IMPORTANCE The collection of patient-reported outcomes (PROs) has garnered intense interest, but dissemination of PRO programs has been limited, as have analyses of the factors associated with successful programs. OBJECTIVE To identify factors associated with improving PRO collection rates within a large health care system using a centralized PRO infrastructure.

Targeted interventions can significantly reduce both the incidence of AD following tracheostomy and associated morbidity. Best practice guidelines to help minimize AD in patients with tracheostomy tubes are proposed.

Use of mercury (Hg) for gold-mining in French Guiana (up until 2006) as well as the presence of naturally high background levels in soils, has led to locally high concentrations in soils and sediments. The present study maps the levels of Hg concentrations in river sediments from five main rivers of French Guiana (Approuague River, Comté River, Mana River, Maroni River and Oyapock River) and their tributaries, covering more than 5 450 km of river with 1 211 sampling points. The maximum geological background Hg concentration, estimated from 241 non-gold-mined streams across French Guiana was 150 ng g-1. Significant differences were measured between the five main rivers as well as between all gold-mining and pristine areas, giving representative data of the Hg increase due to past gold-mining activities.These results give a unique large scale vision of Hg contamination in river sediments of French Guiana and provide fundamental data on Hg distribution in pristine and gold-mined areas.

Limited data are available describing the clinical characteristics, hospital treatment practices, and hospital and long-term death rates of patients hospitalized with decompensated heart failure (HF). To examine the descriptive epidemiology of acute HF in residents of a large New England metropolitan area during the 2 study years of 1995 and 2000, we reviewed the medical records of patients hospitalized with acute HF at 11 medical centers in the Worcester (MA) metropolitan area during 1995 and 2000 for purposes of collecting information about patient's sociodemographic and clinical characteristics, hospital management approaches, and hospital and post-discharge mortality. The mean age of 4,537 residents of the Worcester metropolitan area hospitalized with decompensated HF was 76 years, 57% were women, and the majority of study patients had been previously diagnosed with several comorbidities. The average duration of hospitalization was 6.3 days and 6.8% of patients died during hospitalization. Diuretics (98%) and ACE inhibitors/ARB's (54%) were the most common medications used to treat acutely ill patients. The 1 and 5 year death rates of hospital survivors were 39% and 77%, respectively, with no change observed in these death rates between our 2 study years. In conclusion, the results of this observational study in residents of a central New England metropolitan area provide insights into the characteristics, treatment practices, and short and long-term death rates associated with this increasingly prevalent clinical syndrome.

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