Rheumatic fever in Southern California; problems related to diagnosis

Rheumatic fever occurs in native of Southern California and is a cause of death. The incidence of streptococcosis in Los Angeles is approximately equal to that in three other major cities in the United States where rheumatic fever is known to occur commonly. Manifestations of rheumatic fever may range from mild to severe. It is suggested that a greater percentage of patients in Southern California have symptoms of rheumatic fever that are more mild. Differentiation between prolonged, uncomplicated streptococcosis and rheumatic fever is a major problem. The judicious use of a battery of tests, acute phase reactants, on the same blood sample will frequently help to establish the diagnosis in borderline situations so common to Southern California.     

Pre-Dialysis Visits to a Nephrology Department and Major Cardiovascular Events in Patients Undergoing Dialysis

Background and Objectives

Pre-dialysis care by a nephrology out-patient department (OPD) may affect the outcomes of patients who ultimately undergo maintenance dialysis. This study examined the effect of pre-dialysis care by a nephrology OPD on the incidence of one-year major cardiovascular events after initiation of dialysis.

Design, Setting Participants, & Measurements

The study consisted of Taiwanese patients with chronic kidney disease (CKD) who commenced dialysis from 2006 to 2008. The number of nephrology OPD visits during the critical care period (within 6 months of initiation of dialysis) and the early care period (6–36 months before initiation of dialysis) were analyzed. The primary outcome measure was one-year major cardiovascular events.

Results

A total of 1191 CKD patients who initiated dialysis from 2006 to 2008 were included. Binary logistic regression showed that patients with ≧3 visits during the critical care period and those with ≧11 visits during the early care period had fewer composite major cardiovascular events than those with 0 visits. Patients with early referral are less likely to experience composite major cardiovascular events than those with late referral, with aOR 0.574 (95% CI = 0.43–0.77, P<0.001). Patients with both ≧3 visits during critical care period and ≧11 visits during early care period were less likely to experience composite major cardiovascular events (aOR = 0.25, 95% CI = 0.16–0.39, P < 0.001).

Conclusions

Patients with adequate pre-dialysis nephrology OPD visits, not just early referral, may had fewer one-year composite major cardiovascular events after initiation of dialysis. This information may be important to medical care providers and public health policy makers in their efforts to improve the well-being of CKD patients.     

Substitutes for renal function. Technical trends and logistics of treatment

In France about 50 new patients per million of inhabitants per year with end stage renal disease (ESRD) require treatment with dialysis and/or transplantation. For the last few years new dialysis methods as hemofiltration and continuous ambulatory peritoneal dialysis have been extended. It is too early to predict what will be the role and the future of such methods as compared to hemodialysis, the gold standard. Appropriate logistics of treatment of ESRD rely on an integrated dialysis-transplantation program. In France the percentage of some modes of therapy, including home dialysis and transplantation, should be increased.     

Thromboembolic risk factors in kidney transplantation: hemorheologic examination in secondary polycythemia

Cardiovascular risk factors will increase the lethality of kidney patients being under dialysis treatment and after transplantation. This risk is additionally increased after transplantation by secondary polycythemia. The paper investigates the rheological properties of the blood of 20 patients affected by secondary polycythemia after kidney transplantation, 10 patients without polycythemia after kidney transplantation and 19 test persons. Plasma viscosity, erythrocyte aggregation and whole blood viscosity were determined. As a result, an increase of erythrocyte aggregation without their deformability being changed could be found in patients affected by polycythemia after kidney transplantation. The reduced thrombocyte aggregation identified in these patients can be explained by the influence of therapy.     

