Proportion Of Endemics Research Articles

Elevational Distribution and Conservation Biogeography of Phanaeine Dung Beetles (Coleoptera: Scarabaeinae) in Bolivia

Insect macroecology and conservation biogeography studies are disproportionately scarce, especially in the Neotropics. Dung beetles are an ideal focal taxon for biodiversity research and conservation. Using distribution and body size data on the ecologically important Phanaeini, the best-known Neotropical dung beetle tribe, we determined elevational patterns of species richness, endemism, body size, and elevational range in Bolivia, specifically testing Bergmann’s and Rapoport’s rule. Richness of all 39 species and of 15 ecoregional endemics showed a hump-shaped pattern peaking at 400 m, but overall declined strongly with elevation up to 4000 m. The relationship between endemic and total species richness appeared to be curvilinear, providing only partial support for the null hypothesis that species-rich areas are more likely to be centers of endemism by chance alone. An elevational increase in the proportion of ecoregional endemics suggests that deterministic factors also appear to influence endemism in the Andes. When controlling for the effect of area using different species-area relationships, the statistically significant richness peak became more pronounced and shifted upslope to 750 m. Larger species did not have higher elevational mid-points, and mean body size decreased significantly with elevation, contradicting Bergmann’s rule. Rapoport’s rule was supported: species with higher elevational mid-points had broader elevational ranges, and mean elevational range increased significantly with elevation. The elevational decrease of phanaeine richness is in accordance with studies that demonstrated the combined influence of temperature and water availability on species diversity, but also is consistent with niche conservatism. For invertebrates, confirmation of Rapoport’s and refutation of Bergmann’s rule appear to be scale-invariant general patterns. Analyses of biogeographic patterns across elevational gradients can provide important insights for identifying conservation priorities. Phanaeines with narrow elevational ranges on isolated low-elevation mountains in eastern Bolivia are at greatest climate-change related extinction risk from range-shift gaps and mountaintop extinctions.

Elevational gradient of vascular plant species richness and endemism in Crete--the effect of post-isolation mountain uplift on a continental island system.

Understanding diversity patterns along environmental gradients and their underlying mechanisms is a major topic in current biodiversity research. In this study, we investigate for the first time elevational patterns of vascular plant species richness and endemism on a long-isolated continental island (Crete) that has experienced extensive post-isolation mountain uplift. We used all available data on distribution and elevational ranges of the Cretan plants to interpolate their presence between minimum and maximum elevations in 100-m elevational intervals, along the entire elevational gradient of Crete (0–2400 m). We evaluate the influence of elevation, area, mid-domain effect, elevational Rapoport effect and the post-isolation mountain uplift on plant species richness and endemism elevational patterns. Furthermore, we test the influence of the island condition and the post-isolation mountain uplift to the elevational range sizes of the Cretan plants, using the Peloponnese as a continental control area. Total species richness monotonically decreases with increasing elevation, while endemic species richness has a unimodal response to elevation showing a peak at mid-elevation intervals. Area alone explains a significant amount of variation in species richness along the elevational gradient. Mid-domain effect is not the underlying mechanism of the elevational gradient of plant species richness in Crete, and Rapoport's rule only partly explains the observed patterns. Our results are largely congruent with the post-isolation uplift of the Cretan mountains and their colonization mainly by the available lowland vascular plant species, as high-elevation specialists are almost lacking from the Cretan flora. The increase in the proportion of Cretan endemics with increasing elevation can only be regarded as a result of diversification processes towards Cretan mountains (especially mid-elevation areas), supported by elevation-driven ecological isolation. Cretan plants have experienced elevational range expansion compared to the continental control area, as a result of ecological release triggered by increased species impoverishment with increasing elevation.

