Jersey Shore Research Articles

Extended-Duration Venous Thromboembolism Prophylaxis for Medical Patients

Letters16 November 2010Extended-Duration Venous Thromboembolism Prophylaxis for Medical PatientsMichael P. Carson, MD and Yen-Hong Kuo, PhDMichael P. Carson, MDFrom Jersey Shore University Medical Center, Neptune, NJ 07753.Search for more papers by this author and Yen-Hong Kuo, PhDFrom Jersey Shore University Medical Center, Neptune, NJ 07753.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-153-10-201011160-00020 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:In the EXCLAIM study, Hull and colleagues (1) report the results of their large trial evaluating extended VTE prophylaxis for hospitalized medical patients. It was nice to see transparent reporting of the limitations stated in the abstract and the balanced presentation in the discussion section. We reviewed the article at our resident-run journal club and would appreciate feedback from the authors regarding the reason for reporting nonadjudicated data in Tables 2 and 3 and why they seemed to downplay the risk for major bleeding episodes by stating that the rate was “similar to those seen in previous ...Reference1. Hull RD, Schellong SM, Tapson VF, Monreal M, Samama MM, Nicol P, et al; EXCLAIM (Extended Prophylaxis for Venous ThromboEmbolism in Acutely Ill Medical Patients With Prolonged Immobilization) study. Extended-duration venous thromboembolism prophylaxis in acutely ill medical patients with recently reduced mobility: a randomized trial. Ann Intern Med. 2010;153:8-18. [PMID: 20621900] LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Jersey Shore University Medical Center, Neptune, NJ 07753.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoExtended-Duration Venous Thromboembolism Prophylaxis in Acutely Ill Medical Patients With Recently Reduced Mobility Russell D. Hull , Sebastian M. Schellong , Victor F. Tapson , Manuel Monreal , Meyer-Michel Samama , Philippe Nicol , Eric Vicaut , Alexander G.G. Turpie , Roger D. Yusen , and Extended-Duration Venous Thromboembolism Prophylaxis for Medical Patients Russell D. Hull and Extended-Duration Venous Thromboembolism Prophylaxis for Medical Patients Francesco Dentali , Monica Gianni , and Alessandro Squizzato Extended-Duration Venous Thromboembolism Prophylaxis for Medical Patients Jose A. Nieto , Reina Valle , and Juan B. Lopez-Saez Metrics 16 November 2010Volume 153, Issue 10Page: 689KeywordsAbsolute risk reductionConflicts of interestHemorrhageNumber needed to treatProphylaxisResearch designSafetyVenous thromboembolism ePublished: 16 November 2010 Issue Published: 16 November 2010 Copyright & PermissionsCopyright © 2010 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Returning to the Glory Days: Race, Urban Form, and Redevelopment in Asbury Park, New Jersey - A Planning Critique

Long burdened by the legacies of racial strife and the scorched earth tactics of urban renewal, Asbury Park, New Jersey appears primed for a renaissance. In a particularly bold move that has captured the attention of The New York Times, the Asbury Park Redevelopment Authority recently unveiled a $1.2 billion redevelopment plan that envisions the city’s restoration as the Jersey Shore’s place to be. Grounding the Redevelopment Authority’s Master Plan for Asbury is a Glory Days narrative that presents the historical Asbury as a thriving, relatively egalitarian space. As a review of the Master Plan in light of Asbury’s deeper history suggests, however, the Redevelopment Authority’s narrative is partial and idealized: Asbury’s historical development as a commercial center and resort destination relied heavily on the exploitation and marginalization of the inhabitants of the western region of the town. Vitally, for planners and citizens alike, this history is not past, but rather remains integrally bound-up with the city’s present-day landscape. In attempting to preserve Asbury’s historical form, the work of the Redevelopment Authority promises to resurrect an urban configuration that has traditionally been racially and class exclusive, with no reasonable expectation that redevelopment will alter these historical patterns. As an imagined future for Asbury, the Redevelopment Plan is neither practicable nor sustainable, offering Asbury’s poor not economic revitalization and social inclusion, but rather, further socioeconomic exclusion and spatial segregation.

