Distribution of legacy and emerging per- and polyfluoroalkyl substances in riverine and coastal sediments of Southeastern North Carolina, USA.

The sediment distribution of per- and polyfluoroalkyl substances (PFAS) along a river to ocean transect was investigated. Samples were collected between September 2017 and October 2019 with targeted quantification of six legacy and replacement PFAS by LC-MS/MS. Total PFAS concentrations ranged from below the LOQ to 7.47 ng per g dry weight with PFOA, PFOS, HFPO-DA and PFMOAA the most frequently detected. Significant correlations (p < 0.05) were found between PFOS and HFPO-DA sedimentary concentration and percent organic carbon (% OC); however, PFOA and PFMOAA were not correlated with sediment % OC. This study highlights the occurrence of the replacement PFAS in sediments for the first time. Sediment extracts were screened for 18 additional PFAS compounds by high resolution mass spectrometry. A series of perfluorinated ether carboxylic acid and perfluorinated ether sulfonic acid with either one or two acidic functional groups were detected at various locations in the upper portion of the Cape Fear River. A series of chromatographically resolved isomers (C7F13O5S1; M-1) were detected and may be Nafion™ degradation products.

Dominant effects of the histone mutant H3-L61R on Spt16-gene interactions in budding yeast.

Recent studies have unveiled an association between an L61R substitution within the human histone H3.3 protein and the presentation of neurodevelopmental disorders in two patients. In both cases, the mutation responsible for this substitution is encoded by one allele of the H3F3A gene and, if this mutation is indeed responsible for the disease phenotypes, it must act in a dominant fashion since the genomes of these patients also harbour three other alleles encoding wild-type histone H3.3. In our previous work in yeast, we have shown that most amino acid substitutions at H3-L61 cause an accumulation of the Spt16 component of the yFACT histone chaperone complex at the 3' end of transcribed genes, a defect we have attributed to impaired yFACT dissociation from chromatin following transcription. In those studies, however, the H3-L61R mutant had not been tested since it does not sustain viability when expressed as the sole source of histone H3 in cells. In the present work, we show that H3-L61R impairs proper Spt16 dissociation from genes when co-expressed with wild-type histone H3 in haploid cells as well as in diploid cells that express the mutant protein from one of four histone H3-encoding alleles. These results, combined with other studies linking loss of function mutations in human Spt16 and neurodevelopmental disorders, provide a possible molecular mechanism underlying the neurodevelopmental disorders seen in patients expressing the histone H3.3 L61R mutant.

Improving practice in radiology: a quality-improvement project examining CT colonography patient dose and scanning technique.

AIM: To audit scanning technique and patient doses for computed tomography (CT) colonography (CTC) examinations in a large UK region and to identify opportunities for quality improvement. MATERIALS AND METHODS: Scanning technique and patient dose data were gathered for both contrast-enhanced and unenhanced CTC examinations from 33 imaging protocols across 27 scanners. Measurements of patient weight and effective diameter were also obtained. Imaging protocols were compared to identify technique differences between similar scanners. Scanner average doses were calculated and combined to generate regional diagnostic reference limits (DRLs) for both examinations. RESULTS: The regional DRLs for contrast-enhanced examinations were volume CT dose index (CTDIvol) of 11 and 5 mGy for the two scan phases (contrast-enhanced and either delayed phase or non-contrast enhanced respectively), and dose-length product (DLP) of 740 mGy·cm. For unenhanced examinations, these were 5 mGy and 450 mGy·cm. These are notably lower than the national DRLs of 11 mGy and 950 mGy·cm. Substantial differences in scan technique and doses on similar scanners were identified as areas for quality-improvement action. CONCLUSION: A regional CTC dose audit has demonstrated compliance with national DRLs but marked variation in practice between sites for the dose delivered to patients, notably when scanners of the same type were compared for the same indication. This study demonstrates that the national DRL is too high for current scanner technology and should be revised.

PFOS dominates PFAS composition in ambient fine particulate matter (PM2.5) collected across North Carolina nearly 20 years after the end of its US production.