AB 38. The smoking habits in rural population and its effects on the lung

Background From the mid-20th century, widespread smoking habit and environmental pollution associated with the epidemic increase in the incidence and death from lung cancer. Smoking is the main cause of over 90% of lung cancers which have made the disease a public health problem in endemic proportions. The risk of disease depends on the number of cigarettes smoked. The risk for a smoker of 25 or more cigarettes a day is 25 to 30 times higher than a non-smoker. The purpose of this study was to examine and evaluate in the cytology laboratory retrospectively material samples from 3,064 patients with a history of smoking. We studied the epidemiological characteristics of patients, histological type and smoking habit.

The Coral Triangle Initiative: what are we missing? A case study from Aceh

AbstractThe Coral Triangle Initiative is an ambitious attempt to conserve the marine biodiversity hotspot known as the Coral Triangle. However, the reef fauna in many nearby regions remains poorly explored and, consequently, the focus on the Coral Triangle risks overlooking other areas of high conservation significance. One region of potential significance, Aceh, Indonesia, has not been visited by coral taxonomists since the Dutch colonial period. Here we document the species richness of scleractinian corals of Pulau Weh, Aceh. We also compare the species richness of the genus Acropora at 3–5 sites in each of nine regions in Indonesia and Papua New Guinea. Although dominated by widespread Indo-Pacific species, the coral fauna of Pulau Weh is also the eastern and western boundary for many Indian Ocean and Pacific Ocean species, respectively. We identified a total of 133 scleractinian species, of which three have been previously recorded only in the western Indian Ocean and five are presently undescribed. The mean species richness of the Acropora at Pulau Weh is similar to regions within the Coral Triangle. This high species richness plus the high proportion of endemics suggests that the Andaman Sea is of similarly high conservation value to the Coral Triangle. We suggest that an international initiative similar to the Coral Triangle Initiative is required to conserve this region, which includes the territorial waters of six countries.

Aquatic insects indicate terrestrial habitat degradation: changes in taxonomical structure and functional diversity of dragonflies in tropical rainforest of East Kalimantan

As a group of freshwater invertebrates, dragonflies (Odonata) are commonly used as ecological indicators of freshwater ecosystems. Despite earlier studies suggesting that adult odonates may be good indicators for complex changes in a landscape, the utility of odonates as suitable indicators to indicate health of non-aquatic (forest) habitats remains poorly understood. This study analyses the adult dragonfly assemblage pattern against spatial and temporal disturbance characteristics in Indonesia's Sungai Wain Protection Forest. The core of this reserve comprises one of the few remaining fragments of primary rain forest along the East Kalimantan coast, whereas the rest of the reserve is covered by secondary forest, scrub, grassland, and farmland. Adult dragonfly assemblages at individual sampling sites were analysed in relation to (1) their intensity, (2) frequency of human-caused disturbances, and (3) the time since the last such disturbance, while controlling random variables (type of aquatic and terrestrial habitat) were removed. This study tests the effect of these factors on (1) species richness, (2) proportion of Zygoptera, (3) proportion of forest specialists, and (4) proportion of Borneo's endemics. The human-induced disturbances in the rain forest resulted in pronounced changes in the taxonomical composition and functional diversity of the odonate fauna. Results reported here demonstrate that gradual changes in the odonate assemblages correspond to the degree of anthropogenic influences on forest environments. Adult odonates comprise an appropriately sensitive and versatile indicator group for identifying changes in terrestrial forest environments as well as in freshwater habitats.

Cultural and socio-demographic predictors of car accident involvement in Norway, Ghana, Tanzania and Uganda

The prevalence of road traffic accidents is increasing towards endemic proportions in developing countries. The present study investigated cultural and demographic predictors of car accident involvement in a developed country in Europe and three developing countries in Sub-Saharan Africa. The comparison was carried out with questionnaires among a randomly obtained representative sample of the Norwegian population (n=247) as well as stratified samples in Accra and Cape-Coast in Ghana (n=299), Dar-es-Salaam and Arusha areas in Tanzania (n=599), and the central Kampala and the Mbarara district in Uganda (n=415). Measurement instruments of culture as symbol exchange and destiny orientation were used to predict self-reported road traffic accident involvement by car among the respondents. Demographic characteristics, such as gender, age and education, were also included as predictors of car accidents. The results showed that male gender was the only significant predictor of accident involvement in Norway. Introverted and extroverted culture, destiny orientation and written culture were associated with accident involvement in the African countries. Male gender also predicted accidents in these countries. Non-technical injury preventive countermeasures in developing countries could focus on cultural practice and fatalistic beliefs. Countermeasures in both developed and developing countries should target male drivers.