Preservation Parade: The Mediatization of the Lieb House into a Monument

This essay reflects on the March 2009 relocation of Venturi and Rauch's 1960s Lieb House from its original site on the New Jersey shore to a new seaside location on Long Island, arguing that the Lieb House reached the status of a historic monument only due to the media spectacle of its dramatic waterborne rescue passing through the waters of New York City. Stierli situates the moving of the Lieb House within the tradition of the mobile monument and interprets the voyage as a reconfiguration of ancient processions where the idol has now been replaced by the monument. Historic preservationists, Stierli argues, must comply with the logic of the spectacle while at the same time subverting it.

The SCIP core measures

Jeffrey Paul Booth is the medical management project coordinator at Jersey Shore University Medical Center/Meridian Health, Neptune, N.J.

Signifying in the Ivory Tower

Signifying in the Ivory Tower Wendy Graham My paper focuses on the homologies James forges among business, personal, and aesthetic interests through the lexical strategies of his late fiction. Slogging away at the uncanny reverberations of the term “interest,” page by page, until curiosity and cupidity are rendered virtually synonymous, James’s linguistic fun is the medium of the message that there is no escape from capital but death: [Mr. Gaw] conformed in short to his necessity of absolute interest—interest, that is, in his own private facts, which were facts of numerical calculation altogether: how could it not be so when he had dispossessed himself, if there had even been the slightest selection in the matter, of every faculty except the calculating? (IT 7) In his notes for The Ivory Tower (1914), James reviews the pitfalls he faced in The American Scene (1907), the apprehension that he was out of his depth explaining financial instruments, codicils to wills, amortization of principal and the like: “Enormous difficulty of pretending to show various things here as with a business vision, in my total absence of business initiation” (IT 216). James disparaged the crudity of new wealth in The American Scene by cataloging the material pomp and show of Newport and the Jersey shore: “houses and their candid look of having cost as much as they knew how” (AS 11). Similarly, The Ivory Tower casts a jaundiced eye on “The enormous preponderance of money. Money is their life,” as an axis of community and identity among the denizens of Newport (84). The Ivory Tower supersedes the fact-finding or constative dimension of the earlier work through its improvisation of a middle ground between “the motions of matter and the states of consciousness”—“the most heterogeneous objects we know,” according to Georg Simmel (132). James’s text resurrects the repressed social dimension of the market, in which individuals misconstrue a trumped up “exchange value” as a true measure of a commodity’s production costs and utility—as inherent in the [End Page 68] thing itself. James demystifies commodity fetishism starting with the fetish value of money. Just as a social compact allows money to function as if it were material wealth, rather than its envelope, James’s fictional Newport revolves around the activities of confirmed and reputed millionaires, reminding us that a collective delusion structures the real social activities of men. The performative dimension of James’s late unfinished novel is a perpetual demonstration of the absolute identity, from a functional viewpoint, of language and money within a conceptual framework: “for of what else but money do we ever talk?” (IT 105). Figurative language enables comparisons between things that are qualitatively different, cannily summarized by the phrase, “a treasure of consciousness” (36). Money reconciles the incommensurate aspects of commodities, ignoring qualitative differences in order to streamline the exchange of property: “A definite amount of money can thus determine or measure the value of an object, regardless of whether money and the valuable object possess any identical quality, and so regardless of whether money itself is valuable” (Simmel 133). (Eggs cost $3.00 a dozen; ribbons cost $3.00 each; therefore, a dozen eggs = one ribbon.) Money and language are placeholders of value, symbols without substance. Unwilling to mount a mimetic representation of the financial sector, James resorts to a “symbolic mode of analogical correspondences” between types of human activity in the novel, sweeping aside the ground of reality in favor of rhyming semiotic contexts (de Man 222). The paradoxical assimilation of rhetoric and commerce does not result in a “category mistake,” however, as James does not haphazardly misrepresent the facts pertaining to one category in terms appropriate to the other (Ricoeur 148). He forges a rapprochement between the two through the mediation of the sign, a third term that points to something other than a descriptive reference or literal meaning. The referential function of narrative is suspended throughout, as the reader struggles with the ambiguity of the message and the polysemy of favored terms. The text foregrounds “stereoscopic vision”—the ability to hold two different points of view at the same time (154), all the while urging symmetry between either side of the...

Sexually Transmitted Infection Clinic Musings

From the Jersey Shore University Medical Center. Reprints: Edward Liu, MD. Jersey Shore University Medical Center, 1945 Route 33, Department of Medicine, Neptune, NJ 07754. E-mail: [email protected].

Taking a stand

President and RN representative, Local 5058, HPAE, AFT, AFL-CIO, Jersey Shore University Medical Center, Neptune, N.J.

