Glycemic Control in Diabetic Pregnancies: Effects on Fetal and Maternal Outcome

Background: Both maternal and fetal complications are increased in diabetic pregnancies. Although hypertensive complications are increased in pregnant women with pregestational diabetes, reports on hypertensive complications in women with gestational diabetes mellitus (GDM) have been contradictory. Congenital malformations and macrosomia are the main fetal complications in Type 1 diabetic pregnancies, whereas fetal macrosomia and birth trauma but not congenital malformations are increased in GDM pregnancies. Aims: To study the frequency of hypertensive disorders in gestational diabetes mellitus. To evaluate the risk of macrosomia and brachial plexus injury (Erb’s palsy) and the ability of the 2-hour glucose tolerance test (OGTT) combined with the 24-hour glucose profile to distinguish between low and high risks of fetal macrosomia among women with GDM. To evaluate the relationship between glycemic control and the risk of fetal malformations in pregnancies complicated by Type 1 diabetes mellitus. To assess the effect of glycemic control on the occurrence of preeclampsia and pregnancy-induced hypertension in Type 1 diabetic pregnancies. Subjects: A total of 986 women with GDM and 203 women with borderline glucose intolerance (one abnormal value in the OGTT) with a singleton pregancy, 488 pregnant women with Type 1 diabetes (691 pregnancies and 709 offspring), and 1154 pregnant non-diabetic women (1181 pregnancies and 1187 offspring) were investigated. Results: In a prospective study on 81 GDM patients the combined frequency of preeclampsia and PIH was higher than in 327 non-diabetic controls (19.8% vs 6.1%, p<0.001). On the other hand, in 203 women with only one abnormal value in the OGTT, the rate of hypertensive complications did not differ from that of the controls. Both GDM women and those with only one abnormal value in the OGTT had higher pre-pregnancy weights and BMIs than the controls. In a retrospective study involving 385 insulin-treated and 520 diet-treated GDM patients, and 805 non-diabetic control pregnant women, fetal macrosomia occurred more often in the insulin-treated GDM pregnancies (18.2%, p<0.001) than in the diet-treated GDM pregnancies (4.4%), or the control pregnancies (2.2%). The rate of Erb’s palsy in vaginally delivered infants was 2.7% in the insulin-treated group of women and 2.4% in the diet-treated women compared with 0.3% in the controls (p<0.001). The cesarean section rate was more than twice as high (42.3% vs 18.6%) in the insulin-treated GDM patients as in the controls. A major fetal malformation was observed in 30 (4.2%) of the 709 newborn infants in Type 1 diabetic pregnancies and in 10 (1.4%) of the 735 controls (RR 3.1, 95% CI 1.6–6.2). Even women whose levels of HbA1c (normal values less than 5.6%) were only slightly increased in early pregnancy (between 5.6 and 6.8%) had a relative risk of fetal malformation of 3.0 (95% CI 1.2–7.5). Only diabetic patients with a normal HbA1c level (<5.6%) in early pregnancy had the same low risk of fetal malformations as the controls. Preeclampsia was diagnosed in 12.8% and PIH in 11.4% of the 616 Type 1 diabetic women without diabetic nephropathy. The corresponding frequencies among the 854 control women were 2.7% (OR 5.2; 95% CI 3.3–8.4) for preeclampsia and 5.6% (OR 2.2, 95% CI 1.5–3.1) for PIH. Multiple logistic regression analysis indicated that glycemic control, nulliparity, diabetic retinopathy and duration of diabetes were statistically significant independent predictors of preeclampsia. The adjusted odds ratios for preeclampsia were 1.6 (95% CI 1.3–2.0) for each 1%-unit increment in the HbA1c value during the first trimester and 0.6 (95% CI 0.5–0.8) for each 1%-unit decrement during the first half of pregnancy. In contrast, changes in glycemic control during the second half of pregnancy did not alter the risk of preeclampsia. Conclusions: In type 1 diabetic pregnancies it is extremely important to achieve optimal glycemic control before pregnancy and maintain it throughout pregnancy in order to decrease the complication rates both in the mother and in her offspring. The rate of fetal macrosomia and birth trauma in GDM pregnancies, especially in the group of insulin-treated women, is still relatively high. New strategies for screening, diagnosing, and treatment of GDM must be developed in order to decrease fetal and neonatal complications.