Alteromonas infernus sp. nov., a new polysaccharide-producing bacterium isolated from a deep-sea hydrothermal vent

A deep-sea, aerobic, mesophilic and heterotrophic new bacterium was isolated from a sample of fluid collected among a dense population of Riftia pachyptila , in the vicinity of an active hydrothermal vent of the Southern depression of the Guaymas basin (Gulf of California). On the basis of phenotypic and phylogenetic analyses and DNA/DNA relatedness, the strain GY785 was recognized as a new species of the genus Alteromonas and the name of Alteromonas infernus is proposed. During the stationary phase in batch cultures in the presence of glucose, this bacterium secreted two unusual polysaccharides. The water-soluble exopolysaccharide-1 produced xrcontained glucose, galactose, galacturonic and glucuronic acids as monosaccharides. The gel-forming exopolysaccharide-2 was separated from the bacterial cells by dialysis against distilled water and partially characterized.     

INTRASPECIFIC GENETIC DIFFERENTIATION IN CALIFORNIA SEA LIONS (ZALOPHUS CALIFORNIANUS) FROM SOUTHERN CALIFORNIA AND THE GULF OF CALIFORNIA

Intraspecific patterns of mitochondrial DNA sequence variation were determined among California sea lions ( Zalophus califomianus californianus ) from three colonies along the Pacific coast of southern and Baja California and one colony in the Gulf of California. We found no variation in 368 base pairs (bp) of cytochrome b sequence among 40 sea lions from these localities, but analysis of 360 base pairs of control region revealed eleven genotypes. The four genotypes found in the Gulf of California population were unique and phylogenetically distinct from those found in sea lions along the Pacific coast. The average sequence divergence between Gulf and Southern California genotypes was 4.3%, suggesting a relatively long period of isolation. However, colonies along the Pacific coast, which are less than 200 km apart, shared mtDNA genotypes, indicating that recent genetic exchange has occurred between them. Therefore, we suggest that regional female philopatry exists in California sea lions. Regional boundaries may be related to oceanic currents or patchiness in the distribution of resources. Further research is needed to better understand the underlying causes of genetic differentiation in the California sea lion.     

Drug Abuse—Recommendations for California Treatment and Research Facilities

The California Legislature has directed the Regents of the University of California to collect and act as an information exchange on research and services relating to drug abuse, and to provide advice with respect to fields in which research is needed.The current report, prepared under that directive, outlines the method by which data on drug abuse research and treatment facilities will be collected, and how this data will be prepared so that appropriate recommendations can be made to the state legislature.This initial report also outlines areas of immediate concern in the area of drug abuse for the benefit of the state legislature. These areas include current state policies which interfere with investigators competing for federal research funds; pharmacological misclassification of various agents of drug abuse (including marijuana, cocaine and mescaline); lack of awareness of the major adolescent drug abuse problem in California, namely that associated with methamphetamine abuse; the inconsistent and destructive effects of current Nalline clinic programs, and legal restraints which interfere with the proper treatment of drug abusers by physicians trained in treating such patients.     

Does increasing access-to-care delay accessing of care? Evidence from kidney transplantation

Policies increasing healthcare availability might decrease the cost of delaying accessing of care, leading to potential negative consequences if patients delay treatment. We analyze a policy designed to increase access to kidney transplantation through the use of time since dialysis inception to prioritize patients for transplant, which was piloted at 26 of the 271 kidney transplant centers in the United States in 2006 and 2007. We model the patient’s optimization problem comparing the benefits and costs of early waitlisting and predict that the policy change will lead to delayed waitlisting. To empirically test this prediction, we use difference-in-differences fixed effects panel regression techniques to analyze data on patients who began dialysis between 1/1/2000 and 12/31/2009. The results support the model’s prediction; patients on dialysis who waitlist for kidney transplantation increase pre-waitlist dialysis duration by 11.6 percent or approximately 76 days from a pre-policy mean of 652 days (SD = 654). With regard to waitlist outcomes, the policy is associated with a 4.5 percentage point decrease in the probability of receiving a deceased donor transplant, somewhat offset by a 3.0 percentage point increase in the probability of receiving a live donor transplant. On the extensive margin, patients on dialysis decrease their likelihood of ever waitlisting by 1.5 percentage points. We find an increase in pre-waitlist dialysis time and a decrease in the likelihood of waitlisting at all, especially among populations likely to have experienced increased access to transplantation through the policy change: patients self-identifying as Black or Hispanic rather than Non-Hispanic White, and patients without private insurance. These results suggest that some individuals may not benefit if their access to care increases, if the increase in access sufficiently decreases the penalty of delaying accessing of care.     