Contamination of drinking water by per- and polyfluoroalkyl substances (PFASs) emitted from manufacturing plants, fire-fighting foams, and urban waste streams has received considerable attention due to concerns over toxicity and environmental persistence; however, PFASs in ambient air remain poorly understood, especially in the United States (US). We measured PFAS concentrations in ambient fine particulate matter (PM2.5) at 5 locations across North Carolina over a 1 year period in 2019. Thirty-four PFASs, including perfluoroalkyl carboxylic, perfluoroalkane sulfonic, perfluoroalkyl ether carboxylic and sulfonic acids were analyzed by UHPLC/ESI-MS/MS. Quarterly averaged concentrations ranged from <0.004-14.1 pg m-3. Perfluorooctanoic acid (PFOA) and perfluorooctane sulfonic acid (PFOS) ranged from <0.18 to 14.1 pg m-3, comparable to previous PM2.5 measurements from Canada and Europe (<0.02-3.5 pg m-3). Concentrations above 1 pg m-3 were observed in July-September at Charlotte (14.1 pg m-3, PFOA), Wilmington (4.75 pg m-3, PFOS), and Research Triangle Park (1.37 pg m-3, PFOS). Notably, PM2.5 has a short atmospheric lifetime (<2 weeks), and thus, the presence of PFOS in these samples raises questions about their sources, since PFOS production was phased out in the US ∼20 years ago. This is the first US study to provide insights into ambient PFAS concentrations in PM2.5.

Ancestral Sequence Reconstruction: From Chemical Paleogenetics to Maximum Likelihood Algorithms and Beyond.

As both a computational and an experimental endeavor, ancestral sequence reconstruction remains a timely and important technique. Modern approaches to conduct ancestral sequence reconstruction for proteins are built upon a conceptual framework from journal founder Emile Zuckerkandl. On top of this, work on maximum likelihood phylogenetics published in Journal of Molecular Evolution in 1996 was one of the first approaches for generating maximum likelihood ancestral sequences of proteins. From its computational history, future model development needs as well as potential applications in areas as diverse as computational systems biology, molecular community ecology, infectious disease therapeutics and other biomedical applications, and biotechnology are discussed. From its past in this journal, there is a bright future for ancestral sequence reconstruction in the field of evolutionary biology.

Isomers of emerging per- and polyfluoroalkyl substances in water and sediment from the Cape Fear River, North Carolina, USA.

Per- and polyfluoroalkyl substances (PFAS) have become ubiquitous environmental contaminants found in many parts of the globe and in all environmental compartments. The phase out of legacy C8 PFAS has led to an increase in functionality of the carbon backbone chain to include ether linkages and branching points. With the increased production of functionalized PFAS, there remains a paucity of information regarding the occurrence of constitutional isomers in the environment. In this study, a series of novel PFAS constitutional isomers were detected by high resolution mass spectrometry and characterized by MS/MS in river water collected weekly over 40 weeks. Constitutional isomers of C4H2F8O4S1 (-1.8 ± 2.5 ppm) were detected for the first time in 83% of the samples analyzed and the MS/MS fragmentation patterns clearly indicated there were two coeluting isomers present. Two chromatographically resolved peaks with deprotonated molecular formula C7H1F14O5S1 (1.9 ± 2.7 and 2.2 ± 3.1 ppm) were detected in 85% of the samples measured. MS/MS fragmentation patterns and a standard provided by a fluorochemical manufacturer confirmed the two isomers. A series of novel chlorinated PFAS were detected (M-1: C11H1Cl1F20O5 0.9 ± 2.7 ppm and C14H1Cl1F26O6 2.1 ± 2.6 ppm) in 34% of the water samples analyzed. The exact structure is not confirmed. River sediment collected below the water sample location contained several of the compounds detected in the water column illustrating the connectivity between the environmental compartments. Results highlight the need for further studies on the occurrence of isomers and authentic standards to confirm structures.

A PCBP1-BolA2 chaperone complex delivers iron for cytosolic [2Fe-2S] cluster assembly.