Synthesizing Process and Pedagogy in the Development of a Field Marine Science Course for K-8 Teachers

MAR-380: The Learning and Teaching of Marine Science, is a science course specifically designed to integrate scientific content and pedagogical practice. This course, developed at Rider University, bridges the gap between the learning of science and the teaching of science through a seamless integration of science content and science pedagogy. The course emphasizes an inquiry-based approach, with students examining four different coastal environments through field exercises on the New Jersey shore. Before each trip, students learn about each environment through lecture and discussion, and develop their own questions about potential interactions between physical and biological processes. Students complete assigned readings of exemplary science lessons pertinent to the field site and answer relevant review questions prior to the trip. Students then collaboratively design field procedures to collect appropriate data to answer their questions. Samples are collected and data recorded in the field, analyzed in the lab, and subsequently integrated into site-specific reports. In the culminating activity for the course, students design age-appropriate learning experiences for K-8 students, based on the new science content they have learned. Pre- and post-survey results indicate a general increase in both students' attitudes toward the importance of science and in their perceived ability to do science.

Death and dying in the US: the barriers to the benefits of palliative and hospice care

In August 2006, after a trip to the New Jersey Shore, Peggy was having great difficulty catching her breath. In consultation with her children, Peggy decided that she was ready for hospice care. But, she did not want to relinquish her independence just because shortness of breath and a weakening heart overtook her daily stride. However, a single episode at home had thrown Peggy into crisis. Since Peggy lived alone, hospice care at home presented a host of challenges including safety and how to manage her unstable cardiopulmonary condition. Peggy was an ideal candidate for the hospice’s TeleCare (see box) monitoring program which provided a passive monitoring system, a medication dispenser, and vital signs monitoring for blood pressure, weight, and blood oxygen levels. In addition, the hospice authorized routine draws of BNP (beta naturetic peptide) and BMP (basic metabolic profile) with GFR (glomerular filtration rate) to manage her symptoms aggressively. Medications were adjusted accordingly to maximize quality of life and minimize symptoms. Though some would consider this treatment aggressive, it was the aggressive treatment of Peggy’s symptoms that allowed for an extended quality of life. There was sufficient evidence to support this action based on the concept of risk and reward, especially as there was a minimum of invasive therapies required. In Peggy’s case she went from being homebound and short of breath to living her life up to her final days. TeleCare monitoring enabled a hospice patient like Peggy to not only live independently, but also to leverage the hospice staff ’s ability to care for her. The nurse case manager could identify Peggy’s changing medical status for immediate intervention before symptoms escalated into a crisis. Making more informed and timely adjustments to Peggy’s treatment protocol allowed for intensive treatment of her symptoms and improved her overall quality of life. In Peggy’s case TeleCare monitoring played an important part in her living longer, more comfortably, and with peace of mind. Peggy had witnessed her father suffocate with emphysema and she feared that would also be her fate. But with her hospice care augmented with Telecare, Peggy’s children agreed that their mother never struggled to breathe. Peggy lived at home for another 2 months, and it was there she was able to celebrate her last birthday, close to her children and family.

Stephen Crane and Methodism's Realism: Translating Spiritual Sympathy into Urban Experience

