Health Risk Implications of Volatile Organic Compounds in Wildfire Smoke During the 2019 FIREX-AQ Campaign and Beyond.

Fire Influence on Regional to Global Environments and Air Quality was a NOAA/NASA collaborative campaign conducted during the summer of 2019. The objectives included identifying and quantifying wildfire composition, smoke evolution, and climate and health impacts of wildfires and agricultural fires in the United States. Ground based mobile sampling via sorbent tubes occurred at the Nethker and Williams Flats fires (2019) and Chief Timothy and Whitetail Loop fires (2020) in Idaho and Washington. Air samples were analyzed through thermal desorption-gas chromatography-mass spectrometry for a variety of volatile organic compounds to elucidate both composition and health impacts. Benzene, toluene, ethylbenzene, xylenes, butenes, phenol, isoprene and pinenes were observed in the wildfire smoke, with benzene ranging from 0.04 to 25 ppbv. Health risk was assessed for each fire by determining sub-chronic (wildfire event) and projected chronic inhalation risk exposure from benzene, a carcinogen, as well as other non-carcinogenic compounds including toluene, ethylbenzene, xylenes, and hexane. The cancer risk of benzene from sub-chronic exposure was 1 extra cancer per million people and ranged from 1 to 19 extra cancers per million people for the projected chronic scenarios, compared to a background level of 1 extra cancer per million people. The hazard index of non-carcinogenic compounds was less than one for all scenarios and wildfires sampled, which was considered low risk for non-cancer health events.

Diffusive uptake rates for passive air sampling: Application to volatile organic compound exposure during FIREX-AQ campaign.

Passive (diffusive) sampling using sorbents is an economical and versatile method of measuring pollutants in air, including volatile organic compounds (VOCs). Diffusive uptake rates (UTRs) are needed for each analyte to obtain average concentrations during a specific passive sampling time duration. Here, a simultaneous active/diffusive ambient air sampling technique on Tenax®TA was employed to measure 24-hours, 7, 14 and 28-days UTRs of up to 27 VOCs, including benzene, toluene, ethylbenzene, xylenes (BTEX), C6-C12 hydrocarbons, benzenes derivatives, tetrachloroethylene, pinenes and limonene. Samples were analyzed via thermal desorption-gas chromatography-mass spectrometry (TD-GC-MS) for desired analytes. Seven-day UTR values ranged from 0.17 to 0.59 mL/min and many compounds exhibited a linear relationship with UTR and time duration up to 14 or 28 days. This may be the most comprehensive UTR tabulation of VOCs on Tenax®TA for time periods of 24 hours -28 days available. These rates were applied to VOC data measured during the 2019 NASA/NOAA Fire Influence on Regional to Global Environments and Air Quality (FIREX-AQ) campaign, with goals to determine the chemical composition of western US wildfire smoke and to assess human exposure to air toxics. Summer 2019 exposure levels of BTEX at five Northwestern cities were low and the cancer risk due to benzene was assessed during FIREX-AQ to be background or 1 × 10-6. The UTRs derived here can be useful in applications of diffusive sampling, including estimation of sub-chronic to chronic human exposure risk of air toxics and wildfire smoke.

Effects of Soil Solarization and Trichoderma asperellum on Soilborne Inoculum of Phytophthora ramorum and Phytophthora pini in Container Nurseries.

Infested container nursery beds are an important source of soilborne Phytophthora spp. for initiating disease through movement with surface water or splashing onto foliage. We investigated the effects of soil solarization, alone or with subsequent amendment with a Trichoderma asperellum biocontrol agent, on the survival of Phytophthora spp. inoculum. In field trials conducted with Phytophthora ramorum in San Rafael, CA and with P. pini in Corvallis, OR, infested rhododendron leaf inoculum was buried at 5, 15, and 30 cm below the soil surface. Solarization for 2 or 4 weeks during summer 2012 eliminated recovery of Phytophthora spp. buried at all depths in California trial 1, at 5 and 15 cm in California trial 2, but only at 5 cm in Oregon. There was no significant reduction of Phytophthora spp. recovery after T. asperellum application. Although the population densities of the introduced T. asperellum at the 5-cm depth were often two- to fourfold higher in solarized compared with nonsolarized plots, they were not significantly different (P = 0.052). Soil solarization appears to be a promising technique for disinfesting the upper layer of soil in container nurseries under certain conditions.