Hundreds of cellular proteins require iron cofactors for activity, and cells express systems for their assembly and distribution. Molecular details of the cytosolic iron pool used for iron cofactors are lacking, but iron chaperones of the poly(rC)-binding protein (PCBP) family play a key role in ferrous ion distribution. Here we show that, in cells and in vitro, PCBP1 coordinates iron via conserved cysteine and glutamate residues and a molecule of noncovalently bound glutathione (GSH). Proteomics analysis of PCBP1-interacting proteins identified BolA2, which functions, in complex with Glrx3, as a cytosolic [2Fe-2S] cluster chaperone. The Fe-GSH-bound form of PCBP1 complexes with cytosolic BolA2 via a bridging Fe ligand. Biochemical analysis of PCBP1 and BolA2, in cells and in vitro, indicates that PCBP1-Fe-GSH-BolA2 serves as an intermediate complex required for the assembly of [2Fe-2S] clusters on BolA2-Glrx3, thereby linking the ferrous iron and Fe-S distribution systems in cells.

Compound-Specific Carbon Isotopic Composition of Ethanol in Brazil and US Vehicle Emissions and Wet Deposition.

Global atmospheric ethanol budget models include large uncertainties in the magnitude of ethanol emission sources and sinks. To apply stable isotope techniques to constrain ethanol emission sources, a headspace solid phase microextraction gas chromatograph-combustion-isotope ratio mass spectrometry method (HS-SPME-GC-C-IRMS) was developed to measure the carbon isotopic composition of aqueous phase ethanol at natural abundance levels (1-30 µM) with a precision of 0.4‰. The method was applied to determine the carbon isotope signatures (δ13C) of vehicle ethanol emission sources in Brazil (-12.8 ± 2.4‰) and the US (-9.8 ± 2.5‰), and to measure the carbon isotope composition of ethanol in wet deposition (-22.6 to -12.7‰). A two end-member isotope mixing model was developed using anthropogenic and biogenic end members and fractionation scenarios to estimate ethanol source contributions to wet deposition collected in Brazil and US. Mixing model results indicate anthropogenic sources contribute two and a half to four times more ethanol to the atmosphere than previously predicted in modeled global ethanol inventories. As established and developing countries continue to rapidly increase ethanol fuel consumption and subsequent emissions, understanding the magnitude of all ethanol sources and sinks will be essential for modeling future atmospheric chemistry and air quality impacts.

Variability of ethanol concentration in rainwater driven by origin versus season in coastal and inland North Carolina, USA.

Rainwater ethanol concentrations were measured for one year (June 2013-May 2014) in central (Elon, NC) and coastal (Wilmington, NC) North Carolina, allowing for a comparison of the effects of coastal and marine rain on ethanol concentration and deposition both at the coast and 250 km inland. Rain samples were collected on an event basis and analyzed using enzyme oxidation and headspace solid-phase microextraction (HS-SPME). The volume-weighted average ethanol concentration at Elon (609 ±â€¯116 nM) was higher than at Wilmington (208 ±â€¯21 nM). Rainfall influenced by air masses originating over the Atlantic Ocean has previously been observed to be lower in ethanol concentration than terrestrial rain at the Wilmington location, and this was true during this study as well. Lower-ethanol marine and coastal air masses did not affect the concentration of ethanol in Elon rain, 250 km from the coast. This is likely due to the rapid supply of locally emitted ethanol to air masses moving over the land. No difference in rainwater ethanol concentrations was observed for Elon rain based on air mass back trajectories, most likely because all the rain was impacted by both anthropogenic and biogenic terrestrial sources typical of most inland areas. Seasonal variation in ethanol concentrations was significant in the inland location with elevated ethanol concentrations observed in fall; no seasonal variation was observed in coastal location rain. This study presents for the first time the different drivers for ethanol concentrations in rainwater from a coastal and a proximal inland location.

Use of experimentally determined Henry's Law and salting-out constants for ethanol in seawater for determination of the saturation state of ethanol in coastal waters.

