ESPITE ITS LIMITATIONS, THEstandard 12-lead electrocardiogram (ECG) remains a key diagnostic tool directing the emergency management of patients with an acute myocardial infarction. 1 In 1980, DeWood et al 2 reported that patients presenting with acute chest pain, persistent ST-segment elevation progressing to Q waves, and elevations of cardiac biomarker levels were found to have a total thrombotic coronary occlusion in 87% of cases. A variety of other serious conditions aside from an acute myocardial infarction may also cause ST-segment elevation. 3 Time to reperfusion is a major determinant of outcome in patients presenting with an ST-segment elevation myocardial infarction (STEMI). 4,5 The American College of Cardiology/ American Heart Association STEMI guidelines recommend that the emergency department physician make the decision regarding reperfusion therapy within 10 minutes of interpreting the initial diagnostic ECG, 6 which may be challenging because clinical decisions are often made without a previous ECG result for comparison or time to observe evolutionary ST-segment changes or cardiac biomarker results. Upstream activation of the cardiac cath-For editorial comment see p 2790.

This paper reviews the population trends and threats for the 15 species of cranes, and comments on conservation priorities for the family as a whole. Cranes occur on five continents, with greatest diversity in East Asia (nine species) and Sub-Saharan Africa (six species). Eleven crane species are threatened with extinction according to the IUCN Red List, including one species Critically Endangered, three species Endangered, and seven species Vulnerable. Of the four species of Least Concern, population sizes for the Demoiselle (Anthropoides virgo) and Brolga (Grus rubicunda) are not well known but these species are declining in some areas. The Sandhill (G. canadensis) and Eurasian Cranes (G. grus) are the most abundant cranes and have rapidly increased in part due to their flexible selection of foraging habitats and use of agriculture lands and waste grain as a food source. Status for six species -Grey Crowned (Balearica regulorum), Blue (Anthropoides paradise), Black-necked (G. nigricollis), Red-crowned (G. japonensis), Sandhill, and Siberian (G. leucogeranus) -are summarized in more detail to illustrate the diversity of population shifts and threats within the crane family. A crane threat matrix lists the major threats, rates each threat for each species, and scores each threat for the crane family as a whole. Four of the five greatest threats are to the ecosystems that cranes depend upon, while only one of the top threats (human disturbance) relates to human action directly impacting on cranes. Four major threats are discussed: dams and water diversions, agriculture development, crane trade, and climate change. Conservation efforts should be strongly science-based, reduce direct threats to the birds, safeguard or restore habitat, and strengthen awareness among decision makers and local communities for how to safeguard cranes and wetlands. Especially for the most severely threatened species, significantly stronger efforts will be needed to incorporate our understanding of the needs of cranes and the ecosystems they inhabit into decisions about agriculture, water management, energy development and other human activities.

Within a regional STEMI system of care, half-dose fibrinolysis combined with immediate transfer for PCI may be a safe and effective option for STEMI patients with expected delays due to long-distance transfer.

Sporothrix cyanescens has been recovered from blood and a finger lesion at several medical centers in the United States. The morphology and physiology of these and three additional isolates were studied. S. cyanescens was distinguished from S. schencku and S. fungorum by white to lavender colonial pigmentation and from S. schenckii also by the formation of secondary conidia. Ail isolates of S. cyanescens grew well at 37°C, were cycloheximide susceptible, strongly urease positive, and benomyl resistant, failed to hydrolyze starch, and were inhibited by sodium chloride in vitro at a concentration of. 12%. Study of S. cyanescens in a murine model by using intravenous inoculation failed to demonstrate an invasive pathogenic potential. The validity of the transfer of S. cyanescens to the new genus Cerinosterus Moore is discussed.

Rhyzopertha dominica (F.) (lesser grain borer, Coleoptera: Bostrichidae) is a major pest of stored grain in the United States, Australia, and most other warm regions of the world. It has rarely been detected in Canadian grain, until recently. To determine the distribution of/R. dominica in western Canada, Lindgren multiple-funnel traps baited with R. dominica aggregation pheromones were placed near grain elevators, feed mills, and farms. Rhyzopertha dominica was found flying outside grain-handling facilities in all Prairie Provinces in 1990 and 1991, with thousands collected in Manitoba, hundreds in Alberta, and less than 100 in Saskatchewan. A few R. dominica were caught in Vancouver and Thunder Bay. None were caught in the traps placed beside two grain elevators in southern Ontario. In Alberta and Saskatchewan, the locations with R. dominica were mainly in the south. In Manitoba, the total number of R. dominica caught at each location was higher in the south than in the north. Rhyzopertha dominica were caught as early as 15 May and as late as 18 September, with the peak numbers for a given location occurring between July and September. No difference in the total number of R. dominica caught per year was found among farms, feed mills, or grain elevators in 1990 or 1991. Sampling of stored grain on three farms showed that two of the eight bins sampled had R. dominica. The possible origins of the R. dominica (importation of infested grain, wind-borne migration from the United States, or an established Canadian population) are discussed.