Dissipation of bentazone, pyrimethanil and boscalid in biochar and digestate based soil mixtures for biopurification systems.

Biopurification systems, such as biofilters, are biotechnological tools to prevent point sources of pesticide pollution stemming from on-farm operations. For the purification processes pesticide sorption and mineralization and/or dissipation are essential and both largely depend on the type of filling materials and the pesticide in use. In this paper the mineralization and dissipation of three contrasting (14)C-labeled pesticides (bentazone, boscalid, and pyrimethanil) were investigated in laboratory incubation experiments using sandy soil, biochar produced from Pine woodchips, and/or digestate obtained from anaerobic digestion process using maize silage, chicken manure, beef and pig urine as feedstock. The results indicate that the addition of digestate increased pesticide mineralization, whereby the mineralization was not proportional to the digestate loads in the mixture, indicating a saturation effect in the turnover rate of pesticides. This effect was in correlation with the amount of water extractable DOC, obtained from the digestate based mixtures. Mixing biochar into the soil generally reduced total mineralization and led to larger sorption/sequestration of the pesticides, resulting in faster decrease of the extractable fraction. Also the addition of biochar to the soil/digestate mixtures reduced mineralization compared to the digestate alone mixture but mineralization rates were still higher as for the biochar/soil alone. In consequence, the addition of biochar to the soil generally decreased pesticide dissipation times and larger amounts of biochar led to high amounts of non-extractable residues of pesticide in the substrates. Among the mixtures tested, a mixture of digestate (5%) and biochar (5%) gave optimal results with respect to mineralization and simultaneous sorption for all three pesticides.

Rehabilitation of a U.S. Army soldier diagnosed with cerebellar atrophy with an ataxic gait.

BACKGROUND AND PURPOSE: Balance impairments can disrupt the careers of U.S. Army soldiers and put themselves and their mates in danger. The purpose of this case report is to review the rehabilitation process and outcome of a U.S. Army soldier diagnosed with gait ataxia secondary to cerebellar atrophy. CASE DESCRIPTION: The patient is a 35-year-old active duty U.S. Army male who presented with an ataxic gait pattern and had magnetic resonance image evidence of cerebellar atrophy. OUTCOMES: Over the course of 7 months of rehabilitation, the patient showed improvement in ambulation and balance as evidenced by improved dynamic gait index and Propriotest dynamic motion analysis scores. DISCUSSION: This relatively young, active duty soldier was able to improve with physical therapy intervention. However, even in this young, highly motivated patient, it took several months of rehabilitation to achieve his goals.

Analysis of food-allergic and anaphylactic events in the National Electronic Injury Surveillance System.

BACKGROUND: The National Electronic Injury Surveillance System (NEISS) captures a nationally representative probability sample from hospital emergency departments (EDs) in the United States. OBJECTIVE: Emergency department data from NEISS were analyzed to assess the magnitude and severity of adverse events attributable to food allergies. METHODS: Emergency department events describing food-related allergic symptomatology were identified from 34 participating EDs from August 1 to September 30, 2003. RESULTS: Extrapolation of NEISS event data predicts a total of 20,821 hospital ED visits, 2333 visits for anaphylaxis, and 520 hospitalizations caused by food allergy in the United States during the 2-month study period. The median age was 26 years; 24% of visits involved children < or =5 years old. Shellfish was the most frequently implicated food in persons > or =6 years old, whereas children < or =5 years old experienced more events from eggs, fruit, peanuts, and tree nuts. There were no reported deaths. Review of medical records found that only 19% of patients received epinephrine, and, using criteria established by a 2005 anaphylaxis symposium, 57% of likely anaphylactic events did not have an ED diagnosis of anaphylaxis. CONCLUSION: Analysis of NEISS data may be a useful tool for assessing the magnitude and severity of food-allergic events. A criteria-based review of medical records suggests underdiagnosis of anaphylactic events in EDs.

Swimming pool drownings among US residents aged 5-24 years: understanding racial/ethnic disparities.