The Henry's law constant for ethanol in seawater was experimentally determined to be 221 ± 4 M/atm at 22 °C compared with 247 ± 6 M/atm in pure water. The salting out coefficient for ethanol was 0.13 M-1. In seawater ln(KH) = -(12.8 ± 0.7) + (5310 ± 197)/T where KH is in M atm-1 and temperature is in K. This plus the salting out coefficient allow calculation of KH for any estuarine or sea water between 1 and 35 °C. High concentrations of dissolved organic carbon do not affect KH values in fresh or seawater. Nearshore surface waters were usually undersaturated with respect to gas phase ethanol except when air concentrations decreased, whereas surface seawater 40 km from shore was supersaturated. The percent saturation in surface waters is driven primarily by changes in air concentrations because these change quickly (hours) and more extensively than surface water. This study allows calculation of ethanol saturation states from air and surface water concentrations which is a necessary step to define the role of surface oceans in the global biogeochemical cycling of ethanol both now and in the future as use of ethanol biofuel continues to grow.

Photorelease of microcystin-LR from resuspended sediments.

A series of ten photolysis experiments was conducted with sediments exposed to Microcystis sp. blooms to determine if sunlight is capable of mobilizing the biotoxin microcystin-LR (MC-LR) into the water column. There was a net photorelease of MC-LR in irradiated suspensions in all cases relative to dark controls, ranging from 0.4 to 192µgL-1g-1 into the dissolved phase. This should be viewed as a minimum estimate of photorelease due to concurrent photodegradation of dissolved toxin. Dissolved MC-LR concentrations in a sediment suspension increased linearly in the aqueous phase during a six-hour irradiation with simulated sunlight suggesting that longer exposure times produce greater quantities of MC-LR. There was a significant positive correlation between photorelease of toxin and percent organic carbon of the resuspended material, implying that organic-rich sediments yield the greatest photorelease of MC-LR upon exposure to full spectrum sunlight. Samples exposed to photosynthetically active radiation (400nm-700nm) were responsible for less than 2% of the photorelease compared to full spectrum exposures. Model calculations indicate that photochemical processing of bloom impacted sediments could be responsible for as much as 100% of the average standing stock of MC-LR in a freshwater pond located in southeastern North Carolina, where surface water concentrations were also measured. Mass spectrometric analysis revealed a new peak in light exposed flasks that appears to be a photo-induced isomerized product of MC-LR. Photoproduction from resuspended sediments therefore represents a significant but previously unrecognized source of highly toxic MC-LR and photoproducts of unknown toxicity and fate to aquatic ecosystems.

Bartonella henselae in canine cavitary effusions: prevalence, identification, and clinical associations.

BACKGROUND: Previous reports suggest an association between Bartonella infection and effusions in dogs and human beings. OBJECTIVES: The aims of this study were to determine the prevalence of Bartonella infection in canine effusions and to investigate historic and clinical parameters predictive of Bartonella in dogs with effusions. METHODS: Canine cavitary effusions submitted for analysis and, if available, paired EDTA blood, were screened for Bartonella infection using the Bartonella α-proteobacteria growth medium enrichment culture/PCR diagnostic platform (Bartonella enrichment PCR or ePCR) at Galaxy Diagnostics, Inc. RESULTS: Bartonella henselaeDNA was PCR-amplified and sequenced from 15% (12/80) of sampled dogs. Enrichment culture prior to PCR testing was required for Bartonella detection in 92% (11/12) of cases. Twenty percent (4/20), 13% (8/60), and 0% (0/4) of dogs with pleural, peritoneal, and pericardial effusions, respectively, tested positive. Bartonella henselae was detected most frequently in the fall, and young and middle-aged dogs appeared to be overrepresented. Golden Retrievers and Yorkshire/Silky Terriers each comprised 25% of infected dogs (odds ratio 3.4 for Golden Retrievers). There was a weak association with hemorrhagic effusions. Fifty percent of Bartonella-positive dogs had hemorrhage as a component of their effusion compared to 37% of PCR-negative dogs (odds ratio 1.7). CONCLUSIONS: Viable B henselae organisms occur in pleural and peritoneal effusions of dogs; the clinical relevance of which remains unclear and may represent opportunistic infection. Associations found in this study included seasonal variation, age, breed, and site of effusion.