Control measures for Chagas disease

Chagas disease, also known as American trypanosomiasis, is a potentially life-threatening illness caused by the protozoan parasite, Trypanosoma cruzi. The main mode of transmission of this disease in endemic areas is through an insect vector called triatomine bug. Triatomines become infected with T. cruzi by feeding blood of an infected person or animal. Chagas disease is considered the most important vector borne infection in Latin America. It is estimated that between 16 and 18millions of persons are infected with T. cruzi, and at least 20,000 deaths each year.In this work we formulate a model for the transmission of this infection among humans, vectors and domestic mammals. Our main objective is to assess the effectiveness of Chagas disease control measures. For this, we do sensitivity analysis of the basic reproductive number R0 and the endemic proportions with respect to epidemiological and demographic parameters.

New Brazilian Floristic List Highlights Conservation Challenges

A comprehensive new inventory of Brazilian plants and fungi was published just in time to meet a 2010 Convention on Biological Diversity target and offers important insights into this biodiversity's global significance. Brazil is the home to the world's richest flora (40,989 species; 18,932 endemic) and includes two of the hottest hotspots: Mata Atlântica (19,355 species) and Cerrado (12,669 species). Although the total number of known species is one-third lower than previous estimates, the absolute number of endemic vascular plant species is higher than was previously estimated, and the proportion of endemism (56%) is the highest in the Neotropics. This compilation serves not merely to quantify the scale of the challenge faced in conserving Brazil's unique flora but also serves as a key resource to direct action and monitor progress. Similar efforts by other megadiverse countries are urgently required if the 2020 targets of the Convention on Biological Diversity and the Global Strategy for Plant Conservation are to be attained.

A TB Model with Infectivity in Latent Period and Imperfect Treatment

An epidemiological model of TB with infectivity in latent period and imperfect treatment is introduced. As presented, sustained oscillations are not possible and the endemic proportions either approach the disease‐free equilibrium or an endemic equilibrium. The expanded model that stratified the infectious individuals according to their time‐since‐infection θ is also carried out. The global asymptotic stability of the infection‐free state is established as well as local asymptotic stability of the endemic equilibrium. At the end, numerical simulations are presented to illustrate the results.

Stability Analysis and Optimal Control of a Vector‐Borne Disease with Nonlinear Incidence

The paper considers a model for the transmission dynamics of a vector‐borne disease with nonlinear incidence rate. It is proved that the global dynamics of the disease are completely determined by the basic reproduction number. In order to assess the effectiveness of disease control measures, the sensitivity analysis of the basic reproductive number R0 and the endemic proportions with respect to epidemiological and demographic parameters are provided. From the results of the sensitivity analysis, the model is modified to assess the impact of three control measures; the preventive control to minimize vector human contacts, the treatment control to the infected human, and the insecticide control to the vector. Analytically the existence of the optimal control is established by the use of an optimal control technique and numerically it is solved by an iterative method. Numerical simulations and optimal analysis of the model show that restricted and proper use of control measures might considerably decrease the number of infected humans in a viable way.

Patterns of genetic variability and habitat occupancy in Crepis triasii (Asteraceae) at different spatial scales: insights on evolutionary processes leading to diversification in continental islands.

