Prospective Study Investigating the Prevalence and Evolution of Malnourishment in the Acute Orthopaedic Trauma Patient.

Background: Orthopaedic trauma surgeons believe that nutritional status is important. The primary aim of this study was to prospectively investigate the prevalence and progression of malnourishment in orthopaedic trauma patients and determine when and what labs should be ordered. The secondary aim was to determine if malnourished patients had increased complications. Methods: Prospective cohort study of orthopaedic trauma patients at a Level I trauma center. Assessment of nutritional status over the hospital course was performed using the Rainey MacDonald nutritional index (RMNI) and nutritional laboratory markers on admission, day 3, day 7, and 6 weeks post-op. Results: 98 patients were enrolled and included. On admission, 60%, 41%, and 38% of patients were malnourished based on albumin, prealbumin, and RMNI values, respectively, with 31% in severe acute-phase response (APR) as determined by CRP. By day 3, a significant increase in the percent of malnourished patients was noted based on the laboratory markers, 85%, 90%, and 80%, respectively, with 70% in severe APR. On day 7, values stabilized at 74%, 89%, 69%, with 56% in severe APR. At six weeks, malnourishment persisted in 13%, 19%, and 12% of patients, with 4% in severe APR. Older patients demonstrated a greater depression of nutritional markers throughout the hospital stay. Conclusion: The prevalence of malnourishment, based on serum nutritional markers, in the presence of acute orthopaedic injury is substantial, and it continues to rise during the acute hospital stay. Recommend obtaining prealbumin or albumin levels on hospital day 3 to assess nutritional status.

The spectrum of skin diseases seen in a Jamaican tertiary academic medical center.

BACKGROUND: The diversity of skin diseases seen in a dermatology clinic varies with the composition of the population. OBJECTIVE: The aim was to document the spectrum of cutaneous disorders seen and the variation with sex, age, and seasons. METHODS: This was a retrospective study on new patients attending an academic dermatology clinic in Jamaica during 2018. Disease frequencies and prevalence by sex, seasons, and age group were recorded. RESULTS: There were 547 new patients with 329 females (60%) and 218 males (40%). The mean age was 36.8 years, ranging from 2 weeks old to 103 years old. The largest number of patients were in the third decade (20-29 years) (n = 139). More patients presented in the dry season and in spring and summer. The most common diagnoses were: seborrheic dermatitis (n = 65, 11.9%), acne (n = 56, 10.2%), and contact dermatitis (n = 38, 6.9%). The most common disease groups were dermatitis (n = 161, 29.4%), infections (n = 130, 23.8%), and inflammatory disorders (n = 129, 23.6%). LIMITATIONS: The generalizability of our findings may be limited, and selection bias may play a role in patients choosing to attend an academic dermatology clinic. CONCLUSIONS: Skin diseases varied with age, sex, and season with seborrheic dermatitis being most common.

Health assessment of gasoline and fuel oxygenate vapors: generation and characterization of test materials.

In compliance with the Clean Air Act regulations for fuel and fuel additive registration, the petroleum industry, additive manufacturers, and oxygenate manufacturers have conducted comparative toxicology testing on evaporative emissions of gasoline alone and gasoline containing fuel oxygenates. To mimic real world exposures, a generation method was developed that produced test material similar in composition to the re-fueling vapor from an automotive fuel tank at near maximum in-use temperatures. Gasoline vapor was generated by a single-step distillation from a 1000-gallon glass-lined kettle wherein approximately 15-23% of the starting material was slowly vaporized, separated, condensed and recovered as test article. This fraction was termed vapor condensate (VC) and was prepared for each of the seven test materials, namely: baseline gasoline alone (BGVC), or gasoline plus an ether (G/MTBE, G/ETBE, G/TAME, or G/DIPE), or gasoline plus an alcohol (G/EtOH or G/TBA). The VC test articles were used for the inhalation toxicology studies described in the accompanying series of papers in this journal. These studies included evaluations of subchronic toxicity, neurotoxicity, immunotoxicity, genotoxicity, reproductive and developmental toxicity. Results of these studies will be used for comparative risk assessments of gasoline and gasoline/oxygenate blends by the US Environmental Protection Agency.