OBJECTIVE: We examined circumstances surrounding swimming pool drownings among US residents aged 5 to 24 years to understand why Black males and other racial/ethnic groups have high drowning rates. METHODS: We obtained data about drowning deaths in the United States (1995-1998) from death certificates, medical examiner reports, and newspaper clippings collected by the US Consumer Product Safety Commission. RESULTS: During the study period, 678 US residents aged 5 to 24 years drowned in pools. Seventy-five percent were male, 47% were Black, 33% were White, and 12% were Hispanic. Drowning rates were highest among Black males, and this increased risk persisted after we controlled for income. The majority of Black victims (51%) drowned in public pools, the majority of White victims (55%) drowned in residential pools, and the majority of Hispanic victims (35%) drowned in neighborhood pools (e.g., an apartment complex pool). Foreign-born males also had an increased risk for drowning compared with American-born males. CONCLUSIONS: Targeted interventions are needed to reduce the incidence of swimming pool drownings across racial/ethnic groups, particularly adult supervision at public pools.

Vaginal delivery after ileal pouch-anal anastomosis: a word of caution.

PURPOSE: This study was designed to evaluate the impact of childbirth on anal sphincter integrity and function, functional outcome, and quality of life in females with restorative proctocolectomy and ileal pouch-anal anastomosis. METHODS: The patients who had at least one live birth after ileal pouch-anal anastomosis were asked to return for a comprehensive assessment. They were asked to complete the following questionnaires: the Short Form-36, Cleveland Global Quality of Life scale, American Society of Colorectal Surgeons fecal incontinence severity index, and time trade-off method. Additionally, anal sphincter integrity (endosonography) and manometric pressures were measured by a medical physician blinded to the delivery technique. Anal sphincter physiology also was evaluated with electromyography and pudendal nerve function by nerve terminal motor latency technique. RESULTS: Of 110 eligible females who had at least one live birth after ileal pouch-anal anastomosis, 57 participated in the study by returning for clinical evaluation to the clinic and 25 others by returning the quality of life and functional outcome questionnaires. Patients were classified into two groups: patients who had only cesarean section delivery after ileal pouch-anal anastomosis (n = 62) and patients who had at least one vaginal delivery after ileal pouch-anal anastomosis (n = 20). The mean follow-up from the date of the most recent delivery was 4.9 years. The vaginal delivery group had significantly higher incidence of an anterior sphincter defect by anal endosonography (50 percent) vs. cesarean section delivery group (13 percent; P = 0.012). The mean squeeze anal pressure was significantly higher in the patients who had only cesarean section delivery (150 mmHg) after restorative proctocolectomy than patients who had at least one vaginal delivery (120 mmHg) after restorative proctocolectomy (P = 0.049). Quality of life evaluated by time trade-off method also was significantly better in the cesarean section delivery group (1) vs. vaginal delivery group (0.9; P < 0.001). CONCLUSIONS: The risk of the sphincter injury and quality of life measured by time trade-off method are significantly worse after vaginal delivery compared with cesarean section in patients with ileal pouch-anal anastomosis. In the short-term, this does not seem to substantially influence pouch function or quality of life; however, the long-term effects remain unknown, thus obstetric concern may not be the only factor dictating the type of delivery in this group of patients. A planned cesarean section may eliminate these potential and factual concerns in ileal pouch-anal anastomosis patients.

Sphincter defects are not associated with long-term incontinence following ileal pouch-anal anastomosis.

INTRODUCTION: Frequent loose stools test the integrity of sphincter function in patients undergoing ileal pouch-anal anastomosis. The authors hypothesized that women with anal sphincter defects were more likely to experience incontinence episodes than women with intact sphincter muscles following ileal pouch-anal anastomosis. METHODS: From 1996 to 1998, 42 women with a mean age of 42 (range, 22-63) years were prospectively evaluated by anorectal manometry and endoanal ultrasound before pouch surgery. Forty women underwent a stapled ileal pouch-anal anastomosis and two underwent a handsewn anastomosis. All patients considered themselves continent of stool before the procedure. A postoperative survey including the Cleveland Clinic Florida scale, Fecal Incontinence Severity Index, and Fecal Incontinence Quality of Life scale was sent to study participants. RESULTS: Nineteen women with an obstetrical history had significant sphincter defects associated with significant lower mean resting pressure, mean squeeze pressure, and shorter anal canal length (3 vs. 3.7 cm, P = 0.0007). Thirty-five women (83 percent) responded resulting in a mean follow-up of 62 (range, 49-72) months. Fourteen responders (mean age, 46 years) had sphincter defects but no significant difference was found in Cleveland Clinic Florida scale, Fecal Incontinence Severity Index, or Fecal Incontinence Quality of Life scale scores when compared with those without defects. CONCLUSION: Although almost all women reported episodes of seepage, marked sphincter defects associated with low anal pressures and shorter anal canal length did not affect anal function following pouch surgery. This study supports the findings that continent women with significant sphincter defects on ultrasound evaluation may be considered for restorative proctocolectomy.