Phytophthora ramorum Colonizes Tanoak Xylem and Is Associated with Reduced Stem Water Transport.

ABSTRACT Isolation, detection with diagnostic polymerase chain reaction (PCR), and microscopy demonstrated the presence of Phytophthora ramorum in the sapwood of mature, naturally infected tanoak (Lithocarpus densiflorus) trees. The pathogen was strongly associated with discolored sapwood (P < 0.001), and was recovered or detected from 83% of discolored sapwood tissue samples. Hyphae were abundant in the xylem vessels, ray parenchyma, and fiber tracheids. Chlamydospores were observed in the vessels. Studies of log inoculation indicated that P. ramorum readily colonized sapwood from inoculum placed in the bark, cambium, or sapwood. After 8 weeks, radial spread of P. ramorum in sapwood averaged 3.0 to 3.3 cm and axial spread averaged 12.4 to 18.8 cm. A field study was conducted to determine if trees with infected xylem had reduced sap flux and reduced specific conductivity relative to noninfected control trees. Sap flux was monitored with heat-diffusion sensors and tissue samples near the sensors were subsequently tested for P. ramorum. Adjacent wood sections were excised and specific conductivity measured. Both midday sap flux and specific conductivity were significantly reduced in infected trees versus noninfected control trees. Vessel diameter distributions did not differ significantly among the two treatments, but tyloses were more abundant in infected than in noninfected trees. Implications for pathogenesis, symptomology, and epidemiology are discussed.

Root and Stem Infection of Rhododendron from Potting Medium Infested with Phytophthora ramorum.

Phytophthora ramorum has been detected in soil and potting media, but the potential for root infections is not fully understood. To determine whether the root system could become infected and transmit disease, rhododendron 'Nova Zembla' plants grown from rooted cuttings and native Pacific rhododendron (Rhododendron macrophyllum) plants grown from seed were transplanted into a potting medium artificially infested with P. ramorum. Inoculum consisted of V8-brothvermiculite cultures of P. ramorum, chopped infected leaves, or zoospores. Plants were watered from the bottom to prevent splash dispersal of inoculum onto stems and foliage. Both infested amendments and applications of zoospores resulted in plant mortality within 3 to 7 weeks. P. ramorum was isolated from hair roots, large roots, and stems above and below the potting medium surface. Noninoculated control plants remained healthy and did not yield P. ramorum. Epifluorescence microscopy of tissue culture plantlets inoculated in vitro revealed attraction of zoospores to wounds and root primordia, and colonization of the cortex and vascular tissues of roots and stems, including the xylem. Transmission of P. ramorum from infested potting media to stems via infected, symptomless root tissue demonstrates the need to monitor potting media for presence of the pathogen to prevent spread of P. ramorum on nursery stock.

Susceptibility of Oregon Forest Trees and Shrubs to Phytophthora ramorum: A Comparison of Artificial Inoculation and Natural Infection.