Archipelagos are unique systems for studying evolutionary processes promoting diversification and speciation. The islands of the Mediterranean basin are major areas of plant richness, including a high proportion of narrow endemics. Many endemic plants are currently found in rocky habitats, showing varying patterns of habitat occupancy at different spatial scales throughout their range. The aim of the present study was to understand the impact of varying patterns of population distribution on genetic diversity and structure to shed light on demographic and evolutionary processes leading to population diversification in Crepis triasii, an endemic plant from the eastern Balearic Islands. Using allozyme and chloroplast markers, we related patterns of genetic structure and diversity to those of habitat occupancy at a regional (between islands and among populations within islands) and landscape (population size and connectivity) scale. Genetic diversity was highly structured both at the regional and at the landscape level, and was positively correlated with population connectivity in the landscape. Populations located in small isolated mountains and coastal areas, with restricted patterns of regional occupancy, were genetically less diverse and much more differentiated. In addition, more isolated populations had stronger fine-scale genetic structure than well-connected ones. Changes in habitat availability and quality arising from marine transgressions during the Quaternary, as well as progressive fragmentation associated with the aridification of the climate since the last glaciation, are the most plausible factors leading to the observed patterns of genetic diversity and structure. Our results emphasize the importance of gene flow in preventing genetic erosion and maintaining the evolutionary potential of populations. They also agree with recent studies highlighting the importance of restricted gene flow and genetic drift as drivers of plant evolution in Mediterranean continental islands.

Effect of area and geometric constraints on altitudinal patterns of angiosperm plant richness in Mt. Taibai, the Qinling Mountains, China

The altitudinal distribution patterns of angiosperms in Mt. Taibai, Qinling Mountains, China, were examined based on data of regional flora and Digital Elevation Model. Possible factors determining the distribution, such as geographical area effect and mid-domain effect (MDE) were assessed. The richness and density at species, genus, and family levels showed a hump-shaped pattern along the altitudinal gradient with peak at low-elevations. Similar patterns were identified for four life-forms (trees, lianas, shrubs and herbs), three biogeographical species groups (cosmopolitan, tropic and temperate), and two different range sizes (small- and large-ranged species). The endemic richness displayed a bimodal pattern with increasing altitude, but the proportion of endemism increased rapidly from low to high altitudes. The area of each altitudinal band was highly associated with the species richness, whereas the MDE could explain 87.0 and 50.3% of the richness variance for overall and endemic species, respectively. The collinearity between MDE and area could explain a large proportion (83.3%) of variance in species richness, implying the substitution between the two factors. Moreover, the explanatory power of MDE was stronger for large-ranged species than for small-ranged species. Our results confirmed that both MDE and area were all crucial factors to explain altitudinal richness patterns in Taibai Mountain, China. Key words: Species richness, range sizes, mid-domain effect, area effect, altitudinal gradient.

The Impact of Obesity on the Phenotype of Ulcerative Colitis

Purpose: Ulcerative Colitis (UC) is a chronic inflammatory bowel disease. Obesity has reached endemic proportions in the United States and is associated with the metabolic syndrome and low grade inflammation. The inflammatory adipokines leptin and resistin are increased in both patients with UC and obesity. The purpose of this study was to investigate the impact of obesity on the phenotype of UC. Methods: The charts of 31 patients with UC who were treated at our clinic were reviewed. Body mass index (BMI) and UC disease activity index (UC DAI) were calculated for all patients. Patients were stratified according to BMI; disease phenotype was based on the Montreal Classification: E1-proctitis; E2- left sided colitis; E3- universal colitis. The unpaired student's t-test was used to assess for significance. Linear regression was used to assess for correlations between BMI and disease duration and patient age. Results: Ten patients (32%) were normal weight (BMI≤24.9), 23% were overweight and 45% (n=14) were obese (BMI≥30). There were no significant differences in demographics between normal weight and overweight/obese patients (not presented). Demographics by BMI group are presented. UC DAI increased with increasing BMI (Table 1). There was an increasing proportion of E3 disease with increasing BMI and an increased proportion of E2 disease in overweight patients (Figure 1). There was no significant correlation between BMI and duration of disease (R2 = 0.025) or BMI and patient age (R2 = 0.00).Table 1: DemographicsFigure 1Conclusion: Obesity appears to influence the phenotype of patients with UC; there was an increasing proportion of pan colitis (E3 disease) with increasing BMI. While not statistically significant, elevated BMI was associated with higher UC DAI scores suggesting worse disease. These effects appeared to be independent of disease duration or patient age.