Miniature Compliant Grippers With Vision-Based Force Sensing

This paper is concerned with grasping biological cells in aqueous medium with miniature grippers that can also help estimate forces using vision-based displacement measurement and computation. We present the design, fabrication, and testing of three single-piece, compliant miniature grippers with parallel and angular jaw motions. Two grippers were designed using experience and intuition, while the third one was designed using topology optimization with implicit manufacturing constraints. These grippers were fabricated using different manufacturing techniques using spring steel and polydimethylsiloxane ( PDMS). The grippers also serve the purpose of a force sensor. Toward this, we present a vision-based force-sensing technique by solving Cauchy's problem in elasticity using an improved algorithm. We validated this technique at the macroscale, where there was an independent method to estimate the force. In this study, the gripper was used to hold a yeast ball and a zebrafish egg cell of less than 1 mm in diameter. The forces involved were estimated to be about 30 and 10 mN for the yeast ball and the zebrafish egg cell, respectively.

BLOC-2 targets recycling endosomal tubules to melanosomes for cargo delivery

Hermansky-Pudlak syndrome (HPS) is a group of disorders characterized by the malformation of lysosome-related organelles, such as pigment cell melanosomes. Three of nine characterized HPS subtypes result from mutations in subunits of BLOC-2, a protein complex with no known molecular function. In this paper, we exploit melanocytes from mouse HPS models to place BLOC-2 within a cargo transport pathway from recycling endosomal domains to maturing melanosomes. In BLOC-2-deficient melanocytes, the melanosomal protein TYRP1 was largely depleted from pigment granules and underwent accelerated recycling from endosomes to the plasma membrane and to the Golgi. By live-cell imaging, recycling endosomal tubules of wild-type melanocytes made frequent and prolonged contacts with maturing melanosomes; in contrast, tubules from BLOC-2-deficient cells were shorter in length and made fewer, more transient contacts with melanosomes. These results support a model in which BLOC-2 functions to direct recycling endosomal tubular transport intermediates to maturing melanosomes and thereby promote cargo delivery and optimal pigmentation.

一种新的脑动静脉畸形血液动力学模型

建立了一个新的非定常脑AVM血液动力学模型。模型克服了以往的定常AVM模型无法反映血流实际脉动，以及模型结构和血管性质描述上的缺陷，并依据临床实测数据提出了一种更为符合生理和病理实际的描述AVM供血动脉扩张现象的方法。模型模拟了AVM造成的脑血管压力、流量波形和脑血管输入阻抗的变化，并对脑AVM病人脑血管系统的输入阻抗进行了分析。为研究具有复杂结构的脑AVM血液动力学的特征，提供了一个有效的工具。

Auswirkungen der Wassertemperatur auf die Missbildungshäufigkeit pelagischer Fischembryonen

Malformation rates in embryos of dab, whiting, cod, flounder and plaice have been monitored for several years (1984-2006) in the Southern North Sea. For embryos of all species investigated trends for the fluctuation of malformation rates over the time were registered in the areas showing intermediate prevalences at the beginning of the studies in 1984 and maxima in 1987. Thereafter for all species a decrease of malformation rates was found until 2006 excepting an increase in 1996. A significant negative correlation existed between surface water temperature and prevalences of malformed embryos of dab and other species.

Zusammenhang zwischen Schadstoffen aus der Elbe und missgebildeten Fischembryonen in der Deutschen Bucht.

The trends of malformation prevalence in embryos of dab, Limanda limanda, in the southern North Sea after the year 1990 mirrored the drop in major pollutants in the rivers draining into the German Bight. Despite this general decline we detected a pollution event in the southern North Sea in winter 1995/1996 employing the prevalence of malformations in dab embryos as an indicator. An abrupt rise in malformation prevalence in the embryos of dab, corresponded to a dramatic increase in DDT levels in parent fish from the same area, indicating a hitherto unnoticed introduction of considerable quantities of DDT into the system. This input could be traced back to discharges of unknown origen into the River Elbe.