Genetic structure of natural populations of the California black abalone (Haliotis cracherodii Leach, 1814), a candidate for endangered species status

The black abalone (Haliotis cracherodii) has been severely depleted across much of its historic range by a combination of overexploitation and disease. Natural recovery of extirpated populations along the southern California coast will depend on the extent to which remnant populations can serve as larval sources to geographic locations formerly supporting abalone populations. Population genetic analyses of mitochondrial cytochrome oxidase subunit one (COI) DNA sequences, four nuclear microsatellites, and 142 amplified fragment length polymorphisms (AFLPs) were used to evaluate connectivity among populations of H. cracherodii sampled from the central California coast and four islands in the Southern California Bight. Global divergence among populations was significant at COI and the AFLP loci. The Hka28 microsatellite locus and AFLP data showed significant divergence in multiple pairwise population comparisons and exhibited a signal of isolation by distance. Although estimates of gene flow based on genetic analyses must be interpreted with caution, the observed level of interpopulation genetic divergence suggests that larval dispersal is restricted, and natural recovery of decimated H. cracherodii populations along the coast of California is unlikely to occur in the near future.     

Some species of the genus Phyllodoce (Polychaeta) from Southern California

Five species of the genus Phyllodoce from Southern California are reviewed. A new subgenus (Aponaitides) is proposed and a new species, Phyllodoce cuspidata , is described. A key to the Southern California species is included.     

Renal and urinary proteomics: current applications and challenges

During the past few years, proteomics has been extensively applied to various fields of medicine including nephrology. Current applications of renal and urinary proteomics are to better understand renal physiology, to explore the complexity of disease mechanisms, and to identify novel biomarkers and new therapeutic targets. This review provides some examples and perspectives of how proteomics can be applied to nephrology and how experimental data can be linked to physiology, functional significance and clinical applications. In some instances, proteomic analysis can be utilized to generate a new hypothesis from a set of candidates that are obtained from expression studies. The new hypothesis can then be addressed rapidly by conventional molecular biology methods, as demonstrated by identification of an altered renal elastin-elastase system in diabetic nephropathy and alterations in the renal kallikrein-kallistatin pathway in hypoxia-induced hypertension. The strengths and limitations of proteomics in renal research are summarized. Optimization of analytical protocols is required to overcome current limitations. Applications of proteomics to nephrology will then be more fruitful and successful.     

Analysis of clustered recurrent event data with application to hospitalization rates among renal failure patients

End-stage renal disease (commonly referred to as renal failure) is of increasing concern in the United States and many countries worldwide. Incidence rates have increased, while the supply of donor organs has not kept pace with the demand. Although renal transplantation has generally been shown to be superior to dialysis with respect to mortality, very little research has been directed towards comparing transplant and wait-list patients with respect to morbidity. Using national data from the Scientific Registry of Transplant Recipients, we compare transplant and wait-list hospitalization rates. Hospitalizations are subject to two levels of dependence. In addition to the dependence among within-patient events, patients are also clustered by listing center. We propose two marginal methods to analyze such clustered recurrent event data; the first model postulates a common baseline event rate, while the second features cluster-specific baseline rates. Our results indicate that kidney transplantation offers a significant decrease in hospitalization, but that the effect is negated by a waiting time (until transplant) of more than 2 years. Moreover, graft failure (GF) results in a significant increase in the hospitalization rate which is greatest in the first month post-GF, but remains significantly elevated up to 4 years later. We also compare results from the proposed models to those based on a frailty model, with the various methods compared and contrasted.     

Integrated dialysis and renal transplantation: small is beautiful.