Automatic exposure control calibration and optimisation for abdomen, pelvis and lumbar spine imaging with an Agfa computed radiography system.

The use of three physical image quality metrics, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and mean effective noise equivalent quanta (eNEQm) have recently been examined by our group for their appropriateness in the calibration of an automatic exposure control (AEC) device for chest radiography with an Agfa computed radiography (CR) imaging system. This study uses the same methodology but investigates AEC calibration for abdomen, pelvis and spine CR imaging. AEC calibration curves were derived using a simple uniform phantom (equivalent to 20 cm water) to ensure each metric was held constant across the tube voltage range. Each curve was assessed for its clinical appropriateness by generating computer simulated abdomen, pelvis and spine images (created from real patient CT datasets) with appropriate detector air kermas for each tube voltage, and grading these against reference images which were reconstructed at detector air kermas correct for the constant detector dose indicator (DDI) curve currently programmed into the AEC device. All simulated images contained clinically realistic projected anatomy and were scored by experienced image evaluators. Constant DDI and CNR curves did not provide optimized performance but constant eNEQm and SNR did, with the latter being the preferred calibration metric given that it is easier to measure in practice. This result was consistent with the previous investigation for chest imaging with AEC devices. Medical physicists may therefore use a simple and easily accessible uniform water equivalent phantom to measure the SNR image quality metric described here when calibrating AEC devices for abdomen, pelvis and spine imaging with Agfa CR systems, in the confidence that clinical image quality will be sufficient for the required clinical task. However, to ensure appropriate levels of detector air kerma the advice of expert image evaluators must be sought.

A Glutaredoxin·BolA Complex Serves as an Iron-Sulfur Cluster Chaperone for the Cytosolic Cluster Assembly Machinery.

Cells contain hundreds of proteins that require iron cofactors for activity. Iron cofactors are synthesized in the cell, but the pathways involved in distributing heme, iron-sulfur clusters, and ferrous/ferric ions to apoproteins remain incompletely defined. In particular, cytosolic monothiol glutaredoxins and BolA-like proteins have been identified as [2Fe-2S]-coordinating complexes in vitro and iron-regulatory proteins in fungi, but it is not clear how these proteins function in mammalian systems or how this complex might affect Fe-S proteins or the cytosolic Fe-S assembly machinery. To explore these questions, we use quantitative immunoprecipitation and live cell proximity-dependent biotinylation to monitor interactions between Glrx3, BolA2, and components of the cytosolic iron-sulfur cluster assembly system. We characterize cytosolic Glrx3·BolA2 as a [2Fe-2S] chaperone complex in human cells. Unlike complexes formed by fungal orthologs, human Glrx3-BolA2 interaction required the coordination of Fe-S clusters, whereas Glrx3 homodimer formation did not. Cellular Glrx3·BolA2 complexes increased 6-8-fold in response to increasing iron, forming a rapidly expandable pool of Fe-S clusters. Fe-S coordination by Glrx3·BolA2 did not depend on Ciapin1 or Ciao1, proteins that bind Glrx3 and are involved in cytosolic Fe-S cluster assembly and distribution. Instead, Glrx3 and BolA2 bound and facilitated Fe-S incorporation into Ciapin1, a [2Fe-2S] protein functioning early in the cytosolic Fe-S assembly pathway. Thus, Glrx3·BolA is a [2Fe-2S] chaperone complex capable of transferring [2Fe-2S] clusters to apoproteins in human cells.

Surface waters as a sink and source of atmospheric gas phase ethanol.