Phytophthora ramorum is an invasive pathogen in some mixed-hardwood forests in California and southwestern Oregon, where it causes sudden oak death (SOD) on some members of Fagaceae, ramorum shoot dieback on some members of Ericaceae and conifers, and ramorum leaf blight on diverse hosts. We compared symptoms of P. ramorum infection resulting from four different artificial inoculation techniques with the symptoms of natural infection on 49 western forest trees and shrubs; 80% proved susceptible to one degree or another. No single inoculation method predicted the full range of symptoms observed in the field, but whole plant dip came closest. Detached-leaf-dip inoculation provided a rapid assay and permitted a reasonable assessment of susceptibility to leaf blight. Both leaf age and inoculum dose affected detached-leaf assays. SOD and dieback hosts often developed limited leaf symptoms, although the pattern of midrib and petiole necrosis was distinctive. Stem-wound inoculation of seedlings correlated with field symptoms for several hosts. The results suggested that additional conifer species may be damaged in the field. Log inoculation provided a realistic test of susceptibility to SOD, but was cumbersome and subject to seasonal variability. Pacific rhododendron, salmonberry, cascara, and poison oak were confirmed as hosts by completing Koch's postulates. Douglas-fir was most susceptible to shoot dieback shortly after budburst, with infection occurring at the bud.

B- and T-cell markers in opsoclonus-myoclonus syndrome: immunophenotyping of CSF lymphocytes.

BACKGROUND: Although many lines of evidence suggest an autoimmune etiology, the pathophysiology of opsoclonus-myoclonus syndrome (OMS) remains poorly understood and no immunologic abnormalities have correlated with neurologic severity. Conventional immunotherapies often do not prevent relapse or permanent sequelae. OBJECTIVE: To test the cellular immune hypothesis of OMS in a cross-sectional study and determine if CSF lymphocyte subset analysis provides biomarkers of disease activity. METHODS: The expression of lymphocyte surface antigens was investigated in CSF and blood of 36 children with OMS and 18 control subjects, using a comprehensive panel of monoclonal antibodies to adhesion and activation proteins in combination with anti-CD3 and anti-CD45 antibodies in four-color fluorescence-activated cell sorting. RESULTS: Although most children with OMS had normal CSF cell counts, they exhibited expansion of CD19+ B-cell (up to 29%) and gammadelta T-cell (up to 26%) subsets and a lower percentage of CD4+ T-cells and CD4/CD8 ratio, which persisted even years after disease onset and conventional treatments. The percentage of activated CSF T-cells was also higher. Abnormalities correlated with neurologic severity, as scored blinded from videotapes using a 12-item motor scale, and disease duration. No significant differences were found between tumor and no-tumor groups. In children with neuroblastoma, tumor resection or cancer chemotherapy did not alter immunologic abnormalities. CONCLUSIONS: CSF B- and T-cell recruitment is linked to neurologic signs in pediatric OMS, which may relate to relapses and disease progression.

Detection of Phytophthora ramorum Blight in Oregon Nurseries and Completion of Koch's Postulates on Pieris, Rhododendron, Viburnum, and Camellia.