Wassertemperaturen und Häufigkeiten von Mißbildungen pelagischer Fischembryonen

Malformation rates in fish embryos have been monitored for several years in the Southern North Sea. Their occurrence was interpreted to be related to pollution because malformation rates were highest in near coastal waters known to receive high pollution loads. For embryos of all species investigated synchronous trends for the fluctuation of malformation rates over the time were registered in the areas covered with intermediate prevalences at the beginning of the studies in 1984 and maxima in 1987. Thereafter malformation rates of all species decreased significantly followed by an increase in 1996. It was found that a significant negative correlation between surface water temperature and prevalences of malformed embryos of dab (Limanda limanda) and other species existed over time and space. These correlations became increasingly visible with decreasing concentrations of organochlorines in livers of dab. From these findings it is concluded that temperatures possibly predispose developing fish embryos to the impact of pollutants.

Validade e confiabilidade do Questionário de Qualidade de Vida para Pacientes Orto-cirúrgicos (B-OQLQ)

O Orthognathic Quality of Life Questionnaire (OQLQ) foi desenvolvido em 2000 e validado em 2002, com o objetivo de analisar os impactos e benefícios do tratamento orto-cirúrgico na qualidade de vida dos pacientes. O objetivo deste trabalho foi avaliar a validade de construto e confiabilidade da versão brasileira deste instrumento, B-OQLQ, para verificar se, no processo de adaptação transcultural, as propriedades psicométricas do questionário original foram mantidas. Para tal, foi realizado um estudo seccional com uma amostra composta por cento e um pacientes com necessidade de tratamento ortodôntico-cirúrgico no Hospital Universitário Pedro Ernesto (HUPE) e na Faculdade de Odontologia da Universidade do Estado do Rio de Janeiro (UERJ), utilizando o B-OQLQ na forma de autopreenchimento. A média de idade dos pacientes foi de 26,51 (dp= 9,25), sendo a maioria do sexo feminino (58,42%; n=59) e maior que 21 anos (n=68, 67,33%). Quanto ao tipo de cirurgia, 42,57% (n=43) da amostra necessitavam fazer procedimento cirúrgico que envolveria as duas bases ósseas, 16,83% (n=17) necessitavam operar apenas uma das bases ósseas e para 40,59% (n=41) dos pacientes ainda não era possível definir qual o tipo de cirurgia seria necessária. Uma ortodontista treinada examinou os dentes dos pacientes para registrar o Índice de Dentes Cariados, Perdidos e Obturados (CPOD). A validade de construto foi acessada através do teste de correlação de Spearman entre as pontuações do B-OQLQ e do questionário Oral Health Impact Profile (OHIP-14) e das pontuações do B-OQLQ com as pontuações obtidas através de indicadores subjetivos e objetivos de saúde. A confiabilidade foi acessada em termos de consistência interna e estabilidade (teste-reteste), utilizando-se o alfa de Cronbach e o Coeficiente de Correlação Intraclasse (CCI), respectivamente. Os escores do B-OQLQ se correlacionaram significativamente com: o escore total do OHIP-14 (rs=0,70, p<0,001), a saúde bucal percebida (rs=-0,24, p=0,02), a qualidade de vida medida por um item único de avaliação (rs=-0,29, p=0,03), a satisfação com a aparência física (rs=-0,40, p<0,001) e a satisfação com a aparência facial (rs=-0,39, p=0,0001). Foi encontrada uma associação entre a faixa etária e o escore total do B-OQLQ (p=0,0012), sendo que pacientes maiores de 21 anos obtiveram escores mais elevados que pacientes mais novos. A associação entre o escore total do B-OQLQ e o tipo de cirurgia não foi estatisticamente significativa. O alfa de Cronbach e o CCI foram 0,95 e 0,90, respectivamente. Os domínios do B-OQLQ que mais causaram impacto na qualidade de vida foram aspectos sociais da deformidade (13,0; dp= 10,54) e estética facial (11,81; dp= 6,23). A versão brasileira do questionário OQLQ se mostrou um instrumento válido e confiável, com boas propriedades psicométricas podendo, portanto, ser considerada um instrumento apropriado para acessar o impacto da deformidade dentofacial na qualidade de vida de pacientes portadores desta condição.