Many patients in Britain with chronic renal failure suitable for renal replacement treatment die because not enough treatment facilities are available. Moreover, the number of renal transplants performed is insufficient to meet even present needs, so the number of patients on dialysis is rising. The integrated dialysis and transplant unit in Aberdeen, which has a population base much smaller than the average British unit, meets community needs for dialysis and transplantation. The problem of harvesting cadaver kidneys has been solved; the present supply has not only enabled the number of patients on dialysis to remain stable but has resulted in a net export of kidneys. The Aberdeen unit shows how estimated needs for chronic dialysis and renal transplantation may be met.     

Climatic analysis to determine where to collect and release Puccinia jaceae var. solstitialis for biological control of yellow starthistle

Puccinia jaceae var. solstitialis is an autoecious rust fungus that is native to areas of Afro-Eurasia with a Mediterranean climate. An isolate collected near Sivas, Turkey was released for classical biological control of yellow starthistle (YST), which is an invasive alien weed in California, USA. The fungus has been released throughout California, but long-term establishment rates are generally low, apparently because this ecotype is not well adapted to the climate where the weed is most invasive. Using a site with excellent establishment as a target, the Match Climates function in CLIMEX climate modeling software identified similar sites in and around the San Francisco Bay Area, east to the Central Valley and Sierra foothills, and along the coast of Southern California. Similar sites in other states include Walla Walla, Washington, Pendelton, Oregon and Salt Lake City, Utah. A Compare Locations model based primarily on experimentally measured temperature and humidity requirements of the rust produced similar results. Using Sacramento, California, which is in the center of YST distribution, as a target, the Match Climates function predicted that the best locations to search for rust accessions to use in California are near Tunis, Tunisia, Foggia, Italy, Khalkis, Greece, Kayseri, Turkey, and possibly Constantine, Algeria. This generally agrees with the prediction of a Compare Locations model based on the geographic distribution of YST in California. Climatic factors that limit the long-term establishment of the fungus are likely to be summer heat and/or dry stress and short dew periods.     

Survival of patients treated for end-stage renal disease by dialysis and transplantation.

The results of treatment in 213 patients with end-stage renal disease who underwent hemodialysis, peritoneal dialysis or transplantation, or a combination, between 1962 and 1975 were analysed. Comparison by censored survival analysis showed significantly better (P less than 0.01) patient survival with the integrated therapy of dialysis and transplantation than with either form of dialysis alone. There was no significant difference in survival of males and females but survival at the extremes of age was poorer. Analysis of survival by major cause of renal failure indicated best survival in patients with congenital renal disease. Graft and patient survival rates at 1 year after the first transplantation were 42% and 69%. The major cause of death in this series was vascular disease but infection was responsible for 50% of deaths after transplantation. While integration of dialysis with transplantation produces best patient survival, this course is possible only when sufficient cadaver kidneys are available.     

RANGE CHARACTERISTICS OF PACIFIC COAST BOTTLENOSE DOLPHINS (TURSIOPS TRUNCATUS) IN THE SOUTHERN CALIFORNIA BIGHT

Boat-based photoidentification surveys of bottlenose dolphins (Tursiops truncatus) were conducted from 1982 to 1989 in three discrete coastal study areas within the Southern California Bight: (1) Santa Barbara, California; (2) Orange County, California; (3) Ensenada, Baja California, Mexico. A total of 207 recognizable dolphins were identified in these three “secondary” study areas. These individuals were compared to 404 dolphins identified from 1981 to 1989 in our “primary” study area, San Diego, California, to examine the coastal movement patterns of bottlenose dolphins within the Southern California Bight. A high proportion of dolphins photographed in Santa Barbara (88%), Orange County (92%), and Ensenada (88%) were also photographed in San Diego. Fifty-eight percent (n= 120) of these 207 dolphins exhibited back-and-forth movements between study areas, with no evidence of site fidelity to any particular region. Minimum range estimates were 50 and 470 km. Minimum travel-speed estimates were 11-47 km/d, and all dolphin schools sighted during the study were within 1 km of the shore. These data suggest that bottlenose dolphins within the Southern California Bight are highly mobile within a relatively narrow coastal zone. Home-range dimensions and movement patterns for many vettebrate species are influenced, in part, by variation in food resources. The unique range characteristics documented during this study may reflect the highly dynamic nature of this coastal ecosystem and the associated patchy distribution of food resources available to these bottlenose dolphins.     

