Killer whales (Orcinus orca) have only infrequently been reported from Hawaiian waters, and most of what is known about killer whales worldwide comes from studies in coastal temperate waters. Here we present 21 records of killer whales from within the Hawaiian Exclusive Economic Zone between 1994 and 2004. Killer whales were recorded nine months of the year, most around the main Hawaiian Islands. Although there were more records than expected during the period when humpback whales are abundant around the Islands, there is likely an increase in sighting effort during that period. Killer whales were documented feeding on both a humpback whale and cephalopods, and two species of small cetaceans were observed fleeing from killer whales. Although it is possible that there are both marine mammal-eating and cephalopod-eating populations within Hawaiian waters, it seems more likely that Hawaiian killer whales may not exhibit foraging specializations as documented for coastal temperate populations. Saddle patch pigmentation patterns were generally fainter and narrower than those seen in killer whales from the temperate coastal North Pacific. Analysis of skin samples from two animals indicated two mitochondrial haplotypes, one identical to the ''Gulf of Alaska transient 2'' haplotype (a mammal-eating form), and the other a new haplotype one base different from haplotypes found for mammal-eating killer whales in coastal Alaskan waters.

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Objective: An abnormality of the optical transmission waveform obtained during measurement of the activated partial thromboplastin time (aPTT) has been described in association with DIC and sepsis. This biphasic waveform (BWF) is caused by the in vitro formation of Ca2+-induced complexes between VLDL and CRP. A review of the literature revealed no studies on the BWF in cardiac patients. The purpose of this study was to determine whether the BWF is associated with adverse clinical outcomes among patients in a Coronary Care Unit (CCU). Patients: Consecutive patients admitted to the CCU over a two-month period (n=83) were retrospectively evaluated. Standard of clinical care was not altered. Methods: Laboratory results including aPTT, aPTT waveform analysis, troponin, beta-natriuretic peptide (BNP), complete blood count (CBC), basic metabolic panel (BMP), and high sensitivity C-reactive protein (hsCRP) were analyzed when available. BWF values beyond a pre-set threshold [5 SD’s lower than the mean value of a normal population (n=40)] were signaled by the A2 Flag. Hospital charts were reviewed to determine coronary artery disease (CAD), hypertension (HTN), diabetes mellitus (DM), hyperlipidemia, and renal dysfunction. Hospital course including invasive and surgical procedures and medical interventions were recorded. Results: The A2 Flag was detected in 23 of 83 patients (27.7%) during the entire course of CCU treatment. Using a lower Slope_1 threshold value (as had been used in the DIC/sepsis studies) produced an A2 flag in >90% of the patients. Patients in the A2 Flag and no-Flag groups were comparable for age, gender, HTN, DM and hyperlipidemia. Of the patients with an A2 Flag, 73.9% had acute coronary syndrome (encompassing the spectrum of clinical conditions ranging from unstable angina to non-ST-segment elevation MI to ST-segment elevation MI) vs 59.6% in the no-Flag group, 95.6% had CAD vs 83.8%, 52.1% had arrhythmia vs 32.2% (p=0.020), 60.8% had renal dysfunction (creatinine >1.5) vs 32.2% (p=0.002), 47.8% had elevated BNP vs 22.5% (p=0.037), and 73.9% had elevated troponin vs 50.0%. Length of stay was longer in the A2 Flag group (16.2 vs 7.2 days; p<0.001). Six of seven patients that expired had an A2 Flag. One patient with an A2 Flag expired during a subsequent readmission shortly after the course of this study. Conclusion: The A2 Flag result is reported with the aPTT and thus is a rapid test available at no additional cost. As an adjunct to routine lab testing, aPTT waveform analysis appears to be a novel means to identify a select population of CCU patients that are at higher risk for adverse cardiac events and warrants further investigation. This pilot study is being used to develop a larger prospective study to determine if the A2 Flag can improve patient care through earlier diagnosis and treatment intervention.