Alveolar nitric oxide and its role in pediatric asthma control assessment

Resumen Background: Nitric oxide can be measured at multiple flow rates to determine proximal (maximum airway nitric oxide flux; Jaw(NO)) and distal inflammation (alveolar nitric oxide concentration; CA(NO)). The main aim was to study the association among symptoms, lung function, proximal (maximum airway nitric oxide flux) and distal (alveolar nitric oxide concentration) airway inflammation in asthmatic children treated and not treated with inhaled glucocorticoids. Methods: A cross-sectional study with prospective data collection was carried out in a consecutive sample of girls and boys aged between 6 and 16 years with a medical diagnosis of asthma. Maximum airway nitric oxide flux and alveolar nitric oxide concentration were calculated according to the two-compartment model. In asthmatic patients, the asthma control questionnaire (CAN) was completed and forced spirometry was performed. In controls, differences between the sexes in alveolar nitric oxide concentration and maximum airway nitric oxide flux and their correlation with height were studied. The correlation among the fraction of exhaled NO at 50 ml/s (FENO50), CA(NO), Jaw(NO), forced expiratory volume in 1 second (FEV1) and the CAN questionnaire was measured and the degree of agreement regarding asthma control assessment was studied using Cohen's kappa. Results: We studied 162 children; 49 healthy (group 1), 23 asthmatic participants without treatment (group 2) and 80 asthmatic patients treated with inhaled corticosteroids (group 3). CA(NO) (ppb) was 2.2 (0.1-4.5), 3 (0.2-9.2) and 2.45 (0.1-24), respectively. Jaw(NO) (pl/s) was 516 (98.3-1470), 2356.67 (120-6110) and 1426 (156-11805), respectively. There was a strong association (r = 0.97) between FENO50 and Jaw(NO) and the degree of agreement was very good in group 2 and was good in group 3. There was no agreement or only slight agreement between the measures used to monitor asthma control (FEV1, CAN questionnaire, CA(NO) and Jaw(NO)). Conclusions: The results for CA(NO) and Jaw(NO) in controls were similar to those found in other reports. There was no agreement or only slight agreement among the three measure instruments analyzed to assess asthma control. In our sample, no additional information was provided by CA(NO) and Jaw(NO).

Mães em UTI neonatal: a experiência da maternidade diante do bebê em situação de risco

Esta pesquisa teve por objetivo compreender as vicissitudes da experiência de tornar-se mãe de um bebê em situação de risco neonatal. Emergiu da experiência da autora no acompanhamento psicológico prestado às mães e familiares de recém-nascidos de alto risco internados em uma Unidade de Terapia Intensiva Neonatal (UTI Neonatal). Foi possível perceber ali que a puérpera que tinha seu filho internado em situação de risco logo após o nascimento vivenciava uma experiência de intenso sofrimento, permeada por conflitos e angústias específicas, tais como: o sentimento de incapacidade pelo parto prematuro e/ou pela malformação fetal, a dor/luto diante da situação de risco e eminência de perda do filho, o medo e a ambivalência na relação afetiva com o bebê. Tais vivências podem representar uma ameaça para a construção do vínculo inicial entre pai/mãe/filho, bem como para a própria saúde psíquica da mulher e do bebê em constituição. Para uma aproximação da experiência subjetiva destas mulheres/mães, optou-se pela pesquisa qualitativa na abordagem psicanalítica. A compreensão do fenômeno foi possibilitada pela análise do discurso das mães que tiveram seus filhos internados na UTI Neonatal, através do método de observação participante dos atendimentos grupais prestados pelo Serviço de Psicologia da instituição, bem como pela análise documental das fichas de acompanhamento psicológico destas mulheres. Participaram do estudo, as mulheres/mães que acompanharam seus filhos internados na UTI Neonatal do Núcleo Perinatal do Hospital Universitário Pedro Ernesto (HUPE), da Universidade do Estado do Rio de Janeiro (UERJ) e que receberam atendimento psicológico grupal: Grupo Mães Presentes durante um período de três meses. A compreensão e interpretação dos aspectos essenciais do fenômeno foram fundamentadas nos pressupostos psicanalíticos da teoria do amadurecimento pessoal de Donald W. Winnicott e em outros autores atuais de referência no campo materno-infantil. Acredita-se que este trabalho servirá de reflexão e contribuição para a construção, na assistência neonatal, de um lugar de acolhimento para a experiência subjetiva dessas mulheres/mães e suas repercussões, a partir de uma perspectiva de cuidado humanizado e integral a saúde, tal como preconizado pelas políticas públicas atuais.