Life Cycle Energy Assessment of Alternative Water Supply Systems (9 pp)

Goal, Scope and Background This paper discusses the merging of methodological aspects of two known methods into a hybrid on an application basis. Water shortages are imminent due to scarce supply and increasing demand in many parts of the world. In California, this is caused primarily by population growth. As readily available water is depleted, alternatives that may have larger energy and resource requirements and, therefore, environmental impacts must be considered. In order to develop a more environmentally responsible and sustainable water supply system, these environmental implications should be incorporated into planning decisions. Methods Comprehensive accounting for environmental effects requires life cycle assessment (LCA), a systematic account of resource use and environmental emissions caused by extracting raw materials, manufacturing, constructing, operating, maintaining, and decommissioning the water infrastructure. In this study, a hybrid LCA approach, combining elements of process-based and economic input-output-based LCA was used to compare three supply alternatives: importing, recycling, and desalinating water. For all three options, energy use and air emissions associated with energy generation, vehicle and equipment operation, and material production were quantified for life-cycle phases and water supply functions (supply, treatment, and distribution). The Water-Energy Sustainability Tool was developed to inform water planning decisions. It was used to evaluate the systems of a Northern and a Southern California water utility. Results and Discussion The results showed that for the two case study utilities desalination had 2–5 times larger energy demand and caused 2–18 times more emissions than importation or recycling, due primarily to the energy-intensity of the treatment process. The operation life-cycle phase created the most energy consumption with 56% to 90% for all sources and case studies. For each water source, a different life-cycle phase dominated energy consumption. For imported water, supply contributed 56% and 86% of the results for each case study; for desalination, treatment accounted for approximately 85%; for recycled water, distribution dominated with 61% and 74% of energy use. The study calculated external costs of air pollution from all three water supply systems. These costs are borne by society, but not paid by producers. The external costs were found to be 6% of desalinated water production costs for both case studies, 8% of imported water production costs in Southern California, and 1–2% for the recycled water systems and for the Northern California utility's imported water system. Conclusion Recycling water was found to be more energy intensive in Northern than in Southern California, but the results for imported water were similar. While the energy demand of water recycling was found to be larger than importation in Northern California, the two alternatives were competitive in Southern California. For all alternatives in both case studies, the energy consumed by system operation dominated the results, but maintenance was also found to be significant. Energy production was found to be the largest contributor in all water provision systems, followed by materials production. The assessment of external costs revealed that the environmental effects of energy and air emissions caused by infrastructure is measurable, and in some cases, significant relative to the economic cost of water. Recommendation and Perspective This paper advocates the necessity of LCA in water planning, and discusses the applicability of the described model to water utilities.     

A University/Community Hospital Family Practice Residency Program

A residency program associated with a major university has many obvious advantages. On the other hand, a residency program located in an area of health manpower shortage is a major advantage to that community. This paper describes the development of a university affiliated family practice residency in the Mojave Desert of Southern California. It reports that it is possible to form a successful alliance between a medical center and a rural community, bringing increased primary care to the community, upgrading the quality of medicine practiced in the community and augmenting the staff of the local hospital without sacrificing training for the family practice residents. Furthermore, the residency program can become financially self-sufficient.     

Isolation and characterization of microsatellite loci in hybridizing California and Gambel's quail (Callipepla californica and C. gambelii)

Callipepla californica and C. gambelii are sibling species of quail that hybridize throughout Southern California where their ranges overlap. We developed seven highly polymorphic microsatellite markers that will be used to assess introgression between these species. Numbers of alleles ranged in C. californica from seven to 24 and in C. gambelii from five to 18, with high expected levels of heterozygosity in both species. Alleles exclusive to each species are present at most loci.