Phytophthora ramorum, the cause of sudden oak death in California and Oregon coastal forests and ramorum blight in European nurseries and landscapes (1), was detected in six Oregon nurseries in Jackson, Clackamas, and Washington counties from May to June 2003. The pathogen was isolated from: Viburnum bodnantense 'Dawn', V. plicatum var. tomentosum 'Mariesii', Pieris japonica × formosa 'Forest Flame', P. japonica 'Variegata' and 'Flaming Silver', P. floribunda × japonica 'Brouwer's Beauty', Camellia sasanqua 'Bonanza' and other cultivars, C. japonica, and Rhododendron × 'Unique'. Samples of symptomatic tissues were plated on a Phytophthora-selective medium (PARP) and tested by polymerase chain reaction (PCR) (3). All samples positive for P. ramorum with PCR yielded P. ramorum isolates in culture. The isolates have the European genotype, mating type A1, except for the Camellia spp. isolates, which have the North American genotype, mating type A2 (2). Isolates are deposited in the American Type Culture Collection. Koch's postulates for this pathogen have been completed on V. bodnantense and C. japonica (1). To confirm pathogenicity on the new hosts, isolates from V. plicatum var. tomentosum 'Mariesii', Pieris × 'Forest Flame', Pieris × 'Brouwer's Beauty', and P. japonica 'Variegata' and 'Flaming Silver' were used to inoculate healthy plants of the same cultivars. For isolates from Rhododendron × 'Unique' and C. sasanqua 'Bonanza', pathogenicity was tested on Rhododendron × 'Nova Zembla' and C. sasanqua 'Sutsugekka' and 'Kanjiro'. Three to five plants of each cultivar were inoculated and three to five were noninoculated. Zoospore inoculum was prepared on dilute V8 agar for one isolate from each host. Foliage of plants growing in 10-cm pots was dipped for 5 sec in a zoospore suspension (3 × 104 zoospores per ml) or sprayed to runoff with a hand mister (6 × 104 zoospores per ml). Control plants were dipped in or sprayed with sterile water. C. sasanqua plants were also inoculated by placing 6-mm mycelial plugs on individual leaves that had been wounded by piercing with a pin. Control leaves were wounded but not inoculated. Foliage was enclosed in plastic bags to retain humidity and the pathogen, and plants were incubated in a locked growth chamber (21 to 23°C). After 21 days, plants were examined for symptoms, and isolations onto PARP were made. All inoculated plants showed foliar symptoms, and P. ramorum was consistently isolated from inoculated plants, but not from asymptomatic control plants. On Rhododendron × 'Nova Zembla', nearly all leaves were wilted and dead, as were terminal buds and stems. Pieris spp. cultivars exhibited leaf and stem necrosis and defoliation. On V. plicatum var. tomentosum 'Mariesii', necrotic leaf lesions and defoliation of the lower leaves were observed. On C. sasanqua, necrotic lesions developed only on wounded leaves inoculated with mycelial plugs; these leaves abscised. Our results confirm the pathogenicity of Oregon nursery isolates of P. ramorum on V. plicatum var. tomentosum 'Mariesii', P. japonica × formosa 'Forest Flame', P. japonica 'Variegata' and 'Flaming Silver', P. floribunda × japonica 'Brouwer's Beauty', C. sasanqua and Rhododendron and complete Koch's postulates for several new hosts. References: (1) J. M. Davidson et al. Online publication. doi:10.1094/PHP-2003-0707-01-DG. Plant Health Progress, 2003. (2) E. M. Hansen et al. Plant Dis. 87:1267, 2003. (3) L. M. Winton and E. M. Hansen. For. Pathol. 31:275, 2001.

Diversity of the Burkholderia cepacia complex and implications for risk assessment of biological control strains.

The Burkholderia cepacia complex (Bcc) consists of several species of closely related and extremely versatile gram-negative bacteria found naturally in soil, water, and the rhizosphere of plants. Strains of Bcc have been used in biological control of plant diseases and bioremediation, while some strains are plant pathogens or opportunistic pathogens of humans with cystic fibrosis. The ecological versatility of these bacteria is likely due to their unusually large genomes, which are often comprised of several (typically two or three) large replicons, as well as their ability to use a large array of compounds as sole carbon sources. The original species B. cepacia has been split into eight genetic species (genomovars), including five named species, but taxonomic distinctions have not enabled biological control strains to be clearly distinguished from human pathogenic strains. This has led to a reassessment of the risk of several strains registered by the U.S. Environmental Protection Agency for biological control. We review the biology of Bcc bacteria, especially how our growing knowledge of Bcc ecology and pathogenicity might be used in risk assessment. The capability of this bacterial complex to cause disease in plants and humans, as well as to control plant diseases, affords a rare opportunity to explore traits that may function in all three environments.

Population pharmacokinetic modeling of steady state carbamazepine clearance in children, adolescents, and adults.