In 1883, three years after Reverend Jonathan Townley Crane died, the widowed Helen Crane moved their family from Port Jervis, New York to Asbury Park, New Jersey--one of the many resort towns that had recently sprung up along the Jersey Coast. This section of the Jersey Shore was familiar territory to the Cranes; almost a decade before making Asbury Park their permanent home, Reverend Crane and his family had begun attending Methodist summer camp meetings in neighboring Ocean Grove. Established in 1869 by members of the National Camp Meeting Association for the Promotion of Holiness, Ocean Grove was part of a much larger movement within the Methodist Episcopal Church to revitalize a membership that some felt had lost its prior spiritual zeal and unity. Adherents to the holiness movement advocated a return to turn-of-the-century evangelical preaching styles and to the community-based organizational forms--such as camp meetings and love feasts--that distinguished early Methodism from other Protestant denominations. Full of spontaneous preaching, singing, witnessing, and praying, the frontier-era camp meeting reached its spiritual and peak in the love feast--an event that, as John Wigger explains, traditionally centered upon the eating of a small portion of bread and drinking of a little water in imitation, not of the sacrament, but of the communal fellowship of the early saints, and, most important, unrehearsed individual testimonies of struggles and triumphs in the faith, of what God had done in the lives of those present. (1) Typical of many of Methodism's small-scale liturgical events, the love feast facilitated spiritual uplift through contact. As participants shared the sacred knowledge that they had accumulated through personal experience, they pushed one another to new spiritual heights by strengthening their bonds. At the love feast and class meeting, explained Edmund S. Janes in 1862, Methodists came together not as mere pupils or catechumens, but as fellow-Christians, met for the interchange of religious experience, congratulations, sympathies, and assistances in the way of life. Only through these forms of interactive worship could Methodists realize Christian intimacy, such stated seasons of fellowship, such familiar conversation on religious experience, such spiritual sympathy. Methodism was, Janes explained, an experimental religion that offered its adherents a social means of grace. (2) While modifying the structure of frontier camp meetings, love feasts and other organizational forms in order to accommodate Methodists' changing tastes and leisurely habits, the National Camp Meeting Association for the Promotion of Holiness hoped that a return to these liturgical practices in resort towns like Ocean Grove would provide similar spiritual and benefits for late-nineteenth-century campers. (3) Working as a seaside correspondent in Ocean Grove and Asbury Park for the New York Tribune during the summers of the early 1890s, Reverend Crane's youngest son, Stephen, attested to the replication in Ocean Grove of antebellum Methodism's socio-spiritual dynamics. Briefly sketching the activities of the most important day of Ocean Grove's ten-day camp meeting, Crane wrote: usual 9 o'clock meetings were held an hour earlier to-day, as the camp-meeting love feast had the right of way at that hour. At the young people's meeting a number were converted. The Rev. C. H. Yatman, the leader, possesses a strong-personality and magnetism which, with a graphic way of putting things, wins souls to higher things.... Dr. Stokes asked the people to shake hands in token of brotherly love, which they did with shouts and tears. (4) Taking for granted the confluence of religious conversion and interpersonal connection, Dr. Ellwood H. Stokes--first president of the Ocean Grove Camp Meeting Association--encouraged the young campers to consummate their spiritual experience by shaking hands with one another; he thus began instilling within them a pattern that they would regularly reenact at Ocean Grove. …

389: Postpartum depression: Time of screening and access to care

KAMINSKY, SAGAR PATEL, GELEN DEL ROSARIO, ADRIANNA FITSZIMMONS, ROSELYN YOUNG, JOSEPH CANTERINO, University of Medicine and Dentistry of New Jersey, Obstetrics, Gynecology and Reproductive Sciences, New Brunswick, New Jersey, Jersey Shore University Medical Center, Obstetrics, Gynecology and Reproductive Sciences, Neptune, New Jersey OBJECTIVE: The objective of the study was to determine the time of screening for postpartum depression which will optimize patient access to psychiatric care. STUDY DESIGN: This was a retrospective cohort study. All patients receiving prenatal care at the outpatient clinic at our institution were screened for postpartum depression at 36 weeks gestation, following delivery, and at 6 weeks postpartum visit. Edinburgh Scale for Postpartum depression was used with a cut-off score of more than or equal to ten. The rate of psychiatric evaluation of screen-postitive women was compared at three different times of screening. RESULTS: The results are depicted in the Table. CONCLUSION: Screening for postpartum depression at the time of delivery significantly increased patients’ access to psychiatric care.

Everyman (review)