This study reports the first ethanol concentrations in fresh and estuarine waters and greatly expands the current data set for coastal ocean waters. Concentrations for 153 individual measurements of 11 freshwater sites ranged from 5 to 598 nM. Concentrations obtained for one estuarine transect ranged from 56 to 77 nM and levels in five coastal ocean depth profiles ranged from 81 to 334 nM. Variability in ethanol concentrations was high and appears to be driven primarily by photochemical and biological processes. 47 gas phase concentrations of ethanol were also obtained during this study to determine the surface water degree of saturation with respect to the atmosphere. Generally fresh and estuarine waters were undersaturated indicating they are not a source and may be a net sink for atmospheric ethanol in this region. Aqueous phase ethanol is likely converted rapidly to acetaldehyde in these aquatic ecosystems creating the undersaturated conditions resulting in this previously unrecognized sink for atmospheric ethanol. Coastal ocean waters may act as either a sink or source of atmospheric ethanol depending on the partial pressure of ethanol in the overlying air mass. Results from this study are significant because they suggest that surface waters may act as an important vector for the uptake of ethanol emitted into the atmosphere including ethanol from biofuel production and usage.

Temporal and spatial variability of trace volatile organic compounds in rainwater.

This study presents the first detailed concentration profile of trace VOCs in atmospheric waters. Analytes were detected and quantified in 111 unique rain events in Wilmington, NC, USA over a one-year period. Headspace solid phase microextraction was optimized for detection of these compounds at sub-nanomolar levels. Distinct seasonality in both the occurrence and concentration of compounds was observed with the lowest abundance occurring during low irradiance winter months. In contrast to other rainwater components studied at this location, VOCs did not show any correlation between rainfall amount and concentrations. There was significant spatial variation with regards to air-mass back-trajectory for methyfuran with higher concentrations observed in terrestrial events during the growing season. Air mass back trajectory also impacted CCl4 concentrations in rainwater with evidence of a possible oceanic input. However there was no significant impact of air-mass back-trajectory on the concentration of BTEX observed in rain indicating that storm origin is not the controlling factor driving concentrations of these analytes in precipitation. Members of the BTEX family did, however, have significant correlations with each other occurring in ratios aligned closely with ratios reported in the literature for gas-phase BTEX. Using available gas-phase data from locations with similar anthropogenic sources and Henry's Law constants, calculated concentrations agreed with VOC levels found in Wilmington rain. Results of this study indicate local gas-phase scavenging is the major source of VOCs in rain and wet deposition is not an efficient removal mechanism (<0.1%) of VOCs from the atmosphere.

Investigating the use of an antiscatter grid in chest radiography for average adults with a computed radiography imaging system.

OBJECTIVE: The aim of this study was to investigate via simulation a proposed change to clinical practice for chest radiography. The validity of using a scatter rejection grid across the diagnostic energy range (60-125 kVp), in conjunction with appropriate tube current-time product (mAs) for imaging with a computed radiography (CR) system was investigated. METHODS: A digitally reconstructed radiograph algorithm was used, which was capable of simulating CR chest radiographs with various tube voltages, receptor doses and scatter rejection methods. Four experienced image evaluators graded images with a grid (n = 80) at tube voltages across the diagnostic energy range and varying detector air kermas. These were scored against corresponding images reconstructed without a grid, as per current clinical protocol. RESULTS: For all patients, diagnostic image quality improved with the use of a grid, without the need to increase tube mAs (and therefore patient dose), irrespective of the tube voltage used. Increasing tube mAs by an amount determined by the Bucky factor made little difference to image quality. CONCLUSION: A virtual clinical trial has been performed with simulated chest CR images. RESULTS indicate that the use of a grid improves diagnostic image quality for average adults, without the need to increase tube mAs, even at low tube voltages. ADVANCES IN KNOWLEDGE: Validated with images containing realistic anatomical noise, it is possible to improve image quality by utilizing grids for chest radiography with CR systems without increasing patient exposure. Increasing tube mAs by an amount determined by the Bucky factor is not justified.

Enhanced detection of the algal toxin PbTx-2 in marine waters by atmospheric pressure chemical ionization mass spectrometry.