Carbamazepine (CBZ) clearance decreases from childhood to adulthood and the factors determining this change could include age, size, autoinduction, or maturational changes. This study aims to describe the population pharmacokinetics of CBZ in children and young adults and test the hypothesis that CBZ clearance correlates with weight, surface area, and age. CBZ therapeutic drug monitoring data (sparse data) were collected from child and adult epileptics, and rich data were obtained from a bioequivalence study of CBZ in young adults. Population pharmaco-kinetic analysis was performed using NONMEM V. Forward stepwise, multiple regression was performed on the covariates. Bootstrap validation was performed. A total of 946 observations from 91 subjects, ages 0.7-37 years, were collected and analyzed. A one-compartment, first-order absorption and elimination model, with exponential interindividual error and additive residual error models was developed. The population model was: Clearance (Lhr-1) = ((2.24 x Surface area (m2)) + (0.047 x Dose (mg.kg-1)); Volume of distribution (L) = 0.37 x weight (kg); Absorption rate constant = 0.013 (hr-1). CBZ clearance increased with surface area and dose.

Postinfection Biological Control of Oomycete Pathogens of Pea by Burkholderia cepacia AMMDR1.

ABSTRACT Burkholderia cepacia AMMDR1 is a biocontrol agent that reduces Pythium damping-off and Aphanomyces root rot severity on peas in the field. We studied the effect of B. cepacia AMMDR1 on post-infection stages in the life cycles of these pathogens, including mycelial colonization of the host, production of oogonia, and production of secondary zoospore inoculum. We used Burkholderia cepacia 1324, a seed and rootcolonizing but antibiosis-deficient Tn5 mutant of B. cepacia AMMDR1, to study mechanisms of biological control other than antibiosis. B. cepacia AMMDR1 significantly reduced Pythium aphanidermatum postinfection colonization and damping-off of pea seeds, even when the bacteria were applied 12 h after zoospore inoculation. B. cepacia AMMDR1 also significantly reduced colonization of taproots by Aphanomyces euteiches mycelium, but only when the bacteria were applied at high population densities at the site of zoospore inoculation. The antibiosisdeficient mutant, B. cepacia 1324, had no effect on mycelial colonization of seeds or roots by Pythium aphanidermatum nor A. euteiches, suggesting that antibiosis is the primary mechanism of biological control. B. cepacia AMMDR1, but not B. cepacia 1324, reduced production of A. euteiches oogonia. This effect occurred even when the population size of B. cepacia AMMDR1 was too small to cause a reduction in lesion length early on in the infection process and may result from in situ antibiotic production. B. cepacia AMMDR1 had no effect on the production of secondary zoospores of A. euteiches from infected roots. The main effects of B. cepacia AMMDR1 on postinfection stages in the life cycles of these pathogens therefore were reductions in mycelial colonization by Pythium aphanidermatum and in formation of oogonia by A. euteiches. No mechanism other than antibiosis could be identified.

Zoospore homing and infection events: effects of the biocontrol bacterium Burkholderia cepacia AMMDR1 on two oomycete pathogens of pea (Pisum sativum L.).

Burkholderia cepacia AMMDR1 is a biocontrol agent that protects pea and sweet corn seeds from Pythium damping-off in field experiments. The goal of this work was to understand the effect of B. cepacia AMMDR1 on Pythium aphanidermatum and Aphanomyces euteiches zoospore homing events and on infection of pea seeds or roots. In vitro, B. cepacia AMMDR1 caused zoospore lysis, prevented cyst germination, and inhibited germ tube growth of both oomycetes. B. cepacia AMMDR1 also reduced the attractiveness of seed exudates to Pythium zoospores to nondetectable levels. However, when present at high levels on seeds, B. cepacia AMMDR1 had little net effect on zoospore attraction, probably because it also enhanced seed exudation. Seed-applied B. cepacia AMMDR1 dramatically reduced the incidence of infection by Pythium zoospores in situ compared with an antibiosis-deficient Tn5 mutant strain. This mutant strain also decreased Pythium infection incidence to some extent, but only when the pathogen inoculum potential was low. B. cepacia AMMDR1 did not affect attraction of Aphanomyces zoospores or Aphanomyces root rot incidence. These results suggest that B. cepacia AMMDR1 controls P. aphanidermatum largely through antibiosis, but competition for zoospore-attracting compounds can contribute to the effect. Differences in suppression of Aphanomyces and Pythium are discussed in relation to differences in the ecology of the two pathogens.