Genetic and morphological differences between Sebastes vulpes and S. zonatus (Teleostei: Scorpaeniformes: Scorpaenidae)

The taxonomic status of Sebastes vulpes and S. zonatus were clarified by comprehensive genetic (amplif ied fragment length polymorphisms [AFLP] and mitochondrial DNA [mtDNA] variation) and morphological analyses on a total of 65 specimens collected from a single locality. A principal coordinate analysis based on 364 AFLP loci separated the specimens completely into two genetically distinct groups that corresponded to S. vulpes and S. zonatus according to body coloration and that indicated that they are reproductively isolated species. Significant morphological differences were also evident between the two groups; 1) separation by principal component analysis based on 31 measurements, and 2)separation according to differences in counts of gill rakers and dorsal-fin spines without basal scales, and in the frequencies of specimens with small scales on the lower jaw. Restriction of gene flow between the two groups was also indicated by the pairwise ΦST values estimated from variations in partial sequences from the mtDNA control region, although the minimum spanning network did not result in separation into distinct clades. The latter was likely due to incomplete lineage sorting between S. vulpes and S. zonatus owing to their recent speciation.

Análise clínica e molecular em indivíduos com deficiência mental idiopática no Maranhão: diagnóstico diferencial da síndrome do X frágil

O retardo mental (RM) representa um problema de saúde pública mundial ainda negligenciado no Brasil e, em especial nas regiões mais pobres como o Nordeste. A síndrome do X frágil (SXF) é uma das formas mais estudadas de RM hereditário em seres humanos. Esta doença monogênica, de herança ligada ao X dominante, é decorrente de uma mutação no exon 1 do gene FMR1, localizado na região Xq27.3. A mutação no FMR1 se caracteriza pelo aumento de repetições de trinucleotídios CGG em tandem na região 5 UTR desse gene, sendo a expansão dessas trincas o principal evento mutacional responsável pela SXF. De maneira geral, os fenótipos cognitivos de indivíduos do sexo masculino com a síndrome incluem deficiência intelectual de moderada à grave. No presente trabalho, realizamos um estudo transversal da SXF em indivíduos portadores de retardo mental de causa desconhecida, engajados em Programas de Educação Especial e em instituições psiquiátricas de São Luís-MA, rastreando amplificações de sequências trinucleotídicas no gene FMR1. A amostra foi composta por 238 indivíduos do sexo masculino, não aparentados, na faixa etária de 4 a 60 anos (média = 21 9 anos). O DNA dos participantes foi obtido a partir de 5 mL de sangue coletados em tubos com anti-coagulante EDTA e a análise molecular da região gênica de interesse foi realizada através da reação em cadeia da polimerase, utilizando-se três primers. Dentre os indivíduos triados quanto à presença de mutações no gene FMR1, apenas um apresentou um resultado inconclusivo e 2 (0,84%) foram positivos para a SXF, sendo que um deles (3503) apresentou mais de 200 repetições CGG no locus FRAXA e o outro indivíduo (3660) apresentou uma deleção de ~197 pb envolvendo parte das repetições CGG e uma região proximal às repetições CGG. Ambos possuíam história familiar de RM ligado ao X. No indivíduo 3503 observamos as seguintes características clínicas: temperamento dócil, orelhas grandes, mandíbula proeminente e flacidez ligamentar. O indivíduo 3660 apresentava hiperatividade, contato pobre com os olhos, orelhas grandes, mandíbula proeminente, pectus excavatum, macroorquidismo e pouca comunicação. O esclarecimento sobre a doença oferecido às famílias de ambos contribuiu sobremaneira para o entendimento da condição, do prognóstico e dos riscos de recorrência. A prevalência da SXF em nossa amostra, 0,84%, embora relativamente baixa, encontra-se na faixa de incidência de casos diagnosticados em outras populações que, em sua maioria, relatam incidências variando de 0 a 3%. Em parte, atribuímos o percentual encontrado aos critérios de inclusão utilizados em nosso estudo. Concluímos que o protocolo de triagem molecular utilizado em nosso estudo se mostrou eficiente e adequado para a realidade do Maranhão, podendo constituir uma ferramenta auxiliar a ser aplicada na avaliação de rotina dos portadores de RM, com grandes benefícios para o Estado.

