14 492 calls were received during the specified times in the trial year (7308 in the control arm and 7184 in the intervention arm) concerning 10 134 patients (10.4% of the registered population). There were no substantial differences in the age and sex of patients in the intervention and control groups, though male patients were underrepresented overall. Reasons for calling the service were consistent with previous studies. Nurses managed 49.8% of calls during intervention periods without referral to a general practitioner. A 69% reduction in telephone advice from a general practitioner, together with a 38% reduction in patient attendance at primary care centres and a 23% reduction in home visits was observed during intervention periods. Statistical equivalence was observed in the number of deaths within seven days, in the number of emergency hospital admissions, and in the number of attendances at accident and emergency departments. Conclusions Nurse telephone consultation produced substantial changes in call management, reducing overall workload of general practitioners by 50% while allowing callers faster access to health information and advice. It was not associated with an increase in the number of adverse events. This model of out of hours primary care is safe and effective.

No abstract

The high variability in reproductive performance of North Atlantic right whales Eubalaena glacialis compared to southern right whales Eubalaena australis may reflect differences in lipid reserves. Amplitude-mode ultrasound was used to measure the thickness of right whale integument (epidermis and blubber, herein referred to as blubber thickness) in E. glacialis in the Bay of Fundy, Canada for 5 summer seasons and in E. australis off the South African coast for 2 austral winter seasons. E. glacialis had significantly thinner blubber layers (mean ±1 SD = 12.23 ± 2.16 cm, n = 172) than E. australis (16.13 ± 3.88 cm, n = 117), suggesting differing levels of nutrition between the 2 species. Blubber was thickest in females measured 3 to 6 mo prior to the start of pregnancy (E. glacialis), thinner during lactation (E. glacialis, E. australis) and then thicker with time after weaning (E. glacialis). These results suggest that lipids in blubber are used as energetic support for reproduction in female right whales. Blubber thickness increased in calves during suckling (E. glacialis, E. australis) but subsequently decreased after weaning (E. glacialis). Juvenile and adult male E. glacialis blubber thicknesses were compared between years of differing prey Calanus finmarchicus abundances (data from Pershing et al. 2005; ICES J Mar Sci 62:1511-1523; during a year of low prey abundance whales had significantly thinner blubber than during years of greater prey abundance. Taken together, these results suggest that blubber thickness is indicative of right whale energy balance and that the marked fluctuations in North Atlantic right whale reproduction have a nutritional component.

A description and comparison of the four major methods available for studying conservation physiology of large whales, namely analysis of faecal, respiratory vapour, and skin/blubber biopsy samples, and photographs.

Mammalian reproduction is metabolically regulated; therefore, the endangered status and high variability in reproduction of North Atlantic right whales Eubalaena glacialis necessitate accurate assessments at sea of the nutritional condition of living individuals. Aerial photogrammetry was used to measure dorsal body width at multiple locations along the bodies of free-swimming right whales at different stages of the female reproductive cycle (E. glacialis) and during the initial months of lactation (mother and calf Eubalaena australis) to quantify changes in nutritional condition during energetically demanding events. Principal components analyses indicated that body width was most variable at 60% of the body length from the snout. Thoracic, abdominal and caudal body width of E. australis thinned significantly during the initial months of lactation, especially at 60% of body length from the snout, while their calves' widths and widthto-length ratios increased. The body shape of E. glacialis that had been lactating for 8 mo was significantly thinner than non-lactating, non-pregnant E. glacialis. Body shape of E. glacialis measured in the eighth month of lactation was significantly thinner than that of E. australis in the first month, but did not differ from that of E. australis in the third and fourth months. Body width was comparable with diameter calculated from girth of carcasses. These results indicate that mother right whales rely on endogenous nutrient reserves to support the considerable energy expenditure during the initial months of lactation; therefore, photogrammetric measurements of body width, particularly at 60% of body length from the snout, are an effective way to quantitatively and remotely assess nutritional condition of living right whales.

Post-mortem examination of dead and live stranded beach-cast pinnipeds and cetaceans for determination of a cause of death provides valuable information for the management, mitigation and prosecution of unintentional and sometimes malicious human impacts, such as vessel collision, fishing gear entanglement and gunshot. Delayed discovery, inaccessibility, logistics, human safety concerns, and weather make these events challenging. Over the past 3 decades, in response to public concern and federal and state or provincial regulations mandating such investigations to inform mitigation efforts, there has been an increasing effort to objectively and systematically investigate these strandings from a diagnostic and forensic perspective. This Theme Section provides basic investigative methods, and case definitions for each of the more commonly recognized case presentations of human interactions in pinnipeds and cetaceans. Wild animals are often adversely affected by factors such as parasitism, anthropogenic contaminants, biotoxins, subclinical microbial infections and competing habitat uses, such as prey depletion and elevated background and episodic noise. Understanding the potential contribution of these subclinical factors in predisposing or contributing to a particular case of trauma of human origin is hampered, especially where putrefaction is significant and resources as well as expertise are limited. These case criteria descriptions attempt to acknowledge those confounding factors to enable an appreciation of the significance of the observed human-derived trauma in that broader context where possible.

The humpback whales which winter in the West Indies are principally found over banks which are at latitudes between 10° and 22° N, have substantial areas of flat bottom between 15 and 60 m deep, and lie less than 30 km from the North Atlantic 2000 m contour. The surface sea temperatures in these areas are between 24 and 28 °C. The major concentrations of the humpbacks, which feed little in winter, are on Silver and Navidad banks. On Silver Bank the humpback and humpback song densities peak in the centre of the Bank. Mothers with calves are generally found in areas of calm water, and singers are found over areas with a flat bottom, where they meander slowly. Larger groups move considerably faster and in straighter lines. There is no evidence of whales possessing particular movement patterns, preferred ranges, or territories within the Bank. The concentration of humpbacks may be a significant feature for other humpbacks.

Few studies have examined systematic relationships of right whales (Eubalaena spp.) since the original species descriptions, even though they are one of the most endangered large whales. Little morphological evidence exists to support the current species designations for Eubalaena glacialis in the northern hemisphere and E. australis in the southern hemisphere. Differences in migratory behaviour or antitropical distribution between right whales in each hemisphere are considered a barrier to gene flow and maintain the current species distinctions and geographical populations. However, these distinctions between populations have remained controversial and no study has included an analysis of all right whales from the three major ocean basins. To address issues of genetic differentiation and relationships among right whales, we have compiled a database of mitochondrial DNA control region sequences from right whales representing populations in all three ocean basins that consist of: western North Atlantic E. glacialis, multiple geographically distributed populations of E. australis and the first molecular analysis of historical and recent samples of E. glacialis from the western and eastern North Pacific Ocean. Diagnostic characters, as well as phylogenetic and phylogeographic analyses, support the possibility that three distinct maternal lineages exist in right whales, with North Pacific E. glacialis being more closely related to E. australis than to North Atlantic E. glacialis. Our genetic results provide unequivocal character support for the two usually recognized species and a third distinct genetic lineage in the North Pacific under the Phylogenetic Species Concept, as well as levels of genetic diversity among right whales world-wide.