Factors affecting oral cyclosporin disposition after heart transplantation: bootstrap validation of a population pharmacokinetic model.

OBJECTIVE: To determine factors affecting the population pharmacokinetics of oral cyclosporin (CsA) in cardiac allograft recipients during the first 3 weeks after surgery. METHODS: Data were obtained from routine trough monitoring and from two extra samples drawn during a dosing interval on a randomly selected day. Whole blood CsA concentrations were assayed using high-performance liquid chromatography (HPLC). Approximately equal numbers of patients were prescribed Sandimmun (SAN) or Neoral (NEO) CsA formulations. Parameter values of a one-compartment kinetic model with first-order absorption and elimination were sought together with the inter-patient and intra-patient variances using the NONMEM program. RESULTS: Improved fits resulted from using the following expression in the model to adjust apparent bioavailability as a function of post-operative day (POD): f= 0.2 + 10 x ABS (POD-5)/[(POD + 7) x 60]. The CsA clearance (CL/f) was found to be influenced by current body weight (WT). There was an absorption lag time of about 35 min with SAN, but zero lag time with NEO. Oral bioavailability (f) was increased by about 35% with concomitant diltiazem and about 18% with NEO. The CL/f was 10% higher during the daytime than at night. The final pharmacokinetic model was validated using 200 bootstrap samples of the original data. CONCLUSIONS: Using a validated population modelling approach, it was found that a number of factors influence the pharmacokinetics of CsA during the early postoperative period in cardiac transplant patients. These influences affecting oral bioavailability and clearance may need to be taken into account for maintaining appropriate concentrations of CsA in the bloodstream.

A procedure for generating bootstrap samples for the validation of nonlinear mixed-effects population models.

A method is presented for automated preparation of bootstrap data samples and their presentation to NONMEM for use in the validation of population pharmacokinetic or pharmacodynamic models, which have been developed with relatively small numbers of subjects. The bootstrap sampling procedure involves the use of an MS-DOS batch file and a script file for use with the public-domain text processing program, AWK, which is a single EXE file (48k in size for the version used in this report). A UNIX version of AWK is also available and UNIX users can adapt the process to their needs. Its use obviates the need for expensive, high-end statistical packages and associated script files written using in-built programming languages. The method can easily be adapted to bootstrap sampling requirements in other biomedical modelling applications.

NONMEM population pharmacokinetic modeling of orally administered cyclosporine from routine drug monitoring data after heart transplantation.

The population pharmacokinetics of cyclosporine (CsA) in adult recipients of cardiac transplants were determined from sparse, retrospective drug monitoring data accumulated for at least 3 months after surgery. All were receiving oral CsA twice daily, and morning trough levels in whole-blood were measured by high-performance liquid chromatography. Additional data included height, weight, gender, age, ethnicity, hematocrit, total bilirubin, and concurrent drug use. Population modeling was performed using NONMEM on 36 randomly selected patients, assuming a one-compartment model with first-order absorption and elimination. Improved fits were obtained by incorporating the following expression in the model to adjust oral bioavailability as a function of postoperative day (POD): F = 0.2 + 10 x ABS (POD - 7)/([POD + 10] x 60). Interpatient variability (CV%) in clearance (CL) was 20.2%. There was a mean bias of 8.5% at the average CsA concentration of 250 ng/ml when the predictive performance was assessed statistically in a reserved subset of 33 patients who received cardiac transplants. For the entire population (n = 69 patients), the average CsA CL and terminal half-life (T1/2) were, respectively: CL (l/h) = 0.256 x weight (kg); T1/2 = 11.0 hours, or CL (l/h) = 0.184 x weight (kg); T1/2 = 14.7 hours, if there was concomitant diltiazem administration. These results compared favorably with those reported elsewhere for studies of postcardiac transplant kinetics using the traditional multiple blood sampling approach.