Effect of soil moisture on chlorine deposition.

The effect of soil moisture on chlorine (Cl(2)) deposition was examined in laboratory chamber experiments at high Cl(2) exposures by measuring the concentration of chloride (Cl(-)) in soil columns. Soil mixtures with varying amounts of clay, sand, and organic matter and with moisture contents up to 20% (w/w) were exposed to ≈3×10(4)ppm Cl(2) vapor. For low water content soils, additional water increased the reaction rate as evidenced by higher Cl(-) concentration at higher soil moisture content. Results also showed that the presence of water restricted transport of Cl(2) into the soil columns and caused lower overall deposition of Cl(2) in the top 0.48-cm layer of soil when water filled ≈60% or more of the void space in the column. Numerical solutions to partial differential equations of Fick's law of diffusion and a simple rate law for Cl(2) reaction corroborated conclusions derived from the data. For the soil mixtures and conditions of these experiments, moisture content that filled 30-50% of the available void space yielded the maximum amount of Cl(2) deposition in the top 0.48cm of soil.

Deposition of Cl2 on soils during outdoor releases.

Synthetic soil blends were exposed to dense chlorine (Cl2) plumes released at Dugway Proving Ground, UT, during Spring 2010 with the purpose of determining the magnitude of Cl2 deposition onto soil and assessing its potential for attenuating a high-concentration plume. Samples were exposed at varying distances from the release point to include exposure to the pooling liquid (2-3m) and dense vapor (10-17 m). Following exposure, soil samples were cored, fractionated vertically and analyzed for chloride (Cl(-)) to quantify the integrated amount of Cl2 deposited. Cl(-) was detected as deep as 4 cm in samples exposed to dense Cl2 vapor and in the deepest fractions (13 cm) of samples exposed to liquid Cl2. Chloride concentration, [Cl(-)], in the soil samples positively correlated with soil mass fractions of organic matter and water, and while their individual contributions to Cl2 deposition could not be quantitatively determined, the data suggest that organic matter was the primary contributor. [Cl(-)] results from the top vertical fractions (1.3 cm nearest the surface) were used in an analysis to determine the magnitude of deposition as a loss term under low-wind (≤ 1.6m/s) conditions. The analysis revealed up to 50% of a 1814-kg release could be deposited within 20 m from the release point for soil with high organic matter (43%) and/or water content (29%).

Cl2 deposition on soil matrices.

Deposition of chlorine gas, Cl(2), on synthetic soil sample matrices was examined in a small chamber to ascertain its potential significance as a chemical sink during large-scale releases. The effects of organic matter, clay and sand mass fractions of the soil matrix, soil packing, and exposure to ultraviolet (UV) light on the observed Cl(2) deposition were examined. Organic matter content was found to be the dominant soil variable investigated that affected Cl(2) deposition; all other variables exhibited no measurable effect. Analytical results from the top 8.5mm of soil columns exposed to Cl(2) were fit to a simple kinetic model with six adjustable parameters. The kinetic model included two reactive bins to account for fast- and slow-reacting material in the soil matrices. The resulting empirical equation agreed with the data to within a factor of two and accurately predicted results from soil mixes not used to optimize the adjustable parameters. Total Cl(2) deposition, assuming a penetration depth of 8.5mm, was calculated to be as high as 160 metric tons per square kilometer for soil with an organic content of 10%, and inferred deposition velocities were as high as 0.5 cm/s for organically rich soil.

Preserving and using germplasm and dissociated embryonic cells for conserving Caribbean and Pacific coral.