Reviewed by: Everyman Gurumurthy Neelakantan Everyman, by Philip Roth. Boston: Houghton Mifflin Company, 2006. 182 pp. $24.00 (p). Philip Roth's Everyman, his twenty-seventh book, is all about death, and appropriately its title on the dust jacket appears boxed in red against a background of black. These initial intimations of foreboding and grievous loss get further deepened by the epigraph from Keats's "Ode to the Nightingale." Beginning with Sabbath's Theater and through the American trilogy comprising American Pastoral, I Married a Communist, The Human Stain and also encompassing The Dying Animal, death, the grand theme that has engaged the American literary imagination powerfully since Walt Whitman, is obsessively at work, and, often, as is Roth's characteristic practice, it evolves in relation to the sex drive. This dialectic of Eros and Thanatos in Everyman is explored in an unusual context in that the narrative line of the novel intriguingly conflates the protagonist's biography with his medical history and thereby makes death unmitigatingly real. If the reader assumes that this late work is a confessional statement of the novelist's own health anxieties and fear of impending death, this would be pointless speculation. In interviews that appeared around the time when Everyman was released, Roth categorically dispelled such guesswork highlighting the reasons that prompted him to write the novel. As the novelist himself admits, it is the death of his literary mentor and friend Saul Bellow that compelled him to write the novel: "He [Bellow] was 89 I think, when he died. Yet his death was very hard to accept, and I began to write this book the day after his burial. It's not about him—it has nothing to do with him—but I'd just come from a cemetery, and that got me going." Clearly inspired by the late fifteenth-century morality play Everyman, Roth's Everyman complicates the novelist's attitude to death in interesting ways. Irreverent and dismissive about religion, Roth depicts his Everyman as an American Jew, though this portrayal swerves from an essentializing universalism. [End Page 168] However, this protagonist, a diehard secularist, is susceptible to family feeling, and this is borne out by his fond recollections of his dead parents and his endearing relationship with his elder brother and daughter. Sustaining the ethos of the morality plays which were usually enacted in cemeteries, Everyman too locates large chunks of action in the cemetery. Unlike a typical morality play that associates the human body with sin and depravity, Roth's novel respects the claims of the body, and, in equating the corporeal with life itself, exposes the nullity of death. Roth's unnamed protagonist is a retired adman who subsequent to the events of 9/11 prefers to leave New York to live in a residential village for the elderly on the Jersey shore. Artistic although not a great artist, Everyman is able to sustain his passion for painting through an advertising career into his retirement. He displays a fierce sense of independence, as befitting one belonging to a creative profession such as advertising that is analogous to art. Strangely though, the endless inventive possibilities animating art manifest themselves nowhere in Everyman but in his sexual ardor. Ever suffering the pangs of mortality, he seeks sex as an analgesic to alleviate this inexorable awareness. It is as if Everyman believes that he can escape death by melting into the mercies of voluptuous women. The droll way Everyman suggests the title "Life and Death of the Male Body" for his imagined autobiography turns out to be an uncanny moment of precocious self-awareness. In a sense, his life inseparable from the body adds up to experiencing three marriages and a funeral. Interestingly enough, Everyman's consciousness had been haunted by death ever since his boyhood experience of seeing a dead U.S. marine washed ashore on to the Jersey beach. His intimations of mortality deriving from this experience stalk much of his youth, and, rightly, Everyman decides to postpone this fear of oblivion till he reaches the age of seventy-five. With surgery in 1999 for removing the obstruction in his left carotid artery, "death seemed to have become the...

The Book of One Hundred Truths (review)

Reviewed by: The Book of One Hundred Truths Hope Morrison Schumacher, Julie The Book of One Hundred Truths. Delacorte, 2006182p Library ed. ISBN 0-385-90311-1$17.99 Trade ed. ISBN 0-385-73290-2$15.95 R Gr. 5-8 As twelve-year-old Theodora prepares to board the plane for her annual trip to her grandparents' home on the Jersey shore, her mother hands her a blank notebook. "You can write anything you want in here, as long as every single thing you write is true," she tells her daughter, responding to Thea's recent tendency to intentionally tell lies, a practice Thea's narration hints is linked to her desire to avoid thinking about a frightening reality in her past. At her grandparents', Thea is expected to watch her seven-year-old cousin, Jocelyn, who is obsessed with secrets and certain that their aunts are up to something. Thea soon finds herself ensnared in Jocelyn's [End Page 190] spy tactics, all the while trying to keep her own secrets and to figure out what is meant by truth, as she every day adds "truths" to the list in her notebook. Thea is a thoughtful and realistic protagonist, and the alternating tension and affection that builds between her and Jocelyn is carefully drafted. The book gains suspense from the explanation of Thea's and her aunts' secrets, and the issues of secrets and lies will resonate with young readers. This is a compelling novel, with just the right dose of quiet reflection, self-discovery, and mystery. Copyright © 2006 The Board of Trustees of the University of Illinois

A Clovis Fluted Point from Coastal Waters in Southern New Jersey

This report documents a Clovis-like fluted point found in shallow waters of Great Egg Harbor Bay, a backbarrier lagoon along the Jersey shore. The artifact has a complicated life history and is significant by enriching the vastly incomplete Paleoindian data base from New Jersey's Outer Coastal Plain. Despite the extraordinary circumstances of its discovery, this fluted point calls new attention to the potential of nearshore and estuarine settings in our search for traces of the First Americans in eastern North America.