Investigational vaccine for Escherichia coli O157: phase 1 study of O157 O-specific polysaccharide-Pseudomonas aeruginosa recombinant exoprotein A conjugates in adults.

Escherichia coli O157 causes severe enteritis and the extraintestinal complication hemolytic-uremic syndrome. Serum IgG against the surface polysaccharide antigen, the O-specific polysaccharide of lipopolysaccharide (LPS), may confer protective immunity by lysing the inocula. In a phase 1 clinical study, three investigational vaccines were studied in 87 healthy adults. The vaccines were prepared by covalently binding E. coli O157 O-specific polysaccharide with Pseudomonas aeruginosa recombinant exoprotein A. No significant reactions were reported. Most volunteers (81%) responded with a > 4-fold increase in IgG LPS antibodies 1 week after vaccination; all volunteers responded with a > 4-fold rise at 4 weeks and this level was sustained for 26 weeks after injection. All three vaccines elicited high titers of serum bactericidal activity that roughly correlated with the serum IgG and IgM LPS antibody levels. A phase 2 study in young children is planned.

Multi-disciplinary clinical study of Smith-Magenis syndrome (deletion 17p11.2)

Smith-Magenis syndrome (SMS) is a multiple congenital anomaly, mental retardation (MCA/MR) syndrome associated with deletion of chromosome 17 band p11.2. As part of a multi-disciplinary clinical, cytogenetic, and molecular approach to SMS, detailed clinical studies including radiographic, neurologic, developmental, ophthalmologic, otolaryngologic, and audiologic evaluations were performed on 27 SMS patients. Significant findings include otolaryngologic abnormalities in 94%, eye abnormalities in 85%, sleep abnormalities (especially reduced REM sleep) in 75%, hearing impairment in 68% (approximately 65% conductive and 35% sensorineural), scoliosis in 65%, brain abnormalities (predominantly ventriculomegaly) in 52%, cardiac abnormalities in at least 37%, renal anomalies (especially duplication of the collecting system) in 35%, low thyroxine levels in 29%, low immunoglobulin levels in 23%, and forearm abnormalities in 16%. The measured IQ ranged between 20-78, most patients falling in the moderate range of mental retardation at 40-54, although several patients scored in the mild or borderline range. The frequency of these many abnormalities in SMS suggests that patients should be evaluated thoroughly for associated complications both at the time of diagnosis and at least annually thereafter.

RANZCP guidelines for psychotropic drugs: application to hospital inpatients. Royal Australian and New Zealand College of Psychiatrists.

The objective of this study was to monitor compliance with the Royal Australian and New Zealand College of Psychiatrists (RANZCP) guidelines for psychiatric drug use, in the forensic section of a psychiatric institution in Queensland. The author performed an audit of the charts and medical records of 65 patients in three forensic hospital wards at the John Oxley Memorial Hospital, a 73-bed forensic/secure section of the Wolston Park Hospital Complex. It was found that many patient records were lacking some relevant documentation. There was a higher rate of prescription for multiple psychotropic drugs than is recommended for patients at discharge from inpatient units. This quality assurance exercise has provided a basis for discussion to find ways to more closely comply with the RANZCP Guidelines for Psychotropic Drugs in Psychiatric Practice. No benchmarks are available for equivalent continuing inpatients in a similar setting. It has been shown that, for continuing inpatients in a forensic hospital, there is poor compliance with Draft Clinical Indicator No. 2.1 for Pilot Test (developed jointly by the RANZCP and the ACHS). Perhaps the threshold for this indicator needs to be raised in this clinical setting. The situation may be clarified when the proposed follow-up audit has taken place. There were no patients receiving doses in excess of currently-accepted limits, that is, Clinical Indicator (CI) No. 2.2 was 0, and there were 31 patients (47.7%) concurrently receiving two or more antipsychotic drugs and CI no.2.3 had a value of 31.