Coral reefs are experiencing unprecedented degradation due to human activities, and protecting specific reef habitats may not stop this decline, because the most serious threats are global (i.e., climate change), not local. However, ex situ preservation practices can provide safeguards for coral reef conservation. Specifically, modern advances in cryobiology and genome banking could secure existing species and genetic diversity until genotypes can be introduced into rehabilitated habitats. We assessed the feasibility of recovering viable sperm and embryonic cells post-thaw from two coral species, Acropora palmata and Fungia scutaria that have diffferent evolutionary histories, ecological niches and reproductive strategies. In vitro fertilization (IVF) of conspecific eggs using fresh (control) spermatozoa revealed high levels of fertilization (>90% in A. palmata; >84% in F. scutaria; P>0.05) that were unaffected by tested sperm concentrations. A solution of 10% dimethyl sulfoxide (DMSO) at cooling rates of 20 to 30°C/min most successfully cryopreserved both A. palmata and F. scutaria spermatozoa and allowed producing developing larvae in vitro. IVF success under these conditions was 65% in A. palmata and 53% in F. scutaria on particular nights; however, on subsequent nights, the same process resulted in little or no IVF success. Thus, the window for optimal freezing of high quality spermatozoa was short (∼5 h for one night each spawning cycle). Additionally, cryopreserved F. scutaria embryonic cells had∼50% post-thaw viability as measured by intact membranes. Thus, despite some differences between species, coral spermatozoa and embryonic cells are viable after low temperature (-196°C) storage, preservation and thawing. Based on these results, we have begun systematically banking coral spermatozoa and embryonic cells on a large-scale as a support approach for preserving existing bio- and genetic diversity found in reef systems.

The effects of active chlorine on photooxidation of 2-methyl-2-butene.

Active chlorine comprising hypochlorite (OCl⁻), hypochlorous acid (HOCl) and chlorine (Cl2) is the active constituent in bleach formulations for a variety of industrial and consumer applications. However, the strong oxidative reactivity of active chlorine can cause adverse effects on both human health and the environment. In this study, aerosolized Oxone® [2KHSO5, KHSO4, K2SO4] with saline solution has been utilized to produce active chlorine (HOCl and Cl2). To investigate the impact of active chlorine on volatile organic compound (VOC) oxidation, 2-methyl-2-butene (MB) was photoirradiated in the presence of active chlorine using a 2-m³ Teflon film indoor chamber. The resulting carbonyl products produced from photooxidation of MB were derivatized with O-(2,3,4,5,6-pentafluorobenzyl) hydroxyamine hydrochloride (PFBHA) and analyzed using gas chromatograph-ion trap mass spectrometer (GC/ITMS). The photooxidation of MB in the presence of active chlorine was simulated with an explicit kinetic model using a chemical solver (Morpho) which included both Master Chemical Mechanism (MCM) and Cl radical reactions. The reaction rate constants of a Cl radical with MB and its oxidized products were estimated using a Structure-Reactivity Relationship method. Under dark conditions no effect of active chlorine on MB oxidation was apparent, whereas under simulated daylight conditions (UV irradiation) rapid MB oxidation was observed due to photo-dissociation of active chlorine. The model simulation agrees with chamber data showing rapid production of oxygenated products that are characterized using GC/ITMS. Ozone formation was enhanced when MB was oxidized in the presence of irradiated active chlorine and NO(x).

Mammalian target of rapamycin: a new target in prostate cancer.

Molecular targets in prostate cancer are continually being explored, especially in the poor-prognosis androgen-independent phase of the disease, for which there are currently few therapeutic options. One such target is the mammalian target of rapamycin (mTOR) protein. Activation of mTOR results in sequential activation of downstream molecules, which ultimately results in cell division. In this review, we consider the rationale for pursuing mTOR as a therapeutic target in prostate cancer and summarize preclinical and clinical studies of mTOR inhibition in prostate cancer.

Reverse osmosis processing of organic model compounds and fermentation broths.

Post-treatment of an anaerobic fermentation broth was evaluated using a 150 gal/day, single cartridge prototype reverse osmosis (RO) system. Baseline tests were conducted at 25 degrees C using six organic model compounds representing key species found in the fermentation broth: ethanol, butanol, acetic acid, oxalic acid, lactic acid, and butyric acid. Correlations of the rejection and recovery efficiencies for these organic species, individually and in simulated mixtures, were obtained as a function of feed pressure with and without recirculation of the retentate. The actual fermentation broth obtained from a continuous-flow biohydrogen process was treated by the RO system under the operating conditions similar to those used in the baseline tests, resulting in greater than 95% removal of total organic carbon. These results are encouraging and useful for further studies on the feasibility of incorporating the RO technology into an integrated and field deployable wastewater management and water recovery system.

Inactivation of biological agents using neutral oxone-chloride solutions.