Biogeographic patterns in the Australian chondrichthyan fauna

The major biogeographic structure and affinities of the Australian chondrichthyan fauna were investigated at both interregional and intraregional scales and comparisons made with adjacent bioregions. Faunal lists were compiled from six geographical regions with species from these regions assigned to distributional classes and broad habitat categories. Australian species were further classified on provincial and bathomic structure following bioregionalization outputs from regional marine planning. About 40% of the world's chondrichthyan fauna occurs in Indo-Australasia (482 species) of which 323 species are found in Australian seas. The tropical Australian component, of which c. 46% of taxa are regional endemics, is most similar to faunas of Indonesia, New Guinea and New Caledonia. The temperate Australian component is most similar to New Zealand and Antarctica with about half of its species endemic. Highest levels of Australian endemism exist in bathomes of the outer continental shelf and upper slope. A relatively high proportion of regional endemism (57% of species) on the slope in the poorly surveyed but species-rich Solanderian unit is probably due to high levels of large-scale habitat complexity in the Coral Sea. The richness of demersal assemblages on the continental shelf and slope appears to be largely related to the spatial complexity of the region and the level of exploration. Much lower diversity off Antarctica is consistent with the pattern in teleosts. The complex chondrichthyan fauna of Australia is confirmed as being amongst the richest of the mega-diverse Indo-West Pacific Ocean. Species-level compositions of regional faunas across Indo-Australasia differ markedly because of moderate to high levels of intraregional speciation. Faunal assemblages in Australian marine provinces and bathomes differ from each other, supporting a broader pattern for fishes that underpins a marine planning framework for the region.

Protected and Threatened Components of Fish Biodiversity in the Mediterranean Sea

The Mediterranean Sea (0.82% of the global oceanic surface) holds 4%-18% of all known marine species (~17,000), with a high proportion of endemism [1, 2]. This exceptional biodiversity is under severe threats [1] but benefits from a system of 100 marine protected areas (MPAs). Surprisingly, the spatial congruence of fish biodiversity hot spots with this MPA system and the areas of high fishing pressure has not been assessed. Moreover, evolutionary and functional breadth of species assemblages [3] has been largely overlooked in marine systems. Here we adopted a multifaceted approach to biodiversity by considering the species richness of total, endemic, and threatened coastal fish assemblages as well as their functional and phylogenetic diversity. We show that these fish biodiversity components are spatially mismatched. The MPA system covers a small surface of the Mediterranean (0.4%) and is spatially congruent with the hot spots of all taxonomic components of fish diversity. However, it misses hot spots of functional and phylogenetic diversity. In addition, hot spots of endemic species richness and phylogenetic diversity are spatially congruent with hot spots of fishery impact. Our results highlight that future conservation strategies and assessment efficiency of current reserve systems will need to be revisited after deconstructing the different components of biodiversity.

Features and distribution patterns of Chinese endemic seed plant species

Abstract We compiled and identified a list of Chinese endemic seed plant species based on a large number of published references and expert reviews. The characters of these seed plant species and their distribution patterns were described at length. China is rich in endemic seed plants, with a total of 14 939 species (accounting for 52.1% of its total seed plant species) belonging to 1584 genera and 191 families. Temperate families and genera have a significantly higher proportion of endemism than cosmopolitan and tropical ones. The most primitive and derived groups have significantly higher endemism than the other groups. The endemism of tree, shrub, and liana or vine is higher than that of total species; in contrast, the endemism of herb is lower than that of total species. Geographically, these Chinese endemic plants are mainly distributed in Yunnan and Sichuan provinces, southwest China. Species richness and proportion of these endemic plants decrease with increased latitude and have a unimodal response to altitude. The peak value of proportion of endemism is at higher altitudes than that of total species and endemic species richness. The proportions of endemic shrub, liana or vine, and herb increase with altitude and have a clear unimodal curve. In contrast, the proportion of tree increases with altitude, with a sudden increase at ∼4000 m and has a completely different model. To date, our study provides the most comprehensive list of Chinese endemic seed plant species and their basic composition and distribution features.

