The need for providers and patients to exchange and share imaging has never been more apparent, yet many organizations are only now, as a part of a larger enterprise imaging initiative, taking steps to streamline an important process that has historically been facilitated with the use of CDs or insecure methods of communication. This paper will provide an introduction to concepts and common-use cases for image exchange, outline challenges that have hindered adoption to date, and describe standards for image exchange that show increasing promise of being adopted by vendors and providers.

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Congress passed the Animal Welfare Act 1 (AWA) in order "to ensure the humane care and treatment of various animals used in research or for exhibition or kept as pets. 2 To this end, the Act requires, inter alia, that the Secretary of Agriculture 'promulgate standards to govern the humane handling, care, treatment, and transportation of animals by dealers, research facilities, and exhibitors. "' 3 The Animal and Plant Health Inspection Service (APHIS), the agency under the U.S. Department of Agriculture responsible for implementing the AWA, first promulgated regulations pertaining to the care of marine mammals in captivity 4 in 1979 and has updated various aspects of these regulations on a limited basis since then. The last time the marine mammal care regulations relating to the physical conditions under which these species are held were substantively revised was in 1984. 5 On 3 February 2016, APHIS published a proposed rule to amend the captive marine mammal regulations. 6 The agency took 14 years to issue this proposed rule 7 and had it under consideration for 20 years. 8 APHIS's marine mammal care regulations are intended to "insure that animals intended … for exhibition purposes … are provided humane care and treatment. " 9 The statute does not, however, define the term "humane. " In the absence of a statutory definition, it is appropriate to "look to the common usage of words for

Intensive long-term index sampling of the fish communities of eastern Lake Ontario (outlet basin--gill netting, 1958-98, average annual effort 16.3 km of netting; bottom trawling, 1972-98, 23.0 km; Bay of Quinte--bottom trawling, 1972-98, 12.8 km) provided extensive summer catch data that we used to calculate indices to assess annual relative abundance, variability, and a combination of the two to reflect stability, or status. One of the unique and valuable attributes of these long-term data sets is that they use a community-assessment approach, which includes ecologically important small species and values the data on all species equally. These valuable series confirm that during the past decade, most major species in both the lake and bay have undergone a dramatic, somewhat synchronous change, unprecedented in almost three decades, including the catastrophic winterkills of the late 1970s. Abundance increased to record-high levels in the late 1980s and early 1990s, then decreased abruptly, two years earlier in small species (rainbow smelt, alewife and slimy scalpia) than large ones (lake trout, lake whitefish and walleye). The period of pivotal change was 1991-1993, coinciding with a significant decrease in water temperature from a period of six abnormally warm years, 1986-1991 (Apr.-Sept.--18.7°C), to three abnormally cold years, 1992-1994 (17.3°C). Temperature decrease from 1991 to 1992 (2. I°C) was the most extreme in four decades. Intensive rehabilitative stocking of lake trout, commencing in the mid-1970s, has helped restructure and mature the cold-water community to a point where large species were at record-high levels in the late 1980s and early 1990s, creating increasing prey demand that required maximum prey production; this was possible in the recent high-temperature regime (late 1980s) but was not sustainable in the low-temperature regime that followed. After 1992, large species lost condition, more dead fish were observed, and abundance decreased. This low-temperature perturbation induced a successional setback (enjuvenation event) that should be only temporary in the overall maturity of the ecosystem. However, recent colonization by dreissenids, which are inducing biological oligotrophication, could compound this.

Finding optimal experimental conditions for generating stable negative ion electrospray ionization ion trap mass spectra (ESI-IT-MS) of alkanethiol-derived species is critical for quantitatively characterizing multicomponent alkanethiol-based self-assembled monolayers by this technique. Since alkanethiolates slowly oxidize in solution, purposeful oxidation of alkanethiols to their fully oxidized form (alkanesulfonates) is advantageous: sulfonates are chemically stable and have little affinity for covalent binding to metal surfaces. We have used ESI-IT-MS to characterize the products of H(2)O(2) oxidation of simple n-alkanethiols in solution and have observed monomeric alkanesulfonate species as well as alkanesulfonic acid/alkanesulfonate adducts, yielding gas-phase dimers and trimers. MS intensities of both monomers and adducts exhibit a dependence on the ion transfer capillary temperature that is alkyl-chain-length-dependent and that appears to be correlated with C-S bond cleavage. The trend in optimal capillary temperatures indicates that entropic effects lead to lower thermal decomposition temperatures for short-chain species relative to the longer-chain homologues. MS calibration data from alkanesulfonate mixtures are characterized by large linear dynamic ranges (10(-6)-10(-3) M) and detection limits influenced by their thermal decomposition. The high degree of precision in the calibration data should facilitate distinguishing among mixed SAMs having similar compositions.

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Humpback whales (Megaptera novaeangliae) exhibit maternally driven fidelity to feeding grounds, and yet occasionally occupy new areas. Humpback whale sightings and mortalities in the New York Bight apex (NYBA) have been increasing over the last decade, providing an opportunity to study this phenomenon in an urban habitat. Whales in this area overlap with human activities, including busy shipping traffic leading into the Port of New York and New Jersey. The site fidelity, population composition and demographics of individual whales were analysed to better inform management in this high-risk area. Whale watching and other opportunistic data collections were used to identify 101 individual humpback whales in the NYBA from spring through autumn, 2012–2018. Although mean occurrence was low (2.5 days), mean occupancy was 37.6 days, and 31.3% of whales returned from one year to the next. Individuals compared with other regional and ocean-basin-wide photo-identification catalogues (N = 52) were primarily resighted at other sites along the US East Coast, including the Gulf of Maine feeding ground. Sightings of mother-calf pairs were rare in the NYBA, suggesting that maternally directed fidelity may not be responsible for the presence of young whales in this area. Other factors including shifts in prey species distribution or changes in population structure more broadly should be investigated.

Cefepime is an optimal empiric antibacterial for many infectious processes because of its broad spectrum of activity. It has good penetration into lung tissue and the central nervous system (CNS) and is effective against methicillin-susceptible Staphylococcus aureus (MSSA) and Pseudomonas aeruginosa infections. 1 Cefepime is commonly used in children and adolescents with cystic fibrosis (CF) exacerbations for directed therapy against MSSA and P. aeruginosa infections. 2 Additionally, cefepime possesses a mild adverse effect profile, causing rash in only 4%, diarrhea in 3%, and headache in 1% of patients at its highest recommended dose (2 g every 8 hours). 3 Neurotoxicity, including encephalopathy, myoclonus, and seizures, has been associated with cefepime through postmarketing surveillance. 4-6 Most of these cases involved the elderly or patients with prior renal dysfunction. In a patient with normal renal function, it appears unlikely that cefepime, when administered at the recommended dose and interval, would contribute to these reported neurologic effects. Neurotoxicity has been reported rarely in patients with normal renal function. 6 Aminoglycosides are often used in patients with CF and are well-recognized nephrotoxins. Prolonged aminoglycoside exposure and repeated aminoglycoside courses can increase the risk of acute kidney injury (AKI). 7 To our knowledge, only 3 cases of cefepime-related neurotoxicity in adolescent patients have been reported in the literature. We report an additional case of cefepime neurotoxi-