Using a population-based cancer registry for recruitment of newly diagnosed patients with ovarian cancer.

BACKGROUND: Although rarely used for clinical trial recruitment in the United States, population-based registries are a potential resource for identification of patients with cancer for some kinds of research trials. They record fairly detailed information on a cancer patient's condition at the time of diagnosis (stage, histologic types, and other clinical and demographic variables) and record all patients in a geographic area. This information can be used to identify patients eligible for intervention trials. METHODS: Using a cancer registry to identify newly diagnosed patients and their physicians, this study recruited 60 women for a feasibility trial of a psychosocial intervention designed to improve the quality of life for women with ovarian cancer. Active consent from physicians was obtained before contacting patients. RESULTS: Of 441 women identified as potentially eligible from the cancer registry, 364 (82%) were screened for eligibility and 179 (41%) were eventually determined to be eligible. Of the identified eligible women, 60 (34%) were recruited and enrolled in the trial. CONCLUSIONS: This rate of recruitment is within the range of recruitment rates reported in past studies examining efforts to enroll patients in clinical trials at single institutions. These findings suggest that registry-based recruitment efforts may be useful for expanding recruitment to the larger community.

Anal manometric parameters: predictors of outcome following anal sphincter repair?

Controversy exists over the utility of manometry in the management of fecal incontinence. In light of newer methods for the management of fecal incontinence demonstrating favorable results, this study was designed to evaluate manometric parameters relative to functional outcome following overlapping sphincteroplasty. Twenty women, 29 to 84 years of age (mean age 50 years), with severe fecal incontinence and large (>or=50%) sphincter defects on ultrasound were studied. All participants underwent anal manometry (mean resting pressure, mean squeeze pressure, anal canal length, compliance), pudendal nerve terminal motor latency (PNTML) testing, and completed the American Society of Colon and Rectal Surgeons fecal incontinence severity index (FISI) survey before and 6 weeks after sphincter repair. Statistical analysis for all data included the Wilcoxon rank-sum test, Mann-Whitney test, and Spearman's correlation. Significant perioperative improvement was seen in the absolute resting and squeeze pressures and anal canal length. Overlapping sphincteroplasty was also associated with significant improvement in fecal incontinence scores (FISI 36 vs. 16.4; P=0.0001). Although no single preoperative manometric parameter was able to predict outcome following sphincteroplasty, preoperative mean resting and squeeze pressures as well as anal canal length inversely correlated with the relative changes in these parameters achieved postoperatively. These findings suggest that either the physiologic parameters studied are not predictive of functional outcome or the scoring system used is ineffective in determining function. The perioperative paradoxical changes in resting pressure, squeeze pressure, and anal canal length would support the use of overlapping sphincteroplasty in patients with significant sphincter defects and poor anal tone.

Perioperative resting pressure predicts long-term postoperative function after ileal pouch-anal anastomosis.

The purpose of this study was to determine whether perioperative manometry is useful in predicting long-term functional status after ileal pouch-anal anastomosis (IPAA). Prospectively collected perioperative anal manometry data from 1439 patients undergoing IPAA from 1986 to 2000 were compared to postoperative functional status at various time intervals from 6 months to 8 years after IPAA. A validated questionnaire was used to obtain information regarding restrictions of diet, work, social and sexual activity, urgency, fecal seepage or incontinence, energy level, satisfaction with surgery, and quality of life. The presence of seepage and the degree of incontinence were compared to the patient's perceived quality of life, health, energy level, and satisfaction with surgery. Low (<40 mm Hg) pre- and postoperative resting pressures were associated with increased seepage, pad use, and incontinence. Patients with low resting pressures also reported diminished quality of life, health, energy level, and satisfaction with surgery. There was a significant association (P < 0.001) between seepage and degree of incontinence and quality of health, quality of life, energy level, and level of satisfaction with surgery. Perioperative resting anal sphincter pressures greater than 40 mm Hg are associated with significantly better function and quality of life after ileal IPAA. Improved functional outcome is associated with better quality-of-life outcomes. Low preoperative resting pressures do not preclude successful outcome after IPAA.