Modelling the effects of heavy alcohol consumption on the transmission dynamics of gonorrhea

Prior studies have indicated that heavy alcohol drinkers are likely to engage in risky sexual behaviours and thus, more likely to get sexually transmitted infections (STIs) than social drinkers. Here, we formulate a deterministic model for evaluating the impact of heavy alcohol drinking on the reemerging gonorrhea epidemic. The model is rigorously analysed, showing the existence of a globally asymptotically stable disease-free equilibrium whenever the reproductive number is less than unity. If the disease threshold number is greater than unity, a unique endemic equilibrium exists and is globally asymptotically stable in the interior of the feasible region and the disease persists at endemic proportions if it is initially present. Both analytical and numerical results are provided to ascertain whether heavy alcohol drinking has an impact on the transmission dynamics of gonorrhea.

Spatially explicit analysis of gastropod biodiversity in ancient Lake Ohrid

Abstract. The quality of spatial analyses of biodiversity is improved by (i) utilizing study areas with well defined physiogeographical boundaries, (ii) limiting the impact of widespread species, and (iii) using taxa with heterogeneous distributions. These conditions are typically met by ecosystems such as oceanic islands or ancient lakes and their biota. While research on ancient lakes has contributed significantly to our understanding of evolutionary processes, statistically sound studies of spatial variation of extant biodiversity have been hampered by the frequently vast size of ancient lakes, their limited accessibility, and the lack of scientific infrastructure. The European ancient Lake Ohrid provides a rare opportunity for such a reliable spatial study. The comprehensive horizontal and vertical sampling of a species-rich taxon, the Gastropoda, presented here, revealed interesting patterns of biodiversity, which, in part, have not been shown before for other ancient lakes. In a total of 284 samples from 224 different locations throughout the Ohrid Basin, 68 gastropod species, with 50 of them (= 73.5%) being endemic, could be reported. The spatial distribution of these species shows the following characteristics: (i) within Lake Ohrid, the most frequent species are endemic taxa with a wide depth range, (ii) widespread species (i.e. those occurring throughout the Balkans or beyond) are rare and mainly occur in the upper layer of the lake, (iii) while the total number of species decreases with water depth, the proportion of endemics increases, and (iv) the deeper layers of Lake Ohrid appear to have a higher spatial homogeneity of biodiversity. Moreover, gastropod communities of Lake Ohrid and its feeder springs are both distinct from each other and from the surrounding waters. The analysis also shows that community similarity of Lake Ohrid is mainly driven by niche processes (e.g. environmental factors), but also by neutral processes (e.g. dispersal limitation and evolutionary histories of species). For niche-based mechanisms it is shown that large scale effects such as type of water body or water depth are mainly responsible for the similarity of gastropod communities, whereas small scale effects like environmental gradients affect gastropod compositions only marginally. In fact, neutral processes appear to be more important than the small scale environmental factors, thus emphasizing the importance of dispersal capacities and evolutionary histories of species.

Health impact of supplying safe drinking water containing fluoride below permissible level on flourosis patients in a fluoride-endemic rural area of West Bengal