Crime, Lawbreaking, and Counterhegemonic Humanism in the Songs of Bruce Springsteen

legislatures, courts, and police departments - assume primary responsibility for criminal definitions and designations, but elected officials, religious leaders, and the media also contribute significantly. media in fact eagerly report on how much crime exists, thereby inviting one and all to understand crime as a species of phenomenological fact. Overall, this multifaceted hegemonic tact confirms norms and values, reinforces the state's legitimacy, and contributes generally to the hegemony's self-preservation.2 Unfor- tunately, the process also makes those designated as criminals into extreme outsiders. stage is set for them to be incarcerated, marginalized, denigrated and rejected. An argument can in fact be made that this concern stretches through Springsteen's four decades of singing and songwriting. To be sure, with maturity and changing times Springsteen's styles and focus have changed. verbose ditties of his youth gave way to roaring anthems which in turn gave way to sober reflections on marriage, fatherhood, and responsibility. Instead of singing about kids and their cars, Springsteen came to sing about unemployment and personal disappointment and then, as if that was not enough, about the horror of 9-1 1. One of the great treats for a longtime Springsteen fan is tracking his changes. But still, Springsteen's topical interest in crime and lawbreaking has been present throughout his stylistic shifts and thematic turns. We can think of Guilty and The Hitter as the beginning and current embodiment of Springsteen's attention to crime and lawbreaking. He sang the song Guilty in 1969 and 1970 with Steel Mill, his early band from the Jersey shore. song presents a young lawbreaker who is dragged into court and a jury only too eager to convict.3 The Hitter, meanwhile, appears on Devils and Dust (2005) and is another song about a young lawbreaker. He flees to New Orleans with the police on his tail, makes his way as a prize- fighter, and then is paid off to illegally throw a fight to Big John McDowell. Between Guilty and The Hitter, Springsteen's albums and compact disks have routinely in- cluded treatments of crime or lawbreaking. Nebraska (1982) and Ghost of Tom Joad

Choosing Safe Fish: Too Little Data on the Menu

In recent years, both the benefits and the potential health risks of eating certain types of fish have been well publicized. Consumption advisories by government agencies as well as media reports have raised public awareness of high mercury concentrations in certain fish, particularly swordfish, shark, king mackerel, and tilefish. In this month’s issue, scientists at Rutgers University, the Environmental and Occupational Health Sciences Institute, and the New Jersey Department of Environmental Protection contend that such efforts still are not enough to allow consumers to make truly informed decisions about which fish to eat, how often, and in what quantities [EHP 113:266–271]. With the overall objective of exploring how the information communicated in public health advisories might be enhanced, the group looked at the potential variation in fish mercury levels between regions within a state, between neighborhoods of different economic strata, and between types of stores. They also wanted to determine whether regional levels were significantly different from reported national levels posted by the Food and Drug Administration (FDA) online at http://www.cfsan.fda.gov/~frf/sea-mehg.html. For the statewide comparison, the investigators analyzed the mercury content of samples of three types of fish commonly available in New Jersey—tuna, flounder, and bluefish. The fish were purchased between July and October 2003 from grocery stores and fish markets in regions throughout the state, and in both high- and low-income communities. The species—as expected—varied significantly in their mercury content, with large predatory tuna containing the most and bottom-feeding flounder the least. Mercury content did not vary significantly among store types or economic areas. Just one regional difference emerged: flounder purchased at fish markets along the Jersey shore had higher mercury levels than flounder from markets in other areas, possibly due to the fish coming into the stores from different sources, such as regional distribution centers. To compare actual mercury measures against data reported by the FDA, the team purchased and assayed samples of six additional types of fish (Chilean sea bass, porgy, red snapper, croaker, cod, and whiting) and two types of shellfish (shrimp and scallops) from central New Jersey markets. These species were chosen because of their wide availability in the state. Mean levels of mercury were higher in the sea bass, croaker, whiting, and shrimp available in New Jersey—as well as the tuna sampled in the first tier of the study—than predicted by the FDA’s data; the actual mean for one fish, croaker, was nearly three times the FDA estimate. The authors say these discrepancies show that the FDA should update its database (the data provided were collected mainly from 1990 to 1992). They also suggest that the agency consider providing regional breakdowns of aggregate mercury levels so state agencies can evaluate possible risks for their citizens. According to the researchers, this was the first study of mercury levels in commercial fish that included examination of fish availability, cost, and consumer preference as variables in consumer choice. Flounder struck the best balance between ready availability, affordable cost, and low mercury content. The authors suggest that state agencies responsible for health risk communication conduct more comprehensive studies and disseminate findings on consumers’ fish preferences as well as fish cost, availability, and contamination, including data on commercial fish species with low levels of mercury. Such information would enhance consumers’ ability to make rational decisions about fish consumption. Fish clearly can be a healthful food providing a relatively low-fat protein source as well as beneficial nutrients that protect against cardiovascular disease, the authors point out. They are pursuing studies that more clearly portray the balance between benefits and risks associated with eating different types of fish.

