of these antibiotics, and these factors are addressed. The successful treatment of Lyme disease appears to be dependent on the use of specific antibiotics over a sufficient period of time. Further treatment trials would be helpful in finding the best regimens and duration periods. At present, the diagnosis of Lyme disease is based primarily on the clinical picture. The pathophysiology of the disease remains to be determined, and the basis for the chronic illness in need of additional research. Whether there is continuing infection, auto-immunity to residual or persisting antigens, and whether a toxin or other bacterial-associated product(s) are responsible for the symptoms and signs remains to be delineated.

Oceanic protist grazing at mesopelagic and bathypelagic depths, and their subsequent effects on trophic links between eukaryotes and prokaryotes, are not well constrained. Recent studies show evidence of higher than expected grazing activity by protists down to mesopelagic depths. This study provides the first exploration of protist grazing in the bathypelagic North Atlantic Deep Water (NADW). Grazing was measured throughout the water column at three stations in the South Atlantic using fluorescently-labeled prey analogues. Grazing in the deep Antarctic Intermediate water (AAIW) and NADW at all three stations removed 3.79% ± 1.72% to 31.14% ± 8.24% of the standing prokaryote stock. These results imply that protist grazing may be a significant source of labile organic carbon at certain meso- and bathypelagic depths.

BACKGROUND: Improper bicycle helmet fit increases the risk of head injury. Information on the rate of proper use of bicycle helmets is lacking. Promotion of helmet use is recommended at well-child and adolescent visits. Actual helmet assessment during such visits has not been reported. OBJECTIVES: The primary goal of this study is to measure the proportion of children whose helmets are in proper condition and can be made to fit properly by the child and/or parent. The secondary goal is to begin to assess the value and practicality of helmet inspection during well-child and adolescent visits. METHODS: The study took place at a private pediatric office in Falmouth, Massachusetts, from June 1 through August 31, 2001. Eligible children and adolescents were those aged 4 to 18 years presenting for well examination, along with siblings present at the visit. Eligible families completed a questionnaire, then had a timed attempt to fit a helmet, followed by an assessment of helmet fit and condition against a predetermined standard. RESULTS: Eighty-four percent (395/473) of eligible families participated. A total of 479 participants were assessed. Eighty-eight percent of participants (419/478) owned a helmet. Reported helmet use "always" or "almost always" was 73% for bicycling (317/434), 69% for in-line skating (193/279), 58% for scootering (179/310), and 50% for skateboarding (79/158). Compared with younger children, teenagers were less likely to wear helmets for all activities. Complete pass rate for every aspect of condition and fit was 4% (20/478, 95% confidence interval: 3-6). The pass rate when the parent alone fit the helmet was 0% (0/52). Three individual aspects of fit were most problematic: 1) helmet 'resting position' too high on the forehead (pass rate 249/479; 52%), 2) improper strap position (pass rate 157/476; 33%), and 3) excessive movement of the helmet from front to back of the head (pass rate 247/479; 52%). Mean time for questionnaire completion was 4 (standard deviation: +/-1) minutes, and 7 (standard deviation: +/-3) minutes for helmet assessment. CONCLUSIONS: Ninety-six percent of children and adolescents wore helmets in inadequate condition and/or with inadequate fit. This occurred despite a high acceptance of helmet use by this population. Initial evidence suggests that helmet assessment during well visits may be practical and valuable.

This paper presents a summary of 46 recent whale strandings involving 13 species and 497 animals, as well as six strandings not included in the previous summary by Guiler (1978). Two new species are added to the 22 previously recorded for Tasmania. Details of rescue operations, including an evaluation of current procedures, are given. Causes of the stranding phenomenon are discussed with particular reference to events in Tasmania. Results of pathological examinations are given, together with analyses of heavy metal and pesticide residue in tissues.