The problem of high fluoride concentration in groundwater resources has become one of the most important toxicological and geo-environmental issues in India. Excessive fluoride in drinking water causes dental and skeletal fluorosis, which is encountered in endemic proportions in several parts of the world. World Health Organization (WHO) guideline value and the permissible limit of fluoride as per Bureau of Indian Standard (BIS) is 1.5 mg/L. About 20 states of India, including 43 blocks of seven districts of West Bengal, were identified as endemic for fluorosis and about 66 million people in these regions are at risk of fluoride contamination. Studies showed that withdrawal of sources identified for fluoride often leads reduction of fluoride in the body fluids (re-testing urine and serum after a week or 10 days) and results in the disappearance of non-skeletal fluorosis within a short duration of 10-15 days. To determine the prevalence of signs and symptoms of suspected dental, skeletal, and non-skeletal fluorosis, along with food habits, addictions, and use of fluoride containing toothpaste among participants taking water with fluoride concentration above the permissible limit, and to assess the changes in clinical manifestations of the above participants after they started consuming safe drinking water. A longitudinal intervention study was conducted in three villages in Rampurhat Block I of Birbhum district of West Bengal to assess the occurrence of various dental, skeletal, and non-skeletal manifestations of fluorosis, along with food habits, addictions, and use of fluoride containing toothpaste among the study population and the impact of taking safe water from the supplied domestic and community filters on these clinical manifestations. The impact was studied by follow-up examination of the participants for 5 months to determine the changes in clinical manifestations of the above participants after they started consuming safe drinking water from supplied domestic filters and community filter with fluoride concentration below the permissible limit. The data obtained were compared with the collected data from the baseline survey. The prevalence of signs of dental, skeletal, and non-skeletal fluorosis was 66.7%, 4.8-23.8%, and 9.5-38.1%, respectively, among the study population. Withdrawal of source(s) identified for fluoride by providing domestic and community filters supplying safe water led to 9.6% decrease in manifestation of dental fluorosis, 2.4-14.3% decrease in various manifestations of skeletal fluorosis, and 7.1-21.5% decrease in various non-skeletal manifestations within 5 months. Following repeated motivation of participants during visit, there was also 9.7-38.1% decrease in the usage of fluoride containing toothpaste, and 9.8-45.3% and 7.3-11.9% decrease in the consumption of black lemon tea and tobacco, respectively, which are known sources of fluoride ingestion in our body and have an effect on the occurrence of various manifestations of fluorosis following drinking of safe water from domestic and community filters. Increased prevalence of dental, skeletal, and non-skeletal fluorosis was found among the study population. Withdrawal of source(s) identified for fluoride by supplying domestic and community filters, dietary restriction, and other nutritional interventions led to decrease in manifestation of the three types of fluorosis within 5 months.

Patterns of Early and Late Ventilator-Associated Pneumonia Due to Methicillin-Resistant Staphylococcus aureus in a Trauma Population

Community-acquired methicillin-resistant Staphylococcal aureus (CA-MRSA) infection is approaching endemic proportions nationally, and it is a potential cause for early ventilator-associated pneumonia (VAP) in the acutely injured patient. We sought to determine the prevalence of early (≤4 days) and late (>4 days) MRSA pneumonia in ventilated multisystem trauma patients and to correlate findings with admission nasal swabs. We performed a review of our prospective trauma and infectious disease data bases for all patients admitted to our surgical intensive care unit with early (≤4 days) and late (>4 days) VAP during a 4-year period. The diagnosis of pneumonia was established by clinical pulmonary infection score >6, bronchoalveolar lavage, and quantitative cultures showing >10 organisms. Nasal swabs for early identification of MRSA carriers were performed routinely at admission. One hundred seventy-six patients were identified with S. aureus VAP. Patients with MRSA were compared with those with methicillin-susceptible S. aureus (MSSA). There were 47 (27%) early MSSA VAP and only 4 (2.2%) with early MRSA VAP. One hundred twenty-five patients were diagnosed with late VAP. Forty patients (23%) had MRSA VAP and 85 patients (64%) had MSSA VAP. None of the four patients with an early MRSA VAP had positive nasal swabs at admission. Despite an increase of MRSA nationally, we found a low incidence of early and late MRSA VAP in trauma patients, which was not identified by nasal swab screening. On the basis of our results, we question the efficacy of empiric vancomycin therapy in early (≤4 days) S. aureus VAP. Furthermore, nasal swabs were not helpful in identifying patients at risk for MRSA VAP.