Response to the Letters to the Editor by William O. Roberts, MD, MS and Nick Mohtadi, MD, FRCSC, MSc., Dip. Sport Med

Jersey Shore University Medical Center, Neptune, New Jersey This response was reviewed and approved by the IMMDA board.

Mercury in commercial fish: optimizing individual choices to reduce risk.

Most attention to the risks from fish consumption has focused on recreational anglers and on fish caught by individuals, but the majority of fish that people eat are purchased from commercial sources. We examined mercury levels in three types of fish (tuna, flounder, bluefish) commonly available in New Jersey stores, sampling different regions of the state, in communities with high and low per capita incomes, and in both supermarkets and specialty fish markets. We were interested in species-specific levels of mercury in New Jersey fish and whether these levels were similar to data generated nationally by the Food and Drug Administration (FDA; mainly from 1990 to 1992) on the same types of fish. Such information is critical for providing public health advice. We were also interested in whether mercury levels in three common species of fish differed by region of the state, economic neighborhood, or type of store. We found significant species differences, with tuna having the highest levels and flounder the lowest levels. There were no significant differences in mercury levels as a function of type of store or economic neighborhood. There was only one regional difference: flounder from fish markets along the Jersey shore had higher mercury levels than flounder bought in other markets. We also examined mercury levels in six other commonly available fish and two shellfish from central New Jersey markets. There were significant differences in availability and in mercury levels among fish and shellfish. Both shrimp and scallops had total mercury levels < 0.02 ppm (wet weight). Large shrimp had significantly lower levels of mercury than small shrimp. For tuna, sea bass, croaker, whiting, scallops, and shrimp, the levels of mercury were higher in New Jersey samples than those reported by the FDA. Consumers selecting fish for ease of availability (present in > 50% of markets) would select flounder, snapper, bluefish, and tuna (tuna had the highest mercury value), and those selecting only for price would select whiting, porgy, croaker, and bluefish (all with average mercury levels < 0.3 ppm wet weight). Flounder was the fish with the best relationship among availability, cost, and low mercury levels. We suggest that state agencies responsible for protecting the health of their citizens should obtain information on fish availability in markets and fish preferences of diverse groups of citizens and use this information to select fish for analysis of contaminant levels, providing data on the most commonly eaten fish that will help people make informed decisions about risks from fish consumption.

Trauma Library in Review

Section Editor Carol Rajda, BSN, RN, is the Trauma Clinical Coordinator, and Cara Seguin, BScN, RN, is the Trauma Program Manager at Henry Ford Hospital, Detroit, MI. Carolyn (Ryn) Fernandez, MSN, RN, ARNP-BC is the Trauma Program Manager at Jersey Shore University Medical Center, Neptune, NJ. Wendy Hums, BSN, RN is the Trauma Program Manager at Bronson Methodist Hospital in Kalamazoo, MI. Denise L. Garee, MSN, RN, FRN, is the Clinical Nurse Specialist for Emergency Services at New Hanover Regional Medical Center in Wilmington, NC. Carolyn Larrivee, MSN, RN is the Nurse Manager for the Surgical Intensive Care Unit at the University of Utah Health Sciences Center in Salt Lake City, UT.

The RN first assistant as OR concierge

Managers and staff members in the department of obstetrics and gynecology at Jersey Shore University Medical Center, Neptune, NJ, determined that surgeon and OR staff member problems were impeding their ability to function as a team. An RN first assistant was hired to act as OR concierge. Her primary role was to ensure smooth functioning of procedures performed in the facility. Physician complaints disappeared, OR staff members found the concierge supportive and adept at problem solving, and surgical volume increased significantly.