Review of the crevalle jacks, Caranx hippos complex (Teleostei: Carangidae), with a description of a new species from West Africa

The Caranx hippos species complex comprises three extant species: crevalle jack (Caranx hippos) (Linnaeus, 1766) from both the western and eastern Atlantic oceans; Pacific crevalle jack (Caranx caninus) Günther, 1868 from the eastern Pacific Ocean; and longfin crevalle jack (Caranx fischeri) new species, from the eastern Atlantic, including the Mediterranean Sea and Ascension Island. Adults of all three species are superficially similar with a black blotch on the lower half of the pectoral fin, a black spot on the upper margin of opercle, one or two pairs of enlarged symphyseal canines on the lower jaw, and a similar pattern of breast squamation. Each species has a different pattern of hyperostotic bone development and anal-fin color. The two sympatric eastern Atlantic species also differ from each other in number of dorsal-and anal-fin rays, and in large adults of C. fischeri the lobes of these fins are longer and the body is deeper. Caranx hippos from opposite sides of the Atlantic are virtually indistinguishable externally but differ consistently in the expression of hyperostosis of the first dorsalfin pterygiophore. The fossil species Caranx carangopsis Steindachner 1859 appears to have been based on composite material of Trachurus sp. and a fourth species of the Caranx hippos complex. Patterns of hyperostotic bone development are compared in the nine (of 15 total) species of Caranx sensu stricto that exhibit hyperostosis.

Toward identification of larval sailfish (Istiophorus platypterus), white marlin (Tetrapturus albidus), and blue marlin (Makaira nigricans) in the western North Atlantic Ocean*

The identification of larval istiophorid billfishes from the western North Atlantic Ocean has long been problematic. In the present study, a molecular technique was used to positively identify 27 larval white marlin (Tetrapturus albidus), 96 larval blue marlin (Makaira nigricans), and 591 larval sailfish (Istiophorus platypterus) from the Straits of Florida and the Bahamas. Nine morphometric measurements were taken for a subset of larvae (species known), and lower jaw pigment patterns were recorded on a grid. Canonical variates analysis (CVA) was used to reveal the extent to which the combination of morphometric, pigment pattern, and month of capture information was diagnostic to species level. Linear regression revealed species-specific relationships between the ratio of snout length to eye orbit diameter and standard length (SL). Confidence limits about these relationships served as defining characters for sailfish >10 mm SL and for blue and white marlin >17 mm SL. Pigment pattern analysis indicated that 40% of the preflexion blue marlin examined possessed a characteristic lower jaw pigment pattern and that 62% of sailfish larvae were identifiable by lower jaw pigments alone. An identification key was constructed based on pigment patterns, month of capture, and relationships between SL and the ratio of snout length to eye orbit diameter. The key yielded identifications for 69.4% of 304 (blind sample) larvae used to test it; only one of these identifications was incorrect. Of the 93 larvae that could not be identified by the key, 71 (76.3%) were correctly identified with CVA. Although identif ication of certain larval specimens may always require molecular techniques, it is encouraging that the majority (92.4%) of istiophorid larvae examined were ultimately identifiable from external characteristics alone.

Harvest History of Belugas, Delphinapterus leucas, in Cook Inlet, Alaska

Belugas, Delphinapterus leucas, in Cook Inlet, Alaska, represent a unique and isolated marine mammal population that has been hunted for a variety of purposes since prehistoric times. Archeological studies have shown that both Alutiiq Eskimos and Dena'ina Atabaskan Indians have long utilized many marine resources in Cook Inlet, including belugas. Over the past century, commercial whaling and sport hunting also occurred periodically in Cook Inlet prior to the Marine Mammal Protection Act of 1972 (MMPA). During the 1990's, the hunting mortality by Alaska Natives apparently increased to 40-70 whales per year, which led to the decling of this stock and its subsequent designation in 2000 as depleted under the MMPA. Concerns about the decline of the Cook Inlet stock resulted in a voluntary suspension of the subsistenc hunt by Alaska Natives in 1999. The difficulty in obtaining accurate estimates for the harvest of these whales is due to the inability to identify all of the hunters and, in turn, the size of the harvest. Attempts to reconstruct harvest records based on hunters' recollections and interviews from only a few households have been subject to a wide degree of speculation. To adequately monitor the beluga harvest, the National Marine Fisheries Service established marking and reporting regulations in October 1999. These rules require that Alaska Natives who hunt belugas in Cook Inlet must collect the lowere left jaw from harvested whales and complete a report that includes date and time of the harvest, coloration of the whale, harvest location, and method of harvest. The MMPA was amended in 2000 to require a cooperative agreement between the National Marine Fisheries Service and Alaska Native organizations before hunting could be resumed.