RATIONALE: Karenia brevis, a marine dinoflagellate, biosynthesizes a unique class of polyether toxins called brevetoxins that produce significant health, environmental and economic impacts in and along coastal waters. Previous application of liquid chromatography/mass spectrometry for detection of the most common brevetoxin, PbTx-2, has relied almost exclusively upon electrospray ionization (ESI). A different ionization source is proposed in this study with improved sensitivity ultimately leading to lower limit of detection compared to (+) ESI. METHODS: Brevetoxin standards and samples (PbTx-2) were analyzed by liquid chromatography/mass spectrometry using both (+) atmospheric pressure chemical ionization and (+) electrospray ionization sources. RESULTS: LC/MS with (+) APCI exhibited an order of magnitude improvement in the limit of detection (7.7 × 10(-4) pg mass on-column) compared to the same method using (+) ESI (7.5 × 10(-3) pg mass on-column). The calibration sensitivity of (+) APCI (1.3 × 10(3)) was also five times higher than positive mode (+) ESI (0.26 × 10(3)). CONCLUSIONS: Positive mode APCI represents a significant improvement in detection and quantification of PbTx-2 by LC/MS allowing for smaller sample sizes compared to previous studies using (+) ESI. This in turn leads to higher throughput of samples during and after bloom events giving stakeholders detailed information on the fate of this potent marine toxin.

Examining Hemodialysis Reliable Outflow catheter performance and cost in hemodialysis access.

BACKGROUND: The Hemodialysis Reliable Outflow (HeRO) vascular access device is a hybrid polytetrafluoroethylene graft-stent construct designed to address central venous occlusive disease. Although initial experience has demonstrated excellent mid-term patency rates, subsequent studies have led to external validity questions. The purpose of this study was to examine a single center experience with this vascular access device in challenging access cases with associated costs. METHODS: A retrospective study representing the authors' cumulative HeRO vascular access device experience was undertaken. The primary endpoint was graft failure or death, with secondary endpoints including secondary intervention rates and cost. RESULTS: Forty-one patients with 15,579 HeRO days and a mean of 12.7 ± 1.5 mo with the vascular access device were available for analysis. Secondary patency was 81.6% at 6 mo and 53.7% at 12 mo. The reintervention rate was 2.84 procedures per HeRO vascular access device year. Associated HeRO costs related to subsequent procedures were estimated at $34,713.63 per patient/y. CONCLUSIONS: These data on the patency and primary outcome data diverge significantly from initial multicenter studies and represent a real-world application of this technology. It is costly to maintain patency. Use of HeRO vascular access devices should be judicious with outcome expectations reduced.

Characterization of carbohydrates in rainwater from the southeastern North Carolina.

Carbohydrates have been widely reported in atmospheric aerosols, but have not previously been quantified in rainwater. We have identified and quantified a series of 11 specific compounds including monosaccharides (glucose, fructose, arabinose, galactose and pinitol), disaccharides (sucrose and trehalose), sugar alcohols (arabitol, dulcitol and mannitol) and the anhydrosaccharide levoglucosan. Rainwater analyzed in this study includes 52 distinct precipitation events in Wilmington, NC between June 2011 and October 2012. Our analysis indicates carbohydrates typically contribute <1% of total dissolved organic carbon in rain, but can account for as much as 10-35% during periods of high pollen or local fires. Concentrations of individual carbohydrates reached as high as 5.8 µM, with glucose and sucrose typically being the predominant species. The distribution of carbohydrates exhibited a distinct seasonal pattern, with higher concentrations of most carbohydrates, especially sucrose, in spring and summer, driven primarily by increased biogenic inputs during the growing season. Concentrations of carbohydrates were an order of magnitude higher in storms of terrestrial origin compared to marine events, further supporting a terrestrial biogenic origin of most species. Sequential sampling of Hurricane Irene showed significant quantities of carbohydrates present at the end of the storm when air mass back trajectories traversed over land. The highest level of levoglucosan, a compound associated with biomass burning, was detected in rain with an air mass back trajectory that traveled over a region affected by wildfires. When compared to aerosol concentrations reported by others, the sugar concentrations in rain demonstrate wet deposition is an important removal mechanism of this water-soluble and bioavailable fraction of atmospheric particulate organic matter.