Bleach solutions containing the active ingredient hypochlorite (OCl-) serve as powerful biological disinfectants but are highly caustic and present a significant compatibility issue when applied to contaminated equipment or terrain. A neutral, bicarbonate-buffered aqueous solution of Oxone (2K2HSO5.KHSO4.K2SO4) and sodium chloride that rapidly generates hypochlorite and hypochlorous acid (HOCl) in situ was evaluated as a new alternative to bleach for the inactivation of biological agents. The solution produced a free chlorine (HOCl + OCl-) concentration of 3.3 g/L and achieved > or =5.8-log inactivation of spores of Bacillus atrophaeus, Bacillus thuringiensis, Aspergillus niger, and Escherichia coli vegetative cells in 1 min at 22 degrees C. Seawaterwas an effective substitute for solid sodium chloride and inactivated 5 to 8 logs of each organism in 10 min over temperatures ranging from -5 degrees C to 55 degrees C. Sporicidal effectiveness increased as free chlorine concentrations shifted from OCl- to HOCl. Neutrally buffered Oxone-chloride and Oxone-seawater solutions are mitigation alternatives for biologically contaminated equipment and environments that would otherwise be decontaminated using caustic bleach solutions.

Determination of in situ-generated dimethyldioxirane from an aqueous matrix using selected ion monitoring.

There is a growing interest in utilizing in situ-generated dimethyldioxirane (DMDO) as an oxidant for synthetic purposes and bleaching and decontamination applications, but the ability to quantify the organic cyclic peroxide species is often complicated by the presence of other reactive components, peroxymonosulfate and acetone, within the solution matrix. This paper is the first to report the use of a MS method for the quantitation of DMDO from these complex matrices by utilizing an isothermal 30 degrees C GC program in conjunction with selected ion monitoring (SIM). The volatile organic species is sampled from the headspace of closed batch system vials and quantified by measuring the abundance of m/z 74. The method achieves a practical quantitation limit (PQL) for DMDO of 0.033 mM, and methyl acetate is identified as a minor decomposition product from the aqueous sample matrix, contributing 9% towards the overall DMDO measurements. The spectroscopic method makes use of common analytical instrumentation and is capable of measuring other in situ-generated dioxiranes, such as those generated from 2-butanone and [2H6]acetone.

Use of in situ-generated dimethyldioxirane for inactivation of biological agents.

Dimethyldioxirane (DMDO), generated in situ by adding acetone to an aqueous solution containing potassium peroxymonosulfate (Oxone) at neutral pH, was investigated for inactivation of biological warfare agent simulants. The DMDO solution inactivated bacterial spores, fungal spores, vegetative bacterial cells, viruses, and protein by 7 orders of magnitude in less than 10 min. The kill rates of DMDO were more pronounced when compared to kill rates of buffered Oxone alone. Conditions for the use of DMDO as a biological decontaminant were optimized by evaluating the effects of age and temperature on open systems. DMDO effectiveness was compared to that of current decontaminant solutions such as DS2 (used by the U.S. military), bleach, and hydrogen peroxide and was shown to be superior in achieving a 7-log kill of Bacillus atrophaeus, a Bacillus anthracis spore simulant. The results demonstrate the potential for DMDO to fill the need for a noncorrosive, nontoxic, and environmentally safe decontaminant.

Fate of ammonia in the atmosphere--a review for applicability to hazardous releases.

The physical and chemical mechanisms responsible for the removal of ammonia from the atmosphere have been reviewed. Capture by atmospheric moisture (clouds, rain, fog), surface water (rivers, lakes, seas), and deposition on vegetation and soil constitute the main pathways for ammonia removal from the troposphere. Ammonia catalyzes the atmospheric oxidation of sulfur dioxide to sulfur trioxide and reacts rapidly with acidic components of the atmosphere (sulfuric, nitric, and hydrochloric acids). The ammonium salts formed are the main components of smog aerosols and thus affect the opacity of the atmosphere and the earth radiation budget. Slow oxidation of ammonia in the atmosphere plays only a minor role in its removal. The data obtained for ammonia reactions under normal atmospheric conditions are generally applicable to model chemical reactions occurring during massive release of ammonia in the atmosphere, provided the impact of high ammonia concentration on the mass transfer processes that control some of these reactions, are taken into account.